"Critical on conditions: Two nursing homes cited more than others"
Second of three parts
PART I: Nursing home ratings reveal quality control at several local facilities (Jan. 17)
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
CHICO — Two nursing homes in the north valley have been cited by the state much more often than other facilities in the last six years.
The two are Sunbridge Care Center for Paradise and Riverside Convalescent Hospital in Chico.
Surveyors from the state Department of Public Health inspect nursing homes, normally once a year, and investigate complaints about facilities. When problems are very serious, they can cite and fine owners of the nursing homes. Class AA citations are issued for the most serious offenses, while Class A and Class B citations are issued for less grievous problems.
According to the Web site of California Advocates for Nursing Home Reform (CANHR), a statewide nonprofit organization, Riverside Convalescent Hospital received one A citation and 23 B citations between 2003 and 2008. Sunbridge for Paradise was issued seven A citations and 11 B citations during the period. Each of the other 14 nursing homes in the north valley received between one and 11 citations during that time.
To get a sense of the kinds of things local homes have been cited for, the Enterprise-Record examined state citation records for 2007 and 2008 for Riverside and Sunbridge for Paradise.
At the state Department of Public Health Licensing and Certification Office in Chico, the E-R found these two facilities got a total of 26 A and B citations from the beginning of 2007 through the early part of this month.
They were for such things as not having enough nursing staff on duty, giving patients the wrong medicine, failing to report suspected abuse within 24 hours, and violating rules that protect patients' independence and dignity.
Five of the violations for which these homes were cited, including some of the most serious incidents, involved errors with medicine. Typically, a patient was given another resident's drug or drugs.
Riverside was cited for two cases like this. In September of 2007, an 88-year-old woman was accidentally given medicine prescribed for another resident. The woman who was given the wrong drug became disoriented and sluggish. She was taken to the hospital and recovered, a report stated. Riverside was issued a B citation and fined $1,000.
In the other case, in November 2007, an 87-year-old woman was accidentally given morphine prescribed for another patient. In this case, according to the state, a certified nurse assistant noticed at 8:30 a.m. that the 87-year-old was unresponsive and told two licensed vocational nurses. The LVNs did nothing about it, according to the document. At 4:45 p.m., the CNA told the charge nurse, who called paramedics. The patient's face and lips were blue by then, according to the report. She was taken to the hospital. Riverside got an A citation and was fined $10,000.
Sunbridge received three A citations for incidents involving medication errors. In one case, on Oct. 1, 2007, a 61-year-old man was given eight drugs, including an opiate pain reliever, which another resident was supposed to be given. The man had already been given his own medicines, as well. He was taken to the hospital, diagnosed with respiratory failure, and transferred to the intensive care unit.
Between the beginning of 2007 and the present, Sunbridge Care Center for Paradise has received six A citations. Patient deaths were associated with at least two of those cases.
One instance was the case that was written about at the beginning of this series: a quadriplegic was allegedly not assessed over several days and interventions were not implemented as his condition worsened.
In another case, an 82-year-old woman who had had hip surgery developed a rapid heart rate. According to the citation, she was not assessed by nurses and her doctor was not called. Her heart rate increased, but still no intervention was done, according to state documents. More than 48 hours after her problem was first noticed, the reports stated, an LVN discovered that the woman was not breathing and had no blood pressure. The facility was fined $10,000.
A third case concerned a woman who had lung disease. According to her original care plan, she was to be kept in bed with her head elevated at 45 degrees. However, she repeatedly had to be taken to the hospital because she had trouble breathing and possibly had aspiration pneumonia. According to the state's report, paramedics repeatedly found her lying on her back in bed. Finally, the woman's family decided to provide her with "comfort care" only, and on Nov. 6, 2005, she died.
On Feb. 27, 2007, Sunbridge for Paradise was issued a class A citation and fined $25,000 in this case. The citation said the facility failed to revise the patient's care plan when her condition changed and failed to provide treatment ordered by her doctor.
Stacey Alexander, regional vice president of operations for Sun Healthcare, a large corporation that owns Sunbridge Care for Paradise, wrote in an e-mail that the one-star Medicare rating the facility received was disappointing.
However, she wrote that the facility is now in compliance with state standards and that efforts are being made to improve the quality of care there. A new union contract should help attract and retain good workers, she stated. She also noted that last year, 80 percent of residents at the nursing home rated their satisfaction with the facility as "excellent" or "good."
Joe Miceli, administrator of Riverside in Chico, said he couldn't comment on the citations the facility received or the quality of care there in the past because he'd only been administrator since November.
However, Riverside "is blessed" to have a good number of long-term employees, he said. "It's not an easy industry. It's hard work. We have a lot of folks who have a great deal of love for the residents."
Here are examples of some of the other citations issued to the two nursing homes:
Sunbridge for Paradise was issued a class B citation in the case of a 67-year-old man who continually left the facility in his wheelchair and was found outside.
Another class B citation issued to Sunbridge for Paradise stated a CNA left a 74-year-old woman lying in her urine and feces after she repeatedly called out for help and used her call light. An LVN who was interviewed said that CNA would go into rooms and turn off the call lights without attending to the patients.
A class B citation was issued to Riverside in the case of a 97-year-old woman who was held down by an LVN while a CNA washed her face. The woman was yelling, "Leave me alone," according to the report. The facility put the nurse on probation and ultimately fired her.
Another class B citation was issued over an incident in which a nurse tilted a resident's wheelchair back and then mocked him when he began swearing at her.
BACKGROUND: The state Department of Public Health inspects nursing homes about once a year and investigates complaints when they are made.
WHAT'S NEW: According to a group that advocates for nursing-home residents' rights and safety, two facilities have been cited by the state much more often than others in the north valley.
HOMES DEFENDED: Officials representing the owners of those two nursing homes said improvements are being made and that the facilities have good attributes.