Cook, Caregivers Recall Struggle to Aid Residents at `Closed` Calif. Facility

Oct. 30--Maurice Rowland knew that the closure notice stuck on the front door of his workplace meant the assisted-living residential facility was to be closed Thursday night because of a license revocation.

But why, he wondered, were 19 of the center's 32 residents still there -- some with Alzheimer's, others with what he believed to be schizophrenia, all of them hungry and wanting dinner.

Almost all the caregivers had left. The manager and owners were nowhere to be found. Rowland was the cook, hired three months earlier to prepare meals for the residents at Valley Springs Manor in Castro Valley.

"I didn't know what was going on, but I couldn't just leave them there," Rowland said Tuesday from his Hayward home. "We had built a friendship. So I did the best I could."

Over the next 40 hours, Rowland and two caregivers -- none of whom had been scheduled to work or asked by management to stay -- frantically cooked, cleaned and bathed the residents, gave them their medications, and helped them in and out of their beds and wheelchairs. But they were in over their heads, and there were medication foul-ups. Residents became ill, and Rowland and the caregivers called 911 six or seven times, he said, before emergency responders finally took the last of the residents Saturday.

Rules not followed

The residents were not supposed to have been left behind, said Michael Weston, a spokesman for the state Department of Social Services, the agency that suspended the center's license and ordered it shut down.

"The proper procedures were not followed," Weston said in a statement. "Standard procedure involves department staff working with the licensee of the facility and local agencies to contact family members or other authorized representatives of the residents to ensure they are transferred before the facility closes."

Weston said a review of the incident continues. The Alameda County sheriff's office is also investigating whether there was elder abuse.

Rowland's account and details provided by county authorities raise further questions about why the state didn't step in sooner and why it took multiple 911 calls before emergency responders evacuated every resident from the center.

Medical emergencies dialed in to 911 from Castro Valley go to the Alameda County Fire Department, which did not comment on the incident Tuesday.

Center in turmoil

The state and county have a safety net in place to regulate and oversee the ordered shutdowns of facilities that lose their licenses, yet the system failed in part because the residential care center was in such disarray that basic documentation was missing for some of the residents. The missing documentation meant, for purposes of identification, that these individuals didn't exist.

"Hospitals are struggling to put together health information on these folks and contact their families, quite frankly," said Victoria Tolbert, division director for adult aging and Medi-Cal services in the Alameda County Social Services Agency, which alerted the state to the center's problems in May. "We didn't even know they were there, that they were still there."

In a few cases, evacuated residents of the home weren't identified until family members saw news of the center's closure and contacted authorities to find out what had happened to their loved one, Tolbert said.

Emergency responders answering 911 calls took away some residents Friday. Fourteen residents remained Saturday, and after more 911 calls, Adult Protection Services, a county agency, ordered them moved to hospitals, Tolbert said.

"I know they were placed in hospitals all over Alameda County because no one hospital could handle them all," Tolbert said.

The residents had conditions that prevented them from making decisions about their own care, and some didn't understand what was happening, Tolbert said. Without their medical records, authorities were unable to contact their legal guardians or families.

Facility owner's case

Orrin Grover, an attorney who represents the center's owner, Hilda Manuel, said the residents were not abandoned by caregivers. Manuel and her staff had arraigned to move most residents by Saturday and were trying to figure out what to do with 11 -- not 19 -- remaining residents when the authorities arrived to evacuate them, Grover said.

"We have those 11 residents and they are residents that they can't place, and that's because they rely solely on their Social Security, which is only $1,000 a month," Grover said, adding that few care homes in Alameda County provide services for that sum.

The residents were left with the cook, Rowland, and two other caregivers, one of whom moonlighted as the facility's maid until the remaining residents were safely moved, Grover said.

Rescue was never necessary and an overreaction, Grover said.

Rowland disputes that. No one was being paid, he said. No one told them to stay.

On Thursday night, Rowland said he just could not go home and leave the residents. Instead, he prepared his usual Thursday night meal for them: spaghetti, garlic bread and salad. Then it was one thing after another: Someone needed medication. Someone needed a bath. Someone needed help getting from a wheelchair to a bed.

"It was crazy. We were overwhelmed," he said. "But I was just going to stick it out until someone came."

Asked why there was such a breakdown in procedure that left 19 seriously ill people fending for themselves in an abandoned care center, Tolbert said no one entity was to blame.

"You are pointing out a gap in the services," Tolbert said. "These systems are not quite robust enough. They don't quite touch and overlap enough to make sure that people don't fall through the cracks like this. The county programs are not designed to do that."

But Pat McGinnis, executive director for California Advocates for Nursing Home Reform, said responsibility lies with the state, not Alameda County.

"The law says that (the state social services agency is) responsible for ensuring the safe transfer under the health and safety code," McGinnis said.

Blaming the state

The state has consistently failed, McGinnis said, to make any effort to seriously regulate assisted-living homes, which are held to a much lower standard than nursing homes that provide medical care by licensed caregivers.

"If they had done it, they would not have left all those people to fend for themselves," McGinnis said.

Rowland, the cook who stayed behind, said that for the most part, he liked his job and chipped in to help his co-workers and residents when he could.

After sheriff's investigators interviewed him Saturday afternoon, Rowland went home to his daughter and two nieces and "slept for about two days," he said.

"As long as those people are out of there and safe, I feel good," he said. "Now I can take a breath."

Carolyn Jones and Will Kane are San Francisco Chronicle staff writers. E-mail: carolynjones@sfchronicle.com, wkane@sfchronicle.com

Copyright 2013 - San Francisco Chronicle