Former Nurse Pleads Guilty to Assaulting Developmentally Disabled Boy in RI

By Gina Macris

Kimberly Faneuf, 49, of Cumberland, RI, formerly a licensed practical nurse, pleaded guilty in RI Superior Court June 14 to one count of assault on a severely impaired person, a nine year-old boy with developmental disabilities who is prone to seizures.

After a plea agreement, reached with the approval of the victim’s family, Judge Netti C. Vogel sentenced Faneuf to five years in  prison with 18 months to serve, and the remainder suspended with probation, according to the office of Attorney General Peter F. Kilmartin. 

In addition, Vogel ordered Faneuf to perform 50 hours of community service, seek mental health counseling, and have no contact with the victim.

The state Department of Health stripped Faneuf of her nursing license shortly after she was arrested by Cranston police, nearly three years ago.

The parents of the boy, a Cranston couple, hired Faneuf to care for their son July 29, 2013, while they went out to a rare dinner alone, according to Kilmartin’s spokeswoman.

While they were at dinner, the couple checked in remotely with a camera they had placed in their son’s bedroom to monitor him in case of a seizure.

They saw an image of Faneuf “grabbing their son roughly, assaulting him, and tossing him on to his bed,” according to the spokeswoman for Kilmartin.

The couple rushed home, confronted Fanuef, and took their son to Hasbro Children’s Hospital, where doctors found a bruise on his arm, a bump on his head, and a blood spot in his left eye.

After her arrest, Faneuf  “offered no acceptable reasons for her behavior towards the boy, except to say she was overworked and tired, and admitted the care was ‘not up to standards’  that evening,” according to Kilmartin’s spokeswoman.

Kilmartin said of the case: “This young boy needed care and compassion, but in a fit of rage and anger, his caretaker physically assaulted him. As a professionally trained LPN, her actions are even more troubling. The developmentally disabled are among our most vulnerable population, often unable to report an assault or abuse. Had it not been for his loving parents installing a video camera to monitor their son’s health, this assault very well may not have been reported and this defendant free to assault more patients.”

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.

Click Here for Report  

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.”  

Unannounced Group Home Inspections Begin in Rhode Island

By Gina Macris

Unannounced inspections of Rhode Island group homes for adults with developmental disabilities began Monday March 28 in the wake of the recent death of a woman who lived in the College Park Apartments in Providence, according to a spokesman for the Executive Office of Health and Human Services.

College Park closed March 25, the day after the last of the 14 people still living in the apartments were moved to new housing. Since the beginning of 2015, College Park had been the subject of a total of six complaints of patient abuse or mistreatment, according to a spokeswoman for the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH). 

In addition to criminal investigations underway by the State Police and the Attorney General’s Office,  Elizabeth Roberts, the Executive Secretary of Health and Human Services, has ordered a “comprehensive review” of all licensed group homes in Rhode Island whether they are privately owned or run by the state, according to her spokesman, Michael Raia. He clarified previous indications from BHDDH that the inspections were to target only state-run group homes.

Raia said March 29 that Roberts had asked BHDDH Director Maria Montanaro and Department of Health Director Nicole Alexander-Scott to work together on the review, starting with inspections of the homes with the “highest risk assessment.” 

Inspectors and investigators from both the health department and BHDDH are working as a team on the inspections, which are being prioritized according to “incident reports and complaints for a set period of time,” Raia said. He could not immediately elaborate on the time period in question, although he said the initial round of inspections includes both private and state-operated facilities.  

Updating previously available statistics, Raia said there are 27 licensed state-run group homes, excluding College Park, and 251 licensed homes owned by private agencies.

Nine of the privately-run group homes are vacant, leaving 242 homes that house a total of 1,162 people as of Feb. 29, he said.  Raia said 156 individuals live in state-run group homes, and 284 people are with families in shared living arrangements.   

DD Agency Faces Scrutiny From RI Law Enforcement, Governor and Federal Court

By Gina Macris

With criminal investigations underway into the death of a woman with developmental disabilities in its care, the Rhode IslandDepartment of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) is gearing up for an important deadline on another front.

April 1 is the date by which BHDDH must submit a court-ordered fiscal plan for complying with a 2014 consent decree that enables people with developmental disabilities to get jobs and enjoy other  activities in their communities as required by the Americans With Disabilities Act. Judge John J. McConnell, Jr. has scheduled an evidentiary hearing on the state’s plan for April 8 in U.S. District Court, Providence.

The federal monitor in the case has expressed doubts that the state will be able to rearrange its budget in the next year to make the needed changes.

The Rhode Island consent decree, the first of its kind in the nation, also has received high-level attention from the U.S. Department of Justice in Washington. On Friday, March 18, the Acting Assistant Attorney General for the Civil Rights Division, Vanita Gupta, met with Governor Gina Raimondo to discuss the consent decree.

Coincidentally, the meeting occurred the same day that state human services officials announcedthe death of a 70 year-old woman with developmental disabilities, who had succumbed to a massive infection as a result of a leg fracture that had gone untreated for several days at the College Park Apartments group home on Mount Pleasant Avenue, Providence. Her death on Feb. 15 is under investigation by the Attorney General and the State Police.

The Attorney General’s Office is conducting a total of three investigations in connection with College Park, according to spokeswoman Amy Kempe. She declined to elaborate.

 Including the woman’s death, there have been a total of six incidents of patient abuse at College Park since January, 2015, according to a BHDDH spokeswoman.

 The remaining 14 College Park residents all had been moved elsewhere by the end of the day Thursday, March 24, and the state-owned facility closed March 25, according to Michael Raia, communications director for the Executive Office of Health and Human Services.

He said Governor Raimondo gets regular updates on the investigations related to College Park and is “very focused” on reviewing those findings and receiving an assessment of any systemic problems that health and human services officials may identify.

The Executive Secretary of Health and Human Services Secretary, Elizabeth Roberts, has ordered spot-checks of state-rungroup homes beginning next week, Raia said on Friday , March 25. These checks are to be cooperative efforts between the Department of Health and BHDDH, which currently only has two investigators in Quality Assurance/Quality Improvement.

Raia described the meeting between the Governor and the DOJ’s civil rights chief as a “courtesy call.”

The DOJ requested the meeting, Raia said. The two discussed the state’s appointment of a Consent Decree Coordinator, funding, and the collection of data, he said.

“The meeting was an opportunity for the Governor to listen to the U.S. Department of Justice’s thoughts, opinions and concerns,” Raia said.

The court monitor in the case, Charles Moseley, expressed his concerns in a report to Judge John J. McConnell, Jr. that was made part of the court file on March 18.

The report that the state must turn into the Judge by April 1 is to contain evidence that there is a defined consent decree budget, including a per-person allocation based on the actual costs of implementing community-based activities required by the consent decree.

Moseley, however, said he is concerned the state will not be able to free up enough money in the next year or so to satisfy the consent decree.

According to Raimondo’s budget, the bulk of the funding for mandated services would come from moving a total of 500 people with disabilities, 38 percent of Rhode Island’s entire group home population, into less costly “shared living arrangements” with families by June 30, 2017. 

In the past ten years, a total of 267 people have gone into shared living.

The shift of 500 people would realize a total of $15.5 million in savings by June 30, 2017, but Moseley said he is worried that those targets are “too optimistic” and that BHDDH will not be able to achieve them in a little more than a year’s time.

Moseley also wrote that he is concerned BHDDH will not be able to clearly identify a per-person cost as a foundation for projecting the budget needed to help people obtain supported employment and access to community-based activities.

The state now pays below-cost rates to more than 20 private agencies providing most of the services to more than 3,600 Rhode Islanders with developmental disabilities. The agencies either operate at a loss or depend on outside grants as well as income from programs not dependent on BHDDH funding.

“Although the state has not yet provided the needed financial data, it should be noted that it is, reportedly, meeting consent decree placement targets” for supported employment, Moseley said.

“This must be confirmed, however. From my discussions with providers and state BHDDH staff it appears that these placements are being funded by providers through existing resources, and, as such, may not be sustainable over time. I will be tracking this in the months to come.” 

Moseley noted several positive developments, including staff appointments within state government that he expects will aid implementation of the consent decree.  Among the new positions is the Consent Decree Coordinator, Mary Madden. The full scope of her authority is not yet clear, and Moseley said he has requested a copy of her job description.

In the two years the consent decree has been in effect, both the DOJ and the monitor have cited a lack of interdepartmental leadership and coordination as one of their primary concerns. They have sought appointment of a high-ranking state coordinator who has the authority over n BHDDH and two other agencies responsible for some portion of the reforms, the Rhode Island Department of Education (RIDE) and the Office of Rehabilitation Services of the Department of Human Services (ORS).  

In other developments noted by Moseley, BHDDH has:

• Hired a Chief Transformation Officer. Andrew McQuaide previously served as consent decree coordinator within BHDDH, but he did not have authority outside that agency.

• Advertised for a supported employment coordinator to work with private service providers

• Received approval to hire a chief operations officer and quality improvement coordinator.

“These positions are important to provide leadership and guidance over the systems changes that need to take place,” Moseley said.

Raia said the quality improvement coordinator’s post has been advertised and applications are being accepted.

The new positions, funded in the Governor’s budget for the next fiscal year, reflect the fact that she is “committed to achieving the reforms outlined in the consent decree,” Raia said. He also cited a $2 million increase in funding for community-based daytime activities and an additional $5 million that would provide a raise of 45 cents an hour to staff of private agencies who work directly with people with disabilities. Model progams showcasing community-based services would receive a $1.9 million boost.  

Moseley said BHDDH, RIDE, and ORS are working together on implementing a quality improvement plan in keeping with the consent decree requirements.

Moseley concluded that “the Court’s close oversight over the state’s progress on meeting the terms and conditions of the consent decree is having a very positive impact on both the quality and the pace of change in the state.”  McConnell began holding status conferences on the case in January.

Woman in RI State-Run Group Home Dies, Prompting Criminal Investigation

By Gina Macris

The death of a 70 year-old woman with developmental disabilities in February has prompted the state of Rhode Island to order the group home where she lived to close in the next seven days,  health and human services officials announced March 18. 

The death of the woman, who had an untreated leg fracture, occurred after several allegations of abuse during the last year at the state-run home, College Park Apartments at 612 Mt. Pleasant Ave., Providence.

Health and human services officials have called in the state’s attorney general and the Rhode Island State Police to investigate.

The state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) has placed five employees of the group home on immediate paid leave and will provide strict supervision of the rest of the staff as they work to resettle other residents,  according to a statement from the Executive Office of Health and Human Services.

The remaining 14 residents at College Park Apartments are all to move to other housing before the group home closes next week.

The woman, who was not identified, was sent to  Roger Williams Hospital Feb. 9 for  what the staff reported was a bad bruise, but an x-ray determined that it was a broken thigh bone. The wound was infected, according to a BHDDH spokeswoman. . 

Linda Reilly, the spokeswoman, said the woman improved in the hospital and was sent to a nursing home, but the infection became worse and she was readmitted to the hospital, where she died Feb. 15.

An autopsy has been done but a report has not yet been completed, Reilly said in an email. 

College Park Apartments is both licensed and operated by BHDDH. Its internal investigation unit had responded to multiple reports of mistreatment and abuse in the past year, the department director, Maria Montanaro said at a press conference. .

“We will not tolerate mistreatment of patients anywhere in Rhode Island, including and especially inside group homes under our management. And we will not hesitate to close a group home when residents are at risk,” Montanaro said.

Health and Human Services Secretary Elizabeth Roberts said, “Injuries and mistreatment at the College Park Apartments are unacceptable.”

Going forward, she has ordered the state Department of Health to work with BHDDH on “targeted investigations” of group homes throughout the state.

The state-run network of group homes and apartments for people with developmental disabilities, called Rhode Island Community Living and Supports (RICLAS), houses 210 individuals. That number is 16 percent of about 1,300 people with intellectual challenges living in group homes in Rhode Island. The majority of the group home residents are served by private agencies.