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Daytona Beach News-Journal


Center's shutdown highlights elder care problems

08/31/2008 by Anne Geggis © Daytona Beach News-Journal

ORMOND BEACH -- Walk through the arching entrance of the Care Center of Ormond Beach and you'll get quite a view of the facility.

Cathedral ceilings, custom window treatments and overstuffed leather furniture are perfectly coordinated with the center's Spanish mission-style stucco exterior and red-tiled roof. It convinced Darylan Stratten this was the place for Mother, who turned 90 this month.

"When I went there, I thought it looked nice," Stratten said. "She had a private room. It was brand new."

Beyond that front room, however, state investigators found a grimmer reality: untreated wounds, bedsores, urine-soaked rugs and an inadequate supply of medicines, among other problems. Ultimately, investigators yanked the center's license to operate as an assisted living facility last month.

It was the culmination of two years' worth of complaints -- and 15 complaint investigations -- that points up how assisted living facilities occupy a gray area in Florida's care for the elderly. They are not as tightly regulated as nursing homes -- inspected about half as often -- yet their operators provide essential life-sustaining services to elderly people who, in some cases, are as vulnerable as those staying in nursing homes.

After hearing news of the facility's closing, Stratten, who lives in California, clicked on an Internet newspaper link to the state documents that closed the facility. It was then she realized with growing horror that her mother was "patient 1" -- a resident who wandered off and was found a half-mile from the facility with leg wounds so severe the state transferred her to a nursing home with special wound care.

"My mother was abused by that place," Stratten said. "Abused by neglect."

The man who owned and operated the Care Center, Hassan Jibril, said he intends to fight the state's closure of the facility, licensed for 52 beds. But shortly after the closure, on Aug. 4, "Dr. J" as his patients and staff called him, was forced into a $2.37 million foreclosure sale. Hand Avenue Investors has leased the facility to a Port Orange assisted living operator, and the building will be reopening next month, according to Peter Golub, president of the investor group.

Days before the sale, however, Jibril was insisting there was nothing going wrong at the center, where a new wing with a capacity of 44 beds was completed this spring but never state licensed.

"It is one of the best facilities in Volusia County," Jibril said. "We provide the best care in this area."

The facility's state inspection reports strongly counter his claims.

RED FLAGS FOUND

Unlike nursing homes -- where about 4,000 residents of Volusia and Flagler counties live in 31 facilities -- the state doesn't give star rankings to assisted living facilities, which generally cost less than nursing homes. And, while nursing homes often have hundreds of residents in one place, this area has about 4,000 residents spread among 211 assisted living facilities and adult family homes. Assisted living facilities and even smaller adult family homes are not subject to federal regulations, as nursing homes are.

"We have individuals who are much more compromised in nursing homes -- people who require 24-hour nursing care," explained Molly McKinstry, bureau chief for long-term care services for the Florida Agency for Health Care Administration.

The day before the care center's shutdown -- when her mother was admitted to a nursing home for specialized infected wound treatment -- Stratten said she received a phone call from Jibril. He told her the Care Center was being bought and he would be moving her mother to another place he owned. Despite the care center's loss of its license, state regulations allow Jibril to run a home for adults who need help with the activities of daily living, provided he had no more than two residents.

But then Stratten received phone calls from state investigators telling her about the wounds.

"They told me to stay away from him," Stratten said.

While the Florida Agency for Health Care Administration didn't confirm any conditions that presented direct health threats until January 2006, Florida's Long-Term Care Ombudsman Program, a volunteer, state-funded watchdog, found red flags with medicine distribution as early as September 2005 and verified gross neglect of patients in April 2006. The assisted living facility opened in 2004.

On the advice of his lawyer, Jibril said he wouldn't answer questions about specific allegations, only saying that staff members had let him down. State records show he made the decision to inappropriately admit patients, including one bed-ridden resident who couldn't do anything unaided except eat.

STATE SLOW TO ACT

Donna Mancini moved her mother from Arizona to the Care Center of Ormond Beach in spring 2006. Ten days after her mother, Eleanor Mancini, now 77, was admitted there, she got a call from a nurse concerned that her mother hadn't been given the right medicine.

After some investigation, Mancini said she discovered her mother had received half of the prescribed dose of antipsychotic medicine she received monthly. She took her complaints to the state ombudsman and the abuse hot line, but the results of the finding didn't satisfy her. A complaint record shows that problems with medications being administered were verified by the ombudsman, but the problem was not resolved, and the state Agency for Health Care Administration didn't follow the finding with action.

"It's unbelievable what the state let him get away with," Mancini said.

Gail Camputaro, executive director of the Council on Aging of Volusia/Flagler, said she doesn't fault the state's system of oversight for the problems at Care Center. "They are doing the best job they can with what they have," Camputaro said.

The state Agency for Health Care Administration has designated 27 investigators to oversee 2,223 health care facilities in the region that includes Volusia and Flagler counties, extending up to Jacksonville.

In Volusia and Flagler alone, those investigators check on not only nursing homes and assisted living facilities where a population twice the size of Ponce Inlet live, but also 615 other facilities that include hospitals, ambulatory surgical centers and medical laboratories.<

"I don't see more (investigators) coming to them," Camputaro said.

PROBLEMS FOUND

Eventually, reports about Jibril's facility became prominent on the state's radar screen.

Last November, Care Center of Ormond Beach was ordered to stop accepting new admissions and having an inadequate supply of medications was chief among the reasons for the emergency action.

But things continued to deteriorate at the care center, according to state records. A two-day visit from June 30 to July 1 revealed that Jibril was acting as administrator, even though he is not certified as such, and that medication problems were continuing, with 10 of 13 residents not receiving their medications.

Finally, an emergency order issued 20 days later further illustrated the facility's deficiencies, describing residents unable to make it to the toilet because of inadequate staff, one resident strapped to a wheelchair and unable to release the restraint, and untreated, undocumented conditions and injuries.

But Jibril insists he ran a place where residents wanted to stay.

"One resident refused to get out of this building," Jibril said, recalling the closing. "He said he was here to die. AHCA said I had to call 9-1-1 to get him out."

Stratten, for her part, said she can't believe she had her mother living at that facility for three years and three months. And that she paid Jibril more than $140,000 in that time.

"You trust the people. You trust the hospital. You trust the doctor. You trust the person who tells you this is a good facility," Stratten said, recalling how she heard about the care center from a hospital referral shortly after the center opened.

Her visit last month was troubling, she said. Her mother wasn't wearing underwear or any of the items from her extensive wardrobe. Instead, she wore men's shoes. And her hair had not been styled and had been allowed to grow long.

Stratten recalled, with some irony, that her mother once worked for the state of Florida accrediting nursing homes.

"They told me so frequently, 'We're taking good care of her,' " she said. "Maybe I just didn't want to see it."