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Division of Oversight & Monitoring 161 Delaware Avenue, Delmar, New York 12054

TEL: 518-549-0200

February 25, 2014 David Armstrong, RN Administrator Lakeview New Hampshire NeuroRehabilitation Center 244 Highwatch Road Effingham, NH 03882 Dear Mr. Armstrong: Thank you for your February 21, 2014, response to the New York State Justice Center for the Protection of People with Special Needs (Justice Center) January 21, 2014, correspondence documenting the findings and recommendations shared during our October 2013 visit to Lakeview New Hampshire NeuroRehabilitation Center (Lakeview). The Justice Center has carefully reviewed your response and included attachments. In response to the recommendations that Lakeview improve incident management practices, the Justice Center notes the reported completion of formal, certified investigations training, along with reported plans to appropriately modify incident management policy and procedure. We also look forward to reviewing comprehensive investigation reports and supporting evidence for those incidents recently reported to the Vulnerable Persons Central Register (VPCR). Similarly, the Justice Center further noted that our recommendations related to environmental enhancements and improved fire safety will result in decorative and furnishing improvements in the Monterey 1 and 2 cabins, and that start of shift maintenance checks will henceforth ensure that all fire extinguishers are charged, in place and accessible. Regarding the Justice Centers recommendations concerning staffing and service levels, Lakeviews response referenced facility policies in place prior to the October 2013 visit and asserted that the agency had reliably adequate staffing and service levels. These assertions were not supported by Justice Center observations, independent Justice Center investigative activities, the reports of numerous Lakeview direct care staff members, or the

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findings of New Hampshire Bureau of Elderly and Adult Services (BEAS) investigations now in our possession. While we note Lakeviews position that a steadily increasing number of employees have been retained by Lakeview, the Justice Center maintains the finding that the staff on duty are not reliably able to satisfactorily respond to all resident crises. The Justice Center further maintains its finding that ample investigative evidence was found to conclude that eyesight levels of supervision are not reliably maintained, due in part to the reports of Lakeview staff members that eyesight supervision is neither individually assigned nor documented when transferred to other staff. We further assert that whenever 1:1 supervision is funded specifically to maintain resident safety, it may not be reduced without a formally approved modification to the residents Behavior Support Plan, Individual Service Plan and/or Individual Education Plan. While we are aware of the reported initial confusion by the Lakeview administration regarding Justice Center reporting requirements, the Justice Center recommendation related to inadequate internal and external reporting of allegations of abuse and neglect did not solely refer to matters occurring prior to our first telephone contact with the facility. There were additional reporting failures, including one allegation called in to the VPCR on December 30, 2013, by an outside party after family complaints of neglect made to a case manager and an administrator did not elicit any response (or any incident report). This and other investigations remain open in the VPCR. While we await receipt of the facility investigation into this matter, Justice Center concerns will be shared with New York funding agencies regarding Lakeviews apparent refusal to take substantive steps to improve internal and external reporting. Please note that, consistent with the requirements of the regulations of the New York State Commissioner of Education, Part 200.15(h), Lakeview staff and administrators who care for residents placed or funded by New York State must be trained in required reporting to the Justice Center Vulnerable Persons Central Register (VPCR) and New York Social Services Law definitions of abuse and neglect. Residents from New York and their guardians must similarly be provided with notice, educational materials and instruction regarding these standards, consistent with the requirements of the regulations of the Commissioner of Education, Part 200.15(j). Such training must be provided to staff upon hire and at least annually thereafter, and to residents from New York at admission and at least annually thereafter. Finally, we reviewed the documentation provided in attachments to the Lakeview response regarding the substance and propriety of services offered in the Young Adult Program (YAP). This reported level of individualized service was not reflective of what we viewed during the visit or what was found in the individual program records we reviewed. We will return to Lakeview to verify the completion of reported corrective actions. While at the facility, we will review services to adults receiving OPWDD transitional funding to examine the YAP program in more depth. We will be in contact soon to arrange a date for this visit.

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This letter concludes our correspondence regarding initial Justice Center findings, but does not preclude the Justice Center from issuing a formal report of its review. These findings have been shared with each of the New York agencies funding Lakeview placements, as well as with relevant New Hampshire oversight agencies. Respectfully,

Randal L. Holloway, Unit Manager Division of Oversight and Monitoring Out of State Placements Unit CC: James Delorenzo, NYSED Megan OConnor-Hebert, NYS-OPWDD Emily Bray, Esq., NYS-OCFS