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Déjà vu All Over Again:
California Abandons Enforcement of Federal Nursing Home Standards


A recent federal report sheds new light on the California Department of Public Health’s shocking failure to enforce federal nursing home standards.

The report, Unidentified and Unreported Federal Deficiencies in California’s Complaint Surveys of Nursing Homes, was issued by the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services on September 21, 2011. It found that California, as a “standard practice,” does not evaluate compliance with federal nursing home standards when it investigates complaints and facility-reported events of abuse and neglect.

The details are highly disturbing. According to the report, CDPH received 57, 456 complaints and facility reports involving suspected abuse and neglect from 2008 to 2010, an alarming level by any standard. Yet, it only evaluated compliance with federal standards for 22 percent of the complaints, meaning it did not investigate whether nursing homes met federal standards for 44,816 complaints and facility-reports about suspected abuse and neglect during this period.

Notwithstanding its contract with the federal government to investigate complaints and uphold federal nursing home standards, CDPH was unapologetic for its failures. Echoing the favorite excuse of nursing home operators, CDPH defiantly stated that it did not have to comply due to insufficient federal funding for inspections. It also claims that it is protecting residents by investigating complaints under state law, an allegation that bears no resemblance to the truth.

The OIG report gives a troubling example of a complaint that CDPH investigated only under the state process. It involved a resident who was hospitalized suffering from multiple bedsores and maggots coming from her ears. The CDPH investigation confirmed neglect and falsified records, but only minor state deficiencies were issued. The findings were never reported to the federal government and are not included in the nursing home’s rating on Nursing Home Compare.

The magnitude of CDPH’s failures becomes apparent when you multiply the above-example by 44,816 - the number of complaints and nursing home-reported incidents where CDPH skipped all aspects of federal enforcement. It is hard to imagine the harm that CDPH is causing by training its 600 inspectors to routinely ignore federal standards during complaint investigations.

CDPH’s practices are also corrupting Nursing Home Compare, the federal government’s five-star rating system for nursing homes. How can Nursing Home Compare serve any useful purpose for people seeking nursing home care in California if tens of thousands of complaints and nursing home-reports of abuse and neglect never make it into the system?

California’s defiance of federal nursing home standards has a long history, dating back to 1991 when it refused to enforce the regulations established pursuant to the Nursing Home Reform Act of 1987. It took a court order then to get California to comply. In October 1992, the U.S. District Court for the Eastern District of California ordered the State to enforce federal nursing home standards and investigate complaints in compliance with federal procedures. The court order in that case, Valdivia v CDHS, is still in effect.

CANHR has contacted federal officials about these concerns and is monitoring their response. Please contact Mike Connors at CANHR if you have any information about this matter

Page Last Modified: February 16, 2012