Following a lack of supervision in a state-licensed facility during the alleged assault of a woman with developmental disabilities, state agencies didn’t do enough to ensure that the facility took necessary steps to make sure residents were safe, according to a report released Monday.
The report looks more broadly at a review of more than 150 similar group homes over a five-year period. It found that almost 50 providers were cited for failing to report harm or didn’t have a system to report harm. But only two of those providers were revisited by state Department of Disability Services staff to ensure that they’d taken corrective actions.
The issues with regulation of these homes are tied to years of underfunding for providers, said Sarah Eagan, the state’s child advocate.
“It creates a direct threat to disabled individuals’ quality of life,” Eagan said Monday.
The report details an incident reported in October 2021 at a Department of Disability Services-licensed Community Living Arrangement facility, also known as a group home. The report found several systematic concerns among the state agencies responsible for ensuring both the boy accused of the attempted assault and the woman were safe and had all the services they needed.
This type of facility houses people with certain disabilities in smaller settings, typically five or six people to a house. They’re licensed by DDS, and much of their funding comes through Medicaid, which is administered through the state’s Department of Social Services.
The woman, referred to in the report as Jane, is nonverbal and uses a wheelchair. She has intellectual and other developmental disabilities. The boy, referred to in the report as John, had been in the Department of Children and Families’ custody for several years and had an intellectual disability and autism. The report says he’s described as primarily non-verbal.
The woman’s family reported to the child advocate that the boy had been found in the her bedroom and had been trying to have sexual intercourse with her.
The Office of the Child Advocate found that the incident wasn’t reported quickly enough to the state as a report of abuse or neglect. State agencies also found broad programmatic concerns at the facility but didn’t follow up to make sure the concerns were addressed. And John’s state-appointed attorney didn’t follow guidelines for representing the child, the report says.
“On the one hand, you need a robust regulatory oversight framework,” Eagan said. “But you also need to pay for that service, which we have not been doing. And that has an impact.”
The report said that there are “grave concerns” about oversight of the care of people with disabilities in Connecticut and about the allotment of resources to that care. A 2016 report from the inspector general for the U.S. Department of Health and Human Services found similar concerns and that DDS-licensed facilities had failed to comply with federal Medicaid rules in the care of people with intellectual disabilities.
Monday’s report marks the third in recent months that has raised concerns among state lawmakers about the care of some of Connecticut’s most vulnerable residents.
A report on a group home for children in Harwinton that faced allegations of physical and sexual abuse and a lack of supervision of kids recently led to a state hearing.
On Monday, Republican leadership issued a statement calling for a panel to explore the concerns and solutions raised by the child advocate.
“All is not well in state government, most notably agencies that are responsible for caring for our state’s most vulnerable residents,” Monday’s statement from House Republican Leader Vincent Candelora and Senate Republican Leader Kevin Kelly. “There are clear systemic breakdowns, the least of which is failure to relay critical incidents in a timely manner, or at all, as this latest report from the Office of the Child Advocate has revealed.”
Eagan said she hopes to talk with lawmakers across both sides of the aisle about the critical issues.
“I think that the issues that we were writing about are widespread and are going to need a lot of attention,” she said.
The child advocate’s report and the accompanying executive summary made 13 legislative recommendations to improve processes and services and make sure the people living in state-licensed facilities are safe.
Eagan said she’s heard from several lawmakers about taking on some of these issues, including legislators from the Committee on Children and the Human Services Committee. Rep. Liz Linehan, a Democrat and the chair of the children’s committee, has spoken with her about recommendations from a previous report, Eagan added.
Recommendations included amending state law to strengthen licensing requirements and oversight for group homes, making more information about corrective action plans public, making sure parents know about concerns with the programs, and more money in the state budget for community providers. It also recommended a working group to look at finding more ways to strengthen legal representation for kids.
Reimbursement rates and employee pay for people who provide community services to vulnerable communities was a focus during the last legislative session, when many workers went on strike and protested at the state Capitol.
Agency responses
Eagan said that both DSS and DDS acknowledged that there is a need for improvements and have started taking some steps toward those changes.
In response to the incident, officials in the Department of Social Services said they’re implementing a “redundant critical incident response and sustainability plan.” The plan involves having a subject matter expert review and draft responses to incidents. The person will also work with quality assurance staff to make sure that any corrective actions are implemented.
“This process will be a ‘checks and balances’ process where staff from different divisions hold themselves and each other accountable to complete the report and implement the corrective action plan,” said the agency’s response, sent by Commissioner Andrea Barton Reeves.
Officials at the Department of Disability Services said that they are improving critical incident detection and tracking and have added three regional managers of quality assurance and a manager of critical incident review to address the problems raised in the report.
And the Office of the Public Defender reported it is pushing for better recruitment and retention of lawyers for children and more oversight for the system. The report said that the child’s attorney hadn’t attended meetings about treatment planning for his client.
One of the child advocate’s recommendations was to improve the system of payment so that publicly appointed lawyers for children are compensated for the hours they work.
Susan Hamilton, general counsel at the Department of Children and Families, emailed Eagan and said that the department is continuing to provide training and assessing the investigations it conducts at DDS-licensed facilities.
“The Department is currently assessing the scope of the child abuse and neglect investigations it conducts in DDS-licensed facilities to determine whether these can or should continue to include program concerns not directly related to the abuse or neglect investigation,” Hamilton said. “In addition, the Department continues to support and offer staff training on meeting the safety and treatment needs of children with developmental disabilities with a focus on providing individualized training for staff when they are serving children with developmental disabilities rather than mandating the training in advance.”
Peter Yazbak, a spokesman for DCF, said in a message to The Connecticut Mirror that the department couldn’t make further statements because of pending litigation.
Incident
In October 2021, the child advocate’s office got a report from a first responder about the incident at the group home. The boy had a history of “sexually reactive behaviors,” the report says.
DCF found that the boy had “inadequate supervision given John’s age and cognitive ability.” Staff were eating dinner when the incident occurred, and left John alone for about half an hour, during which time he allegedly assaulted the woman, according to the report.
DDS and DCF both found “program concerns,” according to the report.
Staff called local police, and the woman was taken to the hospital. However, they didn’t report the incident to DDS or DCF in a timely way for an abuse investigation.
“OCA was later contacted by a first responder alleging concerns about the incident and the supervision of both the boy and young woman, including that there had been multiple incidents involving the boy that had not been properly reported to DDS or DCF,” the child advocate’s report says.
Local law enforcement did call the report into the DCF Careline, which handles reports of suspected abuse or neglect, claiming that there had been negligent supervision of a child.
Most investigations of suspected abuse or neglect of a person with an intellectual disability are done internally by the provider rather than by state agencies, the report says. DDS told the child advocate’s office that they don’t have enough staff to investigate every report of abuse or neglect against people with intellectual disabilities.
DCF also investigated allegations of physical neglect of the boy. It took the agency a few days to find a new place for the boy to live, which made it harder for the group home to support the woman who was assaulted, the report says.
Despite both DDS and DCF finding that there were problems with the program, the agencies didn’t follow up enough to make sure that the group home was making necessary improvements, the report says.
“I think what was most concerning specific to the individual case was that there did not seem to be a timely and effective way by which the concerns that were found by regulators and investigators were addressed,” she said. “The more we sort of pulled at that thread, the more concerning the findings became.”
Inspector general
A 2016 federal report found “serious safety concerns,” involving the group homes in Connecticut, the child advocate’s report says.
The inspector general for the U.S. Department of Health and Human Services found that Connecticut had failed to follow Medicaid rules for reporting on, monitoring and following up on incidents involving people with disabilities in the group homes.
“The Inspector General’s audit emphasized that individuals with developmental disabilities are at higher risk of abuse and neglect in the community and they may have limited capacity to report concerns or access help,” the report says.
The inspector general gave the state a series of recommendations to fix the problem. DSS and DDS took several actions, but there still isn’t a federal finding that the state is in compliance with the safety measures.
There is also no method for publicly measuring and reporting on the state’s progress on improving safety conditions, the report says.
Some of the steps the state has taken include implementing a new software program to share data and information across agencies. DDS has also updated its performance goals to measure its progress toward Medicaid-required safety practices.
The report lists several other measures the state has taken to make improvements, although Eagan said more is needed.
“I think there’s a lot of work that needs to take place here to improve this,” Eagan said.
