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Boston Globe seeking information about restraints, staffing, and community integration in group homes
The Boston Globe is seeking information from families of children and adults who are diagnosed with autism and who are living in group homes. That includes group homes that are associated with special education schools for persons under the age of 22.
Below is the message two reporters from The Globe asked us to convey to our readers:
We are reporters for The Boston Globe, and we are researching group homes that specialize in children and adults diagnosed with autism, including group homes that are part of residential schools. We would like to speak with families about their experiences with these types of group homes, including issues around restraints, staffing, and community integration.
We have extensive experience covering health care, social services and family issues in Massachusetts, and are eager to hear from you. You can reach Liz Kowalczyk at Lizbeth.kowalczyk@globe.com or 617-291-4318, and Stephanie Ebbert at Stephanie.ebbert@globe.com or 617-504-6381. We understand these can be sensitive issues, so if families want to reach out initially without using their names, that is fine too. Many thanks for your help.
We are always ready to offer our help to mainstream media outlets that investigate abuse and neglect of persons with developmental disabilities. We encourage you to contact Liz Kowalczyk or Stephanie Ebbert if you think your loved ones meet the criteria they are describing.
We have explained to the Globe that since the COVID pandemic began, we have seen a three-part crisis accelerating in the Department of Developmental Services group home system:
1. Continuing staffing shortages are resulting in both worsening care and conditions in group homes and a reduction in meaningful activities in community-based day programs.
2. Due to an ideology that promotes privatization, successive administrations in Massachusetts have been phasing out state-run Intermediate Care Facilities (ICFs) and state-operated group homes and have been expanding the state’s corporate provider-run group home network. This has stranded potentially thousands of people who are unable to function in community-based settings or who are unable to access state-run programs.
Meanwhile, the expansion of the provider-run system has been correlated with ever-rising financial compensation of provider executives and continuing low pay of direct-care workers.
3. Family members and guardians who complain about the problems noted above often find themselves marginalized by DDS. They are sometimes banned from contact with their loved ones; and, in some instances, the Department has challenged their guardianships.
If the Globe is able to help us shine a light on any of these issues, it will help lead to better lives for some of the most vulnerable members of our society.
DDS says Waltham group home provider must check all homes for insect infestations and plan for possible relocations of residents
As a Waltham group home reopened last week after a month-long shutdown due to a cockroach infestation, the Department of Developmental Services (DDS) ordered WCI, Inc., the corporate provider that manages the residence, to assess all of its group homes for “any hazards.”
In a Resolution Letter, dated March 6, DDS Area Director Joan Thompson also stated that the cockroach problem, which resulted in the February 8 shutdown of the Waltham residence, had actually been a “preexisting issue” there.
Thompson said the residence had been “treated a number of times in recent months.” However, it was only in the latest shutdown, which occurred on February 8, that the residents were relocated.
According to the Resolution Letter, the residents had not been relocated during the previous infestation treatments, which presumably involved the application of pesticides in the home. The letter directed WCI to develop “protocols to relocate residents” if “chemical treatments of any kind are needed.”
In the latest instance, the five group home residents were evalucated to a Marriott Hotel in Woburn where they stayed until their return to the Waltham group home last Tuesday (March 7).
Christine Davidson, whose son John is one of the group home residents, said today that she had not been informed of the previous insect exterminations at the home. She said, in fact, that she happened to walk into the home one afternoon a few months ago, unaware that a pesticide treatment had just been done in the residence.
The home was empty at the time, she said, because the four of the residents were at day or work programs and her son had been taken out for lunch.
DDS claims it wasn’t notified of the insect problem
The Resolution Letter also stated that families, guardians, and DDS had not previously been notified of of the ongoing insect problem in the home. However, Christine said that both she and her son had repeatedly complained to WCI over the past year about the roaches and about other unhygienic conditions in the residence.
“John had complained about bugs being in his (breathing machine) mask. Nobody listened to him,” Christine said. She sent us a photo last month of at least two roaches in John’s breathing machine. She had taken the photo while her son was home with her for a visit on the first weekend after the evacuation of his group home.
Christine previously sent us photos of potentially unhygienic conditions in the home in February 2022.
The March 6 Resolution Letter stated that the latest infestation was brought to the attention of WCI when a DDS staff person in the home observed the insects. “Of additional concern is that at the time of the DDS visit, one staff person stated that they were going upstairs to eat to be away from the roaches,” the Resolution Letter added.
DDS does not address allegedly unhygienic conditions
The DDS Resolution Letter was the apparent conclusion of an investigation done by the Department in response to a complaint filed by Christine following the February 8 shutdown of the group home.
In her complaint, Christine stated that the home staff were “not providing proper living conditions,” and that the home was “infested with rodents and roaches,” according to a February 17 DDS letter stating that the complaint would be investigated.
The March 6 DDS Resolution letter, however, did not specifically address Christine’s allegations of unhygienic conditions in the residence, or order the home to be kept in a cleaner state. The letter stated only that WCI must provide “a detailed plan of scheduled visits …to all homes by maintenance and qualified management staff to assess living environments for any hazards.”
Christine said she didn’t think that latter statement was necessarily a requirement that WCI keep the home cleaner. She said, in fact, that a WCI executive told her that the provider will start sending a cleaning crew to the home twice a month. But she said this was at her suggestion and was not the result of a directive from DDS.
Christine said, however, that WCI did not respond to her request that her son be provided with a new bed and bedding following the latest infestation. She said she toured the home on March 7, the day it reopend, and that “everything still looked grimy. I had expected to see the home enhanced. They got rid of the bugs, but the place still looks dirty. Everything is still topsy turvy.”
She said WCI did send an pest control inspector to her own house to make sure the infestation did not spread to it after her son came home from the hotel on weekends to visit her. She said the inspector determined that her home does not have roaches.
We’re glad to hear the bugs are gone from the Waltham residence, at least for the time being. But we are also concerned about the lack of communication from DDS on this matter. As I’ve mentioned before, DDS Commissioner never responded to an email query I sent her about the group home shutdown in mid-February.
In her March 6 Resolution Letter, Thompson appeared to blame at least some of the lack of communication on WCI.
But Christine said she still has not received answers from DDS itself to her ongoing concerns about the house. She said that despite an initial promise from the Deparment to “work collaboratively” with her in the wake of the latest infestation, DDS officials from Thompson’s office have not returned her phone calls.
UPDATE: Mother’s house may now be infested with insects from group home ordered shut down last month
As Christine Davidson and her son John wait for word as to when John’s Waltham group home will reopen after an infestation of cockroaches and possibly rodents almost a month ago, Christine said her own house may now be infested with the insects.
The group home, which is run by WCI, Inc., a corporate provider to the Department of Developmental Services (DDS), was ordered temporarily shut down by the state on February 8 due to the infestation. Since then, John and four other residents of the group home have been staying in a Mariott Hotel in Woburn.
Christine said that while she still hasn’t been told when the group home will reopen, an executive with WCI invited her to meet him at the residence on Tuesday morning (March 7) to inspect it. She said she was told DDS is scheduled to inspect the home today (March 6).
Christine said that when John first came home for a weekend visit with her last month after having been evacuated from the group home, she saw cockroaches crawl out of his wheelchair. She also found the insects in his CPAP breathing machine, which the group home staff had sent to Christine’s home that weekend. Last week, she said, a roach crawled out from underneath the refrigerator in her kitchen.
“It’s disgusting,” said Christine, who said she has done everything she can to keep her home clean. “This whole thing has been an unending nightmare.”
A letter sent by DDS to Christine on February 17 states that a complaint about the group home infestation was reported to DDS that day, more than a week after the incident. The DDS letter stated that, “the home is infested with rodents and roaches,” and added that DDS would investigate the complaint.
Christine said she doesn’t want her son going back to the residence until WCI provides him with a new mattress in his room, new bedding, and new curtains for his window. But she said the WCI excecutive has so far declined that request. “He (the executive) said if they were to do that for John, they would have to do it for everyone,” Christine said. “I said ‘of course, you should do it for everyone.'”
In an email sent on February 15 to Christine, Jessica Belcher, assistant DDS area director, termed the insect infestation “completely unacceptable,” and said the Department was “holding (WCI) accountable to fix the problem and create a plan so that something like this does not happen again.”
Belcher, whose email didn’t mention the possibility of a rodent infestation as well, also said that DDS would work “collaboratively” with both Christine and her nephew George Papastrat, who are John’s co-guardians, “so that the disruption causes the least amount of stress possible for John.”
Christine said this past weekend, however, that she has lately had trouble reaching Belcher. “I called three times this past week and haven received a call back,” she said.
Christine said that shortly after the group home was shut down, Belcher was responsive to her, and even suggested that John might be able to move to another WCI group home in Waltham. Christine said she was willing to entertain that idea, but was told more recently by WCI that the second residence couldn’t accommodate John, who needs a wheelchair, because the only available bedroom in it is on the second floor.
Christine said she asked Belcher whether a state-operated group home is available in the area for John, but said she has not received an answer to that question.
Christine said she was glad to hear that DDS intends to hold WCI accountable in the matter, but doesn’t understand why nothing was done about her complaints over the past year about unhygienic conditions in the group home. In February 2022, Christine sent us photos of potentially unsanitary conditions inside the group home.
Christine also said the WCI executive told her the provider is offering to exterminate the cockroaches in her own home, but that he did not say when or how that would be done.
Despite the fact that John has now been living in the hotel for close to a month, Christine said she was told by the group home manager that she is not allowed to visit him there. She said the manager did not give her a reason for the prohibition on visits. Such a prohibition would appear to be in violation of DDS regulations stating that family members must be permitted to visit departmental clients at all times.
Christine said a new breathing machine has been delivered to John’s hotel room. But she said John told her he doesn’t want to use it because he is afraid there may be insects in it.
On February 14, I emailed DDS Commissioner Jane Ryder and other top DDS officials to ask for a comment on the incident and whether they considered it to be an isolated case. To date, I have not received a response to that query.
Waltham group home reportedly temporarily shut down due to insect infestation
Five residents of a group home in Waltham for persons with intellectual and developmental disabilities were evacuated from the residence last week after it was ordered shut down due to an insect infestation, according to the mother of one of the residents.
Christine Davidson, whose son John is a resident of the home, which is run by WCI, Inc., a corporate provider to the Department of Developmental Services (DDS), said her son and the other residents have been temporarily moved into the Marriott Hotel in Woburn. She said it has been difficult to get information about the situation, and no one has told her when the group home will reopen.
Christine has previously raised concerns about what she contends are unhygienic conditions in the residence.
The insects appear to be cockroaches, based on a photo taken by Christine of her son’s BiPAP breathing machine, which appears to have two roaches inside it. Christine said that when John came home to her house over the weekend, she saw bugs in his breathing machine, and said two bugs crawled out of his wheelchair. BiPAP and CPAP machines are used to treat sleep apnea.
A portion of John’s breathing machine, which appears to contain two cockroaches. (Photo taken by Christine Davidson.)
It is unclear whether the group home was ordered shut after an inspection by DDS. The Department conducts licensure inspections of both provider-run and state-run group homes.
I sent an email Tuesday morning to DDS Commissioner Jane Ryder, asking whether the Department had any comment on the shutdown of the home, and whether the shutdown is an isolated incident. Ryder has not yet responded to my message.
Christine said the residents are being fed meals in their rooms in the hotel. She said John has been taken on a daily basis to his day program in Medford since his move to the hotel, but has few other activities while he is in his hotel room.
She said she is concerned her son’s health may be at risk as a result of the infestation. “Right now, he (John) doesn’t have a breathing machine,” she said. “It’s a dangerous situation.” She said the group home took back his contaminated machine.
Christine said she believes John could have picked up a pulmonary infection by using a machine that was infested with roaches. She said she has made several calls to her son’s DDS service coordinator and the coordinator’s supervisor hoping to relay her concerns and get answers to her questions, but no one has called her back.
Christine has previously raised concerns about unsanitary conditions at the Waltham group home, including the allegedly unhygienic state of John’s BiPAP breathing mask. On February 3, 2022, Steven Cohen, a gastroenterologist with Beth Israel Deaconess Medical Center, also stated in a medical progress note that John’s breathing mask at that time was “apparently not hygienic.”
Also last February, Christine sent us photos of potentially unsanitary conditions inside the group home, including a clogged air vent, a dirty bathroom, and what appeared to be insect larvae on John’s clothing in his bedroom dresser drawer. At the time, we were not able to confirm that the objects on his clothing were actually larvae.
Christine said that despite her complaints, the unhygienic conditions in the group home have persisted over the past year. It is unclear why those issues have lingered until they apparently triggered a shutdown of the residence.
We are receiving more frequent reports of a lack of activities and proper care of residents in group homes around the state. These reports appear to stem, at least in part, from an ongoing staffing shortage since the COVID pandemic began.
DDS upholds disenrollment of client from shared living, but appears to leave door open for her to reapply
Department of Developmental Services (DDS) Commissioner Jane Ryder last week upheld the Department’s move last summer to disenroll Mercy Mezzanotti, a DDS client, from shared living services because Mercy has refused to move out of the home of her longtime caregiver, Karen Faiola.
However, in accepting a hearing officer’s 10-page decision in the matter, Ryder appeared to leave the door open for Mercy and Karen to reapply directly to a “qualified provider” agency in order to continue their shared living relationship.
DDS does not directly employ shared living caregivers such as Karen, but funds nonprofit “qualified providers” that do directly contract with them.
In an interview last week, Mercy said DDS officials had repeatedly told her that she would have to leave Karen’s home and find another caregiver in order to continue receiving shared living services. But Johanna Soris, the hearing officer, stated in her decision that it is the responsibility of the qualified provider agency, and not DDS, to determine whether to employ a particular caregiver and whether to accept a client into its program.
Karen Faiola and Mercy Mezzanotti
As we have reported, the previous qualified provider in the case, Venture Community Services, temporarily removed Mercy, against her will, from Karen’s Sutton home last May, and placed Mercy in the home of another person in Worcester whom Mercy had never met. That same day, May 23, Venture terminated Karen’s shared living contract without stating a reason for the termination.
Karen and Mercy maintain that Venture terminated Karen’s contract because the two of them had complained that Venture employees had emotionally abused Mercy.
After objecting to her involuntary move, Mercy was able to return, after two days, to Karen’s home. However, DDS notified Mercy in July that she was no longer eligible for enrollment in the Department’s Home and Community Based Services (HCBS) Intensive Support Waiver Program, which funds shared living services.
Mercy appealed her disenrollment, and a “fair hearing” was held on her appeal on November 10. Soris was appointed as hearing officer in the case by Commissioner Ryder.
DDS argued during the hearing that Mercy became ineligible for the HCBS Waiver program when she came back to live with Karen after her involuntary removal from Karen’s home.
According to DDS’s argument, which was presented in a legal brief in the case, shared living services must be provided by a caregiver who is employed by a qualified provider. The Department maintained that because Karen was no longer under contract with Venture, she could no longer provide shared living services under the HCBS Waiver program. And because Mercy had refused to leave Karen, DDS argued that Mercy herself was no longer eligible for the program.
DDS said to have no role in hiring shared living caregivers
Karen, who has continued to care for Mercy in her home, said she contacted a new qualified provider agency, but was told by that agency that DDS would have to refer her to them in order for her to continue to provide shared living services. She said DDS has refused to provide such a referral. As a result, she has not been paid for providing services to Mercy since May.
In her decision, Soris, the hearing officer, asserted that DDS has no authority under the Waiver program to refer Karen to another qualified provider because DDS does not contract directly with caregivers. According to the decision, the shared living process requires both Mercy and Karen to apply directly to qualified providers to participate as a client and caregiver respectively.
In our view, Soris’s decision, while upholding Mercy’s disenrollment from the Waiver program, implies that both Mercy and Karen could apply to any qualified provider of their choosing and ask that they be allowed to remain together. Karen said last week that she and Mercy plan to do that.
Soris’s decision added that, “The Appellant (Mercy) is still entitled to Waiver services so long as she fills out the proper paperwork and works with a DDS service coordinator to find a Qualified Provider.” In our view, it isn’t clear, based on Soris’s other findings, why Mercy would even need to work with a DDS service coordinator in that regard. Soris appears to have concluded that DDS plays no role in the shared living application process, either with regard to the client or the caregiver.
Hearing officer notes that Mercy benefited from Karen’s care
In her decision, Soris’s acknowledged that Mercy had “thrived” under Karen’s care. And her decision provided details that appear to cooroborate Karen and Mercy’s claim that Venture terminated Karen’s contract after Karen and Mercy had both complained that Venture employees had emotionally abused Mercy.
Soris noted that prior to living with Karen, Mercy had lived in four different shared living homes “that were each unsatisfactory in different ways.”
Citing the testimony of both Mercy and of her therapist, Grishelda Hogan, Soris wrote that Mercy originally “came to Karen Faiola’s home as a shy, timid person who could not effectively advocate for herself. Over the course of the four years with Karen Faiola, (Mercy) made great strides in overcoming her shyness and gaining self-confidence,” Soris added.
Soris also noted testimony from both Mercy and her therapist that that Mercy was having “difficulties” with her job coach, who was a Venture employee, and that Karen had asked Venture management on numerous occasions to have the job coach replaced. Mercy maintained that the job coach was emotionally abusive toward her.
Soris then stated that on May 19, Venture convened a Zoom meeting in which Karen “was informed she should resign and Venture employees would be removing (Mercy from Karen’s) home on May 23.” No reason was noted in Soris’s decision for Venture’s decision to terminate Karen.
Mercy told staying with Karen was “not an option”
On May 20, Soris wrote, a behavioral counselor from Venture picked Mercy up at her work place and “instructed her to pack her belongings over the weekend because Venture was taking her to a new home for a new start.” Soris added that Mercy “didn’t know why she couldn’t continue living with Karen Faiola. (The Venture behavioral counselor) told her it was not an option. (Mercy) was crying and stunned at this information.”
Then on Monday, May 23, Soris stated, the Venture job coach picked Mercy up at her work place and dropped her off at the new shared living caregiver’s home. Mercy then spent two days there.
“During that time,” Soris stated, Mercy “phoned and texted Karen Faiola and Grishelda Hogan exhibiting great distress to the point that both women (Karen and Hogan) filed complaints with DPPC (the Disabled Persons Protection Commission) alleging that (Mercy) was experiencing great emotional distress.”
On May 25, after having spent two nights at the new shared living caregiver’s home, Mercy called Karen “and asked her to bring her home,” Soris stated. “Karen Faiola did so and described (Mercy) as a ‘happy camper’ (in returning to her home.)”
As noted, we asked DPPC last fall to undertake a full investigation of the allegations of emotional abuse by the job coach and of Mercy’s involuntary removal from Karen’s home. DPPC has not responded to our request.
DPPC apparently referred the complaints filed by Karen and Hogan to DDS. A September 30 Complaint Resolution letter written by DDS Area Director Denise Healy did not assess whether the alleged actions of the Venture employees were appropriate, or indicate that the allegations of emotional abuse had been investigated.
We are hoping for a happy outcome to this continuing ordeal for both Mercy and Karen. Mercy said the fact that Karen hasn’t been paid since last May to care for her has had a severe financial impact on both of them. “I’m having sleepless nights,” she said. “We could end up homeless.”
DDS placing client in a ‘Catch-22’ position to force her to leave her shared living caregiver
The Department of Developmental Services is arguing in a legal brief that Mercy Mezzanotti, a departmental client, should be disenrolled from a program that provides her with shared living services unless she agrees to move away from her long-time caregiver, Karen Faiola.
But Mercy maintains that she wants to stay with Karen with whom she and her therapist say she has thrived emotionally over the past four years.
In May, Karen’s previous payment agency, Venture Community Services, suddenly canceled her shared living contract without stating a reason in its termination notice. As a result of the contract termination, DDS maintains in the legal brief that Karen is no longer a “qualified shared living provider.”
The DDS brief further argues that because Mercy has refused to move in with a new caregiver, she has “voluntarily declined” shared living services and should be disenrolled from the program.
For reasons that DDS has not revealed publicly, the Department has declined to refer Karen to a new shared living payment agency. DDS does not contract directly with shared living caregivers, but does refer them to shared living payment agencies such as Venture. Were DDS to refer Karen to a new agency, Karen would presumably become a qualfied caregiver once again.
Karen Faiola and Mercy Mezzanotti
Karen and Mercy both maintain that Karen’s contract was terminated after both of them accused Venture employees of emotionally abusing Mercy. They claim DDS is siding with Venture in the matter, and that the Department has refused to fully investigate their charges.
Because DDS has declined to refer Karen to a new corporate payment agency, Karen has not been paid since May for caring for Mercy even though Mercy has continued to reside in her home. In Karen’s and Mercy’s view, DDS’s legal argument has placed both of them in impossible, Catch-22 positions in order to deny what Mercy has expressly stated what she wants – services from Karen.
Mercy’s appeal of DDS’s disenrollment notice is now before a state hearing officer who held a hearing on it last month. By way of disclosure, I attended the November 10 hearing via Zoom and testified in support of Mercy and Karen. I agreed, at the request of hearing officer and Erin Brown, a DDS assistant general counsel, not to publish details of the actual hearing on this blogsite until the hearing officer renders her decision, which is expected sometime later this month.
As a result of that agreement, I am confining this post to a discussion of the legal brief filed by Brown with the hearing officer on December 7, after the hearing concluded. In her brief, Brown laid out the Department’s argument for disenrolling Mercy from services under the Home and Community Based Services (HCBS) federal waiver program.
In May, as we also reported, Venture employees removed Mercy, against her will, from Karen’s home and placed her for two days in the home of another caregiver whom she didn’t know. After objecting to the move, Mercy was able to return to Karen’s home. We have joined Mercy and Karen in asking the Disabled Persons Protection Commission (DPPC) to fully investigate both the removal of Mercy from Karen’s home and allegations made by Mercy that she had been previously emotionally abused by Venture employees.
Catch-22 positions for Mercy and Karen
The key point Brown makes in her brief is that Mercy became ineligible for the HCBS Waiver, which supports shared living, when Mercy came back to live with Karen after her involuntary removal from Karen’s home. Brown’s brief stated that Mercy:
…voluntarily declined shared living supports from a Qualified Provider, and instead choose to live with Ms. Faiola (Karen). This choice, which is her right, resulted in (Mercy) being ineligible for the (HCBS) Waiver because she was not receiving a Waiver program service: Ms. Faiola is not a qualified and licensed provider, nor is Ms. Faiola employed by a Qualified Provider to provide Waiver services.” (my emphasis)
However, as noted above, the reason Karen is not employed by a Qualified Provider is that Venture terminated her contract without stating a cause, and DDS will not refer her to a new Qualified Provider.
Also, while Brown stated that Karen herself is not a licensed or qualified shared living provider, Brown later stated in the same brief that in this case, the licensed and qualified provider was Venture, a DDS-funded corporate agency, that contracts directly with shared living caregivers. Shared living caregivers themselves, such as Karen, are not licensed by DDS.
DDS says psychotherapist’s testimony that Mercy has reportedly thrived under Karen’s care was irrelevant
In her brief, Brown acknowledged that Grishelda Hogan, an outpatient psychotherapist, who has treated Mercy since 2018, testified during the hearing that she has “not had any concerns about (Mercy) in the care of Ms. Faiola.”
As we reported, Hogan actually sent a written statement to the hearing officer prior to the hearing in which she stated that Mercy had “expressed consistently that she was happy in her home (with Karen)…It was clear in therapy that (Mercy) was making great strides in her life and I was able to see her self-esteem and self-worth develop as she finally felt seen and heard.“
Brown stated in her brief, however, that “the entirety of Ms. Hogan’s testimony was irrelevant. She did not testify about the (HCBS) Waiver or Waiver rules. There were no clinical matters at issue in the fair hearing, nor was Ms. Hogan qualified as an expert to speak on clinical matters.”
It appears that Brown is admitting in her brief that Mercy’s emotional state, and her wishes, are irrelevant to DDS. Also, Hogan is a psychotherapist who has worked with Mercy for four years. Brown’s brief offers no reason why she would not be qualified to speak on clinical matters.
Brown similarly contended in her brief that testimony by Mercy’s sister Tami Baxter that Mercy was doing well in Karen’s care was irrelevant. And Brown maintained that Karen’s testimony that DDS has refused to refer her to another qualified provider was “outside the scope of the fair hearing and irrelevant.”
In our view, Karen’s employment relationship with Venture is of central relevance to the case. Venture’s termination of the contract with Karen is the basis of DDS’s argument that Mercy is not receiving services from a Qualified Provider.
As I noted in a written statement that I sent on November 17 to the hearing officer, Mercy had been in several shared living arrangements before she met Karen that were not successful and that left her in a depressed and dysfunctional emotional state. We think placing Mercy with a different shared living provider than Karen would risk a return to the unsuccessful placements of the past for her and would risk undoing the emotional and psychological progress she has made with Karen. Those are risks that we think may be quite high.
We are urging the hearing officer to decide in favor of Mercy Mezzanotti’s appeal to retain her eligibility for services from DDS.
We are also requesting that the hearing officer either order or advise DDS to refer Karen to a new payment agency in order to allow Mercy to continue to receive shared living services from her.
Mother says ‘no’ to DDS offer to drop effort to remove her as son’s co-guardian if she relinquishes all decision making authority
The Department of Developmental Services has offered to drop a two-year-long effort in probate court to remove Cindy Alemesis as co-guardian of her son Nick, whose life she saved in 2018.
But Cindy said that as part of a proposal made last week to settle the case, the Department stated that all medical and residential decision making authority concerning her son would be given to a new DDS-paid co-guardian.
In an interview, Cindy said she is encouraged that the Department is at least now open to her remaining as Nick’s co-guardian. However, she said, she will not accept an arrangement under which she would lose all medical and residential decision making authority in Nick’s care.
“I’m not handing that to them,” Cindy said. “I’ve fought for proper care for Nick and for his rights for his entire life.”
Nick and Cindy Alemesis
In 2018, Nick nearly died after staff in his group home in Dracut failed to take him for a scheduled ultrasound appointment, which would have shown that his brain shunt was leaking spinal fluid.
A few hours later, Cindy was the first to notice that Nick was ill, and made sure he was taken to a hospital. There, doctors found that the shunt was leaking spinal fluid into his body, and that Nick had developed sepsis from it.
Nick spent eight months at Mass. General Hospital, during which he underwent multiple brain operations and other procedures. Cindy was at his bedside for much of that time.
Despite Cindy’s actions in 2018, DDS petitioned the Middlesex County Probate Court for unspecified reasons in October 2020 to remove Cindy as Nick’s co-guardian.
Co-guardianship could still be “suspended” for vague reasons
The new DDS proposal last week to drop the effort to remove Cindy’s co-guardianship also includes a condition that her co-guardianship could still be “suspended” if she was found to be “unwilling to make (Nick’s) health and welfare the ultimate goal of (her) co-guardianship.” The proposal doesn’t explain who would make that determination or how it would be made.
The proposal further states that the DDS co-guardian would have to agree to “the dissemination of protected health information or other personal information about (Nick) with third parties uninvolved with (his) medical care.”
That condition sounds like an effort to prevent Cindy from providing information about Nick’s care or services to an organization such as COFAR. Presumably, if an incident such as a leaking shunt were to happen again to Nick, Cindy would be prohibited, under DDS’s proposed agreement, from saying anything publicly about the matter unless the DDS co-guardian were to allow it.
Cindy alleges poor care and decision making by DDS and provider
Cindy maintained that since Nick’s 2018 hospitalization, DDS and Nick’s residential provider, Incompass Human Services, continued to make poor decisions in providing medical care and services to him. She noted that DDS recently sent Nick back to a day program operated by Incompass, causing Nick to act aggressively and apparently injure himself.
Cindy said that in recent months, Nick was repeatedly injured in the group home, and was afraid of the staff there. The same thing then happened in the day program, she said, because many of the staff were the same.
Following those repeated injuries, Nick was moved out of the group home in September, and is currently living in a respite facility in Saugus.
Cindy said Nick’s former DDS-paid co-guardan, who had imposed a temporary ban this summer on Cindy’s visits and phone contact with Nick, has resigned. But Cindy said she isn’t hopeful the situation will improve with the appointment of a new DDS co-guardian.
The new DDS co-guardianship proposal contains the following stipulations:
- Eva Toscano, who appears to be a program manager with the Department of Mental Health, would be appointed Nick’s new DDS-paid co-guardian. Toscano would have sole medical and residential decision making authority regarding Nick’s care.
- Cindy would be informed beforehand of Toscano’s residential decisions “when feasible,” and would be informed beforehand of Toscano’s medical decisions unless there was an emergency.
It would appear that under this stipulaton, Nick could be moved from one residence to another without Cindy being informed in advance. In all cases, he could be moved without her consent.
- Cindy would have to give 48 hours notice to residential staff prior to visiting her son.
- Cindy would be allowed phone calls with Nick, but only if it were determined to be “not detrimental to (Nick’s) behavior.”
The proposal doesn’t specify who would make that determination as to whether the phone calls were detrimental, but it would appear to be up to the DDS co-guardian. Cindy says Nick has acted out in the past because he objects to a rule cutting off his conversations after 10 minutes.
- Cindy could continue to take Nick to his church, which he has attended for the past 25 years, but the DDS co-guardian could cut off the visits if she decided they were “detrimental to (Nick’s) behavior or health.”
Cindy would not be allowed to make that determination whether attending church was detrimental to Nick.
Both Cindy and Nick’s pastor, the Reverend Keith Phemister, have stated that Nick has never caused problems in his church. Yet Cindy said Nick has been restricted for months by DDS and by providers from attending church services and functions, even online.
In an interview in April, Phemister sad Nick had not been able to attend the church for the past month. “I know he looks forward to coming to church,” he said. It’s his lifeline.”
- Cindy’s co-guardianship could be “suspended” if she was found to be “unwilling to make (Nick’s) health and welfare the ultimate goal of (her) co-guardianship.”
It seems to us that stipulating that a guardian can no longer make residential or medical decisions or give out medical information about their ward essentially amounts to removing their guardianship. At the very least, DDS’s proposed resolution of this case would ensure continuing disputes between Cindy and the DDS co-guardian. We fully understand why Cindy does not want to accept a proposal like that.
In November 2021, Dr. Zaheer Ahmed, Nick’s primary care physician, wrote a letter to the probate court, opposing DDS’s bid to remove Cindy as Nick’s co-guardian. In his letter, Ahmed maintained that Cindy had always acted in Nick’s best interest.
We agree with Dr. Ahmed, and believe Cindy should keep her medical and residential decision making authority.
COFAR asks for full investigation of removal of a client against her will from her shared-living home
COFAR has asked a state agency to undertake a full investigation of the removal in May of a client of the Department of Developmental Services (DDS) from the home of a woman from whom she was receiving shared-living services.
The DDS client, Mercy Mezzanotti, said she was taken, against her will, from the home of Karen Faiola, on May 23 by an employee of Venture Community Services, a nonprofit contractor to DDS. Mercy and Karen allege the employee showed up at Karen’s home in Sutton and drove Mercy to the home of a family in Worcester whom Mercy didn’t know.
Mercy said she was kept in the Worcester residence for two days before Karen was able to locate her and return her to her home. She contends the experience caused her acute emotional distress. “I thought I would never see my home and Karen and my two cats that I love again,” she said.
Karen Faiola (left) and Mercy Mezzanotti
Mercy, 47, has a mild intellectual disability. But while she attended special needs classes in high school, her verbal skills were good enough for her to attend mainstream high school classes in English and to make the honor roll.
As her own guardian, Mercy has full legal authority to decide where to live, as well as to make other major life decisions.
In an email sent yesterday (October 17) to Nancy Alterio, executive director of the Disabled Persons Protection Commission (DPPC), we noted that an “Administrative Review” undertaken by DDS of the incident did not result in any findings about the appropriateness of Mercy’s removal from Karen’s home.
That incident and two other allegations of intimidation of Mercy were reported to DDS on May 26 by Karen, with whom Mercy has continued to live.
Under state regulations, DDS is required to report allegations of abuse to the DPPC, an independent state agency created to investigate “serious physical or emotional injuries” alleged to have been caused by caregivers to adults with disabilities in Massachusetts. However, due to a lack of resources, the DPPC refers the vast majority of abuse allegations it receives to DDS to investigate.
Both Mercy and Karen say they were not interviewed as part of the DDS review of Karen’s complaint.
Therapist corroborated claims of emotional injury
In a July 21 email to Mercy and Karen, Grishelda Hogan, Mercy’s therapist, stated that she had contacted DPPC to report the removal of Mercy from Karen’s home, and had relayed other concerns about Venture’s treatment of Mercy to DDS.
Hogan said that while Mercy was being kept in the Worcester family’s home, she “was reporting intense anxiety, difficulty sleeping, feeling sad and defeated, missing her home and her cat and her shared living monitor. She was reaching out to me consistently asking for help and advocacy to get home.”
DDS acknowledged, but did not assess allegations
In a Complaint Resolution Letter, dated September 30, in response to Karen’s complaint, DDS Area Director Denise Haley acknowledged that Karen had reported that Mercy had been removed from Karen’s home. Haley’s letter also stated that Karen had reported that a Venture job coach had previously threatened Mercy that she would be fired from her job, and that a second Venture employee had previously threatened to stop driving Mercy home from work.
The Complaint Resolution Letter stated that two Venture employees allegedly removed Mercy from Karen’s home on May 23, and brought her to the home of a “stranger.” The letter stated that Mercy “was very upset (at being removed from Karen’s home) and has been crying every day.”
However, Haley’s letter did not assess whether the alleged actions of the Venture employees were appropriate, or indicate that the allegations had been investigated.
The Complaint Resolution Letter concluded with a statement that Mercy told the DDS investigator that she “is doing fine and does not need any assistance (from DDS).”
In a letter to DDS, appealing the September 30 Complaint Resolution Letter, Mercy denied that she had said she was not in need of services. She also stated that her removal from Karen’s home had been traumatic for her.
“They moved me to a horrible place with strangers that didn’t speak English,” Mercy stated in her appeal letter. “I told (the DDS service coordinator) to get me out of there and bring me back home, that I was not going along with this. I explained that I was happy where I was and no one would listen. No one from DDS did anything to get me home.”
Mercy added that she had stated repeatedly that she wanted to continue receiving shared-living services from Karen, but that Venture had terminated its payments to Karen.
Prior to May 23, Venture had been paying Karen to provide shared-living services to Mercy. But Venture terminated its contract with Karen on the same day Mercy was removed from her home. A notice of termination of Karen’s contract from Venture did not contain a reason for the termination.
Both Mercy and Karen contend that Venture was retaliating against them because they had complained to managers of the organization in April that two of its employees had been verbally abusive toward Mercy.
As a result of the contract termination, Karen said, she has not been paid since May for caring for Mercy in her home.
In July, COFAR first emailed DDS Area Director Haley and to Dorothy Cote, Venture executive vice president and CFO, raising concerns about the removal of Mercy from Karen’s home and the termination of Karen’s shared-living contract. To date, we have not received a response from either Ryder or Cote.
Full investigation should have been undertaken
According to letters dated May 27 to Mercy from DDS Area Director Haley, the allegations made by Karen were referred to the DDS area office to conduct “Administrative Reviews.”
Administrative Reviews don’t appear to be required to meet minimum standards for investigations under the DPPC’s enabling statute and regulations. Those standards for full investigations include requirements that both the alleged victim and reporter of the incident be interviewed by an investigator.
DPPC has a supervisory role to ensure that full investigations meeting minimum investigative standards are undertaken in instances over which the agency finds it has jurisdiction, according to the statute and regulations. A key factor in determining that jurisdiction is that the victim has suffered a “serious” physical or emotional injury.
A serious emotional injury is defined in DPPC regulations as:
An injury to the intellectual functioning or emotional state of a Person with a Disability caused by either the verbal or nonverbal conduct of a Caretaker, including but not limited to, coercion; harassment; the inappropriate isolation of a Person with a Disability from family, friends or regular activity; and verbal assault, including but not limited to, ridiculing, intimidating, yelling or swearing (my emphasis).
In our email on October 17 to Alterio, the DPPC executive director, we argued that the agency does have jurisdiction in this case because we believe Mercy did suffer a “serious emotional injury” as a result of the Venture employees’ actions. As a result, we maintained that DPPC should either have undertaken a full investigation of Karen’s complaint, or should have referred the complaint to DDS for a full investigation meeting at least the minimum standards.
Mercy’s appeal letter additionally stated the following:
I have been treated so badly by DDS and so has Karen (Faiola). My human rights were violated since I have the right to choose where I want to live and I have the right to change agencies. … I was threatened by my coordinator from Venture and my job coach was mentally abusive, yet nothing has been done. Were they investigated? … My life has never been better and Karen is the best provider I ever had in the 20 years I’ve been with DDS and the 5 other homes I lived in.
Hogan, Mercy’s therapist, also stated that Mercy had “expressed consistently that she was happy in her home (with Karen)…It was clear in therapy,” Hogan stated, “that (Mercy) was making great strides in her life and I was able to see her self-esteem and self-worth develop as she finally felt seen and heard.“
We are hopeful that in addition to undertaking a full investigation of the allegations that Mercy was abused emotionally, the state will finally acknowledge Mercy’s wish to continue receiving shared-living services from Karen. We also hope Karen will finally be paid for providing those services.
DDS client, who had been denied all contact with his mother, suffers third head injury in group home
Nick Alemesis, who has a developmental disability, was sent to a hospital on Friday from his Dracut group home with the third head injury he has suffered in the residence since March, his mother Cindy said.
The latest injury occurred just before Cindy was due to visit Nick at the end of a 14-day ban imposed on her contact with him.
Incompass, the corporate provider that runs the group home, had charged that Cindy’s previous phone contact and visits with Nick were causing him to act aggressively and injure himself.
COFAR last week raised concerns about the ban, contending that neither Incompass nor the Department of Developmental Services (DDS) had made a sufficient case for restricting family contact with Nick.
We noted that this case appears similar to at least two others in which providers and DDS blamed family members for inciting aggressive behavior in DDS clients, and subsequently imposed punitive bans on family contact with those persons.
The 14-day ban on all family and social contact with Nick had been at least temporarily lifted at the end of last week. But Cindy was unable to visit Nick in the residence on Saturday, as had been agreed, because Nick had been taken to Lowell General Hospital. She said she was leaving this morning to visit Nick in the hospital.
DDS is, meanwhile, continuing an effort in probate court to remove Cindy as her son’s co-guardian for reasons that have never been made clear. In 2018, Cindy saved Nick’s life after staff in the group home had failed to take him to a scheduled ultrasound appointment, which would have shown his brain shunt was leaking spinal fluid.
In a text message to Cindy, dated Saturday, the Incompass assistant program manager wrote that Nick had been sent to the emergency room at Lowell General for self-injurious behavior and threatening to kill himself. Cindy maintains that Nick has frequently said he would kill himself if he was forced to remain in the group home. She said Nick is afraid to be in the residence.
Cindy is one of two co-guardians of Nick. The other co-guardian, Donna Nolan, is paid by the Department of Developmental Services (DDS) to serve in that role. Nolan is not related to Nick.
Nolan, along with Jean Phelps, the CEO of Incompass, signed off on a provider document on August 17 that imposed the 14-day ban on all family and social contact with Nick.
COFAR has joined Cindy in urging DDS not to send Nick back to the Dracut group home. Cindy said she is concerned Nick has been abused in the residence.
We suggested last week that Nick be placed at the Hogan Regional Center where we think staff are better trained to care for clients who exhibit aggressive behaviors.
Even if Nick’s injuries have been self-inflicted in the group home, it appears to be clear that Cindy’s contact with Nick is not the primary cause of his aggressive behaviors.
Neither DDS Commissioner Jane Ryder nor Jean Phelps, the Incompass CEO, have responded to an August 25 email from COFAR raising concerns about the ban on contact.
Cindy said Nick was previously injured in the group home on March 16, and was injured again two to three weeks ago. Cindy reported that March 16 head injury to the Disabled Persons Protection Commission (DPPC) because the injury had not been reported by the staff.
DDS, which conducted a limited Administrative Review of the March incident, concluded that there wasn’t sufficient evidence to show that Nick’s injury was caused by staff of the group home, and that the injury had most likely been self-inflicted.
UPDATE: Ban on mother’s contact with son at least temporarily lifted
[UPDATE TO YESTERDAY’S POST (BELOW): Cindy Alemesis was informed yesterday (August 30) that the ban on family contact with her intellectually disabled son Nick would be lifted as of today, at the end of a 14-day period specified by Nick’s group home provider and DDS co-guardian (see post below).
However, Cindy also said that in a phone call yesterday, the Incompass group home manager told her the ban on all contact could be re-imposed if Nick continues to display aggressive behaviors. Cindy believes Nick has been acting out because he may have been abused in the group home, and that he wants to leave it.
Cindy said she asked the group home manager whether the ban on family contact was actually a form of punishment of Nick. “I said to him, ‘so, as punishment, Nick loses his mom?’” Cindy said. “And he said, ‘well Nick has to learn.’”
In a text message to Cindy yesterday, the Incompass director of residential services, said Cindy will be allowed to visit Nick at the group home this Saturday. She will also be allowed one 10-minute phone call a day with Nick. But the Incompass director stated that the phone call would be terminated by staff, “if Nick begins displaying unsafe/inappropriate behaviors during the call.”]
Cindy Alemesis, who saved her intellectually disabled son Nick’s life in 2018, was subject to a ban on all contact with him for the past two weeks because Nick allegedly began behaving aggressively after her visits and phone calls.
The ban was imposed on August 17 by Incompass Human Services, a Department of Developmental Services (DDS) group home provider, and by a co-guardian of Nick, who is paid by DDS. The Department is, meanwhile, continuing an effort in probate court to remove Cindy as her son’s other co-guardian for reasons that have never been made clear.
Nick Alemesis and his mother Cindy
Cindy believes Nick acts aggressively because he doesn’t want to remain in his group home in Dracut, and may have been abused there. Cindy has reported at least two incidents of injury suffered by Nick in the Incompass residence.
Both Incompass staff and DDS have failed to report those injuries to the Disabled Persons Protection Commission (DPPC), as required by law.
Neither DDS Commissioner Jane Ryder nor Jean Phelps, the Incompass CEO, have responded to an email last week from COFAR raising concerns about the ban on contact and the alleged failure to report the injuries.
Similar to past bans on contact
The ban on family contact with Nick is similar to bans imposed in at least two other cases, which led to emotional pain and suffering for DDS clients and their families (see here and here).
As we noted in our email to Ryder and Phelps, cutting off family and social contact with DDS clients is an extreme measure that runs counter to their well being and rights under DDS regulations to support human dignity. Among those fundamental rights is the right to visit and be visited (115 CMR 5.04).
In Nick’s case, the ban on contact also follows from previous restrictions imposed by Donna Nolan, the DDS co-guardian, on Nick’s visits to his church and community.
Reason for latest ban on contact disputed
Records sent to us by Cindy show that Incompass has charged that Nick has engaged in “unsafe and self-injurious behaviors” after visits or phone calls from her and other family members.
In an Incompass document titled, “Human Rights Request for Approval of Restriction,” both Phelps and Nolan signed their approval on August 17 of a 14-day ban on all family communication and visitation with Nick as well as “access to social situations” for Nick. The document, which concerned both family visits to the group home and visits by Nick to Cindy’s home, left open the possibility of extending the ban indefinitely.
The document stated that after speaking with his mother by phone on August 9, Nick threw a phone and later a stone from his bedroom at staff, and refused to take his medications.The document alleged that Nick was taken that day to Lowell General Hospital where he exhibited similar aggressive behaviors after Cindy called him and then visited him there.
The Incompass restriction document, however, did not identify any statements or actions by Cindy or any family members that might have incited Nck to act out. Cindy contends Nick acts out because he does not want to live in the group home, or return to it when he is taken elsewhere.
We would echo Cindy’s concern that conditions in the residence itself may be causing his behaviors and injuries. We think the solution to the problem is to change his residential setting.
Text messages and statements from Nick indicate that he may be afraid of being hurt or injured by staff in the group home. Cindy said Nick has told her that staff have “hurt his head.” Cindy also forwarded a July 28 text message from Caitlyn Alekshun of Bridgewell Counseling Services indicating that there is uncertainty as to why Nick has been agitated and engaging in possibly self-injurious behaviors.
As discussed below, an earlier message from Alekshun to Nick’s service coordinator indicated that the group home staff were not providing timely information to her about the possible cause or causes of Nick’s behavior.
We haven’t seen any records that indicate that either Cindy or other family members have done or said anything to incite Nick to act out or injure himself. In a July 21 email, Nick’s DDS service coordinator wrote that he had “observed Nick become dysregulated. Staff report that it is like this every day.” That would appear to rule out Cindy as the sole, or even main cause of Nick’s behaviors.
However, the August 17 restriction document, signed by Phelps and Nolan, concluded that:
Due to these recent events and to Nicholas’ increasingly unsafe behavioral response to interactions with Cindy, both in person and by phone, it is proposed that Nicholas does not have any communication or contact with family members (including, but not limited to Cindy…) for a period of 14 days. This period of time will allow the program to work more effectively with Nicholas to keep him safe, unencumbered by external stimuli that may significantly impact his ability to regulate his emotions and subsequent behavior.
At the end of this initial 14-day period of no-family contact, the treatment team will revisit this restriction and assess whether continuing the practice is warranted for an additional 14-day period(s).
Staff not providing information to clinician
The restriction document did not make it clear how or why contact with Cindy or other family members would incite Nick to engage in aggressive behaviors. We think that without establishing a clear cause of those behaviors, Incompass has not made a case for restricting family contact.
Nick (right) and his pastor, the Rev. Keith Phemister, and Keith’s wife Gloria. Nick has been restricted at least twice this year from visiting his church.
In fact, records indicate that the group home staff have been uncooperative with at least one clinician seeking to determine the cause of Nick’s aggressive outbursts.
In response to the service coordinator’s July 21 email, Alekshun of Bridgewell wrote that she had requested “recent behavioral data from the residence a few times, but haven’t received anything more recent than May.” Such data, she wrote, might “help justify the need for an inpatient placement” for Nick at a hospital setting.
Failure to report injuries
We are also concerned that DDS and provider staff have failed to report potentially serious injuries that Nick suffered in the group home, as required by law. In the most recent case, Cindy said she was forced to report a head injury that Nick suffered on March 16 to the DPPC because the injury had not been reported by the staff.
Both the DDS Decision Letter and subsequent Action Plan resulting from the March 16 incident stated that the alleged abuser didn’t report the injury.
Cindy said the incident resulted in bleeding from Nick’s ear, which would classify the injury as a serious physical injury under DPPC regulations. Nick received emergency room treatment for the injury.
DDS declines full investigation
After Cindy reported Nick’s March 16 head injury, DDS apparently conducted a limited Administrative Review of the incident. Administrative Reviews do not meet DPPC standards for full investigations. The DDS Decision Letter, issued after the review was completed, acknowledged that a “regulatory investigation” had not been conducted.
Given, in particular, that the bleeding Nick suffered from his ear would classify the injury as serious under DPPC regulations, it would appear that either DPPC or DDS should have conducted a full investigation of the matter, and not an Administrative Review. The DDS Decision Letter did not explain why a full “regulatory investigation” was not done.
The DDS Decision Letter concluded that as a result of the limited review, there was insufficient evidence to conclude that Nick had been abused by a staff member, and that Nick had “acknowledged” his injury had been self-inflicted. However, the Decision Letter did not disclose who was interviewed by the investigator. Cindy said she was not interviewed, and it is not clear whether even Nick was interviewed, based on accounts in the Decision Letter and subsequent DDS Action Plan.
The Action Plan, in fact, stated that, “It was reported by the provider that (Nick) exhibited self-injurious behaviors (SIB) causing injury to himself and was restrained.” (my emphasis). This statement appears to imply that the DDS investigator may have relied on an account from the provider, possibly even from the alleged abuser, in concluding that Nick had injured himself.
Both the Decision Letter and Action Plan said only that “during the course of the investigation witness(es) were interviewed and relevant documents were reviewed.” There was no specificity as to which documents were reviewed, or which witness or witnesses were interviewed. In fact, it isn’t clear, based on the word “witness(es),” whether more than one person was actually interviewed.
DPPC regulations (118 CMR 5.02) require that in full investigations, the investigator interview the reporter of the injury — in this case, Cindy. Cindy said that never happened.
The regulations also require that the investigator provide an assessment of the “immediate protective services needs” of the alleged victim to prevent the risk of further harm. There was no indication in the Decision Letter or Action Plan that such an assessment was done in this case.
The Action Plan recommended only that Nick’s residential and day provider staff “create a communication log that documents such incidents so everyone is informed.” There was no recommendation in the Action Plan relating to failure of the provider or DDS to report the injury to DPPC.
Similarly, DDS and DPPC declined to undertake an investigation of an incident in 2018 in which Nick contracted sepsis and spent eight months in a hospital because of the apparent negligence of staff in his group home. That incident was also not reported by the provider staff or by DDS to DPPC.
No response from DDS or Incompass
As noted, on August 25, I sent an email to both DDS Commissioner Ryder and to Phelps, the Incompass CEO, noting our concerns about the restriction on family contact and about reports of poor conditions and staff treatment of Nick that led him to state and text to his mother that he did not want to remain there. As such, I wrote, we are concerned the residence is potentially unsafe for Nick. To date, I haven’t received a response to my email.
We urge DDS and Incompass to reconsider the restrictions placed on family contact with Nick. We also urge DDS to conduct a full investigation of the injury that occurred to Nick on March 16, and to investigate the care and conditions in the residence.
Finally, we urge DDS to work with Cindy to identify another residential setting for Nick or a placement in an Intermediate Care Facility such as the Hogan Regional Center.
COFAR blog 