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By Editor Becky Watts
MOLENA - Pike County Times called Molena Health and Rehab last week after finding out that it was closing from a comment on social media. The person who answered the phone advised that all residents were being relocated and the facility was closing. Later that day, after receiving an anonymous tip about the facility closing because of complaints, Pike County Times made some phone calls to the state and requested information about the closing through the Open Records Act.
Information obtained through open records includes that Molena Health and Rehabilitation is owned by Mr. Mike Winget, Sr and Mr. Mike Winget, Jr in Bolingbroke, Georgia through a management company called, “C. Ross Management, LLC” which is also located in Bolingbroke. These owners operate 14 other nursing homes here in the state of Georgia and, according to the Centers for Medicare & Medicaid Services, “…many of these facilities have had poor survey outcomes.” A 74 page State Survey from July 25, 2019, noted numerous deficiencies with many that had been ongoing for some time.
Inspections that were conducted this year found severe deficiencies resulting in a civil money penalty of $283,369.50 and termination of Molena Health & Rehab’s Medicare provider agreement as of August 22, 2019 at 11:59 p.m. The Notice of Mandatory Involuntary Termination from August 19, 2019 can be read in full at: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Termination-Notice-Georgia-Molena-Health-and-Rehabilitation-08-20-2019.pdf and reads as follows:
NOTICE TO PUBLIC OF MOLENA HEALTH AND REHABALITATION INVOLUNTARY TERMINATION
Date: August 19, 2019
Title: Molena Health and Rehabilitation Involuntary Termination
Notice to Public of Involuntary Termination of Molena Health and Rehabilitation
“The Centers for Medicare & Medicaid Services (CMS) is providing notice that on August 22, 2019, Molena Health and Rehabilitation, 185 Hill Street, Molena, Georgia, will no longer participate in the Medicare program. The Medicare provider agreement between Molena Health and Rehabilitation and the Secretary of Health and Human Services (HHS) is to be terminated on August 22, 2019, due to their failure to meet Medicare’s basic health and safety requirements. The facility has been notified that Medicare will cease to pay for services furnished to Medicare and Medicaid beneficiaries admitted after August 11, 2019. CMS is committed to patient safety and quality of care. We are closely monitoring the relocation of Medicare and Medicaid patients to other facilities. CMS requires facilities to meet certain health and safety standards to be certified as a Medicare provider. Involuntary termination of a provider agreement is generally a last resort after all other attempts to remedy the deficiencies at a facility have been exhausted. In this instance, the Atlanta Regional Office, has found that Molena Health and Rehabilitation is out of compliance with CMS basic health and safety requirements. While we understand the relocation of residents and patients can be challenging for all parties involved, CMS prioritizes patient safety and care quality. For residents, patients, and their family members, CMS recommends visiting the following websites for additional assistance through the relocation process: •Nursing Home Compare Website •Hospital Compare Website”
Background Information
CMS stands for Centers for Medicare and Medicaid Services. According to www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/index.html the “Social Security Act mandates the establishment of minimum health and safety and CLIA standards that must be met by providers and suppliers participating in the Medicare and Medicaid programs. These standards are found in the 42 Code of Federal Regulations. The Secretary of the Department of Health and Human Services has designated CMS to administer the standards compliance aspects of these programs.” This Act provides for payment for services as well as ensures that all providers of services comply with specific “Federal health care quality standards.” According to CMS.gov, State Survey Agencies carry out the Medicare certification process as well as set an enforce Federal quality standards including those for Medicaid.
According to www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/NHs.html there are provider compliance requirements by that must be met in order to receive payment from Medicare and Medicaid. According to this page, surveys are not announced beforehand and are completed on consecutive workdays whenever possible. These surveys may be conducted by the State at any time, 24 hours a day, and may be conducted on weekends, and the State’s compliance certification for skilled nursing facilities is subject to the approval of CMS. There is a large amount of specific information on this page including downloads on data and reports for Nursing Homes.
According to www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/SFFList.pdf CMS and State Agencies “inspect nursing homes on a regular basis to determine if they are providing the quality of care that Medicare and Medicaid requires in order to protect and improve residents’ health and safety.” When these healthcare or fire safety standards are not met, “deficiencies” are noted and providers are required to correct these problems.
According to this download, “Most nursing homes have some deficiencies, with the average being 6-7 deficiencies per inspection.” It goes on to say that there are “a minority of nursing homes” that have “about twice the average number of deficiencies,” more serious problems “including harm or injury experienced by residents,” and a pattern of serious problems over a long period of time that goes back three years before the date that the facility was placed on the Special Focus Facility list. “Although such nursing homes may periodically institute enough improvements to correct problems identified on one inspection, significant problems would often re-surface by the time of the next inspection. Such facilities with a “yo-yo” or “in and out” compliance history rarely address underlying systemic problems that give rise to repeated cycles of serious deficiencies, which pose risks to residents’ health and safety.” CMS has created the Special Focus Facility program to address this problem.
Molena Health and Rehabilitation was one of ten facilities listed on Georgia’s Special Focus Facility (SFF) list.
Current Situation
According to the Medicare.gov Nursing Home Compare site located at https://www.medicare.gov/nursinghomecompare/profile.html#profTab=0&ID=115693 Molena Health & Rehab (Molena Extended Care LLC is the legal business name) is a for profit corporation. Ownership can be viewed at https://www.medicare.gov/nursinghomecompare/ownership-info.html#ID=115693 with ownership interest greater than 5%, operational/managerial control, officers, and managing employees being listed here.
www.medicare.gov/nursinghomecompare/profile.html#profTab=1&ID=115693 shows that this is a 64 certified beds facility that participates in Medicare and Medicaid, has an automatic sprinkler system where required, and is located at 185 Hill Street in Molena, Georgia. There are links to health inspections, fire and safety inspections, staffing, quality of resident care, and penalties.
At the time of the last update to this website, the most recent health inspection rating was Much Below Average with a link to the September 20, 2018 full report. There were 15 citations with 3.9 being the average number of health citations in the state of Georgia and 8.0 being the average number of health citations in the nation. Complaint inspection reports for September 20, 2018 and April 4, 2019 can be viewed on this page. The website states that there have been 5 complaints that resulted in a citation in the past 3 years and there were 0 facility reported uses that resulted in a citation in the past 3 years.
Health Inspections for the past three years through April 4, 2019 can be viewed by clicking here.
However, much has happened with this facility since April 4, 2019. Pike County Times has been in contact with CMS/the Department of Health & Human Services out of Atlanta and was advised by a CMS spokeswoman of the following which is listed verbatim from background information that was provided by email through open records.
“On Aug. 20, 2019, CMS issued a Final Mandatory Involuntary Termination notice to Molena Health and Rehabilitation stating that its Medicare Provider Agreement will be terminated effective Aug. 22nd. As a result, The Long Term Care Ombudsman, State Medicaid Agency and all relocation team members have been notified.
Note: CMS does not close facilities. That is solely a business decision by the facility’s ownership.
Statement: CMS’s first priority is to protect the health and safety of the residents. CMS and the Georgia State Survey Agency are working together to ensure the safety of all residents in this facility.
The Long Term Care Ombudsman, State Medicaid Agency and all relocation team members have been notified.
Background Summary:
• On July 25, 2019, an Immediate Jeopardy was identified due to the failure of the facility to provide sufficient, competent staff to provide wound care to residents. Specifically, this systemic failure included not ensuring that thorough skin assessments were completed routinely by licensed nurses for residents at high risk for altered skin integrity; treatment orders were not always transcribed and completed as ordered by the attending physician. Residents developed new pressure areas, and existing pressure sores worsen necessitating debridement, antibiotic therapy and/or hospitalization.
• The Georgia State Survey Agency (SSA) conducted a first revisit survey to determine if immediate jeopardy was removed on August 1-2, 2019. Based on the investigative findings, immediate jeopardy remained ongoing. The SSA identified new pressure areas on residents unknown to nursing home personnel. In addition, agency staff did not report for duty to provide care to residents on one hall. Supervisory personnel were unaware there was no staff on the unit for more than an hour.
• There have been significant and frequent changes in the Administrator and Director of Nursing Services. Since May 29, 2018, there have been eight changes in Administrators. Since February 28, 2017, there have been five different Directors of Nursing Services.
• Molena Health and Rehabilitation is listed as the third candidate on the Special Focus Facility (SFF) list, has a one star rating and a high number of days with no Registered Nurse (RN) on duty. On the July 25, 2019 survey, staffing was cited at immediate jeopardy and deemed a contributing factor in the lack of consistent care delivery.
• Enforcement remedies imposed for the July 25, 2019 survey include discretionary denial of payment for new admissions and discretionary denial of payment for all Medicare and Medicaid residents.
• Molena Health and Rehabilitation also had immediate jeopardy identified in survey conducted March 25, 2019 through April 4, 2019. Staff failed to administer insulin as ordered by the attending physician, recognize significant changes in resident’s clinical condition and provide care to a resident following a fall that resulted in an impacted comminuted left femur intertrochanteric fracture. Based on the April 2019 survey findings, CMS imposed a civil money penalty of $283,369.50. The owners of the facility requested a 12-month extended repayment plan.
• Recently on July 30, 2019, CMS entered into a settlement agreement with Molena Health and Rehabilitation granting the request for financial hardship and approved an 18 month extended repayment plan.
• The facility is owned by Mr. Mike Winget, Sr and Mr. Mike Winget, Jr., located at 8369 Rivoli Road, Bolingbroke, Georgia 31004. The owners have established a management company titled, “C.Ross Management, LLC” located at P.O. Box 69, Bolingbroke, Georgia 31004.
• The owners operate fourteen (14) other nursing homes in Georgia, and many of these facilities have had poor survey outcomes.”
Molena Health and Rehab Responds
Pike County Times contacted Molena Health and Rehabilitation Administrator Sonia Pughsley by email on Friday, August 23, 2019 to advise that it has been in contact with the Department of Health and Human Services regarding the closing of Molena Health and Rehabilitation and is in receipt of the Notice of Involuntary Termination sent to her on behalf of C. Ross Management LLC on August 20, 2019 as well as the summary of immediate jeopardy survey and the survey itself. Ms. Pughsley sent a reply to each question that is included verbatim below.
"1) I was advised when I called Molena Health and Rehab this week that all patients would be moved to other locations. Have all patients been moved at this time?
ANSWER: No, however, the facility is working diligently with the State Agency on finding appropriate placement for each of our residents. As of today, twenty-six (26) out of forty-three (43) residents have been placed in other facilities.
2) I have been advised that CMS does not close facilities. What prompted the decision to close this facility?
ANSWER: It is regrettable that Molena Extended Care is being closed after years of providing quality care for residents in this rural area. Despite our best efforts and due to unfortunate circumstances, it has been impossible to adequately staff this rural facility with enough licensed personnel who are qualified to care for residents. We will work with the State agencies on the transfer of each residents over the next thirty days.
3) A check of C. Ross Management LLC online has found a number of facilities with poor survey outcomes including a fine of $3459 at Thomasville Health and Rehab LLC. What is being done at the remaining facilities to ensure that the health and safety of residents is being properly provided?
ANSWER: This is an unfortunate but isolated incident. In our previous surveys we have corrected any cited issues and were able to achieve compliance with State Regulations in a timely manner. Unfortunately, in the case of Molena Health & Rehab, we were not able to recruit the necessary staff within the time restraints we were given and therefore we were not able to achieve our desired outcome.
4) Is a plan in place to improve the quality of care that is being provided at all remaining facilities?
ANSWER: We have been providing quality care for our residents in our facilities since we have been in business. When we have issues develop at one facility, we investigate and, if needed, implement changes in our other facilities to ensure continuity of quality care for our residents."
Closing
According to the Involuntary Termination Notice dated August 20, 2019, Molena Health and Rehab has rights to appeal. It may request a hearing before an administrative law judge of the Department of Health and Human Services, Departmental Appeals Board by filing a written or electronic request for a hearing no later than 60 days after the date of the August 20, 2019 notice. The request for a hearing “should identify the specific issues, findings of fact and conclusions of law with which you disagree.” It also states that a basis the contention that the findings and conclusions are incorrect must be stated in this request for an appeals hearing and that an attorney paid for and representing Molena Health and Rehabilitation may attend the hearing.
The Involuntary Termination Notices lays out a strict relocation plan for residents with involuntary termination from Medicare and Medicaid beginning at 11:59 p.m. on August 22, 2019. According to the letter, Molena Health and Rehab “shall submit a resident relocation plan to the State Survey Agency an CMS to facilitate the orderly relocation of residents. The letter further states that if the facility is close, written notification of the closure shall be provided to residents of the facility along with the legal representatives of the residents or other responsible parties. The letter reads, “Residents will be transferred to the most appropriate facility or other setting in terms of quality, services and location, taking into consideration the needs, choice, and best interests of each resident.”
The facility is also mandated to provide a list of residents in the facility and their contact information to CMS and the Social Security Administration by midnight on August 22, 2019 as well as a relocation plan “that provides for the safe and orderly transfer of residents that desire to move to a certified facility.” The letter also notes that no new residents are allowed to be admitted on or after the date that notification is given to CMS about the intent to close. Failure to comply with these requirements could bring about a civil money penalty of up to $100,000 and could exclude the company from participation in any federal health care program.
[Note from the Editor: Pike County Times would like to extend a hearty thank you to everyone on a state level who spoke to me regarding this situation and open records. My questions were answered in a timely manner, and I was directed to the appropriate entities who provided open records in a quick and efficient manner.]
If there are any other further developments on this situation, Pike County Times will update this article at that time.
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