Assisted Living Home Probes Too Slow, Say Complaints
This article first appeared in U-T San Diego.
Two days after Gary Ernst moved his 89-year-old mother into The Manse assisted living home in Vista, he found her badly infected, dehydrated and covered in bruises.
She was rushed to Tri-City Medical Center and responded favorably to treatment, but Ernst moved her out of the home and filed a complaint with regulators about the neglect and abuse he suspected.
That was a year ago.
The facility operator, Alicia Sanchez, declined to discuss the allegations, saying the case remains under investigation. The home has a history of violations and deficiencies, according to its public file.
Ernst said investigators at the Department of Social Services have done almost nothing in response to his complaint. As late as December, an analyst was still asking preliminary questions.
“This reeks,” said Ernst, who is the Oceanside city treasurer. “I’ve been in financial services for over 35 years and when I smell dirty cheese, there’s usually a rat nearby. In this case, it’s the Department of Social Services.”
Social Services officials declined to discuss what happened to Martha Ernst, a mother of three who served as a nurse at the Navy hospital in Balboa Park during World War II.
Spokesman Michael Weston said the department investigates every complaint as quickly and thoroughly as possible, and tries to keep family members updated on any progress.
“There are complexities in investigating cases, particularly when the department has to interview people,” Weston said. “So investigations can take time.”
State lawmakers want to speed things along.
Under the RCFE Reform Act of 2014, the package of bills introduced in January in response to the “Deadly Neglect” series published last year by U-T San Diego, Social Services would be required to open and close cases in a more timely manner. RCFE is the state acronym for residential care facilities for the elderly.
Existing law requires complaint investigations to begin within 10 days, and they are open-ended. A new bill would require claims involving neglect or abuse to be opened within 24 hours and closed within 30 days.
Investigators also would have to provide a written notice of findings to the person lodging complaints, and family members like Ernst would have an opportunity to appeal the results.
“You put your loved one in a facility that is licensed by the state, you expect it to be safe,” said Assemblywoman Nancy Skinner, D-Berkeley, who introduced the timely-investigations bill. “If a bad situation occurs, you complain and nothing happens, that is unacceptable.
“The purpose of our bills is to get the department to do its job and to put in real timelines and real consequences so Californians have confidence that if a facility is licensed and regulated, it is functioning properly and the residents will be safe.”
Published in September and December in partnership with the CHCF Center for Health Reporting, “Deadly Neglect” identified 27 deaths in San Diego County assisted living homes from abuse or neglect since 2008.
The reform package was introduced in January by a bipartisan group of lawmakers in response to the U-T San Diego series and investigations by other news organizations.
In addition to stepping up investigations, the bills would increase the penalty for violations, now capped at $150 even for negligent deaths, and require unannounced annual inspections rather than the current minimum requirement of once every five years.
The legislation also would require licensees to carry liability insurance, so consumers could recover damages in cases that result in jury awards.
The most significant proposal may be the residents’ bill of rights, which would establish a standard for care and allow prosecutors, clients and the public to seek an injunction to stop violations.
Elder-abuse attorney George Kindley said assisted living home residents need a set of rights and stronger protections from regulators because the rules are violated so routinely.
“It’s really scary,” said Kindley, who represents Aaron Byzak, the Oceanside man who organized the “Hazel’s Army” advocacy group after his grandmother died in a rest home last year.
“The legislators have to confront it head on,” Kindley added. “It’s like the Wild, Wild West.”
Another provision in the RCFE Reform Act requires Social Services to post regulatory documents online so consumers can check compliance records remotely.
‘NOBODY TELLS YOU’
Retired Navy commander Elaine Londak said she would never have placed her friend Ann Cunningham in an Escondido assisted living home if she had Internet access to the home’s records.
Cunningham suffered several unexplained injuries while living at Lomas Serenas Residential in late 2011, Londak said. She filed a complaint with state regulators in January 2012, alleging medication errors, over-capacity, intimidation of residents and other violations.
The initial report states “further investigation” was needed, although an inspector cited the home for incomplete record-keeping and handling of medications.
In July 2013, a year and a half after the complaint was filed, regulators substantiated the complaint that the home served more residents than it was permitted but found the other complaints inconclusive, records show.
The six-bed facility had been cited three times in January 2009 for improper record-keeping and failing to complete criminal background checks on employees. Those violations and a civil penalty were dismissed nearly two years later — in part because regulators delayed responding to the case.
“I didn’t know they had all those violations,” Londak said. “Nobody tells you this. People buy these homes, they stick in a bunch of beds and they’re open for business.”
In a brief interview, licensee Oscar Gonzalez said the violations were dismissed and the complaint about Cunningham’s treatment was unfounded.
“We are trying to do the best job we can,” he said.
One San Diego County negligence case that did make its way to the Attorney General’s Office just concluded with two criminal convictions.
Alexander Pura pleaded guilty Jan. 22 to involuntary manslaughter in the death of 85-year-old Frank Kiser, who lived at the Bonair Rest Home in Vista.
Pura’s father, Bonair licensee Raymundo Pura, was found guilty Feb. 6 of elder abuse with great bodily injury and involuntary manslaughter. They are both scheduled to be sentenced March 25.
According to court records, Kiser died in 2010 after being found covered with bedsores, some of which were stage 4 and necrotic.
Martha Ernst now lives in the Blue Skies rest home in Oceanside. She said in an interview that she likes the facility — especially because her 9-year-old Pomeranian, Cassie, is welcome inside the home.
“It’s nice here,” she said. “The people are friendly.”
In the kitchen nearby, Blue Skies operator Lauren Delancy was making lunch and pondering the likely increase in fees and regulations governing assisted living homes.
Inspectors “only come every five years, unless there is a complaint,” she said. “If they increase fees, what can we do? It’s fair, though. They’re understaffed.”
Gary Ernst said the reform bills are a good idea but is skeptical they will resolve problems he has seen too often.
“They’re either short-handed or incompetent,” he said of the regulators. “Either way, they’re not in a position to take on these new responsibilities.”
Skinner, who chairs the Assembly budget committee, said she will fight for extra money to pay for increased oversight.
“If we add enforcement tools, we are going to have to add staff,” she said. “It will be a discussion in the budget (process) and we will do our best to see that the governor accepts that we need more staff.”
The Department of Social Services recently set up a hotline for people to report concerns with specific homes or inspectors. That number is (855) 305-7848.