1、The Protection and Advocacy System for South CarolinaNo Place To Call Home:How South Carolina Has Failed Residents of Community Residential Care Facilities Protection and Advocacy for People with Disabilities, Inc.3710 Landmark Drive, Suite 208, Columbia, SC 29204 HYPERLINK :/ protectionandadvocacy-

2、 July 2009 Executive Summary This report was prepared by attorneys and other staff members of Protection and Advocacy for People with Disabilities, Inc. It was funded in part by the US Department of Health and Human Services (Substance Abuse and Mental Health Services Administration and the Ad

3、ministration on Developmental Disabilities) and by the US Department of Education (Rehabilitation Services Administration).Community Residential Care Facilities (CRCFs) are the homes of last resort for as many as 16,700 South Carolinians. The Department of Health and Environmental Control licenses a

4、nd regulates CRCFs, DHEC R. 61-84. As of May 2009, there were 16,741 licensed CRCF beds in South Carolina. A licensed CRCF may also refer to itself as an assisted living facility. The facilities discussed in this report are those that serve residents with disabilities and low incomes, usually with g

5、overnment funding, including Supplemental Security Income, Social Security Disability Income or veterans benefits. For CRCFs willing to accept a monthly cap of $1100 for all fees, SC Health and Human Services also has an Optional State Supplementation (OSS). It supplements a residents other earnings

6、 or benefits so that a total of $1100 a month is available to pay CRCF charges. See: . The CRCFs included in this report are predominantly operated by individuals as sole proprietorships or small corporations. Boarding homes, providing only food and shelter without personal care, do not have to be l

7、icensed as CRCFs and were not included in this report. These poorly overseen facilities, which range in size from two to more than one hundred beds, provide housing, food, and care to individuals who are unable to live independently but who do not need institutional or skilled nursing care. DHE defi

8、nes a CRCF as: A facility which offers room and board and which, unlike a boarding house, provides/coordinates a degree of personal care for a period of time in excess of 24 consecutive hours for two or more persons, 18 years old or older, not related to the licensee within the third degree of consa

9、nguinity. It is designed to accommodate residents changing needs and preferences, maximize residents dignity, autonomy, privacy, independence, and safety, and encourage family and community involvement. Included in this definition is any facility (other than a hospital), which offers or represents t

10、o the public that it offers a beneficial or protected environment specifically for individuals who have mental illness or disabilities. These facilities may be referred to as “assisted living” provided they meet the above definition of community residential care facility. Residents of CRCFs have phy

11、sical, emotional, or intellectual disabilities. Many cannot manage their own funds. These vulnerable individuals often do not have family members or friends who can advocate for them. The SC Department of Health and Environmental Control (DHEC) currently licenses over 480 separate community resident

12、ial care facilities in South Carolina. DHEC listing of Community Residential Care Facilities: .Since 1986, Protection and Advocacy for People with Disabilities, Inc. (P&A) has conducted unannounced visits to more than 1000 CRCFs through the Team Advocacy Program. S.C. Code 43-33-350. The Team Advoca

13、te uses a number of factors to develop the list of CRCFs to inspect throughout the year, including balancing the different regions of the state, the number of facilities in each area/region, how many of those have a Memorandum of Agreement with DMH, the date of Teams last inspection of that facility

14、 (if any), the availability of volunteers, the size of the facility, travel time, concerns or problems reported with facilities, etc. P&A is the state and federally mandated protection and advocacy system for South Carolina. P&A was established as a nonprofit corporation in 1977 by S.C. Code 43-33-3

15、10 et seq. to protect the rights of people with disabilities. Each year P&A serves thousands of South Carolinians who have been abused, neglected or denied their rights to equal treatment and access to services. P&A has broad authority under state and federal law to advocate for the rights of indivi

16、duals with disabilities and to investigate allegations of abuse and neglect when such incidents are reported or when probable cause exists to determine that abuse and neglect has occurred. P&A has found that many CRCFs are filthy, do not provide adequate food and heat, do not safely administer medic

17、ations or arrange for needed medical care, and do not provide protection from abuse, neglect and exploitation. Inspectors have found infestations of cockroaches in facilities, blood on the walls, and food which is out of date and rotting. Some residents routinely lack prescribed medications or are g

18、iven the wrong amounts of medications, and some residents have been physically harmed by staff or other residents due to lack of supervision. These CRCFs are no place to call home.Oversight of CRCFs is fragmented, slow to respond, and ineffective in protecting residents. In fact, as anyone who follo

19、wed the story of Peachtree Manor in Winnsboro until its closing knows, the current system protects the owners of the facilities more than the residents. During 2007 and 2008 P&A received many reports about increasing frequency and severity of abuse and neglect at some CRCFs. See Appendix for a brief

20、 description of the methodology used to select the six facilities included in the report. The reports included deaths, sexual and physical abuse and neglect, including the failure to appropriately administer medication and to provide basic necessities such as food, heat and basic care. P&A has filed

21、 a complaint with DHEC about conditions in CRCFs in about 40% of the facilities inspected under the Team Advocacy program. While many CRCF owners are committed to operating facilities that provide a good quality of care, the lack of effective oversight puts all residents of CRCFs at risk of harm. Th

22、is report presents six case studies In order to protect the privacy of residents, these facilities are referred to by pseudonyms, except Peachtree Manor, which received widespread publicity throughout 2008. that illustrate common problems found in CRCFs throughout the state, as well as the inability

23、 of the current system to prevent or cure these problems in a timely fashion. Even though the shocking conditions at these six CRCFs have been widely known among state agencies, five of the six remain open. The single closure discussed here took an overwhelming amount of time and resources from seve

24、ral state agencies and P&A, despite the facilitys repeated failure to comply with regulations and a lengthy series of investigations that routinely confirmed the presence of deplorable, unsafe conditions. As a result of P&As review of hundreds of facility and agency documents and conversations and i

25、nterviews with CRCF staff and residents and agency personnel, P&A recommends: 1. The statutes and regulations governing CRCFs should be revised to give licensing agencies more enforcement options against frequently cited facilities and administrators, such as:The power to suspend new admissions to C

26、RCFs with repeated, uncorrected violations that significantly jeopardize residents life or health while the appellate process to suspend or revoke a license is pending; Nursing homes that accept Medicaid payments are barred from accepting new admissions pending appeal of revocation of their operatin

27、g license, 42 C.F.R. 488.414. Also, the statute could be expanded to include suspensions for prolonged periods of substandard conditions and repeated, uncorrected violations that present an unhealthy living environment. A third option would be to make suspensions automatic when a license has been re

28、voked, followed by an emergency hearing to determine whether the facility should remain closed during the appeal or be allowed to resume operations. A fourth alternative would be to include an option for the licensing agency to request an expedited appeal process as well as injunctive relief pending

29、 appeal, if conditions so warrant. This injunctive relief could include a bar on the admission of new residents. The power to make suspension of operations automatic when a license has been revoked, followed by an emergency hearing to determine whether the facility should remain closed during the ap

30、peal or be allowed to resume operations;The ability to suspend the license of an administrator, prior to a hearing, based upon frequent or egregious violations that significantly jeopardize residents life or health; The creation of an expedited appeal process to review license suspensions or bars to

31、 new resident admissions;The consideration of information relating not only to the current licensing period, but of all pertinent information regarding the facility and the applicant when considering applications and renewals of licenses;2. DHEC should inform the public and concerned parties about p

32、roblem facilities. Facility inspection reports, including corrective actions, should be made available to the public on the agencys website (without personal information identifying residents) In its 2005 Annual Report, the Adult Protection Coordinating Council (APCC), a group created by the Omnibus

33、 Adult Protection Act, recommended that DHEC post inspection reports on its website. and posted at the facility. 3. The state should create an Adult Abuse Registry of individuals who have substantiated allegations of abuse or neglect of vulnerable adults against them. Facilities should be required t

34、o check the Registry before hiring a prospective employee.4. The General Assembly should fully fund enough DHEC inspection staff to provide for periodic unannounced visits and full, timely investigation of allegations of regulatory violations. 5. The General Assembly should adequately fund the SC De

35、partment of Labor, Licensing and Regulation (LLR) to enable prompt investigation of complaints against CRCF administrators. CRCF administrators are licensed by the Board of Long Term Health Care Administrators, located in LLR; complaints are investigated by LLRs Office of Investigation and Enforceme

36、nt. Current procedures provide only an illusion of oversight. The General Assembly, the Department of Health and Environmental Control, the Long Term Care Ombudsman and the other responsible agencies must act before more residents continue to live in squalor, suffer abuse and neglect or even die, an

37、d before more state and federal funds are wasted on grossly inadequate care. CRCF residents deserve to have a place to call home.NO PLACE TO CALL HOME:HOW SOUTH CAROLINA HAS FAILED RESIDENTS OF COMMUNITY RESIDENTIAL CARE FACILITIES TABLE OF CONTENTSINTRODUCTION TOC o 1-2 h z u HYPERLINK l _Toc233535

38、900 Fragmented Regulation and Oversight of CRCFs PAGEREF _Toc233535900 h 2 HYPERLINK l _Toc233535902 WHAT DID INPECTORS FIND AT THE SIX CRCF FACILITIES? PAGEREF _Toc233535902 h 5 HYPERLINK l _Toc233535903 FACILITY A PAGEREF _Toc233535903 h 5 HYPERLINK l _Toc233535904 Facility B PAGEREF _Toc233535904

39、 h 6 HYPERLINK l _Toc233535905 FACILITY C PAGEREF _Toc233535905 h 7 HYPERLINK l _Toc233535906 Facility D PAGEREF _Toc233535906 h 8 HYPERLINK l _Toc233535907 Facility E PAGEREF _Toc233535907 h 10 HYPERLINK l _Toc233535908 PEACHTREE MANOR PAGEREF _Toc233535908 h 11 HYPERLINK l _Toc233535909 Findings P

40、AGEREF _Toc233535909 h 13 HYPERLINK l _Toc233535910 Conclusion PAGEREF _Toc233535910 h 14 HYPERLINK l _Toc233535911 Recommendations PAGEREF _Toc233535911 h 15 HYPERLINK l _Toc233535912 Methodology of This Report PAGEREF _Toc233535912 h 19 HYPERLINK l _Toc233535913 LEGAL RIGHTS OF CRCF RESIDENTS PAGE

41、REF _Toc233535913 h 20 HYPERLINK l _Toc233535914 INSPECTIONS AT THE FACILITIES PAGEREF _Toc233535914 h 22 HYPERLINK l _Toc233535915 FACILITY A PAGEREF _Toc233535915 h 22 HYPERLINK l _Toc233535916 Facility B PAGEREF _Toc233535916 h 28 HYPERLINK l _Toc233535917 FACILITY C PAGEREF _Toc233535917 h 33 HY

42、PERLINK l _Toc233535918 Facility D PAGEREF _Toc233535918 h 42 HYPERLINK l _Toc233535919 FACILITY E PAGEREF _Toc233535919 h 51 HYPERLINK l _Toc233535920 PEACHTREE MANOR PAGEREF _Toc233535920 h 59IntroductionCommunity Residential Care Facilities (CRCFs) are the homes of last resort for as many as 16,7

43、00 South Carolinians. These poorly overseen facilities, which range in size from two to more than one hundred beds, provide housing, food, and care to individuals who are unable to live independently but who do not need institutional or skilled nursing care. DHE defines a CRCF as: A facility which o

44、ffers room and board and which, unlike a boarding house, provides/coordinates a degree of personal care for a period of time in excess of 24 consecutive hours for two or more persons, 18 years old or older, not related to the licensee within the third degree of consanguinity. It is designed to accom

45、modate residents changing needs and preferences, maximize residents dignity, autonomy, privacy, independence, and safety, and encourage family and community involvement. Included in this definition is any facility (other than a hospital), which offers or represents to the public that it offers a ben

46、eficial or protected environment specifically for individuals who have mental illness or disabilities. These facilities may be referred to as “assisted living” provided they meet the above definition of community residential care facility. Residents of CRCFs have physical, emotional, or intellectual

47、 disabilities. Many cannot manage their own funds. These vulnerable individuals often do not have family members or friends who can advocate for them. The SC Department of Health and Environmental Control (DHEC) currently licenses over 480 separate community residential care facilities in South Caro

48、lina. DHEC listing of Community Residential Care Facilities: This report initially provides information regarding the fragmented regulation and oversight of CRCFs in South Carolina. Information is provided about six CRCFs, including one known as Peachtree Manor. After two years of operation, Peachtr

49、ee Manor was finally closed by Administrative Law Court decision in April 2008, due to its poor and unsafe conditions.Fragmented Regulation and Oversight of CRCFsOversight of CRCFs is split among many agencies:Ms. A is a 65-year-old woman, with diagnoses of traumatic brain injury, dementia, and seiz

50、ure disorder. She uses leg braces, a walker, and occasionally wears adult incontinency products. Ms. A can communicate very little verbally. Ms. A has lived in the same CRCF for over twenty years. Team Advocacys inspection found an overwhelming odor of urine in the bedroom; no shower curtain and dan

51、gerously loose handrails in the bathroom; and dangerously low lighting in the bedroom. Ms. As clothing was dirty and had holes. The residents had to ask for toilet paper, which was difficult for Ms. A to communicate. When asked where she stored her toilet paper, she reached through a small hole in h

52、er walker and pulled out a few sheets which she was hoarding. The South Carolina Department of Health and Environmental Control (DHEC), Division of Health Licensing licenses and inspects CRCFs through regulation DHEC R. 61-84. HYPERLINK The regulation covers most aspects of facility management, incl

53、uding reporting of abuse, neglect, and injuries; physical safety; nutrition; administration of medicine; residents rights; and enforcement of regulations. DHEC has authority to make unannounced inspections, although they are rare. DHEC has the authority to levy fines up to $10,000 for repeated serio

54、us violations, although in practice fines are usually substantially reduced. DHEC R. 61.84.302; HYPERLINK The South Carolina Department of Health and Human Services (HHS) provides financial supplementation to Social Security Disability Insurance/Supplemental Security Income (SSDI/SSI) benefits throu

55、gh Optional State Supplementation (OSS), a state-funded program administered by HHS. OSS payments, which provide additional funds to pay for the cost of the poorest residents in CRCFs, are made directly to the facility. CRCFs currently receive $1100 per month for individuals receiving OSS. HYPERLINK

56、 :/ dhhs.state.sc.us/Internet/pdf/ossadvJanuary2009.doc o :/ dhhs.state.sc.us/Internet/pdf/ossadvJanuary2009.doc HHS also is responsible for the administration of Medicaid, which most residents receive. The Attorney General is responsible for prosecuting Medicaid fraud and other issues.The Departmen

57、t of Labor, Licensing, and Regulation (LLR) licenses and disciplines CRCF administrators HYPERLINK :/ /coderegs/c093.htm through the Board of Long Term Health Care Administrators. The Board does not have the power to suspend a license before a hearing, regardless of the seriousness o

58、f the misconduct. The Long Term Care (LTC) Ombudsman in the Office of the Lieutenant Governor is responsible for investigation of reports of abuse and neglect of residents of CRCFs. As part of the Omnibus Adult Protection Act, HYPERLINK . Local law enforcement or SLED may also receive reports.Mr. B

59、is a 46-year-old man who has diagnoses of schizophrenia and hypertension. He had been living at a CRCF in the Charleston area for a month. His family could not visit him because they lived over 200 miles away. He did not know why he had been placed so far from his family. Team Advocacys inspection f

60、ound: bedrooms were overheated at 81F and 82.6 F; several of the residents were wearing dirty and worn clothing; residents were not allowed to sit in the front living room area because a sign written by the administrator stated that they wanted to keep that area clean and smelling good; Mr. B stated