California Department of Public Health Endangers Lives and Mission of Nursing Home Inspectors

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The notoriously mismanaged California Department of Public Health (CDPH) is back in the news again for all of the wrong reasons. Not only has the Department now acknowledged that it has failed to regularly test for COVID-19 the inspectors surveying nursing facilities with outbreaks of the virus, but it has embarked upon a sweeping plan to undermine the independence and reliability of its own inspection program at a time when nursing home residents need rigorous enforcement most.

An investigation by the Los Angeles Times – As coronavirus ravaged nursing homes, inspectors were not being tested – found that CDPH “has not provided coronavirus testing for the very people it is sending to make sure facilities comply with rules on infection control.”

The Times interviewed eight registered nurse (RN) inspectors who described their fears that they are spreading the disease during visits to many facilities without being tested or having proper personal protective equipment (PPE). After initially appearing to claim that it was  testing inspectors, CDPH later acknowledged it was not. Only after the Times expose was published on July 24 did Governor Newsom announce that the Department would establish a testing program for inspectors.

One inspector reported she came down with a bad cough and tested positive for COVID-19 soon after visiting more than a dozen nursing homes in two days. It is a frightening possibility that untested inspectors are spreading the virus during such visits. Moreover, sending an inspector to visit more than 12 nursing homes in two days adds to the concern that CDPH has directed inspectors to make drive-by infection control visits at nursing homes to create the appearance it is monitoring nursing homes during the pandemic.

Another inspector summed up the situation: “We’re missing the whole point of public health 101, and we’re the public health department.”

The shocking revelations came after five months of lockdowns in California nursing homes, where more than 3,100 residents have suffered and died alone. It is hardly the first time that CDPH’s actions or inactions have endangered the lives of nursing home residents during this crisis. It covered up outbreaks and deaths for weeks at the outset of the pandemic, waived key standards, dragged its feet on requiring and monitoring testing, ordered inspectors not to cite violations during infection control surveys, allowed dangerous nursing homes to be designated as dedicated COVD-19 facilities and permitted operators to run nursing homes even after denying them a license to do so. And all along, CDPH leaders have taken their direction from the nursing home industry.

CDPH Escalates its Attack on Mission of Nursing Home Inspectors

The mission of inspectors to enforce federal and state nursing home standards is also threatened. As CANHR reported in June, CDPH leaders established a plan for inspectors to “Adopt-a-SNF” that would turn hundreds of its inspectors into free consultants to nursing home operators. Heidi Steinecker, Deputy Director of CDPH, touted it as a model for the nation during legislative hearings in June.

According to inspectors, CDPH recently intensified its plan to convert them into facility consultants by issuing and requiring them to sign a new duty statement that states thirty percent of their time will be spent educating, advising and assisting nursing home operators and their staff. This action puts inspectors in the impossible position of deciding whether to issue deficiencies for observed violations while knowing that doing so will reflect poorly on their peers and the Department’s leaders.

CDPH also issued a renamed version of the Adopt-a-SNF plan, which it is now calling the “Quality and Safety State SNF Survey Model.” The renamed plan acknowledges that nursing home residents’ lives are at high risk due to poor care and infection control caused by lowly-paid and under-trained staff, transient management, and lack of medical director leadership. Yet the plan does nothing to address these longstanding dangers.

Its solution:  Assign surveyors to act as consultants to nursing homes, the same as the Adopt-a-SNF plan.

CANHR has repeatedly urged CDPH to withdraw the plan and to turn its attention to our recommendations on protecting the lives of residents during the pandemic and CANHR’s Ten-Point Plan to Reform California Nursing Homes. It’s given no sign that it intends to do so.