For nearly 17 years, Silvia Cata cared for elderly clients in her home on a dead-end street in Sacramento's Gardenland neighborhood, a residential enclave flanked by tire shops, lube and oil joints and a check-cashing store on the corner.
For much of those 17 years, the state of California expressed exasperation and dismay over Cata's work, filling her Department of Social Services file with complaint investigations, deficiency reports, citations, fines and plans of correction.
But she never lost her license that is, not until an elderly woman in her care died last year, and another state agency decided it would build its own case against Silvia Cata and her Super Home Care on Bowman Avenue.
Cata returns to Sacramento Superior Court today to face felony charges related to the June 2012 death of 88-year-old Georgia Holzmeister, who suffered from dementia and lived at the facility for more than five years. Holzmeister developed a Stage IV bedsore while living in the home and, despite emergency hospital treatment, died five days later without regaining consciousness.
Last month, California's attorney general took the extraordinary step of charging Cata with involuntary manslaughter, believed to be a first for state prosecutors in an elder-care case. She also is charged with a second felony count of elder or dependent adult abuse, resulting in death, and faces up to 12 years in prison.
The unusual prosecution arises from what the attorney general describes in court papers as Cata's "deliberate and complete reckless disregard for performing the essential duties as Holzmeister's caretaker."
Cata, 52, was no stranger to a sister state agency, the Department of Social Services, which has produced a flurry of paperwork on the provider almost since the day she was licensed in June 1996.
A Bee review of Cata's licensing file shows the caregiver was cited at least 40 times since 1996 for violations in her facility, including 26 Type A deficiencies. These are the most serious violations under state regulations, as they pose direct and immediate risks to residents' health, safety or personal rights.
The Department of Social Services did not suspend Cata's license until Feb. 12, the day after her arrest and eight months after Holzmeister's death. Meanwhile, Cata continued to care for three clients during that period, receiving 12 more citations for violating regulations before the state notified her that it had begun the legal process to yank her license.
"That shows an absolute failure of this department," said Carole Herman, founder and president of the Sacramento-based Foundation Aiding the Elderly. "She should have been shut down a long time ago."
Michael Weston, spokesman for the Department of Social Services, said Wednesday in a prepared statement:
"In reviewing the case, the department should have moved more quickly in taking administrative action. We are thoroughly reviewing the circumstances surrounding this case and will take the necessary actions to prevent this from happening again."
But Weston also said that before a complaint was filed last year regarding Holzmeister's death, Cata "showed no pattern of noncompliance, which would warrant administrative action."
Cata's defense attorney, Johnny Griffin III, acknowledged that his client had a history of violations but said the incidents were not reflective of poor patient care.
"They really can't say she provided bad care," said Griffin, describing Cata's facility as neat and clean and her clients as properly washed and fed.
Griffin said the attorney general is overreaching by charging Cata criminally. In California, as in most states, the vast majority of elder abuse and neglect allegations are handled in the civil courts.
"It boils down to, she didn't call sooner (about Holzmeister's bedsores)," Griffin said. "Is that truly criminal? Should this truly be in the criminal courts?"
Family trusted referral
In filing felony charges, the attorney general contends that Georgia Holzmeister was bedridden and neglected, allowing a massive pressure sore to develop. By the time her family was notified of her failing health, the state contends, the deep bedsore on her buttocks had triggered a raging bacterial infection from which she never recovered.
"I think she should have to answer for what she did," said Holzmeister's granddaughter, Shelly Carlson of Elverta.
Carlson, 49, said family members were unaware of Cata's licensing history and had trusted a referral years earlier from a friend. She said family members had resisted placing Holzmeister in institutionalized care with government assistance, paying her bills out of their own pockets to enable her to live in what they believed would be a safer, cozier homelike setting.
"We're all carrying a lot of guilt," she said.
The attorney general points to the home's history of violations as evidence of Cata's "complete disregard for the well-being of the residents in her care," according to court documents.
But the case also aims a spotlight on the actions, or inactions, of the state Department of Social Services.
Cata's home, licensed for up to six residents, is classified by the state as a "Residential Care Facility for the Elderly" or RCFE, and is regulated by the department's community care licensing division. RCFEs, which also include large assisted living facilities, are voluntary housing arrangements designed for people 60 years and older, or those needing similar help with daily needs.
California currently has some 7,500 RCFEs, serving more than 143,000 clients. Where the community care licensing division once conducted annual inspections of these facilities, budget constraints have curtailed that oversight to at least one unannounced inspection every five years, Weston said.
Facilities with chronic deficiencies continue to receive annual inspections, he said, noting that a complaint against a facility triggers a visit within 10 days.
The state revoked 42 RCFE licenses in 2011 and 15 in 2012, though some of last year's cases have not been resolved.
The licensing file for Super Home Care reveals that, over the years, Cata repeatedly failed to promptly address deficiencies identified by state workers. One month after she was licensed in June 1996, for instance, a state inspector cited her for three Type A deficiencies and one Type B, including poisons stored in the open, having an accessible pool without safeguards, and staff without first-aid training.
The same worker returned almost a year later and scribbled a handwritten report in large block letters: "I am sorry I missed you today. However as I told you last year the deadbolt must be removed from your gate."
In March 2007, Cata was warned by a licensing representative that her fingerprints needed to be on file, as required by regulations. Five months later, when she had failed to comply, the state fined her the maximum $500.
She was fined $150 last year for violations related to Holzmeister's illness and death.
Licensed until arrest
Holzmeister's death on June 23 ushered in renewed scrutiny of Cata's home by state licensing officials but did not imperil her license for eight more months.
In September, the department summoned Cata to a "noncompliance conference" to discuss the circumstances surrounding Holzmeister's death. At that meeting, officials concluded that, despite being licensed for more than 16 years, Cata had "failed to demonstrate knowledge of the rules and regulations" governing care homes.
Even so, Cata retained her license and continued caring for three residents until the day after her arrest on Feb. 11.
Several elder-care experts said they reject the notion that Cata's past violations were unrelated to patient care.
In 2000 and again in 2007, Cata was cited by the state for attempting to care for seriously ill or bedridden clients who required more intensive medical care, such as a skilled nursing facility, according to the licensing file for Super Home Care. The state issued her another Class A deficiency last year for the same violation, this time related to Holzmeister.
In California, homes such as Cata's that are licensed as RCFEs are considered non-medical facilities that provide varying levels of care and services. Patients who need 24-hour nursing are not allowed in RCFEs, and operators often must seek special state approval to continue providing care to residents whose conditions change or worsen.
Dr. Kathryn Locatell, a specialist in geriatric medicine who examined Holzmeister's medical records for the attorney general, determined that the woman likely had been bedridden for at least five weeks before her death and "should not have been retained at Super Home Care," court records state.
Holzmeister's family had been paying Cata $2,800 a month to care for the woman, an amount later reduced to $2,000 when the family discovered she had been housed with a roommate, documents show.
After Cata's arrest, the three remaining clients were moved across the street to the home of Cata's daughter, Ionela Lup, who had helped provide care in her mother's home. The daughter and her husband, Adrian Lup, obtained their own RCFE license from the state the month before Cata's arrest.
Griffin, Cata's attorney, said his client has deep support from family and church friends and members of Sacramento's Romanian community, many of whom have established their own residential care facilities for the elderly.
He said he expects supporters to pack the courtroom for today's hearing. Cata remains in the Sacramento County jail in lieu of $300,000 bail.
CATA'S HISTORY OF CITATIONS
Silvia Cata's Super Home Care facility has been cited for numerous violations over the years.
June 26, 1996 Cata is licensed to run a Residential Care Facility for the Elderly (RCFE) at 341 Bowman Ave. in Sacramento.
July 11, 1996 At her first post-licensing inspection, Cata is cited for three Type A deficiencies and one Type B, including poisons stored in the open, having an accessible pool without safeguards, and staff without first-aid training.
June 24, 1997 Despite a warning in June 1996 to remove deadbolt locks, Cata fails to do so and is cited for a Type A deficiency.
May 31, 2000 Cata is cited for six Type A deficiencies involving two clients deemed to be inappropriate for her facility because they require a higher level of care.
April 24, 2002 The state opens a complaint investigation into an allegation that Cata may have improperly received a client's property after he died the previous month. The state closes the case as "inconclusive" after finding insufficient evidence to support the complaint, noting that the deceased resident "did not have close relatives."
March 21, 2007 Cata receives two Type A deficiencies and one Type B for a variety of violations, including failure to complete residents' care plans. She is warned to complete a fingerprint clearance to meet criminal background check requirements.
Aug. 10, 2007 Cata is cited for three Type A deficiencies, including inappropriate retention of two residents deemed to need more intensive care. The state fines her a maximum $500 for failing to complete the fingerprinting process as ordered in March.
April 22, 2010 Cata is cited for two Type A and seven type B deficiencies, including insufficient food supplies and poor record-keeping.
May 3, 2012 Cata's care facility is cited for two Type B deficiencies after a licensing worker finds that she failed to update two residents' annual assessments. The worker also cites her for improperly documenting one resident's medication.
June 27, 2012 The Department of Social Services receives a complaint about Cata's facility after Georgia Holzmeister, 88, dies on June 23 following hospitalization for a Stage IV bedsore.
Aug. 15, 2012 Cata is cited for seven Type A and three Type B deficiencies, including failure to seek prompt medical attention for Holzmeister's bedsore and poor record-keeping. She is fined $150 for violations related to Holzmeister's illness and death.
Sept. 7, 2012 The Department of Social Services summons Cata and her daughter to a "non-compliance conference" to review the circumstances surrounding Holzmeister's death. Among other things, the state concludes Cata had "failed to demonstrate knowledge of the rules and regulations" governing care homes.
Nov. 19, 2012 Two Type A deficiencies are logged against Cata, including outdated medical reports for two residents and cleaning solution found in the residents' shower.
Feb. 11, 2013 Cata is arrested in connection with Holzmeister's death. California's attorney general charges her with felony elder or dependant adult abuse, causing great bodily injury and death, and involuntary manslaughter.
Feb. 12, 2013 The Department of Social Services suspends Cata's license and closes her facility, pending a hearing on the formal accusation. Her remaining clients are relocated.
Source: California Department of Social Services; California attorney general; court documents.
Call The Bee's Marjie Lundstrom, (916) 321-1055.