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Regional Medicare, Medicaid office threatens to stop payment to local nursing home

A legal notice in the Duluth News Tribune January 18 warned that Medicare and Medicaid payments to Inter-Faith Care Center in Carlton "will be terminated effective February 2, 2013."

What that legal notice failed to mention was that the payments and other arrangements will be terminated IF the long term care facility fails to pass a fourth inspection, expected to occur this week.

"It's too early to tell whether we will terminate or whether they will achieve compliance by that date," said Heather Lang, branch manager of the Long Term Care Certification and Enforcement Branch of the Centers for Medicare and Medicaid regional office in Chicago, which issued the legal notice.

In an interview Tuesday, Inter-Faith Care Center Administrator Connie Anderson said she felt confident the nursing home and its staff will achieve compliance. At the same time, she confirmed that Inter-Faith was out of compliance at its annual inspection Aug. 1, 2012, and has found been out of compliance for at least one item during subsequent inspections.

She explained that Inter-Faith was cited after the most recent visit for care issues and documentation for pressure ulcers/ bed sores related to one patient. She said the level of "scope and severity" was a "D" level, meaning that it was isolated with no actual harm.

Lang confirmed that the single remaining deficiency at the nursing home involved treatment of pressure ulcers; she called it a Level 2 offense, meaning "no actual harm, no immediate jeopardy."

Since the initial inspection, Anderson said Inter-Faith has been working with the Minnesota Department of Health and the Care Providers of Minnesota Trade Association as well as a wound-care consultant, Pathways Health Services.

"We have updated our policies, procedures and documentation," Anderson said. "We had a wound-certified RN (registered nurse) come and train everyone for a week in wound care protocol, treatment and intervention. We believe we're in substantial compliance and we're hoping for a revisit this week."

The initial inspection in August found several compliance issues, however. All were Level 2 - no actual harm -and they ranged from issues with care plans, pressure ulcers, drug regimen and monitoring, food preparation and storage, sprinkler system deficiencies, backup fire alarm system and records of quarterly fire drills on different shifts and under different conditions. Also, the nursing home was given a Level 2 rating for failure to "hire people with no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents" as well as "develop policies that prevent mistreatment, neglect, or abuse of residents or theft of resident property."

Anderson said all of the initial deficiencies were corrected quickly, except for the lingering pressure ulcer issue. She noted that D level citations are common in the industry.

Lang said the Minnesota Department of Health (MDH) inspectors have made three revisits since August.

"Some deficiencies were corrected, but other deficiencies were cited," she said.

She added that her agency makes the decision whether a fourth revisit will be allowed. If it isn't, or if the facility fails to pass a fourth inspection, the facility "will be terminated" from the Medicare and Medicaid system.

On the other hand: "If we find that the last deficiency is corrected and the facility has a good plan in place, then we rescind the termination," Lang said.

Both Lang and Anderson explained that the legal notice was a required step in the process.

It's a step Anderson isn't thrilled with, but Inter-Faith has made changes as a result of the inspections and she noted that nursing leadership has been working hard to correct the problem.

"I want to assure the community that Inter-Faith Care Center has continued to provide quality of care during our struggles with survey compliance," she said. "We're committed to passing the next revisit."

The nursing home got a state monitoring visit Wednesday, a precursor to a fourth inspection, which Anderson said went very well.

A copy of the August inspection report is available online at