Nearly Half of County’s Nursing Homes Fined : Health: Inspectors credit enforcement changes for increased number of citations. Thirty-eight of county’s 83 facilities paid $222,750 in penalties, the state’s third highest total. Some violations were minor.

A Santa Ana nursing home resident died after she did not receive proper treatment for nine bedsores, lost 35 pounds and became severely dehydrated.

At a nursing home in Anaheim, lack of proper care forced the amputation of a patient’s maggot-infested toe.

Those are among the problems cited at Orange County nursing homes by Department of Health Services officials in statewide inspections, according to an annual report released this week by a nonprofit Sacramento-based advocacy group.

A majority of Orange County nursing homes had no major state code violations last year, said the California Advocates for Nursing Home Reform’s annual report.

But 38 of Orange County’s 83 nursing homes paid $222,750 in fines for state code violations, the third highest total among 56 California counties, according to the advocacy group’s report. (Orange County has the fourth highest number of nursing homes in the state.)

Citations can include minor violations such as sweeping the kitchen during meal service and do not necessarily indicate a problem with the overall quality of care, state officials said.

In the past two years, the number of citations received by Orange County nursing homes has increased dramatically. In 1992, state inspectors issued only two citations, prompting a legislative review of the inspection process. As a result, the Orange County office of the state Department of Health Services increased staffing, improved training and increased monitoring by supervisors.

In 1993, Orange County inspectors wrote 56 citations, and in 1994, the total increased to 94. The upswing reflects the enforcement changes rather than a decline in the quality of care, said Maggie DeBow, a deputy director for the health services department.

“I would characterize [the Orange County citation figures] as being reflective of the care that’s being given there,” she said.

California Advocates for Nursing Home Reform officials agreed enforcement has improved.

“The Orange County office got a lot of heat from legislators involved and our people and the media too put the pressure on them, and I think they’ve . . . felt that,” said David Seubert, a spokesman for the advocacy group that monitors nursing homes and reviews state inspection reports.

Six Orange County facilities were on the group’s list of 50 California nursing homes with the highest total number of violations, including Harbor Health Care in Fullerton, No. 7; and Orange West Care Center in Buena Park, No. 10.

Harbor Health Care was assessed $37,500 in fines, the fourth highest total among the state’s 1,448 nursing homes. The violations included failing to properly monitor residents for bedsores and failing to change soiled bed linens.

In April, new management took over Harbor Health Care, said Bruce Rubin, spokesman for the 300-bed nursing home.

“My response is: That’s old news,” he said of the home’s 1994 record. “You won’t see [problems] under the new management company.”

The Maryland-based company, Integrated Health Services, specializes in running troubled nursing homes, Rubin said. He was unable to specify what changes the management company would make, other than saying officials planned more staff training.

In Buena Park, a spokeswoman for Orange West Care Center--also on the list of top violators--said the tally of citations is misleading.

“It can be for a green bean not cooked properly to a patient with two different colored socks on,” said Carole Cavanaugh, administrator for the 99-bed facility.

Statewide, according to the group’s reports, state inspectors found 32,216 deficiencies at California nursing homes, six times more than the national average in 15 key areas of care.

State officials said the numbers are high because enforcement efforts are better here.

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State Can Provide Data on Facilities

State officials urge people who want to evaluate a nursing home to read state inspection reports. By law, each nursing home must post its state report, which reviews quality of care, staffing and other areas.

In Orange County, the reports are available at the state Department of Health Services’ district office: 2150 Town Centre Place, Room 210, Anaheim 92806; (800) 228-5234.

People with complaints also can contact the district office or the Orange County Council on Aging’s Ombudsman Services: (714) 863-0323.

Nursing Home Problems

Most of Orange County’s 83 nursing homes had no violations last year, but there were some problem spots. One county facility, for example, was among the most heavily fined in the state:

Golden State Manor Convalescent Hospital, Bakersfield: $112,000

Cypress Rehabilitation & Nursing, Santa Cruz: $51,350

Lorel Way Care Center, Yuba City: $40,400

Harbor Health Care, Fullerton: $37,500

Lakeport Skilled Nursing Center, Lakeport: $33,300

County Violators

Six county nursing homes also were among the 50 homes statewide with the most violations, defined as those with the most deficiencies, citations and complaints received:

Harbor Health Care, Fullerton: 163

Orange West Care Center, Buena Park: 151

Windsor Gardens Convalescent Center, Anaheim: 133

Park Superior Healthcare, Newport Beach: 128

Port Bay Convalescent Hospital, Costa Mesa: 117

Anaheim Convalescent Center, Anaheim: 93

Report Card

Here’s how code violations, complaints and fines in Orange County compare to nearby counties:

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County Facilities Code Violations Complaints Fines Los Angeles 436 9,011 1,611 $474,900 Orange 83 2,296 295 222,750 Riverside 51 1,185 276 73,050 San Bernardino 56 1,505 358 328,175 San Diego 103 3,443 684 192,050

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How to Select a Nursing Home

Choosing a nursing home is a difficult enough decision without worrying providers may be substandard. Tips for avoiding bad facilities:

* Ask friends, family or co-workers for recommendations.

* Stop by nursing home unannounced; if you can walk in without being questioned, there are obvious security problems.

* Once inside, take in a deep breath; avoid facilities smelling of urine or cleaning products.

* Watch interactions between orderlies and patients. Are residents treated with respect and care?

* Check shared areas, cafeteria and kitchen for cleanliness.

* Ask to see home’s report card; if administrators won’t comply, leave.

* Ask nurses and orderlies why they work there. Do they have complaints about conditions?

* Ask residents in recreational areas what they like/dislike about facility.

Source: California Advocates for Nursing Home Reform