Coronavirus: Nursing homes with COVID-19 deaths have history of serious problems
April 19-- Apr. 19--Lack of controls to stop dangerous infections. Not enough personal protective equipment for caregivers. Staffing so thin the facility can't provide proper care for patients. Frequent situations that put the frail and elderly at even greater risk of getting sick and dying. General chaos.
As a deadly pandemic sweeps the country, would you want your loved one in a nursing home like that?
Public records show that such conditions have existed for years inside a pair of nursing homes in Hayward and Orinda with the highest known toll of infections and death from COVID-19 in the Bay Area. And, the records show, the owners of those homes have a track record of similar problems in their other facilities -- a pattern experts say is all too common in the industry.
Prema and Antony Thekkek, owners of Gateway Rehabilitation and Care Center in Hayward, have at least seven other nursing homes with records of poor care. Crystal Solorzano, who owns Orinda Care Center and at least 10 other facilities, also has a history of state and federal safety violations at some of her facilities.
The California Department of Public Health has taken the rare step of rejecting new applications from the Thekkeks and Solorzano to open licensed facilities a combined eight times, citing violation histories.
Both owners appear to be among what an expert called the "bad actors" in an industry where profits often come before patient needs and regulations are blatantly ignored. Records of 22 nursing homes they own or have previously owned show 1,110 state deficiencies and more than 1,700 complaints over the past three years.
In 2018 the Thekkeks were forced to close a Sebastopol nursing home because of bad care; they have been turned down for licenses to run other homes five times. The state health department rejected three license applications from Solorzano in December.
Experts say there is a correlation between the owners' records and the large coronavirus outbreaks at Orinda Care Center and Gateway Rehabilitation and Care Center, where a combined 17 patients have died as of April 17 and state data released Saturday show more than 150 staff and patients have been infected.
"It's absolutely no surprise" that owners of facilities with bad safety records own the homes in the Bay Area with the deadliest outbreaks, said Michael Connors, of the watchdog group California Advocates for Nursing Home Reform, known as CANHR. "Nursing home residents are in such grave jeopardy."
Dr. Mehrdad Ayati, a geriatrician who teaches medicine at Stanford University, said that homes with adequate staffing, sufficient training and whose owners act responsibly have been more successful at stemming outbreaks. As to the more poorly run homes, he said, "we see skilled nursing facilities who have not followed basic regulations related to staffing and other things -- they are more at risk of getting it."
Records show Gateway had serious problems well before the pandemic. In 2017 state inspectors found the facility broke rules meant to curb the spread of infection, including insufficient changes of gloves while treating patients and failing to swap out urine bags frequently enough.
In 2019, a patient with sepsis and another with an infected wound didn't receive critical injections of antibiotics because there was no one on duty qualified to give them. Another patient fell and broke bones in 2018 when an aide left her alone on the toilet despite knowing the woman had trouble keeping her balance.
Staff even struggled to properly dispose of medical waste. During an inspection last year, three washbasins filled with used hypodermic needles were found in an unlocked closet.
The Thekkeks also:
-- Had five license applications -- including for homes in Millbrae, Menlo Park and San Jose -- denied by the state based on past performance, including three rejections in 2015 because of poor care at a Bakersfield facility described by advocates as having "nightmarish conditions."
-- Were forced to close the Fircrest Convalescent Hospital in Sebastopol in 2018 when the federal government stopped it from taking Medicare patients, citing repeated safety violations and failures to provide adequate staffing.
-- Have been cited across their facilities for lack of infection controls, medication errors, poor medical record-keeping, lack of pharmaceutical services, poor food, failing to protect patients from falls, lack of staff and not safely maintaining the nursing homes themselves.
"To the best of our knowledge, no other chain operator has been subject to this pattern of denials by the department," CANHR's executive director, Pat McGuiness, wrote in a letter to the state health department.
Inspectors found staff at the Bakersfield home failed to contain the spread of bacterial infections and didn't make sure doctors and family members visiting sick patients wore personal protective equipment.
The home was cited four times under the Thekkeks' watch for conditions that put patients in "imminent danger of death or serious harm," records show.
At the Thekkeks' nursing home in Sebastopol, Fircrest Convalescent Hospital, inspectors also found conditions during a flu outbreak in late 2017 that seemed to foreshadow conditions at Gateway in Hayward three years later: Staff could not contain the spread of the disease.
One inspection took place during a norovirus outbreak in the facility. An inspector checked the sanitizer level in the kitchen's dishwasher and found it was five times lower than what was needed to kill the virus.
Federal reports on the flu and norovirus outbreaks don't say how many patients were sickened, but the decision by the federal Centers for Medicare and Medicaid Services to shutter Fircrest Convalescent came within months. It remains closed.
Neither Antony Kekkek nor Prema Kekkek, a registered nurse, returned repeated phone and email requests for an interview for this story.
The list of serious violations at Solorzano's Orinda Care Center -- where at least four people have died and 53 people have contracted coronavirus -- is also long, including an audit by the state that found it did not meet minimum staffing requirements on 16 out of 24 days that were monitored.
Last year, state inspectors found that dietary staff at the facility could not describe or demonstrate the correct procedures for sanitizing cookware and tableware, and that staff was storing expired and current medications together -- sometimes without refrigerating those that required it.
"We believe these were unacceptable, but isolated, incidents," said a spokesman for her facilities, Dan Kramer. "We're doing everything we can to ensure they won't happen again."
In December, the California Department of Public Health denied three applications submitted by Solorzano to operate skilled nursing facilities in San Jose, Canoga Park and Glendora because inspectors found 97 federal regulatory violations in facilities she owned, managed or operated between October 2016 and October 2019, as well as 46 violations of state requirements and three administrative penalties for failing to meet minimum staffing requirements.
Among the deficiencies the state cited in its denial to Solorzano were:
-- A 2018 inspection at her San Bernardino facility that found staff failed to notify a doctor about injuries to patients, including a fall that left a resident with a fractured hip.
-- An incident at Lake Merritt Healthcare Center in Oakland during which faulty exposed wiring burned the floor, leading to a power outage in three rooms and "the potential for fire."
-- The February 2019 sexual assault and rape of a Glendale facility resident inside her room by a nursing assistant.
-- Other violations across multiple facilities including a lack of sanitary precautions for food storage and bad pharmacy record-keeping.
In the denial letters, state health officials also noted that Solorzano's nursing home administrator license had been revoked because she provided fraudulent college transcripts in applying for the license. Although the revocation means she cannot operate a facility as a licensed administrator, she can still own them.
Kramer contended that Solorzano's administrator's license was not revoked but rather the state sent the letter in error, noting that a hearing on the matter is scheduled for September. "This is about Ms. Solorzano's due process rights and we plan to present information on or before that date fully exonerating," her.
She has also appealed the denials of her facility applications.
The number of positive COVID-19 cases at all of the facilities owned by Solorzano and the Thekkeks is unknown, but according to data published by the state department of health Saturday, Solorzano's Orinda Care Center had 58 positive cases among staff and patients and her Redwood Healthcare Center in Oakland had between one and 11. That data showed Gateway with 33 staff and 69 patient infections, a jump from the 66 total figure Alameda County released Thursday. Officials did not respond to emailed questions Saturday.
But at the Thekkeks' Gateway, family members of patients described horrendous conditions even before the COVID-19 outbreak.
Deonn Morgan's mother, Willie Ann Morgan, was first sent to Gateway about two years ago after she had a stroke and was unable to speak or walk on her own.
Morgan said in the past, her father would sometimes visit her mother for three or four hours at a time without seeing a nurse or nursing assistant come into her room.
On March 25, a social worker told the family that Willie Ann was being moved into a room with other residents to make space for new patients.
"I said we do not want my mother moved from her room," Morgan said, but the worker told them they had already moved her. "Then three to four days later Kaiser called us and said my mother was tested positive with coronavirus."
As of Friday, she was in stable condition at a Kaiser hospital, Deonn Morgan said. But she said Kaiser coordinators want to send Willie Ann back to Gateway, which her daughter refuses to allow. "She can't go back here -- it needs to be off-limits from everyone."
A Kaiser spokesperson issued a statement that acknowledged the "difficult situation" for patients and families.
"We are evaluating the latest developments in this evolving situation and are reviewing the care our patients receive, and will ensure our patients' safety and well-being," the spokesperson said.
District Attorney Nancy O'Malley said her office has been investigating Gateway for its handling of the pandemic.
As patients at Gateway died in recent weeks, their relatives sometimes watching helplessly through street-level windows while their fever-ravaged loved ones struggled to breathe, Prema and Antony Thekkek enjoyed the Easter holiday at their 6,300-square-foot, 15-room home in Alamo, their social media posts show.
Prema's posted photos on Facebook of frying pans heaped with sizzling meats and onions, and she noted that her Easter dinner menu included duck curry. Antony, meanwhile, reminded his followers of his other profession, acting, where he goes by the screen name "Thampy Antony." According to listings on the website IMDb.com, he has 30 acting credits since 2002 in movies with titles including "Calcutta News" and "Papilio Buddha."
Prema urged her friends "to pray for this pandemic to be over," but neither of them mentioned anything about the patients and workers suffering at Gateway. Prema did offer advice: "Let us all stay safe at home and stop the spread of COVID-19," she wrote.
"Wash your hands with soap and water."