Monday, February 22, 2010

Oklahoma's major newspaper investigate numerous violations at state's group homes

The first of a two-part series of stories investigating conditions in Oklahoma's group homes for the mentally retarded, mentally ill and elderly. The investigation was conducted by reporters from the Tulsa World and The Oklahoman. Read Part 2 here. In the picture is Royal Living Care Center, a residential home in Prague, which has racked up 70 violations since 2006 — more than any other facility of its kind in the state.

Within three years, the Oklahoma State Department of Health found more than 830 violations in at least 70 residential care homes for the mentally ill and elderly, according to a joint investigation by the Tulsa World and The Oklahoman.

Violations include 30 cases of inappropriate medical care and 24 cases of client abuse or neglect, four involving the death of a resident.

From late 2006 to early 2009, inspectors documented residents who were covered in feces, stolen from, threatened with knives or left to sleep on dirty mattresses.

Some were supervised by felons. Others lived in buildings infested with ants, cockroaches and mice.

At least two people allegedly were raped.

During an inspection in late 2006, a developmentally disabled woman living at Prague's Royal Living Care Center told a state official that she didn't like three of the home's male residents, saying one hurt her the previous night.

"Hits me. Hurts me. Hurts me," she said, pointing to her crotch. "I don't like it when he hurts me there."

The home's administrator said she had seen the resident with a lot of the home's men. She called the woman "easy," reports state.

"I suspect some of them were even doing anal sex to her because she acts like she's in a lot of pain the way she can't sit still and rocks back and forth," the administrator said.

That evening, the Health Department removed the woman from the home.

Officials from the home declined to comment.

The state inspects residential care homes once every two years. That's not enough, said Tamie Hopp, director of government relations and advocacy for Voice of the Retarded, a nonprofit organization.

"These are folks who are the most vulnerable in our society, and the oversight is really critical," Hopp said.

Oklahoma is home to about 80 residential care facilities housing 2,600 people.

While residential care facilities look like and have similar goals to the federally supported Intermediate Care Facilities for People with Mental Retardation (ICFMR), the residential care homes have fewer inspections and standards, which are set by state law, said Dorya Huser, the state's chief of long-term care service.

"It (a change) would have to be motivated by a legislator or request," Huser said.

To qualify for a residential home, a person must be ambulatory and able to live without routine skilled nursing care. Injections and assessments are given, however.

"A lot of times, it's a medication issue," said Mary Fleming, director of surveys for the state Health Department. "They should be essentially capable of managing their own affairs. If (the homes) maintained the population they ought to have, it wouldn't be a big thing.

"We have some very successful residential care homes. That is probably the source of the fewest complaints."

Michael Brose, executive director of the Tulsa Mental Health Association, called Oklahoma's model for licensed residential care for people with mental illness "archaic and out-of-date."

Similar to ICFMR homes, the goal of residential care homes is to promote independent and active lifestyles.

However, Brose said many residential care homes fall short of "safe, affordable and decent housing" because of concerns about overcrowding, substandard care, a lack of recreational activities and appropriate staff. He said problems have been apparent for years.

"As is often the case, these licensed residential care homes do little or nothing to help the individual establish and maintain a plan of action that promotes mental and physical wellness, along with recovery," Brose said.

"Without this type of encouragement and support, people are often left to languish, versus having the opportunity to thrive."

During the nearly three-year span studied by the World and the Oklahoman, at least three people died after wandering away from Oklahoma residential care facilities.

In one instance last year, an 82-year-old man prone to hallucinations climbed out of his window at Early Autumn's Residential Care Facility in Stillwater before falling off a cliff and dying face-down in a nearby creek.

The home failed to properly care for the man, Health Department reports state.

The man's family members said they placed him in the home because they thought it was an assisted-living center, and they wanted 24-hour supervision. "I took him there to be protected," a family member told investigators.

Sharral Tye, Early Autumn's administrator, declined to comment.

Others died in similar instances, records show:

In April 2008, 19-year-old William Eugene Hurst, a resident of the now-closed Green Country Residential in Fairland, was hit by a truck and died after he wandered from the facility. Hurst was mentally ill and had previously walked away from the home seven times in 37 days.

A month later, a 54-year-old schizophrenic resident wandered away from Edna Lee's Residential Care in Vinita. He was found seven days later dead from dehydration.

A male resident died in 2007 after officials at North Fork Residential Care in Checotah failed to treat his infection.

"The cause of death was felt to be directly traceable to his sepsis and shock," a Health Department report states.

Officials from those homes declined to comment or could not be reached for comment.

State law requires that the state Health Department be notified when a person in a residential care home goes missing, dies or is assaulted.

But that doesn't always happen.

According to inspection reports, Green Country Residential failed to notify the state after a resident ran away on five different occasions. The home failed to notify the state of four resident-on-resident assaults, when a resident hopped a fence into the play area of a child-care center and when a resident punched a window, cutting herself, after she was threatened with eviction.

Owners of the home — Greg and Cindy Bedford — gave up the license after being cited for several serious violations and complaints, including one surrounding Hurst's death, records show.

In an agreement of closure on Feb. 25, 2009, the couple or their relatives were not allowed to open a residential care home, health officials said. In April 2009, the Bedfords were found to be operating unlicensed residential homes in Fairland. They were ordered to cease operations and fined $6,750, according to a May 11, 2009, administrative hearing record. Efforts to reach the couple for comment were unsuccessful.

Fifteen of the state's 80 homes had minor violations only, the newspapers' analysis found. Huser said most of Oklahoma's residential care homes perform well and care for their residents properly. "We do feel like while there is a lot of room for improvement, we do have some good facilities in Oklahoma," Huser said.

Housekeeping problems rank among the top deficiencies, tallying 45 violations since late 2006, data show. Infestations accounted for seven violations.

Peppered throughout the reports are stories of homes battling mold and mice, leaky roofs and filthy bathrooms.

Inspectors visited Jeanies Residential Care Home, a 57-bed Bluejacket facility, in June 2008. They noticed a strong urine odor in the southeast hall.

A toilet in the bathroom of one room had a dark substance surrounding the base.

"When flushed, water ran out from beneath the toilet and onto the floor," according to an inspector's report.

That same day, a resident told inspectors that she was afraid to drink water out of her pitcher because it was covered in ants the previous day.

The Health Department inspector found ants crawling on the bathroom sink.

Owner Jeanie Wesley said the problems with the bathroom had to do with a resident not taking care of his room.

"We have an exterminator each month in our home," Wesley said in a voicemail. "I personally have never seen ants covering water. I've seen them on sweet things, but not water."

During a March 2007 inspection of Edna Lee's Residential Care, state officials found cockroaches on the furniture of a resident's room.

Said the home's administrator, "Yeah, I know I have a huge problem."

Two months later at Noble Residential Care in Noble, inspectors determined that the home's rodent infestation had become an emergency.

In a letter dated May 29, 2007, a service manager for Terminix, a pest-control company, recommended obtaining total control of the facility. "The most important issue is for the safety of the residents," the letter states.

That wasn't the only time the facility had an infestation problem.

In 2005, the state had to evacuate residents of the Noble home after inspectors found more cockroaches than they could count. The same day, officials found rodent droppings, urine-soaked kitchen plates and insects crawling on residents' clothing and bedding.

In January 2006, the owners — Roger Daniel Howe, Linda Faye Howe and Cynthia D. Howe — were charged with caretaker abuse after an elderly man wandered away from the home into the town. Charges were dismissed against Roger and Linda Howe, and Cynthia Howe pleaded guilty to a lesser charge of public nuisance, records show.

While the Health Department was in the process of revoking the Noble home's license, the building was destroyed by fire. The state considers the owners ineligible for a license because the home was out of compliance when it burned