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Pedestrians walk by the Oakland Springs Care Center on 10th Avenue on Thursday, Sept. 17, 2009, in Oakland, Calif. A 64-year-old woman fatally shot her disabled daughter and killed herself at the facility on Sept. 13. (Jane Tyska/Staff)

Exactly what drove Diana Harden to walk into an Oakland nursing home and shoot her disabled daughter and then kill herself remains a mystery.

But at least one factor behind her drastic decision may have been the treatment her brain-damaged daughter, Yvette Harden, received at the Oakland Springs Health Care Center on 10th Avenue, where she had been a patient for six years, according to a detailed letter the mother wrote before ending both their lives Sunday night.

Yvette Harden was severely impaired by a near-fatal auto crash in 1994. The accident left her partially paralyzed and with little impulse control and essentially no inhibitions because of brain damage, the mother wrote in a letter sent to KGO-TV's ABC7 News before she fatally shot her daughter and then herself.

"This is a dangerous and misunderstood condition by nursing home personnel," Diana Harden of Livermore wrote in the letter, dated Aug. 26, that ABC7 posted on its Web site.

She complained in the letter that despite her efforts to educate staff of Oakland Springs Health Care Center about the brain injury, they treated her daughter like an "animal or non-person."

The certified nursing aides "tell her "... she's a 'Fat Pig' and that they 'hate taking care of her,'"‰" Diana Harden wrote. She wrote that the aides bathed Yvette "like a car," with cold water at times to punish her. When Yvette would scream, the aides would turn the hot water back on before the nurse in charge could arrive, according to the letter.

"There's much more but you can ask my family. "... They can tell you. I can't go on like this. She has been begging me to end it for two years," Diana Harden wrote. "My health is failing and I don't want to leave her alone."

Oakland Springs Health Care Center's co-owner said staff did everything they could to care for Harden, who openly talked to Oakland Springs staff about wanting to kill herself.

"Could we have done anything to prevent it?" Tony Perez said, referring to the murder-suicide. "I don't think so. But I trust that my staff gave the best of care to her."

The California Department of Public Health has launched a vigorous investigation into Oakland Springs, according to spokesman Al Lundeen.

He said the department could not discuss the details of the investigation but added that the facility has been the subject of past complaints — 48 that were substantiated since January 2008.

Tony and Leticia Perez, under the licensee name of LTP Legacy LLC, took over the facility April 29, 2008, but problems persisted, Department of Public Health records show.

Harden's ordeal

Harden had spent six years at Oakland Springs before her death. She had been in and out of nursing homes since her 1994 accident including Hayward Convalescent in Hayward, which had her taken to the John George Psychiatric Pavilion, a hospital in San Leandro run by Alameda County that treats psychiatric patients.

She stayed there for four months while her mother searched for a facility that would accept Yvette, who had been labeled as problematic by the Hayward facility because she was combative and had scorched the patio table with a lighter, according to the letter.

Oakland Springs was the only facility that would admit her, Diana Harden wrote.

Complaints about Yvette's care by the mother and daughter prompted investigators from the Department of Public Health to inspect the facility.

Because she was partially paralyzed, Yvette Harden could get around only with a wheelchair. But staff took away the motorized chair after Harden broke a glass patio door and bent the metal on a gazebo fixture in July 2008. She was given a manual chair that she had to be strapped into because it was too small and made the pain in her legs and back worse, according to Department of Public Health records.

She told her mother, "I want to die; I don't want to live without my wheelchair," according to the Department of Public Health records.

Because of her weight, 320 pounds in September 2008, Harden was at risk for developing pressure sores, especially because she spent more than eight hours a day in the ill-fitting chair, Department of Public Health records showed.

Department of Public Health records show that the director of nursing at Oakland Springs confirmed the facility's occupational therapist did not assess the appropriateness or fit of the wheelchair. The nursing director told the inspector that it was assumed they didn't need to because the manual wheelchair was acquired by Yvette Harden in April 2008.

Perez said staff took away Harden's motorized wheelchair because she was a danger to herself and other patients.

"She had no control of the wheelchair," he said.

But nothing was done to teach her how to use the motorized wheelchair, according to the Department of Public Health records.

Limiting mobility can put patients at "risk for depression, emotional distress, accidents, harm, pain, and diminished mobility," a Department of Public Health investigator wrote in September 2008.

Indeed, the staff knew Harden wanted to kill herself and responded with a plan to monitor her and encourage her to take part in activities.

"However," the investigator wrote, "the care plan did not address (her) reduced mobility."

Troubled history

Harden was not the only resident who faced problems at Oakland Springs, according to Department of Public Health documents.

On May 19, 2008, an inspector found a resident having dinner in bed with a pillow case wrapped around his neck instead of a bib, Department of Public Health records show. An inspection of the linen closet revealed that the facility lacked clean towels, washcloths, nightgowns and bedding except for one or two isolated pieces, the Department of Public Health records show.

In each case, Oakland Springs submitted a plan of correction to the Public Health Department. But during an annual survey in November 2008, inspectors found peeling paint on outside walls. Inside, several rooms reeked of urine, and there were smears of brown matter on bathroom floors, according to Department of Public Health documents.

Residents told the investigator that some residents had wandered off because the alarm was not working according to Department of Public Health records.

"The batteries must be out," the maintenance supervisor told the investigator.

Bolt cutters were found on the long flight of stairs outside the door, records state.

The hot water heater was broken, leaving one side of the building with only cold water, records state. A certified nursing assistant was told to "get along the best she could." The facility offered cold showers, the inspector was told by the president of the Resident Council, which is composed of patients who advocate for themselves for better care.

A review by inspectors of medical records indicated that a mentally disabled resident who needed total assistance with daily needs because he had a gastric feeding tube had not been showered for the entire month of September 2008 and only once in October 2008.

The inspector found the teeth of another resident yellow and decayed. His tongue was discolored, cracked and dry, according to Department of Public Health records. Thick mucous had accumulated around his mouth, and he was unshaven. He still hadn't been cleaned up when the inspector returned the next day.

Diana Harden wrote in her letter, which was mailed the day before the Sunday night killings, that her daughter had pleaded with her to expose the problems Yvette had faced at the facility.

"She asked me to write this letter and for you to lobby the state to find a way for brain injured patients not to continue to fall through the cracks," Diana Harden wrote.