DHEC records show violations that could endanger residents at Catawba Community Care Home

jmcfadden@heraldonline.comOctober 26, 2013 

A York County residential care facility where a 61-year-old man was recently slashed in the face by another resident was cited this year for 12 violations that might “present an imminent danger” for residents or “result in death,” according to the state Department of Health and Environmental Control.

During a routine inspection of the Catawba Community Care Home on Oct. 1, DHEC issued seven citations for Class 1 violations to the facility, which serves the indigent, records show. In June, DHEC cited the facility for Class I violations during a fire safety evaluation. DHEC provides oversight for all the state’s nursing, retirement and community residential homes.

The October inspection came 12 days before Garland Edwards was sent to Piedmont Medical Center, where he received 42 stitches in his face after starting a fight with another resident and suffering cuts on his chin, under his jaw line and near his ear, his sister said.

Both residents involved in the fight have been kicked out of the facility, and Pat Terry, the facility’s owner, said she will request more thorough background checks on prospective residents before they are admitted.

Catawba Community Care Home has also penned a required “plan of corrective action” to DHEC specifying how the agency will fix the issues cited, said DHEC spokeswoman Lindsey Evans.

Edwards was injured on Oct. 13. At about 8:30 a.m., deputies were called to the facility at 400 Rowell Road after an employee reported a fight between two male residents, according to a York County Sheriff’s report. When authorities arrived, they found paramedics placing Edwards into an ambulance. Authorities photographed his injuries before learning that no employees witnessed the fight, but some heard about a scuffle in the common area where residents watch television, the report states. They found Edwards and another resident, 70, fighting on the floor amid splatters of blood.

Staff members pulled the men apart and began tending to Edwards’ wounds, the report states.

The other man told deputies that Edwards yelled at him about a chair he was sitting in before he started throwing punches, the report states. Tired of “getting beat on by” Edwards, the man fought back and they traded blows.

The man told deputies he cut Edwards with a “blade of some type,” the report states. He later said he had a box cutter, which he threw underneath the back porch of the building.

Deputies found the box cutter and spoke with two other residents who said they witnessed the fight but did not see the blade, the report states. They said Edwards hit the man first. Police do not expect to file charges against the man who wielded the box cutter because “we believe he was acting in self-defense,” said Sheriff’s Office spokesman Trent Faris.

“I’m very, very upset” about the incident, said Terry, the facility owner. “Nothing like this has ever happened before.”

Edwards’ sister, Deborah Hemphill, said her brother suffers from Alzheimer’s disease and “wants to claim everything,” thinking “this belongs to me ... this is my TV ... this is my chair.”

He was diagnosed with Alzheimer’s after suffering his third stroke in Virginia, Hemphill said. The siblings moved to York County about eight months ago. She placed him in Catawba Community Care Home after administrators at a nursing home told her he did not qualify to live there because he was able to care for himself.

Now, he is unable to write his own name or tie his shoes, Hemphill said. He asks why their mother, who died several years ago, won't visit him.

Hemphill placed him in the Catawba facility because a family member attends church nearby and would be able to check on Edwards when she could not.

“It was the worst mistake I’ve ever made,” she said.

Terry is unsure how the second man brought a box cutter into the facility, she said.

“That’s not something we use here,” she said. “I don’t know how he got it in. He didn’t tell us. A visitor could have brought this in. People can hide stuff from you, and that’s what happened in this situation.”

DHEC does not have regulations for weapons or materials brought into community care facilities, Evans said. Those policies are set by the facility but are reviewed by DHEC before the facility is initially licensed. The policies are reviewed again if “an incident such as this one occurs.” The community home has been open in Catawba for nearly 30 years.

Catawba Community Care Home is a state-licensed community residential care facility that admits people “nobody else takes care of,” Terry said. Staff members care for people who need help with cooking, taking their medications or other daily activities. The facility does not provide medical care, and it does not accept residents with cognitive disabilities or those who are “bedridden.”

“They're independent people,” she said. “They just pay to live here. They’re able to move around and go in and out. They get to go home to family. They go to church. They get in fights.”

Unlike a nursing home, Catawba staff members don’t monitor residents “24 hours a day,” she said, but do monitor their rooms and shopping bags to make sure they are not smuggling anything they should not have inside the home. “We are not allowed to do strip searches on people. This is not a prison.”

The facility does not have any metal detectors, but it does have a security alarm system that detects visitors from the outside. There are no measures protecting residents on the inside. Since the Oct. 13 incident, staff members have ensured that there are no additional weapons on facility grounds.

“Staff was here” when the incident happened, Terry said. “That's how the fight was stopped – by staff.”

Terry said she plans to work with DHEC to figure out “how far” staff members can go when searching residents and their visitors. Staff members will perform more “serious background screenings.” In the past, only employees underwent criminal background checks. Now, Terry said she will pay the state an extra $25 to receive criminal record checks on every prospective resident. If there is an indication of anything criminal or violent, the resident will not be admitted.

Neither Edwards nor his assailant have criminal records in South Carolina, court records show.

The fight between the men has affected how she admits residents, Terry said. Already, she has turned away some people because something in their past has raised red flags.

“A lot of people will get turned away and have no place to stay,” she said. “The family is not going to tell me, the system’s not going to tell me.”

Last week, Edwards had been released from the hospital but evicted from Catawba Community Care Home. He now lives in an assisted living facility.

Terry said she never saw evidence of Edwards suffering from Alzheimer’s. Her mother suffered from the disease.

“I never detected any Alzheimer’s in him,” she said. “He was fully aware of everything going on. He was alert; he did his own bathing. He knows what day it is; he knows what year it is.”

Community care facilities must perform an assessment on residents 30 days before they move into a unit, according to state law. Terry said an assessment on Edwards was completed, but he showed no indications of the disease.

Hemphill said Catawba administrators knew about her brother’s condition because she had to give them medical records and a list of medications he took.

“We don’t take care of people when they get to the point they can’t take care of themselves,” Terry said. “Once a person is diagnosed with Alzheimer’s,” they are sent to a nursing home.

Hemphill showed The Herald several of Edwards’ medications. They include Namenda, which treats Alzheimer’s disease and dementia, and Aricept, used to treat mild to moderate dementia caused by Alzheimer’s disease. She did not have handy a copy of Edwards’ medical records showing an Alzheimer’s diagnosis.

Citations and violations

On Oct. 1, DHEC conducted a routine general inspection of the facility and cited it for 12 violations. Seven of those were Class I violations.

DHEC defines Class I violations as issues that can present “imminent danger to the health, safety or well-being” of patients or residents in the facility. Those issues mean a “substantial probability that death or serious physical harm” can result.

Terry said many of those issues were “minor” maintenance problems that she has started to address.

One Class I violation stems from a complaint in which a resident said his blood-clotting medication levels went unchecked for eight weeks because staff members failed to take him to physician appointments.

DHEC learned that staff members forgot to put the resident’s appointment on the calendar, so he missed meeting with his physician and the opportunity to schedule another appointment. The facility was served with a citation but never fined.

Other Class I violations inspectors noted included:

• Missing documentation meant to show what medications were given to residents.

• Records showing what medications were given by staff members on a previous shift were blank. Also, a bottle of prescription medication was found without a label.

• Unsecured oxygen tanks in two residential rooms.

• Hot water temperatures at 132 and 136 degrees respectively in two bathrooms. State law requires the water to be at least 100 degrees but not more than 120 degrees. Terry said she quickly responded to this violation by turning down the water temperature.

• Two staff members, including Terry, who could not provide paperwork showing what kind of in-service fire response training they had received. Terry disputed this violation, saying she did have the training and has since been able to prove it.

After citations are noted, DHEC requires facilities to submit a plan of corrective action explaining how they plan to come into compliance. Catawba Community Care Home submitted its plan to DHEC on Oct. 15, and it was reviewed last Wednesday, said Lindsey Evans, DHEC spokeswoman.

“DHEC has asked for additional clarification on how they plan to prevent future occurrences of this nature,” Evans said. “Once this clarification has been received, the facility will be considered” in compliance.

During a June fire safety inspection this year, DHEC issued five Class I citations against the facility, saying it did not install ramps with noncombustible materials or install a National Fire Protection Association-approved sprinkler system in rooms used to store combustible materials.

All electrical installations and a fire alarm did not meet federal guidelines, records show, and the facility was not free of fire hazards or impediments to fire prevention.

Failure to correct a violation can result in hefty fines. Details on what DHEC investigators specifically found during their June inspection were not available by Friday. The Herald has requested those documents from state officials.

Terry said all those issues have since been corrected.

“All my stuff is clear,” she said. “Everything is taken care of.”

Throughout its history, the facility has amassed more than 30 other citations. But DHEC has never fined the home because it’s “not had a history of enforcement action or fines, which would only be warranted if the facility had a history of repeated noncompliance,” Evans said. “Historically, this facility has established compliance with their plan of correction.”

DHEC typically only levies fines if facilities routinely fail to come into compliance after inspections, she said.

Staff members work “diligently” to come into compliance any time DHEC notes a violation, Terry said. “I intend to keep my license. We’re constantly working on improving ourselves. We’re never going to be citation-free. If they come in and find a piece of paper on the floor where it’s not supposed to be, you get cited for it.”

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