New Times / Cover Story
The following articles were printed from New Times [newtimesslo.com] - Volume 29, Issue 5
After 37 years of operation, the De Groot Nursing Home for Children could be shuttered by state regulators
By RHYS HEYDEN AND COLIN RIGLEY
Eighty-six-year-old Sjany de Groot shuffled slowly to a bed in the corner and rolled a small girl on her side, gently repositioning a thick plastic breathing tube as she did so.
The girl was 10 years old, smothered as an infant by drug-addicted parents, de Groot said. She made slight wheezing sounds with each breath.
The room filled with the lingering scent of a midday meal mixed with a combination of nursery and hospital. In another part of the building, a 13-year-old named Xander clanged toy metal cars together amid the sounds of flat-screen televisions playing Toy Story and The Muppets.
“Mom, are you crying?” Xander said as he continued to smash cars together.
“I’m not crying,” de Groot responded and, in fact, she showed no sign of tears.
She adjusted a mist machine that pumped a steady stream of vapor over his bed.
Somewhere else in the building, speakers blared the sounds of a chorus of children singing “Hush, Little Baby.”
A painting on the far wall read, “It matters not how long I live, but how.”
With slow, small steps, de Groot meandered through the building in a pair of thick purple socks. She spoke softly through a thick Dutch accent that still lingers from her upbringing in Holland. In 1959, de Groot and her late husband, Rokus, moved from Holland to the United States, bringing with them three children. They adopted four more after the move, and 37 years ago opened the De Groot Nursing Home for Children.
De Groot began caring for children as a promise she said she made while watching her family suffer under Nazi occupation, and witnessing Hitler’s infanticide campaigns.
“God, if you save the lives of my family, I will take care of the kids that Hitler is killing now,” she remembers praying.
The problem today
Health inspectors have regularly visited the house, but on July 2 a team of inspectors—including a federal health inspector out of Chicago—completed a three-day survey of the home. Not long after, the De Groot Home received its first list of changes.
According to the home’s attorney, Paul Phillips, the board of directors went over the proposed changes, outlined what they could accomplish, and noted things that didn’t make sense at the facility.
“It’s a home, it’s been operating a certain way, and if certain changes need to be made, then [de Groot] wants to be given the opportunity to comply,” Phillips said. “And whether there’s going to be sufficient opportunity to do that, I do not know the answer.”
De Groot said the first list included 14 “survey deficiencies.” She called them “little lousy things.”
When she and her staff responded, they were dealt a new list of 97 deficiencies—ways the home doesn’t meet Health Department standards—stretching across about 100 pages. But the new letter indicated that the De Groot Home would be facing an uphill battle, and the inspectors had already made a recommendation to the Health Department “… that action be initiated to terminate your Medi-Cal certification.”
It’s a thick packet of health department recommendations and citations that span everything from the lack of posted food menus (many of the patients are unable to read) to a requirement that children be given bed baths to dings for the lack of staff training and appropriate methods in preparing medication.
One of the recommendations was to change how medications are prepared because one staff member was seen preparing meds in the same area where children were bathed. Yet another recommendation would have de Groot either remove the railing from one patient’s bed or place her mattress on the floor to prevent a fall.
Standing at the girl’s bed, where a 16-year-old lay repeatedly thumping her leg against the mattress, de Groot said of that idea, “Not in my house.”
The biggest contention is not so much that the Health Department created such a significant list of changes; rather, locals want to know: Why now?
That’s a question that few people seem able to answer.
“I can’t understand the urgency,” said Dr. Rene Bravo, the home’s attending physician. “I don’t understand why now.”
Bravo’s best guess is that the increased scrutiny came about as part of a federal hunt for fraudulent institutions under the Affordable Care Act, and possibly because a new inspector unfamiliar with the facility led the latest inspection. Bravo had no qualms with prosecuting legitimately fraudulent and abusive practices, but argued that the De Groot Home was targeted because it doesn’t fit the mold of most health-care facilities.
“They came in with an agenda to prove that she was not worthy, and to close her down,” Bravo said. “They came in looking for problems, not an inspection.”
There are some changes de Groot said she could make; she contends that others—most significantly a requirement to separate the various beds with walls and doors—are unnecessary. Building those walls would cost about $30,000, she estimated, would require city approval, and would likely require a sign off from the fire marshal, which she said was unlikely.
De Groot’s home is uniquely designed, with large open expanses leading from room to room unobstructed by any doors. Aside from several collapsible sliding dividers, there are few definable rooms in the house. Bravo said de Groot developed claustrophobia when she was forced to hide in small spaces during the Nazi occupation. De Groot openly acknowledged her claustrophobia, but at the same time pointed out that the lack of walls makes it easier for her and her staff to watch over multiple children at once.
“How can you lock up kids in little cells?” she said.
Public health officials gave the De Groot Home until Sept. 30 to comply with the recommendations. If the department decides the home is still out of compliance after that date, de Groot could lose her Medi-Cal funding, and she said that the state indicated it would remove the kids within two weeks—even those for whom she’s a legal guardian.
De Groot subsists on Social Security and depends on Medi-Cal payments to provide care to the kids. Those children come from a variety of places but typically are transferred from hospitals that are unable to care for them.
Xander, for example, suffers from brittle bones. Despite being 13, he’s only about 30 inches tall.
“He was all broken from the delivery,” she said.
Asked how many children she’s worked with over the years, de Groot said, “I think that it’s close to a hundred went to heaven.”
If the state moves the children currently living there out of the home, she said they’d likely be taken back into hospitals, and probably moved out of state.
During a New Times visit, de Groot said her staff was on 24-hour alert. She keeps a pair of clothes by her bed that will be easy to throw on when the regulators come, and she said she’s reluctant to leave the house.
“I can’t go to the store,” she said. “I can’t do nothing because I can’t leave the kids alone.”
She’s stopped billing Medi-Cal for Xander, “just to safeguard him.” And if and when officials from the Health Department came to take the children, she said, “The doors will be locked, believe me.”
The hall that leads from de Groot’s dining room into the nursery is lined with plaques and framed certificates. There’s an award for Woman of the Year in 1989 from former Assemblyman Eric Seastrand, and another in 1996 from former Assemblyman Tom Bordonaro Jr.
Beneath those framed certificates is another commendation, dated 1988, which reads: “In recognition of exemplary community service in the finest American tradition.”
It’s signed by Ronald Reagan—not Gov. Reagan, but President Reagan.
“The love and compassion and care that the De Groot Home has shown is unmatched, and continues to be,” said Phillips, the De Groot Home attorney.
De Groot said regulators told her to re-staff the nursery, eliminating the seven registered nurses who make anywhere from $17 to $20 per hour, and replace them with nurses at $11 per hour.
Additionally, Health Department officials asked de Groot to not utilize her family members for volunteer help. They instructed her not to work the nursery floor because she’s an administrator, and further said that she should hire a professional administrator. De Groot said doing so would cost about $8,000 per month.
One of the key figures in the unfolding dispute is Assemblyman Katcho Achadjian (R-San Luis Obispo).
“She is one of a kind, she has great passion, and nobody else can take care of those kids,” Achadjian said. “I’m optimistic that we can all come to our senses and have common sense prevail.”
Achadjian said he regularly visits the home around the holiday season and has gotten to know de Groot and the children she cares for very well. He added that, in his opinion, this is a case of an overly strict application of the law.
“I think you have to put yourself into her shoes, and not so much deal with the exact letter of the law,” Achadjian said. “I think people need to get off their high horse and see the need for the human touch. The bottom line is: Are these kids taken care of? In that area, I give the home two thumbs up.”
According to Achadjian, gears are in motion to hold a meeting with his office, the Health Department, de Groot, and Dr. Bravo. Achadjian hopes all parties can come to some sort of a compromise that will avoid any dire consequences for the facility.
“It is a difficult situation, but we need to see how we can help [de Groot] and those children,” Achadjian said.
New Times reached out to the Health Department for clarification and further details about the compliance survey that resulted in the nearly 100-page report.
“During a recent recertification survey, the California Department of Public Health (CDPH) found serious compliance issues at De Groot’s Nursing Home and a Statement of Deficiencies was issued,” department spokesman Corey Egel wrote in an email to New Times. “The areas of deficient practice have been cited in past surveys and were identified again in the July 2014 survey at greater severity.”
Available online Health Department records for the De Groot Home date back to 2005. Before this year’s long litany of 97 survey deficiencies, the facility had drawn only between three and 12 deficiencies per year.
When asked if there was a different inspector this year, Egel said that this year’s survey was “randomly selected” by the federal Centers for Medicare and Medicaid Services (CMS) as a “partnership survey.”
Essentially, this means that a “federal surveyor” partnered with other Health Department inspectors this year—bolstering the theory that a new inspector unfamiliar with the facility influenced the inspection.
“I think this was a new person who came in and just saw everything that wasn’t up to code, rather than taking notes and observing how it works well,” Achadjian said.
Egel said it is “not uncommon for survey team composition to change,” but declined to detail what caused the Health’s Department’s point of view on the suitability of the facility to change so drastically.
“During an onsite visit, the department survey [sic] for compliance with state and federal regulations,” Egel wrote. “A facility’s non-compliance with those requirements determines the suitability of a written deficiency.”
Asked how the Health Department aims to ensure compliance and come to a solution with the facility in the coming days, weeks, and months, Egel said the department would follow standard procedure.
“De Groot’s Nursing Home has elected to voluntarily participate in the Medi-Cal program. In doing so, they are obligated to follow all the conditions of participation and must be able to show they are in substantial compliance to these standards and conditions of participation,” Egel wrote. “De Groot’s Nursing Home is afforded, as is [sic] all Intermediate Care Facilities (ICF) providers, an opportunity to correct the deficient practices cited during the survey and provide a plan of correction to the department.
“Upon timely submission to the department of acceptable documentation of corrective action and a revisit survey indicating substantial compliance, termination from the Medi-Cal program will be rescinded,” he added. “Otherwise, should the facility fail to come into substantial compliance with the standards and conditions for participation, actions to terminate the provider agreement with the Medi-Cal program will proceed down the termination track.”
In response to a request from New Times, Egel also included a redacted copy of the compliance survey, which assessed the care of three of the five children at the facility between June 30 and July 2, 2014. Two Health Department inspectors and a federal surveyor filed the survey.
Among the main “survey deficiencies” cited: lackluster physical therapy and education programs, lack of privacy for the children, lack of a “sanitary environment” and “sanitary hygiene practices,” substandard equipment, and not properly reporting the death of a patient to the Health Department.
Asked about the more significant deficiencies outlined by inspectors, de Groot—as well as Bravo—argued that the findings were largely overblown. Inspectors, for example, took issue with nurses bathing patients in a sink rather than the tub. De Groot said there was greater drowning risk in the tub. When inspectors suggested bed baths, she said it would be difficult to fully bathe patients, particularly to wash their hair.
In another finding, inspectors said the home had no physical therapist on staff. De Groot, however, said there is a physical therapist, as well as a dietician, but they are volunteer positions and were not counted by inspectors.
In one case, inspectors said that one patient wasn’t receiving the attending physician’s prescribed amount of food. De Groot countered that the patient received the proper amount of calories, but the amount of food had to be reduced because the patient would vomit after receiving too much tube feeding. She added that Bravo is regularly consulted, and makes visits about every six weeks, though not every visit is recorded.
Inspectors also said the physician could not be reached because he was on vacation, but Bravo said he was never even contacted.
As for the unreported death, inspectors noted that a nurse at the facility said she called the Health Department to report the death, but didn’t fax in paperwork.
De Groot said the child was brought in with an extremely grim prognosis, and he actually died in her arms. She added that De Groot Home staff “faxed a bundle of paper to them.”
Overall, she seemed to take offense at the notion that the home wasn’t sanitary. Bravo agreed that while there could be some improvements, he didn’t feel the children are in danger.
“There’s no crisis in the home,” he said. “The children are not groveling around in the dirt.”
For de Groot, who was awaiting another call from Sacramento as of press time, the future of the home seems to be largely out of her hands. She repeated several times that her home is not meant to be a traditional institution; it’s meant to be a home.
“Because the kids are terminal, why can they not live before they die?” she said.