Los Angeles County auditors have found problems with the way the public health department investigates nursing home complaints involving issues of safety, neglect and other problems that could jeopardize the well-being of residents.
After reviewing a sampling of cases from 2012 to this year, they found that some were "inappropriately" closed without a full investigation, according to an audit report released this week. In others — including five that involved patient deaths — inspectors wrote up problems or issued citations, but the findings were downgraded by department supervisors, sometimes without discussing the changes with the issuing inspector.
In some of those cases, inspectors had concluded that nursing homes failed to comply with doctors' orders, check to see whether patients had adverse reactions to medications or put preventive measures in place to reduce the risk of injuries.
"The quality and integrity of investigations is impaired when surveyors' conclusions are changed without their knowledge," the report concluded.
In response to the audit, public health officials wrote that they have "implemented numerous operational and administrative changes that have measurably improved the program." The changes include new leadership over the inspections program, increased training and improved record-keeping, they said.
But the public health officials said auditors failed to take into account "the dire need for additional staffing and resources," and if the state does not provide more funding, the county should end its contract with the state to handle inspections. The county is responsible for inspections of more than 2,500 health facilities, including nursing homes, acute-care hospitals and hospices.
A previous county audit completed in April found a backlog of 945 nursing home investigations that had been open for more than two years.
The county Board of Supervisors called for the audits in March after an investigation by Kaiser Health News found that public health officials told inspectors to close certain cases without fully investigating them in an effort to reduce backlogs. Public health officials at the time insisted that all complaints were fully investigated, but that sometimes the required paperwork wasn't completed.
Michael Connors, with California Advocates for Nursing Home Reform, called the most recent audit report "extremely troubling," particularly the conclusion that supervisors often stepped in to downgrade inspectors' findings.
"Inspectors get the idea that their supervisors won't approve deficiencies or citations that would trigger needed enforcement actions," he said. "The consequence is that nursing homes throughout the county hardly ever face any consequences, even when the department detects neglect or abuse."
But Connors said it was unclear whether returning inspection responsibilities to the state would be an improvement. A program analysis completed by an outside consultant this month found that the California Department of Public Health's licensing and certification program also was having trouble staying on top of workloads — including closing its own investigations in a timely manner.
That analysis also specifically faulted the state agency's oversight of its contract with the county public health department, which covers nearly a third of the facilities in the state.
A spokesman for the state's public health department said his agency "continues to work with" the county to resolve issues raised in the county audit.
Tony Bell, spokesman for county Supervisor Michael D. Antonovich, said the supervisor plans to seek expedited and increased state funding for the inspection program.