Assisted living fines often go uncollected
This story originally appeared in the U-T San Diego.
When the California Department of Social Services issues fines to assisted living homes for failing to properly care for elderly residents, the owners are told to pay within 10 days.
That’s not what usually happens.
Since July 2007, the department has collected only half of the $2.9 million in penalties it levied against facilities statewide, according to a U-T Watchdog review of state data.
The majority of fines either don’t get paid or are satisfied weeks, months or even years after they are billed. One factor at play: There’s no penalty for late payment.
“You cannot have a situation where the laws are on the books and you don’t somehow enforce the laws, and then when fines are assessed, you don’t in fact collect the fines,” said state Sen. Leland Yee, D-San Francisco, the chairman of the Human Services Committee. He has called for hearings in response to the U-T’s ongoing coverage of assisted living centers.
Hundreds of facilities remain licensed and serving the elderly even though they are months or years overdue paying fines. More than three dozen of those are in San Diego County.
State officials said they do their best to collect from licensees that are penalized, but too often violators close up shop and move away.
“Frequently in these cases the entity dissolves and there’s no one to collect the penalty from,” said Michael Weston, a California Department of Social Services deputy director.
With limited resources, Weston said, state social workers have to juggle responsibilities, and collecting penalties is not always at the top of their list.
“The department has placed a priority on the health and safety of residents by placing a priority on field operations — administrative actions that have a more direct influence on the quality of life for people we serve,” he said.
The record of collections underscores the findings in “Deadly Neglect,” a special report published by U-T San Diego in September.
The newspaper’s ongoing investigation, in partnership with the CHCF Center for Health Reporting at the University of Southern California, uncovered a host of problems within the state’s assisted living industry.
The reports highlighted the maximum penalty for violations — $150 — even when a resident dies due to negligent care. For nursing homes regulated by the California Department of Public Health, fines run as high as $100,000.
‘Incomplete and inadequate’
The largest outstanding debt in San Diego and Imperial counties has accumulated for Golden Joy Residential Care, an El Centro assisted living home that owes $8,300 to the state of California.
The state is unlikely ever to collect; the home is now out of business and the former licensee could not be located.
Tender Care of San Marcos was fined $6,750 for a series of violations, most related to the home’s failure to provide employee background checks and fingerprints to regulators.
Administrator German Zamora Jr. said he regretted the oversight and is making payments on the debt.
“This is a small, family-run home,” Zamora said. “We’re trying to make arrangements and trying to make it work on both ends, for the residents and for our family.”
Villa Bonita in Chula Vista is one of the larger homes on the state list of past due accounts. According to state data, the center owes $1,400 to the state. Violations have included failing to document staff background checks and mismanaging a resident’s medication.
Villa Bonita said the state billing records are wrong.
“The Department of Social Services doesn’t keep its database up to date. We pay our fines if we have them,” said Ryan Test, the Villa Bonita executive director. “We’re one of the ones who do things right.”
Weston, the California Department of Social Services deputy director, did not respond to follow-up questions about Villa Bonita.
John O’Connor, editorial director of industry publication McKnight’s Long-Term Care News, said the assisted living sector began as an alternative to nursing homes, which face heavy federal regulation.
“What assisted living succeeded in doing in the 1970s, ’80s and ’90s was essentially scooping up what were the most desirable residents,” he said. “The ones with lower acuity and private pay.”
In assisted living, he said, each state sets its own rules and regulatory environment. He said he doesn’t understand why California has not recovered half of the fines imposed on licensees.
“It makes a reasonable person wonder what’s going on,” he said. “It’s not necessarily an indictment, but it’s reasonable to ask why this money is not being collected.”
The Watchdog’s analysis of collections data resembles findings from the California Controller’s Office, which issued a report in 2010 that exposed serious flaws in the Department of Social Services’ business practices.
Specifically, the report said the department lacked strong internal controls and kept delinquent accounts on its books. Social Services “had limited success in collecting fines from licensees providing day care or residential care to the elderly and children, as many licensees simply closed after fines were imposed,” the report stated.
Department officials did not dispute the findings. Instead, they pledged to do a better job writing off uncollectable debts and institute staff training to improve performance.
They also noted that plans to participate in a pilot effort to privatize collections had been stalled, and a recommendation to impose late fees on delinquent licensees required legislative action.
The collections rate may also be affected by the length of the appeals process.
Licensees may request reconsideration of monetary fines, a process that can take months and often results in penalties being lowered or eliminated.
The Department of Social Services was unable to provide specific data on appeals filed and granted.
Weston said the department is reviewing ways to prompt violators to pay their fines. Among the most obvious fixes, he said, is to examine licensee payment records in preparation for inspection visits.
“If you have a problem paying your civil penalty, we need to start looking deeper at your facility,” Weston said.
More than 80,000 seniors reside in California assisted living homes, nonmedical residences designed to provide a safe haven to people who need some level of care but do not require skilled nursing or other specialty services. On average, the state receives about 3,000 complaints a year involving those centers. Monetary fines are but one way to resolve complaints or deal with violations.
Regulators work to make sure homes comply with rules by ordering correction plans and, if need be, scheduling meetings with licensees. They can also place violators on probation and suspend or revoke licenses. Only one of the more than 600 assisted living homes in San Diego County was on probation as of this month.