FOR IMMEDIATE RELEASE
May 11, 2007 

Contact:
Nanci Gonder                          
Office of Public Information
573-751-6062

Missouri Department of Health and Senior Services and the Federal Centers for Medicare and Medicaid Services move to decertify Greene Haven from the Medicare/Medicaid Program

Greene Haven, a skilled nursing facility, is scheduled to be terminated from the Medicare and Medicaid programs for skilled nursing facilities effective midnight, Monday, May 14, 2007.  This action was taken following the identification of multiple deficiencies at the immediate jeopardy level at the facility.

Greene Haven is a skilled nursing facility located at 920 South West Avenue in Springfield, Missouri. It is licensed for 120 beds. Ninety-four residents continued to live at the facility as of May 9th.

Section for Long-Term Care Regulation (SLCR) staff in the Springfield office began an annual survey at the Greene Haven facility on April 9, 2007. The process was completed on April 19th.  One federal surveyor was present during the entire survey process. Federal surveyors randomly accompany state survey staff on survey processes to evaluate the state surveyors' adherence to federal regulatory requirements.

Based on the survey, approximately 50 separate regulatory deficiencies were cited. Of these, four deficiencies were cited at the immediate jeopardy level due to their severity and impact on residents.  These include the following:

• The facility failed to prevent a facility staff person from verbally and mentally abusing residents. At least one resident expressed fear of this staff person to the point of physical illness and crying when this staff person was working.
• The facility failed to assess and provide appropriate care to one critically ill resident who had a significant change in condition (the resident developed a fever as high as a 102 degrees, symptoms of a urinary tract infection, stopped eating and drinking, and developed hypotension). The resident subsequently died following transfer to the hospital. At the hospital, the resident was diagnosed as unresponsive secondary to the urosepsis, and experiencing acute renal failure secondary to profound dehydration.
• The facility failed to provide supervision to prevent accidents. Staff restrained one resident in a wheelchair with a non-releasing belt restraint; failed to assess for another resident the need for and appropriate type of restraint; allowed a third resident to smoke unsupervised while restrained; and did not develop and implement interventions to prevent further falls for at least two other residents who were injured after falling.
• The Administrator failed to provide supervision as evidenced by the preceding examples that constitute immediate jeopardy to the residents.

At the time of the exit conference on April 19th, the facility was presented a handwritten statement of deficiencies itemizing these four areas of immediate jeopardy. Before the survey staff left the facility, Greene Haven staff provided a handwritten plan of correction for the four areas of immediate jeopardy. State and federal confidentiality requirements do not allow for the release of the names of affected residents.

Other, less serious citations were made in the areas of dietary services, infection control, urinary incontinence, pressure sores, restraints, unnecessary drugs, privacy and dignity, and assessments and care plans, and general environmental conditions.

On April 22, 2007, in coordination with the federal Centers for Medicare and Medicaid Services (CMS), denial of payment for new admissions was imposed on Greene Haven. This means that the facility could not admit any additional Medicare or Medicaid residents at that time.

On May 4th, SLCR made additional recommendations to CMS with respect to sanctions to be imposed on Greene Haven. The recommendations included:

• A civil monetary penalty of $10,000;
• Termination from the Medicaid and Medicare programs; and
• Loss of approval to conduct nurse aide training.

On May 9, 2007, SLCR conducted a revisit of Greene Haven to determine if the immediate jeopardy violations had been addressed.  Addressing the immediate jeopardy violations could have reduced the scope and severity of the violations even if they had not been completely corrected. However, SLCR found that the immediate jeopardy conditions still existed.

Therefore, on May 10, 2007, Greene Haven was informed by DHSS that the section was recommending that the facility be terminated from the Medicare/Medicaid programs effective May 14, 2007. CMS concurred in this recommendation and has/will formally notify the facility.

Effective midnight, Monday, May 14, 2007, Greene Haven will no longer be certified for Medicare and Medicaid. Reimbursement will continue for an additional 30 days after May 14th to ensure the orderly relocation of residents. Department and section staff, along with the state's long-term care ombudsman, can assist residents and their family members in identifying facilities to which they may move.

SLCR staff in the Springfield office will be conducting ongoing, unannounced monitoring visits at Greene Haven to observe the care provided to residents and to determine whether the health, safety and welfare of the residents is being protected. SLCR plans to contract for independent monitoring later this month.

The facility may seek a stay of the termination from the U. S. District Court. DHSS has been advised that the facility has applied for such a stay. At this time, DHSS has not been informed whether such a stay has been granted. The U. S. Department of Health and Human Services, along with the U. S. Attorney's office, handles these proceedings. The request for a stay is in conjunction with the facility's right to seek review of the termination decision at the departmental appeals board of the U. S. Department of Health and Human Services. The facility has 60 days to seek such review.

In addition to the decertification, the state has the option to seek a state civil monetary penalty and other licensure sanctions, including revocation. The department's program staff and office of general counsel are reviewing these options. If the department determines to seek revocation of the license, state law requires that the facility be provided at least ten days' notice. In other situations, revocation has been made to coincide with the end of the thirty days' of continued reimbursement so that the facility remains licensed during the resident relocation process. 

The facility could appeal any revocation action to the Missouri Administrative Hearing Commission, which may also grant a stay of the revocation pending review of the department's revocation decision. The Commission may impose conditions on the facility during the period of the stay such as requiring an independent monitor to report to the department and the Commission on conditions at the facility.