Nursing Home Abuse Lawyer Blog

We discussed the situation at Friendship Manor of Grinnell in a previous blog.

Ruth Louden entered Friendship Manor of Grinnell for rehabilitation after she fell and fractured her ankle. Her doctor put her in a medical stocking and brace and facility staff were to monitor her leg for circulation and check her skin every shift for signs of redness or swelling. Sadly, while Ruth complained to facility staff of "horrible" and "excruciating" pain for the next four weeks, no one every checked her leg.

Approximately one month after Ruth's fall, a physical therapy aide noticed that Ruth's leg smelled like "rotting meat" and the stocking showed blood seepage. Ruth was taken to the hospital and physicians there found that the wound dressing that had been put on a month earlier looked like it had never been touched. Ruth was diagnosed with gangrene and doctors were forced to amputate her leg to save her life. Sadly, she died three months later.

The facility was fined more than $101,000 due to the incident and the owner, Tim Boyle, appealed the penalty. The case was settled in early January 2010 with the facility agreeing to pay the U.S. Centers for Medicare and Medicaid Services $75,000.

Iowa's Department of Inspections and Appeals investigated and found that during Ruth's stay at Friendship Manor - 25 days - no one ever removed her stocking to check her leg and no physician ever examined her. Sadly, Ruth's doctors told state inspectors that Ruth's bone fracture was nearly "nonexistent" and that her amputation was avoidable.

A Muscatine, Iowa woman faces two counts of unlawful procurement of a prescription drug, a Class C felony, after she reportedly stole prescription drugs from residents at a nursing home facility where she worked. She also faces three misdemeanor counts of possession of a controlled substance, identity theft, and fifth-degree theft.

Kristine Renee Maher, a registered nurse who formerly worked at Carrington Place of Muscatine in Muscatine, Iowa, allegedly stole prescription drugs from the residents she cared for and falsified prescriptions for her own use while employed at the nursing home facility.

If convicted, Maher faces up to 20 years in prison and $20,000 in fines.

Carrie Garza pleaded guilty to three Class C felony charges of prohibited acts and three aggravated misdemeanor charges of wanton neglect of a resident at a health care facility. Her crime? Stealing pain medications from vulnerable residents at an Iowa nursing home facility.

Reportedly, a woman called the Alverno Health Care Facility in Clinton, Iowa on September 15, 2008, alleging to be a pharmaceutical provider and claimed to have recall information on Fentanyl patches. She requested the names of the residents using the medication.

Shortly after making the call, Garza came to the facility and staff directed her to the rooms of three female residents. Garza removed the patches from the residents and left the facility.

Clinton police received a tip on September 19, 2009 that Garza reportedly had been arrested for similar acts in Rock Falls, Illinois. She was identified in a line up by one of the facility's nurses.

Garza was ordered to serve two years supervised probation. The Court suspended three ten year prison terms and three two year prison terms and suspended the fines on the charges. Garza has already completed a substance abuse program and must pay restitution.

The Terry Law Firm is experienced in handling cases of nursing home abuse and neglect. Please contact us with any questions or concerns at www.nursinghomejustice.com.

Daniel Larmore recently resigned as the Administrator of Harmony House Care Center in Waterloo, Iowa. He remains the current Chairman of the Iowa Board of Nursing Home Administrators. The question some have is: should he hold that position?

The Iowa Board of Nursing Home Administrators is responsible for licensing and disciplining Iowa's nursing home administrators, but has not taken any action against an administrator in two years.

A Des Moines Register report published this week listed instances of nursing home administrators who were accused by the state of failing to prevent or investigate resident abuse without being disciplined by the Board. Interestingly, Larmore found himself in this position in 2004 when he was the Administrator of Harmony House and serving on the Board; he was never disciplined by the Board. Public health officials could not say if Larmore's case was ever reviewed by the Board, but Larmore acknowledged that the Board failed to review some cases that were sent in for potential disciplinary action.

In 2004, the Iowa Department of Inspections and Appeals alleged that Larmore failed to properly investigate and respond to complaints that a female nurse aide was repeatedly engaging in sexual intercourse with a 29 year old brain injured male resident. Co-workers had witnessed several suspicious encounters between the two and the resident's roommate also complained about the two allegedly having sex on the other side of the privacy curtain. Larmore argued that "The relationship was initiated by, and was meaningful to, (the resident)...The presented situation was one of mutual interest of a (resident) and a caregiver and, although inappropriate, did not present potential or actual harm to the consumer due to the reciprocal fond relationship." In Iowa, a professional caregiver who engages in sexual intercourse with a nursing home resident can be criminally charged with dependent adult abuse.

We discussed Dubuque Retirement Community and Jefferson Point Assisted Living Center and their intent to forego government licensure and inspection in our previous blogs. Now, Iowa officials have warned the owners of these facilities that if they move forward with plans to forfeit their licenses, they will be violating Iowa law.

In the past, both facilities had problems meeting minimum standards of care and have a combined total of more than $40,000 in fines in the past 18 months. Essentially, facility owners believe that, by forfeiting their licenses, the facility will be acting as a landlord rather than a health care provider and the facilities can avoid all inspections and regulations that come with assisted living centers. Allegedly, a separate company will deliver health care services to the residents.

State officials will not comment on what action could be taken against the facilities, but owners could be charged with running illegal, unlicensed care facilities.

As of August 21, 2009, Assisted Living Concepts informed Department of Inspections and Appeals Director Dean Lerner that it disagreed with his assessment of the situation and that plans to forfeit the license remain unchanged.

Fejervary Health Care Center, a nursing home facility located in Davenport, Iowa, faces yet another fine for its role in a recent patient death. The facility has had a history of problems and fines from the Iowa Department of Inspections and Appeals. The most recent fine was assessed in July 2009 in the amount of $6,000.

On June 12, 2009, a resident was admitted around Noon. The resident and spouse both advised the facility of the resident's recent history of falls. The facility identified the problem on the resident's Care Plan and listed interventions that included a bed alarm and body alarm.

Around 9 p.m., the resident attempted to get out of bed and the alarm sounded. Later, around 4:25 a.m. on June 13, 2009, the alarm sounded again. Responding facility employees found the resident on the floor in a puddle of urine. The first employee responding said that the resident fell head first but failed to tell the nurse that the resident had hit their head. After bandaging a small hand wound, the resident was asked if they were hurt and the resident responded "no". No one checked the resident's pupils or performed any neurological checks.

Around 9:20 a.m., the resident complained of hip pain and was given pain medication. Once again, the resident was not assessed.

Around 10 a.m., the resident "became restless and agitated, looking for cigarettes. The resident complained of having a headache above his/her right eye." Upon returning to the room, the resident was unresponsive and was taken to the hospital. The resident later died. The facility failed to inform the resident's physician about the fall.

Last year, the facility was fined $7,500 in connection to a missing resident, a resident who required additional monitoring due to inappropriate sexual behavior, and a resident who was left in a dark cafeteria waiting for breakfast for more than two hours.

The Terry Law Firm is experienced in handling cases of nursing home abuse and neglect. Please contact us with any questions or concerns at (888) 317-2525 or visit us on our website at www.nursinghomejustice.com.

We discussed two Iowa care facilities that were opting to relinquish their licenses and avoid state regulation in our previous blog.

Now, the Dubuque Retirement Community is defending its decision to give up its license. The facility will relinquish its license on September 14, 2009 and will become an unregulated facility not subject to annual inspections, state oversight, or sanctions for inadequate care. The facility is owned by Assisted Living Concepts, which operates six other assisted living centers in Iowa: Amelia House, Eiler House, Reed House, Swan House, Floyd House, and Allen House. According to Laurie Bebo, Assisted Living Concepts' CEO, the company considers its decision to give up its license to be a pilot program that will be evaluated over the next several months and "we need to see what the repercussions are".
Further, Bebo says the license forfeiture "doesn't have anything to do with the fines", which was met with laughter and groans from its residents during a recent meeting.

According to David Werning, the spokesperson for the Iowa Department of Inspections and Appeals, the agency is concerned about the facility's recent move and the repercussions it may have on its residents. Currently, the law prevents assisted living facilities from caring for people from caring for individuals needing multiple workers to assist with transfers. Once the facility gives up its license, the agency is worried that "we'll get a complaint that what they're actually running is an unlicensed nursing home. That's a real serious issue that we're trying to address with them now." Additionally, the agency is also concerned that Swan Home Health, which is a care provider owned and operated by Assisted Living Concepts, is nothing more than a dummy corporation. According to Werning, "It's a legal question as to whethere they've set up a fictitious corporation, Swan Home Health, to provide assisted living services just so they don't have to maintain an assisted living license."

The Dubuque Retirement Community is also in the eye of the Iowa Department of Inspections and Appeals for failure to comply with a March 12, 2009 order banning the admission of new residents while the facility's license is on conditional status due to past care problems. Despite the order, the facility has continued to admit new residents and according to CEO Bebo, she was unaware that the state would have a problem with that.

Jefferson Point Assisted Living Center in North Liberty, Iowa and Dubuque Retirement Community in Dubuque, Iowa are assisted living centers in Iowa that may soon be skirting the law and operating without any oversight. Both facilities plan to give up their licenses and separate health services from the housing, which will enable them to bypass state regulations that were designed to protect vulnerable, elderly residents. Both facilities plan to become only "landlords" and provide only housing to its residents. Health care services will be offered through a separate home health company.

One concerned nursing home and assisted living owner, Ed Osby, stated, "So there won't be any oversight there at all. You've got a renegade facility there that's doing an endrun around the regulations." According to an Assisted Living Concepts executive, the lack of oversight will not have any negative effect on care and will allow some residents to remain in their apartments without being sent to a nursing home when their health deteriorates.

Unfortunately, both facilities have had problems meeting minimum care standards in the past. The Dubuque Retirement Community was fined $16,500 in the past 18 months and Jefferson Pointe has been fined $10,000.

Interestingly, Jefferson Point was constructed with $7.2 million in federal assistance in the form of state approved loans and tax credits through the Iowa Finance Authority and Iowa Department of Economic Development. Jefferson Pointe intends to forfeit its assisted living license to attract more residents and both governmental agencies have granted approval.

The Center for Medicare Advocacy had contacted government officials concerning the imminent switchover. The Center for Medicare Advocacy is also objecting to Assisted Living Concepts' practice of evicting residents once their savings are depleted and they are dependent on Medicaid. Federal law prevents this practice in nursing home facilities but does not prevent it in assisted living facilities.

Bureau Chief for the Iowa Department of Inspections and Appeals Ann Martin has stated that while the actions to appear to be legal, they are unprecedented. "There will be no oversight at all. It's unheard of," she said.

Recently, there was an interesting idea posed by a concerned citizen in Des Moines, Iowa: expose the names of nursing home owners to elicit improved standards of care at the facilities. This citizen is correct that we might be surprised to learn that the owners of some nursing homes are considered who "outstanding citizens" actually operate below average facilities, making substantial money at the expense of the elderly. The names of these individuals in our community should be known.

Nursing home owners often hide under the cloak of an elaborate corporate scheme designed to siphon money from the nursing home facility into the owners' pockets. This is done by creating a myriad of corporations all owned by the same people that do business with each other. All the while their residents suffer in facilities underfunded. State fines are obviously not working as abuse and neglect continue. Let's expose owners' names in newspapers every time their business is cited by the state. Possibly then they will take an active interest in their business and quit ignoring and excusing poor care.

After February and March 2009 complaint investigations, Urbandale Health Care Center faces approximately $8,500 in fines for alleged health and safety regulation violations at the facility.

The February and March 2009 complaint investigations substantiated six separate allegations of substandard care. The Iowa Department of Inspections and Appeals issued a 99 page list of deficiencies at the facility and assessed fines.

Among the alleged problems was an incident involving resident assault. In February 2009, one facility resident pinned another resident against a bathroom door and repeatedly struck the pinned resident with a coat hanger. The next day, the alleged attacker threatened another resident who had accidentally run over his foot with a wheelchair.

The facility was also cited for having an insufficient staff. Residents and family members reported by complained that it could take staff up to 45 minutes to respond for an assistance call.

The facility was cited for failing to provide adequate care for residents on oxygen. According to state investigators, several residents were hooked to oxygen tanks that had either been turned off or were empty. Facility employees informed inspectors that the facility would periodically run out of oxygen.

Other violations of substandard care were failing to accurately transcribe physician orders, failure to treat bedsores, failure to prevent accidents, failure to conduct adequate background checks, and inadequate nutritional services.

The Terry Law Firm is experienced in handling cases of nursing home abuse and neglect. Please contact us with questions or concerns at 1 (888) 317-2525 or visit us at www.nursinghomejustice.com

The Dubuque Retirement Community faces the possible loss of its operating license if it does not improve its care of its residents.

The facility has accumulated fines in the amount of $6,500 from a complaint investigation involving the fall of one of its residents. The 92 year old resident fell in his or her apartment on November 3, 2008 around 3:00 a.m. and was not found for twelve hours. The facility was cited for failing to meet the resident's needs through sufficiently trained staff, including failure to administer medication.

In March 2009, the Iowa Department of Inspections and Appeals placed the facility on conditional certificate status, which is a step away from revocation. To read the investigation report, click here.

The Terry Law Firm is experienced in handling cases of nursing home abuse and neglect. Please contact us at 1 (888) 317-2525 or visit us at www.nursinghomejustice.com if you have any questions or concerns.

New Homestead Care Center has been hit with a $7,000 federal fine for ignoring complaints of sexual abuse against its residents.

During 2005 and 2006, employees at New Homestead Care Center in Guthrie, Iowa reported to managers and supervisors that a male nurse aide named Juan Bautisa-Meraz was abusing the residents. There were eight separate alleged incidents involving eight different residents.

In one instance, Bautista-Meraz allegedly put a chair against the door of a female resident's room while inside. Another worker forced her way into the room and found Bautista-Meraz bent over the mentally disabled resident, who was partially undressed and bleeding from her vagina. Bautista-Meraz turned his back on the other worker and claimed he was cleaning the resident, even though he had no washcloths or other supplies.

In another instance, a resident complained that Bautista-Meraz ordered her to undress while he watched. Another instance revealed that Bautista-Meraz grabbed a female resident's breasts. Other residents alleged that Bautista-Meraz was mean, rough, or handled them in a sexually suggestive manner.

New Homestead Care Center was fined in November 2006 for failing to investigate the allegations of abuse and failing to report the abuse allegations to the state. The facility was assessed the $7,000 fine.

The facility appealed the fine alleging that only one incident was confirmed by state inspectors. The facility also argued that some of the incidents involved actions that are so "commonplace" that they could not possibly rise to the level of abuse. With respect to the incident involving the mentally disabled resident, the facility said it was not unusual for the staff to position a chair against the woman's door and vaginal bleeding was expected given her abdominal cancer.

The fine was recently upheld with the Administrative Law Judge stating the facility "displayed indifference and disregard to resident care and safety" due to its unwillingness to investigate the abuse allegations. The facility Administrator, Maradith Janssen, plans on further appealing the fine.

This facility was also fined $5,000 last year for insufficient nursing supervision.

The Terry Law Firm is experienced in handling cases of nursing home sexual abuse. Please contact us at 1 (888) 317-2525 or visit us at www.nursinghomejustice.com.

Country View Nursing Home, one of two county run nursing facilities in Iowa, has been cited for failure to provide proper care for pressure sores to some residents and problems with the times medication was administered. The Iowa Department of Inspection and Appeals levied a $3,500 fine following the December 2008 inspection. A follow up inspection on January 23, 2009 found the facility to be in substantial compliance in correcting those issues but other problems were noted, including poor housekeeping, failure by staff to follow protocol in feeding some residents, cleaning those suffering from incontinence, and wheelchairs being in poor repair. The second visit led to a daily fine of $200 until the facility obtains compliance. Additionally, a recommendation has been made to The Centers for Medicare and Medicaid to deny new admission payments.

The facility Administrator, Jack Musker, said lack of training was a large part of the problem. Country View has been without a staff trainer for nearly one year. The facility is unable to fill many open positions and relies on temporary employment agencies to fill the gaps.

Friendship Haven in Fort Dodge, Iowa was slapped with a $10,000 state fine after a resident was injured stumbling in a bathroom on more than one occasion. The $10,000 fine was reduced after a federal penalty of $260 was imposed.

The resident was taken to the restroom by a nurse's aide on March 8, 2008. After the resident was seated, the aide turned to take the resident's dentures to the sink. When the aide turned back to assist the resident, the resident was standing and stumbling backward. The back of the resident's head struck a wall. The resident was later transported to Trinity Regional Medical Center and transferred to a Des Moines hospital for treatment of a broken arm, broken hip, and cut on the back of the head.

The resident returned to the facility on March 14, 2008. On March 25, the same resident suffered another injury when the resident stood up in the restroom and stumbled backward, striking the head on the wall. The resident died on April 2.

In another incident involving a resident, Agnes Thompson, 103, died on January 21, after falling just hours earlier. She fell while returning to bed after using the bathroom and suffered a cut to the head and a broken left hip. Iowa Department of Inspections and Appeals imposed a $8,000 fine, which was reduced to $5,200.

The Terry Law Firm is experienced in handling cases involving falls at nursing homes. Please contact us at 1 (888) 317-2525 or visit us at www.nursinghomejustice.com.

Villa Care Center

Villa Care Center, a nursing home located in Fort Dodge, Iowa, has been slapped with an $18,000 fine by state regulators after an investigation revealed that the facility's staff failed to obtain prompt care for at least five residents last year.

One instance involved a resident who suffered a broken arm after a bulletin board fell from a wall and struck the resident on August 26, 2008. The resident did not undergo an x-ray of the arm until two days later.

In another incident, a resident fell out of a wheelchair and complained of pain for several days before receiving treatment. Other incidents involved a resident who was found on the floor and was not sent to the hospital for medical treatment until two days later and two residents with open sores on their bodies.

The Department of Inspections and Appeals charged the facility with failing to assess and provide timely interventions for residents that had the onset of adverse symptoms, failing to provide assistive devices and ensure residents received adequate supervision, and failing to provide wound care and prevent pressure sore development.

The Terry Law Firm is experienced in handling cases of nursing home abuse and neglect. Please contact us at 1 (888) 317-2525 or visit us at www.nursinghomejustice.com.

Oak Park Place is an assisted living facility located in Dubuque, Iowa. The facility has come under fire from the Iowa Department of Inspections and Appeals recently following citations for insufficiencies concerning the care of its 42 residents, many of whom have serious health issues.

Recent inspections found several instances of failure to evaluate, deliver and follow up on resident care, problems with proper distribution of medications, and staffing issues. Some of the staffing issues involved not having appropriately trained nursing staff on duty. Inspectors also found evidence of records falsification "to the good of the administration".

One of the concerns involved an 84 year old resident with multiple medical problems, including Diabetes and coronary artery disease. A physician was to have been called if the resident's blood sugar level rose above 450 mg or below 60 mg. In September 2008, the resident's blood sugar rose above 450 mg at least eight times. There was evidence in the resident's chart that the physician was contacted sometimes, but not always. The facility failed to follow the physician's order.

Following a March 2008 inspection, the facility received its first fine in the amount of $2,500. The facility failed to make necessary corrections by July 2008 and was slapped with an additional $4,000 fine and a conditional certificate. A conditional certificate is a step below a license revocation. Recently, the facility was hit with a $10,000 civil penalty and the conditional certificate was continued until the program was in compliance or until August 25, 2009. If the facility fails to be in compliance by that date, it can lose its license. The facility can lose its license prior to that date if more violations are uncovered. In addition to the conditional certificate, the facility is not allowed any new admissions until the restriction or conditional certificate is removed. The facility is also required to submit monthly updates on medication reviews and nurse delegation training forms, and life safety training forms. In the past eighteen months, the facility has received twelve conditional certificates.

The Terry Law Firm is experienced in handling cases of nursing home abuse and neglect. Please call us at 1 (888) 317-2525 or visit us at www.nursinghomejustice.com.

Most people view nursing homes as a place to care for a resident's physical needs and provide safety. Often, the ailments of nursing home residents cause mental or emotional issues and nursing home social workers vital to nursing home residents to care for those needs. The social workers are to advocate for residents and monitor them for emotional issues, stress, and depression. Nursing home social workers are to help residents and their families transition between the facility and the hospital or hospice and assist with locating necessary resources for nursing home residents.

Interestingly, even with such important responsibility for residents, nursing home social workers are not held to any standardized qualifications. The federal standards for nursing home social workers are very low and state laws are inconsistent.

According to a recent study from the University of Iowa, only half of 1,071 nursing home social workers have a degree in social work and 20% do not have a four year degree. Two-thirds of the social workers surveyed do not belong to a professional organization that keeps them up to date on current nursing home social work issues, such as elder suicide and physical, emotional or financial abuse, and only 38% are licensed social workers.

Federal law requires homes with more than 120 beds to employ a full-time social worker. Most facilities do employ one, but devoting an appropriate amount of time to any one individual is nearly impossible. Federal guidelines indicate that one social worker can handle up to 120 residents. However, when asked, the majority of the survey panel indicated that fewer than 60 residents could be managed by one social worker.

Ten states do not address nursing home social worker qualifications and seven state codes do not comply with federal regulations. Twenty-one states require a social work degree and most others require a four year degree - but not necessarily in social work. Anyone with a bachelor's degree in any human service field and one year of supervised experience in the field is considered qualified. There are glaring loopholes in Colorado and Indiana. In Colorado, for-profit nursing homes in rural areas do not have to hire a qualified social worker if they advertise for a week in a local paper are unable to fill the position. In Indiana, social services can be provided by a member of the clergy who completes a 48 hour course and consults with a social worker.

Given the importance of social workers in the nursing home setting, one wonders if this is not an area that should be examined more closely.

Tabor Manor Care Center, located in Tabor, Iowa, faces a $3,000 fine from the Iowa Department of Inspections and Appeals for allowing a resident to sexually assault other residents.

The alleged attacker, who was finally moved to another care facility on October 13, 2008, had a history of alcohol abuse and was involved in five suspicious incidents in sixteen weeks.

In June 2008, a resident reported to facility staff that the man who lived in the room next to her had touched her breasts and genitals.

In July 2008, a facility staff member reported seeing the same man inside the room of a female resident fondling her.

In September 2008, a facility staff member reported seeing the man running from the room of another resident wearing only his underwear into his room across the hall. Finally, following this incident, the facility installed a laser-equipped alarm on the alleged attacker's door.

A few days after the installation of the alarm on the man's door, a resident complained that the man came into her room and grabbed her breast. He walked out of her room laughing when she threatened to hurt him.

In October 2008, a facility employee reported seeing a female resident leaving the man's room with her pants pulled down and fluid dripping down her leg. She told staff members that the man had hurt her. The Director of Nursing assessed the victim and while she believed some of the fluid near the victim's genitals was blood, she elected not to report the incident or report it to the woman's physician. The Director of Nursing finally told a physician about the incident three days later and the doctor elected not to examine the woman as "all the evidence would be washed away by now".

Following the fifth incident, the inspections department investigated and slapped the facility with the $3,000 fine.

Tabor Manor is not a stranger to problems. Earlier this year, the facility was cited for numerous problems, including not having a registered nurse on duty each day. Last year, the facility was fined $3,575 because of a resident's aggressive and threatening behavior.

The Terry Law Firm has handled numerous cases involving sexual assault in nursing homes. For more information, contact us at (314) 878-9797 or at info@terrylawoffice.com.

Meadowlawn Health Care Center of Davenport, an Iowa nursing home that is now closed, has been sued for a second time since it closed in late 2007.

Harold Edwards resided at the facility from November 2006 through March 2007. He was discharged from the facility and dropped off at an unfurnished apartment with only $30 to his name and a four day supply of medication. Nine days later, he was hospitalized with congestive heart failure. His hospitalization resulted in the installation of a cardiac defibrillator.
His lawsuit against Petersen Health Care, the owners of the defunct facility, accuses the facility of wrongful discharge, breach of contract, dependent adult abuse, failure to properly administer medications, insufficient staff, and inappropriate behavior when he complained about the care he received. He also is alleging emotional distress after seeing other residents harmed.

Trina Curtis also sued Petersen Health Care on behalf of her deceased mother, Janet Martin. That lawsuit alleges that staff failed to properly manage Ms. Martin's wounds and refer her to appropriate medical care. Ms. Martin developed "uncontrolled health issues", which included life-threatening medical complications from her wounds and improper diet and hydration. She died on January 24, 2006, a mere three weeks after leaving Meadowlawn.

Meadowlawn Health Care Center of Davenport closed in September 2007 after its Medicare and Medicaid funding were revoked and its license was in jeopardy. It had received several fines in the past, including a $12,000 fine for moving residents out with little or no notice as the facility was closing.

We discussed Glenwood Resource Center's inability to provide quality care for its residents in previous blogs. Glenwood was hit with its third - and largest - fine this year in the amount of $27,500. The fine would have been significantly less except that Iowa triples fines for serious offense violations. In this instance, the State of Iowa found that the facility provided inadequate nursing care by failing to provide physician-ordered services.

This time, the facility failed to provide a resident with physician-ordered oxygen. This incident involved two different shifts and two different nurses. Inspectors discovered that neither nurse noticed that a patient's oxygen tank was turned off for four and a half hours.

Four weeks later, the same resident was found in bed, pointing to his/her chest. The resident's fingers were blue. The patient's oxygen line was disconnected. The nurse suctioned the resident's airway and reconnected the oxygen. This same resident had been hospitalized in the past year for a collapsed lung and bowel obstruction.

The spokesperson for the Iowa Department of Human Services said that "caretaker mistakes are not acceptable".

Glenwood was fined in April 2008 after a nurse failed to take action in response to respiratory distress, which resulted in a resident death. The facility was also fined in August 2008 for hundreds of medication errors and other problems.