Following slew of citations, SWITC, now in compliance, beefs up staff training

NAMPA — The Southwest Idaho Treatment Center has been at risk three times in recent months of losing its license to accept Medicaid.

All of the center’s 18 residents are on Medicaid, according to the Idaho Department of Health and Welfare, which oversees the treatment center. The Nampa facility houses clients who have developmental disabilities and behavioral challenges, with the goal of transitioning them back into the community.

State surveyors periodically visit the center to make sure it’s in compliance with state and Medicaid standards, and they also do surveys after receiving a complaint. Since September 2017, surveys have three times found problems at SWITC that, if not fixed, would prohibit the center from receiving Medicaid reimbursements.

Some of the citations listed in the surveys found that residents were put in immediate jeopardy — a situation that “has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident,” according to the Centers for Medicare and Medicaid Services.

The center corrected those issues and is currently not at risk of losing its Medicaid license, SWITC Administrator Jamie Newton said.

One of the “immediate jeopardy” citations in February prompted Newton to file an appeal. Surveyors documented an altercation between residents identified as Individual 10 and Individual 11. The survey reports that Individual 10 became upset with staff over food portions, and his yelling prompted Individual 11 to come out of his room and yell, calling Individual 10 names.

According to the survey, when Individual 11 became upset, the crisis plan for his threatening behavior was to have staff step between 11 and the other individual. The survey said the plan specifically instructed staff not use any restraints on him.

But according to the survey, two staff linked arms with Individual 11 and walked with him away from Individual 10. This restraint, which was against the individual’s plan, placed him in immediate jeopardy, according to the survey.

After reviewing the video of the incident, Newton said she felt like staff did a “tremendous job.”

“Then to get a citation and call of immediate jeopardy,” she said. “It took us by surprise.”

Newton filed an Independent Dispute Resolution, the center’s first appeal in its seven-year history. (The site previously operated as the Idaho State School and Hospital until becoming the Southwest Idaho Treatment Center in 2011.)

After reviewing Newton’s appeal, a five-member resolution panel on May 17 upheld the survey’s citation. The panel includes two Health and Welfare representatives, two representatives from the intermediate care facility field, and a member from an advocacy organization for people with intellectual disabilities.

The issue was corrected the day of the survey on Feb. 22, Newton said, but she filed the appeal to better understand the grounds for the citation.

“It helps us understand their perspective on what is a restraint and what isn’t,” she said. “We definitely had a different interpretation on that.”

The nearly 130-page complaint survey on Feb. 22 listed other incidents of client-on-client abuse, such as residents hitting and threatening each other, and occasions of staff and client altercations. For example, one resident was heard saying she was going to go into another resident’s room and “bash his head in while he’s sleeping.” Another resident later went into the threatened resident’s room and dumped water on him, calling him a “filthy pig,” according to the survey.

“Most (clients) have serious behavioral histories,” Newton said. “A lot of them have come to us because they’re dangerous to others or themselves.”

Clients assaulted staff members 875 times in fiscal year 2017, Idaho Department of Health and Welfare Director Russ Barron told the Idaho Press in January. Assaults range from hair pulling to more extreme injuries, such as a traumatic brain injury, according to department spokeswoman Niki Forbing-Orr. Residents also caused roughly $43,000 in property damage on the treatment center grounds from 2011 to 2016, she said. In some cases, clients have been arrested.

The citations in the surveys added to a list of problems the mental health center has worked to overcome. The Idaho Press has covered stories ranging from abuse by staff at the SWITC campus, a death of a resident at the center, and residents leaving the facility and causing damage to property and injuries to members of the community.

Boost in training

SWITC has beefed up training for new staff, Newton said. Since February, new hires are trained for over two weeks before working with residents. Before, new staff shadowed another employee in their unit, which led to inconsistencies in the training. The new model of training, held in a classroom, allows more learning and discussion on how to apply it, Newton said.

The center also started holding all-staff meetings so employees in any unit can know what to expect with each resident.

Two members in the center’s quality assurance program have been doing mock surveys and providing guidance on what’s going well and what needs to improve, Newton said.

The changes aren’t necessarily a result of the surveys, but rather a result of seeing what needs to change with staff performance, Newton said.

“Staff at SWITC are committed to providing good resident care and good safety,” she said. “I’m continuously proud of the work and progress they’ve made.”

Newton said the campus is not what the state hospital used to be, which was for people with profound disabilities. Today, most of the residents have gotten in trouble with the law but are not competent to stand trial. They are still aggressive, but have rights just like anyone else while staying at the SWITC campus, Newton said. It’s a balance between keeping staff and residents safe, she said.