When paramedics tried to revive 66-year-old Irma Easton in her room at Avocado Post Acute nursing home on June 8, they found several powdered doughnuts blocking her airway.
A nurse at the El Cajon facility had given Easton a pack of the doughnuts from a vending machine, then left her alone to eat them. But Easton was a diabetic with a history of choking and she needed her food mechanically softened before she could eat it.
Despite the paramedics’ efforts, Easton choked to death on those doughnuts.
“She didn't have to die this way,” said Easton’s daughter Beatriz Berrios. “There are trained medical staff there. What are they doing?”
There are trained medical staff at the for-profit skilled nursing home. But not nearly enough highly trained nurses, according to a KPBS review of Avocado’s financial reports.
The review, done with the help of lawyer Ernie Tosh — who is a nationally recognized expert on senior care facilities’ finances — shows Avocado has failed in recent years to provide the level of registered nursing (RN) care expected by regulators.
For example, records from the first quarter of 2018, the most recent that are publicly available, show that based on levels of care Avocado is reimbursed for by the federal Centers for Medicare & Medicaid Services (CMS), the facility short-changed its residents 184 hours of cumulative registered nursing care per day.
The 2018 discrepancy was part of a pattern.
Avocado shorted its residents more than 170 hours in registered nursing care per day in both 2016 and 2017, according to the independent analysis by Tosh.