Around 300,000 Californians are in nursing homes at any given time, and according to the State Auditor, their safety is at risk.

The California Department of Public Health (CDPH) has a backlog of more than 11,000 complaints related to long-term health care facilities, many of them with “relatively high priorities,” according to a report (pdf) issued Thursday. The department “has not effectively managed investigations of complaints related to long-term health care facilities.”

On average, the complaints have been sitting around for about a year. State and federal laws require the CDPH to investigate complaints in a timely fashion at more than 2,500 facilities, which is handled through 15 district offices. They look at open complaints from the public and entity-reported incidents (ERIs) generated by the facilities themselves.

Ten out of every 11 backlogged cases are public complaints. The state auditor found 370 of those involved situations where patients were in “immediate jeopardy―indicating a situation that poses a threat to an individual’s life or health.” One out of 11 cases are ERIs.

Although the report identified a number of reasons for the unwieldy backlog, it singled out a lack of oversight of the district offices. “Until late 2013, when it established a tracking log of open complaints and ERIs, Public Health did not have a standardized method for monitoring the status of open complaints and ERIs at the district offices and for assessing whether these complaints were being addressed promptly.”

There were no formal agency policy and procedure guidelines for investigating complaints. District offices were not given time frames for completing investigations. That lack of oversight led to striking inconsistency in the quality of investigations from one locale to another. Some of the offices conducted on-site investigations of ERI cases (97% of the time in Chico) while others did not (less than 20% in Orange and L.A. counties).

Three out of the four district offices visited by the state auditor said they didn’t have the resources to do the job properly. Their complaints were echoed by members of the Professional Certification Board (PCB), the state agency’s investigative group.

Anna Gorman at Kaiser Health News wrote that the auditor’s report was a result, in part, of stories they wrote about the Los Angeles County Public Health Department closing cases without completing investigations because they lacked a complainant or listed one as anonymous.

“They are supposed to take action to protect people from harm,” Michael Connors, an advocate with California Advocates for Nursing Home Reform, told Gorman back in March. “They are supposed to set out right away, investigate and take action to stop it from occurring. . . . They don’t have the option of picking and choosing.”

Assembly Democrat Mariko Yamada, who asked for the audit, told Kaiser the “mangled” investigative process reflected “almost a culture of indifference.”

–Ken Broder

To Learn More:  

California Audit Faults Health Officials’ Handling of Nursing Home Inspections (by Anna Gorman, Kaiser Health News)

Audit: California Nursing Home Oversight Haphazard (by Marjie Lundstrom, Sacramento Bee)

L.A. County Officials Told Inspectors to Cut Short Nursing Home Probes (by Anna Gorman, Kaiser Health News)

California Department of Public Health: It Has Not Effectively Managed Investigations of Complaints Related to Long-Term Health Care Facilities (California State Auditor) (pdf)