Dubuque County-owned Sunnycrest Manor has been fined $6,000 for three violations discovered during its most-recent state inspection.
The violations were among nine deficiencies noted in the mid-September inspection.
County Supervisors Wayne Demmer and Tom Hancock said they believe the hiring of Cristine Kirsch last month as the facility's full-time administrator -- after nearly two years of interim leadership -- will help resolve issues.
"The new administrator can address those (issues)," Hancock said. "It's her job. She needs to straighten it out."
Kirsch did not return calls from TH Media for comment Thursday, Friday, Monday, Tuesday or Wednesday.
The inspection report, provided to TH Media on Monday, states inspectors found nine deficiencies at the long-term care facility, with three of those resulting in citations. Sunnycrest was fined $5,000 for an Aug. 16 incident in which an unnamed resident fell and broke a hip. (State inspection reports do not include residents' names or genders.)
The resident was walking with a wheeled walker and a certified nursing assistant was following with a wheelchair when the resident fell to the ground. The report notes staff had been told to use a gait belt with the walker but failed to do so.
Another violation involved Aramark's management of dietary services at Sunnycrest, prompting a $500 fine.
"Based on observation, resident and staff interviews, and record review, the facility failed to take into consideration residents' choices and preference and maintain adequate food for residents' meals," according to the citation report.
It states that eight residents interviewed by inspectors expressed issues with meals. One said he or she has purchased some personal food due to dissatisfaction.
"(That resident said) the eggs make him/her choke, and the hamburgers and hot dogs are not edible," the report said.
That resident also said staff is afraid to "speak up for fear of getting fired."
Other residents stated they had dietary restrictions, and when they didn't like items on the menu, there weren't alternatives available that they liked. Residents also said the kitchen sometimes ran out of prepared meals.
Dubuque County hired Aramark in June to manage dietary services at Sunnycrest. The report said inspectors spoke with the dietary director and a dietitian from the contract agency, who said residents could get alternative food, such as a peanut butter and jelly sandwich, from the nurse's station on each floor if they do not like menu food. Fresh salad also is available at every meal, they said.
The report said inspectors Sept. 16 saw residents who required eating assistance were not offered grits, as was stated by the menu. On Sept. 15, dietary staff failed to serve three residents who "required assistance with eating a roll."
The report also notes that the proper background checks were not completed on the dietary director and another dietary employee prior to being employed. This resulted in a $500 fine.
OTHER DEFICIENCIES, HISTORY
Other deficiencies without citations include inspectors dissatisfied with the quality of food during a sampling, a kitchen staffer not wearing a hairnet and not having a full-time administrator or medical director.
Over the past five years, inspections at Sunnycrest have found varying levels of deficiencies -- four in an earlier 2015 inspection, zero in 2014, one in 2013, five in 2012, four in 2011, two in 2010 and nine in 2009.
Before the latest inspection, the facility only had been fined for a violation once since 2009. In 2011, a $3,500 fine was levied after a resident who was supposed to be on a soft-food diet choked on a ham sandwich.
After being provided the report, Aramark spokesman Chris Collum emailed a statement saying the menus for Sunnycrest are made specifically for senior care residents.
"For nearly 80 years, we have been experts in delivering high-quality dining programs, serving more than 2 billion meals each year," the statement said. "Our food service programs and food safety practices are industry leading. If concerns are raised, we work to fix them quickly."
Hancock said Sunnycrest has had an exemplary record with inspections compared to other nursing homes and that Kirsch should be able to find solutions. Kirsch started as full-time administrator at the end of September. She previously served as administrator of Luther Manor in Dubuque.
Hancock said he would like to give Kirsch the opportunity to handle the solutions before the supervisors would intervene.
"Like with any other department or agency, I'm not inclined to micromanage," he said. "That's why we hired an administrator."
Kelly McMahon, who was serving as interim administrator at Sunnycrest at the time of the most recent inspection, wrote in an email Tuesday that she would speak with TH Media on Wednesday to comment for this story. However, efforts to speak with her Wednesday were unsuccessful.
Demmer said he had been contacted by one person who had a family member at Sunnycrest who thought the food portions were smaller.
"Now that (Kirsch) has come in and has a background with many other homes, these are questions I can ask her," Demmer said.
Demmer said there has not yet been formal discussion among the supervisors about the violations. He said they intend to have ongoing meetings with Kirsch about Sunnycrest updates.
AFSCME Iowa Council 61 represents Sunnycrest employees. Council 61 President Danny Homan said in a written statement that the union appreciates that Dubuque County is working with it to address issues raised by the inspection report.
"However, it would have been better if Dubuque County had not rushed into changes to food services in order to give more time for resident feedback and proper training for employees on how to prepare the new menu's meals," Homan said via email. "We continue to believe that resident care must come first and that will remain our priority as we work with Dubuque County to address these issues."