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Watchdog: Hazards, training, background checks among problems at troubled assisted-living facilities


Original source:
http://www.ocregister.com/articles/care-694150-facility-facilities.html

The Orange County Register
LILY LEUNG
Nov. 29, 2015

Mother Marcy Home Care-Chateau, an assisted living center in Anaheim, evicted a resident earlier this year without advance notice and abandoned him at a hospital 3 miles away, state inspectors say.

One of the facility’s reported owners, who has a lengthy felony record, allegedly defied state officials’ orders to stay away from residents but continued to visit the six-bed elder care home on a regular basis.

Those are just two of the 80-plus citations issued by the state over the past five years at Mother Marcy Home Care-Chateau and a sister facility, Mother Marcy Home Care, also in Anaheim. That landed them on a list of troubled elder care facilities in Orange County.

A Register review of the most-cited assisted living facilities – which families rely on for long-term and often expensive care of their loved ones – showed patterns such as:

• Failing to provide the minimum required training to caregivers.

• Overlooking “common sense” procedures, such as keeping toxic chemicals, sharp objects and unsafe foods away from residents.

• Not running background checks on employees.

Bowing to public pressure, the state Department of Social Services released a downloadable database last summer that details enforcement measures imposed on licensed residential care facilities for the elderly throughout California.

However, critics say the database is a limited resource, as it lacks specifics on some violations. What’s more, so far only a limited number of inspection reports are available.

‘MINI-HOSPITALS’

Assisted living facilities are meant for the growing population of elderly residents who can’t live on their own but generally don’t need the kind of care offered at skilled nursing homes. The Council on Aging-Orange County estimates there are more than 1,000 assisted living facilities in the region, totaling more than 22,000 beds.

Facilities in Orange County vary in size – some of the smallest are run out of houses. The cost can range from $1,000 to as much as $8,000 a month, depending on location, services and amenities. Few facilities in the county accept very-low-income residents.

By definition, these are not medical centers. Yet they tend to accept residents with limited mobility and conditions such as dementia, which can require constant supervision.

“They’re becoming mini-hospitals. The trouble with that is these are social models, not medical care models,” said Chris Murphy, co-founder of Consumer Advocates for RCFE (Residential Care Facilities for the Elderly) Reform.

Getting information on facilities is critically important to the growing number of Orange County residents who are searching for the best facility for a loved one at an affordable price. But often families don’t start the process until they’re rushing to find care.

Susan Iwamoto of Costa Mesa and her husband had 24 hours to relocate his father, Gilbert, from a hospital to a residential care facility after a surgery. A case manager handed them a list of elder care homes and told them to go door-to-door.

“They only give you so much time,” said Iwamoto.

Five days after entering a facility, Gilbert’s feet had “swollen to the size of watermelons,” rendering him unable to walk, Iwamoto said. The facility didn’t call 911 or notify the family; the swelling turned out to be a sign that Gilbert had a cardiac event, she said. He died days later.

The Iwamoto family sued the facility and settled the lawsuit in 2013 for an undisclosed amount.

Some facility operators fail to train their staff or don’t give them the nominal, minimum amount of training hours mandated by the state. By law, caregivers at assisted living centers are required to log at least 10 hours of on-site training within a month of being hired, and four hours each year after that. Staff at centers offering dementia care must get at least six hours of special training within a month of hiring, and eight hours every year thereafter.

Starting Jan. 1, the minimum requirements will increase to 40 hours of initial training and 20 hours of annual follow-up training, says the California Department of Social Services, which regulates elder care facilities through a licensing division. Also, all caregivers will be required to get training in dementia care.

De Palma Terrace Senior Living in Placentia was cited in 2014 for failing to train its medical technicians. In a follow-up visit, inspectors discovered a resident hadn’t received a medication for more than a week, public records show.

TURNAROUND EFFORT

Meridian Senior Living, a national chain, purchased the distressed facility in late August, promising to turn it around, said Kevin Carlin, a company principal and senior vice president.

The 100-plus bed facility is undergoing a major rehab, and Meridian is converting one of its buildings into a “memory care” center for dementia and Alzheimer’s cases, Carlin said.

Meridian officials say its De Palma property has four nurses, which helps the facility handle more serious medical issues. Assisted living facilities are not required to have nurses.

In the event of a medical emergency, staff are required to call 911 and report incidents to authorities and the licensing division.

“Does it always happen? I’m not going to say it does,” said Libby Anderson, an ombudsman at the Council on Aging-Orange County. “It does go back to the training.”

Such training was lacking at Mother Marcy Home Care, the six-bed sister property to Mother Marcy Home Care-Chateau, state officials found.

Owner John Habash failed to provide staff the mandatory 10 hours of training and six hours of medication training, a report said. State inspectors also observed improper treatment of residents with dementia.

In one instance at Mother Marcy Home Care-Chateau, a resident with severe dementia suffered “a bad gash” that had apparently gone unreported to family or authorities. In another instance, Habash installed a lock on a resident’s bedroom door, preventing free access. He didn’t know such locks were prohibited, according to state records.

Habash told the Register he has “made major improvements” since those citations were issued, but declined to discuss each case.

State officials don’t appear convinced. They’re in the process of revoking Habash’s license and shutting down both Mother Marcy facilities.

Anchoring the Department of Social Services’ case against Habash is an allegation that one of Mother Marcy’s purported owners, Alfred P. Miaco, who has been convicted of felonies including grand theft and embezzlement, ignored orders to stay away from both centers. Habash requested a criminal-record exemption for Miaco in 2012, but it was denied.

Habash declined to discuss the case, and Miaco – who also goes by Kris Miaco – could not be reached for a comment. The state will decide in February if the homes, which are still operational, can stay open.

Habash has been cited at least two times for failing to have staff undergo background checks.

‘COMMON SENSE’

Anderson, at the Council on Aging-Orange County, pays unannounced visits to a dozen elder care facilities to check on residents and report issues to state officials. During visits, she’s looking for foul smells, unsecured sharp objects and general cleanliness.

“It’s a little bit of common sense,” she says.

Many of the citations issued at the county’s worst-performing centers involve those same issues.

Ayette Loo, owner and operator of Regency Care in Seal Beach, has racked up $1,700 in fines for issues that include uncovered electrical outlets, unlocked pool-cleaning supplies and an unsanitary refrigerator, state reports show. Similar issues came up in 2012.

Loo did not respond to multiple requests for a comment.

Fullerton Residential Manor, another problematic facility, has been dealing with an ongoing bedbug issue that has plagued the facility for at least four years. In 2011, inspectors called it “the worst bedbug case they have ever seen.”

Erie Mercado, the administrator of the 194-bed facility, said staff has contracted with a new pest control company, purchased pricey equipment to eradicate the bugs and discarded some common-area furniture. The bedbug issue is compounded, he added, when some tenants don’t want cleaning staff to enter their rooms.

“We are trying to combat the issues to the best of our ability," Mercado said.

Murphy, of the reform group, says such facilities are not inspected enough. Several years ago, they were visited twice a year. Due to budget cuts, that has been reduced to once every five years. An inspector will go out if prompted by a complaint, but families often don’t file complaints because they fear retaliation.

“The point is, it’s hard to tell the difference between a good facility and bad facility” if you’re just looking at the numbers, said Murphy.

Contact the writer: lleung@ocregister.com or 714-796-4976 Twitter @LilyShumLeung