State Inspectors Find Outer Mission Nursing Home at Fault in Death of Patient
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The report, prepared by the California Department of Public Health, resulted in a severe "AA" citation for the San Francisco Nursing Center -- formerly known as Convalescent Center Mission Street -- and $100,000 fine for the facility.
The incident that led to the investigation was the alleged smothering of patient Barbara McIver on March 22, 2010, by Maximo Hong Fajardo Jr., a certified nursing assistant. Fajardo Jr., a recently hired worker, was found holding a pillow over McIver's face, leading to her death, according to police and state regulators.
He then allegedly fled the nursing home and went on a carjacking spree. Criminal charges have been filed against him, including murder. His next court hearing, to set a trial, is scheduled for this Wednesday, according to Erica Derryck, spokeswoman for District Attorney George Gascón.
The report sheds light on the role administrators and managers at the nursing home played in McIver's death. According to the report, the administrator, director of nursing, and two experienced nurses "neglected to monitor, supervise and evaluate" Fajardo Jr.'s training or work, and thus "failed to provide [McIver] the right to be free from deadly assault." (How's that for a grim piece of bureaucrat-speak?)
Among the findings were that the director of nursing at the facility ignored warnings from some nurses on the day of McIver's death about Fajardo Jr.'s bizarre behavior, and that he was hired "in spite of having no patient care or elder care nursing experience."
A woman who answered the phone at San Francisco Nursing Center today said no one was available to comment on the Department of Public Health report, and a phone message left for the center's administrator was not returned.
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