Staffing shortages and health and safety problems have continued to plague the Yukio Okutsu State Veterans Home in Hilo, two years after the state took over the nursing facility and fined the company that was managing it over $510,000 for numerous violations following a COVID-19 outbreak that infected more than 80% of residents, killing 27.

The Centers for Medicare and Medicaid Services cited the 95-bed facility at the end of 2022 for 18 deficiencies for failing to meet federal standards relating to the care and rights of residents, including infection control. In February, CMS fined the nursing home $129,720 for the more serious infractions, according to documents provided by the state Department of Health to the Honolulu Star-Advertiser this week. The fine was reduced by about one-third after the veterans home waived its right to an administrative hearing to contest the findings.

DOH’s annual inspection of the facility found that it wasn’t providing appropriate care to treat and prevent pressure injuries, commonly referred to as bedsores, which can result in dangerous infections. One patient developed a bone infection as a result and required four rounds of antibiotics. The veterans home also failed to provide appropriate pain management to a patient who was found to be in severe pain, making it hard for him to move and diminishing his mood and appetite.

Inspectors also found that Yukio Okutsu State Veterans Home was falling short of requirements to provide a safe, clean and comfortable environment for residents, citing repeated instances of resident urinals, some of them filled, being left on bedside tables where food and drinks were also kept.

Staff and residents reported nursing shortages and high turnover rates. A representative for residents reported that at times it could take 30 minutes or more before staff responded to calls for assistance using the urinal, resulting in incontinence, according to the inspection report. A registered nurse reported caring for 30 residents at a time and said newly hired registered nurses quit because the workload was too heavy.

The facility was also flagged for not developing complete care plans for residents, failing to execute infection prevention protocols in response to a December COVID-19 outbreak and not implementing sufficient safeguards to prevent medication errors, among other problems.

The inspections are carried out annually for all nursing homes receiving Medicare and Medicaid funding and are based on federal care requirements. DOH inspected the facility on behalf of CMS in October and December.

CMS currently rates the facility at below average, giving it 2 out of 5 stars based on the health inspections, staffing and other quality measures. It’s also been flagged by CMS as a “special focus facility candidate,” which means the nursing home has a history of major deficiencies and is at risk of being included in a program that involves greater government oversight and improvement requirements that must be met to retain Medicare and Medicaid certification.

Elena Cabatu, speaking on behalf of the veterans home, said the facility has been working to improve.

“Sometimes there is a bump in the road, and it is just part of the path we are taking here,” she said. “It’s tough to get this kind of report, especially when, to me, they have really started to turn their ship toward a better course since (the state) took over.”

Yukio Okutsu State Veterans Home, which opened in 2007, was previously managed by Utah-based Avalon Health Care under a state contract. The facility came under intense scrutiny for its safety protocols after a devastating COVID-19 outbreak in August 2020. Subsequent inspections found that infection-control procedures were sorely lacking, and the veterans home was fined $510,640.

Amid the uproar over the COVID-19 outbreak and resulting deaths, the state took over management of the veterans home in January 2021. The nursing home is now overseen by the East Hawaii Region of the Hawaii Health Systems Corp., which also includes Hilo Medical Center, Kau Hospital and Hale Hoola Hamakua. HHSC acts as a safety net for neighbor island acute-care and long-term care facilities in the state.

Cabatu said Yukio Okutsu State Veterans Home is still struggling to hire enough staff and that as a result, on average, only about 60 of its 95 beds are filled. She said the facility, in particular, is short of certified nursing assistants, whom it’s working to train and recruit.

Cabatu said a more recent survey of the nursing home, conducted by the Department of Veterans Affairs, was positive.