Nursing Home Crackdown Will Expand to Cover State

An experimental crackdown on nursing home abuses involving surprise inspections during off hours has uncovered major problems and will be expanded throughout California, state officials said Friday.

Health Services Director Kenneth W. Kizer said a hospital in Orange County and another in San Jose, in which an 83-year-old woman died of dehydration, may face closure. He said the San Jose case might be referred for possible criminal prosecution.

By selecting nursing homes with histories of problems and inspecting them on weekends and during early-morning or night hours, the state hopes to get a better idea of actual conditions facing the mostly elderly patients.

Kizer said the off-hour inspections during the last three weeks represented “a much more aggressive approach” by the Department of Health Services in clearing up problems in the nursing home industry.

Until now, the department has been inspecting nursing homes only once a year or in response to specific complaints. These visits usually occurred during normal working hours.

To Continue Indefinitely

After conducting surprise visits to 10 facilities in Orange, Riverside, Kern, Fresno, Santa Clara and Fresno counties on a test basis, the department decided to continue the program indefinitely and to expand it.

Under the program, Kizer said, the state licensing officials will continue to schedule off-hour surprise inspections in the worst of the state’s 1,200 nursing homes.

Kizer singled out Northlake Convalescent Hospital in San Jose as having the most serious problems. The facility faces $55,000 in fines, and officials are deciding whether to try to close the facility and possibly to seek criminal prosecution in the death of an elderly woman, he said.

The investigators reported finding some patients left in their own urine and feces and others unattended despite serious medical problems. They also cited the facility for unsanitary conditions, including puddles of urine on the floor. The inspectors charged that the 83-bed nursing home is inadequately staffed.

The most serious charge against Northlake involves the death in April of an 83-year-old woman whose medical records showed that she had all the symptoms of extreme dehydration, including urine that was “cloudy, sticky as syrup.” For several days, the staff did nothing to treat her condition, the investigators said.

Bedsore Complaint

A Northlake spokeswoman, who refused to identify herself, said the facility will have no comment on the state inspection report.

In an early Sunday morning inspection at Bristol Care Center in Santa Ana, state officials reported finding an instance in which serious bedsores were left untreated for days. They reported finding unsanitary conditions including numerous cockroaches. They cited the facility for the failure of its emergency generator to work properly and failure to maintain hot water at a safe temperature.

The nursing home faces fines totaling $30,000. Kizer indicated that the department is considering whether to revoke Bristol Care’s license.

But Robert L. Pruett, executive director for South Coast Care Corp., which operates Bristol Care and five other nursing homes, said the nonprofit company intends to appeal the citations and fines.

The bedsore citation, he said, was not the result of a failure to treat the patient but of a failure to document the treatment in writing. He said the cockroaches appeared when workmen tore off old paneling during an extensive remodeling project at the 145-bed facility.

Contract Canceled

Pruett said that even before the inspection last month, the company had canceled its contract with Health Care Enterprises of San Clemente, the management firm that had been operating Bristol Care.

Under state law, nursing homes can take their appeals to the department and then to the courts before fines are actually collected.

Kizer indicated that three of the 10 facilities inspected as part of a test of the new statewide program had no problems; others faced only relatively small fines.

None of the facilities was in Los Angeles County, where the county Department of Health Services conducts nursing home inspections under a contract with the state.

Ralph Lopez, chief of the county’s health facilities division, said the county has had staff on call at all hours and on weekends for five years to field complaints against nursing homes and to make immediate inspections if necessary.