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This used to be a really good nursing home. I don’t what happened to make this change.

Laconia – The Belknap County Nursing Home has been cited by the state as having conditions that “constitute immediate jeopardy to resident health.”

In a March 3 letter to the administrator of the 94-bed facility, the state cited “widespread deficient practice” in analyzing medication errors, not notifying physicians of errors and failing to assess patients for bed sores or properly documenting the problems.

The letter from the Department of Health and Human Services stated that if immediate steps are not taken to correct the problem, the facility’s agreement in the Medicare/Medicaid Program would be terminated March 10. No more federal funds would be extended and a civil penalty of $3,050 a day would be imposed.

Philip “Bud” Daigneault of Laconia, one of the county commissioners who govern the nearly full facility, said yesterday that a plan to correct the concerns had been submitted and accepted yesterday by the state and that the notice of immediate jeopardy was lifted yesterday afternoon.

“I can assure you we have been dealing with this since day one. We run a very good facility here and at no time were patients in jeopardy of their health or safety,” Daigneault said. He noted the criticism focused primarily on paper work and documentation and that patients were receiving the medical care and treatment needed.

“We just came through a bad review,” he said, noting it had never happened before.

Commissioner of Health and Human Services John Stephen said last night that a verification visit is planned by his department for today and that if sufficient, an “immediate jeopardy” notice would be removed.

“We are working very collaboratively with the county commissioners to make sure seniors receive good quality care. We are pleased that they are responding … very positively,” Stephen said. “We will have a follow-up tomorrow.”

Robert Ehlers, bureau chief for certification in the Health Facilities Administration within the state HHS, who sent the county home the letter, declined to comment on the matter yesterday afternoon.

But in the letter, obtained by the New Hampshire Union Leader, Ehlers told Bernard Gray, administrator of the Belknap County Nursing Home, that a survey team found that the facility “failed to ensure that nine of 11 residents with pressure ulcers in a standard survey sample of 19 received the necessary treatment and services to promote healing, which resulted in immediate jeopardy to residents.”

It noted that the facility “failed to provide ordered treatment” and assess resident skin status, failed to document skin status, failed to provide pressure-relieving devices, failed to provide consistent pressure treatment, and provided treatment without doctors orders.

In a separate but related count the team found medication errors.

It was determined that the nursing home:

* failed to fully investigate medication errors;

* failed to provide education to prevent medication errors;

* failed to report all medication errors to a physician;

* failed to administer medication in a timely manner;

* and failed to utilize the Quality Improvement Committee to analyze the reasons for medication errors.

Ehlers wrote that in order to avoid termination March 10, “you must correct the Immediate Jeopardy and submit to this office a letter of credible allegation of compliance. “

Daigneault said such a letter was sent Tuesday and that it had been approved by HHS yesterday.

Stephen said the department still needs to verify things today.

Daigneault said the Belknap County Commission was meeting with the staff of the nursing home yesterday afternoon to go over ways to ensure that the problems do not occur again.

He said the facility is fully staffed and fully funded through the federal, state and county for the 90 or so who are in residence.

He said the county and the state share equally in the non-Medicaid portion of the operation.

“We went through extensive renovations last year to bring everything up to snuff,” he said of the home which was built in 1998.

Fully staffed, he said the home uses agency nurses which is not inconsistent with other nursing homes in addition to its full time nursing staff.

Daigneault said the county has the option to appeal any finding and has 60 days to request a hearing.

“The commission is meeting now and we are having a meeting with director to discuss this,” he said.