Montgomery County and Maryland health officials have refused to renew the operating licenses of a Bethesda nursing home that has been cited several times for violating nursing-care regulations since its opening nearly 3 1/2 years ago.
The Bethesda Health Center, a 180-bed facility at 5721 Grosvenor La., is continuing to house 170 patients while appealing separate decisions by the county and state not to renew the licenses, which expired Oct. 1. The county has expressed hope closing will not be necessary.
While annual license renewal is routine for most of Maryland's 200 nursing homes, the Bethesda center's were revoked after two inspections during the summer cited it as being understaffed, poorly managed and infested by flies and cockroaches, according to a state health department report.
In a related development, the County Council last week unanimously passed legislation empowering health officials to ban admissions to nursing homes that do not meet health standards. The bill, which has the support of County Executive Charles W. Gilchrist, was prompted by conditions at Bethesda Health Center, council staff members said.
Montgomery County police confirmed this week that they are investigating allegations made by the county health department of patient abuse at the nursing home.
Charles F. Chester, the nursing home's attorney, blamed the health violation citations on changes in the home's management and staffing. "The facility is in good shape now," he said. "What few insignificant problems there have been in the past have been corrected." Chester denied patient abuse is a problem at the facility.
The center, a target of health officials under previous ownership when it was the Wildwood Nursing Home, was first cited for nursing and sanitary problems under the current owner in 1979, and has been cited for similar health-code violations every year since then, according to state records.
Sharon E. Martin, director of the health department's licensing division, said the home's record was among the worst she had seen in her 14 years with the department.
However, Assistant County Attorney Joann Robertson said last night the facility has indicated it is making a substantial commitment to improve conditions. The county hopes the facility can remain open, she added.
Admissions at the center have been suspended by health officials twice since it opened, once for a month after patients became ill with salmonella poisoning and last year for health-code violations, according to state records. A subsequent attempt last year to ban further admissions was overturned, but the center voluntarily agreed to restrict new admissions.
In inspections of the facility in June and August, investigators found more than 100 violations of state and federal nursing-home regulations, according to state records.
Inspectors found a dead roach in a patient's meal, according to a state report. "A female patient requested sanitary napkins for three days without obtaining same," the report went on. "A nursing assistant was observed handling soiled linen, then handling another patient, without washing her hands . . . "
Flies were seen throughout the nursing home and on patients, the state report said; a review of the home's own records showed that there were 29 patient falls in June, 27 in July, and 10 in the first 10 days of August--a number that investigators said was "disproportionately high" for a nursing home of its size.
Results of the summer inspections were included in a Sept. 17 letter from Charles R. Buck, Maryland's secretary of health and mental hygiene, to David J. Becker, who has owned the center since 1979.
Buck's letter criticized the nursing home for poor nursing services, lax administration and a poor dietary plan. In roughly half of the records reviewed, "there was no documentation that the nutritional needs of the patients were addressed," the letter said. "Menus did not meet the basic four food groups." In some cases, "stop orders for medication . . . were not being followed," the letter said.
"Maryland has one of the best nursing-home programs in the country, but this facility . . . is so skewed from reality that it can't be tolerated," said Montgomery licensing chief Martin.
County police are investigating "several allegations of patient abuse dating from August," according to police spokesman Philip B. Caswell. He said the allegations were made by relatives of patients to county health officials. There have been no charges, he said.
Chester, the center's attorney, said there was one incident in June in which an employe struggled with a patient. The employe, who was described as an orderly, "was fired on the spot," he said. "That is the only incident involving patient abuse that I know about," Chester added.
He also disputed nearly all of the investigators' reports this summer. "We had great inspection reports in the winter and spring of 1981," he said. "Unfortunately, at the time of the survey this summer, we were minus some of our top nursing people. . . . There was a breakdown in management."
Becker, who also owns several other nursing homes in upstate New York, became administrator in August and revamped the center's management, Chester said. On his lawyer's advice, Becker would not comment about his operations here.
Chester said the dead roach that inspectors found on one patient's plate had crawled from a nearby table or chair; other roach sightings were the result of recent spraying by exterminators, he added.
Additional violations of dietary, sanitary and nursing regulations were caused by a staff shortage, not negligence, he said. The center has hired the additional nurses and physical therapist missing earlier this year, he added.
"You have to be realistic," Chester said. "There will be a roach every once in a while, there will be a hole in a bedspread every once in a while. These things are just going to happen," Chester said. "The question is: Is it dangerous to the patients?"
Health officials agreed that there are no life-threatening conditions at the Bethesda Health Center, but also said they have rarely seen a nursing home with such a poor compliance record. "There hasn't been any like this for a while," Martin said. "All the bad ones are out of business now. We practically bent over backwards to let them comply."
Lawyers for the state and those representing the center will meet Friday to lay the ground rules for a hearing at which the center will appeal the state's refusal to renew its license. The Montgomery County Board of Appeals has scheduled a Feb. 10 hearing on the health department's decision not to renew the center's county license.