An Iowa nursing home, where a resident choked to death, has been cited by the state for insufficient staff and employing a noncertified nurse aide. The Iowa Department of Inspections, Appeals, and Licensing (DIAL) proposed, but held in suspension, an $8,250 state fine against the nursing home. With the state penalty in suspension, the Centers for Medicare & Medicaid Services (CMS) is expected to decide whether a federal fine is warranted.
DIAL found that the nursing home failed to provide proper supervision of residents, particularly in ensuring timely intervention during a choking incident on December 4, 2024. The facility allegedly did not ensure that appropriately trained staff were present to assist residents at risk of choking.
According to state inspectors, a male resident was eating supper in the assisted-dining area when a noncertified nurse aide noticed he was choking on a tenderloin sandwich. The aide, who was responsible for assisting the resident, was the only staff member in the area along with two other residents. The aide, unable to perform the Heimlich maneuver because she could not fit her arms around the resident, was unable to help effectively. Additionally, her walkie-talkie failed to work, prompting her to shout for help.
A dietary aide responded but left the room to find additional help. Meanwhile, the noncertified aide attempted to clear the resident’s airway by pounding on his back. After three minutes, during which the resident’s lips turned blue and his teeth clenched, a nurse arrived and was able to remove a piece of bread from the resident’s airway. An ambulance arrived shortly after, transporting the resident to a hospital where he was diagnosed with aspiration pneumonia. Despite efforts to save him, the resident died within hours from cardiac arrest due to acute respiratory failure caused by choking.
State inspectors later interviewed the noncertified aide, who admitted she was not certified but had been allowed to work under the administrator’s decision. She stated that she had never been trained in CPR or the Heimlich maneuver, despite claiming to know how to perform them. Employment records showed that she had worked in a restaurant serving food and briefly at another care facility before being hired by the nursing home.
Under Iowa law, noncertified nurse aides can work in a facility for up to four months without certification, provided they are training or undergoing evaluation. However, the noncertified aide in this incident did not meet the requirements for training or competency evaluation.
In response to the findings, the nursing home’s vice president of operations instructed the administrator and director of nursing to ensure only licensed or certified staff assist residents during meals. The administrator also educated staff on the importance of ensuring walkie-talkies are functional for communication.
Compliance Perspective
Issue
F805 and F808 require facilities to ensure that residents receive meals prepared according to their individual needs and care plans, as prescribed by their physicians or dietitians. F838 mandates that facilities maintain sufficient staff with the necessary competencies to meet resident safety and care requirements.
Discussion Points
- Review and update policies and procedures related to food and nutrition services, individualized restricted diets, care plans, and emergency responses to choking incidents. Ensure these policies reflect current standards of care and regulatory requirements, and that staff are clear on expectations for following them.
- Provide training on the various meal consistencies, feeding techniques, and the importance of following physician orders and care plans. Train staff on the proper response to choking incidents, including the Heimlich maneuver, and emphasize the importance of appropriate supervision and timely intervention during meals. Ensure all staff are properly licensed or certified as required by state regulations.
- Conduct periodic audits to compare physicians’ orders with the actual meals served, ensuring that diet sheets are followed and meal consistencies align with individual care plans. Audit staff during mealtimes to verify that appropriate supervision is provided to residents who need assistance, and that assistive devices are used when necessary. Regularly assess staffing levels to ensure they meet resident needs, and that staff are equipped to respond to emergencies, ensuring safe, quality care.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*
