The state agency that oversees nursing homes in Iowa has dropped its case against an Iowa nurse accused of running an illegal, unlicensed care facility.
In the fall of 2020, the Iowa Department of Inspections and Appeals sent inspectors into the Sutton Senior Home, located just off Park Avenue in Des Moines. After reviewing the level of care being received by the six elderly people living in the house, DIA concluded the building was functioning illegally as an unlicensed residential care facility or assisted living program.
DIA alleged the owner, Anne M. Porter, a registered nurse from Ankeny, was circumventing state laws requiring licensure and inspection of care facilities by using one corporate entity that she controlled, Sutton Senior Home, to provide housing, as a landlord normally would, while using another company that she owns, A-Plus Home Care Services, to provide health care for residents.
In responding to those allegations, Porter’s attorneys didn’t argue the residents weren’t in need of nursing care. Instead, they argued that by delivering the housing and health care through two “separate and distinct legal entities,” Porter need not have a license.
In November 2020, DIA gave Porter a deadline of Dec. 1, 2020, to submit a plan to relocate tenants of the home. Seven months later, with no action taken by Porter, the state agency took her to court, seeking a judicial order that would force her to stop operating Sutton Senior Home as an unlicensed care facility.
Those proceedings were quickly put on hold when it was determined that DIA had failed to properly exhaust all administrative remedies in the matter, a necessary step before the court could even hear the case.
A hearing before an administrative law judge was held in August, after which there was a series of delays in the matter while the two sides pursued settlement negotiations.
Last week, DIA dropped its court case against Porter, citing a settlement in the administrative case. “DIA no longer finds that Sutton Senior Home is operating an unlicensed residential care facility or assisted living program,” the agency stated in court filings.
City zoning and fire inspections still an issue
The settlement requires Porter to sell A-Plus Home Care Services. Then, through her continued ownership of Sutton, she will be barred from steering residents to A-Plus for nursing care. Although she will be allowed to offer tenants a list of local home-care agencies they can choose from, any such list will have to include companies other than A-Plus, and Porter will be prohibited from expressing a preference for A-Plus.
It’s not clear who will own A-Plus once the sale is completed. The settlement agreement is based on the sale having been completed “on or before Feb. 19” – but as of Feb. 25, records maintained by the Iowa Secretary of State’s Office indicate the business is still owned by Porter and is being run out of a house in Ankeny that’s owned by AMP Properties, a limited liability company with Porter as its agent.
Assuming the sale takes place, it would effectively separate the landlord and the care provider at Sutton Senior Home, but it would not address issues related to oversight, state inspections, or the level of care that’s delivered to residents.
Also, the City of Des Moines still has a civil case against Porter, alleging Sutton Senior Home is a business that’s being run out of a residential neighborhood in violation of zoning laws. The single-family house, which was home to five tenants at one point last year, generated up to $46,800 per month in revenue, according to state records.
There’s also a question of code enforcement. The state fire marshal’s office typically inspects care facilities for potential fire-code violations since those buildings are subject to more stringent requirements than others.
But the state fire marshal’s office has said it won’t inspect Sutton Senior Home absent a court finding that it’s operating as an unlicensed care facility. With DIA declaring that it “no longer finds that Sutton Senior Home is operating an unlicensed residential care facility,” such a ruling seems unlikely.
Last year, the Office of Inspector General at the U.S. Department of Health and Human Services issued a report that said Iowa was doing an inadequate job of enforcing federal fire-safety laws even in the state’s fully licensed and inspected nursing facilities.
The OIG conducted on-site inspections at 20 Iowa nursing homes with a history of serious, past violations and identified significant, new violations related to life safety and emergency preparedness at every one of those homes.
“We found 122 instances of noncompliance with life-safety requirements related to building exits, fire detection and suppression systems, hazardous storage, smoking policies, and electrical equipment maintenance, among others,” the OIG reported.
The OIG concluded that residents of the 20 Iowa nursing homes “were at increased risk of injury or death during a fire or other emergency” and the office blamed Iowa’s Department of Human Services – the agency that provides Medicaid funding for the homes – for not having “a standardized life-safety training program for all staff.”
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