Elderly Care Homes Lack State Vigilance, Critics Say

State regulators responsible for protecting elderly residents of board and care homes routinely allow substandard and dangerous facilities to operate for months and sometimes years while senior citizens are neglected and abused, records show.

Licensing officials say immediate action is taken to close homes if there is “imminent danger” to elderly residents. But inspection records and other documents show that even after the state has identified homes as problem-plagued, such facilities remain open while inspectors go on issuing ineffective citations and warnings.

These problem facilities do not reflect the quality of care provided by the board and care industry as a whole. Even the severest critics acknowledge that there are good homes. But when a facility is substandard, the enforcement system gives operators little incentive to improve conditions, records and interviews indicate. State officials rarely levy fines against substandard homes in Los Angeles County and collect less than 10% of the penalties imposed. No statewide figures were available.

Last year state officials levied $38,400 in fines against board andcare homes for the elderly in the county, but collected $3,034.

“We call them and write them letters, but it’s hardly worth it,” said Martha Lopez, deputy director of community care licensing for the state Department of Social Services.

Critics of board and care regulations say minor traffic violations are more strictly enforced than the potentially life-threatening situations in some homes.

“It [the current regulatory system] is like parking in an illegal parking space and having a police officer come by and say, ‘Don’t do it again and I won’t give you a ticket,’ ” said Jeannine L. English, executive director of the Little Hoover Commission, a state watchdog agency that regularly investigates conditions of long-term care for the aged.

Commission Warning

Five years ago, the Little Hoover Commission reported improvement in board and care homes for the elderly, but warned the state to “concentrate its . . . efforts on enforcing existing laws and eliminating rogue facilities that refuse to comply with state standards.”

Top state licensing officials insist that operators of such homes face swift and effective discipline.

“For a short period of time they present a risk of health and safety to persons in care,” said Dave Dodds, spokesman for the deputy director of the Community Care Licensing Division, “[but] we will take the license away if we can’t get them into compliance.”

Yet the very files cited by the state as examples of how quickly they have clamped down on some 40 of the worst violators in Los Angeles County show that efforts to regulate problem homes often drag on for years.

* Problem board and care homes are repeatedly cited for “deficiencies” such as neglect of residents, shortage of staff, vermin infestations, rundown conditions, spoiled and inadequate food and lack of activity programs, usually without facing meaningful discipline. Instead, inspectors issue “fix-it” citations requiring repairs or observance of regulations within a set time period. Operators frequently repeat the violations or commit new ones.

* Facilities that are found operating without licenses--a violation of the law--typically are not referred to local prosecutors. Instead, inspectors encourage the owners to get licenses. Some of these homes remain problem facilities for years afterward.

* State law prohibits housing the aged in the same board and care homes with “incompatible” mental patients who have severe and disruptive behavior problems, but such mixes are common in problem facilities and sometimes result in the elderly being terrorized and badly beaten.

One home operator racked up a record of serious deficiencies over 15 years, cited among other things for serious maintenance problems, insufficient staff and dangerous neglect, which allegedly resulted in a death and a rape--yet never paid a fine. Another operator, accused of illegally running a home without a license, was encouraged to become licensed, after which she compiled five year’s worth of citations for serious deficiencies, including roach infestations, maintenance problems and dangerous neglect of residents before her permit was revoked.

“The Department of Social Services’ regulatory system is set up to fail,” said Eric Carlson, attorney for Bet Tzedek Legal Services, a nonprofit law firm that concentrates on long-term care issues. “There is no ability to collect fines . . . and little ability to revoke licenses.

“Some home operators are decent people trying to do a decent job,” he said, “but some know they can get away with virtually anything [and] have been neglecting and abusing residents for years.”

State attorneys maintain that it takes time to build cases for revocation proceedings before administrative law judges.

As for the failure to seek prosecution of unlicensed operators, state officials say that local authorities are usually too busy with more serious crimes to prosecute such cases.

Under state regulations, licensing officials say, fines are used for the most part as leverage to force operators to correct deficiencies. Once such corrections are made, they say, regulations do not call for assessing penalties.

“I wouldn’t want to say that I’m going to put somebody out of business because they haven’t paid a $300 fine,” said licensing chief Lopez. “I mean, that’s not something that I want to do.”

Numbers on Rise

The number of board and care homes in the state has mushroomed along with the dramatic growth of California’s elderly population, increasing from 3,500 facilities a decade ago to 5,000 today. In Los Angeles County, 900 facilities are licensed to house 29,000 residents.

Formally known as community care facilities for the elderly, board and care homes range in size from six-bed mom and pop operations to those that house hundreds of residents. Conditions range from dismal to elegant.

Board and care is meant for senior citizens who need help with such routine activities as bathing or dressing--not the kind of skilled medical services provided by nursing homes, which generally cost far more. The government pays $670 a month for board and care for the poor in California, compared to as much as $2,860 for nursing homes. Because of the money crunch in medical services, more fragile elders are being pushed into board and care, experts say.

Many of the residents of the New Fern Guest Home in Rosemead were especially vulnerable. Owner Charles I. Boyd limited his clientele to women, most of whom, he said, had been abused by men.

A former hair stylist, Boyd took over New Fern from his parents 30 years ago. Records over the last 15 years show that Boyd has been accused by state officials of, among other things, dangerous and deadly neglect, improperly mixing young disabled occupants with the elderly, keeping inadequate records, and of numerous maintenance problems, including torn and cracked flooring, cracked toilet seats, and a dirty refrigerator and kitchen cupboards.

In an August 1987 state evaluation, New Fern was found substandard in 18 of 58 categories of care. Deficiencies included failure to provide such services as a clean, safe and sanitary facility, an adequate food supply, a hazard-free environment, a clean kitchen, proper medication records or an activity program.

In 1990, New Fern’s operating license was put on probation after an elderly woman died of head injuries. Boyd and his late wife Margaret allegedly failed to observe the woman’s deteriorating condition after she fell out of bed and suffered the injury in 1987.

Boyd and his wife also were accused of illegally restraining an occupant with a straitjacket-type device, improperly storing medical supplies and operating a dirty kitchen.

Boyd denies the reports’ accusations, saying, “We never used restraints on anybody.” He maintains that allegations of poor maintenance and procedures are simply bureaucratic nit-picking.

“Anything licensing has ever suggested that I do, I’ve done,” he said. “But it’s really tough maintaining a facility when you’re talking about meeting all the state standards.”

Boyd says he was put on probation because state officials needed to justify a long investigation into the woman’s death and that most of the probationary period was retroactive. Documents indeed show that Boyd was required to serve only three months of the one-year probationary period in 1990.

But a few years later, New Fern was again involved in trouble.

In an accusation filed against the New Fern license in 1995, state officials accused Boyd of failure to protect a mentally ill resident who died in June 1993 after drinking dishwashing soap and in whose system toxic levels of the drug Thorazine were found.

Boyd denies that the death was his fault and said he had helped the woman cut down on her doses of Thorazine.

Then in November 1994, an elderly resident of New Fern was raped by a registered sex offender who had been regularly visiting a young mentally disturbed woman living at the facility. Licensing documents allege that Boyd had been advised by police to get a restraining order to keep the suspect away from the home, but had failed to do so.

Boyd contends that he did all he could to keep the suspect away and even had the man arrested.

Licensing officials cited Boyd for several deficiencies from autumn 1994 to spring 1995, including maintenance problems, inadequate staff and incomplete records.

Again, Boyd contends that he was being victimized by bureaucratic nit-picking because officials were upset about the rape.

In his 30 years of operating New Fern, Boyd was never fined.

In August, state officials filed a formal action to revoke Boyd’s license. By then he had sold the facility and was acting as temporary administrator for the new owner, Alvin Chin, a pediatrician.

Chin has applied for a license and Boyd has moved to Nevada. Boyd agreed in a settlement with the state that he would not open another board and care home.

Why did the state wait so long to move on Boyd?

“He has had ongoing difficulties.” said Robert Pate, manager of the Eastern Valleys District licensing office. “But what he does is correct them. You go out and cite the problems and he corrects them, you go out and cite different deficiencies and he corrects them.”

Mental Patients

State regulations prohibit mixing extremely disruptive mental patients in boarding homes with the elderly. But state officials acknowledge that home operators, often under economic pressure to fill vacant beds, sometimes admit deeply disturbed residents. State procedures for removal of “inappropriate” occupants are slow and bureaucratic.

“Our responsibility is to go to the facility and review the records,” Pate said. “If we do a complete evaluation and find a client like that, we would talk to the administrator. . . . It’s their responsibility to develop a [relocation] plan.”

Less than two years ago at Beth Avot for Retirement Living in Hollywood, a 57-year-old schizophrenic resident who stood 6 feet tall and weighed 210 pounds brutally beat two elderly women, one 95, the other 80, who lived at the home, according to police reports. Both were hospitalized as a result of the assault.

Photographs show that 95-year-old Ella Freireich’s face was beaten into a mask of bloody bruises. Her son said he was unable to recognize her in the hospital.

State officials were aware more than a month before the attack that the suspect in the beatings was potentially dangerous but did nothing to protect elderly residents, according to depositions in a lawsuit filed by Freireich’s family on her behalf.

Six weeks before the assault, licensing officials were told by residents during an inspection of the 50-bed home that the suspect was known for getting drunk, pounding on doors and intimidating elderly occupants whose rooms he entered with a passkey, according to depositions from inspectors and the home’s staff. The suspect scrawled “die” and “death” on the walls and talked incoherently, according to the depositions and state inspection documents.

State licensing officials considered the man potentially dangerous--sworn testimony by a state inspector indicates that he frightened another inspector--but did not seek his removal.

State attorneys point out that the mental patient was never prosecuted for the assaults because of lack of evidence and argue that licensing inspectors had no authority to remove him from the home.

“If they thought he was an immediate danger,” said Lawrence B. Bolton, acting chief deputy director of state Social Services, “what they could do is contact the legal office and we would tell the facility to eliminate the dangerous condition . . . [but] law enforcement didn’t even feel there was enough evidence to prosecute the man [after the assaults].”

Besides learning of the potentially dangerous mental patient at Beth Avot prior to the assaults, inspectors observed 64 deficiencies at the home during a single inspection, enough to fill an 11-page report. Among the problems noted: watered down milk and juice, a filthy refrigerator containing rotten fruit, no special diets for diabetics, a failure to provide soap, presence of cockroaches throughout the home, torn screens, drywall exposed and hanging out the windows, urine odor in a resident’s room so strong that inspectors wrote in their report that they could not breathe, and failure to administer medications.

Beth Avot owner Pearl Munter did not return repeated telephone calls from The Times.

Licensing officials say their records indicate that the home had deteriorated for only a short time before the host of deficiencies were noted and that improvements were made after the inspection. But depositions in the Freireich civil lawsuit filed in Los Angeles Superior Court indicate that the facility had been degenerating for years.

Longtime employees testified that young aggressive mentally ill patients were regularly mixed at the facility with elderly residents. One crazed occupant jumped from the roof and another set the basement ablaze, according to sworn statements. A disturbed young woman dressed prostitute-style and made forays at night onto the Hollywood streets, according to testimony. Still another mental patient physically abused the elderly, according to the testimony of a former staff member. Roaches were so numerous and aggressive that they crawled on the faces of old people while they slept, the former employee testified.

The home was summarily shut down by licensing officials Aug. 12, 1994, six days after the beatings of the elderly women.

“The state must accept some of the blame,” said attorney David Wood, who sued the facility on behalf of Freireich, “because they have people whose job it is to inspect these places and there is no way to describe this place other than a cesspool, going back two or three years.”

The lawsuit was settled in 1995; its terms are confidential.

The 80-year-old assault victim recovered and lives in another home.

Freireich lost her memory from the beating, according to her family. She underwent brain surgery, family members said, and was in and out of the hospital before she died in October.