Articles Posted in Nursing Home Citation

As the COVID-19 pandemic continues to rage, nursing home residents are among the hardest hit demographic and make up a large portion of the fatalities nationwide. Though the virus is undoubtedly deadly, especially for elderly individuals and those with compromised immunity, the concentration of deaths in nursing homes is concerning. Adding to that concern is the fact nursing homes are currently permitted to self-inspect as a result of the pandemic. The lack of oversight presents numerous issues we’ll explore more.

Independent Inspections Suspended

At the outset of the pandemic, the Centers for Medicare and Medicaid Services (CMMS) decided to temporarily stop regular inspections at over 15,300 nursing home facilities nationwide to focus instead on the coronavirus threat. Instead, routine inspections were developed and implemented as a way to safeguard the residents. Unfortunately, when the government halted its own inspections, it authorized nursing home facilities to self-inspect.

Village Square Healthcare Center, a nursing home located in San Marcos, California, received 29 citations for health and safety deficiencies in its most recent inspection, on February 14, 2019. According to Centers for Medicare and Medicaid Services records accessed on February 26, 2020, that figure numbers more than twice the statewide average of 12.8 citations, and more than three times the U.S. average of 8.0. A for-profit corporation owned by GC Holding Company LLC., Highland Springs Care Center is a Medicare and Medicaid participant with 118 certified beds and an average of 117.8 residents at the facility per day. The deficiencies described in the February 2019 citations include the following:

  1. The nursing home did not ensure residents were adequately protected from accidents. Federal code requires nursing homes to maintain a resident environment free of accident hazards and with adequate supervision to prevent accidents. An inspection found that Village Square Healthcare Center did not provide such in two capacities. According to this citation, an inspector observed water temperatures in resident bathroom sinks that exceeded safe levels. The inspector separately observed that a paraplegic resident was not provided with adaptive equipment to call facility staff. The resident stated in an interview that when he calls the facility’s main number using Alexa and his computer, these calls “go to voicemail 50% of the time,” and that he cannot use his soft touch pad call light provided by the facility “because he cannot turn his head enough to use his chin to turn it on.” The resident stated additionally that while he sends text messages to staff when he requires assistance, “in an emergency his only option would be to call 911.” A Certified Nursing Assistant stated in an interview that she did not know how to retrieve voicemails left by the resident, and that the current system for the resident to contact staff “is not safe.”
  1. The nursing home did not implement adequate measures to prevent and control infection. Federal code requires nursing homes to establish and implement infection prevention and control protocols. An inspection determined that Village Square Healthcare Center failed to do so in three capacities. In one, an inspector observed a staff member assisting residents during mealtime without conducting proper hand hygiene between residents. In another, an inspector observed a staffer moving between residents and providing them assistance without conducting proper hand hygiene. In a third, an inspector observed a resident’s urinary catheter drainage bag lying on the facility’s floor, in contravention of policy.

Meadowbrook Health Care Center, a nursing home located in Hemet, California, received 20 citations for health and safety deficiencies in its most recent inspection, on April 20, 2019. According to Centers for Medicare and Medicaid Services records accessed on February 26, 2020, that figure numbers more than the statewide average of 12.8 citations, and more than U.S. average of 8.0. A for-profit corporation owned by Johnre Care Inc., Meadowbrook Health Care Center is a Medicare and Medicaid participant with 64 certified beds and an average of 48.8 residents at the facility per day. The deficiencies described in the April 2019 citations include the following:

  1. The nursing home did not ensure residents were provided with appropriate treatment. Federal code requires nursing homes to provide residents with “appropriate treatment and care according to orders, resident’s preferences and goals.” An inspection found that Meadowbrook Health Care Center did not provide such in an instance when the facility did not “ensure signs and symptoms of bleeding were monitored” per the plan of care of a resident reviewed for side effects of blood thinner medication. The citation states further that the failure to ensure such “may have contributed” to the resident being sent to the emergency room for rectal bleeding. According to the citation, the resident was receiving an anticoagulant agent to prevent blood clots, and the plan of care stated that they should be monitored for signs and symptoms of excessive anticoagulation. A Licensed Vocational Nurse confirmed to state authorities, however, that “there was no documentation” the resident was being monitored such during the month in question, and “should have been monitored” in the period leading up to the resident being sent to the hospital.
  1. The nursing home did not ensure the competencies of food and nutrition services staff. Federal code requires nursing homes to ensure that its staff have “appropriate competencies and skills sets to carry out the functions of the food and nutrition service.” An inspection found that Meadowbrook Health Care Center failed to ensure its supervisory staff failed to carry out their key functions in an instance wherein the facility’s Dietary Manager and Registered Dietitian “did not provide management and oversight to ensure food was stored, prepared, and served according to facility and industry standards,” as well as that equipment and other food service items were maintained in good working condition. The citation goes on to state specifically that an inspector found that the facility’s RD did not ensure residents were provided with “a comparable in nutrient content alternate” when they requested one instead of the “main entrée.” The inspector also found that the RD did not “report the poor condition” of certain food service items, and that cutting boards and cooking pans were not maintained in good condition. The citation states that these deficiencies resulted in the potential for the facility’s residents to experience “food borne illness and nutritional related health complications.”

The Elder Abuse and Dependent Adult Civil Protection Act (Act) was strengthened in 1991, when California legislature added Welfare & Institutions Code §15657 to the Act. This was done to specifically address the needs of California elders and the unique struggles they face, to include elder abuse, neglect, and abandonment.

Because elders may be seen as a disadvantaged class, California elder abuse attorneys who advocate for elders who have been abused, or the families of those who have passed away, are able to charge attorney’s fees and costs to the defendant (abuser). This helps those whose loved elders were mistreated by others who intentionally acted in a reckless, malicious, fraudulent, or oppressive manner to recover damages for the elder, or the family if the elder is deceased.

As such, those who can sue for Elder Abuse in Southern California will include both the family members of the abused elder (if the elder is deceased), or the elders themselves. If the suspected victim has died as the result of abuse or neglect while residing in a California nursing home, the family has the right to file a lawsuit on behalf of their deceased elder, and the court proceedings will ensue as if the elder were still living.

In many cases, where the elder has died, and the family believes the death was caused by misconduct, negligence, or abuse by the hands of another, two cases will evolve. One case will directly address the abuse, and proceed as if the elder were still alive. The second will be a wrongful death case filed on behalf of the survivors. The cases are very different. The injury/abuse case will take into account the injuries sustained by the elder, which will then be granted to the deceased elder’s estate. The wrongful death suit will serve to compensate the family and heirs of the elder who has passed away.

If you are unsure as to whether or not you have a case for an elder abuse lawsuit, contact Chris Walton today for a free consultation. Chris is an award winning elder abuse attorney who is based in San Diego, CA. Walton Law, APC focuses their entire practice on advocacy for elders who have been abused, or those who have suffered grave personal injury. Click here to schedule a consultation.
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The Department of Justice and the Department of Health and Human Services have released “The Elder Justice Roadmap” on their website: www.hhs.org:

Supported by the Department of Justice (DOJ) and the Department of Health and Human Services (HHS), the Elder Justice Roadmap was developed by harnessing the expertise of hundreds of public and private stakeholders from across the country and by gathering their input. The goal of these expert summits was to identify the most critical priorities and concrete opportunities for greater public and private investment and engagement in elder abuse issues. The Elder Justice Roadmap reflects the knowledge and perspectives of these experts in the field and will be considered by the Elder Justice Coordinating Council and others in developing their own strategic plans to prevent and combat elder abuse.

“The Roadmap Project is an important milestone for elder justice,” said Associate Attorney General Tony West. “Elder abuse is a problem that has gone on too long, but the Roadmap Report released today can change this trajectory by offering comprehensive and concrete action items for all of the stakeholders dedicated to combating the multi-faceted dimensions of elder abuse and financial exploitation,” he explained. West continued, “While we have taken some important steps in the right direction, we must do more to prevent elder abuse from occurring in the first place and face it head on when it occurs.”

Understaffing nursing homes is incredibly dangerous to adults over 65 residing in long-term care facilities such as Southern California nursing homes. That’s precisely why specific laws and regulations are in place which mandate proper staffing at long-term care facilities.

Under California law, “The facility shall employ an adequate number of qualified personnel to carry out all of the functions of the facility” Health & Safety Code § 1599.1(a). Moreover, Health & Safety Code §1276.5-1276.65 mandates that nursing homes must provide a minimum of 3.2 nursing hours per patient per day.

Unfortunately, many facilities choose to ignore the California law. Even worse, the understaffing of nursing homes has been directly correlated to abuse and neglect of elders. Indeed, understaffing in California nursing homes leads to substandard care over and over again. Substandard care in nursing homes then leads to illness, injury, and too often, death.

Understaffing nursing homes is incredibly dangerous to adults over 65 residing in long-term care facilities such as Southern California nursing homes. That’s precisely why specific laws and regulations are in place which mandate proper staffing at long-term care facilities.

Under California law, “The facility shall employ an adequate number of qualified personnel to carry out all of the functions of the facility” Health & Safety Code § 1599.1(a). Moreover, Health & Safety Code §1276.5-1276.65 mandates that nursing homes must provide a minimum of 3.2 nursing hours per patient per day.

Unfortunately, many facilities choose to ignore the California law. Even worse, the understaffing of nursing homes has been directly correlated to abuse and neglect of elders. Indeed, understaffing in California nursing homes leads to substandard care over and over again. Substandard care in nursing homes then leads to illness, injury, and too often, death.

As a nursing home abuse and neglect lawyer, one of the most common questions is, “how do I choose the right nursing home for my loved one?” Unfortunately, there is rarely an easy answer to this question. However, there are some important guidelines listed below that I believe will assist you in selecting the most appropriate nursing home for you or your loved one.

Make a List:

Similar to any other big decision in life, there is no substitute for doing your homework and acquiring as much information as you can. Start by making a list of the nursing homes in a community close to relatives, friends, and/or people that will visit your loved one while in the nursing home. To obtain a list of nursing homes, you can contact your local California Department of Public Health District Office. Alternatively, California Advocates for Nursing Home Reform maintains an online nursing home guide that is very helpful.

It is an unfortunate fact that elder abuse is a common and growing problem in San Diego and throughout the United States. Abuse of the elderly can take many forms, ranging from neglect and abandonment to physical, verbal, financial, and even sexual abuse. Fortunately, professionals in health care are constantly working towards new breakthroughs in treatment and the prevention of abuse in the elderly population. It’s true that new research and techniques are changing the face of convalescent care every day.

As the population of elders in San Diego continues to grow, it’s also encouraging to see the elder abuse epidemic be drawn out of the shadows and into the light, so we can all learn to recognize symptoms of elder abuse, and report any suspicions. One such example of shining a light on elder abuse prevention will be coming to Southern California next month.

On September 15, 2016 the 2-day USC Judith D. Tamkin International Symposium on Elder Abuse will welcome “researchers, academics, physicians, nurses, and psychologists” to participate in a weekend committed to “Closing the Research Gaps and Moving the Field of Elder Abuse Forward.”

Perhaps in response to the revelation that the California Department of Public Health has been negligent in investigating claims of elder abuse occurring in nursing homes and assisted living facilities across the state, Governor Jerry Brown’s proposed fiscal budget includes the addition of roughly 260 positions in the Licensing & Certification Division of the California Department of Public Health.

A statement issued by the California Advocates for Nursing Home Reform (CANHR) in response to the proposed budget reads:

“According to the Department’s Budget
Change Proposals, the Department is requesting the new positions primarily because its prior methodology for assessing its staffing needs failed to consider that inspectors were needed to investigate its vast backlog of complaints or to finish complaint investigations and write reports after onsite visits were conducted.”

Unfortunately, even given the influx of a proposed $30 Million, and the addition of hundreds of jobs, CANHR also said that it is expected to take an additional four years for all pending investigations to be completed. Their statement further said:

“In other words, the Department allowed thousands of complaints involving nursing home abuse and neglect to languish for years because its leaders could not competently perform the most basic assessment of its staffing needs. Some of these failed leaders remain at the Department and should be replaced by qualified and competent managers before it is awarded any more money.

CANHR calls on Governor Brown to swiftly appoint a new leadership team at the Department of Public Health. The new leaders should have the qualifications, experience, and will to build the Licensing & Certification Division into a premier consumer protection agency that will protect the interests of nursing home residents and patients of other health facilities throughout California.”

If you suspect that an elder is being abused, it is vital to report your concerns immediately. Under California law elder abuse can be both a criminal and civil offense. The state of California has taken a firm stance and zero tolerance policy towards elder abuse in any capacity. As part of their mission to encourage all Californians to report suspected elder abuse, the state has created The Citizen’s Guide To Preventing and Reporting Elder Abuse, which can be viewed in its entirety here. You should report suspicions of elder abuse to:

• Local Law Enforcement, including the Police, Sheriff, and District Attorney’s office. The San Diego County Sheriff’s Department can be reached at (858) 565-5200. The San Diego County District Attorney may be reached at 619-531-4040.
• Long-Term Care Ombudsman Program provides a 24/7 Crisis Complaint Hotline at 800-231-4024.
• Adult Protective Services (APS). In San Diego County, you may contact: San Diego County Aging and Independent Services (858) 495-5660.
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