At Valentine Law Group, we believe that prevention of abuse and neglect altogether is the best way to solve this tragic problem in our communities. Just like many things in life, there are good facilities and bad facilities. Therefore, family members must educate themselves about the history of the proposed facility before there loved one is admitted there.
There are government agencies who oversee the various types of care facilities for elderly and dependent. Searching facilities on these agencies’ websites is a good starting point, but it is imperative that further research on facilities needs to be done before deciding on a place for your loved one.
The best way to gather information about a facility is to personally visit and observe that facility. You know your loved one and you should use and trust your instincts about whether a particular place feels like it would be a good fit for them.
The reality is that most of the problems in these facilities begin within the first few weeks of your loved one’s admission. There are several reasons why this occurs, but chief among them is that your loved one is in a new environment, which they must learn to adjust to, and because the facility staff members are unfamiliar with your loved one and may not know the specific ways your loved one communicates discomfort or pain. When your loved one is in a facility, try to visit at various times throughout the day instead of keeping to a set routine. That way, you can observe as much staff activity as possible and see what type of care is being provided at different times. Pay attention to how often staff members are coming to your loved one’s room. If your loved one is bedbound, are staff members repositioning them every two hours, per industry standard?
For skilled nursing facilities, staff must create a baseline care plan within 48 hours of your loved one being admitted to the facility. See Code of Federal Regulations 482.21A. A complete assessment and comprehensive care plan must be done within 21 days of admission. There must be a care plan meeting that includes the family and the department heads of all relevant areas of specialty in the facility. If there are any changes of condition to your loved one, this process must be redone to address that change. Family members must be as participatory as possible. Family members should ask for copies of the care plan so they can ensure that staff are giving the care that is laid out in those plans. Be armed with information, get the documents, and make sure the care is being carried out.
For RCFEs or assisted living facilities, there must be a resident-centered care plan meeting between the caretakers, the resident or their representative, and any other health care providers involved with the resident’s care. This meeting must occur within the first fourteen days of the resident being admitted to the facility. In this group meeting, discussion should focus on the risks, problems, and interventions involved in you loved one’s care. If this meeting does not occur or does not address these topics, this is an immediate “red flag.” See California Health & Safety Code §1569.80.
CENTERS FOR MEDICARE AND MEDICAID SERVICES “FIVE STAR” RATING
The California Health & Safety Code requires that a skilled nursing facility that has been certified for the purposes of Medicare or Medicaid post their overall annual facility rating as determined by the federal Centers for Medicare and Medicaid Services (CMS). The Five-Star Quality Rating System was created to help consumers, their families, and caregivers compare nursing homes more easily and help identify areas about which you may want to ask questions. Nursing home ratings are assigned based on ratings given to health inspections, staffing, and quality measures. Search using a zip code and/or facility name.
The website for the Five-Star Rating is here.
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH FACILITY DATABASE
The California Department of Public Health (CDPH) curates a database for the 10,000+ health care facilities that fall under their regulation. This database provides consumers with information about licensed and certified facilities throughout California. Search using a zip code and/or facility name.
Facilities that participate in the Medicare and/or Medicaid programs have an onsite comprehensive inspection annually on average, with rarely more than fifteen months elapsing between inspections for any one particular facility. Inspections are unannounced (but happen within a specified window of time) and are conducted by a team of health care professionals who spend several days in the facility to assess whether the facility is in compliance with federal regulations. These inspections review facility practice and policies in areas such as resident rights, quality of life, medication management, skin care, resident assessment, nursing home administration, environment, and kitchen/food services.
In addition to the state surveys, inspectors also investigate formal complaints made against a facility. Anyone can file a complaint against a healthcare facility or provider – a patient or facility resident, a relative, a friend, or even a member of the general public – either anonymously or by name. An investigation can result in findings of “substantiated,” meaning that the inspector could verify by evidence that the alleged action in the complaint occurred, or “unsubstantiated”, which means there was no supporting evidence. The inspector can also find that the complaint was substantiated but no regulation was violated. Often, a complaint cannot be substantiated if a resident dies, is incompetent, or leaves the facility.
The website for the CDPH Facility Information Database is here.
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES ELDERLY ASSISTED LIVING DATABASE
The California Department of Social Services (DSS) curates a database for facilities licensed as Elderly Assisted Living Facilities, otherwise known as Residential Care Facilities for the Elderly. Consumers can find facility evaluation reports and can also see the number of complaints and citations a facility has received. Search by facility name or address. Blue text on a facility’s page are links that will lead to documents available to the public.
Facilities licensed by the California Department of Social Services have onsite comprehensive inspections with far less regularity than those licensed by the Department of Public Health. Therefore, information regarding these facilities’ evaluations may not be as recent. However, inspectors conduct complaint investigations with great similarity to those conducted at DPH facilities. A member of the general public can sign up to get automatic updates regarding a particular facility to see whenever a complaint investigation occurs.
People should be leery of a facility that has a substantial number of complaint investigations, whether substantiated or not.
The website for the DSS Elderly Assisted Living Database is here.
The Sacramento Bee published an outstanding three-part article series on the lesser-known aspects of California nursing homes. Find this excellent source of information here:
Unmasked, Part 1: How California’s largest nursing home chains perform
Unmasked, Part 2: Who owns California’s nursing homes
Unmasked, Part 3: California falls short in disclosing nursing home ownership