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The Summerville at Potomac nursing facility in Potomac has been barred from accepting new patients and fined $10,000 after state and county surveyors discovered numerous violations of state regulations that govern patient care at nursing homes.

The facility must complete a six-point "directed plan of correction," issued by the state Department of Health and Mental Hygiene and the county, after a routine survey of the facilities Nov. 4-12 revealed among other violations that staff there improperly cared for pressure ulcers, mismanaged patients' medication, didn't properly intervene with patients who were prone to falls and failed to report excessive patient weight gain and loss.

The facility houses 108 residents, with 16 housed in a memory care unit.

"These are very serious violations. We do not see them routinely," said Wendy Kronmiller, director of the Department of Health and Mental Hygiene's Office of Health Care Quality. "We do not direct a plan of correction routinely."

Many of the problems could be attributed to a lack of coordination of care, according to Kronmiller. The survey found that the facility lacked a delegating nurse, an RN who routinely monitors patient care and acts as a "traffic controller," issuing directives to the staff regarding the health care of each patient.

"In a place like this, typically many of the caregivers are not skilled people — they are following instructions," Kronmiller said. "There's no doctor onsite, so all the health care really hinges on the delegating nurse."

Minimum state regulations require that a delegating nurse visit the site every 45 days. The November survey found that a delegating nurse had not been to the facility since August.

In a 54-page "statement of deficiencies" issued from DHMH to Reuben Rosenfeld, Summerville executive director, surveyors graphically detailed the condition in which they found certain patients at the facility. One woman in the memory care unit sustained an infected pressure ulcer with heavy greenish-yellow discharge that was emitting a foul odor, according to the report. The woman was one of six patients who did not receive proper care for pressure ulcers, the report stated.

"[Pressure ulcers] happen when there an extensive amount of pressure put on the skin and it dies," said Bill Vaughan, a registered nurse with the Office of Health Care Quality. The ulcers can often happen in people who are sitting or lying down for long periods of time.

However, Vaughan said that they are relatively easy to prevent and treat by turning the patient, monitoring nutrition, and other methods.

"Pressure ulcers are not what you should find in a health care facility," Kronmiller said.

In one situation detailed by the report, staff failed to report to a physician a resident who gained 49 pounds in four months. In other cases, there was no fall prevention plan put in place for patients who had fallen up to 10 times, the report found. In one situation, a patient did not receive proper pain medication during a wound treatment, the report found.

Kronmiller also expressed dismay at what she said were quality of life issues that seemed to exist at the facility. The report found that patients who were fed pureed diets were given food in which all items were mixed together, rather than blended separately. "It's not just about health care needs," Vaughan said.

Along with the admission ban, the six-point "directed plan of correction" indicates that Summerville must appoint a full-time registered nurse; examine the skin of each patient and report the findings; enlist a wound care specialist to address ulcer concerns; operate under a monitor that will report to officials; and notify residents and their families about the survey.

According to a statement released by Rosenfeld, the plan is already "well underway" at the facility. "Summerville at Potomac is in full cooperation with the state regulators and is working to correct all the deficiencies identified in the survey. We have submitted a formal plan of correction to the Department of Health and Mental Hygiene," the statement read.

The statement also indicated that the facility has "hired a registered nurse to conduct a health assessment of each resident to develop an updated personalized plan of care to ensure that the needs of each resident are being appropriately met."

Resident safety and security is a top priority, Rosenfeld wrote.

Kronmiller pledged that her office would keep close tabs on the facility through the appointed monitor. "You can imagine how it feels to know something like this is out there and under our watch," she said.