Following up on complaints filed by a resident, an inspection by the California Department of Social Services July 24 found that at least two residents were fed food improper for their health conditions. Medications were also not available or not given to one resident in a timely manner, reports noted.
Santa Clara County health inspectors in an Aug. 20 inspection found that meals were not being refrigerated, reheated or held at temperatures that would prevent food-borne illness.
"We've responded to everything and corrected everything they've asked for," Lytton's Chief Executive Officer Gery Yearout said last week.
Lytton Gardens operates an assisted-living facility, residential independent-living housing and a skilled-nursing care facility in downtown Palo Alto.
The complaints surfaced after a resident complained in June and July about conditions ranging from inadequate supplies of toilet paper to being fed foods contraindicated by a physician's orders.
Violations were found in all three Lytton facilities, according to inspection reports.
County and state officials said concerns about senior safety are taken seriously, especially when there is a potential for food-borne illness. Senior populations are at high risk for serious illness and death from food-borne disease, according to federal and state reports.
Officials said they found no evidence of food-borne illness at Lytton facilities, just that conditions existed that could cause such illness.
The Aug. 20 inspection by Santa Clara County Department of Environmental Health found that refrigerator temperatures at Lytton Gardens' skilled-nursing and assisted-living facilities were higher than 60 degrees Fahrenheit. Cold food placed on tables was 60 to 70 degrees instead of being kept at the required 41 degrees or less.
Lytton's Assisted Living unit also did not have a probe thermometer for checking temperatures, inspectors reported.
Reheated food in the Independent Living kitchen was not reaching the required 165 degrees and hand washing was not occurring in the skilled-nursing unit, the reports stated.
Stored or held foods must be kept below or above the danger-zone range of 45 to 135 degrees Fahrenheit, the temperatures at which bacteria grow to dangerous levels, according to U.S. Centers for Disease Control (CDC) standards.
Lytton Gardens does not prepare food on site. All meals are delivered by Food Service Partners of South San Francisco, which makes deliveries the night before. Lytton Gardens refrigerates and reheats the prepared meals the next day, the county inspection report noted.
Yearout said Lytton Gardens had been inspected by various state regulatory agencies for years but that no one had ever told Lytton management about the food regulations.
"It's new. It's a new regulatory group. We don't even know the standards. We were never asked before in the past," she said.
One county inspection report said staff had received food-safety training, however.
A follow-up inspection found that food was still not being reheated to the required 165 degrees. Plastic wrap used to cover foods was being heated on the foods in ovens and had melted onto food in the assisted-living facility, the inspection reported.
An Aug. 30 inspection also noted that food was being compromised in the health-care or skilled-nursing unit as a result of being refrigerated at too-warm temperatures. Yearout said Lytton Gardens did not have commercial appliances but has changed to all commercial appliances to comply with the county health agency.
Vicki Everly, supervising environmental health specialist for the county, said no evidence of food-borne illness has been found at Lytton Gardens.
She stressed that Lytton Gardens is not under investigation by her department and has not been cited, although the three facilities are required to correct the violations.
Formal citations were issued by the state, however.
The California Department of Social Services Community Care Licensing Division cited Lytton Gardens on July 24 for feeding dairy products to two lactose-intolerant residents in the assisted-living facility. Basic services were not being provided as a result of the dairy-laden meals, the citation report noted, because the residents could not eat the meals and thus were not receiving nutritionally balanced meals and snacks as prescribed by their doctors. The facility does not always have an appropriate substitute for residents, the report indicated.
In non-food issues, residents were not given adequate rolls of toilet paper for their personal needs and mold was growing in the refrigerator of the resident who filed the original complaint, the inspection report noted.
Lytton Gardens was also cited on Aug. 16 for failing to provide a Nitro Patch for an assisted-living resident with a heart condition. The resident ran out of her Nitro Patch medication, and the facility was unable to give her another patch, the report noted. The facility also delayed for 12 hours giving the patient her prescribed morning aspirin after she returned from a hospital stay following chest pains, according to the social-services report.
Lytton Gardens filed a plan of corrections for the deficiencies found on July 24, which were deemed corrected, according to social-services documents.
But an Aug. 16 visit prompted additional violation-citations. Margarine purchased for residents had expired five months prior. The facility continued to provide the resident with food she should not eat. The resident had a medical order for a clear, liquid diet followed by bland foods but was again given a tray of solid food.
Yearout said the complaints were from one individual who has since moved out of Lytton to another senior-care facility.
"We gave her a 100-percent individualized menu. We tried to give her a list of all of the food items so that she could see which items, (such as) crackers, had milk in them and which did not," she said.
Yearout added that she thinks the more stringent regulations are a good idea.
Lytton, along with more than 70 other senior-care facilities in Santa Clara County, had not previously been inspected by county health officials. Prior to February 2007 they were under the state's purview. The jurisdiction shifted recently, and a two-month-old law now requires senior-care facilities to be licensed by counties.
Because of the multi-jurisdictional nature of senior care, it will take time for the county to sort through a morass of legalities and competing requirements, Everly said. But she said the county can provide a higher level of inspection than the state, and in coming months, she expects senior-care facilities will experience more frequent inspections.
Lytton Gardens and other facilities will have to undergo a permit process, she said.
Oscar Ramirez, spokesman for California Department of Social Services Community Care Licensing, said such violations are not uncommon.
"We take all complaints very seriously, and we act when alerted. We encourage anyone who has complaints to contact us," he said.
Lytton's Independent Living unit was cleared for a county permit on Sept. 12, according to county records. A planned fresh-produce market adjacent to the independent living facility was also approved. It will provide fresh fruits and vegetables to residents and staff, but not to the general public, a health department report said.