Richland County nursing facility addresses state "immediate jeopardy" citation as board reviews finances and staffing

The Pine Valley facility's administrative staff reported to the Richland County subcommittee that state surveyors issued an immediate‑jeopardy (IJ) finding tied to delayed clinical assessments and non‑ambulance transport in early 2025, and that corrections have been implemented while the state determines next steps.

Administrator Britney told the panel that the IJ stemmed from two residents who experienced a significant change in condition and were not assessed promptly. She said the facility changed its transportation policy immediately after learning staff had used taxis to send residents to the hospital. "I changed the transportation policy immediately," Britney said. "Under no condition should anybody with a change of condition ... be sent out via cab." She said she also notified local emergency medical services so ambulance crews understand the facility's expectations.

Why it matters: an IJ finding is the most serious citation a survey can issue; it can carry daily fines and other penalties until the state validates that the facility has corrected the problems. Britney told the committee the facility made a range of corrections — audits of staff licensure, completion of overdue annual performance evaluations, new social‑services self‑report interview forms and changes to care‑planning and 24‑hour reporting — and that she had removed the IJ status at the facility level and is waiting for the state to return and clear the citation.

Financial review and vouchers: the board reviewed March financial statements and vouchers. The facility reported an average census of 66 for March (budgeted for 64) and a current census of 67. Accounts receivable days were 39.5 (the stated target is below 40). The facility reported March receipts of $930,465.73 and described semiannual debt service and related interest payments totaling $1,269,087 and a workers' compensation insurance adjustment of $3,062. In a line‑item review of the credit card bill, staff identified charges including $279.39 for a resident Super Bowl event, $390 for laundry baskets, $3,325 for CNA training (five staff at approximately $665 each), and other facility purchases. The subcommittee moved and voted to approve the vouchers as presented.

Aging report: staff said a $7,601 billing error was identified and would be corrected the next day; staff also said they were following up with Medicaid on another item and had cleared a separate item through a journal entry. The facility indicated it will present the aging report monthly going forward.

Staffing, wages and training: subcommittee members and staff discussed ongoing recruitment and retention challenges. Staffing gaps reported for nursing included two full‑time positions and additional per‑diem shifts on day and evening shifts; CNA and med‑tech classes are planned to develop internal candidates. Staff said hospitals in the region pay higher wages (an example figure of $37.10 per hour for hospital RNs was cited in comparison to the facility's published RN rate of about $32), and that the facility is reviewing job descriptions and the wage study to address pay band placement. The facility has reinstated employee recognition efforts, monthly events and an "employee of the month" program to support morale.

Med‑tech scope and practice: staff described use of med techs (who pass medications but do not perform assessments) as a strategy to help staffing shortages. The subcommittee was told med‑tech pay is "slightly above the CNAs" and that the facility is restricting nurse‑tech duties to stay within permitted scope until staffing stabilizes.

Quality and safety practices: staff outlined changes to fall investigations, incident documentation and care‑plan updates. The administrator said the facility had reeducated staff on 24‑hour reporting and clarified responsibilities for supervisors to complete and review annual performance evaluations so those reviews are not missed in the future.

Operations and infrastructure: staff reported problems with overhead paging and the facility's ability to hear fire alarms and other emergency announcements in all areas. The facility is working with MIS/IT to enable paging capability on the phone system and said the old building had an overhead system that was not carried over to the new facility. Staff also reported they expect a water‑system engineer to visit within weeks to deliver project plans; the board earlier approved $15,000 to study three possible approaches to remedy the water issue.

Public comment and adjournment: a family member raised a concern that staff did not notify family after finding a resident on the floor, saying, "they found your dad on the floor this morning. I was like, well, did you, like, check him out?" Staff explained the policy that family notification depends on resident cognitive status and power‑of‑attorney activation, and reiterated steps taken to improve communication. The subcommittee approved the agenda, minutes and vouchers by voice vote and then adjourned.

What remains unresolved: staff said the state will return to determine whether the IJ has been lifted and will issue any monetary penalties; the facility said the amount will depend on the state's follow‑up. Several operational fixes (paging, water‑system engineering, and wage adjustments pending job‑description updates) remain in progress.