A Pikeville nursing home has been added to a list of the nation's most troubled nursing homes, bringing the number of Kentucky homes on the list to four.
Nursing home inspectors found 19 federal deficiencies at Parkview Nursing and Rehabilitation Center from Jan. 1, 2010, through Jan. 31 this year, said Beth Fisher, spokeswoman for the Cabinet for Health and Family Services. The state average for deficiencies is six.
One of the main problems at Parkview was residents who smoked. The staff did not supervise some residents who smoked because they turned violent if their cigarettes or pipes were taken away, according to records obtained by the Herald-Leader under the state's Open Records Act.
On June 3, Parkview staff allowed a resident whose identity was not released to leave a smoking room with a pipe. The resident fell asleep with the pipe, and the mattress caught fire, according to a Type A citation, the most serious regulatory censure given by the state.
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As the fire smoldered, the resident, who was mentally disabled, was found in a smoke-filled hallway, on his knees, coughing. The resident's hand had second-degree burns, the citation said. No other residents were injured in the fire.
A Type A citation is issued when a resident's life or safety has been put in danger.
The Pikeville nursing home also was added to the federal Special Focus Facilities list — a designation by the Centers for Medicare and Medicaid Services for nursing homes with a history of poor care.
Nursing homes on that list receive twice as many inspections as other facilities for state and federal violations.
The Type A citation involving the smoking incident was issued June 14.
Federal guidelines allow nursing homes to have smoking rooms, but the staff must supervise and help those who can't handle smoking materials safely on their own.
The Parkview resident was physically and verbally violent when smoking materials were taken away, according to staff interviews. So nursing home staff members allowed the resident to keep the pipe, according to the citation, and had for four years.
Investigators also learned that another resident had reacted violently when a nurse tried to take away his smoking materials, "striking the nurse and ripping the nurse's shirt off, "according to inspection records.
In June, Parkview also received five federal deficiencies for acts that posed immediate jeopardy to a resident's health or safety, according to the CMS Web site. The five included failure to make sure the nursing home was free of dangers that cause accidents, failure to follow a resident's care plan, and failure to run the nursing home in a way that leads to the highest level of wellbeing for each resident.
Fifteen other deficiencies causing "minor harm" were found for the year beginning Sept. 1, 2009, according to the CMS Web site.
The problems included failure to maintain quality care, to assess residents and to provide proper nutrition.
The nursing home submitted a plan of correction to investigators. Tiffany Cox, a new administrator at Parkview, said Wednesday she was not at the nursing home when the citations were issued.
"I am confident in the quality of care and services we currently provide to those who have entrusted us with their care," Cox said. "We care greatly about our residents."
Cox said Parkview is a limited liability corporation, and she is the manager.
Meanwhile, Arbor Place of Clinton in Hickman County, a facility that had been on the federal list for 13 months, has not improved, according to the ratings.
Arbor Place received a total of 24 federal deficiencies in its inspections from Jan. 1, 2010, until Jan. 31 of this year, Fisher said. Seven deficiencies posed immediate jeopardy to a resident's health or safety.
The overall problems included failing to protect residents from potential mistreatment and failing to treat bedsores.
Officials with Benchmark Healthcare, the Missouri corporation that owns Arbor Place of Clinton, did not return calls seeking comment Thursday.
Two other facilities, Bluegrass Care and Rehabilitation in Lexington, which had been on the list for six months, and James S. Taylor Memorial Home in Louisville, on the list for 12 months, were listed as showing improvement in their inspections last summer.
Since then, James S. Taylor has closed voluntarily, according to cabinet officials.