California's second-largest nursing home chain has agreed to pay $1 million and improve the quality of care at its 30 facilities in the state, California Attorney General Bill Lockyer announced.
The settlement will result in a permanent injunction that resolves a civil lawsuit filed by the Attorney General's Bureau of Medi-Cal Fraud and Elder Abuse in Los Angeles County Superior Court.
"Despite dozens of warnings and fines, Pleasant Care was simply unable to provide an appropriate level of care for its residents. This injunction will make sure that Pleasant Care complies with existing law and also provides the best level of care possible," Lockyer said.
Lockyer's lawsuit stems from numerous allegations of elder abuse and criminally negligent care, including more than 160 citations that the California Department of Health Services (DHS) has issued against Pleasant Care facilities across the state over the last five years for regulatory violations.
The injunction was issued by Superior Court Judge Laura Matz.
Under the terms of the injunction, all 30 of Pleasant Care's skilled nursing facilities in California must comply with numerous conditions that will immediately and dramatically improve the quality of care provided to residents occupying the company's more than 4,300 skilled nursing facility beds, including:
• Mandatory Staff Training - staff must undergo training on proper patient care in such areas as wound treatment, accurate record keeping, and the prevention of malnutrition and dehydration;
• Abuse and Neglect Investigations - each facility is required to implement policies to ensure prompt reporting and investigation of any alleged act of abuse or neglect towards a resident, and staff persons reasonably suspected of committing abuse must be placed on administrative leave during the course of the investigation;
• Compliance Officer - Pleasant Care must hire a Compliance Officer who will be responsible for ensuring that each facility complies with the law, properly responds to state and federal investigations, and delivers proper levels of care to residents;
• Independent Monitor - Pleasant Care will pay for an Independent Monitor, selected in consultation with the Attorney General, who has broad authority to order statewide quality of care improvements, and will annually report its findings to the AG over the next five years;
• Nurse to Patient Ratio - Pleasant Care must maintain nurse staffing ratio of 3.2 hours per patient, per day, subjected to outside audits to ensure compliance, and ordered to pay stipulated fines for any failure to maintain the required nurse-to-patient ratio; and,
• Whistleblower Protections - Pleasant Care must establish and maintain a whistleblower program that allows employees, residents and other individuals to anonymously report suspected violations and mistreatment of residents. A log detailing all complaints made and investigation outcomes also must be maintained and made available to the Independent Monitor and the AG.
In addition, Pleasant Care is required to pay $1 million in civil penalties and $350,000 to reimburse the state for investigative costs. Failure to fully comply with any provision of the injunction also could result in civil penalties of up to $6,000 per violation, other sanctions deemed appropriate by the court, and exclusion from receiving funding from both the Medi-Cal and Medicare healthcare programs.
Pleasant Care currently operates 30 skilled nursing facilities in 14 different California counties, including: Alameda, Butte, Kern, Los Angeles, Marin, Mendocino, Riverside, San Diego, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Sonoma and Sutter.
Over the last five years, DHS has issued more than 160 citations and fines against numerous Pleasant Care facilities for violations of patient care regulations, with several citations involving violations which presented an imminent danger that death or serious harm would result.
In 2004 alone, for example, eight different Pleasant Care nursing homes in California were found to have delivered "substandard" care to residents in annual surveys conducted by DHS.
Other specific instances of deficient service and care also formed the basis for the AG's lawsuit.
In 2003, a resident at the company's Ukiah facility suffered a seizure and a blocked airway, but the nurse was unable to effectively aid the resident due to the fact that the facility's suction machines had not been kept in working order. The resident died from acute cardiopulmonary arrest stemming from his inability to breathe.
In 2004, a resident at Pleasant Care's Novato facility suffered from a pressure sore that was allowed to worsen so severely that the resident ultimately died. The coroner who examined the female resident later told DHS that his examination showed that she had been subjected to "abominable wound care management."
According to data maintained by the Office of Statewide Health Planning and Developement, Pleasant Care has also consistently failed to staff its chain of nursing homes at the rate of 3.2 nursing hours per patient, per day as required by California law. The failure to adequately staff its facilities with qualified nurses resulted in increased profits for the corporation at the expense of its residents' health and safety.
In a related case, Pleasant Care of Northern California (PCNC), a wholly-owned subsidiary of Pleasant Care Corporation, is scheduled to appear in Napa County Superior Court tomorrow for the purpose of entering pleas in a criminal case filed by the Attorney General.
The case alleges that PCNC delivered criminally negligent care to patients at its now closed Napa facility, and charges the facility with five misdemeanor counts of elder abuse and one count of willfully violating California's nursing home patient care regulations.