Attorney General Lockyer Issues Report on First Year of Surprise Nursing Home Inspections in Northern California

Operation Guardians Making a Difference, Prompting Nursing Home Improvements

Monday, April 16, 2001
Contact: (916) 210-6000,

(OAKLAND, Calif.) – Attorney General Bill Lockyer today issued a report on Operation Guardians in northern California, where the multi-agency task force in its first year of surprise inspections has triggered improvements in the quality of care and living conditions at nearly two dozen nursing homes.

"Operation Guardians is making a difference," Lockyer said. "The surprise inspections are triggering positive changes in the facilities visited. Never knowing when an inspection team could come knocking gives other nursing homes new incentives for ensuring the quality care of elderly residents. With the productive first year, we are looking to expand Operation Guardians to other areas of the state."

The Attorney General's report, "Operation Guardians - 2001 Annual Report for Northern California," covers 22 inspections in six northern California counties between April 2000 and March 2001. Results of the task force inspections ranged from near-complete compliance to problems significant enough to be referred to law enforcement or regulatory and/or licensing agencies. Surprise nursing home inspections were conducted in the counties of Alameda, Fresno, Monterey, Napa, Sacramento and Santa Clara.

"We are finding nursing homes responding to the surprise inspections by quickly addressing many of the problems cited," Lockyer said. "For elderly and dependent Californians in these facilities, this means rundown and unsafe nursing home buildings are being fixed, improvements are being made in the quality of care they receive and renewed attention is being given to their dignity. At the same time, major problems have been referred for further investigation and possible enforcement actions."

Problems found in Operation Guardian inspections fell generally in five categories:

Environmental Non-compliance. Of the 22 northern California inspections, 21 found compliance problems based on substandard maintenance of the grounds or buildings, which in varying degrees violated the nursing home's responsibility to provide a habitable, safe and livable environment for residents. Problems included foul odors from urine; loose or otherwise unsafe handrails; mildew; hazardous walking surfaces; broken screens allowing infestations by flies and other bugs; and dilapidated residential living quarters.

Patient Care Non-compliance. Of the 22 inspections completed, 20 found compliance problems relating to patient care, such as failure to keep adequate patient charts, poor maintenance of emergency medical equipment, unsafe storage of prescription drugs, malfunctioning call lights or non-response to patients seeking attention using call lights; medical staff failing to make required rounds to visit patients; and preventable injuries and health problems.

Administrative Non-compliance. Of the 22 inspections completed, 15 found compliance problems relating to oversight of personnel matters, patient trust accounts and other administrative responsibilities, such as personnel files failing to contain up-to-date licensing information on care givers; poor accounting practices; missing patient identification tags; and improperly maintained patient discharge records.

Fire Safety Violations. Of the 22 inspections completed, eight found violations of local fire safety ordinances that if left unabated could result in serious harm or death, such as unsafe chemical storage; inoperative fire extinguishers; inoperable fire alarms; obstructed fire exits; exposed wiring; and improperly operating fire doors.

Staffing Level Non-compliance. Of the 22 inspections completed, two found compliance problems with state and federal laws governing proper staffing levels for skilled nursing home facilities. State law requires at a minimum 3.2 hours of nursing care (Certified Nursing Assistants, Licensed Vocational Nurses, Registered Nurses or other appropriately certified staff) per patient per day. Higher staffing levels may be needed to meet high-need patients with medical difficulties. Federal regulations require staffing levels to be adequate to care for all patient needs "to attain or maintain the highest practicable physical, mental and psycho-social well-being of each resident."

Operation Guardians is a cooperative effort of the Attorney General's Bureau of Medi-Cal Fraud and Elder Abuse; local district attorneys, local fire departments and the federal Office of Inspector General, US Department of Health and Human Services. The University of Southern California School of Medicine, UCLA School of Medicine, and the Medical Board of California also have been part of the team. Elder abuse ombudsmen also have participated locally.

In the operation, state investigators, local fire marshals, code enforcement officials and patient-care specialists make unannounced visits to nursing homes selected randomly by the Attorney Genearl's Bureau of Medi-Cal Fraud and Elder Abuse. Local inspectors review physical structures for sanitation, safety and fire hazards, while health experts help detect any abuse and neglect of nursing home residents. State and local prosecutors are available to bring criminal action if warranted. Health quality violations are referred to the state Department of Health Services (DHS). These surprise inspections complement the regular inspections required to be conducted no less than every 15 months by DHS, which is responsible for licensing and regulating the state's approximately 1,500 skilled nursing home facilities.

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