Collaboration in Civic Spheres

State targets care quality problems at Central District facility

by Matt Rosenberg October 21st, 2013

A 120-bed retirement home and assisted living facility in Seattle’s Central District named Cannon House is now dealing with its fifth state enforcement action this year for substandard care of paying residents. Operated since 2009 by the major regional health and social services non-profit Sea Mar, Cannon House was fined $9,200 in September by the Washington Department of Social and Health Services for 92 different patient care violations and earlier this year barred from admitting new residents until it straightens things out. Its administrator was ordered by the state to either retake training classes or hire a management mentor to help improve performance. The state also required Cannon House to hire a registered nurse to develop and implement a plan to better monitor resident health and ensure appropriate medication, care and planning are provided.

Problems with medication, monitoring, care planning
Cannon House officials did not respond to repeated calls for comment Friday, and we’re awaiting a response from Sea Mar to an interview request. Personnel at Cannon House did confirm a mentor has been engaged. The 92 patient care violations were outlined in a September 13 letter which also spelled out the required corrections.

Thirty-two times Cannon House staff failed to give residents scheduled doses of medication, and 49 times patients were not weighed when required, resulting in a 23-pound gain for one with congestive heart failure, according to the state notice. Five times the facility didn’t “identify, update or address” individual health care plans for a resident whose health conditions were undergoing change, and until six days after it was reported by a doctor and resident, a room was left untreated for bed bug infestation.

State DSHS enforcement file shows series of problems this year
Cannon House’s enforcement letter file online at DSHS’s Assisted Living Facility Locator site shows that from mid-April, 2010 (before which such letters are not posted) until early this year, there had been no citations or actions. Then a series of troubles began.

In March, DSHS fined Cannon House $700 for seven state administrative code violations. Four times the facility failed to monitor resident conditions after “significant medical events,” and three times needed medical services were not arranged for with outside providers.

“Stop Placement” order issued
Such problems were still a concern for the state when in July it issued a “stop placement” order barring any new or returning residents from being admitted, saying “the administrator failed to ensure the proper delivery of services and quality of care to meet minimum licensing requirements.”

“Washington State Database Tracks Assisted Living Mishaps”

In August Cannon House was fined another $300 for allowing two residents to return to the facility from the hospital even though the “stop placement” order was still in effect, and for not updating an “assessment and care plan” for a resident.

Then came the September enforcement action with the $9,200 fine for 92 quality of care violations, and the corrective action requirements.

Facility’s initial focus was on African-American elders
Cannon House was founded by community leaders in Seattle’s traditionally African-American Central District in the early 2000s, and originally conceived as a place for black elders in need of some care to comfortably retire, and live in a culturally appropriate setting. However it was purchased by Sea Mar in 2009, a non-profit which runs several dozen health services clinics in Western Washington for a clientele it says is 90 percent low-income and 40 percent Latino.

Critical HUD audit in wake of mortgage default
2009 was also the same year that the U.S. Department of Housing and Urban Development’s Office of the Inspector General released an audit of Cannon House, which opened in January 2002 after construction financed with an $11.5 million loan insured by HUD under the National Housing Act. That loan was tied to a user agreement spelling out required management practices and procedures, which in several cases HUD said were not followed as fiscal troubles dogged Cannon House all the way to loan default.

Management problems under earlier owners
According to the 2009 HUD audit, Cannon House broke its loan guarantee agreement with the feds by leasing copiers for $189,000 without HUD’s okay; by purchasing unneeded fax machinery for $10,700; and by not properly documenting another $317,000 in purchases or debts for legal, marketing and accounting services and other expenses. The audit added these mistakes happened because of broader problems: Cannon House hired Global Health Management to run the facility but that firm erred by “entrusting…operations to an inexperienced…administrator” whose general mismanagement of funds “contributed to the default on its $11.5 million HUD-insured mortgage.”

Much of the missing expenditures documentation was subsequently provided, according to the audit. However the audit further details a series of personnel moves by Global including the hiring of two successive management subcontractors for Cannon House whom HUD said failed to stanch the fiscal bleeding, resulting in missed mortgage payments. One big factor, stated the audit, was low average occupancy rates at Cannon House of 74 percent on average from 2003 to 2007. There were also two “stop placement orders” issued by the state, in 2004 and 2006, temporarily barring the admittance of new or returning residents. In 2008 a new management agency took control at HUD’s request and in September of that year the mortgage was assigned to HUD by the loan servicer.


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