CMS to fine Vermont Vets' Home


BENNINGTON -- The Vermont Veterans' Home is facing a substantial civil monetary penalty from the Centers for Medicare and Medicaid Services on the basis of surveys conducted at the home in March.

The penalty started off at $115,000 but may end up being reduced to around $35,000, officials said at the Wednesday Board of Trustees meeting. Home Administrator Melissa Jackson said she did not know what the final amount of the fine would be or when she would know what it is.

The fine is the result of visits and investigations conducted by the state Division of Licensing and Protection of the Agency of Human Services, Department of Disability, Aging and Independent Living. This body regulates nursing facilities on behalf of the CMS, which administers the federal Medicare and Medicaid funding which accounts for much of the facility's budget.

In 2012, the home had been in danger of losing this money after deficiencies were found during Licensing and Protection (L&P) inspections.

In her written report to the trustees, Jackson said the penalty imposed was based on March 12, 26, and April 1 inspections by L&P.

"We do have a civil monetary penalty that we are going to be paying," she said during the meeting. "We had a conversation with CMS this morning -- we are going to waive our right to appeal and we have filed hardship paperwork. The fine will at least be reduced. And then 35 percent of the reduced fine will come off the reduced fine and we will pay that fine."

In May, L&P was at the home with representatives of CMS and the facility was found in compliance "due to the hard work and dedication of our staff," she said.

"They've been incredible, to see the growth in their ability to handle that pressure, [I'm] just very proud," Jackson said. Staff have gone from being very uncomfortable dealing with a survey to now approaching the surveyors and telling them with confidence why they do what they do.

"So they've come a long way and that's reflected in our survey results," she said,

Board of Trustees Chairman Joseph Krawczyk Jr. said the reduction in the fine was due to the efforts of Jackson, Secretary of Administration Jeb Spaulding, and Commissioner of Finance and Management Jim Reardon, who was present at the meeting.

"We have systems in place that that will not happen again," Krawczyk said during a break in the meeting. "That's what they found when they were here last month. We think the systems are there."

Also spoken to during a break in the meeting, Jackson referred to a letter on CMS letterhead that cited the four areas of deficiency. Specifically, these areas are: Abuse or involuntary seclusion, hiring only people with no history of abusing, following the quality of care plan, and making sure the nursing area is free from dangers that cause accidents.

"Because we've had so many regulatory issues in the past, they've subjected us to these penalties. The best part about it, or the good news, is we've written a plan of correction," she said. "It's been accepted by CMS and we're back in compliance. So this is part of the normal operating procedure of CMS."

Jackson said the home is asking for a hardship waiver and because it is not appealing the ruling, the fine will be automatically reduced as well. "It's unfortunate we that have the fine and it's not reflective of the great care we give right now," she said. "We've made such great strides over the past couple years to improve our quality of care."

Documents relating to the home's recent regulatory deficiencies can be found through the Division of Licensing and Protection's website.

* L&P in March investigated a Feb. 28 incident in which a licensed nursing aide allegedly yelled at a resident who had finished his or her meal and wanted to return to their room. The report cites three witnesses, apparently home staff members, who said the aide yelled at the resident and forced the resident to sit back down. This resident was taken to the emergency department the same day and diagnosed with a right wrist strain. The report further alleges deficiencies in the reporting of the allegation and also implies a person with a past history of abuse had been employed by the home.

In response, the report includes numerous actions the home took or will take in response to the incident.

* In another issue, L&P asserts the home failed to follow interventions in the care plan of a resident to prevent falls. According to the report, on March 2 this resident was being taken to the bathroom without walker or wheelchair, when the accompanying LNA became distracted by another resident urinating on the floor, leaving this resident by the nurses' station desk. This patient then walked a few steps and fell to the floor, and was taken to SVMC, where a neck fracture was diagnosed.

Again in response, the report includes numerous corrective actions the home has or will take to more closely follow care plans and avoid resident falls.

* During the inspection of March 31 and April 1, surveyors found a power wheelchair was "nearly" blocking an exit door and was parked in front of the fire pull box despite a sign on the door indicated that it was a no-storage zone. They also found a four-wheeled walker with an oxygen tank hanging off the bar.

* On May 23, however, an L&P letter notes that the Division of Fire Safety found veterans' home to be in compliance with Life Safety Code Requirements.


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