(Dunlap, Iowa; Iowa Capital Dispatch) – An Iowa care facility considered among the worst in the nation has been cited for failing to adequately respond to fatal injuries sustained by a resident of the home. The Iowa Capital Dispatch reports State inspectors allege the staff at Dunlap Specialty Care, run by one of Iowa’s largest nursing home chains, failed to inform a female resident’s hospice provider of a serious head injury sustained by a resident. The injury was allegedly caused by a fall about 8:30 a.m., Oct. 8, 2023, when the woman attempted to walk to the bathroom without the staff’s assistance.

According to inspectors, a worker found the woman found lying on the floor in a large amount of blood that appeared to be the result of a head wound. It wasn’t until 10:07 a.m. that the woman’s hospice nurse was notified. The nurse and the woman’s son arrived at the facility at 11:38 a.m., a full three hours after the fall, and saw lacerations on the woman’s arm and bruising on her head, with a softball-sized hematoma surrounding her left eye, which was swollen shut. The woman’s son allegedly complained to the staff that his mother should have been taken to the hospital immediately after the fall.

At about 5 p.m. that day, a physician provided an order for the woman to be evaluated at the hospital. It was there that the woman was diagnosed with subarachnoid hemorrhaging throughout the brain. The woman died about 24 hours later, with the hemorrhaging listed as the immediate cause of death. The woman’s son later told inspectors that when he first arrived at the home, his mother’s injuries were “bad,” and he showed the inspectors a photo of her eye swollen shut with a softball-sized lump on her head and dried blood on the left side of her face.

A worker at the home told inspectors she saw the woman shortly after the fall, sitting in her wheelchair and bleeding from her head wound. “It looked absolutely horrible,” the worker told inspectors. The staff had placed ice packs on the woman’s face to keep her comfortable, but her knee and head were bleeding and “she had a huge knot on her head,” the worker said. One of the home’s registered nurses, who was off duty at the time of the fall, allegedly told inspectors the woman should have gone to the emergency room sooner, and that she would have seen to it had she been working that day.

The state has proposed an $11,500 fine against Dunlap Specialty Care, which is being held in suspension while the federal Centers for Medicare and Medicaid Services (CMS) determines whether a federal penalty should be imposed. In June of this year, CMS imposed a $45,075 against the home due to allegations of resident abuse and failure to keep residents safe.

In 2022, CMS fined Dunlap Specialty Care a total of $200,489. The home currently has a one-star rating from CMS – the agency’s lowest possible rating – for overall quality and staffing. At one point during the COVID-19 pandemic, 46 of the home’s 48 residents tested positive for the virus. According to CMS data, at one point the home had more resident deaths due to COVID-19 than any other nursing home in Iowa.

In late 2020, the home was cited for failing to adequately prevent the spread of infection by having COVID-positive employees working in the facility and for telling one resident’s family that if they wanted their loved one hospitalized, they’d have to pick him up and take him there themselves.

For the past six months, Dunlap Specialty Care has been on CMS’ national list of homes eligible for special-focus status due to the number and severity of violations. Homes that are designated special-focus facilities receive additional oversight and guidance from the state to help them improve care. However, homes such as the one in Dunlap, which are deemed eligible for that status without actually being named a special-focus facility, do not receive that additional level of scrutiny and assistance.

Dunlap Specialty Care is owned and managed by one of Iowa’s largest nursing home chains, the tax-exempt nonprofit Care Initiatives, based in West Des Moines. No one at Care Initiatives could be reached for comment Wednesday.