Many of the vulnerable patients of the Oakhill Springs Care Center on High Street in Oakland are dependent on staff for even the most basic needs.

They cannot dress or bathe themselves, they need help eating, and they spend most of their days in a chair or under restraints. Many cannot use the bathroom on their own, and most have psychiatric problems, dementia or behavioral symptoms — sometimes in combination.

But when state Public Health Department inspectors arrived at the low-slung stucco building in May for an annual review, they found residents whose specific medical needs were ignored, according to the department's inspection records.

Oakhill Springs, licensed to Leticia and Tony Perez under the name LTP Heritage LLC, according to Public Health Department and secretary of state documents, was one of the four facilities in Oakland that ranked among the lowest on the federal government's one- to five-star rating system. Facilities with Medicare or Medical contracts are awarded one to five stars based on inspections, staffing levels and other quality-of-care measurements over three years.

Oakhill Springs' current one-star ranking is based in part on staffing levels and on the most recent annual inspection by Public Health Department inspectors, which was in May.


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Tony Perez refused to comment on the quality of patient care at Oakhill Springs or the couple's other facilities, which include the Oakland Springs Health Care Center, where a woman shot and killed her daughter then turned the gun on herself Sunday night.

The woman, Diana Harden, of Livermore, left a note indicating her daughter had been mistreated by the staff at Oakland Springs and that the family's frustration in dealing with the problems was one of the reasons she resorted to taking her daughter's life. The incident and past citations have prompted an investigation by the Public Health Department.

Oakhill Springs

The Perezes have a history of taking over troubled facilities. They have improved conditions at Oakhill Springs to some degree, but problems have continued.

Despite the facility's high-need patients, the majority of nursing is done by certified nursing aides. Patients saw a registered nurse only 15 minutes on average per day in May — half of the national or state average, according to Medicare, which analyzes data the nursing homes report to the Public Health Department. Certified nursing aides, who do not receive the level of training required of registered nurses, did the bulk of the work — more than two hours.

While it is difficult to assess how that ratio affected care based on the limited information, the total hours of skilled nursing care each resident received — 3.5 hours per patient per day — is just above the state minimum requirement of 3.2 hours, which is insufficient to address the needs of nursing home residents, said Kathryn Locatell, a forensic geriatrician who analyzes and investigates cases of suspected elder abuse as a consultant to the U.S. and California Departments of Justice.

Public Health Department documents also revealed that the ability of one woman at Oakhill Springs to move her legs deteriorated within six months because there were no care plans or rehabilitation services to assist the woman in maintaining her ability to use her legs. That put her at risk of a permanently reduced mobility, an inspector wrote.

Another resident, also at Oakhill Springs, was allowed to use a fast-acting inhaler that can have life-threatening side effects, even though the patient was not mentally able to self-administer medications and did not want to, according to Public Health Department records.

More problems

An annual Public Health Department inspection in May found:

  • Out of 10 patients, seven were not given proper diets and several lost weight because they received insufficient calories to promote weight gain important to their well-being — despite orders by their doctors to the facility.

  • One woman had lost nearly 8 percent of her body weight because she wasn't given the puréed fortified diet her doctor had prescribed. The records show the physician was perplexed at why the woman continued to lose weight despite the health shakes he had ordered three times daily. But the inspector found no record of the order having been implemented, or that diets were fortified with the high-calorie food to promote weight gain. When an inspector asked the cook how she fortified the diets, she said, "I add thickener to the puréed food."

  • Patients suffering from kidney disease were given high-potassium foods, which could have worsened their kidney disease or could have become life-threatening.

  • Another resident was served fish despite a severe allergy to fish and shellfish that was recorded in the patient's medical records.

    The Public Health Department documents also showed that:

  • In October 2008, nursing staff put an iron medication tablet into a resident's feeding tube, which became clogged. The nurse in charge of medication said the required liquid iron had not been in stock for two weeks since the medication was ordered.

  • In June 2009, inspectors found that doors could not be closed because beds were in the way, which would make it easier for smoke or flames to spread in the case of a fire.

    The Perezes submitted plans to correct the problems. But that is more a formality than a guarantee of compliance, Locatell said.

    The Public Health Department will accept plans of corrections in the vast majority of cases as evidence that facilities are in compliance with state and federal laws that govern care homes. The operators may or may not take action, and problems are allowed to occur repeatedly.

    "It's like the clock starts all over again," she said.

    A spokesman for the Public Health Department, which oversees skilled-nursing facilities and other long-term care homes, said the agency takes each reported complaint seriously and investigates each one. The department's Licensing and Certification division conducts about 1,320 on-site inspections of nursing homes and responds to approximately 6,650 complaints, as well as 19,300 incidents reported by the facilities, spokesman Al Lundeen said.

    These inspections evaluate compliance with state and federal requirements, he added.

    Lack of oversight

    A 1998 analysis by the U.S. Government Accountability Office found that despite federal and state oversight, some California nursing homes are not being monitored closely enough to guarantee the safety and welfare of their residents. The GAO found that nearly one in three California nursing homes was cited by state surveyors for serious or potentially life-threatening care problems. Moreover, the GAO believes the extent of serious care problems portrayed in federal and state data is likely to be understated.

    While improvements have been made, a December 2005 follow-up report said officials from the San Francisco regional Center for Medicare and Medicaid Services office acknowledged that confusion by state surveyors as to what constituted actual harm had contributed to the decline in California.

    Locatell said there is too much leeway in the number of times the same violations are allowed to occur. In addition, the level and scope of danger to patients that deficiencies pose is assigned by inspectors, she said.

    Their decisions are subjective, said Locatell, who founded Kaiser Permanente's nursing home oversight program in Sacramento in 1994. If inspectors don't assign a deficiency as critical, the state may not pursue the problems, she said.

    And, Locatell added, people rarely contest the state inspectors' findings.

    Even when inspectors do pursue a facility vigorously, they run into many layers of bureaucracy that makes going after operators difficult, she said.

    Other facilities

    The Perezes also operate the Oakgrove Springs Care Center in Oakland; Hayward Springs Care Center in Hayward; Lafayette Care Center in Lafayette; and Pleasant Hill Manor in Pleasant Hill.

    The Pleasant Hill facility was cited by the Department of Social Services for inappropriate food storage, inadequate food supplies, incomplete staff records and discarded furniture stacked up on the patio. A resident in 2004 was overmedicated and required hospitalization, according to a record from the state Department of Social Services.

    Leticia Perez also owns the Nurses Alliance Corporation, one of the many enterprises under which the Perezes do business. Most of them are limited-liability companies.

    The Perezes' licensing company, LTP Legacy LLC, has been named as a party in a lawsuit asserting that the care an elderly woman received at Oakland Springs — called Clinton Village Convalescent Hospital until the Perezes took over April 29, 2008 — contributed to her death. The lawsuit contended that Tressie Mae Evans was often was found lying in her dirty bed with feces and soaking wet in urine while she was a resident from December 2007 until her death six months later.

    There is no record of a state investigation into Evans' death.

    "Nursing home care is often bad," Locatell said, "because oversight by the regulatory agencies is inadequate."

    Reach Angela Woodall at 510-208-6413.

    Low-rated CARE
    Four nursing homes in Oakland received just one out of five stars in the federal government's rating system:
  • Oakhill Springs Care Center
  • Oakridge Care Center Inc.
  • Oakland Care Center
  • Medical Hill Rehabilitation Center