The hang-up 911 call came into Alexandria's emergency communications center early Sunday morning from the Sunrise Senior Living facility on Duke Street.
Police responded at 2:55 a.m., but the after-hours call button, telephone calls and their cruiser sirens could not get the attention of caregivers inside. Eventually, the officers gained entry through an unlocked side door and swept the building.
Authorities said what they found was startling.
One resident, a hospice patient, was lying helplessly on the floor after falling out of bed, calling out for help. Another was having trouble with a catheter and had called 911 out of frustration.
No one had come to their aid, police discovered, because the three caregivers at the site were asleep. A fourth employee had not shown up for work.
Police located two of the employees sleeping on the third floor of the Alzheimer's wing and found a care manager asleep in a vacant room on the first floor, despite an audible burglar alarm sounding less than 10 feet away.
"Had a more severe emergency existed (fire, cardiac arrest, etc.), would the night staff be able to handle such an emergency locked away in vacant rooms sound asleep?" said Deputy Fire Marshal Andrea L. Buchanan, who described the scene to a supervisor in an e-mail obtained by The Washington Post. "How long has this practice been going on?" Reached yesterday, she declined to comment.
City and state officials, as well as long-term care advocates, all have begun investigations. Since Monday, each has sent staff to the facility, at 3520 Duke St., to interview employees and patients.
"The city is outraged," said Alexandria spokeswoman Barbara Gordon. "The good news is both the residents are okay."
Two Sunrise employees were fired Monday because of the incident, Gordon said. Sunrise officials would not comment on their employees. At a minimum, Virginia requires that homes need to have "sufficient" staff on hand to meet residents' needs and to conduct a fire drill.
The quality of care in Virginia's assisted-living facilities has become a political issue, with some members of the General Assembly vowing to introduce legislation to overhaul the system.
The Washington Post published a series of articles on the facilities earlier this year, finding thousands of incidents of harm since 1995, including avoidable deaths and injuries.
Sunrise Senior Living is the nation's largest chain of its kind, with more than 374 assisted-living operations. Alexandria's facility is privately owned and houses 109 residents. It is licensed to operate through Virginia's Department of Social Services, the sole agency that can mandate changes in procedures.
Yesterday, corporate officials with Sunrise would not comment on the incident at Sunrise of Alexandria except to say they are cooperating fully with city and state agencies investigating the matter and would take actions to prevent a similar incident.
"Our main concern is the safety and well-being of the residents we serve," said Sunrise spokeswoman Sarah Evers. "We'll implement the necessary corrective action."
Sunrise markets itself as providing special services for dementia sufferers, which it says includes a "safe and stimulating" environment.
But licensing records on Sunrise facilities in Virginia cite about 80 violations related to seriously mentally impaired residents from 2000 through early this year.
The Alexandria facility was fined twice in 2001 for lapses in the care of residents and was cited in February 2003 for not providing aggression training to staff members after an incident of violence between two residents.
MaryAnn Griffin, director of the city's Office of Aging and Adult Services, said she spoke with the chief administrator at Sunrise in Alexandria and was told that corrective action would include periodic spot-checks.
"They thought they would implement it immediately and do checks once a week . . . during the wee hours," Griffin said.
Yesterday Debra Collins, director of the city's Department of Human Services, was preparing a letter to executives at Sunrise to express the city's concern.
"We want to express our disappointment and outrage that this occurred," Collins said. "We expect that Sunrise will do due diligence in ensuring that residents are safe."
Among the agencies working to ensure the facility is safe is the Northern Virginia long-term care ombudsman program, which is funded by local governments to serve as an advocate for quality care.
Rita Schumacher, who directs the program, is overseeing the investigation at the facility, which she visited yesterday to talk with patients. So far, she said, she has not heard anything unusual about the quality of care there.
If there is a lesson to be learned, she said, it is that the facility serves as a good example of why care managers and nursing assistants need to be well compensated for the demanding work they do.
"Assisted living is reaping what they're sowing," Schumacher said. "They're not offering good wages and benefits so they're going to get folks who are not as responsible . . . because they're paid so minimally they may have a second job or work a double shift so they're tired."
While she characterized the incident at Sunrise as a serious lapse, she said it is hard to have thorough oversight unless checks are being done around the clock.
"We're not going in at 2 a.m. to check the night shift," Schumacher said. Incidents like this one "may happen more than we know about."
Staff writer David S. Fallis contributed to this report.