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Another Audit Finds Fault With Nursing Home Inspections In Los Angeles County

By Anna Gorman

August 29th, 2014, 12:24 PM

This KHN story can be republished for free. (details)

Los Angeles County public health officials inappropriately closed nursing home investigations and failed to follow state guidelines on prioritizing complaints, according to an audit released this week.

The Los Angeles County auditor-controller also found that even after nursing home inspectors found serious problems, their supervisors downgraded the severity of findings without any explanation or without discussing the changes with the inspectors as required.

“The quality and integrity of investigations is impaired when surveyors’ conclusions are changed without their knowledge,” according to the audit.

The audit was the latest of several reviews showing problems with how the county Department of Public Health oversees residents’ health and safety at about 385 nursing homes. The county, the most populous in the state, contracts with the state and the federal government to inspect the facilities and to investigate complaints from residents, family members and staff.

Earlier this summer, the California Department of Public Health determined that the county wasn’t following state policies on inspections, leading to incomplete and delayed investigations. The county issued an audit in April that documented a lengthy backlog of investigations and concluded that a lack of central oversight contributed to the delay. At the time, about 945 cases, had been open for more than two years.

The scrutiny of the department came after a Kaiser Health News investigation found the county was instructing inspectors to close cases without fully investigating them.

The most recent audit was based on a review of a small sample of cases — about 20 of the more than 3,044 that were open in March 2014 and 30 of the 1,124 cases that had been closed between July 2012 and April 2014. The audit found that five of the 30 cases were closed inappropriately without “conducting or completing the investigations.”

In addition, supervisors downgraded inspectors’ findings in 12 of the 30 closed cases, meaning that the nursing home got a less serious citation or a smaller fine. In most of those cases, there was no documentation for the reason.

The audit didn’t give many specifics on the problems found at the nursing homes but noted that five cases involved deaths. In one, an inspector found the death could have been prevented. Others involved nursing homes not complying with doctors’ orders or checking whether a patient had negative reaction to medications.

The auditor-controller recommended that the department’s inspectors, managers and doctors improve documentation and communication to “ensure the quality and integrity of their investigations.”

“Without adequate documentation, it is very difficult to ensure that deficiencies and citations are handled in a consistent, thorough and equitable manner,” the audit read.

The audit also found that the public health department failed to reassign a case when an inspector retired.

The county Department of Public Health responded to the audit with a letter saying that it agreed that the documentation was “sometimes lacking” and that improvements were necessary. Officials also said that they had already made several changes, including putting new people in charge of the division responsible for inspections and improving the tracking and prioritization of complaints.

But, as in the past, county public health officials also wrote that the department is underfunded and “severely understaffed.”

The county public health department is responsible for reviewing one-third of the state’s facilities but only receives 15 percent of the funding, according to the response. If the state doesn’t provide “sufficient resources” for the program, county public health officials wrote, the department may not be able to continue its contract to oversee the nursing homes.

The April audit found, however, that the county did not spend  all the money at its disposal — more than $2 million of the roughly $27 million in state funds in each of the last two fiscal years.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

2 Responses to “Another Audit Finds Fault With Nursing Home Inspections In Los Angeles County”

  1. Ann Stanton says:

    This is very interesting since I’m still in the process of trying to find out why Medicare and the PA health dept (state surveyors) would not do a proper investigation into my sister’s injury and death when she had been in a Pittsburgh nursing home. They wouldn’t look into the medical records from that facility even though I submitted copies of that info and told me they could only go by MDS records. I finally received those with the help of Senator Toomey’s office but it took almost a year (the appeal over three months due to FOIA). I got them and have been putting a report together regarding discrepancies in the MDS information. I sent a letter about poor care at various hospitals also to Secretary of HHS and asked where I would send my report of MDS problems once I have finished that but no response yet. I can only assume they are just not interested in what happens at these facilities. As in the article, this is happening in LA but also in other parts of the country and it’s a shame that so much time must go into finding problems that should have been investigated by the proper authorities.

  2. Dave says:

    I don’t know which facility in PA it is you are talking about, but you are correct, it happens all over the country. The problem is that there’s really no oversight over the survey team. They can really decide to make anyone look very good or very bad. many times its PR and Political connections of the facility that make them a non-target, leaving the survey team to find another facility to bash in order to justify their position. the good aren’t good and not all the bad are bad. these are facts that anyone involved with a nursing home, either as a residents family member or as an employee, knows. it became a serious PR game. and they can always excuse their failures with we are underfunded and understaffed, they are not! they want to run an uninterrupted shop. that’s all. the question has been for a long time, WHO POLICES THE POLICE?