Inappropriate touching led to reasonable Immediate Jeopardy citation, court finds

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A federal appeals court recently upheld Immediate Jeopardy penalties against a North Carolina skilled nursing facility that it agreed did not respond adequately to a resident's inappropriate touching of other residents and staff.

A male resident at privately-owned Libertywood Nursing Center in Thomasville began engaging in inappropriate sexual touching after his arrival in Aug. 2009, according to court documents. However, it took the SNF more than a month to institute one-on-one monitoring of the male resident at 15 minute intervals, and this measure did not prevent incidents from occurring outside the 9 a.m.-8 p.m. monitoring window.

The Centers for Medicare & Medicaid Services determined the response from Libertywood created Immediate Jeopardy for other residents, and fined the SNF more than $270,000. CMS levied additional fines of $100 for each day until the facility's compliance could be confirmed.

Stating that the male resident posed a foreseeable risk that Libertywood did not adequately address, the U.S. Court of Appeals for the Fourth Circuit upheld all the fines in a Feb. 28 unpublished opinion.

Nursing home operators must be well-informed and strategic in how they approach the issue of Immediate Jeopardy, said Joan Redden, vice president of regulatory and consumer affairs at Skilled Healthcare, at the 2012 American Health Care Association annual convention. Redden will provide more insight in an upcoming McKnight's Online Expo webcast. Redden's session will be one of five sessions offered March 20-21 as part of the seventh annual Online Expo. Continuing education credits are available for attending these sessions. Registration is ongoing at