Kool-Aid dripped on the tops of insulin bottles; other medications found in the refrigerator had expired.
Residents were allowed to bathe only every other day because there were no clean towels, and a shower was "dirty and stained with a black and green substance."
A hallway smelled of urine and feces.
There had been no milk in a month because the bill hadn't been paid.
These were just some of the conditions state inspectors found when they visited Golden Years Rest Home in Letcher County in December, according to documents obtained by the Herald-Leader under the state Open Records Act.
At the time of the inspection by the Cabinet for Health and Family Services, 35 people — many with mental illness or mental disabilities — were living at Golden Years.
"Quite frankly, if children were living in the same conditions that are found at some, but not all, personal care homes, we would never tolerate it," said Marsha Hockensmith, director of Protection and Advocacy, a state agency that advocates for the mentally ill and mentally disabled.
The state may need to examine whether the personal care home — a less-skilled form of long-term care — is the best model to serve the mentally ill and mentally disabled, she said.
The recent problems documented at Golden Years are the latest in a litany of legal and regulatory difficulties that include the conviction of a former administrator on abuse charges, the death of a resident who wandered away and froze and an indictment of the same administrator in 2010 for taking $500,000 in state and federal payments to residents over four years.
The cabinet's Office of Inspector General, which oversees personal care homes, said the home has not had enough serious regulatory violations to warrant being closed.
The office said it is still waiting to receive the home's plan to correct the problems. Previous problems cited by officials were corrected, and Golden Years' criminal problems are separate from its regulatory problems, officials said.
The new head of Golden Years — the grandson of the previous administrator — says the home is making improvements. Many of the problems uncovered during the December inspection have been corrected or were overblown, said Jonah Tackett, the administrator.
"What doesn't make news is all of the good things that we do here," said Tackett.
Care of last resort
In Kentucky, there are 82 free-standing personal care homes and 90 that are attached to nursing homes. The homes provide meals and some assistance with medication and tasks of daily living. They receive $1,194 a month for each resident in the form of state and federal disability payments.
Too often, personal care homes have become the provider of last resort for those who have nowhere else to go, Hockensmith said. Many residents are wards of the state and have no family members to look after them.
Personal care homes, overseen by the Office of Inspector General, are seldom shut down. Hilltop Rest Home in Pulaski County is the only such home closed by the state in two years. It was shut down in December for offenses that included failure to keep a three-day supply of food on hand and hiring an employee who was on the Kentucky Nurse Aide Abuse Registry, according to state documents.
Hockensmith of Protection and Advocacy, which has monitored conditions at Hilltop and Golden Years, said many personal care homes have few, if any, activities for residents, and need more intensive services.
Protection and Advocacy investigators visited with residents at Golden Years in November and found other problems there including a lack of privacy for residents, few activities and confusion among staff and residents over who had control of residents' finances. Those concerns were forwarded to the Office of Inspector General.
"We have done a great job of moving people out of institutions into the community," Hockensmith said. "But these people are often living in isolation in an institution-like setting."
Resident froze to death
Problems at Golden Years go back several years.
Larry Bruce Huff, 64, was sent to Golden Years after being discharged from a psychiatric hospital in December 2006.
Huff battled schizophrenia and mild dementia and had a long history of alcoholism. But family members said he loved being around people and was well-liked in the community of Cumberland in Harlan County.
On Jan 8, 2007, Huff wandered away from Golden Years and later froze to death in the snow.
According to a state citation issued to the home, staff members waited 17 hours to notify police, even though Huff had a history of wandering away. He had left the facility at least six times in the two weeks before he died, according to state records.
Johnny Huff, Larry Bruce Huff's son, said if police had been called right away, "I believe they could have saved his life."
Huff said he thought that personal care homes were in a position to help people like his father.
"If it's done right, it's a good thing to take care of people with problems," Johnny Huff said. "If it's done with actual care instead of a money thing."
Huff's family filed a civil lawsuit against Golden Years that was settled in 2010, Johnny Huff said.
Assault and theft
That wasn't the only legal problem for Golden Years.
In 2007, James "Chum" Tackett, then the administrator at Golden Years and a former mayor of Jenkins as well as a former Letcher County official, was convicted of assaulting a resident at the home.
According to an inspector general's citation, a resident said Tackett smacked him in the face and hit him on the head with a rubber hammer. The resident tackled Tackett, he said, and Tackett and another staff member began to hit him, which resulted in the resident crashing into a filing cabinet. He was taken to the hospital and the wound required several stitches, according to the citation.
During the investigation of the fight, state regulators found that a staff member had a criminal conviction for having sex with a minor, but had never undergone a criminal background check, as required by the state.
Tackett pleaded guilty to reckless abuse of an adult in the summer of 2009 and was given two years probation. As part of his probation agreement, Tackett was to have no further contact with the facility. But when state inspectors returned in July 2009, Tackett was there, which led to another citation of the facility.
In April, 2010, James Tackett was charged with taking up to $500,000 that was supposed to go to residents at the facility. The indictment came after a seven-month investigation by Attorney General Jack Conway's office.
Tackett and the facility pleaded not guilty to the charges. A trial is set for Oct. 3.
Jonah Tackett, who has been in charge of the facility for a year and a half, said that there have not been as many problems during his tenure.
Golden Years is owned by Letcher Co. Golden Years Rest Home Inc. According to the secretary of state's Web site, James Tackett was still an officer of the company as of February 2010.
"It's under a new administration," Jonah Tackett said. "I don't see anything happening like that now and I don't see anything like that going to happen in the future," he said of past legal problems.
Tackett said his grandfather, James Tackett, ran Golden Years for more than three decades and is not guilty of taking anyone's money.
"He has always been good to the people here," Tackett said. "He would never hurt anybody."
Jonah Tackett said last week that all the problems cited in the December inspection have been corrected and some of them were misstated or overblown.
For example, the Kool-Aid could not have dripped on the insulin medication because the medication was in a box.
Residents are allowed to take baths every day, Jonah Tackett said.
The report also cited an incident in which a resident tried to hit another resident with a wall hanging and Golden Years staff did nothing, according to the report. So a Kentucky State Police officer who was with state inspectors took the person to jail.
Tackett said that staff will receive appropriate training on how to deal with unruly residents in coming weeks.
While he admitted that the facility did not have milk for a while, he said: "We had 2 percent powdered milk and they liked that just as good."
State investigators also said in the December report that Golden Years staff said Jonah Tackett only stopped in one or two times a month.
"I'm on call 24-7," Tackett said. "I'm coming in every day. Just because somebody don't see me here don't mean I'm not here."
Monitoring the home
The facility said it has submitted a plan of correction to the Office of Inspector General, which can accept or reject it.
The office can also do a follow-up to ensure that the problems have been corrected, said Beth Fisher, a spokeswoman for the office.
"The Office of Inspector General will continue to monitor this facility," Fisher said.
Hockensmith said Protection and Advocacy will be doing its own follow-up visit to Golden Years and will be making sure that the Office of Inspector General does ensure that people at Golden Years are safe.
"We will continue to share our concerns," she said.
There are many personal care homes that do an excellent job providing services and care to residents, Hockensmith said.
"There are problems at some of these homes, but we also need to look at this system overall," Hockensmith said.