State Inspectors Cite Azria Health for Ignoring Nursing Aides’ Concerns Before Resident’s Death

In November of last year, a resident of Azria Health of Clarinda died after her physical and mental health deteriorated over a 24-hour period. State inspectors have cited the facility for its response to the resident’s decline. Inspectors have also proposed a fine of $11,750.

Two certified nursing assistants observed the resident’s declining vital signs. They told the on-duty nurse about declining oxygen saturation (63 percent). This is well below the saturation level (88 percent) that requires prompt medical care. The aides were also concerned about the resident’s low blood pressure (79/39).

The on-duty nurse responded to these concerns by putting the woman on bottled oxygen. Within 20 minutes, oxygen saturation reached 92 percent. The resident displayed confusion and pain. The aides told the nurse about these concerning vital signs, but the nurse did not seem to take these concerns seriously.

Hours later, the aides measured oxygen levels of 72 percent. The on-duty nurse told the aides to increase oxygen, but this did not improve the resident’s condition.

The assistants told the overnight nurse and she agreed with them that the resident needed to go to the hospital. The resident was transported to the hospital at 10:30 p.m., a total of four hours after the assistants first became concerned about oxygen levels.

One day after being admitted to the hospital, the resident passed away from congestive heart failure.

Nurse, Director of Nursing Denied Knowledge of the Resident’s Condition

The Iowa Department of Inspections and Appeals (DIAL) investigated the events leading up to the resident’s death. They talked to the nurse who downplayed the aides’ concerns, but she said she was not told the resident was in critical condition. Azria Health’s director of nursing said she did not talk to the nursing assistants before the woman’s death and did not know their concerns about oxygen levels.

The resident’s vital signs may have been written on a CNA assignment and vital sheet, which was allegedly provided to the director of nursing. The problem is that inspectors could not find that document, and the director of nursing could not explain why the form was missing.

The investigation resulted in multiple citations, including for:

• Medication violations
• Treatment violations
• Failing to address resident’s changing condition
• Failing to provide proper quality of care

The Iowa DIAL proposed a fine of $11,750, however, the Centers for Medicare and Medicaid Services suspended the fine. CMS may impose a federal fine.

This is not the first example of questionable care at Azria Health of Clarinda. Back in 2022, the state cited the facility for not doing an adequate assessment of a resident who ended up in the emergency room. Doctors at the hospital opened the resident’s airway. They then had the resident airlifted to another hospital. Unfortunately, the resident died during this trip. This situation resulted in a federal fine of $19,646.

Overall, Azria health currently has a three-star rating from CMS. The facility has one star for quality of care and three stars for inspection results.

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