One of the deadliest COVID-19 outbreaks in the state’s assisted-living industry has occurred at a La Mesa facility with a troubled regulatory past.
Elmcroft of La Mesa reported 12 of its residents have died from the novel coronavirus, the second highest resident death toll among assisted-living facilities in California, according to recently released state data .
At the 56-bed memory care site 34 residents were infected, a total that includes the 12 seniors who died. The grisly numbers show the vulnerability of those in senior homes during the pandemic.
Elmcroft of La Mesa also recorded that 12 staff members got the virus, with no staff deaths. The facility declined an interview request, but forwarded a May 6 letter to residents and families stating it doesn’t have any new confirmed cases. The letter says a 14-day quarantine — the clock started with the most recent positive test — is expected to end May 10.
For now, the facility said group activities have been suspended and all residents must remain in their rooms. To keep up social engagement, families can set up virtual visits and staff works one on one with residents “while physically distanced,” the letter states.
“We work in close partnership with the County of San Diego Health & Human Services Agency. In our conversation with them this morning, they continue to be very pleased and complimentary of our protocols and practices,” the letter says. The county did not respond to a request for comment.
Industry watchdog Chris Murphy called the facility numbers tragic and scary. She added Elmcroft of La Mesa and other assisted-living facilities are ill-equipped to deal with coronavirus because of what she called a lack of infection control rules and staff training in the nonmedical industry.
“They were absolutely unprepared for what’s ravaging through their facilities,” said Murphy, the executive director of Consumer Advocates for RCFE Reform, a San Diego nonprofit focused on residential care facilities for the elderly, or RCFEs.
Compared to assisted-living facilities, skilled-nursing homes are more heavily regulated.
After naming senior facilities with COVID-19 cases three weeks ago, the state on May 7 began disclosing virus death tolls at specific nursing homes and assisted-living facilities. Health officials and industry groups have clamored for this information, both to aid in placement decisions and trace the virus’ path.
In San Diego County, nine skilled-nursing facilities  and six assisted-living facilities  reported at least one staff or resident death attributed to the disease. Determining the exact number of senior care fatalities in the region is difficult because facilities with fewer than 11 deaths don’t have to report precise numbers under state rules.
In California, 176-bed Redwood Springs Healthcare Center in Tulare County recorded 28 resident deaths related to coronavirus, the most among skilled-nursing facilities. In the assisted-living industry the highest COVID-19 resident death total is at Gordon Manor, an 82-bed site in San Mateo County that reported 13 resident deaths.
In a statement, the California Department of Social Services, which regulates assisted-living facilities, said it’s “working hard to ensure that residents of residential care facilities for the elderly have the appropriate level of care, and that residents and staff who do not have COVID-19 are protected.”
“The Department will continue to issue and update guidance  and offer technical assistance to licensees, including assisted living facilities, as this rapidly changing situation evolves,” the statement said.
COVID-19 has raced through even well-staffed facilities with strong infection control policies, health officials say. But a pattern of past infection control or staffing problems at a facility raises questions about preparedness for COVID-19.
It’s key to examine whether “past incidents led to important change” at hospitals or senior facilities, said Michael Mina, an epidemiologist at Harvard’s T.H. Chan School of Public Health.
Before coronavirus, regulators cited Elmcroft of La Mesa’s inadequate supervision as a factor in fights between residents. The facility is geared toward those with Alzheimer’s, dementia or other memory care needs.
Last year, facility staff weren’t present when a resident hit another resident in the face in the shower, according to a regulatory document. The resident who was struck was supposed to be accompanied by a caregiver while bathing.
In 2017, an administrative law judge put Elmcroft on probation after three fights, one of which was deadly. In 2015, a resident who was known to be aggressive physically assaulted another resident, ultimately causing her death, according to public regulatory documents harvested by Consumer Advocates for RCFE Reform for its database meant to boost industry transparency.
The judge stipulated a corrective plan that included outside review of the facility, security cameras and improved training.
As part of a larger property shuffle  Elmcroft of La Mesa relicensed in 2018, meaning its regulatory history before that time no longer exists online. Instead, it can only be retrieved at a Department of Social Services office. Because of this, watchdogs say too often relicensing obscures a facility’s past, even when there are links between the old and new licensee.
Eclipse Senior Living, which is owned in part by the current licensee of Elmcroft of La Mesa, in 2018 hired  most of the staff of Elmcroft Senior Living, the prior licensee of the La Mesa facility.
Karen Van Dyke, who owns a senior placement agency, said even before COVID-19 she didn’t recommend consideration of Elmcroft of La Mesa because of an extensive history of citations.
“There are a lot of places that my clients tour,” Van Dyke said.
Despite the release of information on COVID-19 cases and deaths in senior facilities, notable data gaps exist. Some skilled-nursing facilities in San Diego didn’t respond to the latest survey, an act that’s yet to draw enforcement action from the state, according to a records request.
Even doctors who care for seniors throughout the county say nursing facilities sometimes don’t notify them  about new COVID-19 cases.
In addition, the state’s figures omit assisted-living facilities with six or fewer residents — or about 74 percent of San Diego’s 593 assisted-living facilities.
The Department of Social Services said it excluded small facilities to protect privacy. Watchdog groups have argued the cutoff imperils placement decisions. Compounding the gaps in data: a shortage of COVID-19 testing in the facilities.
San Diego County outlined plans to help long-term care facilities with testing in a May 4 letter. That includes helping facilities acquire test supplies, and running facility tests at the county lab.
“In order to mitigate the risk of COVID-19 entering or to prevent its spread in your Facilities, the county of San Diego is offering testing of staff and residents of facilities by the County Public Health Laboratory,” states the letter from San Diego County Public Health Officer Wilma Wooten.
Once tests are turned into the county, results would be available in 24 hours.
Jared Whitlock reported this story with support from the 2019 Impact Fund, a program of the USC Annenberg Center for Health Journalism .