Parents sound alarm over troubled Washington state in-home care provider

In February of this year, Leigh Anne Francisco’s severely autistic 21-year-old son moved into a home for people with developmental disabilities operated by Aacres WA LLC in Snohomish County.

Almost immediately, Francisco grew concerned about conditions in the home.

First, she noticed mysterious bruises on her son, including a large dark purple one on his inner thigh.

Then Angus Francisco and his housemate were left unsupervised one night because the overnight staff member never showed up.

There were other issues too.

Leigh Anne Francisco said her son was overfed and rarely taken out for a walk or to kick a soccer ball into the net she had set up for him in the backyard. He quickly gained 30 pounds.

When she visited, she said she often found her son’s hygiene had been neglected. The condition of the house also dismayed her — food and garbage on the floor, shampoo and toothpaste spilled in the bathroom. To make matters worse, Leigh Anne Francisco said, the staff was often “lounging around and on their phones.”

There were also medication errors. By September of this year, she was frantic and trying to get Angus Francisco moved out of Aacres’ care.

“This is not what I had imagined for my son!” Leigh Anne Francisco wrote in an email summarizing her concerns.

She is one of two parents who, independently of each other, contacted the public radio Northwest News Network in September regarding concerns about Aacres in Snohomish County. The second was Bo Simmons, whose 23-year-old son Andrew Simmons is also profoundly autistic and lives with three other Aacres clients in a home in Lynnwood.

In his message to the Northwest News Network, Bo Simmons said Aacres was “very much not living up to expectations as a residential care provider for the state.”

“We’re talking about a serious burn which was never communicated to us, repeated times where there is a single staff member for four residents, never taking our son out into the community,” he wrote.

In recent weeks, the parents’ pleas for oversight and accountability have reached state regulators who say they’re now investigating the company’s Snohomish County operations.

The complaints are just the latest against Aacres, a long-troubled care provider that currently has contracts with Washington’s Developmental Disabilities Administration to provide in-home support to developmentally disabled clients in Clark, Pierce, Thurston and Snohomish counties.

Canceled contracts

In 2019, the state Department of Social and Health Services cancelled three contracts it had with Aacres WA to provide care for vulnerable clients in Spokane County. The Developmental Disabilities Administration said it took the action “based on serious non-compliance with the law and regulations.”

One of the contracts was terminated following the death of a client who was given household cleaning vinegar in lieu of colonoscopy prep medication. A former Aacres caregiver was subsequently charged with third-degree assault, and reckless endangerment in connection with the death. Her trial is scheduled for January.

Related: Secrecy surrounds the death of a Spokane woman with developmental disabilities

In a statement at the time, the then-assistant secretary of the Developmental Disabilities Administration, Evelyn Perez, said: “We have lost confidence in Aacres Spokane. Not being in compliance with regulations and ensuring the health and safety of our clients is unacceptable.”

Previously, Aacres had also operated in King County. But in November 2018, Aacres announced it was pulling out of King County because of a lack of affordable housing and challenges related to recruiting and retaining staff. The move came after the state had put the company's King County operation on 90-day provisional status for failing to correct serious deficiencies that "jeopardized clients' health, safety and welfare."

Nevertheless, the Developmental Disabilities Administration allowed Aacres to continue serving vulnerable clients elsewhere in Washington under separate contracts with the state.

Records show that during the 2019 to 2021 biennial budget, Washington’s Department of Social and Health Services paid Aacres more than $92 million making it the agency’s seventh largest contractor. So far this budget cycle, which started July 1, state payments to Aacres total $16.3 million.

As of the end of 2020, Aacres served approximately 220 clients across the four counties, according to the Developmental Disabilities Administration.

Founded in 1974, Aacres is one of several human services companies operated by Spokane-based Embassy Management LLC. According to the website for Bregal Partners, a New York private equity fund, Embassy is one of its portfolio companies.

Aacres and Embassy Management did not respond to multiple requests for comment.

In previous statements, Aacres has said that shortcomings in care “in no way reflects our passion, commitment and resolve to our mission to safely serve individuals in their homes and communities.”

A beleaguered industry

Historically, people with developmental disabilities in Washington were served in state institutions known as residential habilitation centers. But over the decades those facilities have downsized as part of a state and national shift to serving individuals in the community.

The Developmental Disabilities Administration’s largest community residential program for people with developmental disabilities and significant support needs is called Supported Living Services.

Today, roughly 140 supported living agencies, including Aacres, serve about 4,600 clients who qualify for Developmental Disabilities Administration services.

Clients live in their own homes with up to three other housemates while being supported, often around-the-clock, by agency staff.

The clients pay for rent, food and other expenses, while the state’s Medicaid program covers the cost of the support staff. In 2020, Washington’s supported living expenditures were $768 million, according to the Developmental Disabilities Administration. That included a temporary COVID-19 rate increase for contracted agencies paid for with federal relief dollars.

But Scott Livengood, the legislative chair for the state's Community Residential Services Association, said the industry has not caught back up since rates were cut during the Great Recession.

“Due to funding increases not keeping pace with the cost of living and the steady increase in our statewide minimum wage, the average starting wage for a [direct support professional] is now around $15 per hour, which is only 5% above the statewide minimum wage [that takes effect] next month and 25% below a self-sufficient wage,” Livengood said in a statement.

As a result, he said, most frontline support staff work two to three jobs and average turnover in the industry is about 50%. Livengood estimated the current vacancy rate is approaching 20% as agencies lose workers faster than they can hire them.

“The pandemic has made the situation even worse, as we are competing with fast food and retail jobs offering $18 to $20, along with attractive benefit packages and hiring bonuses,” said Livengood, who is also CEO of Alpha Supported Living Services, a nonprofit serving clients in King, Snohomish and Spokane counties.

To try to slow the attrition, supported living agencies have offered signing bonuses and hazard pay during the pandemic. But the federal stimulus dollars that funded those enhancements are scheduled to expire at the end of the year, making it even harder to recruit new employees, Livengood said.

It’s not just the pay, but the nature of the work, that makes finding and keeping employees difficult. Staff are often required to work nights and weekends. And clients can exhibit challenging and even violent behaviors.

In the past, Aacres has pointed to the challenge of recruiting and retaining front-line staff as a factor in its quality-of-care lapses.

State records show that, since 2018, Aacres in Snohomish County has been subject to four inspections, two investigations and one enforcement action.

In January 2019, Aacres was fined $1,000 after the subflooring in one of its Snohomish County homes failed and a client fell into the space below and was injured.

Then in August of this year, an unannounced inspection of Aacres homes in Snohomish County found a number of deficiencies — especially around COVID-19 protocols. Among the findings: Visitors, staff and clients weren’t properly screened for COVID-19 symptoms.

The concerns of family members have also reached state regulators. The state’s Residential Care Services, a division of the state Department of Social and Health Services, confirmed to the Northwest News Network that it has active investigations underway into multiple complaints about substandard care at Aacres homes in Snohomish County.

However, Aacres in Snohomish County has not been put on “stop placement” status, where an agency is barred from accepting new clients, nor has it been put on provisional certification status which is the last step before decertification.

“If the complaints are found to be substantiated, Aacres, like any other provider, will be held accountable for its deficiencies,” Residential Care Services Director Mike Anbesse said in a statement.

Aacres isn’t the only supported living agency to draw scrutiny this year. Over the past 11 months, the state has issued 171 citations and 48 statements of deficiency against supported living providers for violations, according to data provided by the Developmental Disabilities Administration.

An unreported burn

For months, Bo and his former wife Louise had been uneasy about the care their son Andrew Simmons was receiving from Aacres. They noticed staff turnover was high and sometimes there was only one caregiver on duty in the home, despite there being four clients to care for.

Often Andrew Simmons would spend much of the day in bed. Occasionally, the staff failed to get him to dental and doctor appointments. He even missed virtual meetings with a job coach.

But concern turned to alarm earlier this year when Louise went to visit her son and discovered the palm of his hand had been burned, possibly from touching the stove.

Adding to their distress was the fact no one told them about the injury. Andrew Simmons had also not been taken to the doctor for treatment of the burn.

Then, about a month ago, there was another upsetting incident. Andrew Simmons, who has migraines and often bangs his head on surfaces because of the pain, slammed his head into a plaster wall in the bathroom. Shortly after that he knocked a staff member to the floor and in the tussle hit his head a second time.

Medics were called to the house. They evaluated Andrew Simmons, but did not take him to the hospital. Bo Simmons said the staff was supposed to monitor Andrew for signs of a concussion. Instead, he said, they gave Andrew a sedative and let him go to sleep. When Louise came to visit Andrew that afternoon, she found him in bed soaked in urine.

For Andrew Simmons’ parents, that was the last straw.

“He’s a very amazing young man, and he deserves better,” Bo Simmons said tearfully during an interview.

In his desperation, Bo Simmons launched what he described as a “full court press” to bring attention to the plight of his son and other Aacres clients in Snohomish County.

Working closely with Louise, he’s urged the state to conduct a “complete review” of Aacres and its parent company, Embassy Management. He’s also lobbied the Developmental Disabilities Administration to move his son to a different supported living provider. And, recently, he retained an attorney who specializes in representing the interests of people with special needs.

In September, Bo Simmons summarized his concerns about Aacres in an email to a top Developmental Disabilities Administration official.

“Andrew has languished in their care,” Bo Simmons wrote. “We suspect that there are many other clients who are not well represented who are in a similar state and we want to advocate for them as well.”

Last month, Bo Simmons followed up with an even more desperate message to the Developmental Disabilities Administration regional administrator in Snohomish County.

“The situation is dangerous. Seriously dangerous,” Bo Simmons wrote. “The residents and the caregivers are being placed in an extremely unsafe and dangerous environment. It is Aacres management who are to blame for this situation, not the caregivers.”

In response, Developmental Disabilities Administration officials said they’re aware of the concerns.

“I do understand that we are experiencing some challenges right now up in Snohomish County with Aacres,” said Shaw Seaman, Developmental Disabilities Administration’s quality assurance chief.

Seaman said the state is committed to quality improvement and interested in supporting Aacres so that it can get back on track.

Getting results

Lately, Bo Simmons said he’s seen some signs of progress.

First, Developmental Disabilities Administration dispatched an inspector to visit all of the Aacres homes in Snohomish County to document immediate health and safety hazards. Aacres is now required to submit weekly reports on progress in correcting any deficiencies, according to email communications Bo Simmons shared with the Northwest News Network.

Bo Simmons also met with Aacres management and received assurances that the company would address his concerns. Soon after, Aacres held a retraining session for the staff who work with Andrew Simmons.

Aacres management also sent a behavioral clinician and its clinical director to visit Andrew Simmons and observe him in his environment. The behavioral clinician plans to continue twice weekly visits with the goal of modeling “for staff how to work with him,” according to an email Aacres’ area director sent Bo Simmons.

Then, on the evening before Thanksgiving, both parents attended a virtual meeting with Developmental Disabilities Administration officials. In a post-meeting email, Bo Simmons said the staff showed “empathy and compassion for our situation.”

The state has also agreed to make a referral for Andrew Simmons to a state-operated home for people with developmental disabilities, although there’s no guarantee of a bed being available for him.

Bo Simmons is hopeful his son’s care will improve. But he also continues to question whether Aacres is deserving of the $726.28 a day that the state pays the company to care for his son.

“Andrew is most definitely not receiving what the state is paying for,” Bo Simmons wrote in his September email to Developmental Disabilities Administration.

Leigh Anne Francisco, Angus Francisco’s mother, also reported her concerns to the Developmental Disabilities Administration and Residential Care Services, but said months went by before she heard back from anyone. Separately, she was contacted by Adult Protective Services (APS) and provided the investigator with a statement. APS would neither confirm nor deny if it’s currently investigating Aacres.

Like Bo Simmons, Leigh Anne Francisco also decided that she needed to get her own son moved out of the Aacres home. Her final straw came when Angus Francisco and his housemate were left unattended overnight earlier this year.

“He’s not safe there, the other roommate is not safe,” Leigh Anne Francisco said.

But in the months since, she’s had no luck finding another provider to take him.

“I feel as if I’ve failed as a mother because I haven’t gotten him out of there,” she said.

Leigh Anne Francisco recently had a conference call with the new area administrator for Aacres who apologized and told her they want to do better.

Even before that call there were some hopeful signs. The waist-high lawn in front of Angus Francisco’s house was finally mowed and damage the residents had done to the walls, which had previously been covered by cardboard, was repaired.

“I’m always cautiously optimistic,” Leigh Anne Francisco said: “But the story that I’ve been given so many times is ‘we’re going to make this better, we’re so sorry, we’re retraining everybody.’”