The sanitary inspector stood in front of the hot table looking at the array of food laid out for breakfast. From his pocket he took a thermometer and plunged it into the tray of sausages.
"Only 120 degrees," he noted, making a mark on his pad. "It should be 140 degrees."
He moved off to the ranges to check for cleanliness and the pantries to check on storage. A ripped plastic bag holding paper cups drew another mark on the pad. "Single service items should be returned to closed containers," he said.
On the other side of the room, the dietician inspector checked menus for nutrition and variety and stopped a young kitchen aide to ask what he'd do in case of fire.
"Run," he said, and that answer was duly noted in her pad on deficiencies.
The nursing home inspectors are one element of a multilayered system of inspection for licensing and certification that the federal, D.C., state and county governments have set up to regulate nursing homes, to see that they are clean, that the food is palatable, that the place is fireproof and physically safe for elderly patients.
There is no way to guarantee quality of care, to insure that nurses will be kind and patients sympathetically treated, but as far as physical conditions and medical procedures are concerned, this is how the system works. Virginia
To operate, the home must be licensed by the state, and if it accepts Medicaid or Medicare patients it must be certified by the federal government. Licenses and certifications are issued annually but state inspectors, sent by the Department of Health in Richmond, visit every nursing home in Northern Virginia at least four times a year - twice by appointment and twice unannounced.
An inspector, who is a registered nurse, or a team of inspectors, check on each home. In addition, fire hazards are checked once a year by the state fire marshal's office. Follow-up visits to check on deficiencies bring the average number of visits to a Virginia home by an inspector to five or six a year.
New standards and regulations for Virginia nursing homes went into effect in 1973. Since then approximately 40 Virginia homes have been closed, some in Northern Virginia. There have been no recent, local closings, according to Robert Ham, director of the bureau of medical and nursing facilities for the Virginia department of health.
State inspectors do both the state licensing and federal certification inspections and file separate reports, which are a matter of public record. Federal certification reports are on file at local Social Security Administration offices, which are located at 825 S. Washington St., Alexandria; 101 W. Broad St., Falls Church, and 2300 9th St. South, Arlington.
Licensing reports are available for inspection in person at the state department of health in Richmond.
Nursing home residents or their families who have complaints about the care or safety at a nursing home should call Robert Ham at 804/786-2081. Maryland
A team of state health department inspectors annually visits every nursing home in Prince George's and Montgomery counties. In order to operate, a nursing home must be licensed by the state. In addition, a home in Montgomery county must be licensed by the county. If the home accepts Medicaid or Medicare patients, it must be certified by the federal government.
To get licenses and certifications, each of which are issued annually, the homes open their doors to a team of inspectors. Each team consists of a registered nurse, sanitarian, dietician, fire protection engineer and physical therapist.
The initial visit, by appointment, is followed by unannounced visits by appropriate team members to follow up on the correction of deficiencies. According to Hal Gordon, director of the division of licensing and certification for the state health department, it is impossible for any home to be deficiency free, which means Maryland homes receive inspection visits on an average of 11 times a year.
Serious, life-threatening deficiencies, such as the lack of an adequate fire sprinkler system, step up the correction schedule - the home is given a specified, short length of time to correct the problem - and may result in the loss of license or issuance of a provisional license.
Records are kept of all visits, deficiencies and plans of correction and these records, voluminous at times, are a matter of public record. Although the state team does both the licensing and certification inspection, separate reports are filled.
Federal certification reports are on file at Social Security Administration offices at 962 Wayne Ave., Silver Spring, or 6400 Old Branch Ave., Camp Spring. Licensing reports are available through the Division of Licensing and Certification in Baltimore. To see these you must visit the office at 201 W. Preston St., Baltimore.
The state health department's complaint and validation unit looks over licensing inspectors' shoulders, making spot checks at nursing homes. The unit also handles quality of care and safety complaints from residents of nursing homes or their families. Each complaint is pursued without divulging the name of the complainer or the patient's name. The unit's telephone number is 301/383-2517. District of Columbia
Regulations passed in June, 1974, gave licensing inspectors more authority to inspect nursing homes from top to bottom, inside closets and out on the patient floors. They can - and do - interview patients, talk to physicians, read medical records and verify the qualifications of the staff. They also check on the housekeeping procedures and on the variety of the menus.
Licensing inspectors, sent by the department of human resources, visit every nursing home in the District twice a year. The team of inspectors consists of a registered nurse, sanitarian, social worker, fire safety inspector, pharmacist, nutritionist and physical therapist. An initial visit is followed up by visits to check to see that the home has corrected deficiencies and to help the home come up with a plan to correct problems. A nursing home in the District receives an average of four visits a year.
To operate in the District, a nursing home must be licensed by the city government. To accept Medicaid or Medicare patients, the home must be certified by the federal government. Although the city team does both the licensing and certification inspection, separate reports are filed.
Federal certification reports are on file at the Social Security Administration office at 2100 M St. NW. Licensing reports are on file with the Licensing and Certification Division, 1406 L St. NW. The division also receives complaints about nursing homes in the District. The telephone number is 629-4121.
Another source of help with quality of care problems is the D.C. office on aging's program coordinator for nursing homes, Caryn Barquin, at 638-2406.