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What’s Wrong with DPH, Licensing and Certification?
Why Do They Fail to Protect Nursing Home Residents?


According to its website, the “top priority” of the Department of Public Health, Licensing and Certification is to “protect patient safety and ensure quality care for all patients and residents of the more than 10,000 health care facilities we regulate in California. We ensure compliance with state licensing laws and federal certification regulations in our role as the state survey agency for the Centers for Medicare and Medicaid Services for which we certify facilities to receive Medicare and Medi-Cal reimbursements.”

Here's the problem: DPH, L&C does not protect patient safety, ensure quality care or ensure compliance with the licensing laws. In fact, with their hands-off and lax approach to enforcement, their message to nursing homes in California is: no matter the seriousness of the violation – even if your failures kill residents – we’ll have your back. Not only will they have your back, but they will give you a license to run other facilities after you’ve failed with previous facilities.

Illegal Transfers and Discharges

In case after case, nursing homes feel free to transfer residents they no longer want to care for; residents whose family members might complain too much; and most frequently, residents whose Medicare days have run out and are on or applying for Medi-Cal. Transferring residents to unlicensed board and care homes that are sorely unprepared to care for high acuity residents with no discharge assessment and no discharge planning; transferring residents to acute care hospitals and refusing to readmit them while their bed-hold days are still running, even when they win an administrative appeal;  and, in one recent case, transferring a resident with dementia, cerebral hemorrhage and other ailments to her home, with no supervision and no plan of care to lay for days in her own waste until a relative found her. All are common actions of California’s nursing homes that have nothing to fear from Licensing and Certification.  L&C’s general response – if there is one at all – is to issue a $2,000 fine. A couple of thousand dollars is a cheap price to pay to get rid of a Medi-Cal resident in exchange for a highly reimbursed Medicare or private pay patient.

Multiple Violations – One Citation

In numerous instances, when a citation is actually issued to a facility for a violation, L&C will issue one citation for a variety of violations impacting numerous residents. Failure to deliver medications to residents as prescribed?  CNAs stealing the medications? Medication errors impacting 10 residents in one facility and 27 in another?  Don’t worry about it.  Yes, these “mistakes” might kill residents, but the facility will only receive one citation for $2,000.

Severe neglect of 3-5 residents in one facility? Don’t worry about it. The facility will receive one citation – usually $2,000, since that tends to be the favored civil monetary penalty amount the district offices, regardless of how many individual residents were impacted or how many individual illegal events occurred.

Abuse – Physical, Mental, Verbal and Sexual

Abuse is on the rise under the current DPH administration.  In one case, the facility was fined $2,000 after a CNA took a video of a partially naked resident and the resident’s exposed genital area and posted it on snapchat.  The facility was cited for mental abuse and for failing to “enforce its cell phone policy.”  Say what?  Physical abuse, verbal abuse, sexual abuse and mental abuse are increasingly common in California’s nursing homes, and by failing to refer these cases to the Attorney General’s Office or to local law enforcement, by failing to impose civil penalties commensurate with the gravity of the violation, DPH, L&C does little to curb such abuse. Again, they are telling California nursing homes – it’s okay – we’ve got your back.

The Question is Why?

Why is DPH – L&C so willing to pander to the multi-billion dollar nursing home industry at the expense of the 300,000+ citizens who enter these facilities in any given year?  Clearly, the nursing home industry has the ear (if not the hearts) of the DPH/L&C leaders, as many of those who leave positions at the Department end up working for the nursing home industry. And clearly, they are more afraid of the wrath of the nursing home industry than they are concerned by the neglect and deaths of residents.

In one of the worst examples of pandering to the industry and indifference to the fate of the residents, DPH just approved a provisional license for yet another nursing home for one of the most notorious violators in the history of the nursing home industry with these words of welcome: “Thank you for your shared goals of increasing access to Skilled Nursing Facilities in California while ensuring high quality care for patients and communities.”

These words from DPH were written to an operator who has had three of his nursing homes closed or decertified due to deadly neglect of residents; an operator who received 12 citations involving extreme neglect at another facility this year; whose facilities have been investigated and raided by the FBI; and who was described by the Attorney General’s Office as “a serial violator of rules within the skilled nursing industry.”

If this is DPH/L&C’s vision of “high quality care,” no wonder we are in such trouble.

Page Last Modified: August 16, 2019