Irvine California Nursing Home Abuse Attorneys

Irvine Nursing Home Injury LawyerThe cases involving nursing home abuse, mistreatment and neglect has remained a national disgrace for decades. The ever-increasing aging population within the United States and the rising demand for more nursing home beds and lack of trained nurses has increased to the widespread problem that many families are facing. In fact, the Irvine nursing home neglect attorneys at Rosenfeld Injury Lawyers LLC understand the nursing home residents have a much higher risk of injury or death than many families can imagine.

Many civil lawsuits and cases for compensation within Southern California involve nursing home resident injury or death as a result of preventable falls, untreated bedsores, lack of access to water, food or other preventable ailment. These cases are expected to rise in the near future because many more individuals of the baby boomer generation are entering their retirement years.

This problem is significantly important to residents of Orange County. More than 225,000 individuals reside within Irvine city limits, of which nearly 30,000 are 65 years and older. This number is nearly double that when accounting for all residents in Orange County, where many of these elders will soon require the skills provided in nursing homes, assisted living facilities and rehab centers throughout the community.

Irvine Nursing Home Resident Health Concerns

Our Orange County nursing home lawyers continuously review national databases including Medicare.gov and other information released to the public by the CMS (Centers for Medicare and Medicaid Services). This information outlines problems, failures, opened investigations and filed complaints against nursing facilities throughout the United States. We publish our findings in an effort to assist families who either have a loved one in an Irvine area facility or must find a location that provides the highest standards of care to meet the needs of every resident in their charge.

Comparing Irvine Area Nursing Facilities

The detailed list below was compiled by our Southern California elder abuse law firm outlining nursing facilities throughout the Irvine area who currently maintain below standard ratings compared to other homes nationwide. We have also added our primary concerns detailing specific health inspections, a lack of quality care or other condition resulting in the harm or death of the resident.

Information on California Nursing Home Abuse & Negligence Lawsuits

Our attorneys have compiled data from settlements and jury verdicts across California to give you an idea as to how cases are valued. Learn more about the cases below:

LAKE FOREST NURSING CENTER
25652 Old Trabuco Road
Lake Forest, California 92630
(949) 380-9380
A “For-Profit” 175-certified bed Medicaid/Medicare-participating facility

Overall Rating – 2 out of 5 possible stars

2 star rating

Primary Concerns –

Failure to Follow Procedures and Protocols When a Resident Has Been Allegedly Abused to Protect the Resident from Further Abuse

In a summary statement of deficiencies dated 12/09/2015, a complaint investigation against the facility was opened for its failure to “ensure a clinical assessment was conducted for [a resident at the facility] when an allegation of abuse toward [the resident] was reported to the facility.” The complaint investigation is in response to the resident’s family member reporting that the resident “had been abuse on 11/16/2015; however, a clinical assessment was not done.”

The state surveyor conducting an investigation of the complaint also noted that the facility’s failure “to assess the resident, placing the resident at risk for inaccurate or incomplete care and/or a delay in care, which could negatively impact the resident’s health status and her emotional well-being.”

As a part of the investigation, the state surveyor conducted a review of the resident’s MDS (Minimum Data Set) that indicated the resident “usually understood others and usually was able to make herself understood.” Additional facility investigative documents dated 11/16/2015 indicated that the facility “had been notified about an allegation of physical abuse toward [the resident on that day].”

A review of the investigative documents “did not show any clinical assessment have been conducted for [the resident] during the facility’s investigations”, nor did the resident’s clinical records “show any documented evidence that a clinical assessment had been conducted on 11/16/2015, when the allegation of physical abuse was reported to the facility.”

The state surveyor conducted a concurrent interview and review of facility documents at 10:00 AM on 12/08/2015 with the facility’s Director of Nursing who was “asked to locate documentation in the clinical record to show [the resident] have been clinically assessed when the allegation of physical abuse was reported to the facility.”

In response, the Director of Nursing stated “that is usually done by the RN supervisor; however, … there was no documentation to show this was done.” Additionally, the Director of Nursing “and from the facility’s investigative documents for the allegation of abuse did not show the clinical assessment had been conducted for [the resident].”

Our Lake Forest nursing home abuse attorneys recognize that failing to follow protocols and procedures involving an allegation of abuse of a resident could place the health and well-being in the resident in immediate danger. The deficient practice by the nursing staff and administrators at Lake Forest Nursing Center might be considered additional abuse, mistreatment or negligence. The unacceptable action of the facility violated federal and state nursing home regulations.

LAGUNA HILLS HEALTH AND REHABILITATION CENTER
24452 Health Center Drive
Laguna Hills, California 92653
(949) 837-8000

A “For-Profit” 208-certified bed Medicaid/Medicare-participating facility

Overall Rating – 2 out of 5 possible stars

2 star rating

Primary Concerns –

Failure to Accurately Assess and Communicate Why a Severely Cognitively Impaired Resident Was Complaining of Extreme Pain after a Physical Therapy Session

In a summary statement of deficiencies dated 10/21/2015, a complaint investigation against the facility was opened for its failure to “ensure [the resident’s] change of condition was immediately communicated and thoroughly assessed timely.” The complaint investigation was initiated in response to a resident complaining “of acute pain in her right heel after ambulating during the PT session.

The state surveyor conducting an investigation into the complaint noted that the Physical Therapist “failed to report the resident’s right heel pain to the nurses or physician.” In addition, the resident’s “continued to complain of right heel pain which was not assessed for further evaluation. An x-ray showed [the resident] had a fractured right heel […and] the resident’s nephrologist ordered an MRI which was positive for fracture. Failure to promptly report the incident of pain placed [the resident] for a delay in treatment.”

As a part of the complaint investigation, the state surveyor reviewed the resident’s MDS (Minimum Data Set) that revealed the resident “had severe cognitive impairment required assistance from the staff for ambulation.”

In addition, a review of the 09/07/2015 interdisciplinary team Progress Note revealed that at 3:30 PM on 09/04/2015, the resident “complaint of right foot pain after ambulating with the Physical Therapist. The resident stated her right foot was hit by a wheelchair when she was ambulating. Staff documented there was no redness, swelling or discoloration noted to the resident’s right foot.”

The state investigator conducted at 11:40 AM 09/22/2015 interview with the facility’s two Physical Therapist who stated that the resident “complained of acute right heel pain on 09/03/2015, during her therapy session. Staff were not able to verify the time of this occurrence.” One of the Physical Therapist at the facility stated that “the resident was ambulating with both [Physical Therapist] and they were on either side of the resident [… stating] another Physical Therapist have been following them with the resident’s wheelchair.”

Both Physical Therapists stated that the resident “had a sudden onset of pain to her right heel and claimed the wheelchair [that was being pushed by the third Physical Therapist] had bumped into her right heel.” However, one of the Physical Therapist stated that “the wheelchair was behind and not close enough to hit [her] foot.” The resident “was immediately seated into the wheelchair.”

On the state investigator asked the Physical Therapist “if she had reported the sudden onset pain to the licensed nurses” she responded “of course I did. When asked if there was documentation showing that communication, she stated, ‘No’.”

The state investigator noted that the 09/04/2015 x-ray report revealed that the resident “showed no definite fracture of her foot.”

An interview was conducted with the Registered Nurse providing the resident care who stated “she was not aware of the complaint of pain on 09/03/2015 and was not aware of the nurse’s notes dated 09/04/2015 at 10:30 AM, which show [the resident] was complaining of pain from a therapy session.” In addition, the Registered Nurse stated that “she had not interviewed the resident as part of the investigation into [the resident’s] pain.”

State investigator conducted an interview at 12:00 PM on 09/22/2015 with the resident and a family member where the resident stated “she continued to experience pain regardless of the x-ray results showing no fracture […and left the building for outside treatment] on 09/06/2015, and reported to her nephrologist about her heel pain [describing the pain as an electrical shock radiating from her foot to her ankle].” As a result, the nephrologist “ordered an MRI of the right foot.” The results of the MRI indicated that the resident’s right foot showed a fractured toe and a right ankle stress fracture on the calcaneus (heel of the foot).

The resident’s stated during a 2:15 PM 09/22/2015 interview with the state surveyor that “it was difficult to assess the resident’s pain due to her low pain tolerance. Physician stated he had not received reports [that the resident] continued to complain of pain; therefore, he did not order an MRI after the x-ray result was negative. He stated he was in contact with the resident’s family and was aware [that] the nephrologist ordered an MRI.”

The state investigator conducted a 09/22/2015 interview with the facility’s Director Rehabilitation Services who revealed “she did not see notes from the investigation. When asked if the resident complained of pain during a therapy session with the [Occupational Therapist/Physical Therapist] what her expectations of communication would be between the therapist and the licensed nurses be. The Director stated it should be clearly documented in the resident’s clinical record.” The state investigator then asked the Director of Rehabilitation Services “if she could find any documentation regarding the resident’s pain communication from the therapy staff to the staff about the resident’s pain.” The Director of Rehabilitation services replied, “No.”

Our Laguna Hills nursing home neglect attorneys recognize the failing to provide a level of care for a cognitively impaired resident suffering broken bones caused during a physical therapy session could cause additional pain and injury to the resident. The deficient practice by the nursing staff at Laguna Hills Health and Rehabilitation Center might be considered negligence or mistreatment, especially because the resident suffered ongoing pain long after the incident causing the fractured bones occurred.

PALM TERRACE HEALTHCARE & REHABILITATION CENTER
24962 Calle Aragon
Laguna Hills, California 92653
(949) 587-9000

A “For-Profit” 99-certified bed Medicaid/Medicare-participating facility

Overall Rating – 2 out of 5 possible stars

2 star rating

Primary Concerns –

Failure to Develop, Implement and Enforce Policies and Procedures to Prevent Abuse, Neglect and Mistreatment of Residents at the Facility

In a summary statement of deficiencies dated 07/24/2015, a complaint investigation was opened against the facility for its failure to “implement their policies and procedures related to abuse investigation for [a resident] when staff members on all shifts who had contact with the alleged employee were not interviewed.” The deficient practice by the nursing staff and administration at Palm Terrace Healthcare and Rehabilitation Center “created the increased risk of missing an opportunity to identify other staff who might have seen or heard of the alleged abuse and place the resident at risk for harm.”

The complaint investigation involved a 1:15 PM 07/23/2015 initial tour of Palm Terrace Healthcare Rehabilitation Center where a family member was observed in a resident’s room while “the resident was in bed and awake”. A family member of the resident “was asked of the resident had complained of rough handling by a facility staff member.” The family member responded that the resident had “complained a male CNA [Certified Nursing Assistant] tossed him in bed and at one time left [the resident] at the hallway, cold.”

The state surveyor conducting the investigation reviewed the resident’s MDS (Minimum Data Set) as an assessment tool that showed that the resident “had moderately impaired cognitive status […and] was continent of bowel and bladder; however, the resident required extensive assistance with toileting.”

The surveyor also reviewed the 07/07/2015 Nurse’s Progress Note revealing that on 07/05/2015 at 11:58 AM, a Certified Nursing Assistant reported that a resident “made allegations that the night shift CNA handled [the resident] roughly.” As a part of the facility’s Investigation Report it was revealed that the resident’s “allegation of rough handling by the night shift CNA show the night shift RN supervisor, night shift Charge Nurse of the alleged CNA, and the alleged CNA were interviewed. However, there were no documented evidence to show other night shift Charge Nurses and CNAs were interviewed as per the facility’s procedures and policies.” The state investigator also recognized “there was no documented evidence to explain why additional staff were not interviewed. In addition, there was “no documented evidence to show the facility had attempted to interview other staff members from all shifts who might have witnessed the incident as per the facility’s policies and procedures.”

The state investigator conducted an interview at 3:40 PM on 07/23/2015 with the facility’s Director of Nurses who “was informed of the facility’s policies and procedures related to investigation of allegations of abuse was not implemented for [the resident].” The Director of Nurses reviewed the investigation report and “acknowledged the findings.”

Our Laguna Hills nursing home abuse attorneys recognize that any failure to develop, implement and enforce policies and procedures that prevent abuse has the potential of causing the resident additional harm or abuse. The deficient practice by the nursing staff and Administrator at Palm Terrace Healthcare and Rehabilitation Center violates both state and federal nursing home regulations and does not follow the established policies and procedures including the facility’s revised April 2013 policy and procedure title: Abuse Prohibition Program that reads in part:

“All identified events reported to the Administrator/designee will be thoroughly investigated. The investigation shall consist of interviews with staff members on all shifts who had contact with the alleged employee.”

BROOKDALE YORBA LINDA
17803 Imperial Highway
Yorba Linda, California 92886
(714) 777-9666

A “For-Profit” 45-certified bed Medicaid/Medicare-participating facility

Overall Rating – 2 out of 5 possible stars

2 star rating

Primary Concerns –

Failure to Provide Adequate Care and Services to a Resident with an Indwelling Urinary Drainage Catheter That Resulted in the Development of a Urinary Tract Infection

In a summary statement of deficiencies dated 03/24/2015, a notation was made during an annual licensure and certification survey by a state investigator concerning the facility’s failure to “consistently and thoroughly assessed one [resident’s] bladder function after the removal of an indwelling urinary drainage catheter.” The deficient practice involved a resident who “had her indwelling urinary catheter in place on admission and removed three days later. However, the resident was experiencing [a medical condition that required] re-catheterization.”

The deficient practice was noted by state investigator who noted that “there was approximately nine hours where there was no documented evidence staff assess the resident’s urine output and bladder distention. When the resident was finally assessed, she had 800 cc of urine drained from her bladder. In addition, [the resident] developed UTI [urinary tract infection] requiring antibody treatment. This had the potential for the resident to develop further urinary complications.”

As part of the investigation, the state surveyor conducted a full review of the resident’s MDS (Minimum Data Set) that revealed the resident “was alert and able to make her needs known. She required assistance with ADL (activities of daily living) including toileting and transfers out of bed.”

The state investigator also reviewed the 12/27/2014 License Nurse’s Progress Note that revealed that “at 6:44 PM, the resident’s indwelling urinary drainage catheter was discontinued.” At 1:25 AM the following morning, “the resident voided one time during the shift with no complaints of pain or burning.” Approximately 45 minutes later at 2:03 AM, the resident was noted as suffering a hypnotic condition “due to the inability to sleep. There was no documentation [the resident] had voided nor was there any documented evidence staff assess the resident’s abdomen for bladder distention.”

By 3:27 AM, the Licensed Vocational Nurse provided the “resident care assessed the resident’s affectivity of the medication administered. Again there was no documentation [that the resident] had voided or was assessed for bladder distention.”

Later that morning at 10:40 AM, 11:00 AM and 11:47 AM, the same Licensed Vocational Nurse “wrote a late entry and documented” the resident “was alert and monitor” but “complained of burning when urinating. Staff order to insert a straight catheter, but the resident refused [… asking] for a bedpan to try to urinate.” During this time, the resident’s family member “alerted staff the resident was not urinating. Staff offered to insert a straight catheter, but the resident refused and only wanted to use the bedpan. There was no documented evidence the resident’s abdomen was assessed for bladder distention or interventions attempted to assist the resident and emptying her bladder.”

The nursing staff noted at 11:47 AM that the resident still “had not voided and refused to be catheterized. There was no documented evidence the resident’s abdomen was assessed for bladder distention.” The state investigator noted that along with no documented evidence indicating that the licensed nurses had consistently assessed the resident for bladder distention, they also failed to notify the resident’s physician.

At 5:46 PM a notation is made in the License Nurse’s Progress Notes shows that the resident “was able to void large amount x2.” However, this conflicts with notes by another nurse documented at 8:47 PM revealing that “she was called in the resident’s room at 8:30 PM, by another nurse regarding [the resident’s] inability to void. The nurse documented she [the resident] had not voided since catheter removal on PM shift previous day. Patient had notable abdominal distention. Foley catheter inserted and drained 860 milliliters.”

State investigator conducted an interview with the Registered Nurse providing the resident care and asked “about the nursing standard practice after removal of the indwelling urinary drainage catheter.” The Registered Nurse stated, assess the resident for bladder distention. If the resident’s bladder was distended, provide stimulation to help pass urine.”

A subsequent interview was conducted by the state investigator with the Licensed Vocational Nurse working the night shift on 12/27/2014 who revealed “she did not recall checking the resident’s bladder until around 4:00 AM [on that morning]. This is approximately nine hours after the resident had her indwelling urinary catheter removed.” Licensed Vocational Nurse also stated that she recalled the resident “telling her that she had not gone to the bathroom.”

The state investigator “asked about her documentation to show the resident had voided one time during her shift (on 12/27/2014 at 1:25 AM).” Licensed Vocational Nurse replied that “she asked the resident’s CNA if [the resident] had changed in her briefs and the CNA told her yes.” The investigator asked the Licensed Vocational Nurse to identify the Certified Nursing Assistant (CNA); however, the nurse could not recall.

Our Yorba Linda nursing home neglect attorneys recognize the failing to follow protocols when providing care to a resident that recently had an indwelling urinary drainage catheter removed could place the health and well-being of the resident immediate jeopardy. The deficient practice of the nursing staff at Brookdale Yorba Linda might be considered mistreatment or negligence because the substandard care likely caused the resident to develop an avoidable UTI (urinary tract infection) requiring antibiotic treatment.

BROOKDALE SAN JUAN CAPISTRANO
31741 Rancho Viejo Road
San Juan Capistrano, California 92675
(949) 248-8855

A “For-Profit” 45-certified bed Medicaid/Medicare-participating facility

Overall Rating – 2 out of 5 possible stars

2 star rating

Primary Concerns –

Failure to Provide Every Resident Environment Free of Life-Threatening Medication Errors

In a summary statement of deficiencies dated 09/25/2015, a state surveyor made a notation during an annual licensure and certification survey concerning the facility’s failure to “ensure physician’s order was followed for [a resident of the facility who] did not receive three doses of the medication as ordered.” A notation was made by the state investigator that the deficient practice of not providing medication to the resident as ordered could produce “extreme high levels of potassium in the blood [that] could lead to [a serious medical condition] and death.”

The deficient practice was noted upon review of medical records and a resident’s 11/03/2015 laboratory report indicating that the resident’s potassium level was 5.4 mEq/L – where the reference range for normal levels is 3.5 – 5.1 mEq/L (MilliEquivalent Per Liter).

A state investigator reviewed a 8:43 PM 11/03/2015 computerized entry into a resident’s records revealing a “telephone order to administer [the resident’s medication] by mouth one time a day every other day… A second entry created [at the same time] was discontinued and changed to [a different medication to be given] by mouth one time a day. The area to document the reason the previous order was discontinued showed [of the Registered Nurse] had verified the order with the physician.

Later that same day at 7:00 PM a conflicting entry entered into the Progress Notes documents that the Registered Nurse “had clarified the “physician’s orders regarding the medication to be given to the resident] to be administered every other day.”

A review of the resident’s November 2015 MAR (Medication Administration Record) “failed to show [the resident’s medication] was administered from 11/04/2015 to 11/09/2015.” The 11/09/2015 laboratory report show that the resident’s “potassium level had increased to 5.5 mEq/L.”

The investigator conducted a 3:10 PM 11/10/2015 concurrent clinical record review and interview with the Registered Nurse providing care to the resident who was asked to “verify the frequency of administration of [the resident’s medication] as documented on the handwritten telephone order dated 11/03/2015.” The Registered Nurse stated that “the order showed to administer [the resident’s medication] by mouth every other night [… stating that the resident’s medication] should have been administered on 11/05/2015, 11/07/2015, and 11/11/2015.

The investigator asked the Registered Nurse for any documented evidence indicating that the resident was administered their medications on those dates. However, the Registered Nurse “was unable to provide documentation.”

A telephone interview was conducted on 11/16/2015 at 3:45 PM by the state investigator with the Licensed Vocational Nurse providing care to the resident who verified that the resident’s medication “was not administered to the resident on 11/07/2015, because he did not see it on the electronic MAR (Medication Administration Record).”

Investigator conducted a concurrent clinical record review and telephone interview with the facility’s Director of Nursing on 11/17/2015 who stated that “the order dated 11/03/2015 for [the resident’s medication] to be given every other night was clarified on 11/03/2015 to every other day [… stating that the resident’s medication] should have been administered on 11/05/2015, 11/07/2015 and 11/09/2015 at 7:30 PM.

Our San Juan Capistrano nursing home neglect attorneys recognize the failing to follow procedures and protocols when administering medication per physician’s orders has the potential of causing life-threatening conditions for the resident. The deficient practice by the nursing staff at Brookdale San Juan Capistrano might be considered negligence or mistreatment because their actions led to a life-threatening elevation of potassium levels in the resident’s blood.

Proving Negligence or Abuse

Statistics maintained by the CDC [Centers for Disease Control and Prevention] and CMS (Centers for Medicare and Medicaid Services) reveal that four out of every 10 residents in a nursing facility will be a victim of abuse, neglect or mistreatment at some time during their stay.

Unfortunately, many families have no idea what steps need to be taken to ensure that their loved one does not become the victim of neglect or abuse while residing in a nursing home in Southern California. In many incidences, proving that caregivers, administrators or other residents in the facility caused injury or harm to a resident can be challenging to prove. Many times, the victim remains reluctant to give details or speak out about what happened to them in fear of retaliation or embarrassment. Other times, the victim lacks the capacity to communicate clearly and concisely or does not have the cognitive function to even know what occurred.

Our Orange County nursing home neglect attorneys have witnessed many cases where the nursing staff and other caregivers explain away obvious signs of neglect and abuse as a normal part of aging. Registered nurses, licensed vocational nurses and certified nursing assistants can explain that mental and physical deterioration, signs of dementia, confusion or accidentally falling on the premises is all an expected part of the process of growing older, even when that is not true. Typically, it takes an experienced lawyer or doctor who specializes in these types of cases to identify and prove that neglect and abuse is occurring.

Some common indicators that abuse and neglect or mistreatment is occurring in a nursing facility will involve:

  • A sign of emotional trauma where the resident appears depressed, fearful or anxious
  • An indicator of physical abuse including fractures, sprains, bruises, or noticeable bruising on the ankles or wrists or the resident could have been restrained or grabbed;
  • Signs that the resident has developed a facility-acquired bedsore which is nearly always preventable through proper care, monitoring and mobility assistance;
  • An indicator of sexual assault including acquiring a sexually transmitted disease or bruising on the breasts or genital area;
  • Overmedicating or under medicating the resident that could cause irreparable harm or life-threatening condition;
  • A lack of maintenance on medical devices and equipment;
  • Hazardous conditions within the facility that could promote preventable accidents;
  • The administration and/or nurses failing to report an injury of unknown origin to the proper authorities is required by law;
  • Missed medical diagnosis and failure to treat;
  • Slippery floors or dangerous areas that have the potential of causing unavoidable fall;
  • A lack of supervision caused by inadequate staffing or improperly trained staff; and
  • Wrongful death.

Even though state and federal regulators have developed enforceable rules and regulations in an effort to minimize the potential of neglect or abuse, mistreatment at nursing facilites still occur. Even today there is a lack of checks and balances to ensure that every resident receives the proper level of health and hygiene care. Because of that, many families will hire a skilled personal injury attorney who specializes in nursing home abuse cases to serve as a legal advocate of their loved one to protect their rights and take immediate action to prevent further harm or injury.

Hiring an Attorney

If you suspect that your loved one is receiving a substandard level of care or has become a victim of abuse or neglect, it is best not to wait until your suspicions have been proven to be true. Our Irvine nursing home abuse attorneys at Rosenfeld Injury Lawyers LLC can quickly assess your priority complaints or suspicious issues against the nursing staff or facility and assess whether you have cause for concern. Our team can take immediate action to determine if anything went wrong that caused harm or could cause harm to your loved one.

Our California elder abuse lawyers are available to evaluate your case seven days a week, 24 hours a day. Our team of dedicated Orange County nursing home abuse law firm will fight aggressively to protect those you love. We encourage you to contact our firm today at (888) 424-5757 for your free full review case consultation. We handle all cases through contingency fee arrangements meaning we are only paid for our fees once we have settled your case out-of-court or successfully presented your lawsuit at trial in front of a judge and jury.

For additional information on California laws and information on nursing homes look here.

If you are looking for information on a specific facility or an attorney, please see links below to respective locality pages.

 

Client Reviews

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Jonathan did a great job helping my family navigate through a lengthy lawsuit involving my grandmother's death in a nursing home. Through every step of the case, Jonathan kept my family informed of the progression of the case. Although our case eventually settled at a mediation, I really was impressed at how well prepared Jonathan was to take the case to trial. Lisa
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After I read Jonathan’s Nursing Home Blog, I decided to hire him to look into my wife’s treatment at a local nursing home. Jonathan did a great job explaining the process and the laws that apply to nursing homes. I immediately felt at ease and was glad to have him on my side. Though the lawsuit process was at times frustrating, Jonathan reassured me, particularly at my deposition. I really felt like Jonathan cared about my wife’s best interests, and I think that came across to the lawyers for the nursing home. Eric