Laguna AIDS Refuge Cited : Health: State investigators write up private Ahimsa nursing home for a dozen violations. The facility was already under fire from critics who allege substandard care.

Ahimsa, a private nursing home heralded 18 months ago as the first in Southern California to open its doors to AIDS patients, has been cited for a number of state health and safety code violations, including cockroaches crawling on walls.

According to state health reports obtained by The Times, Department of Health Services investigators paid two surprise visits to the 47-bed facility in recent months and found a dozen violations.

“Cockroaches were observed crawling on the wall over a resident’s bed,” investigators Joe Ann Carroll and Nadine Ford said in a Feb. 12 survey report. “In the bathroom there was a cup with a toothbrush inside. A cockroach was observed crawling inside the cup.”

Although state officials stressed that the violations are not severe enough to close the home and said they were satisfied the problems were being corrected, the report comes at a critical time for the facility. Ahimsa’s license comes up for renewal later this month and, at the urging of the city, the Chamber of Commerce is giving the nursing home the proceeds from a May 28 fund-raiser.

Ahimsa has also been under fire lately from critics whose allegations of substandard care at the facility have created a bitter rift in this artist community battling the highest incidence of acquired immune deficiency syndrome in Orange County. One of the few nursing homes in California that offers long-term care for people with AIDS, Ahimsa is the only place locally where many can turn when they become incapacitated by the debilitating illness.

Since November, 1988, when Western Ahimsa Care Centers Inc., announced that it would offer “homelike care” for AIDS patients, Ahimsa has enjoyed a close relationship with the city.

City Councilman Robert F. Gentry, a former mayor who is gay, is one of the nursing home’s most ardent supporters. Gentry, whose longtime lover died a year ago from complications resulting from AIDS, had been making plans to admit him to Ahimsa for hospice care when he died. His current partner is a nurse at the facility, he said.

“I have heard nothing but glowing reports about Ahimsa from the patients and relatives of patients who have been there,” Gentry said.

But for months, some former patients and AIDS activists have complained privately about a lack of medical attention and understaffing at the nursing home, particularly at night and on weekends. Critics saw the state report as an affirmation of their fears.

“Just because they’re the only show in town doesn’t mean they can afford not to provide the best possible service,” said Steve Peskind, former director of Laguna Shanti, a largely volunteer support organization in Laguna Beach that offers counseling for AIDS patients.

After receiving two complaints about poor medical care, state investigators inspected the facility in January and February. During one visit, investigators found that a nurse did not change gloves after examining patients in isolation, a precautionary measure to prevent the spread of highly contagious diseases such as staph infections and hepatitis.

A spokeswoman for the Board of Registered Nurses in Sacramento called the violation of infection control policies a “complete failure of standards.”

“That is a very basic thing,” said Catherine Puria, executive officer of the state board that oversees the licensing of RNs. “You wouldn’t examine someone with an infection, then leave your gloves on and go into the next room. Anyone who’s been to any kind of school would know that.”

Ahimsa was also cited for allowing unqualified nurses to administer intravenous medication, a “serious threat” to patient safety, records showed. Under state law, only licensed RNs are permitted to give medication intravenously.

Still, Department of Health Services officials said the violations do not pose a serious enough risk to lift the home’s license. State health records show that Ahimsa’s license comes up for renewal May 31.

“I think you have to consider that we got a complaint, we did a visit and they corrected it,” said Jacqueline Lincer, district administrator for Health Services’ licensing division. “There are no outstanding complaints.”

Sharon Lucas, Ahimsa’s chief administrator, said the nursing home is appealing the citation for having untrained nurses administering IV medication. She said unqualified nurses had signed off on some patient charts but the medication was actually given by RNs.

“Procedurally, we made a mistake, but at no time was anyone’s life in danger,” Lucas said. “I contested it (the citation). That’s under review and we’ll see what happens.”

She said Ahimsa officials are scheduled to meet next week with a state hearing officer to determine whether the citation will stay on Ahimsa’s record.

Responding to the report, Lucas said cockroaches were visible while investigators were there because exterminators had sprayed the day before. Ahimsa, she said, plans to correct all of the violations that investigators found.

“Most of the deficiencies have been corrected,” she said. “We’re not perfect. We’re not saying we’re perfect, but we care and we are trying to set an example for the rest of the county so they won’t be afraid to take AIDS patients.”

Yet some critics charge the example being set is not a good one.

One Laguna Beach physician said he will not refer patients to Ahimsa because of “quality-control problems.” Dr. Leonard Lamont, a former member of the city’s AIDS task force, said Ahimsa once sent a patient to a hospital for radiation treatment wearing only a diaper.

The patient’s lover said he later filed a complaint alleging poor medical care with the state Department of Health Services, which led to an unannounced visit to the facility in late January. John, the 40-year-old patient’s lover and legal guardian, requested that his last name and the identity of the patient not be published because he fears he will lose his job if his employer learns his roommate has AIDS.

In his complaint, John said the patient was not receiving his medication and that he had severe radiation burns on his ears that were not treated. The patient is paralyzed from the waist down and suffers from brain cancer brought on by AIDS, John said. After six weeks in Ahimsa, John ordered him discharged and hired a private nurse to care for him at home.

Ahimsa supporters characterize the complaints as a smear campaign against the nursing home by a few disgruntled clients and Lamont, who they claim wants to start his own hospice. Lamont has denied that charge.

“While (Ahimsa) has some problems that can and should be corrected, I certainly don’t want to see that facility jeopardized because it’s got growing pains,” Gentry said. “It’s too important to the care of people with AIDS.”

“Cockroaches in Laguna Beach to me is not as important as a life-threatening illness,” he added.

For some, such as Delores Spaulding, Ahimsa has lived up to its promise to provide a caring, warm atmosphere for AIDS patients to spend their final days. Her son, Scott Spaulding, 32, died last month after spending four months at the home.

“In all honesty, I tell you, it was the staff of Ahimsa that helped me keep my sanity,” she said. “Some of the nurses were so caring and really took time and did things for those patients that their own families wouldn’t do.”

Karen Jones, chairperson of the city’s Aids Task Force, said the health code violations were not serious “at all.”

“The thing that impressed me most is that none of these things were serious, and secondly, they have implemented a plan of action and the problem is not recurring,” Jones said. “Laguna has bug problems and unfortunately when you have a skilled nursing facility you are not allowed to tent it. The only thing open to them is weekly sprayings.”

Based on the recommendation of the AIDS Task Force, the Chamber of Commerce is donating the proceeds from a fund-raiser later this month to Ahimsa to start a fund for AIDS patients who don’t have private insurance and cannot afford a stay at the home.

All but nine of the 69 AIDS patients who have been cared for at Ahimsa since November, 1988, have been privately insured. The home is not certified to treat patients on Medi-Care and Medi-Cal--government health insurance programs for the indigent.

At present all 11 beds for AIDS patients are filled. The remaining space is occupied by 32 geriatrics and four cancer patients. AIDS patients pay a flat fee of $350 per day, double the rate for geriatrics, for basic care with intravenous medications costing extra.

While the community is sharply divided over whether Ahimsa has fulfilled its promise to provide quality, “homelike” care, both supporters and critics of the nursing home agree on one issue.

“We have no choice but to send AIDS patients there,” said Pearl Jemison-Smith, AIDS coordinator for UCI Medical Center. “It is a sad commentary that other nursing homes won’t take AIDS patients.”

Correspondent Leslie Earnest contributed to this report.

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