A year after shutting down a troubled provider of in-home care for people with developmental disabilities, the Washington Department of Social and Health Services is cutting ties with the provider’s sister company, citing similar problems of neglect, abuse and mismanagement that allegedly resulted in one woman’s death.
Families and disability advocates criticized DSHS last year when the agency revoked the license of S.L. Start & Associates and placed many of its clients under the care of Aacres Washington, even though both providers are owned by the same company, Spokane-based Embassy Management.
DSHS announced Tuesday it is terminating its contract with Aacres, which provides state-subsidized “supported living” services to nearly 60 adults with developmental disabilities in the Spokane area. The contract is worth more than $700,000 a month.
“We have lost confidence in Aacres Spokane,” Evelyn Perez, who leads the agency’s Developmental Disabilities Administration, said in a statement. “Not being in compliance with regulations and ensuring the health and safety of our clients is unacceptable.”
Messages left with Aacres and Robert Efford, the chief executive of Embassy Management, were not returned Tuesday.
Although one division of DSHS, the Developmental Disabilities Administration, is ending its contract with Aacres, the company is still operating under a 90-day provisional certification granted by another DSHS division, Residential Care Services, which handles regulatory matters.
Shaw Seaman, chief of quality assurance and communications at DSHS, said the agency will work to connect Aacres clients and their families with other supported-living providers in the area.
“It’s going to take a few months, but we’re hoping for a smooth transition,” Seaman said.
There will be “no gap in services” for those clients, said Lisa Copeland, an agency spokeswoman. “Aacres is going to be on contract until we find new providers for all of them. And that will happen within 90 days.”
After multiple investigations, DSHS ordered Aacres to stop accepting new clients on July 10 and issued the provisional certification last Friday, citing “continued noncompliance” with client care requirements.
Among other deficiencies, DSHS found that Aacres staff, including a supervisor, failed to report incidents of “isolation and mental abuse” of three clients. Aacres staff also failed to ensure that one client took mental health medication for six days, and failed to notify the doctor who prescribed that medication, according to a “statement of deficiencies” report.
The company also failed to update personalized care plans for multiple clients and failed to ensure that staff met state-mandated training requirements, the report says.
DSHS slapped Aacres with a $6,000 fine in May, for the alleged abuse and failure to report it. Last month, the agency concluded that inaction by Aacres staff had resulted in the death of a vulnerable 64-year-old woman.
DSHS found that Aacres staff failed to ensure she received medication as prescribed and failed to assist her in preparing for a scheduled colonoscopy. The report says Aacres failed to provide appropriate medical attention “after staff identified concern of household cleaner ingestion by the client.”
“This resulted in the client ingesting household cleaning vinegar instead of the physician’s ordered medication and the client not obtaining immediate medical evaluation which culminated in the client’s death,” the report states.
Copeland, the DSHS spokeswoman, said the woman died in February.
Embassy Management, which owns S.L. Start and Aacres, is a subsidiary of U.S. Community Behavioral, which is in turn owned by Bregal Partners, a New York private equity firm.
Public radio’s Northwest News Network reported in April 2018 on the decertification of S.L. Start, which served more than 200 clients in King, Spokane and Yakima counties under DSHS contract.
In taking that unprecedented step, DSHS cited “serious and pervasive” deficiencies that “jeopardized clients’ health, safety and welfare.” As with Aacres, the agency found S.L. Start had failed to report abuse and failed to provide appropriate medical care for a client who later died.
All S.L. Start staff, including Executive Director Kendra Ellis, became employees of Aacres. Ellis told the Northwest News Network the company was working to solve deficiencies. In a letter to clients, families and guardians, the company described the transition as a merger, made no mention of the decertification and said there would be “absolutely no change to staff, homes or scheduled support to you or your loved one.”
In a letter to DSHS at the time, the advocacy group Disability Rights Washington said it had “grave concerns” that clients, guardians and families were being misled by an “unqualified provider” operating under a different name only. But DSHS placed many clients with Aacres anyway, saying it was a separate entity with a better track record than S.L. Start.
“At the time, Aacres was in good standing and was certified,” said Copeland, the DSHS spokeswoman.
She added that, because of the decertification, DSHS had only two weeks to place S.L. Start’s 200 clients and that there is a limited number of licensed providers.
“We’ve started doing smaller contracts now, so that if the contracts don’t work out for some reason, we don’t have to place so many people all at once,” Copeland said.