Many Nursing Homes Faulty, GAO Reports

Many California nursing homes are frequent violators of federal rules on patient care, with problems ranging from nurse shortages to broken plumbing and bad food, the General Accounting Office said Wednesday.

Eight California facilities, including three in Los Angeles County, were singled out for having repeated deficiencies.

A nationwide survey of nursing home inspection records shows that California, Arkansas, Connecticut and Kansas have particularly poor records of compliance with quality rules, the GAO said. The news is “grim,” said Sen. John Heinz (R-Pa.), who asked for the nationwide study of nursing home inspection records compiled by the states.

California officials, however, maintained that the state does an effective and aggressive job of enforcing regulations.

“I have not seen the GAO report, but I think we do an outstanding job,” said Jack Toney, deputy director of licensing and certification for the state Department of Health Services. “We’ll take a look at the GAO report and assess whether we see any problems.”

Toney said that about 60% of the state’s 1,200 long-term care facilities did not receive any citations for violating rules.

Medicare Pays Bills

The federal government certifies these facilities to care for patients whose bills are paid by Medicare, the federal health program for those over 65 and the disabled, and by Medi-Cal, the health program for the poor.

“Many skilled nursing facilities do provide quality care,” Heinz said. “But, with the health and safety of America’s oldest and frailest citizens at stake, even one rotten apple is too many.”

The GAO study covered 126 of the 442 federal rules for nursing homes, which involve such diverse issues as handrails in corridors and the sanitary storage of linen, and looked at nursing home compliance over a four-year period ending in 1985.

About 41% of the nation’s 8,298 skilled nursing facilities were repeatedly deficient in meeting the rules “most likely to affect resident health or safety,” the GAO said.

The GAO made a detailed study of the records of 26 nursing homes in five states with repeated deficiencies, including most commonly “inadequate nursing services, poorly maintained and dirty interior surfaces such as walls and floors, malfunctioning or broken plumbing, uncontrolled odors, improper use of physical restraints and improper diets.”

The list included eight California facilities: Apple Arbor Inn Health Center in Castro Valley, Angelus Convalescent Center East in Inglewood, Canterbury Villa of Hanford, Good Hope Convalescent in Los Angeles, Park Central Convalescent in Fremont, Superior Care Center in San Pablo, Valley Convalescent in Bakersfield and Western Convalescent in Los Angeles.

In one example in the GAO report, an unidentified California nursing home was cited three separate times in 1985 for “failing to give care to five patients to prevent formation and progression of bedsores.” The nursing home also failed to provide care for patients “to maintain clean, dry skin free from feces and urine,” the report said.

‘Kept in Compliance’

“I’m very surprised by this,” Alice Gibson, administrator at Apple Harbor, said of the GAO report. “We had a survey in 1985, and the housekeeping department was not up to par. We have kept in compliance since then very well.”

At Angelus Convalescent Center, Administrator Jerry Eisinger said: “I can’t understand what this is all about. We don’t have any citations from the state. You can send somebody over and look for yourself.” She said there had been problems in 1985 with training for nurses’ aides and with linen services but that the facility’s director had since been replaced.

Ronald O’Haver, owner of Valley Convalescent, said that “all of a sudden I’m getting a black eye that’s not deserved.” He has been running the facility since 1986, when the state asked him to take it over because it faced possible closure for violations.

“This place had a bad reputation in the past. I know all we have done to fix it up,” O’Haver said. “The state says we’re doing a fine job. Now, it’s extremely upsetting to be put on this list I never heard of before.”

Mark Mostow, a spokesman for Care Enterprises of Laguna Hills, which owns Park Central Convalescent, declined to comment Wednesday “without reviewing the report first.” The administrator of Canterbury Villa of Hanford also declined to comment. Administrators at Good Hope Convalescent, Superior Care Center and Western Convalescent could not be reached.

Sponsoring Legislation

Heinz and Sen. George J. Mitchell (D-Me.) are sponsoring legislation to provide fines and other penalties as punishment for nursing home violations. Under current federal rules, Heinz said, the only penalty is the most drastic one: closing a facility by removing its Medicare and Medicaid (called Medi-Cal in California) eligibility. Because nursing home beds are scarce, Heinz said, inspectors are reluctant to take this ultimate action.

Intermediate penalties, such as fines, would be effective methods to improve the quality of care throughout the nation, he said.

California already has a system of intermediate penalties, including fines. The state collected $5 million in fines last year, inspection director Toney said.

California nursing homes “do a good job and provide good care,” said Kevin Eckery, spokesman for the California Assn. of Health Facilities, a trade organization.

Times Medical Writer Robert Steinbrook in Los Angeles contributed to this article.