"Critical on conditions: Nursing home ratings reveal
quality control at several local facilities"
First of three parts
PART 2: Two nursing homes cited more than others (Jan. 18)
PART 3: Satisfied staff called key to good care (Jan. 19)
Chico Enterprise Record
By LARRY MITCHELL-Staff Writer
Posted: 01/17/2009 12:00:00 AM PST
PARADISE — The nursing home patient who arrived at a local hospital one morning in 2006 was in such bad condition, the emergency room staff expressed amazement.
He was said to be dirty and appeared to have not been bathed in days. His grimy fingernails were long and cutting into his palms. He was severely dehydrated, had a distended abdomen, and his catheter was not draining.
"How does somebody get that bad?" a nurse was quoted as saying.
As a quadriplegic, the man was completely dependent on the staff for his care, according to a report from the state Department of Public Health.
He'd been admitted to Sunbridge Care Center for Paradise on Jan. 16, 2006, for treatment of severe bedsores.
He had a feeding tube inserted into his abdomen, and a catheter to drain his bladder. His doctor had ordered the Sunbridge staff to make sure he received enough liquid and that his output of urine was closely monitored.
Two days after he was admitted, the staff recorded their concern that his urinary output was minimal. But over the next five days, they failed to consistently assess the problem and did not provide him with extra fluid as had been ordered, according to state records.
At 9 a.m. on Jan.23, it was noted he had a temperature of 103.6 degrees, was sweaty and breathing rapidly, and had produced only a very small amount of dark brown urine containing sediment. After being called, the patient's doctor ordered him sent to the hospital emergency room.
At the hospital, he was cleaned up and given lots of liquids, and his urinary symptoms improved.
Unfortunately, he died of "aspiration pneumonia" at the hospital within a day or two.
According to the report, his family said he'd been alert and "fine" just a week before he'd been transferred to Sunbridge.
Because of this episode, the nursing home, on Feb. 15, 2007, was issued a Class A Citation and fined $25,000.
Reports such as this inspire nightmares. Hearing such stories, family members and the very elderly themselves wonder where they can find a nursing home that will give them good care.
To help provide an answer, rating systems for nursing homes have been developed.
One of the newest is on the Medicare Web site (www.medicare.gov). It rates all of the 15,800 nursing homes that participate in Medicare or Medicaid.
The Medicare report card gives nursing homes an overall rating of between one and five stars, and also rates them separately on health inspections, staffing levels, and "quality measures."
There are 16 nursing homes in the north valley (Butte, Glenn, Tehama and Colusa counties) excluding facilities connected to acute-care hospitals.
None of the 16 got an overall rating of five stars (much above average) or four stars (above average).
Four nursing homes got overall ratings of three stars (average). They were Shadowbrook in Oroville, Twin Oaks in Chico, Cypress Acres in Paradise and Valley West in Williams.
Five homes received overall ratings of two stars (below average). They were California Park Rehabilitation Hospital in Chico, Evergreen Health Care in Gridley, Paradise Skilled Nursing in Paradise, and Brentwood Skilled Nursing in Red Bluff.
Seven facilities were given one-star overall ratings (much below average). They were Country Crest Health Center in Oroville, Windsor Chico Creek in Chico, Olive Ridge in Oroville, Riverside in Chico, Windsor Chico Care in Chico, Sunbridge Care in Paradise, and Sunbridge Care in Willows.
While no local facilities received a high overall grade, according to this system, around the state many did get four-star or five-star overall ratings. Of the 1,247 nursing homes in California, 44.2 percent got either four-star or five-star overall grades, according to Jack Cheevers, a spokesman for the agency that administers Medicare.
Questions have been raised about how much the Medicare report card really means.
"It's a tool among a lot of other tools," said Betsy Hite, a spokeswoman for the California Association of Health Facilities, which represents many nursing homes.
She said there's no substitute for a "good, old-fashioned" visit to a nursing home to see how it looks, smells and feels.
Pat McGinnis, executive director of California Advocates for Nursing Home Reform (CANHR), a non-profit agency that works to improve longterm care, agreed. There's only so much a statistical survey can tell, she said, adding that such ratings can be misleading.
Nevertheless, McGinnis said, report cards can suggest whether a home is having problems.
Ron Brown, administrator of Shadowbrook Health Care in Oroville, said one fault with Medicare's grading system is that the data it is based upon is not current. Cheevers, however, said the ratings are based on the most recent three years' worth of information, which should include data from 2008.
Two other agencies also offer Internet rating systems where you can look up nursing homes. These are CANHR, McGinnis' non-profit watchdog organization (www.canhr.org), and the California Healthcare Foundation (www.calnhs.org), another non-profit organization that deals with various health-care issues.
Among other information, the CANHR site lists the number of citations issued by the state to California nursing homes from 2003 to 2008. The most serious problems are denoted by a Class AA Citation. Class A is somewhat less serious, and Class B is still less serious.
According to the CANHR site, the number and type of citations issued to north-valley facilities between 2003 and 2008 are as follows:
Shadowbrook Health Care in Oroville, one B citation; Valley West Care Center in Williams, one B citation; Chico Creek Care and Rehabilitation Center, two B citations; Windsor Chico Care Center, two B citations; Brentwood Skilled Nursing and Rehabilitation in Red Bluff, two B citations; Paradise Skilled Nursing, three B citations; Cypress Healthcare Center in Paradise, four B citations; California Park Rehabilitation Hospital in Chico, one A citation and three B citations; Evergreen Gridley Health Care Center, one AA citation and five B citations; Olive Ridge Care Center in Oroville, one A citation and five B citations; Sunbridge Care Center for Willows, one A citation and six B citations; Country Crest in Oroville, 10 B citations; Red Bluff Health Care Center, 10 B citations; Twin Oaks Health and Rehabilitation Center in Chico, one AA citation and 10 B citations; Sunbridge Care Center for Paradise, seven A citations and 11 B citations; and Riverside Convalescent Hospital in Chico, one A citation and 23 B citations.
To try to get a more complete evaluation, the E-R examined how north valley nursing homes given one star or three stars by Medicare ranked when all three Web sites were considered.
By this method, the E-R came up with the top two homes and the two lowest-rated homes. The top two were Shadowbrook and Valley West and the bottom two were Sunbridge Care for Paradise and Riverside for Chico.