A A I /tr Aim/?/ August 5, 2015 Via Email and overnight Mail Bureau of Licensing Certi?cation Health Facilities Administration Licensing 129 Pleasant Street - Concord, New Hampshire 03301?3 85 7 Re: Lakeview NeuroRehabilitation Center, Inc., License No. 02224 Complaint Investigations No. 002762, No. 002-763, No. 002764 Notice of Administrative Fines dated July 16, 2015 Dear Sir or Madam: Lakeview NeuroRehabilitation Center, Inc. (?Lakeview?) submits the following consolidated response to the Bureau?s investigation reports, ?ndings, and plans of correction related to Complaint Investigations No. 002762, No. 002763, and No. 002764. I . Lntrodu ction On or about September 30, 2014, the Disability Rights Center published a report (the ?Report?) containing a number of in?ammatory allegations related to Lakeview, based largely on an incident that occurred almost two years prior to publication of the Report. The Report, supported in part by the expert opinion of one of Lakeview?s iantate competitors that has had its own share of problems, was highly critical of both Lakeview and the New Hampshire Department of Health and Human Services (the ?Department?). Following publication of the Report, the Governor, the Department, or some other state actor or combination of state actors imposed a moratorium on in-state admissions to Lakeview. (Not surprisingly, the moratorium on in-state admissions resulted in a moratorium on out-of-state admissions.) Thereafter, Lakeview was subject to hundreds and hundreds of unannounced inspections and surveys, occurring day and night on weekdays, weekends, and holidays. Based on inspections and surveys conducted by the Department and its consultants, Lakeview was required to submit a plan of correction to address the large number of perceived de?ciencies. Lakeview did in fact submit a plan of correction (the ?Plan? and that Plan was accepted by the 244 HIGHWATCH ROAD, NH 03882 0 FAX (603) 539-8888 0 PHONE (603) 539-7451 MAINE - MASSACHUSETFS - NEW HAMPSHIRE - - WISCONSIN Department on or about February 13, 2015. Contrary to the suggestion by critics and by the Department?s own consultant that it would take years for Lakeview to implement the Plan, the Plan is already substantially implemented. On or about July 25, 201 5, following an extensive two-day survey, the Joint Commission recognized Lakeview with a full three-year accreditation. Despite Lakeview?s substantial implementation of and compliance with the Plan, the Bureau is now directing that Lakeview close its facility based upon the above-referenced investigations, and the Bureau has declined to fully acknowledge Lakeview?s continuing commitment to remain operational. Lakeview hereby obiects to and contests the Bureau?s de facto termination of Lakeview?s license; obi ects to and contests the directed plans of correction related to Investigations No. 002762 and No. 002763; and, submits the plans of correction below in response to Investigations No. 002762, No. 002763. and No. 002764. 2. Findings Common to Investigations No. 002762 and No. 002763 In directing that Lakeview close its facility (and effectively revoking Lakeview?s license), the Bureau appears to rely heavily on various statements and actions byLakeview and its personnel following the New Hampshire Department of Education?s termination of Lakeview?s school license on or about June 10, 2015. Both the months-long moratorium on admissions and the closure of Lakeview?s school did and continue to cause signi?cant ?nancial strain for Lakeview. Even as we submit this response, we cannot be sure that Lakeview will recover ?om that strain. When it became evident that Lakeview might not survive the ?nancial hardship, it was responsible for Lakeview to have announced the possibility of a shut-down and to have provided, at the Department?s insistence, notices of intent to discharge. When it became evident that Lakeview?s dwindling census could not support the entirety of its payroll, it was reSponsible for Lakeview to have laid off personnel. When it became evident that the Department had no intention of accepting or rejecting Lakeview?s invited proposal (for continued operation by a third party) until Lakeview discharged all of its residents, it was essential that Lakeview attempt to provide notice to its employees as required by state and federal law. Even as Lakeview has taken these responsible actions, Lakeview has consistently maintained that it continues to pursue alternatives that might permit the continued operation of its Ef?ngham facility, whether by Lakeview, by a third party, or a new company. The Bureau and the Department have been made aware of Lakeview?s efforts in that regard whether by their review of the proposal the Department invited, by their direct communication with Lakeview?s Executive Director, by their receipt of new license applications, or by their communications with Lakeview personnel related to advisable types of new licenses. Upon conclusion of the very hearing during which it terminated Lakeview?s school license, the Department of Education invited Lakeview to submit a new license application for the Operation of a new special education school, which Lakeview is in the process of submitting. To be clear: Whether or not the state actors elect to lift the months-long moratorium, and whether or not the Department continues to insist upon the discharge of Lakeview?s remaining residents, Lakeview does not intend to relinquish its license voluntarily; Lakeview does not intend to ?close? its facility voluntarily; and, Lakeview does not intend to cease its efforts to pursue alternatives that might permit the continued operation of its Ef?ngham facility. The directed plans of correction related to Investigations No. 002762 and No. 002763 bear no reasonable relationship to the ?ndings, and Lakeview submits the fully-implemented plans of correction below in their stead. 3. Investigation No. 002762 and Plan of Correction Independent of the plan of correction referenced in this letter, Lakeview recognized the need for changes to the Level of Supervision policy guiding supervision of participants. In early 2015 Lakeview developed a new Level of Supervision (LOS) Policy and trained all staff on its implementation. All staff provided signed con?rmation of their understanding of this new policy and procedures for implementing levels of supervision. Contrary to the assertions made in the Bureau?s investigation report, Lakeview was adequately staffed during the incident on June 1 1. The staff assigned to the clients involved were appropriately trained and informed of the clients? levels of supervision. The staff member was also aware of appropriate break protocols and relief was available for the staff member to take a break. This event was not the result of a policy, procedure, training, or staf?ng issue or concern. Rather, the event occurred as the result of the failure of an individual staff member to follow the proper policies and procedures associated with his assignment. This staff member was immediately terminated by the facility following prompt investigation. Plan of Correction: Given the speci?c circumstances of this incident, termination of the staff member involved is the most prudent corrective action. Lakeview took that action In addition, Lakeview will vigorously continue implementation of the Plan of Correction and stringent requirements for training and accountability by direct care and supervisory staff. 4. Investigation No. 002763 and Plan of Correction Lakeview was adequately staffed during the incident on June 11 cited in this report. The staff member assigned to the client involved was appropriately trained and informed of the client?s level of supervision. This event was not the result of a policy, procedure, training, or staf?ng issue or concern. Rather, the event occurred as the result of the failure of an individual staff member to follow the proper policies and procedures associated with his assignment. This staff member was immediately terminated by the facility following prompt investigation. Plan of Correction: Given the speci?c circumstances of this incident, termination of the staff member involved is the most prudent corrective action. Lakeview took that action In addition, Lakeview will vigorously continue implementation of the Plan of Correction and stringent requirements for training and accountability by direct care and supervisory staff. 5. Investigation No. 002764 and Plan of Correction To this day, Lakeview cannot know whether any handgun was located on Lakeview?s campus. Lakeview has received one picture that admittedly depicts Lakeview?s breakroom. Lakeview has received another picture that may or may not have been taken on Lakeview?s premises, and that may or may not depict a handgun. Upon of the alleged presence of a handgun at its facility, Lakeview investigated the matter fully and found no evidence that any staff who worked during either weekend in question who was instructed that there was in fact a gun on campus, or witnessed a gun on campus. Nonetheless, to correct any perceived de?ciency, Lakeview has drafted and instituted a policy that expressly prohibits guns and other weapons on campus. Lakeview has required that all staff review and sign off on this policy to make abundantly clear that no guns or other weapons are permitted on campus. Plan of Correction: As speci?ed above, Lakeview has drafted, instituted, and trained all staff on a policy that expressly prohibits guns and other weapons on campus. 6. Conclusion Since September 30, 2014, Lakeview has undergone signi?cant ?nancial hardship due to the moratorium on admissions and the resulting loss of revenue. We have been subjected to intense scrutiny in the form of hundreds upon hundreds of unannounced inspections and surveys at all times of day and night. At the same time, we have been provided generally positive feedback from investigators at the time of their tours, with minimal or no expressions of concern about the issues which were later reported. Throughout this time, we have steadfastly maintained our commitment to implementing the plan of correction agreed upon by the State and have made efforts to engage in dialog about moving forward with a new service focus. As a result, we have made numerous positive changes despite the distractions and dif?culties we have faced. Our progress was evident during a recent 2-day Joint Commission survey, the result of which was full 3-year accreditation. The events cited in the investigations addressed in this letter are not the result of systemic problems for which Lakeview should be forcibly closed. Our systems of communication, LOS assignment, and training are sound and continue to improve as we pursue our plan of correction. Rather, these events were the result of human error. Lakeview had, and continues to have, strong safeguards to prevent problems and a stringent process for reporting and investigating problems when they do occur. We have behaved responsibly and have executed appropriate action plans to address these events (including termination of two employees). For these reasons, we ?nd the directed action plan for these events, to proceed with closure, to bear no direct or reasonable relationship to the source of the problems or reasons for their occurrence. We therefore dispute the Bureau?s ?ndings and directed plan of correction. Lakeview does not intend to close its facility voluntarily. We will continue to pursue alternatives that might permit the continued operation of its Ef?ngham facility. It is our hope that we can do so in partnership with the Department and its Bureau of Developmental Services moving forward. Executive Director