The Kentucky Attorney General's office is reviewing a state citation stemming from the way officials at a Danville nursing home responded to allegations that a former male nurse's aide tried to suffocate one resident and, weeks later, lay in bed with and kissed another.
The Type A citation, the state's most serious, was issued Aug. 30 against Charleston Health Care Center by the Cabinet for Health and Family Services Office of Inspector General. A Type A citation indicates that a resident's life or safety has been endangered because of violations of state regulations.
The citation, which was obtained by the Herald-Leader through the state's Open Records Law, says Charleston Health Care Center's staff failed to immediately report the allegations to the administrative staff after the alleged incidents on July 20 and Aug. 10. It also said the administrative staff failed to conduct a thorough investigation and failed to report all allegations of abuse to the appropriate state agencies.
The Cabinet for Health and Family Services sends all Type A citations to Attorney General Jack Conway's office, whose Office of Medicaid Fraud and Abuse Control decides whether to refer the case to local prosecutors.
Shelley Johnson, a spokeswoman for Conway's office, said Friday that the citation, received Sept. 1, is under review.
Nursing home officials, who fired the nurse's aide after the alleged kissing incident on Aug. 10, are appealing the Type A citation, said Lisa Hinkle, the nursing home's attorney. The appeal challenges "the factual findings of the Office of Inspector General," Hinkle said in a statement.
"None of the allegations of abuse arising out of the facts in the Type A citation were substantiated," Hinkle said. She declined to discuss details of the appeal further because the matter is pending but, she said, "it is also important to know that Charleston has provided quality nursing- facility care to its residents for a very long time."
The nursing home is owned by Marlin K. Sparks Management, according to state records.
Marlin K. Sparks, who identified himself as president, said via email, "We are still not certain that the actions of July 20 actually did happen."
"Employees have rights, as well, and to be positive about an incident is most important," he wrote. "We deal with people who make statements who are not always factual. We take care of frail, elderly individuals who are not always lucid. When we did actually witness an incident, the employee was removed immediately."
The citation and other documents say that on July 20, a resident who was admitted in 2010 to the nursing home with a head injury and schizophrenia told nursing home staff that the male aide "placed a pillow over the resident's face in an attempt to suffocate the resident, and then hit the resident four times, twice on each side of the head." It's not clear whether the resident was male or female.
The nurse's aide worked for three more days, a report says. The nursing home had a policy that called for suspension of employees accused of abuse. The nurse's aide was suspended for two days while nursing home officials investigated.
According to the nursing home's written response to the state, nursing home officials and the resident's family said the allegation did not appear to be true because of the "resident's mental status and frequent statements that did not reflect reality."
The assistant administrator told investigators that the resident recanted the story, state documents said.
However, investigators heard from a certified medical assistant who said the resident had a small facial bruise that was not there the previous day. A nurse told investigators that the resident's story sounded convincing, according to the documents.
The nurse's aide "returned to work on another unit and shift," state documents said.
According to the citation, interviews with six staff members revealed that the nurse's aide behaved inappropriately with residents from February to August 2011. The nurse's aide was seen being "physically, mentally, and verbally rough with residents" and kissing them on the face and neck, according to the citation.
The human resources director told state investigators that she had witnessed him inappropriately kissing a resident in June, had counseled the nurse's aide about his behaviors, and had informed the director of nursing, according to state documents.
However, the citation said, "there was no evidence these allegations had been investigated and reported by the facility. In addition, there was no evidence the facility protected residents from further potential abuse."
Then, on Aug. 10, a staff member said she witnessed the nurse's aide jump onto a bed with a female resident with "severely impaired cognition," then lie down in a spooning position with the resident, documents said.
The staffer said she told the nurse's aide that his actions were inappropriate, according to the citation. The citation also says the nurse's aide told her "that his actions were common practice and no one cared what he did." Then he kissed the resident's cheek in front of her, the citation said.
The nurse's aide worked another two days until the assistant administrator learned of the alleged kissing incident. The nurse's aide was fired and escorted from the premises by law enforcement.
He later told state investigators in an interview about the Aug. 10 incident that he was told not to kiss or hug the residents. He "acknowledged that he had kissed the residents on the cheek and he had lain in bed" with the resident, state documents said.
The Type A citation said the nursing home's staff failed to immediately report allegations of abuse to administrative staff.
"Administrative staff failed to protect residents by allowing the alleged perpetrator to continue to work, failed to conduct a thorough investigation, and failed to report all allegations of abuse to the appropriate state agencies," the citation stated.
"The assistant administrator stated the facility had not notified the Office of Inspector General of any of the allegations," the citation said.
The failure to communicate the allegations "placed residents in imminent danger and created substantial risk that serious mental or physical harm to a resident would occur," the citation said.
Cabinet spokeswoman Beth Fisher said Friday that the nursing home was in compliance with state regulations. Documents outlining the nursing home's response to the state show that all employees have been trained in what to do in the event that abuse allegations arise.
Meanwhile, Sparks, the president of the nursing home's ownership company, said nursing home officials notified the cabinet's Division of Adult Protective Services, which investigates allegations of abuse. He said it was ''an oversight'' not to call the inspector general's office, which inspects nursing homes. "Incidents such as these happen so seldom that we are not polished as to the procedures to follow when such as this happens," Sparks said.
Sparks said the nursing home has four stars on the federal government's five-star rating scale for long-term care centers. He said, "Our patients' health and well-being are paramount to us. We are serious about the care and treatment of our patients.
"For 49 years, we have strived and delivered care to the elderly in the most caring manner that we know how," he said. "We employ over 180 people caring for 110 patients. ... To know everyone's actions all the time is a challenge."