One of Brius Healthcare’s largest nursing homes is “woefully understaffed,” forcing residents to go weeks without a shower and sit in their own excrement for hours waiting for assistance, according to a recently released report by state investigators.

The 10-page report offers a stunning picture of life inside a Brius nursing home.

“I’ve waited several hours after pressing the call light for staff to come. One time I needed to go to the bathroom, I pressed the call light and no one came, and I ended up soiling myself,” one resident of Novato Healthcare Center told state inspectors. “I felt I didn’t have any dignity left.”

Another resident told inspectors that call lights sometimes don’t get answered at all.

“One night at midnight I needed pain medications and pressed the call light repeatedly and no one came,” the resident said. ‘I got up, left the room and sat on the couch outside the facility for two hours and no one ever came to check on me.”

The 181-bed facility, which is the largest nursing home in Marin County, has been cited for understaffing multiple times over the past year by the California Department of Public Health, the agency responsible for licensing and regulating nursing homes. A nearby Brius facility, San Rafael Healthcare & Wellness Center, was fined $15,000 by the agency last year for violating the state’s minimum staffing laws. In the most recent investigation, Novato Healthcare Center was cited for two violations of federal law.

Understaffing appears to be a key Brius strategy for boosting Novato Healthcare Center’s profits. The nursing home reported $1.8 million in profits during 2016, the most recent year for which data are available. This figure translates into an operating profit margin of 11.4%, which is nearly five times higher than the statewide average for nursing homes.

Last month, caregivers and residents of Novato Healthcare Center testified at a public hearing about understaffing by Brius, which controls one-in-five nursing home beds in Marin County. After listening to caregivers and patients, local community leaders called on the company to improve staffing and boost pay in order to reduce the constant turnover of staff at the facility.

Echoing the concerns of community leaders, the resident who experienced chest pains didn’t blame nursing assistants for poor care, citing their heavy workload. “(They) have too many residents and are not able to do everything,” he said.

Another resident told investigators that on some days nursing assistants each had to care for up to 17 residents each. On one of those days, the resident said: “I got trapped in my bed and could not get out and pressed the call light for help and it took one and a half hours for staff to respond.”

Another resident said she had gone weeks without a shower. When inspectors reviewed her file they saw that she had received only one shower in January, despite a policy that residents should be showered twice a week. A third resident, who arrived midway through January, received no showers during the month, according to records reviewed by inspectors.

And a fourth resident wasn’t shaved in January and received only one shower, records showed. That same resident reported having to lie in his own excrement for “several hours” before someone arrived to clean him.

Several nurses and nursing assistants said understaffing had made their jobs nearly impossible. “There is not enough time to do everything, to answer all call lights, feed residents, clean the residents,” one nursing assistant told inspectors. “You cannot give them high quality care.”

Another nursing assistant stated that “residents were soaked in urine and soiled with feces when nursing assistants came in the morning because there were not enough of them during the night shift.”

Two residents, who were roommates, told investigators: “The facility is understaffed. Woefully understaffed.” “The beds don’t get made.” “Call lights take up to two hours to be answered.” “Food trays are not picked up after meals.”

The latest citations stem from an inspection completed in February in response to a complaint filed by the National Union of Healthcare Workers (NUHW), which represents caregivers at the facility. During their investigation, state officials interviewed 9 residents, 7 nursing staff, residents’ family members, and the Director of Nursing. Inspectors also reviewed medical records and facility policies.

The nursing home was cited for failing to provide residents with sufficient nursing staff and failing to post daily nurse staffing data in a public place inside the facility that’s accessible to residents and visitors. However, the California Department of Public Health failed to fine the nursing home despite the conditions described by residents.

Understaffing appears to be a key Brius strategy for boosting Novato Healthcare Center’s profits. The nursing home reported $1.8 million in profits during 2016, the most recent year for which data are available. This figure translates into an operating profit margin of 11.4%, which is nearly five times higher than the statewide average for nursing homes.

Last month, caregivers and residents of Novato Healthcare Center testified at a public hearing about understaffing by Brius, which controls one-in-five nursing home beds in Marin County. After listening to caregivers and patients, local community leaders called on the company to improve staffing and boost pay in order to reduce the constant turnover of staff at the facility.