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From five stars to one, a nursing home's steep decline

Above: An excerpt from the letter that the state Agency for Health Care Administration sent to Maggie Smith in response to her complaint regarding Bon Secours’ treatment of her father, Clem Mawicke.  at right: Clem Mawicke and his daughter, Maggie Smith, in a 2008 photo. Mawicke sustained five falls in a month earlier this year at Bon Secours Maria Manor.

Family photo courtesy of Maggie Smith

Above: An excerpt from the letter that the state Agency for Health Care Administration sent to Maggie Smith in response to her complaint regarding Bon Secours’ treatment of her father, Clem Mawicke. at right: Clem Mawicke and his daughter, Maggie Smith, in a 2008 photo. Mawicke sustained five falls in a month earlier this year at Bon Secours Maria Manor.

ST. PETERSBURG — In 2002, Bon Secours Maria Manor was a top-rated, five-star nursing home and one of the first recipients of the state's Gold Seal of Excellence award for long-term care facilities.

This year, the St. Petersburg home landed on another list. It was named a special focus facility, a federal program for nursing homes with a recent history of serious quality issues.

Now only a one-star home in the eyes of federal health officials, Bon Secours faces serious penalties if it doesn't improve within two years.

The dramatic decline for one of the Tampa Bay area's largest and most popular nursing homes startled many, including those inside its walls. "We were surprised we were on the list," said Jim Higgins, the CEO.

But official records tell the story of the institution's struggles over the past two years. State inspection surveys, complaint investigations and other documents show that Bon Secours had more numerous and serious problems than most other nursing homes.

• Bon Secours was cited for its handling of a December 2008 case involving an 86-year-old resident who told nursing staff she felt she was violated after a male nurse placed his hand in her vaginal area. He said he was checking her for a urinary tract infection. State inspectors faulted the home for not immediately reporting an allegation of sexual abuse.

• State officials found that "rules and laws were violated" in the home's care of a 76-year-old resident who fell five times in one month earlier this year.

• A June 2008 annual inspection found housekeeping and maintenance problems, including shower stalls soiled with a "dark brown substance.''

The home corrected problems as they were pointed out. But federal and state health officials found Bon Secours to be in the category of homes that often "yo-yo" in and out of compliance.

Bon Secours' situation shows how quickly even a well-regarded home can run into trouble.

Karen Reich, executive vice president for Bon Secours St. Petersburg, said in an interview Friday that the home took its placement on the special focus facility list "very seriously."

"We have responded to those citations immediately with plans of correction that were put into place and approved by the state," Reich said.

"We continue to hold quality as our highest priority and pursue improvements in a variety of ways."

• • •

The nursing home opened in 1963 as Florida Care of St. Petersburg. It was sold and renamed later that year to Fairview of St. Petersburg.

The Diocese of St. Petersburg, the governing body for Roman Catholic churches in the area, bought the home in 1975 and renamed it Maria Manor. It took its current name in 1998, when it was purchased by the Bon Secours Health System, a Maryland-based not-for-profit Catholic health system founded by the Sisters of Bon Secours. The diocese now has no role in running the home.

In recent years, Bon Secours has added assisted-living, rehabilitation and home care services to its St. Petersburg facility.

The nursing home has enjoyed a reputation for excellent care. Catholics, particularly, are attracted by the home, which offers weekly Masses, and it remains about 85 to 90 percent occupied.

But its treatment of two patients in the past year has drawn attention from state regulators and even law enforcement.

On Dec. 2, 2008, licensed practical nurse Antticus Jones, 44, was among several staffers who responded to a female resident's bed alarm. A nursing assistant was going to change the resident's diaper when Jones said he wanted to check her for a urinary tract infection. But rather than taking a specimen and sending it to a lab, Jones first put on gloves, placed his hand in her vaginal area, smelled his hand and said he detected an odor indicative of infection.

A nursing assistant reported the resident said she "felt like she was violated,'' a complaint the resident repeated to a friend.

A urine sample was taken the next day, and the test came back negative for infection.

Jones said in a phone interview with the St. Petersburg Times that he apologized to the woman for not explaining what he was doing. He says the smell test is a diagnostic tool. But he was fired, and arrested by St. Petersburg police on Dec. 11. He awaits trial this month on a felony battery charge.

State health officials investigated and found that Bon Secours waited several days to notify the resident's physician, family and law enforcement. It did not start its own investigation right away or follow federal guidelines on reporting abuse allegations.

Investigators also said the home did not do enough to ensure that staff treats patients with dignity.

Reich said the incident, which she thinks was a major factor in the "special focus facility'' designation, prompted changes.

"There was an inordinate amount of staff education and re-education," Reich said, particularly in the areas of communication and notification.

The home also told nurses that urinary tract infections were to be diagnosed by sending urine specimens to the lab.

The resident's family moved her to another facility.

• • •

Clem Mawicke, suffering from anemia and Alzheimer's disease, moved into Bon Secours on April 25, 2009.

The next day, he was found lying on his back in a corridor, with a large bump near his left eye. Staff called 911, and Mawicke was taken to the hospital.

He fell four more times at Bon Secours. His final fall, on May 22, required another 911 transport to a hospital, where he was diagnosed with a subdural hematoma, a collection of blood on the brain that usually is the result of a serious head injury.

Mawicke's family filed a complaint with the state and moved him to Wright's Health Care and Rehabilitation in Seminole, where his daughter, Maggie Smith, said he received excellent care until his death on July 8 from an infection.

State inspectors found that Bon Secours wasn't doing enough to protect residents prone to falling, and specifically failed to address Mawicki's need for more supervision.

"Rules and laws were violated at the time of our visit," read a letter to Smith from Patricia Reid Caufman, a field office manager for the Florida Agency for Health Care Administration.

In response to the AHCA report, Bon Secours said it would, among other steps, review its policies regarding patients who have fallen more than once in the prior three months.

• • •

What happened at Bon Secours to prompt its decline from five-star status?

Erwin Bodo of the Florida Association of Homes and Services for the Aging said the home has had a lot of administrative turnover, including the departures of the chief executive officer, administrator and director of nursing.

Former Bon Secours managers contacted for this story declined to be interviewed.

Bodo, whose nonprofit association represents long-term care facilities, said such moves are bound to have an impact. "Any time an organization goes through those types of changes, you can go up or down. They went down."

The most notable change has been at the top. Higgins, who took over as CEO in 2007, also serves as CEO of the Bon Secours New York Health System and is not in St. Petersburg full time, unlike his predecessor.

Additionally, the Centers for Medicare and Medicaid Services, a federal agency that runs the two programs, rated the home two stars (out of five) for staffing, and one star (out of five) in the more specific category of registered nurse staffing.

To fill in the gaps, the home has been using temporary staff from a health care agency. Residents have complained that they were seeing more temps, especially at nights and on weekends, according to the last two annual assessments from the state Long-Term Care Ombudsman's office.

Temporary staff are not as familiar with the residents and the home as permanent employees are, potentially affecting care, explained Laila Petrou, the volunteer ombudsman who has conducted the last three assessments of Bon Secours.

"It can be an issue if there's too much agency staff," Petrou said.

Reich said Bon Secours has added nursing positions in its budget but has had a hard time filling them. The home is also trying to reduce its need for temporary staff by creating "flex teams" of existing staff that can fill in for people on vacation or out sick.

"It's certainly a goal of ours to eliminate (agency staff)," Reich said. "We have had some success in that over the past few months. We have more work to do."

Another recent change: Nuns, once a familiar presence at the nursing home, no longer work there full time. The last two nuns were relocated by their orders in the past year, Reich said.

Reich hopes nuns will one day return to the nursing home, but knows that may not happen.

"Many of the Sisters have retired," said Sister Frances McCabe of the Sisters of Bon Secours, explaining that like many other religious orders, hers has seen its numbers decline. Nuns from the order remain involved in other aspects of the Bon Secours Health System; McCabe and another sister serve on the St. Petersburg home's board of directors.

• • •

Despite the negative inspection reports and the drop from five stars to one, ombudsman Petrou wrote in her 2009 assessment that "the residents had no complaints mostly."

Roberta Pearlstein on Friday described her aunt Mary Ducker's stay at Bon Secours as filled with "so much love."

Ducker was a resident at Bon Secours since 2004, starting in its assisted living facility, and moving to the nursing home in 2006. She died Sept. 6, at age 92.

Pearlstein, who stays connected with Bon Secours as president of its family council, said her aunt enjoyed the daily activities, especially a sing-along music program.

"She was so happy here," Pearlstein said.

Times staff writer Stephen Nohlgren contributed to this report. Richard Martin can be reached at rmartin@sptimes.com or (727) 893-8330.

Assessing nursing home quality

There are many online resources to help.

• The St. Petersburg Times' health page (tampabay.com/health) offers links, including an interactive map of the area's four- and five-star nursing homes.

• The Centers for Medicare and Medicaid Services site (medicare.gov/nhcompare) lets you find and compare nursing homes in your area. You can also download a nursing home checklist and a 68-page guide to choosing a home. Call (800) 633-4227 for information.

• The Florida Agency for Health Care Administration offers its own nursing home guide (ahcaxnet.fdhc.state.fl.us/nhcguide/) where users can search by region. You can also download state surveys and complaint investigations for a particular facility.

From five stars to one, a nursing home's steep decline 11/14/09 [Last modified: Sunday, November 15, 2009 12:32pm]

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