Group Home Inspections Show Deficiencies; Need for Ombudsman to Add Transparency

In the RI Senate Lounge, Maria Montanaro, director of the RI Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, left; listens to the report on group home  by Elizabeth Roberts, Secretary of Health and Human Services.

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By Gina Macris                               

A random inspection of 30 Rhode Island group homes for adults with developmental disabilities did not show systemic problems as severe as the ones at a state-run facility where a resident suffered an unexplained injury and died in February.

But the Executive Secretary of Health and Human Services, Elizabeth Roberts, told the Rhode Island Senate Committee on Health and Human Services that the inspections revealed many operational lapses at individual homes, including medication errors. She said accountability and transparency must improve in all the group homes in the state.

Roberts said she favors legislation that would create an ombudsman for individuals with developmental disabilities and their families, similar to the Child Advocate and the Mental Heath Advocate. 

Roberts also said there is a need to remove the conflict now inherent in the Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH) licensing and investigating its own group homes.

BHDDH director Maria Montanaro said she has learned that during a previous administration, management did not always follow the professional recommendations of the investigatory unit.

While the recent inspections found no life-threatening situations, they did raise medical concerns, including numerous overdue physical exams and various medication errors. For example, in 10 of the 30 homes, there were medication orders that weren't filled. There was also a lack of documentation of numerous other requirements, including many related to communications with residents and guardians.

According to a summary of the findings, 17 of the 30 homes were not carrying out all provisions of behavioral support plans written for residents with behavioral problems.

In 15 homes, residents were not receiving all the services required by the individual service plan, the “master plan” of activities and supports. 

Another 10 homes have participants who do not have these “master plans” at all.

 In 14 of the 30 homes, inspectors heard about “staffing issues” that were not described in more detail in the report given to the committee.

Low pay and high turnover are pervasive problems in the developmental disability system. Governor Raimondo has asked for higher pay for workers in this field in her budget for the next fiscal year. 

The report did not specify where the deficiencies occurred, but listed the names of all the group homes surveyed and the agencies which operate them. In the report, RICLAS homes are operated by the state, and the remainder are privately operated.

All the group homes will be notified of specific violations and given 30 days to file corrective action plans, according to the report.

The unannounced inspections were prompted by the death Feb. 15 of Barbara A. Annis, 70, who lived in College Park Apartments in Providence – a state run group home that operated more like a nursing home.

Five of the 27 staff members have been put on paid leave and the facility’s license has been revoked. The Rhode Island Attorney General’s Office and the Rhode Island State Police are conducting criminal investigations.

At the Senate HHS briefing Tuesday, Roberts said, “We have responsibility for the care and well-being of some of the most vulnerable Rhode Islanders. I take that responsibility very seriously and I hold the entire Health and Human Services Secretariat accountable for delivering high-quality services.”

Roberts said an ombudsman would bring a new level of transparency to the state’s developmental disability system, serving as a conduit for releasing information of public interest.

“Public reporting on investigations is extremely limited by current statute and regulation,” she said. “Current statutes restrict BHDDH from releasing information most other – if not all other – licensing bodies would be obligated to release,” Roberts said.

She suggested she would support new laws that would “protect residents’ privacy and ensure that the public – especially families who count on these residential services – are aware of issues with resident safety.”

Roberts said she has asked Montanaro to begin a review of the department’s licensing and investigatory procedures.

Montanaro said during initial remarks at the hearing that her department has a “robust” investigatory arm, but she later acknowledged that three of the five investigative  positions have been vacant sometime in the last fiscal year.

Two of the vacancies were due to the fact that the positions were on loan from the Department of Human Services, but funding for those positions did not come through, Montanaro said. She said Secretary Roberts straightened out that problem. Interviews are now underway to fill the last remaining vacancy, she said. 

BHDDH had two investigators working at the time Annis died. The head of the investigatory unit told Montanaro she had noticed a pattern of problems at College Park dating from the previous year, Montanaro recalled. That was one of the factors that led to the three week-long series of group home inspections, performed with assistance from inspectors from the Department of Health.

After the hearing, Roberts acknowledged that unless an investigator notices a pattern of problems and notifies a supervisor, it is not easy to for management to spot system-wide concerns.

“We haven’t had an organized database to do that,” she said, repeating her contention that part of the problem is overly restrictive state confidentiality laws. She said public reporting is one of “a number of ways to focus on consumers’ needs and public accountability.”