Lax enforcement in personal care homes

Deficiencies in care, living conditions and record-keeping have piled up in scores of Georgia personal care homes, with the state rarely shutting down violators or levying heavy fines, The Atlanta Journal-Constitution has found.

An analysis of five years worth of inspections, violations and enforcement actions revealed that many frequent violators have faced nothing more than a fine of a few hundred dollars.

The Atlanta Journal-Constitution’s investigation found numerous troubling instances — from live cockroaches in the kitchen of one home to another in which eight residents were out of medication.

About half of the state’s 2,000 licensed personal care homes are in metro Atlanta, and they provide more than 12,000 beds for some of the region’s most fragile residents — those who are disabled, elderly or mentally ill.

Such weak enforcement, advocates say, creates a culture in which unscrupulous operators believe they can game the system.

Brian Looby, head of the state Department of Community Health office that regulates personal care homes, told The Atlanta Journal-Constitution the agency is working hard to shore up enforcement. The department, he said, is trying to revoke more licenses, assess more fines and review the training requirements for personal care home workers.

Unlike nursing homes, personal care homes do not provide intensive medical care. Instead, they provide lodging, food, bathing and other grooming services, and can help residents manage their medications. Many are in individual homes in residential neighborhoods.

When Looby took the job a year ago, he acknowledged that he was “a bit surprised” at the state of enforcement. The agency struggled with a backlog of enforcement cases, which he thinks created pressure to settle cases rather than take stronger, more time-consuming steps.

Fixing the system, he said, remains “a work in progress.”

Take the Caring Hands Personal Care Home in Decatur, for instance. It had 166 violations over five years.

Inspectors found that a manager had a criminal record, and the home repeatedly failed to track financial transactions involving residents. Inspectors found dirty floors, bathtubs and walls, soiled toilets and live cockroaches in the kitchen.

Yet, the facility received one fine of $601 and remains in business.

Several attempts to reach the facility and its owner were unsuccessful.

Tara Plantation in Cumming had 134 violations over five years. Surprise inspections found that eight residents were out of medication. Two others had urinary tract infections because their undergarments had not been changed often enough. The home remains open.

A company spokesman said the home immediately addresses any violations but added that the agency does a poor job at communicating whether the fix satisfies state standards.

Some call for change

Industry representatives and advocates say most personal care homes are well-run and provide a valuable service.

And a new law that calls for tougher enforcement goes into effect July 1.

As Beth Rosenthal sees it, the system needs to be changed — and she wants to make sure nobody suffers the way her brother did after he moved into the Guiding Hand Personal Care Home in Jonesboro in January 2011.

Robert Rosenthal, 56, suffered from dementia.

About three weeks after he moved into the facility, he was hospitalized with kidney failure and respiratory arrest. He had bruises over almost his entire body, had abrasions on his knees and legs, and a cut lip, according to a police report.

By April 2011, he was dead.

The Georgia Bureau of Investigation ruled his death a homicide by neglect. Clayton County police investigated but did not bring charges.

The owner of Guiding Hand did not answer phone calls, and there was no way to leave a message. Data obtained from DCH reflect one violation — and no fines — against Guiding Hand over the past five years.

The home is no longer in business.

Recording of violations

The Atlanta Journal-Constitution did find many instances in which inspectors were diligent in their recording of violations, as well as returning to homes to ensure problems were cleared up.

Common problems included residents who were so frail or ill that they needed services beyond those provided by personal care homes. Other common issues were failure to document required employee training, failure to conduct regular fire drill evacuations, failure to obtain background checks on employees and inadequate staffing.

But some cases were far more serious.

Arbor Terrace at Crabapple, for instance, was levied a $601 fine after staff failed for several days to provide a resident with required medicines for diabetes and heart disease, according to agency documents.

The resident was hospitalized and died about a week later.

DCH did not determine that Arbor Terrace’s actions caused the man’s death, but found that it had created a serious threat to residents’ health.

Shirley Paulk, a vice president of the Arbor Co., said she could not discuss the specifics of incidents. Whenever a facility is found not to be in compliance, it immediately undertakes a plan of correction, she said.

More inspections pushed

Over the past five years, DCH initiated 91 license revocation proceedings, the newspaper’s analysis showed. This year, the agency has stepped up the pace dramatically.

The data, though, do not indicate how many of the revocation proceedings actually ended in the loss of the license and the closing of the home. A review of the agency website indicated that about a third of the facilities remain in operation.

Officials said some of the proceedings stemmed from a home’s failure to pay an annual licensing fee; when the owner paid, the revocation action ended.

Only one of the top five violators in metro Atlanta had its license revoked: Phelps Personal Care Home in Stone Mountain. None was fined more than $3,300, despite the fact that all of them racked up more than 100 violations over five years; one was fined only $300.

Part of the problem, some advocates say, is that the agency needs to inspect homes more often than the current schedule of every 18 to 24 months.

“How can they expect quality if they don’t inspect?” said Bill Kissell, president of the Georgia chapter of National Alliance on Mental Illness.

He prefers quarterly inspections.

DCH has 19 inspectors; two staffers handle enforcement actions. The state Long-Term Care Ombudsman’s office also has staffers and volunteers who visit personal care homes regularly. They can lodge complaints on behalf of residents and forward them to the state for follow-up.

However, two former volunteers told The Atlanta Journal-Constitution that they witnessed ombudsman staffers coach residents out of filing complaints.

Former volunteer Stacy Mi-ley of Norcross said that when she reported concerns about rotten food and feces on the floor of a personal care home to ombudsman officials, she was told it was not her job to moni tor such conditions.

Karen Boyles, coordinator in the ombudsman’s Atlanta office, said the volunteers’ statements were untrue and that volunteers can come to her at any time for advice on how to proceed with a complaint.

Staff data specialist Kelly Guckian contributed to this report.


To bring you this special report, we obtained and analyzed data on personal care homes, which serve the elderly, the disabled and the mentally ill. We learned:

• In the past five years, the state found 35,000 violations but pursued 544 fines, other penalties and revocations.

•The average fine is $600.

• Eighteen homes had more than 100 violations each over five years.

• Fourteen of them are still in operation; six are in the process of having their licenses revoked, the state said.


Our analysis of personal care homes also includes many places that call themselves assisted living facilities. Until this year, all such facilities in Georgia fell under the legal designation of personal care homes. A new law, enacted in January, created a new designation for assisted living facilities, which tend to be larger and provide more care than a personal care home. These facilities must receive a new license for this assisted living designation.