Friends Home at Guilford

2014 REVIEW: Once again, the Friends Home at Guilford is a 5-star facility with fantastic staffing levels. As you can see in the below chart their CNA staffing is almost twice the state average. CNAs provide the bulk over nursing home skilled care.

Guilford Staffing Overview

Having strong staffing levels greatly increases the likelihood of good care and this level of CNAs is one of the highest in the Piedmont area. In addition to high staffing levels, in the last inspection at Friends Home Guilford, the state found no health deficiencies at all. The average nursing home in North Carolina gets four deficiencies, but Friends had none.

The Quality Measures were also very good. There were only two areas: falls and pressure sores that seemed a little high. Overall, however, the Friends Home at Guilford is doing a good job.

2013 REVIEW: Friends Home at Guilford is a smaller nursing home with only 50 beds, which is about half the size of the typical nursing home. Historically, (based on my memory only without fully researching it) the Friends Home has been a highly ranked, good nursing home. I have met one of the DONs in the past, and she was knowledgeable and motivated to provide good care. I think that it is an outstanding home, so hold judgment until you read this entire article. We will need to start at the beginning: the Friends Home is now a 2-star facility which is "below average". If you want to compare this home to other Greensboro nursing home, look at my Ranking and Review of local homes. Back to Friends Home, let's look at the staffing levels.

2013 Review of Guilford

Staffing- In a nutshell, these staffing levels are outstanding. The CNA staffing level, in particular, is one of the highest in the Greensboro area. Of course, these CNA levels are near twice the state average. CNAs deliver the bulk of the hands-on care for nursing home residents. They feed, dress, bathe, get residents out of bed, etc. With these high staffing levels, they should be extremely attentive and well cared for. In bad homes, low CNA care is usually the core problem as residents become dehydrated, stay wet, aren't getting out of bed. This Friends Home at Guilford facility should not have any of these problems. I can't say enough about this. One of my goals in writing on local nursing homes is not to just provide information to people but to also put pressure on nursing homes to provide good care. On the other hand, we should all applaud homes like Friends Home when they do it right. Not only should we applaud these good homes, but we should also encourage people to go there.

Health Inspections- While the staffing is fantastic, the Friends Home got only two stars for inspections and one star for their Health Inspection. One star is the lowest score you can get and is "much below average". Again, it seems that the Friends Home just can't catch a break. They received this very low score based upon one inspection in 2013. You can see a detailed breakdown here, but it was essentially a failure to monitor weight loss and care plan properly. This appears to be a failure with the dietary management department. While this was deficient care for this resident, it was just one resident. Don't get me wrong, nursing homes must follow the standard rules. One rule is that if there is severe weight loss something must be done about it. On the other hand, this is only one resident. I am surprised that the facility got one star for this. This one star is what is dragging down this entire facility score.

Quality Measures- Friends Home received four stars "much above average" for Quality Measures. Quality Measures looks at the residents and how they are doing in the nursing home. Most of these indicators are very good. If we look at the weight loss issue, you will see that for long term residents 7.4% lost a lot of weight while the average in North Carolina is 9.2 %. This is important as it shows that the above inspection result was more of an isolated problem. You can't just rely on the inspections alone, you have to look at the bigger picture.

Summary- Friends Home at Guilford is a good nursing home with outstanding staffing levels. You should receive good care at that home.

Old 2012 Staffing Levels

Old Staffing Levels

(The far right is the US average, the middle is the NC average and the left is the Friends Home)

Staffing- Whenever I am researching a nursing home, the first thing I look at is the staffing level. The Friends Home is a 5 star facility for staffing, which is the highest possible rating. If you look at the actual staffing numbers, you will see why. The RN hours are over one hour per resident day. The average in NC is 45 minutes. So, the actual RN hours substantially exceeds the norm.

The CNA staffing is what is truly remarkable. The Friends Home has an incredible 4 hours and 6 minutes of CNA hours. The average in NC is 2 hours and 27 minutes. Therefore, the CNA staffing at this facility is almost twice as high as the average home in NC. This facility has the highest staffing levels of any facility that I have researched in the Guilford County area. No wonder Friends Home has such a great reputation.

Quality Measures- The Friends Home got four stars which is "above average." Short term resident pain control was great, all got the pneumonia vaccine and none were on antipsychotic medications. For long term residents, pain control was great, UTIs and pressure sore incidence was very low, and incontinence levels are very low.

Inspections- When I looked at the inspections, I could then see what had probably caused the lower rankings for Quality Measures. There was a very serious instance of physical abuse by one of the staff attacking a resident. This is a summary from the DHHS state investigation:

February 24, 2012 Based on record review and staff interview the facility failed to protect 1 of 1 resident (Res. #1) from physical abuse and failed to intervene or call for assistance while witnessing 1 of 1 resident being abused. Findings include:

Immediate Jeopardy began on 02/04/12 when NA #2 hit/punched Resident #1 two - three times in the stomach and NA#1 did not intervene or call for assistance. The Administrator was notified of the Immediate Jeopardy on 02/23/12 at 5:00 PM. The Immediate Jeopardy was removed on 02/24/12 at 9:20 PM. The facility remained out of compliance at a Scope and Severity level " D " (an isolated deficiency that constitutes no actual harm with potential for more than minimal harm that is not Immediate Jeopardy) to ensure that the policies and procedures implemented by the facility could be reviewed and evaluated by the Quality Assurance Committee. The facility was also in the process of ensuring the completion of the employee training. The facility was in the process of ensuring the completion of the investigation.

Nothing makes people more rightfully angry than actual abuse by nursing home staff. The staff should be fired, and in-service should be performed on remaining staff. The facility should be investigated to determine if they are properly performing background checks on employees. The facility should be held accountable, but… no one can completely control the actions of others. Occasionally, employees may just lose their minds and do something unanticipated. While the nursing home should be held accountable, we should all remember that some things just can't be prevented. Nursing homes need to do their part only: provide adequate staff, do background checks, train these staff, supervise this staff and discipline staff with problems. If this facility did that, then it doesn't deserve 2 stars for the unforeseen actions of an employee.

If you notice, the first problem was that one employee struck a resident, the second problem was the other employee not reporting it. One employee was kneed by the resident and then struck the resident three times in the stomach. This is completely inexcusable, and the employee should be fired. However, having two employees participate starts to call into question levels of supervision, training and background checks. The witness CNA did say that she was waiting to talk to a supervisor, but this doesn't seem credible. Staff members have the phone numbers of staff nurses, DONs and the administrator. They all know that they can call them at any time.

Once the administrator learned of the assault, they immediately interviewed the staff and called the police department. The CNAs were fired, and the remaining staff members were trained in this event. Ultimately, this was probably a heart-breaking incident for many people involved. I have never heard of something like this happening at Friends Home before, it is a good nursing home. No nursing home has a supervisor watching CNAs at all times. Also, the resident was very combative, and the CNA stated that he/she had never done something like this before. This shouldn't warrant a 2-star rating as this is a 4-star facility at the very least. Given their staffing levels, it is an outstanding place. On the other hand, I do understand the position of DHHS. They certainly don't want to seem "soft" on a true abuse case. This is probably why the facility got 2 stars. I imagine that this is just a blip on the radar for this facility, and it will be back to a highly ranked facility next year. In the meantime, with those high staffing levels and the offending staff fired from the facility, the Friends Home should be a great facility.

While I am a nursing home abuse attorney and very active in the elder community, my goal with this blog is to provide information. If anyone from the Friends Home provides me some information regarding this facility, I will post it if relevant and informative. If any family members of people in the nursing home want to contact me, I would love to have feedback positive or negative regarding the home.

UPDATE- I started to try and summarize and rank all of the nursing homes in the Guilford County and Greensboro areas. If you would like to see a ranking of best to worst of all homes, click on Guilford County Greensboro Area Nursing Homes.