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Citadel nursing home in Salisbury, site of state’s worst COVID-19 outbreak, has closed

According to the Centers for Medicare and Medicaid Services (CMS), the nursing home failed to meet Medicare’s basic health and safety requirements.
The Citadel in Salisbury has now closed its doors. Here's what led up to its closure.
Published: Jun. 23, 2022 at 6:10 AM EDT
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SALISBURY, N.C. (WBTV) - The Citadel in Salisbury has now closed its doors.

The facility on Julian Road in Salisbury was the site of the state’s worst outbreak of COVID-19, and recently lost its agreement for Medicare to pay for services.

According to the Centers for Medicare and Medicaid Services (CMS), the nursing home failed to meet Medicare’s basic health and safety requirements.

In a statement to WBTV on June 14, a spokesperson for CMS said:

Access to safe, high-quality health care is a top priority and responsibility for the Centers for Medicare & Medicaid Services (CMS). Federal law requires facilities to meet certain health and safety standards to be certified by CMS as a Medicare and Medicaid provider.

Since August 24, 2020, The Citadel Salisbury has been enrolled in CMS’ Special Focus Facility (SFF) program since surveyors identified instances of substandard quality of care and actual harm to residents. The SFF is a program reserved for nursing homes which have a history of serious compliance and quality issues to stimulate improvements in the facility’s quality of care. The Citadel Salisbury was previously enrolled in the SFF program from June 18, 2014, to February 4, 2015.

The Citadel Salisbury has continued to be out of substantial compliance after multiple on-site health and safety surveys (February 19, 2021; September 2, 2021; and March 4, 2022) documented a failure to comply with several federal requirements.

Despite multiple opportunities to address its non-compliance, The Citadel Salisbury did not demonstrate that it can ensure the health, safety, and well-being of its residents. The facility has had a cyclic pattern of immediate jeopardy, substandard quality of care and actual harm to residents.

CMS issued The Citadel Salisbury an involuntary termination letter on May 4, 2022, indicating that the Medicare and Medicaid provider agreement would end on May 19, 2022, based on a survey of completed on March 4, 2022, that found substandard quality of care and actual harm to residents.

CMS is committed to and prioritizes resident safety and quality of care. Involuntary termination is generally the last resort after all other attempts to remedy noncompliance of deficiencies have been exhausted. CMS will be working with the facility to ensure residents are properly relocated during the 30 days following termination, when payments will continue for residents admitted prior to April 5, 2022.

The facility has the right to appeal CMS’ determination. In addition, The Citadel Salisbury can choose to re-apply for Medicare/Medicaid certification, which will require correcting the ongoing underlying quality issues and demonstrating sustained compliance with the Federal Participation requirements.

While the facility will no longer receive payment for Medicare and Medicaid residents after the 30-day period ends, the facility may continue to serve patients who are private-pay or who are covered by other insurers. However, the State of North Carolina will determine if the provider remains licensed by the state to operate as a dual participating skill nursing facility in the State of North Carolina.

CMS held discussions with both the North Carolina Department of Health and Human Services and local officials about the availability of beds and services for residents impacted by this situation to ensure that the community’s health care needs can be met.

Concerns have been raised about the nursing home’s quality of care for at least the last two years.

[Family members: Conditions have not improved at The Citadel]

Allegations of poor treatment and not providing medication on time were reported by WBTV in 2020.

Officials with the Centers for Disease Control and Prevention visited The Citadel Salisbury months later. The location was one of four across North Carolina where “strike teams” from the CDC came in following large COVID-19 outbreaks.

By Sept. 9, 2020, 168 cases and 21 deaths from the virus had been reported.

The next year, a class-action lawsuit was filed. The suit was filed by Wallace and Graham, P.A. on behalf of two of the nursing home’s residents and family members, citing “severe systematic understaffing at the Citadel nursing home.”

[Class action lawsuit filed against The Citadel in Salisbury, site of NC’s largest COVID-19 outbreak]

Upon hearing the nursing home’s participation in the Medicare program had been terminated, Mona Lisa Wallace and Olivia B. Smith, attorneys at Wallace and Graham, released the following statement:

“Since early 2020, Wallace and Graham has had significant concerns over the quality of patient care at the Citadel Salisbury nursing home. As laid out in public court filings, our concerns over quality of care extend not only to this facility, but also to the other 36 North Carolina facilities under common ownership, affiliated with the Portopiccolo Group and managed by Accordius Health. Our law firm previously filed a lawsuit that sought to enforce the North Carolina nursing home resident bill of rights, including the right to adequate care and patient safety. Since the Citadel Salisbury’s change of ownership in February 2020, residents and families’ concerns over patient care have only escalated. In 2021, our firm filed a class action lawsuit which alleges that the company’s cost-cutting business model has led to chronic understaffing and decreased quality of care. After exhausting all other attempts to remedy the deficiencies at the facility, as a last resort Medicare has ultimately terminated the facility’s provider agreement. Our firm continues to represent residents and families affected by this matter.”

A state inspection in April 2022 was filed days before the termination was announced but didn’t paint the nursing home in a better light.

According to the report, staff would not help a resident after they were propositioned for sex acts by another.

[Disturbing report on The Citadel raises questions about options for families]

The report also noted one employee working 22 hours straight. The reason? Low staffing – an issue previously mentioned in the 2021 lawsuit.

A resident’s wound dressings went weeks before it was changed and medication errors were plentiful, according to the report.

“Just imagine if it was your mother or your father or one of your relatives, in that situation, you want them to get the best care possible, I find it pretty bad,” said Robert Lattimore of Salisbury told WBTV in April.

To learn more about the termination process, click here.

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