Tag Archives: California Department of Public Health

Brius nursing home cited in resident death

State regulators have slapped a Brius nursing home with a severe patient care citation for leaving a 59-year-old obese, mentally ill resident in a prone position on her bed where she was later found dead.

Vernon Healthcare Center – one of the most troubled nursing homes run by Brius CEO Shlomo Rechnitz — received the Class A citation in March 2017, according to a California Department of Public Health citation obtained by Brius Watch. The agency has not yet announced financial penalties for the violation, which is the second most severe class of citations available to state regulators.

Investigators found that the nursing home repeatedly failed to follow protocol in caring for the patient, who experienced a “behavioral episode” the day before her death during which she began screaming and fell off her bed three times.

The facility failed to have a nurse assess her sudden deterioration or alert her doctor as required. Investigators also determined that staffers “did not receive appropriate training to manage a behavioral episode of a mentally ill, obese resident.”

Moreover, administrators at the home were unaware that the death merited an investigation and autopsy. The investigators wrote:

“When asked if the Director of Nursing knew that the resident was found not breathing and pulseless in a prone position, she answered, “Really?” Who told you that?”

The facility’s medical director told investigators he failed to investigate the death or request an autopsy because he was never informed that the resident was lying in a prone position when she was found unresponsive.

The Vernon facility is no stranger to major violations. Two years ago, the CDPH slapped it with a Class A citation and $20,000 fine for failing to provide adequate supervision and assistance to a nursing home resident that was at high-risk for falls.

That same year, the agency also fined it $60,000 for another Class A citation for failing to provide adequate supervision and assistance to a nursing home resident with a history of wandering behavior.

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California ruling threatens Brius expansion

Brius has mounted an 11th-hour challenge to a ruling by California regulators that denied the company licenses for five nursing homes and effectively has halted the company’s rapid expansion across the state.

Last July, the California Department of Public Health (CDPH) denied Brius licenses to operate the facilities citing the company’s 386 serious patient care violations over the previous three years. Brius lost its first appeal in December after it failed to provide to provide legal documents ahead of deadlines, triggering a “Default Decision” against it.

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On May 17, attorneys for Brius asked a judge with the Office of Administrative Hearings and Appeals to overturn the Default Decision and reinstate its appeal. A ruling is expected later this year.

The facilities in question are:
Anaheim Point Healthcare and Wellness Centre
Brookdale Healthcare and Wellness Centre
Chico Heights Rehabilitation and Wellness Centre
Chico Terrace Healthcare and Wellness Centre
River Valley Healthcare and Wellness Centre

Brius is currently operating all of them while it exhausts its appeals process. Should the ruling stand, it could have major ramifications for the company, which has emerged over the past decade as California’s largest nursing home operator, accounting for one-in-14 beds.

Brius’ expansion plans were challenged in 2014 when California Attorney General Kamala Harris filed an emergency motion in federal bankruptcy court seeking to block the company from taking over 19 nursing homes. In court papers, she called Brius CEO Shlomo Rechnitz  a “serial violator” of nursing home rules.

If the CDPH’s denial is upheld, Rechnitz may find himself unable to win approval for new nursing homes in California. In denying his applications last year, state regulators noted that 38 of Brius’ 386 patient care violations put patients in “imminent danger” of death or serious harm. Altogether, 265 of the 386 violations were at a scope and severity level of F or higher, indicating more serious and widespread violations.

There is no reason to think that the CDPH would soon become more amenable to the prospect of Rechnitz taking over additional facilities.

In fact, Rechnitz may have reached the same conclusion as he has already begun expanding into Nevada and Texas.

California Legislation Targets Brius

Last year, Humboldt County residents learned that when a single company monopolizes an entire county’s nursing home beds, patients are at its mercy. Now, the county’s representative to the California Assembly, Jim Wood, is championing legislation that would limit the power of nursing home conglomerates to move patients far from their loved ones.

Last week, Wood introduced Assembly Bill 275 in response to Brius Healthcare’s bid last year to close three of its five nursing homes in Humboldt County. Brius, the largest nursing home operator in the state and the only one in Humboldt, threatened to force nearly 200 elderly and frail patients out of the county in what critics said was a ploy to boost the company’s Medicaid reimbursement rates.

After a four-month stand-off with local officials and patient allies, including the California Association for Nursing Home Reform and the National Union of Healthcare Workers, Brius CEO Shlomo Rechnitz backed down and agreed to close only one facility without forcing any residents of the county and away from their loved ones.

The episode was “a roller coaster ride of anxiety” for patients and their families, Wood, the Assembly Health Committee chairman, said upon introducing the legislation last week. “It became obvious to me that new protections would have to be put in place to prevent this trauma from happening to other residents in the future.”

Wood’s bill would strengthen patient safeguards and empower state regulators to protect patients and prevent operators from simultaneously closing multiple homes in one community.

Rather than merely being able to accept or reject an operator’s closure of a nursing home, Wood’s bill gives the California Department of Public Health the authority to require operators to adopt specific measures to “help prevent possible resident transfer trauma.”

If an operator is proposing to close two or more nearby facilities simultaneously, the department would be authorized to deny approval and “require the facilities to resubmit their closure plans with different timelines.”

The bill also:

  • Increases from 30 days to 90 days the advance notice that operators must give to residents prior to closing a facility.
  • Requires that patients being forced to relocate are assessed by a doctor and a mental health clinician.
  • Mandates that operators closing two or more facilities within a six-mile radius conduct a “Community Impact Report.” The report would include the number of affected residents; the number of nearby nursing homes; the reason for the closures; the number of residents who could potentially experience transfer trauma; and the number of residents who are taking psychotropic medications, diagnosed with dementia or under conservatorship.

California inspectors flunk Brius kitchen in San Rafael

Brius’ San Rafael Wellness & Healthcare Center is located in one of the state’s wealthiest counties, but like many nursing homes operated by Brius CEO Shlomo Rechnitz, it can’t pass a basic health and safety inspection.

The latest issue surrounds it serving expired food to residents. Last year, the California Department of Public Health issued a 45-page report citing the nursing home for stocking its kitchen with expired food including six boxes of “thickened apple juice” that had been expired for nearly four months.

Inspectors also found bagels that had had been expired for more than a week and five bags of dry beans and three bags of chicken flavor stuffing that been expired for 18 months.

Not only were the food temperature logs and kitchen cleaning logs incomplete, but inspectors found that they were covered with a “thick black sticky substance.”

The facility was also cited for its failure to “employ a qualified dietitian” to manage its dietary services.

Today, as the state is reportedly preparing to cite the nursing home for more violations discovered during a subsequent inspection, issues with the kitchen have still not been fully resolved, according to caregivers.

This is hardly the first time that state regulators have cited the San Rafael facility, where Brius has refused to adopt caregivers’ proposals for improved staffing levels and other reforms designed to improve residents’ care and daily lives. In 2014, the facility was cited for being understaffed and under-resourced. Among the items in short supply were gloves and underwear.

Another 2014 report found that the linoleum floor had missing sections and the wooden handrail next to the bathroom was splintering. One resident described the facility as a “slum.”

The next year, inspectors cited the facility for continuing to admit patients during a norovirus outbreak. According to state records, the new patients soon were showing signs of being infected with the virus, which causes fever, vomiting and diarrhea.

When questioned by inspectors about admitting the patients, facility managers responded: “We have already taken the hit financially,” according to state records. Those mangers initially told inspectors that the new patients were admitted to a separate ward, but when pressed for floor plans, they admitted no such ward existed.