Costly Violations Found at Nursing Home : Medicare, Medi-Cal Funding Cut at Alvarado; Center Appeals Ruling

Federal and state regulators have withdrawn the rights of a San Diego nursing home to receive Medicare and Medi-Cal reimbursement after finding numerous violations of federal health standards and “imminent danger” to patients.

The decertification announced earlier this month could mean that about 150 patients, with an average age of 85, will have to be moved out of the Alvarado Convalescent and Rehabilitation Hospital to other nursing homes qualified to receive public funding.

However, Alvarado administrator William Stover said late Friday that his company has appealed the regulators’ action. He said he expects a decision late Monday on whether the home might be re-surveyed and perhaps be able to reapply for certification.

“Our families and physicians don’t agree with the results of the survey,” said Stover, who has run the 301-bed Alvarado Road facility since 1972. “We feel that we do a good job. That’s why it’s such a surprise.”

The decision by the federal Health Care Financing Administration to decertify the 17-year-old nursing home came after two surveys in which inspectors from the California Department of Health Services reported finding widespread violations of federal standards.

180-Page Report

During the first survey, a regularly scheduled inspection completed March 13, regulators reported numerous instances of inadequate nutrition, medication errors, insufficient staffing, poor record-keeping, and failure by the nursing staff to follow doctors’ orders and to take steps to prevent patients from injuring themselves.

Their findings filled a 180-page report.

“It was determined that there was some imminent danger to the patients in that facility and a fast-track termination procedure was implemented,” said Ernest Trujillo, district administrator for the state’s licensing and certification office. Trujillo said Friday that the nursing home was warned that its certification was in jeopardy and was surveyed again.

The second inspection, completed April 10, once again turned up instances of failure to follow doctors’ orders, insufficient staffing, poor record-keeping, poor patient hygiene, lack of attentiveness to the needs of patients, and inadequate nutrition.

For example, one patient lost 34 pounds in less than 30 days, according to reports on file with the state. Another patient gained nine pounds in two weeks then lost nine pounds the next two weeks.

Other findings during the two surveys included instances of bed sores, scabies, soiled linen, lack of privacy and patients repeatedly falling with injuries.

May 5 Deadline

State officials said Friday that the nursing home has until May 5 to transfer all Medicare and Medi-Cal patients to certified facilities. Officials said 137 such patients are living at Alvarado and about 13 have already left.

Maria Leslie, administrator of the Medi-Cal field office in San Diego, said there are about 50 nursing homes in San Diego County that accept Medi-Cal patients. However, Trujillo said, it appears that finding available beds “seems to be a problem.”

Late Friday, Stover said representatives of Hillhaven West Inc., the corporation that owns Alvarado, had been meeting with federal officials in San Francisco in an attempt to work out a compromise. He expressed optimism that by late Monday they might reach an agreement for the facility to be resurveyed and eventually recertified.

“We don’t agree with all the findings,” Stover said. “I realize that you can make improvements anywhere. A lot of it, in my opinion, reflects back to the medical records. If you don’t document it, (it’s as if) you didn’t do it.”

Hillhaven, which Stover said operates about 300 nursing homes nationwide, is a subsidiary of National Medical Enterprises, one of the largest for-profit health care chains in the country.