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In California, $1 Million in Unpaid Fines for Assisted Living Centers

A ProPublica review of records from the California Department of Social Services shows the state collected less than half of the more than $2 million in fines it issued against assisted living facilities from 2007 to 2012.

Valley Manor Residential Care on Oct. 28, 2013, in Castro Valley, Calif. The California Department of Social Services failed to take prompt action after the owners of the Bay Area facility abandoned its residents, leaving 19 frail or impaired seniors to fend for themselves. (Marcio Jose Sanchez/AP Photo)

The California Department of Social Services issued more than $2 million in fines against assisted living facilities throughout the state from 2007 to 2012.

But a ProPublica review of department records shows it collected less than half of that. Indeed, the agency failed to wrest any money from the vast majority of facilities it hit with the most serious sanctions.

Of the 50 largest fines assessed over those years, the review showed, the department collected no money in 39 cases. In one instance, a facility in a tiny Shasta County town that was operating without a license accrued more than $250,000 in penalties and paid none of it.

“The fact that the fines were not paid is a concern,” said state Sen. Leland Yee, a Democrat who represents San Francisco and San Mateo County. “The reason we have fines is to deter individuals from breaking the rules and breaking the laws.”

ProPublica, as part of its ongoing examination of the multibillion-dollar assisted living industry, had asked California officials to produce records detailing their oversight of the state’s 7,700 assisted living facilities, which have tens of thousands of seniors in their care. The officials ultimately conceded they could not produce basic data about fundamental aspects of the department’s regulatory operations. For example, they could not say how many inspections the department conducts each year, or how many “unusual incidents” – injuries, abuse allegations, medication errors – the facilities report to the state.

The revelations come as state lawmakers, advocates for the elderly, and news organizations have heightened their scrutiny of the department’s performance. Last month, in a case that garnered national publicity, the department failed to take prompt action after the owners of a Bay Area facility abandoned its residents, effectively leaving 19 frail or impaired seniors to fend for themselves. Working without pay or training, a janitor and a cook tried to care for the clients.

While the federal government regulates the nursing home industry, it has left oversight of the assisted living business to the states, which, over the past two decades, have crafted a hodge-podge of widely divergent laws. Today some 750,000 elderly Americans reside in assisted living facilities, many operated by national chains.

Home to more assisted living facilities than any other state, California is widely seen as one of the loosest regulatory environments in the country. ProPublica’s examination of the state’s regulatory records lends evidence to that view.

Our review shows that troubled facilities often pay pennies on the dollar after they have been fined. A Southern California facility hit with $19,200 in fines in 2009 paid only $1,600. Another facility was fined $5,400 but wound up writing a check for $600.

Department spokesman Michael Weston pointed to an array of factors that slow – and sometimes halt – the state’s collection of fines. Some facilities go out of business and never pay. Some pay off fines in installments. Some choose to appeal the fines repeatedly – there are four levels of appeal – eventually succeeding in getting fines reduced or dismissed altogether.

Yee chairs the state Senate’s Human Services committee and intends to convene hearings on the state’s oversight of assisted living early next year. “When we hold hearings in January that is one of the things we’ll be looking at – why the fines were not paid,” he said.

Weston said “the department is committed to improving” the process of collecting fines and is “looking at creating an automated system to track the unpaid debts. We don’t have that presently.” He added that the state expects to collect at least a portion of the money that has so far gone unpaid.

By one measure, the state appears to be growing more aggressive in policing assisted living facilities.

In 2008, the department revoked the licenses of 52 facilities, exercising what officials describe as their most effective enforcement tool. In 2012, the most recent year for which data is available, the state moved to revoke 72 facility licenses and is still litigating to shutter many of those facilities.

But in other regards California’s oversight efforts are faltering. The state maintains one of the least rigorous inspection schedules in the nation. Ten years ago as state leaders stared at grim budget shortfalls, lawmakers dramatically revamped the department’s inspection regimen, decreasing the frequency of routine inspections from once a year to once every five years. The revised law is unequivocal: “Under no circumstance shall the department visit a residential care facility for the elderly less often than once every five years."

But the state has not been perfect in meeting even this relaxed mandate. Weston said the department had failed to inspect 13 facilities during the past five years. Weston said he did not know why the state had failed to meet its own requirement, but said the 13 facilities had now “been flagged.”

“Somebody is going to go out and perform an inspection,” he said.

In recent years, an industry lobby group, the California Assisted Living Association, has emerged as a force for reform, pushing repeatedly for more frequent inspections. Last year, the organization supported an unsuccessful bill that would’ve required inspectors to make unannounced visits to facilities every two years.

“We believe that more frequent inspections will further enhance the integrity of assisted living,” said CALA president Sally Michael, adding that the group’s members are willing to pay 20 percent more in annual licensing fees to help fund increased inspections.

What a waste of time!
$1M is chump change for the state of CA.

Mike Suddarth

Nov. 21, 2013, 2:18 p.m.

Not very many things are more important than protecting neglected and abused seniors with no advocates.  Any effort is worthwhile.  The threat of punishment is more important than the amount taken in.  The state has failed because voters won’t pay for successful oversight.

Janice Epperson

Nov. 21, 2013, 3:07 p.m.

Classic: regulatory laws w/o teeth. Not surprised.

They rejected a requirement of one unannounced visit every TWO years? I should thin every six months would be more appropriate. Meanwhile they cannot even manage to visit these home once every FIVE years? God help the hapless residents.
Assuming many of these businesses are not making a lot of money, phps some operating on a shoestring or at a loss (I have no idea if this is true) perhaps fines are not the way to go. Revoke their licenses, but suspend the revocation and put them on probation and demand the failures or shortcomings be corrected in say 45 days, then have an unannounced inspection at some point soon thereafter, and if any of the problems have not been corrected, permanently revoke their licenses

They rejected a requirement of one unannounced visit every TWO years? I should think every six months would be more appropriate. Meanwhile they cannot even manage to visit these home once every FIVE years? God help the hapless residents.
Assuming many of these businesses are not making a lot of money, phps some operating on a shoestring or at a loss (I have no idea if this is true) perhaps fines are not the way to go. Revoke their licenses, but suspend the revocation and put them on probation and demand the failures or shortcomings be corrected in say 45 days, then have an unannounced inspection at some point soon thereafter, and if any of the problems have not been corrected, permanently revoke their licenses, have families notified, and give them 30 days to find other accommodations for their elder or incapacitated relative.

George Robertson

Nov. 21, 2013, 5:27 p.m.

I volunteer as an ombudsman and visit one nursing home and one assisted living facility almost every week—the same ones! I also visit five adult foster homes on a regular basis. Isn’t there an ombudsman program in California to help advocate for residents? Your story also makes me wonder how many fines levied in Oregon have been paid. Thanks for your reporting on this important issue.

Mike Suddarth

Nov. 21, 2013, 6:42 p.m.

Ombudsman is active in California as well.  Some areas are served well, others poorly.  The difference is usually money provided to operate.  If not for Ombudsman, California would have many more problems.  State oversight has withered since the Prop 13 mind hold of not paying taxes became our “guiding principle”.

Hermann Helmholtz

Nov. 21, 2013, 9:16 p.m.

A law that prohibits an inspection agency from inspecting is laughable, if it was not tragic.

The mere fact that the agency closed 52 and is aiming at 72 more with “one inspection every five years” is a monumental evidence of corrupt legislature - which did not lift a pen to cancel the law after the crisis California faced - due to the mismanagement of the Governor and the legislature.

If the story did not come out - almost accidentally, nothing would have changed. In fact, even after it did, the “review"of the agency will not take place for two months… no doubt in the meantime the lobbyists would do their fancy footwork, and at the end little would change in the shameful situation.

We have “got used to it.” And what is more, we don’t seem to care as the legislator are elected once and again with at times less than 4% of the vote and less, if unopposed, and many are. 

But then, healthcare in the United States, of which Assisted Living is certainly a component, is a business. And like all businesses it must make profits. That it does so at the expense of the health or even the life of citizens has to be immaterial, and any hindrance in the pursuit of profit is almost unpatriotic.

We have “got used to it,” and we can do nothing, but nothing, to change it.

The max fine for a wrongful death is $150. One California facility director shared that she simply wrote the check because disputing the citation would cost far more than the $150. She considered it simply a cost of doing business and had zero concern or remorse that CCL concluded her facility’s action/inaction killed someone.

Why are CCL inspections and citations not available via the internet?

Why does every food service place in CA display a Health Dept letter grade by the front door, yet CCL has no similar program for Assisted Living Facilities?

Why does California Welfare & Institutions Code 15657.3(d)(2) require an elderly victim to die before a family member can file civil litigation in an effort to stop elder abuse?

Why do law enforcement agencies determine that nearly any from of elder abuse (except that which leaves a visible mark) is a civil matter, especially when W&I15657;.3(d)(2) prevents the civil litigation until after the victim dies?

Why does CA DSS communicated in written letters that completely isolating elders is legal?

Why do CCL inspectors ignore violations that they observe because the observed violation wasn’t what they were told to look for?

There is a LOT more to the story on how California and other states currently treat our elders. Time, accident, and/or negative health event could make any one of us the next elder abuse or dependent adult abuse victim if we don’t demand correction NOW!

Thanks ACT. I have a great new story about a SF woman being abused by the Monterey County Public Guardian.

California should do as New Jersey does, just do not investigate legitimate complaints.
No investigation = No violation = No fine = No lack of collection.
Even our egotistical governor will not require the NJDOH to investigate violations. Money talks.

This article is part of an ongoing investigation:
Life and Death in Assisted Living

Life and Death in Assisted Living

Is the loosely regulated, multi-billion dollar assisted living industry putting seniors at risk?

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