How good are the Commonwealth’s inspections of nursing homes?

In Pennsylvania, nursing homes are inspected by the Commonwealth’s Department of Health.  This agency conducts annual inspections to determine whether the nursing facility of meeting standards set by the federal and state government.  If noncompliance with regulations is found, the home will be subjected to more frequent visits and corrective action must be taken.

The inspections are performed by a team.  If there are areas of noncompliance with regulations, these are reported and available for free on-line.  Go to www.health.state.pa.us .  Once there, on the left side of the page you will find a list of options.  Select the option “FACILITIES, PROVIDERS AND MANAGED CARE PLANS”.   This page will show a box of “Quick Links”.  Select the first one Nursing Care Facilities.  You will get a map of Pennsylvania that will show all the counties.  Just click on a county and it will bring up a list of nursing homes in that county.  If you want to see survey results (i.e. the inspection results) for a specific nursing home, just click on Patient Care Survey for that facility.  Once there, it will show you the latest results for that facility – that is, was it in compliance or not.   If you want to look at that home’s history, you can select specific dates of inspections that will show you details regarding what problems were found, if any.  You can also look at building surveys and other services that the nursing home states that they offer.

These inspections are one source of information on a nursing home but the limitations are significant.   For example, on February 12, 2011, the Boston Herald reported that one nursing home resident suffering from dementia killed another resident in the dementia unit.  Staff of the Cambria Care Center in Ebensburg, Pennsylvania became aware of the attack by the resident when they found the victim lying in a pool of blood as a result of being bashed in the head with a door by the other resident.  Additionally, bruises were found all over the victim’s body. 

Recent evaluations for this Care Center on the Commonwealth’s web site are instructive as to both the Center and the inspections themselves.  Results for the period January through August showed noncompliance issues in the areas of Visitations; Notification of Medicare/Medicaid Benefits; Prevention of Decreases in Range of Motion; the Completeness, Accuracy and Accessibility of Records; Services to Prevent Pressure Ulcers; Provision of Care/Services for the Highest Well-Being; Requirement Services Meet Professional Standards and others.  Additionally, in three cases patterns of violations were found, including Accurate Procedures for the Pharmacy Services, Safe Sanitary Environment and Self-Determination.   

No single violation here precisely foreshadows the events of February 11, 2011.  Nevertheless, cumulatively they are suggestive of the need for a much closer review of the practices, staffing and management of the home.  Notably, the fact that violations continued to be found is especially concerning.  It is important to remember that the inspections are extremely limited in scope, are only as good as the inspectors and can vary according to the time of day, day of the week and many other variables.  Finally, they capture only those violations that reflect noncompliance with minimum regulations that are oftentimes sketchy and vague.