Reprint of news article
By Michael Collins
Tuesday, December 1, 2009
Ventura County Star

Sylvia Taylor Stein, middle, visits Dorothy Daley, left, and Joan Wright, residents at Los Robles Care Center in Ojai. Stein is the executive director of Ombudsman, a service based in Ventura helping to advocate for people in long-term care. The facility is well ranked among the county's nursing homes.Photo by Karen Quincy Loberg

A third of the nursing homes in Ventura County received low scores on the federal government’s rating system that was set up to show which facilities are doing a good or poor job providing care.

Seven of the 22 nursing homes in the county received either “below average” or “much below average” rankings on the Nursing Home Compare system run by the Centers for Medicare and Medicaid Services.Two facilities — Victoria Care Center in Ventura and Thousand Oaks Healthcare Center in Thousand Oaks — were scored “much below average,” the lowest ranking possible.

Five others — Country Villa Oxnard Manor Healthcare Center, Shoreline Care Center in Oxnard, Camarillo Healthcare Center, Santa Paula Healthcare and Westlake Healthcare Center in Westlake Village — were rated “below average.”

Quality care advocates say the low rankings should raise a red flag for people who are shopping around for a nursing home for relatives.

“It’s plenty of reason for concern,” said Mike Connors of the California Advocates for Nursing Home Reform. “It suggests that a large percentage of the nursing homes in the county are providing substandard care.”

Sylvia Taylor Stein learns that Los Robles Care Center was able to accommodate Richard Holden, left, when he had to leave his home and join his wife Estelle Holden, lower right, at the Ojai facility. Stein, executive director of Ombudsman, visits the center that has rated well among the county's nursing homes.Photo by Karen Quincy Loberg

Nursing home care in Ventura County “definitely needs to improve,” said Sylvia Taylor Stein, the county’s chief watchdog over nursing facilities.

But while the low rankings are alarming, the rating system relies on information that is often outdated and may not truly reflect the current state of care at a given facility, she said.

“It does give us a road map, but it doesn’t give us the whole story,” said Stein, executive director of Long Term Care Services of Ventura County’s ombudsman program, which investigates allegations against nursing facilities.

The national ratings are a good starting point for people searching for a nursing home, Stein said, but they should also visit the facility before making a decision and consult with her office if they have any questions about the current state of care at a particular home.

“We are in the nursing homes every week, and we look for improvements,” she said.

Better marks expected

Wally Annas, 101, loves to pet Judah, the therapy dog who comes once a week to the Victoria Care Center in Ventura. Annas gives the dog treats and also talks to him. Photo by Juan Carlo

The rankings for the two Ventura County homes that received the lowest rating possible were, in fact, based on complaint investigations from June 1, 2008, to Aug. 31 of this year. Stein said both facilities have since made improvements and, in the case of Victoria Care Center, she would not be surprised to see its federal rating upgraded.

The ratings system, implemented late last year, includes information on everything from fire safety and food preparation to rates of residents suffering from bedsores.

The system assigns each facility a ranking on a scale from one to five stars. Five stars indicate the home ranks “much above average”; four stars are “above average”; three are “about average”; two are “below average”; and one is “much below average.”

Four facilities — Fillmore Convalescent Center, Mary Health of the Sick and Convalescent Center and Nursing Hospital in Newbury Park, St. Joseph’s Health and Retirement Center in Ojai and Los Robles Care Center in Ojai — each received five stars, the highest rating possible.

Homes operated by for-profit companies tended to receive lower scores than those that are nonprofit, a trend that also shows up nationwide.

In Ventura County, the average ranking was 2.8 stars for homes operated by for-profit companies and 4.4 stars for the nonprofit homes.

Ventura County has a higher percentage of privately owned, for-profit nursing homes than the rest of the nation. Seventeen, or 77 percent, of the county’s nursing homes are for-profit; the national average is 68 percent.

For-profit companies nationwide tend to operate their homes with smaller staffs, and that was the case in Ventura County. The average was 1.9 hours of staff time by a certified nursing home worker per resident per day at for-profit homes. In the five homes operated by nonprofits, the average was 2.2 hours.

Magdalena Suarez, 92, visits her husband Manuel Suarez, 84, at the Victoria Care Center in Ventura. She comes every day, helping him in whatever he may need, sometimes just combing his hair. Photo by Juan Carlo

With the poor economy, nursing homes can’t afford to pay employees, and that means they probably don’t have the employee ratio that they need, said Katharine Raley, program manager of the Ventura County Area Agency on Aging.

Another problem, Raley said, is that a lot of homes have staff members who don’t speak English well. That inhibits their ability to communicate with residents, she said.

“I have had complaints in the past from our Medicare beneficiaries that they can’t understand the employees,” she said. “I think that could be a breakdown of care.”

Dorothy Lowe gets help by her daughter Diane Jetton, who comes and visits her three times each year from Brevard, North Carolina, at the Victoria Care Center. She was helping her mom with some bead work. Photo by Juan Carlo

Raley said she has seen firsthand the appalling results of improper resident care.

“This summer, I had a client who was in a nursing home,” she said. “The client kept calling, and I visited. I found that he or she had feces on their hands. On the draw curtain that goes around their bed, there was feces on that. It was just horrible. I didn’t even dare look into the bed.”

Raley declined to identify the nursing home. But, “this is not that uncommon, I don’t think,” she said. “Other times, you can go in, and the smell of urine can knock you over even before you get into a patient’s room.”

Stein agreed that adequate staffing is probably one of the biggest problems the county’s nursing homes face.

Janine Chavira gets a gentle touch, greeted by Sylvia Taylor Stein at Los Robles Care Center in Ojai. Stein is executive director of Ombudsman, a service based in Ventura helping to advocate for people in long-term care. Stein regularly visits the facility that has rated well among the county's nursing homes.Photo by Karen Quincy Loberg

“It’s very, very difficult to find the labor pool for these facilities,” she said. “The caregivers have to pass background clearance checks, which they should. And we just don’t have a large labor pool for this kind of work, so it’s very difficult for facilities to find the care people that they need.”

At Victoria Care Center, inspectors found 35 health deficiencies during the period in which the facility received its “much below average” ranking.

The problems involved mistreatment of residents, nutrition and dietary deficiencies, pharmacy services, environmental matters and administrative issues.

New leader cleaning up

Sylvia Taylor Stein talks with Connie Perez, who is 100 years old and living Los Robles Care Center in Ojai. Stein is the executive director of Ombudsman, a service based in Ventura helping to advocate for people in long-term care and makes regular visits to the facility well ranked among the county's nursing homes. Photo by Karen Quincy Loberg

Stein said many of the problems could be traced back to the home’s previous administration, but the new administrator, John Albrechtsen, is working to turn the facility around.

“What they are dealing with today is the past, when they had a lot of issues that hadn’t been dealt with,” she said. “But they have done an excellent job of cleaning up the past. I really have a lot of hope for cleaning up this facility.”

Albrechtsen, on the job for just six months, said Victoria Care takes in residents that other facilities sometimes aren’t willing to accept. Those residents often require a higher level of care, he said, but the federal system doesn’t take that into consideration when assigning quality ratings.

With 188 beds, Victoria Care is the second-largest nursing home in the county. Because of the home’s size, the state assigns more inspectors to survey Victoria Care than it does at smaller facilities, which increases the likelihood that problems will be discovered, Albrechtsen said.

“While we do feel like there have been some challenges in the facility in the past, it’s very different now,” he said.

Thousand Oaks Healthcare Center was found to have 24 health deficiencies, involving issues of patient mistreatment, quality of care, resident rights, nutrition and diet, pharmacy services and administration problems.

A spokeswoman for the facility did not return a reporter’s phone call. But Stein said the facility recently underwent a change of administrator and is making improvements.

Big improvements possible

Ralph Madlener shares his experiences in the Hollywood film business to Sylvia Taylor Stein at Los Robles Care Center in Ojai. Stein is the executive director of Ombudsman, a service based in Ventura helping to advocate for people in long-term care. She visits the facility that has rated well among the county's nursing homes.Photo by Karen Quincy Loberg

A nursing home’s ranking in the federal system can change dramatically from one period to the next.

Twin Pines Health Care in Santa Paula, for example, was given a one-star ranking after investigators reported 11 deficiencies involving quality of care, pharmacy service, environmental issues and administrative matters.

But on Wednesday, the federal government upgraded its ranking to four stars. In other words, the facility went from the worst rating possible to being ranked as “above average.”

Administrator Cindy Jordan said while the facility’s one-star rating had been disappointing, she felt the state officials who inspected the home had been fair.

The facility addressed the deficiencies and went through another inspection in September, Jordan said, so she had been certain that its federal ranking would improve.

“If I thought I was running a one-star facility, I would definitely be hiding in the closet,” she said. “We come here because we like doing what we’re doing. We like to care for the residents.”

— Thomas Hargrove and Lee Bowman of Scripps Howard News Service contributed to this report.