Editor’s note: This is the second in a five-part series looking at nursing homes in Union County that are rated by Medicare. Each installment will cover a different nursing home facility and will publish on Sundays. All rating information can be found at Medicare.gov.
Courtyard Rehabilitation and Health Center received five out of five stars overall on their nursing home ratings, provided by Medicare.gov.
Medicare assigns the ratings to the nursing homes based on past health inspections, staffing and quality measures.
“There’s only one other home in a 50-mile radius from El Dorado that has a five star rating,” said David Lewis, administrator. “So it’s not an easy thing to accomplish.”
Lewis said he believes they received five stars because of the people that work at the home. He said most of the information is done through the Minimum Data Set (MDS), “which tells everything we do for the patients.”
According to the Medicare website, MDS is a resident assessment performed by the nursing home at regular intervals. It measures a resident’s health, physical functioning, mental status and general well-being.
Lewis has been the administrator for the home for five years, and previously worked at Hillsboro Manor, now Grace Point, before moving to Courtyard.
“We actually had a five star rating when I left there,” he added.
Staffing
Courtyard is a 101-bed nursing home and Lewis said they have about 80 residents. He said the home does a lot of therapy and most people stay 20 to 30 days.
“Our goal is to get people in and out as fast as possible and most of those people go home,” he said. “About 80 percent go home, we just have some that can’t.”
He said there are 98 employees at the home. Out of that 98, around seven are part-time employees, “but 95 percent of the people are full time.”
There are only three salaried positions in the home: the administrator, the director of nursing and the dietary manager.
Lewis said the registered nurses (RNs) make anywhere from $20 to $25 an hour, while licensed practical nurses (LPNs) make around $17 to $20 an hour and certified nursing assistants (CNAs) make $10 to $12 an hour.
“RNs get more money because they have more education,” Lewis said. “It’s all based on your experience.”
The residents have their own physicians that check on them regularly. Lewis said if a doctor can’t come to the home to see their patient, he will take them to the doctor’s office in the facility’s bus.
There is also a medical director at the center that will see patients if they do not have a physician.
Medicare staff ratings are based on RN hours per resident per day and total staffing hours per resident per day. Courtyard received four out of five stars for staffing ratings and three out of five stars for RN staffing rating.
According to the Medicare ratings, the average time an RN spends with a patient at Courtyard is 28 minutes, compared to the state’s 23 minutes and the nation’s 40 minutes. Lewis said he believes the home has enough RNs to fill the patient’s needs.
“We’re above the state average so I’m good — I have enough,” he said.
Other than RNs, LPNs and CNAs, Lewis said the home has numerous consultants that visit regularly. Pharmacists visit to review the pharmaceutical records monthly and the lab company does a chart review quarterly.
“I mean it’s just a lot of people that come in and helps you do what you’re supposed to,” he added.
Lewis said his management style is “if you have something to say, come talk to me” and that his door is always open.
“I know them all,” he said referring to his staff. “If they’re happy at work, then they’re going to do a better job.”
He said the home works around the staff’s schedule if they are furthering their education.
“We’re all for more education,” he said. “I’ve got some CNAs that just graduate from LPN school.”
When discussing specific positions that are hard to keep at the home, he said it’s difficult keeping LPNs and CNAs, adding “we’ve got way too many nursing homes in El Dorado.”
Quality of care
According to the Medicare ratings, Courtyard received five stars for quality of resident care.
He said that all of the quality measures they are graded on are important and when it comes out, they look at what they need to work on.
“I don’t think there’s anybody in town that can do as good as that,” Lewis said, referring to the five star quality rating. “That’s all because of the people I’ve got working here.”
Medicare breaks down the quality ratings into 24 measures. Courtyard scored above the state and national average percentages in every category except one: percentage of long-stay residents experiencing one or more falls with major injury.
Lewis said one of the most misleading statistics are falls.
“People fall at home, they fall at work, they fall at the grocery store, just because they’re in this type of environment doesn’t mean they’re not going to fall,” he said. “We’re extremely proud of our quality measures.”
Lewis said one thing he is proud of is that the home has been antipsychotic medication free for two and a half years.
“It took us about six months to get there, but we took everybody off antipsychotics that did not have a specific diagnosis for that drug, and they all woke up,” he said. “Antipsychotics are a big overuse in the elderly, so we decided we were going to do something different.”
Past citations
Courtyard has not received any federal fines in the last three years.
The home has a three star health inspection rating, with their last health inspection being in July 2017.
The home has previously been cited on health inspections for:
• Failing to ensure meals were prepared and served according to the planned, written menu to meet the nutritional needs of the residents. The failed practice had the potential to affect five residents who received pureed diets and 18 residents who received mechanical soft diets, according to the Diet List dated July 25, 2017.
• Failing to ensure hot food was served hot and cold food was served cold to maintain palatability and encourage good nutritional intake for residents who ate meals in their rooms. The failed practice had the potential to affect 24 residents who ate in their rooms on the 200 Hall and 20 residents who ate in their rooms on the 300 Hall, according to lists provided by the Food Service Supervisor on July 27, 2017.
In 2018, the only complaint report was filed on Jan. 12 and states that the facility failed to ensure two staff assisted with a transfer using a gait belt, as care planned, to prevent injury for one resident who was being assisted during transfers. The failed practice had the potential to affect 11 residents who were to be assisted by the assistant director of nursing on Jan. 12.
Referring to the citations, Lewis said they’ve already been fixed and that they are constantly working to prevent them from happening again.
“They give you basically 30 days,” he said, referring to fixing the problems. “I wouldn’t still have a license if I didn’t fix it.”
The home also has a wound care certified nurse, Linda Cameron.
“Nobody in town has got that,” Lewis said. “I don’t think the hospital has got that.”
Quality of life
The home has a Parkinson’s spoon and fork, that has a computer attached to it. Lewis said he saw a man feed himself with the spoon for the first time in three years because he had Parkinson’s.
“We’re out of the box. We try to do whatever we can do to make people healthier,” he said. “I want people going home.”
The home also has a poodle named Phineas. Phineas was trained as a diabetic sniffing dog and can detect high and low blood sugar in a person.
There is also a room with a stove, microwave, refrigerator and washer and dryer, so that when someone is ready to go back home they can make sure they are able to do laundry and cook a full meal for themselves.
Ashley Matthews, speech language pathologist at the home, said they have very advanced technology at the home.
There is a machine she uses to help patients swallow after loosing that ability. Matthews said she had a 102-year-old patient who was unable to swallow.
“I did four weeks of just this machine, and within a month she was able to swallow,” Matthews said. “I feel like every facility needs one of these.”
The rooms in the building include cable TV, a refrigerator and a recliner. Patients are welcome to decorate their rooms to make them more comfortable.
“Families will bring pictures, comforters from home, anything to make it look like what it did when they were at home,” said Karen McCullar, director of nursing.
Lewis said one of the best features of the home is the outside area located in the middle of the facility. The area is completely self-enclosed, allowing any patient to venture outside, without having to be supervised.
Lewis said he had a woman call him up a couple of years ago, saying that she hadn’t been able to give her husband a bath in three years. She was standing him up in the shower, but couldn’t get him in the tub. The woman asked if she could bring her husband in once a week to take a bath in the whirlpool at the facility, and Lewis said “why not?”
Every Sunday, the woman brought her husband to bathe at the facility, until he entered the home once she was completely unable to take care of him.
McCullar added that the facility has done that for several other families in the community.
“It’s just something we should do, and that shows in our ratings,” Lewis said. “It shows in our quality measures.”
McCullar added that she believes that Courtyard provides the best quality care and that the facility does things “other facilities in town don’t do.”
Resident Fran Cardin, who has been at the home for a couple of months receiving therapy and rehab from a stroke, said that her favorite part about being at Courtyard is her room and “everybody’s kindness.”
“I think it’s pretty and the aids, most of them are really good,” Cardin said. “Everybody I’ve met has been really nice.”
Kaitlyn Rigdon can be reached at 870-862-6611 or [email protected].