Audit shows nursing home neglect in California is rampant

LOS ANGELES — California health regulators have allowed poor care to proliferate at nursing homes around the state, and the number of incidents that could cause serious injury or death has increased significantly in recent years, according to a stinging state audit released this week.

The state auditor singled out the California Department of Public Health for particular criticism, saying it had not performed necessary inspections or issued timely citations for substandard care. The audit also found that the department’s nursing home licensing decisions were inconsistent and lacking in transparency.

“Together, these oversight failures increase the risk that nursing facilities may not provide adequate care to some of the state’s most vulnerable residents,” California State Auditor Elaine Howle wrote.

Safety and accountability problems at nursing homes across the United States are rampant. Federal inspection reports, for example, show that infection control is routinely ignored. At the same time, the Trump administration has scaled back the use of penalties to punish nursing homes that put residents at risk of injury.

In California, confirmed cases of substandard care at nursing homes statewide increased by 31 percent from 2006 to 2015, according to the audit. And incidents of nursing home noncompliance that caused or could have caused serious injuries or fatalities rose by 35 percent in the same period.

In a written response, published in the auditor’s report, the public health department rejected the allegation of faulty oversight. “CDPH disagrees with this conclusion,” wrote Karen Smith, the agency’s director. “In fact, CDPH believes that the increased number of ... deficiencies cited demonstrates that CDPH has increased its enforcement activities.”

But the audit showed that in the vast majority of cases where investigators found problems that could severely harm patients, the public health department failed to cite or fine the facility involved.

“There is an expectation of a level of care and safety,” said Democratic state Assemblyman Jim Wood. “When that doesn’t happen, it’s really disconcerting.”

Wood said it was “very, very disturbing” that the public health department was not holding nursing homes accountable. The failure to issue citations, as well as delays in issuing them, are particularly worrisome, he said. “They are not doing their job.”

The California Legislature ordered the audit last year after a request by Wood, who chairs the Assembly Health Committee, and Democratic Sen. Mike McGuire.

In her written response, Smith dismissed the claim that licensing by the department was inconsistent, saying the auditor did not completely understand the process.

But she agreed the department should issue citations in a more timely way and said it is working on that. The agency has begun training investigators to write citations properly, and it is creating a standard template for them, she said.

The quality of care at nursing homes will be crucial as baby boomers age and demand for these services grows, the auditor wrote.

The audit also investigated three large private nursing home operators whose earnings skyrocketed over the past decade — from less than $10 million each in 2006 to between about $35 million and $54 million in 2015. It said the owners of the three companies are swelling their profits by doing business with companies they own or in which they have a financial interest.