Death and two hospitalizations lead to $5,687 fine against nursing home • Iowa Capital Dispatch

An Iowa nursing home was fined $5,687 for deficiencies in the quality of care that led to the death of one resident and the hospitalization of two others.

In May, the Iowa Department of Inspections, Appeals and Licensing visited the Crestview Specialty Care facility in West Branch in response to nine separate complaints regarding resident care. Four of the complaints were substantiated.

The home was charged with four code violations and fined $8,750. The fine was then reduced by 35% to $5,687 when the home waived an appeal.

According to state inspectors, Crestview Specialty Care failed to properly assess residents’ conditions and provide medical intervention when needed. As a result, inspectors allege, one resident suffered worsening gastrointestinal problems — including abdominal pain, stomach pain and vomiting — for four days until he apparently began having difficulty breathing.

An ambulance was called and when it arrived, paramedics reportedly remarked “he looks awful” and then discovered that the man was suffering from acute respiratory failure and had critically low blood pressure. Even after administering intravenous medication, paramedics were unable to take a blood pressure reading.

The resident was taken to a hospital emergency room where he was intubated and a three-liter intestinal obstruction was suctioned from his stomach. The hospital was unable to stabilize the resident’s condition and he died within six hours of arriving at the emergency room.

In a second incident, Crestview allegedly failed to intervene when a male resident was unable to urinate for two days and showed signs of swelling due to fluid retention. The man was eventually hospitalized.

In a third incident, Crestview allegedly failed to properly transfer a physician’s insulin order, resulting in a resident being hospitalized for diabetic ketoacidosis.

Crestview Specialty Care has an overall rating of two stars on the Centers for Medicare and Medicaid Services’ five-star scale.

Last year, an intruder reportedly spent four hours at Crestview before staff found him partially undressed in bed with a resident.

According to state inspectors, several Crestview employees had contact with the man in the hours before he was discovered in the resident’s bed. One employee had expressed concern that the man appeared to be homeless, another employee twice showed him the way to the victim’s room. A third employee heard the victim scream “Help me” while being pushed through the facility in a wheelchair by the intruder.