Brius has the worst patient care record among California’s largest nursing home chains, according to a scathing report issued by the California State Auditor on May 1. The 82-page report also criticized state regulators for failing to safeguard patients from unscrupulous operators providing substandard care.

California State Auditor Elaine Howle found that the California Department of Public Health has failed to perform necessary inspections or issue timely citations for substandard care. She also criticized the department for failing to use consistent and transparent parameters in licensing homes.

“Together, these oversight failures increase the risk that nursing facilities may not provide adequate care to some of the state’s most vulnerable residents,” Howle wrote.

Among California’s three largest nursing home chains, Brius racked up .52 citations per 100 nursing home beds. That was nearly double the next two leading operators and nearly 24 percent higher than the statewide average.

Should state legislators adopt the Auditor’s recommendation to reduce Medicaid funding to operators with poor patient care records, Brius would lose $7.4 million in state funding, according to the audit.

“This audit is a scathing report and points out significant deficiencies that exist in Brius skilled nursing facilities in California.” State Sen. Mike McGuire told the Eureka Times-Standard.

McGuire and Assemblymember Jim Wood requested the audit after reviewing data compiled by the National Union of Healthcare Workers showing that in 2015 Brius owner Shlomo Rechnitz had his homes pay for $67 million worth of goods and services from 65 companies also controlled by Rechnitz.

“It’s no surprise that if you siphon money away from elderly residents, they’ll get poorer care,” NUHW President Sal Rosselli said. “We applaud the Auditor for recommending that the state now establish new laws to hold nursing homes accountable so our elderly receive the care they need and deserve.”

The audit confirmed NUHW’s research, and found that from 2007 through 2015, Brius increased its related-party expenses per patient bed by about 600 percent, according to the audit.

While these insider transactions are currently legal, Michael Connors of the California Advocates for Nursing Home Reform told California Healthline that they ultimately “siphon off money intended for care in order to pad and hide profits.”

Assemblymember Wood has already drafted legislation aimed at increasing transparency of these insider transactions, and the audit recommends that the state amend reporting protocols to mandate that operators detail every one of their transactions and provide their related companies’ profit and loss statements.

“It is impossible to get an accurate view of [Brius’] total profit and loss statement because they did not include all related companies that work within their health care realm,” McGuire told the Times-Standard.

The auditor directed much of its criticism at the state health department, which it held responsible for continued “substandard quality of care” at nursing homes.

Citations issued by the state declined 34 percent between 2006 and 2015, while federal citations increased 32 percent during the same time period, the Auditor found. State regulators only issued citations for 15 percent of the most serious deficiencies it identified and failed to perform relicensing inspections on nursing homes as required under state law.

The auditor also found that the state failed to issue citations in a timely manner and failed to collect fines. Although the Department of Public Health assessed more than $28 million in citation penalties between 2006 and 2015, it collected only $17 million, the auditor found.

Wood told the Times-Standard that it was “very, very disturbing” that the Department of Public Health was not holding nursing homes accountable. The failure to issue citations, as well as delays in issuing them, are particularly worrisome, he said. “They are not doing their job.”

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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.

A 181-bed Brius nursing home in Marin County, Calif. has been cited for understaffing and providing such substandard care that a state investigator said it was “very dangerous” for certain residents.

Novato Healthcare Center was cited with 19 deficiencies in 2017, according to reports posted by the California Department of Public Health. Brius – the largest operator of nursing homes in Marin  – controls one in five nursing home beds across the county.

Most of the deficiencies stem from an inspection last May that found many residents struggling to get the care they needed as the home suffered from severe understaffing. The facility was also cited for stocking expired medications.

These new findings come as caregivers, patients and their loved ones recently testified about understaffing at the facility as well as a second nearby Brius home, San Rafael Healthcare and Wellness Center. A board composed of community leaders conducted a public hearing earlier this month and issued preliminary findings that both facilities need more staff and better pay to reduce turnover. The board is also considering whether to recommend that a new operator be identified  to replace than Brius.

Inspectors reviewing the Novato home last year found that staffing was such an issue that the family of one resident hired a private caregiver to sit with a terminally ill resident after the resident had suffered a fall.

One male resident was found with long, dirty fingernails, unkempt, greasy hair, and unshaved. A caregiver questioned about the man’s appearance suggested that it was due to the facility’s having hired many temporary nursing assistants from a nursing registry.

Investigators were also troubled by the care provided to a man who was paralyzed on his left side from a recent stroke. The man had been left for hours on his left side, unable to move or alert staff that he had soiled himself. The investigator noted that medical staff failed to properly instruct caregivers about the resident’s needs and care. This failure was especially dangerous because he was being cared for by temporary nurses and nursing assistants.

A separate investigation, stemming from a resident complaint made last April, further documented Novato Healthcare Center’s chronic understaffing.

One caregiver told investigators that staffing was so low they had to work double shifts and that there were so few nursing assistants that nurses had to take on their jobs.

Another staffer said she had been assigned as many as 28 residents during a single shift, and that the staffing situation is “overwhelming” for staff.

Even the staffing coordinator acknowledged that the home was relying on temporary workers, and that even with temps the facility was still shortstaffed.

As part of its $6.9 million settlement with the U.S. Department of Justice over allegations of Medicare and Medicaid fraud, Brius has signed “Corporate Integrity Agreements” (see below) that require enhanced federal oversight of its four San Diego area nursing homes during the next five years.

The agreements, obtained by BriusWatch, require the homes to provide annual reports to the US. Department of Health and Human Services’ Office of Inspector General documenting their compliance with federal anti-kickback laws.

The homes are required to appoint a compliance officer who will be in charge of “developing and implementing policies, procedures and practices designed to ensure compliance,” monitoring compliance, and making compliance reports to the nursing homes’ governing bodies.

The facilities also must hire an outside entity – such as an accounting, auditing, law for consulting firm – to serve as an “Independent Review Organization,” which will monitor the homes and prepare annual reports.

The facilities also must train employees about the anti-kickback statutes, establish a compliance committee that reports to federal regulators, and create an anonymous hotline where whistleblowers can disclose any “potential violation of criminal, civil or administrative law.”

The corporate integrity agreements, signed by Brius attorney Mark Johnson, are in place at Amaya Springs Health Care Center in Spring Valley, Brighton Place – San Diego, Brighton Place – Spring Valley, and Point Loma Convalescent Hospital.

Following an FBI corruption probe, Brius admitted that its employees at the four San Diego nursing homes used corporate credit cards to pay for gift cards, massages, tickets to sporting events, and a Hornblower cruise given to discharge planners at Scripps Mercy Hospital San Diego in order to induce patient referrals.

A Brius employee said she personally informed CEO Shlomo Rechnitz about the “pervasive” fraud during a meeting at his Los Angeles home in the spring of 2010, according to a federal lawsuit. Nonetheless, the kickback schemes continued. The following year, the employee alerted federal authorities.

Following a federal investigation, Brius — which controls one-in-14 California nursing home beds — agreed to pay up to $6.9 million to resolve allegations that it defrauded government healthcare programs through the kickback scheme.

“Kickbacks for patient referrals are illegal under federal law because of the corrupting influence on our nation’s healthcare system,” Acting U.S Attorney Sandra R. Brown said late last year when the settlement was announced.

Under the five-year Corporate Integrity Agreements, the homes must also create a centralized tracking system “monitoring the use of leased space, medical supplies, medical devices, equipment and other patient care items to ensure that such use is consistent with terms of the agreements.”

Federal investigators will also have full authority to interview officials at the nursing homes and review records to verify compliance.

The homes will be subject to $2,500 daily fines for failing to implement the compliance program or submit timely annual reports. Failing to grant access to federal investigators will carry a $1,500 fine and any compliance report that includes false information carries a $50,000 fine.

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Brius recently dropped its application to permanently operate a Chico nursing home, raising new questions about the future of two dozen additional California nursing homes that the company is running without permanent licenses.

Over the past four years, California officials have taken action to block Brius owner Shlomo Rechnitz from obtaining licenses to operate new homes, citing his company’s poor patient care record. Yet, Rechnitz, the state’s largest nursing home operator, has been able to run these facilities on an interim basis, creating a situation where more than one quarter of his roughly 80 California nursing homes are being run with provisional licenses.

The California Department of Public Health’s first action to block Brius’ rapid expansion came in 2014 when it denied the company’s application to take over Windsor Healthcare’s Riverside Convalescent Hospital in Chico. Department officials cited Brius’ history of patient care violations for its denial, but allowed Brius to continue operating the facility, now known as Riverside Point Healthcare and Wellness Centre, as Brius appealed the state’s ruling.

Last September, Brius abruptly withdrew its appeal in advance of hearings before an administrative law judge. However, instead of finding a new operator, state regulators have so far continued to allow Brius to run the facility despite a scathing report last year by federal inspectors.

The report, compiled by the Centers for Medicare & Medicaid Services (CMS), quoted one nursing assistant employed by Brius telling inspectors that there were frequently only two nursing assistants on the overnight shift at the 99-bed facility. “Not the care I want to provide,” the caregiver said. “Feel so bad because we have their lives in our hands.”

The facility’s director of nursing reported that at one point the Chico home was staffed entirely by temporary workers from a nursing registry. Not surprisingly, the home racked up more than twice as many health citations as the California average.

Two years after state regulators denied Brius’ initial application to take over the Chico nursing home, they denied the company’s request to permanently operate five additional Windsor homes, citing that over the previous three years Brius had amassed a whopping 386 serious patient care violations.

There is also little clarity concerning the status of these five homes. Rechnitz lost his initial appeal seeking to overturn the state ruling when his attorney failed to file timely paperwork. However, an administrative law judge has allowed Brius to move forward with its appeal despite its procedural violation. The case has not yet been heard by a judge.

Rechnitz and Windsor Healthcare’s former top executive Larry Feigen are close associates who teamed up two years ago to help bankroll an unsuccessful congressional campaign by a Republican candidate in Southern California.

Among the more than 20 nursing homes that Brius currently operates without permanent licenses, a majority were acquired through bankruptcy court. In 2014, a judge awarded Brius control of 18 nursing homes formerly operated by Country Villa Health Services despite an emergency motion filed by then California Attorney General Kamala Harris seeking to block the transaction.

The California Department of Public Health has still not granted Brius licenses to operate these facilities on a permanent basis.

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Brius is facing its fifth wrongful death lawsuit in Humboldt County in the past 15 months, this time from the relatives of a resident they claim had a such a large build-up of fecal matter in her digestive tract that it looked like “an eight-month pregnant uterus.”

The Eureka Times-Standard reported last week that the fecal matter build-up occurred over several months and eventually blocked the passageway out of Jeannette Sharp’s stomach.

“The operating physicians captured 3-4 liters of fecal matter from Ms. Sharp’s colon with more spilling into her abdominal cavity,” court documents state. “Because of the severity of her fecal impaction, Mrs. Sharp died shortly after the surgery.”

The lawsuit alleges that Granada Rehabilitation and Wellness Center failed to follow Sharp’s care plan, which required monitoring of her bowel movements.

Sharp, who also suffered from dementia, had lived at the nursing home since November 2010, according to the paper.

The lawsuit, filed by the firm Janssen Malloy LLP, also names Brius CEO Shlomo Rechnitz among the defendants. The firm has also filed lawsuits against Brius over the deaths of two patients, Ralph Sorensen and Randy Kruger, who developed severe pressure sores, and Alan Dewey, whose family alleged that he was dumped at a nearby hotel, where he later died.

Last month, Brius was hit with another lawsuit which claimed that 84-year-old Ida Branch died five days after being admitted to the Pacific Rehabilitation and Wellness Center in Eureka following a surgical procedure on her leg. Branch’s family is being represented by law firm of Garcia, Artigliere & Medby.

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