Its administrator had failed to hire enough nurses to keep all the elderly residents comfortable. One woman sat in a wheelchair, her forehead resting on a coffee table, for 11 hours. The staff hadn't effectively treated any of the 19 residents suffering bedsores. One man's wound, when a nurse unwrapped it, emitted "a very foul odor" that had been lingering for days. The home ignored some incontinent residents. One diapered man lay in a urine-soaked bed for nearly three hours, in full view of a nurse who placed his breakfast tray out of his reach and later removed it, untouched.
Those and other infractions cost Ansley Pavilion nursing home its federal Medicaid funding and its license to operate in Georgia. The state Department of Human Resources, which revoked Ansley Pavilion's license last month, has ordered the home to close Dec. 16. All 76 residents must find a new facility to care for them.
Ansley Pavilion residents, once they relocate, can anticipate less threatening problems -- but problems nonetheless. Inspections filed by the DHR show that other nursing homes have broken more rules than Ansley Pavilion; they just haven't broken them quite so irreparably.
Conditions as egregious as those at Ansley Pavilion rarely surface. But deficiencies of some sort mar at least 80 percent of Georgia's nursing homes, according to David Dunbar, director of the DHR's Long Term Care division. Statewide, there are an average of four deficiencies per home. The national average is five.
Inspectors found 11 deficiencies at Ansley in October. They've found higher numbers elsewhere.
"What's different [with Ansley Pavilion] is the scope of the noncompliance," Dunbar says. "We saw a lot of care issues that were not being addressed by the facility, and the facility was neglecting to provide some very basic care to people who needed it."
During an October visit to Ansley Pavilion, two DHR inspectors found 11 examples of neglect, according to DHR files obtained through an Open Records request. Of those 11 deficiencies, six posed an immediate and serious threat to residents. During a Nov. 16 follow-up visit, five deficiencies remained serious and immediate.
No other Medicaid-funded nursing home in DeKalb or Fulton county was cited in the past year for a deficiency that was serious or immediate, according to DHR inspections posted on Medicare's website.
But at least five nursing homes in Fulton and DeKalb counties have caused actual harm to residents in the past year, and five are cited for having 10 or more deficiencies.
This summer, for instance, DHR inspectors identified 17 deficiencies at Meadowbrook Nursing Home in DeKalb County. Two of the deficiencies were directly harmful to residents. Meadowbrook failed to maintain the best quality of life for a few residents and neglected to tell physicians or family members about a change in a residents' health, the inspection found.
Meadowbrook, despite these deficiencies, managed to clear Medicaid hurdles and be listed as an option for residents relocating from Ansley Pavilion.
On Nov. 27, families of Ansley Pavilion residents picked up a list of homes with vacancies in an eight-county area. Of the 57 facilities listed, 18 had a line drawn through them. They had been crossed off, Dunbar says, because they're "having problems, or recently had some serious problems, or just over time may have had problems."
Meadowbrook does not have a line drawn through it. The home's administrator couldn't immediately be reached for comment.
Dunbar says homes that have a high number of deficiencies are not necessarily in worse shape than homes that have just a few. The severity of each individual deficiency must be weighed.
"If you have a few deficiencies and they're all at the jeopardy level, that's a lot more serious than if you had 17 deficiencies but they're all on the lower level," Dunbar says.
He also says that a home on the list that is crossed might still be a viable choice for relocation. He says a home might be crossed out simply because the staff is working to eliminate problems that an influx of new residents could exacerbate.
Integrated Health Services of Buckhead had a line drawn through it. It has also accepted one patient from Ansley Pavilion, who has already moved in. The admissions office has fielded several calls from other family members who want to move their relatives there from Ansley Pavilion.
"Probably some of the folks from Ansley will go to some of the places that were scratched off, which is fine," Dunbar says. "None of those facilities are in the position where we're trying to take their permit."
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