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Alzheimer's patient was sexually abused, state says. Now nursing home says it's closing

Sacramento Bee - 9/2/2017

Sept. 02--A large Carmichael nursing home that was targeted for years by government regulators for poor quality care has decided to voluntarily close after state inspectors determined that a female resident was sexually abused multiple times by another resident at the facility.

For 37 months, the Eagle Crest nursing home, formerly known as Carmichael Care & Rehabilitation Center, was on the federal government's consumer-beware list of troubled facilities. Other facilities nationwide came and went from the list, but Eagle Crest remained, supposedly operating under stepped-up scrutiny intended to nudge it back into compliance.

In June, the state had had enough.

Documents obtained late Friday from the California Department of Public Health show that the state recommended this summer that federal regulators drop the facility from its Medicare provider rolls, a drastic action that strips a nursing home of its critical government funding.

Instead, the nursing home's owner acted first.

In a business move that will upend the daily lives of dozens of patients and their families -- and significantly reduce the number of skilled nursing beds in the Sacramento region -- Pennsylvania-based Genesis HealthCare Inc. recently notified the state it would voluntarily close Eagle Crest in October.

The company took issue with the state, though, noting that the 126-bed facility had self-reported the allegation of sexual abuse in February. The company disputed the state's findings that an "immediate jeopardy" citation was warranted or even that the facility was out of compliance at all.

A finding of immediate jeopardy, known as an IJ, is a heart-stopper for nursing home operators and can carry among the steepest penalties. Immediate jeopardy is called when a provider's noncompliance has caused, or is likely to cause, serious harm or death to a resident.

In its investigation, the state found that the female patient, who had Alzheimer's disease, had been fondled, kissed and abused by a male resident who was known to be a risk for inappropriate sexual behaviors and had a "history of inappropriate touching of a confused patient," state documents show. Even so, the male resident, who the state report described as "cognitively intact," was not receiving one-on-one monitoring, the report says.

The facility's failure to safeguard the woman had placed all 36 female residents at risk for sexual abuse, the state found.

The facility had self-reported to the state that the man had been found in February in the woman's room, pulling up his pants while she lay fully undressed in her bed, documents show.

On June 22, the state notified Eagle Crest administrator Harumi Hurrianko it was recommending that the Centers for Medicare and Medicaid Services terminate its provider agreement. A month later, a lawyer for Genesis notified the state it would voluntarily close, calling the immediate jeopardy citation the "straw that brings us to make this difficult decision."

The closure of one of the region's largest skilled nursing facilities startled elder care advocates this week. They say they are worried about the loss of beds and the stress placed on vulnerable residents suddenly being forced to relocate, possibly out of the county. The single-story beige building is located along a busy stretch of Fair Oaks Boulevard, about a mile west of the boundary between Carmichael and Fair Oaks.

Over the years, Eagle Crest has had its share of notoriety, including a rash of state citations and fines, numerous federal deficiencies and generally poor ratings. Some recent inspection reports show the facility has been written up and penalized for inadequately treating or preventing bed sores, failing to self-report possible abuse and not attempting CPR on a resident who wished to be resuscitated.

But none of the health care advocates contacted by The Bee late this week was aware of the sexual abuse allegations that preceded the company's decision to close.

"This really caught us off-guard," said California's long-term care ombudsman, Joe Rodrigues, reacting to the closure news. He noted that the local ombudman's office first learned about the company's closure plans around mid-August.

"This is going to have a big impact; it's such a large facility," Rodrigues said. "Where are we going to find homes for these people? And why are they closing this facility in the first place?"

A spokeswoman for Genesis Healthcare, Jeanne Moore, would not say why the facility was closing. But Moore offered assurances in an email that the facility is coordinating the closure with the California Department of Public Heath and "will comply with the requirements for closing a nursing center." Closure will be around Oct. 20, she said.

"We will continue our day-to-day care and operations during this process until our last patient or resident is transferred and the center is closed," she stated. "We will take all reasonable precautions to eliminate or reduce any negative effects that may result from the transfer."

She specifically cited three other facilities owned by Genesis in Northern California that could take residents from Eagle Crest: American River Care Center in Carmichael, Creekside Center in Stockton and Willows Center in Willows.

Two of those facilities have had their own alleged quality issues, with both American River and Willows Center receiving "below-average" ratings in an ongoing statistical analysis of California nursing homes by the University of California, San Francisco. The database, which examines numerous aspects of facilities from staffing ratios to complaints to deficiency trends, was created to help consumers make long-term care choices.

Eagle Crest currently has an overall "poor" rating, while Creekside Center was deemed "superior" in the ratings available on the CalQualityCare.org website.

Of the 59 nursing homes in the four-county region, only 15, or about a quarter, have more licensed beds than Eagle Crest. Genesis informed the California Employment Development Department that 72 jobs also would be lost in the closure.

A spokeswoman for the California Department of Public Health, which licenses and inspects nursing homes, said the state approved the closure and relocation plan on Aug. 4.

Under California law, if 10 or more residents are likely to be moved due to a change in a nursing home's operation, the facility must submit a proposed relocation plan to the state and cannot proceed until it's approved. Whenever homes close, advocates worry about possible "transfer trauma," in which the upheaval and separation from family, friends and known caregivers can cause serious harm and even death to fragile residents.

"People who live in nursing homes are extremely vulnerable," said Michael Connors of California Advocates for Nursing Home Reform, based in San Francisco. "Separating them from everyone and everything they care about is cruel and traumatic."

Transfer trauma has become a hot topic in California. Outrage erupted last year in Humboldt County over the prospect of widespread transfer trauma when the state's largest nursing home owner, Shlomo Rechnitz of Los Angeles, threatened to close three of his facilities in the remote region. Before Rechnitz significantly modified his plan, some patients were facing the possibility of moving hundreds of miles away.

As a result, Assemblymen Jim Wood, D-Healdsburg, introduced a bill that would increase the amount of advance warning that residents and others receive prior to a nursing home closure. AB 275 was signed by the governor on Friday.

Even before the Eagle Crest shutdown, the Genesis chain of nursing homes had been facing widespread regulatory and public-relations problems.

In June, the U.S. Department of Justice announced that Genesis HealthCare Inc. would pay the government nearly $54 million to settle six federal lawsuits. The government alleged that companies and facilities acquired by Genesis had submitted false claims to government health care programs for medically unnecessary services, and "grossly substandard nursing care."

A 2014 Bee investigation found that nursing homes operated in California by Genesis HealthCare received complaints of abuse at seven times the statewide average. The company is headquartered in Kennett Square, Pa.

The closure of Eagle Crest illustrates the difficulty regulators have in pushing operators to make improvements amid accusations of substandard care -- even when they are publicly shamed by government inspectors.

Eagle Crest spent more than three years on the "Special Focus Facility List" maintained by the U.S. Centers for Medicare and Medicaid Services. The list is a kind of improve-or-else warning program aimed at getting operators to correct serious problems, or lose their ability to collect government funding.

Special Focus Facilities are surveyed more frequently and, if problems persist, are subject to possible fines and other penalties, including termination from the Medicare and Medicaid programs.

On the latest list, updated Aug. 17, only one nursing home out of 118 nationwide that were publicly identified had been on the list longer than Eagle Crest.

"It's a token enforcement program that's done a poor job of turning around dangerous nursing homes," said elder-care advocate Connors. "The question is, what's wrong with the system if the worst of the worst are under all this scrutiny -- then why aren't they getting better?"

California, with 1,241 licensed skilled nursing facilities, currently has seven nursing homes on the feds' consumer-beware list. One, in Fairfield, has "shown improvement," the list reveals, while another in Los Angeles is said to have recently graduated.

The other California homes, including Eagle Crest, are defined by the government as having "serious quality issues" and have been assigned to the program to "stimulate improvements," according to the government's web page on its Special Focus Facility Initiative.

Marjie Lundstrom: 916-321-1055, @MarjieLundstrom

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(c)2017 The Sacramento Bee (Sacramento, Calif.)

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