California Turns to ‘Consultant’ Model for Nursing Home Inspections Amid Low COVID Citations

The California Department of Health will be changing how state surveyors inspect nursing facilities, with an eye toward the conditions caused by the COVID-19 pandemic — and critics in the Golden State argued that the changes could lead to worse outcomes for patients.

The station NBC Bay Area — KNTV reported on the change on Monday, though Heidi Steinecker, deputy director of the California Department of Health, testified in June about the change in plan for California’s 600 nursing home inspectors.

Under the new plan, inspectors would be converted to a safety consultant role, in which they would “adopt” and regularly visit a handful of nursing homes during the COVID-19 pandemic, while maintaining their federally mandated oversight role, the station reported.


The “Adopt a SNF Model” was listed as one of the six strategies of the Department of Public Health to respond to the COVID-19 situation in nursing homes, which according to NBC Bay Area has led to more than 3,500 deaths in SNFs across California.

The advocacy group California Advocates for Nursing Home Reform (CANHR) criticized the plan; at the time of Steinecker’s June testimony, the organization listed more details in a June 15 article as she outlined them before the state legislature.

Under the “Adopt a SNF” system, inspectors would assign inspectors two to three nursing facilities, where they would perform daily check-ins and weekly visits. They would also provide training for facility staff and be part of the safety and oversight group of each facility.


CANHR criticized the plan, both at the time it was announced and as NBC Bay Area reported that California is finalizing the details of the new model.

“This is a huge conflict of interest for surveyors,” CANHR attorney Tony Chicotel told NBC Bay Area.

Leza Coleman, executive director for the state’s Long-Term Care Ombudsman Association, agreed, telling the station that surveyors did not like the idea of being a consultant to the facilities.

However, Dr. Mike Wasserman, president of the California Association of Long-Term Care Medicine, told the station that some change is overdue, since the focus of the surveys often is issuing citations, rather than addressing the root cause of problems in the nursing home.

The news comes amid a renewed national focus around nursing home inspections, with the federal Centers for Medicare & Medicaid Services (CMS) on Monday moving to resume routine surveys that had been on hold since March due to the pandemic.

CMS late last week also announced that it had handed down $15 million in civil monetary penalties to nursing home operators since the start of the pandemic, alongside a threefold increase in citations for infection control violations.

Advocates in California, however, pointed to records indicating that citations dropped significantly during the pandemic, NBC Bay Area reported.

The question of how to overhaul the nursing home inspection process has long been controversial; resident advocates generally claim that fines must be increased to incentivize improvements, while industry leaders and some academic researchers counter that a punitive approach will not help bolster care in a sector stretched thin by the COVID-19 pandemic.

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