Community Health & Wellness

Documents provide peak inside local nursing homes — but don’t rely on them exclusively

Posted on September 19th, 2024 By: Conor Wilson

After 16 residents tested positive for COVID-19 last year, staff at Bridgeview Nursing Home in Bremerton failed to follow proper protocol and prevent transmission, an inspector with the Washington Department of Social and Health Services wrote in a 2023 report. The lapse put all 93 residents at risk.

The incident is one of dozens of deficiencies of varying severity that health inspectors documented at East Bremerton nursing home since the beginning of last year.

Gig Harbor Now and the Kitsap Sun reviewed complaints, inspections and federal ratings for Bridgview and the 11 other nursing homes on the Kitsap Peninsula since the start of 2023. Below is a glimpse of the findings, including notable or frequent violations and tools available to consumers.

Understanding ratings and reviews

The Centers for Medicare and Medicaid Services, the federal agency with oversight of nursing homes, ranks all facilities on a five-star scale. Ratings are based on the last three health inspections; complaints or violations in the last three years; staffing levels and quality control.

Most facilities on the peninsula have at least three stars, meaning they are at least of “average” quality.

Homes falling below that include Belmont Terrace in Bremerton (2 stars), Bridgeview (1 star) and Gig Harbor Health & Rehabilitation (1 star). Five-star homes include Northwood Lodge in Silverdale, the Life Care Center of Port Orchard, Bainbridge Island Health and Resource Center and Heron’s Key in Gig Harbor.

Heron’s Key received a five-star rating from the federal Centers for Medicare and Medicaid Services.

These ratings are easily searchable online and can be a good starting place when looking for a nursing home. But it is best to dig deeper and take these ratings with a grain of salt.

The results rely partially on self-reported data. At least one news report has found nursing homes often inflate their data to improve their scores, among other shortcomings. Additionally, ratings for staffing levels — a challenge at the majority of homes — are based on a comparison between homes, not a universal benchmark.

Show up unannounced

Dana Gargus, Kitsap County’s Long-Term Care Ombuds, said the best way to determine a home’s quality is to show up unannounced in-person. She recommends going at different times of day and talking with staff. Long-tenured staff are a sign of a facility’s stability.

Consumers should also ask each home for a copy of its most recent survey report, an unannounced inspection performance at least every year by the Washington Department of Social and Health Services. Homes are required to have these reports available, Gargus said. Some of these reports are online, but they may not all be published.

The survey “only captures one moment in time,” she said. “But it’s a helpful tool.”

If residents have further questions about a home, they should contact either their county and or state ombudsman.

What have survey reports found

With the expectation of Martha & Mary Health Services in Poulsbo, all nursing homes on the peninsula received at least one enforcement letter from DSHS in the last two years, notifying them of action taken by the state to compel a return to compliance. These letters result from both isolated incidents to repeated patterns of deficiencies.

Belmont Terrace, Bridgeview, Emerald Bay Care, Washington Veterans Home, Avamere Rehabilitation at Ridgemont, Life Care Center of Port Orchard and Gig Harbor Health and Rehabilitation have received enforcement letters for what are described as patterns or widespread deficiencies.

Eight Peninsula nursing homes have been fined at least once in the last three years: including: Bridgeview (7 fines); Cottesmore of Life Care (4 fines); Heron’s Key, Emerald Bay Care (3 fines); Gig Harbor Health (2 fines); and Belmont Terrace, Avamere Rehabilitation at Ridgemont, Washington Veterans Home-Retsil (1 fine).

At least six homes (Belmont, Bridgview, Emerald Bay, Life Care Center, Gig Harbor Health, Washington Veterans Home and Heron’s Key) had a deficiency related to infectious control in the last three years.

Below is a list of other notable deficiencies documented in reports since the start of 2023.

Staffing shortages

Administrators at Bridgeview Nursing home were notified in an April 2024 letter from DSHS that they were about 400 hours short of federal requirements to provide over three hours of direct care per resident per day.

Last year, in a November report, an anonymous staff member told DSHS surveyors that staffing levels were the worst they had been in eight years. Several employees reported being responsible for entire units by themselves and being unable to keep up with work.

Many staff members said they were responsible for 15 or more residents at a time. Documents found one employee was assigned to approximately 65 residents at once. This caused resident care to suffer, staff said.

One resident in a wheelchair with severe cognitive impairment was left in the home’s dining room from 7 a.m. to 12:30 p.m., the report notes. Staff said they had not gotten back to the dining room, saying they “just have not had time.”

Another resident said they had to wait over an hour for care. When staff would not change them every couple of hours, they wet their bed, the surveyor wrote. The resident said their hallway was not for inexperienced staff, and that they had seen new staff not able to handle the workload and walk off.

An unnamed administrator told the investigator that they had not made them aware of staffing concerns. An email sent to Bridgeview’s executive director seeking comment was not returned.

Food and nutrition grievances

Residents at the Gig Harbor Health and Rehabilitation nursing home frequently complained about being served low-quality, frozen, raw or uncooked food. In one instance, detailed in an inspection reported dated Feb. 24, 2024, kitchen staff were observed serving trays of pork chops that finished cooking 53 minutes earlier. By the time all residents received their trays it had been two hours since the meat had finished cooking.

Surveyors observed a receptionist and the director of rehabilitation, neither of whom had food handlers permits, working in the home’s kitchen at the request of the dietary manager. The manager was working with an expired food handlers permit, had no formal training and had not completed a required certification course.

The entrance to Gig Harbor Health & Rehabilitation.

The dietary manager said the food they received from its supplier was of low quality. They also told the surveyor that they had been hired four months ago and “had inherited a mess.”

An email seeking comment was not returned.

Documenting abuse

In a March incident at the Washington Veterans Home in Port Orchard, surveyors said one resident punched another in the upper torso during a witnessed altercation.

Neither resident had recollection of the fight due to cognitive impairment, the survey noted. There was no documentation of interventions made following the incident. A survey also found the facility failed to implement or document behavior monitoring for the resident.

Pest control

Last year, Avamere Rehabilitation at Ridgemont in Port Orchard was infested by phorid flies, and written up for failing to fix the root cause of the infections. The infestation was the result of a broken pipe under the facility, which had caused sewage to leak.

Residents told a surveyor flies frequently swarmed them whenever they ate. Flies were found throughout the facility, including the kitchen, office, activity room, and multiple hallways.

An administrator for the home told the DSHS surveyor that the owners of the nursing home secured a company to fix the pipe, but decided not to proceed with the repair. The administrator said they didn’t want bugs in the facility, but their “hands were tied.” The only permanent solution is to fix the sewer pipe, they said.

An email sent to Avamere was not returned.