Editor’s note: This is the fourth in a five-part series looking at nursing homes in Union County that are rated by Medicare. Each installment covers a different nursing home facility and will publish on Sundays. All rating information can be found at Medicare.gov.
Grace Point has undergone several transformations in its more than 40-year history.
Originally built in the 1960s, the facility has been added on to twice, in the 1980s and ’90s. Grace Point has also had some remodeling done since it was bought by Keith Head of Conway, adding new beds and redoing floors, among other upgrades.
“This building was built in three different decades,” said administrator Sandra Mancell.
Original building plans are displayed on a wall in one of the older sections of the facility. A lake that was previously present on the property can be seen. Mancell said there also used to be horses at the facility, which used to be called Hillsboro Life Manor.
Walking through the home, the difference in the age of different units is easy to see. Mancell said they put as few people as possible in the part built in the 1960s, since the bedrooms don’t have en suite bathrooms.
The attached assisted living facility, Ella Manor, is one of the newest parts of the facility. Technically separate, the two facilities cater to different clients. Ella Manor has more short-term residents who only require minimal assistance, while Grace Point has more long-term residents who need 24-hour care. Ella Manor is the only assisted living facility in Union County, Mancell said.
Grace Point also boasts the only secure unit in any of the El Dorado nursing homes. Mancell said it is helpful for elders who are not supposed to leave but try to.
“Those that may want to try and wander away, it’s just another door to prevent them from making it out and on the street and keeping them safe,” she said. “We just pick wonderful staff to go back there.”
Medicare ratings
Grace Point is a skilled nursing facility that participates in Medicare and Medicaid. As such, they report to Medicare, which assigns ratings based on past health inspections, staffing and quality measures that are determined by Medicare.
Health inspection ratings are based on a facility’s three most recent health inspections and any recent complaint inspections. Any penalties incurred by a facility for severe citations or failure to correct a citation are also included in the health inspection ratings.
Grace Point scored two out of five stars on their health inspection rating, a score considered by Medicare to be “below average,” and the facility’s worst score on all the categories Medicaid grades on. They were fined by the federal government in April 2017 for $59,930 for failure to properly secure a resident into a van, causing injury to the person.
Mancell said they have paid the fine in full already and have put in place new procedures to prevent a similar incident from happening again. She said she personally oversees any patient transport, and if the van driver fails to properly secure a resident into the van, they are not allowed to transport residents.
She said the fine was so high because the amount grows every day that the deficiency goes unaddressed. She said it took about three days to fully design and implement the corrective actions that were necessary to make sure residents would be transported safely.
“If they’re going to fine me, it’s their way of telling me this is something that has to be fixed now, not in two days. So they want to see you stop what you’re doing and fix it,” she said.
Grace Point had 11 citations in their most recent health inspection in November 2017; they have also had two complaint inspections this year, in January and April, with 13 citations between the two inspections, three in April and 10 in January.
One citation was regarding a resident who had a stage four pressure ulcer, or bedsore. The home was cited for failing to identify the severity of the wound and provide appropriate care in a timely manner. Mancell was not the administrator at that time; however, she explained that the citation occurred during the middle of trying to correct a different deficiency.
“Because I really wasn’t here at the time, it’s hard to say what happened. … It’s a snapshot of a very small window in time and I believe they had, they were in the middle of issues in changing of the staff. In the middle of trying to correct something, the surveyors just came in the building before it was fully [corrected],” Mancell said.
However, since taking over as administrator, she said she has worked hard to ensure deficiencies like those mentioned do not happen again.
“I’m very hands on and I monitor everything. I actually read everybody’s nurses notes every week,” she said. “It’s how I keep up with what’s going on, keeps my nurses doing what they’re supposed to do, documentation they have to turn in to me weekly. I have to see it, we go over it. … I’m flipping through to see body audits are done weekly and done like they’re supposed to be and that everybody’s staying on top of it.”
Staffing
Staffing ratings are based on two measures: Registered Nurse (RN) hours per resident per day and total staffing hours per resident per day. Grace Point’s overall staffing rating was four out of five stars, an “above average” score.
Mancell said several employees have left and returned, her included. She lives in North Little Rock and commutes to El Dorado several times a week. The days she doesn’t commute, she stays in town, living in a room in Ella Manor.
“For me, it’s like going and checking in to the Hampton Inn,” she said.
She also noted that several employees have been there for a long time.
“My current DON (Director of Nursing) was here for 10 years and left for five to raise her family and came back and said ‘It’s home. I want to come back to work here because it’s home,’” Mancell said.
Shadel Willis is a Certified Nursing Assistant as well as the activities director at Ella Manor. She has worked at the facility for 10 years, she said.
“I’m here for the residents,” she said. “I like dealing with the elderly.”
She is also responsible for transportation from Ella Manor. She said she takes residents to Champagnolle Landing Senior Wellness Center and the Arboretum. She also designs games and activities to keep residents happy and busy, she said.
Tereka Miller is a Licensed Practical Nurse at Grace Point. She said she has been there for 12 years.
“I like patient care,” she said. She also noted that she has great co-workers that she enjoys working with.
Shakesha Jackson, the activities director at Grace Point, is another enthusiastic employee.
“[I try to] see if we can make their stay here more pleasurable,” she said about her job duties.
Laci Ross is a CNA at Grace Point. She said she loves working there and also commented on the good relationship she has with her coworkers.
Grace Point scored three out of five stars on their RN hours per resident per day. RNs at Grace Point spend an average of 26 minutes with an average of 62.6 residents per day. The state average is 22 minutes with 79.4 residents, while the national average is 40 minutes with 86.4 residents per day.
Grace Point’s licensed nurse staff, which includes RNs, spent an average of 102 minutes with an average of 62.6 residents per day. Nurse aides at Grace Point spend an average of 183 minutes with 62.6 residents per day, and physical therapists at the facility spend an average of six minutes with the 62.6 residents per day.
The state average for licensed nurse staff’s hours per resident per day is 83 minutes for an average of 79.4 residents per day. The national average is 92 minutes per 86.4 residents per day, both lower than Grace Point. By every staffing metric, Grace Point bested state averages. The national average for physical therapist hours per resident per day is equal to Grace Point’s.
The home is licensed for 122 beds and currently has 55 residents. Ella Manor is licensed for 62 beds and has 18 residents right now. Staff members have weekly in-service meetings to go over documentation practices, policies and patient care. Community groups also sometimes direct the in-service meetings. She said last month, their regional resident ombudsman came to talk to employees about resident rights.
“We’re trying to pull from community resources as well to do our meetings,” Mancell said.
A Registered Nurse at Grace Point could start out making $21 an hour, she said. CNAs start at around $9 an hour, but, Mancell said, depending on how much experience they have, can make more. She noted that Arkansas has a shortage of nurses that affects all nursing homes.
“I heard, just in the nursing home industry, they were saying there was a shortage of around 500 nurses, and that’s just LPNs and RNs in Arkansas,” she said.
Grace Point will also help their employees further their education, so long as it is related to the work they do at the home. She said staff morale is high, and that was evident meeting nurses and CNAs that are employed there.
Quality of life and care
The final metrics measure the quality of care a resident receives from the facility. Medicare collects data from their own claims data, such as bills sent from the nursing home to Medicare for payment purposes, as well as the Minimum Data Set (MDS) national database. The MDS is a resident assessment performed by the nursing home at regular intervals, according to the Medicare website. The MDS measures a resident’s health, physical functioning, mental status and general well-being.
Grace Point scored five out of five stars on the quality measures metric, a “much above average” score. In 14 of 23 quality measures calculated by Medicare, the facility outperformed state and national averages.
Mancell said the MDS is a helpful tool for nursing homes because it allows them to see areas where they are lacking and address them promptly. She said they fill out the 38-page MDS weekly, send them to Washington DC for review by Medicare, and then the home’s quality measures are sent back to Grace Point for review and action.
“We can turn around and use that information that they give back to us to make it better, see what we’re doing, did we miss something, did we code it wrong. … It’s a big cycle of: we push information and they push it back to us so that we can be better,” she said.
Despite the helpfulness of the MDS, she said it’s still important for her to personally oversee patient care at Grace Point.
“Nothing is going to substitute for actual eyesight and looking and being out on the floor. If you’re not out on the floor and you’re sitting in your office, you’re not going to be able to see what’s going on,” she said. “I normally clock about two miles a day walking around in here.”
Residents have a resident’s council they can use to address grievances and plan special activities. Linda Wright, 69, is the president of the resident’s council. She moved into Grace Point while her husband was also a resident at the facility; on a trip to visit him, she fell and broke her hip, at which point she joined him at the home.
“I like it fine,” she said about the home. She said her favorite thing about Grace Point are the activities they participate in. About the resident’s council, she had mixed feelings.
“I don’t know how much attention they pay to it, but yeah, I think it [has helped address problems],” Wright said. She couldn’t think of anything she would do differently if she was the administrator of the home.
Mancell said she works with the resident’s council to keep residents happy while still staying within the guidelines of nursing home regulations.
“It’s my job to go back and explain to them and see how we can work it where it is within the regulations and everybody kind of agrees on it,” she said.
Physical, occupational and speech therapy are offered for Grace Point residents. There are multiple dayrooms for residents to spend time in, as well as a library and daily activities. There are two activities directors at Grace Point, one for the secure unit and one for the general population.
Mancell said she brought her personal Roku streaming device to the home so residents could watch old Western shows and movies. Residents could be seen gathered in one dayroom watching a black-and-white gunslinger show, doing puzzles and socializing.
Grace Point is currently the reigning champion of a townwide nursing home domino tournament. They will host next year’s event, hoping to hold their title.
They will also be hosting a Senior Olympics in the next few months; a date has not been set for that event yet.
“They’re doing baseball throws, beanbag toss, horseshoes and flying Frisbees for a discus throw and the softball is for a shot put. Then they have wheelchair races,” Mancell said.
There are several outdoor spaces for residents at Grace Point and Ella Manor to spend time. Willis said that residents at Ella Manor bring bird feeders and baths to their area. Visiting hours at both facilities at from 8 a.m. until 8 p.m.
Mancell encouraged anyone interested in learning more about Grace Point to come by and visit the home.
“What I always say is come out, come visit. Don’t call and make an appointment. Come through, see what it’s like and then after you’ve kind of wandered around a bit, then go talk to administration,” she said. “We’re just kind of folksy and homey around here.”
Caitlan Butler can be reached at 870-862-6611 or [email protected].