The North Dakota Health Department had selected Trinity Homes for extra focus as part of a program in which the state identifies a nursing home that is most in need of correction based on the past three years of inspections. As a Special Focus Facility, Trinity was subject to two inspections a year rather than one. With Trinity Homes no longer under the designation, the state’s new Special Focus Facility is Western Horizons in Hettinger.

Trinity Homes remains in the bottom five in the points-system ranking of nursing homes in the state, as does Minot Health & Rehab, according to Bruce Pritschert, director of the health facilities division in the health department. Minot Health & Rehab was the state’s Special Focus Facility in 2016-17.

Pritschet said most nursing homes are close enough in points that it doesn’t take a major movement to drop different facilities into the bottom five. Half of the state’s facilities are within 10 to 15 points of each other, he estimated.

Medicare also publishes star ratings that give the public a snapshot of how nursing homes compare in quality. Pritschet said a number of North Dakota nursing homes are rated five stars. According to the Nursing Home Compare website, in the Minot region, facilities in Harvey, Garrison and Stanley are five stars. Minot Health and Rehab is one star, and Trinity Homes currently is unrated because it is just coming off the Special Focus Facility list.

Jill Schramm/MDN Trinity Homes in northeast Minot is certified for 230 beds.

Low rankings indicate issues, which nursing homes generally strive to correct because failure to do so can cost a facility its Medicaid and Medicare payments. Staffing shortages can create challenges for facilities trying to meet inspection standards, and that may be contributing to the struggles of the Minot facilities, Pritschet said.

One local resident with a family member at Minot Health & Rehab said her family has had a number of concerns with the facility, from call button waits of an hour or more to unnecessary medication because of failure to update care plans. She said her family member has stayed up until midnight at times, waiting for staff to respond to assist him into bed.

“We let them know all the concerns. Nothing changes,” she said.

She noted Minot Health & Rehab has some excellent staff and has fired employees who weren’t good. Even so, her family has concerns about food safety protocols, difficulty communicating with staff who possess limited English, improper medical administration of oxygen, unreported falls, bruising of residents by staff and moving call buttons away from residents believed to use them too frequently.

It’s not been possible to find an alternate facility near Minot to relocate their family member, she said.

The August 2018 survey of Minot Health & Rehab included deficiencies related to improper use of insulin pens, an excessive opioid instance due to duplicate prescriptions, failure to serve food at palatable temperatures, improper hand hygiene and inadequate training for three CNAs. However, none of the deficiencies rated the more serious marks.

Most deficiencies cited in recent years for Trinity Homes and Minot Health & Rehab ranked as moderate, indicating isolated instances with minimal harm, though potential for greater harm exists.

“North Shore Healthcare and its affiliated centers take pride in the care we provide our residents,” Minot Health & Rehab spokeswoman Kristi Mueller said in a statement. “One of our core values is continuous improvement, and our recent achievements in receiving quality awards has shown that the systems we’ve put in place, the teams we’ve established, and our dedication to improve has benefited centers across our organization, including at Minot Health & Rehab. As always we focus on ensuring the quality of care and services we deliver to our residents.”

Randy Schwan, a Trinity vice president, said in a prepared statement that previous news reports regarding prior citations at Trinity Homes have been incomplete and left out key details. For instance, a serious citation involving cleaning chemicals on an unattended cart was reduced by the health department after manufacturer’s information verified the dilution of the chemical on the cart posed no threat to any resident.

A 2017 incident involving a resident in a wheelchair who went outside to smoke during the winter was disputed by Trinity Homes and the health department consequently reduced the severity score significantly. The survey had reported the individual went out in below zero weather, became stuck in the snow and was assisted by a maintenance worker. Trinity states the resident was independently mobile and within her rights as a resident to go outside, which she did with staff assistance. A staff member in the area helped her back into the facility within 10 minutes.

“The surveyor observed the resident go outside but did not intervene, stating that if the situation was critical she would have intervened. The surveyor observed as the staff member assisted the resident outside,” Schwan said in the statement. “We disagreed then and we still do now that the resident was in ‘potential danger.'”

The health department confirmed the violations were downgraded, which led to a reduction in the 2017 fine assessed to Trinity from about $38,000 to $24,703.

“Regarding staffing, it’s worth noting that in the Spring of 2017 – the approximate time period of the state survey – the Centers for Medicare and Medicaid Services accorded high marks to Trinity Homes in each of these categories: Quality Measures-4 stars, Staffing-5 stars; RN Staffing-5 stars. In other words, anecdotal statements about staffing were not borne out by the evidence,” Schwan said in a statement. Resident comments about staff shortages were recorded on an inspection survey and cited in news reports.

“Finally, during the SFF designation period stemming from Winter 2017, Trinity Homes has been surveyed at a rate double the norm and has not received a serious deficiency,” Schwan said.

Pritschet said the goal of surveys is to encourage facilities to do their best.

“It’s meant to be a motivation – to motivate these facilities to pay attention to make sure they are doing things correctly,” he said. “North Dakota facilities, by and large, are very good nursing homes. If you compare the numbers to other states, our lowest five would probably be in the upper third of other states’ facilities.”