Special Reports

State shuts down personal care home

State regulators are shutting down a personal care home in Pulaski County after citing it five times since July for putting the lives or safety of residents in danger. It is the first time in at least two years the state has closed such a home.

Hilltop Rest Home in Science Hill received five Type A citations — the state's harshest — for violations of state regulations. The offenses 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 an order issued by the Office of Inspector General of the Cabinet for Health and Family Services.

The facility's license will be revoked Dec. 9, the order said.

"They had the opportunity to appeal that action. They chose not to," said Beth Fisher, spokeswoman for the cabinet.

Many people who live in personal care homes have mental illnesses or mental disabilities. Unlike residents of nursing homes, residents of personal care homes must pay for their own care because the homes do not receive Medicaid, a health care program for the poor and disabled.

"While we have made some progress in keeping people with mental illness from living in institutions for long periods of time, some of these personal care homes are like institutions," said Marsha Hockensmith, director of the Kentucky Division of Protection and Advocacy. "Many, but not all of them."

Hilltop is owned by Health Solutions Assisted Living, a limited liability company in Somerset. Derek Cimala is the manager of Health Solutions.

Cimala said he already had decided to close the facility after the state began raising issues in the summer. Before that, he said, the facility had "an excellent reputation."

"We had already investigated and made plans to close the facility sometime in the next several months anyway," Cimala said. "The facility was very, very old. It was getting very, very difficult to maintain the facility. ... The state's action accelerated the inevitable decision. ... We accept the state's decision."

The cabinet has been helping to place Hilltop's 27 residents, including 17 wards of the state, in other personal care homes, Fisher said. At least four of the residents who were considered at risk were wards of the state.

The problems

July 2: The July 2 citation involved several issues, including a ward of the state who was missing for four or five hours before local police were contacted by the home. The resident was found by police more than a day later in a town 66 miles away, intoxicated. The facility did not investigate and did not have a policy on missing residents and how to assure their safety, the citation said.

"If we haven't seen them for a while, we look for them," a staff member told investigators.

That same citation said the facility did not have adequate food on hand. Investigators found that while one menu called for hot and cold cereal, bacon, sausages, egg and toast, the facility had none of the items on hand except hot cereal.

Cimala said that the day investigators checked on the food, it had not been delivered. "That happened one time. It was not a routine event," he said.

The citation also said the assistant administrator, who gave daily medications, "was unable to accurately read the medications, dosages or administration instructions ... on the medication packaging."

Several of the home's rooms did not have air conditioning, it said.

Aug. 18: The state cited the facility, alleging a mentally ill resident was allowed to wander outdoors in 100-degree temperatures. Another mentally ill resident with a history of running away for days at a time was also not properly monitored, the citation said. Both were wards of the state.

Sept. 1: The facility received a citation for hiring a person listed on the Kentucky Nurse Aide Abuse Registry.

In 2008, the facility hired an employee who was on the registry, the citation said. The person resigned in January 2010 because of "accusations of physically abusing a facility resident," according to the citation. The employee was rehired as a nurse's aide, although investigators said they couldn't tell when. The citation said the employee was providing direct care to residents in July and had been promoted to assistant administrator on Aug. 23.

Sept. 22: The facility was cited for not monitoring a mentally ill ward of the state who had a history of ingesting household chemicals. The resident drank shampoo and had to go to a hospital.

Oct. 13: The facility received a Type A citation alleging a resident had not been given psychiatric medication for three days and tried to commit suicide.

Diabetic residents were admitted to the facility with the understanding that their diabetes would be monitored and that they would be fed special diets. But after a diabetic was sent to a hospital, investigators found that the administrator, assistant administrator and the medication aide whose job it was to check blood-glucose levels were unable to properly use the equipment to check those levels.

The administrator told investigators "the facility was unable to provide specialized diabetic diets" because it did not have a consulting dietician.

'On the porch, smoking'

Hockensmith, of Protection and Advocacy, applauded the cabinet's inspector general for moving quickly to address problems at Hilltop. Protection and Advocacy is a state agency that advocates for the mentally and physically disabled.

"This facility was given an opportunity to right their wrongs, and obviously they did not do that," Hockensmith said.

She said Protection and Advocacy visited Hilltop in September after receiving reports of problems there. Agency investigators were concerned about a host of issues, including that residents of the facility had little or no privacy, that there were no organized activities and that residents were isolated from the community.

"They found that people were generally spending all day outdoors on the porch smoking," Hockensmith said.