LE MARS, Iowa — A nursing home that has operated in Le Mars for 45 years will be forced to close Feb. 1 as a result of the Centers for Medicare and Medicaid Services terminating its contract with the home, where investigators found a "history of serious quality issues."

It's the first time since 2009 that the CMS has decertified an Iowa nursing home, said Sara Throener, an executive officer for the Iowa Department of Inspections and Appeals. Since March 2014, CMS -- the federal agency that runs Medicare, the health care program for the elderly, and works with states to administer Medicaid, which serves low-income and disabled residents -- has denied payments to The Abbey six times.

The Abbey, the Iowa Department of Human Services, the Inspections and Appeals department and other "stakeholders" are working to find alternative housing for the facility's 23 residents, Throener said.

Don Butcher, director of The Abbey, a for-profit residential care facility, met with the residents Wednesday to notify them of the CMS decision. He released a statement thanking the residents, staff and partner agencies for their years of service, and briefly addressed the closure. 

"Unfortunately, due to a changing regulatory landscape, The Abbey of Le Mars finds it impossible to continue to operate," he wrote. "We wish all our residents and their loved ones, and our staff the best in the coming year."

He declined further comment.

CMS, which found numerous violations in two surveys conducted on its behalf by the state Department of Inspections & Appeals Health Division in July and November, will cut off funding on Feb. 1 to The Abbey, 320 First Ave. S.E. The state agency conducts its surveys in conjunction with the federal surveys and files separate reports that address each agencies' concerns.

One incident cited in the November survey resulted in a $10,000 state fine against The Abbey. An unidentified resident was found dead by an unidentified certified nursing assistant on Oct. 15. The resident “had a significant respiratory change and increased phlegm, which required assessments and interventions, including needed services at a hospital,” prior to the death, according to the report.

Inspectors found the facility “failed to assess and provide timely interventions when a resident has an onset of adverse physical conditions." The 15-page long citation report was on based on record reviews, staff and physician interviews and a review of the facility's policy and procedures.

The survey cited another incident in which an unidentified resident was injured when staffers bumped his or her head against a window sill, which resulted in the resident developing a 2-by-2 inch area of swelling on the right eyebrow with a "walnut sized goose egg with a scabbed area (gash) in the center."

In another incident, the facility was cited for failure to "provide adequate supervision and assistive devices to prevent accidents for a slightly impaired resident at risk for falls.”

The report also said the facility "failed to prevent the development of pressure ulcers and failed to assess pressure ulcers to ensure and promote healing for residents."

When asked if the cited incidents were the basis for CMS’s decision to terminate its agreement with the home, Throener said there was more to it than that.

“I don’t think there is a tipping point, I think it’s the totality of everything taken together,” she said.

The Abbey has been on CMS's Special Focus Facility list since October 2014 based on recommendations from the agency and the state Department of Inspections and Appeals. That decision was based on the federal government's five-star rating system, which grades staffing, survey history and number of complaints against a nursing facility, on a scale of one to five, with five being the highest level of care. The Abbey’s current rating is a two, according to the CMS.

The SFF was created as a "special program to stimulate improvements in their quality of care," according to the CMS.

Prior to having its Medicaid and Medicare funding cut, The Abbey had been on the SFF list for 29 months.

“Once they are on the Special Focus Facility (list), we survey them every six months,” Throener said. “From October of 2014 to November of 2016, they didn’t have a survey that didn’t have a high level citation — that’s the issue. Somebody could be on it for a long time if they had some surveys that didn’t have high level deficiencies.”

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