In an unprecedented move, the state of Washington is shutting down a major provider of in-home care for developmentally disabled adults in King, Spokane and Yakima counties because of repeated serious violations of care standards.
On April 4, the Department of Social and Health Services sent the provider, SL Start & Associates, a decertification letter based on a “history of serious … non-compliance with the law and regulations.”
The letter cited two years of deficiencies that included failing to report alleged abuse of clients and failing to get appropriate and timely medical care for a client who later died.
“These serious deficiencies have jeopardized clients’ health, safety and welfare and support decertification of your agency,” the letter from the director of DSHS Residential Care Services said.
SL Start was one of the larger providers of in-home care to adults with developmental disabilities. A DSHS official said he couldn’t recall a supported living program that served as many clients under a single license being decertified.
But it’s what DSHS did after the decertification that’s causing alarm among some families and disability advocates: the agency is moving most of SL Start’s clients to its sister company, Aacres Washington.
‘We Are Alarmed’
Beverly Davis said she only recently learned of SL Start’s long history of deficiencies. Her 45-year-old son Christopher Davis was one of the company’s clients. Now she’s even more upset that the state is transferring him to Aacres.
Sitting at her dining room table in her north Spokane home, Davis described her son as “happy-go-lucky.” He’s severely developmentally disabled and non-verbal, but she said he still finds ways to communicate.
“He squeals, he enjoys life,” Davis said.
But Davis said her son has also endured a lot over the years, including neglect by caregivers, serious health problems and several disruptive moves as care providers went out of business, were decertified or said they couldn’t handle his behavior.
Most recently, SL Start provided Christopher Davis with round-the-clock care in his own apartment. But his mother said she noticed problems with that care when she would visit him or he would come to stay with her on weekends.
“He’s not getting his meds all the time, his hygiene is horrible,” she said.
In March, following a routine dentist appointment, Christopher Davis’s dental hygienist sent SL Start a letter warning that his periodontal health had degraded in the previous six months and was now in a “necrotizing state.”
“How long do we just stand there and watch our loved ones being treated like this,” Beverly Davis said.
Once SL Start was decertified, Davis faced a dilemma: give SL Start’s sister company a second chance or put her son through another disruptive move to a new care provider.
“It’s kind of like they back us into the corner,” Davis said.
Last week, the advocacy group Disability Rights Washington sent a letter to DSHS Secretary Cheryl Strange that said it has “grave concerns about an unqualified provider continuing to deliver services to (Washington Developmental Disabilities Administration) clients.” The letter also alleged that clients and families “are being grossly misled.”
“We are alarmed to the point that we’re going out and doing our own monitoring and making sure that people know how to advocate for themselves, because we are afraid that our state has put them in a vulnerable position and we want to empower them,” said Susan Kas, the Disability Rights Washington lawyer who wrote the letter.
Also concerning to Disability Rights Washington was an April 5 letter SL Start sent to its clients and their families that described the move to Aacres as a merger and made no mention of its decertification. Instead, the letter emphasized clients would experience a seamless transition. “There is absolutely no change to staff, homes, or scheduled support to you or your loved one,” the letter read.
DSHS recently concluded that SL Start violated state rules by failing to notify its clients of the decertification in that letter. SL Start said it plans to appeal that finding.
Scramble To Avoid Disruption
After SL Start lost its certification, Washington's Developmental Disabilities Administration said it had just two weeks to transition the more than 200 clients. The goal was to avoid an interruption of care and keep as many of them as possible in their homes. That's why the decision was made to move the clients to Aacres.
SL Start and Aacres are both owned by the same company—Spokane-based Embassy Management. According to business filings in Washington and Delaware and news reports, Embassy Management is a subsidiary of U.S. Community Behavioral, which in turn is owned by Bregal Partners, a New York private equity firm.
Don Clintsman, the deputy assistant secretary of the Developmental Disabilities Administration, said he understood the concern about moving clients to a sister organization, but said the two entities are different.
“The expertise that Embassy has shown and that Aacres has shown in running a supported living program give us confidence the SL Start residents will get the right service,” Clintsman said.
He added that for at least the next three months DDA will conduct monthly in-home inspections of at least 15 percent of the former SL Start clients’ residences to ensure they are getting adequate care.
A small number of clients in Yakima County are being transferred to a provider that is not owned by Embassy Management because Aacres doesn’t have a license to operate there.
Decertification Called A ‘Surprise’
In a lengthy interview Wednesday, Kendra Ellis, the executive director of Aacres who also served in that same role for SL Start, said the decertification came as a surprise. Ellis said SL Start had been working with state regulators since last October to address deficiencies and was implementing a “plan of correction.”
But in March, while SL Start was under a second 90-day provisional certification, two clients died after being taken to the hospital for illnesses.
In one of those cases, a visiting state inspector encountered a client in respiratory distress and directed staff to call 911, according to state officials. In the other case, investigators found that caregivers delayed getting medical attention for a client who “exhibited signs and symptoms of a life threatening illness.”
The statement of deficiencies issued by DSHS and obtained by the Northwest News Network found that SL Start failed to properly train staff and noted this was a repeat violation.
Soon after, the state notified SL Start that it would be decertified to care for adults.
Ellis said she was “blindsided,” but the company decided not to appeal and instead continue to serve clients through Aacres while working on the turnaround plan that was already underway.
“We’ve taken ownership for our deficiencies, identified steps that we need to take to improve our systems, identified additional training that’s needed, oversight in the homes,” said Ellis, who noted the company has recently hired a chief clinical officer, director of nursing and chief quality officer.
Ellis attributed some of SL Start’s deficiencies to a statewide shortage of trained caregivers and the fact the company worked with individuals with complex needs.
“It’s opened us up for increased chances for citation, for things to go wrong, greater chance of deficiency,” Ellis said.
As clients make the transition to Aacres, Ellis said, she wants families to have confidence in the company’s ability to provide care, but she notes they also have the option to find another agency.
In Spokane, that’s something Beverly Davis said she’s already decided to do—even though it means her son will have to move again. She’s recently found a woman who’s agreed to take care of him.
“I’m going to place Chris in her care and hope and pray that it’s going to be better than what he’s had,” Davis said.
SL Start is still licensed in Washington to care for children with developmental disabilities. State records show DSHS has paid SL Start more than $26 million since July 1, 2017.
SL Start also has operations in Oregon. A spokeswoman with the Oregon Department of Human Services there said there are no complaints or actions pending against SL Start or Embassy Management.
Emily Schwing contributed to this story.