Nursing Home Tied to Serious Violations Loses Public Funds

A Lemon Grove nursing home has been stripped of its right to receive Medi-Cal and Medicare reimbursements after being cited for serious deficiencies in patient care, state health officials said Wednesday.

The decision means that as of Sept. 3, as many as 140 elderly patients at Cresta Loma Convalescent Home on Palm Avenue may have to move to homes qualified to receive public funding.

Donna Loza, a supervisor in the state Department of Health Services’ licensing and certification division, said the action came after two surveys conducted by local investigators found widespread violations of standards that posed “a considerable threat to the health and safety of patients.”

Overall, Cresta Loma’s performance was “inadequate” in six of 18 performance categories established by state and federal regulators, Loza said.

“(Patients) were not being fed properly, their teeth were not being brushed, their grooming needs were not being met, their dentures were not being put in, they were not being turned every four hours, and they did not have their bed linens changed frequently enough, so they were lying in their own excrement,” Loza said. “As you can see, this was not a question of poor record-keeping.”

Loza said that there were numerous patient health problems, including weight loss, and that patients’ privacy rights were not adequately observed during dressing and grooming by aides.

The home failed to sufficiently involve patients in group activities to keep them alert and active, Loza said. Problems with the physical plant were also cited, including general upkeep and roaches in the kitchen area. Deficiencies in patients’ diet and inadequate training of nursing staff were noted as well.

The state also filed two citations of patient abuse. One involved a bruise on a patient’s arm, apparently inflicted by an aide attempting to restrain him. Details on the other citation were not available.

The Cresta Loma’s owner, Phil Jordan, did not return calls from The Times on Wednesday.

‘Typical of Over-Regulation’

But a spokesman for the Health Facilities Assn., which represents the Lemon Grove home and about 90% of all convalescent beds in the state, said the action is typical of “the environment of over-regulation and very punitive activity” that exists in California today.

“Cresta Loma has been providing quality long-term care to the people of San Diego County for 10 years, and now because of this excessively punitive posture by the state, we are being run out of business,” said Joseph Diaz, who represents homes in seven Southern California counties.

Diaz said the home’s operators realize they have “minor problems” but characterized them as things like “failing to answer a patient’s call bell within X number of seconds” and “not following through with documentation” of a patient’s medication after administering it.

The home’s practices were not putting patients at risk, Diaz said. Still, he added, “excessive” state regulations have burdened the facility’s staff with an inordinate amount of paper work that sometimes affects the level of care.

State and federal laws require hospital personnel to make a total of 1.5 million written entries annually at an average, 99-bed nursing home, he said.

Staff Shortage Is Problem

The biggest problems facing convalescent facilities, however, are caused by the chronic shortage in available, trained nursing staff, Diaz said, noting that Cresta Loma has had a 100% turnover in staff in the last two months.

“We spend $20,000 a month in advertising in San Diego County to attract quality employees, but they’re just not out there,” Diaz said. “What are we supposed to do?”

Diaz said Cresta Loma plans to appeal the fines--which could range from $10,000 to $30,000--that will accompany the decertification. Moreover, the home will apply for recertification, but that is a lengthy and difficult process, he said.

Meanwhile, Diaz is meeting with families of the patients--whose average age is 80--to find new accommodations. Already, 35 have been moved to private homes, acute-care hospitals or other convalescent facilities on a temporary basis. (The state covers the cost of such moves and continues to provide benefits for relocated patients.)

But the more critically sick--those who are bedridden or on feeding tubes--will be more difficult to house, and many lack family in the immediate area, Diaz said.

Moreover, the closure of another nursing home--the 301-bed Alvarado Convalescent and Rehabilitation Hospital--earlier this summer means that already scarce space for the elderly is now even scarcer. A third home--the Golden Age Leisure Gardens in Vista--closed last year.

“I don’t know what we’re going to do with these people, some of whom are very frail,” Diaz said. “We may have to move them to Orange or San Bernardino counties. It is very hard on them and their families.”

Sympathizes With Patients

Loza said she sympathizes with the patients’ plight. However, “When we find facilities where the health and safety of patients is in jeopardy, then our job and responsibility is to forward it to the federal government for action,” she said. “When you have food encrusted on patients’ teeth, it’s obvious there are serious problems.”

Cresta Loma was first surveyed in June during the state’s routine evaluation of all nursing homes. The home was deficient in six categories--overall management, nursing services, group activities, social services, infection control and physical plant.

The state notified the home that it would need to take corrective action or face the loss of its right to reimbursements. A month later, Cresta Loma invited officials back for a second look.

Though some improvements had been made, the state determined that care was still not up to par and recommended that the federal Health Care Financing Administration decertify the 10-year-old home. The federal agency made that decision Aug. 11.