More than a half-dozen residents lost their ability to walk, suffered permanent limb deformity or both because of inadequate staffing at a Ross nursing home, according to the Pennsylvania Department of Health. ManorCare Health Services North Hills has been barred from accepting new admissions until it addresses a long list of deficiencies identified by the department. The facility also has been fined $9,850. Seven residents in a restorative care program at the facility lost their ability to walk and seven suffered contractures — permanent, avoidable limb deformity due to lack of movement, according to the department. The 13 residents in the program had such conditions as Parkinson's disease or dementia. Restorative care is designed to help residents retain or improve range of motion and ability to walk. ManorCare's regular license has been downgraded to "Provisional I." Facilities issued provisional licenses must submit a plan to the state detailing how deficiencies cited by the department will be addressed. Failure to resolve the problems in six months results in another downgrade. If the problems remain six months after a fourth provisional license is issued, the license is revoked. "This facility obviously had some problems," state health department spokesman Richard McGarvey said. "Basically, what this does is, it's the first step toward a facility losing its license." Insufficient staffing, inadequate rehabilitative care and sour milk served to residents were among problems cited by the health department. Restorative care at the facility was inadequate, the department said, because of understaffing. Residents received only a fraction of the restorative care they should have, the department said. McGarvey said that before a six-month inspection at the facility, an unannounced survey will be conducted to see if ManorCare has made enough progress to allow the admissions ban to be lifted. Of 64 nursing homes in Allegheny County, seven currently have provisional licenses. Two of those facilities, one in Ross and another in Monroeville, are ManorCare homes. ManorCare also owns homes in Bethel Park, Green Tree and Whitehall and 33 others statewide, more than any other company, according to the health department. HCR Manor Care, ManorCare's parent company in Toledo, Ohio, is the largest nursing-home chain in the country with 296 homes, according to the company. Manor Care Inc. posted annual revenues of $2.69 billion and $283.4 million in net cash in 2001. ManorCare in Monroeville was fined $6,700 and its license downgraded to provisional after a December inspection found 11 deficiencies. A resident there suffered two broken legs — the left in June and the right in October — when employees failed to follow a physician's orders to use a mechanical lift to move the resident, according to the health department. Another resident was not bathed for 49 days, and another was bathed just once in all of October and November, the department said. A follow-up inspection in January found only two violations, both minor. Administrators at both the Ross and Monroeville facilities did not return repeated calls this week seeking comment. Kelly Kessler, a spokeswoman for HCR Manor Care, said Wednesday that she would look into questions about the provisional licenses and comment the next day. She did not return calls Thursday. While licenses rarely are revoked, a ManorCare home in Harrisburg received a third provisional license, McGarvey said. No ManorCare nursing home in Pennsylvania ever has had its license revoked, McGarvey said. In California, a consumer fraud lawsuit has been filed against the state's nine ManorCare nursing homes, charging abuse and neglect. The suit also claims residents are paying for care that isn't being delivered, according to Ila Swan, a nursing home residents' advocate involved in the suit. Other problems cited at the Ross facility in the state's November inspection: Staffing levels below required state statistical minimums. Failure to perform proper criminal background checks on some employees. Insufficient clean bed linens. Failure to assess residents for pain and bedsores. Inadequate housekeeping and maintenance. Failure to allow proper privacy during bathing and incontinence care. Provisional licenses Allegheny County nursing homes that currently have provisional licenses after failing inspections by the Pennsylvania Department of Health. Beverly Healthcare, Monroeville Beverly Healthcare, Oakmont Forbes Road Nursing and Rehabilitation Center, East Liberty The Heritage Shadyside, Squirrel Hill ManorCare Health Services Monroeville, Monroeville ManorCare Health Services North Hills, Ross Southwestern Veterans Center, Lincoln-Lemington/Belmar With the exception of ManorCare North Hills, inspections of all facilities subsequent to having licenses downgraded have found either no violations or only minor violations. ManorCare North Hills has not been reinspected since its license was downgraded. The Pennsylvania Department of Health Web site offers detailed inspection reports dating back more than two years for all nursing homes in Pennsylvania. The site is ecapps.health.state.pa.us/commonPOC/nhlocatorie.asp .

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