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"Lawmakers step up pressure on nursing home regulators"

The Press–Enterprise

The Press–Enterprise

The agency that oversees California nursing homes is under intense scrutiny in response to complaints about tardy and inadequate investigations.

The California Healthcare Foundation, an independent organization that researches health care delivery and financing, found that nursing home complaints increased to 12,194 in 2005 from 7,972 in 2000. Yet only 16 percent of the 2005 complaints were validated, compared with 41 percent of those from 2000, according to a foundation report released this month.

Critics of nursing homes say delayed investigations have led to more cases of lost evidence and unreachable witnesses, leaving investigators unable to validate complaints.

Evaluators at the California Department of Health Services are not required to fully explain why complaints are or are not validated.

"The Department of Health Services has one of the most highly trained and dedicated staff in the country and cares deeply about the health and safety of nursing home residents," spokeswoman Lea Brooks said in a statement.

State legislators ordered an audit of the Department of Health Services last year after a critical report from the state Legislative Analyst’s Office, which provides fiscal and policy advice to the Legislature.

The department’s licensing division already must prove it performs timely investigations because of a suit filed by nursing–home reform advocates.

Now, an Assembly Health Committee will hold a hearing Tuesday to consider legislation that would impose a 40–day deadline for completing investigations and making detailed investigation findings available to the public.

Assemblyman Mike Feuer, D–West Hollywood, is sponsoring the bill that would require investigation deadlines and more complete findings.

"This is a matter of basic human dignity," said Feuer, a lawyer who has handled nursing–home complaint cases.

Nancy Armentrout of the California Association of Health Facilities, a nonprofit organization for providers of long–term health care, said her group supports Feuer’s bill.

"The Department of Health Services has not in the past done a very good job in investigating complaints," she said. "Nursing home administrators want someone to come out to investigate complaints before staff turns over or evidence is gone."

Karen Nielsen, of Moreno Valley, said delays affected the outcome of a complaint she filed last June about a Perris nursing home. Last week, she received a letter from the Department of Health Services stating that it could not validate the complaint about her mother’s care at Ember Care Health Center.

"Just because they couldn’t substantiate it doesn’t mean something didn’t happen," Nielsen said.

Kathy Gonzalez, administrator at Ember Care, said the unsubstantiated report proves Nielsen’s mother, Eileen Wigmore, received adequate care.

"Mrs. Wigmore received all the appropriate care we could give," Gonzalez said. "She got everything she needed."

An investigator went to the nursing home on Oct. 13, four months after Nielsen’s complaint and more than two months after her mother had died, according to the letter.

Wigmore, 77, died July 30 at another nursing home as a result of late–stage dementia, her death certificate indicates.

Kathleen Billingsley, deputy director of the Health Services Department’s licensing and certification division, could not be reached for comment despite repeated attempts. The division investigates complaints about nursing homes.

Feuer said agency officials should explain what happened. "I want the process to be as efficient and to be as transparent as possible," he said.

Greater Scrutiny

Next month, the state auditor’s office is scheduled to complete its review of the Department of Health Services’ licensing and certification division. Lawmakers ordered the audit after the Legislative Analyst’s Office found that evaluators had failed to detect deficiencies during nursing home inspections, failed to follow up on problems and didn’t enforce state standards.

The timing of annual inspections often was predictable. So, nursing home operators knew when evaluators would arrive, the report concluded.

Meanwhile, California Advocates for Nursing Home Reform, a nonprofit consumer advocacy group, sued the Department of Health Services’ licensing division to force it to begin investigations as required by state law. San Francisco Superior Court Judge Peter Busch in September ordered the division to start chipping away at nearly 1,300 backlogged complaints and begin investigating 80 percent of new complaints within 10 days as required.

Busch also required the division to file quarterly reports. So far, the division has filed two reports indicating it is meeting court demands.

"The Department of Health Services appears to be complying faster than the court ordered," said Mike Connors of the nursing home reform group. "It doesn’t mean they have completed the complaints. The judge’s order doesn’t address the quality of the investigations or how fast they are to be completed."

Pat McGinnis, the group’s executive director, said delayed investigations led to high numbers of unsubstantiated complaints.

"It’s not because the incidents didn’t happen," she said. "In the time it took for investigations to begin, people would die, evidence was gone, there was staff turnover, or evidence was changed."

People who have filed complaints have a right to visit the nursing homes with investigators but are rarely notified of such visits, she said.

"There’s no real effort to make sure places clean up," McGinnis said. "Nobody second–guesses the evaluators."

Questions Unanswered

Nielsen’s mother had hip replacement surgery April 30. Wigmore’s Medicare provider admitted her to the Perris nursing home May 8 for rehabilitation and help walking, despite Nielsen’s concern over the distance between her Moreno Valley home and the nursing home.

"I didn’t have a choice," said Nielsen, 41. "My mother’s insurance company told me Ember Care was rated number two in the state."

Nielsen said she and her husband visited her mother nearly daily during Wigmore’s three–week stay at Ember Care. However, Nielsen said she didn’t see her mother walk while she was at the nursing home. She also never met the nursing home’s doctor, despite several attempts, she said. Staff members also didn’t inform her of any problems, Nielsen said.

Two days before her scheduled discharge from Ember Care, Wigmore went to Moreno Valley Community Hospital with pneumonia, Nielsen said.

Besides pneumonia, hospital staff discovered that staples used to close Wigmore’s surgery incision had not been removed, according to medical records. They also found broken ribs and bedsores — including a severe one on Wigmore’s heel — and diagnosed her with intestinal disease. They concluded she was malnourished and dehydrated.

Ember Care’s Gonzalez disputed allegations of poor care.

"From what I can tell, Mrs. Wigmore received excellent care," said Gonzalez, who has been at the nursing home about a year. "DHS investigated and found the complaint unsubstantiated. I don’t know what’s going on with Mrs. Wigmore’s daughter. I don’t know why she’s going on about this."

Evaluators thoroughly investigated the complaint and examined all Wigmore’s records, Gonzalez said. They visited the nursing home at least three times, she said.

Nielsen said she filed her complaint because members of the nursing home’s staff couldn’t answer questions about what had happened during her mother’s stay. No one could explain what had happened to her mother’s clothes or understand her concern for her mother’s welfare, she said.

The Department of Health Services sent Nielsen a letter in August that contained a complaint number and listed steps evaluators would take to investigate what happened. The letter also said Nielsen would be allowed to accompany evaluators during the investigation.

Nielsen said she lost hope in February after she repeatedly called the agency and was told the investigation was unfinished. She said evaluators told her they went to Ember Care three times, but she was not notified of those visits, which she wanted to attend. Nielsen said none of the evaluators went to Moreno Valley Community Hospital to inspect her mother’s medical records.

Bonnie Holle, Riverside district administrator for the Department of Health Services, would not comment.

Nielsen has requested a hearing with Holle’s office.

"How many reports are unsubstantiated because the Department of Health Services didn’t do its job?" Nielsen asked. "If I had done that to my mother, I would go to jail."

Nursing home violations

California Department of Health Services investigators have cited these nursing homes in Riverside County since January 2006:

Feb. 3, 2006 — Brighton Gardens of Rancho Mirage. Fined $10,000; case still being negotiated.

Feb. 3, 2006 — Pleasant Care Convalescent Center in Corona. Fined $500; case still being negotiated.

March 30, 2006 — Life Care Center of Corona. Fined $15,000; final payment was $9,750. Case closed April 17, 2006.

May 22, 2006 — Cloverleaf Healthcare Center in Hemet. Fined $20,000; case still being negotiated.

May 31, 2006 — Ember Care Health Care in Perris. Fined $10,000; final payment was $6,500. Case closed June 13, 2006.

June 9, 2006 — Cherry Valley Healthcare in Banning. Fined $6,000; case still being negotiated.

June 14, 2006 — Alta Vista Healthcare in Riverside. Fined $1,000; final payment was $650. Case closed June 28, 2006.

Sept. 25, 2006 — Alta Vista Healthcare in Riverside. Fined $3,000; final payment was $1,950. Case closed Oct. 29, 2006.

Oct. 25, 2006 — Plymouth Tower in Riverside. Fined $1,000; final payment was $650. Case closed Nov. 6, 2006.

Nov. 2, 2006 — Banning Healthcare. Fined $1,000; final payment was $650. Case closed Nov. 8, 2006.

Nov. 17, 2006 — Palm Grove Healthcare in Beaumont. Fined $1,000; final payment was $650. Case closed Nov. 24, 2006.

Jan. 19, 2007 — California Nursing & Rehabilitation Center in Palm Springs. Fined $1,000; final payment was $650. Case closed Jan. 23, 2007.

March 13, 2007 — Manorcare Health Services in Hemet. Fined $75,000; case still being negotiated.