It’s been more than a year since the Washington Department of Social and Health Services took the unprecedented step of shutting down a major in-home care provider for developmentally disabled adults.

Now, 16 months after the provider’s sister company, Aacres Washington, took over care of many of those vulnerable adults, the cycle is repeating itself.

On Tuesday, the Developmental Disabilities Administration — a division of DSHS — announced it is terminating one of three contracts it has with Aacres Washington “because of a number of incidents,” including the death of a client in February.

Under that contract, the company provided supported living services to approximately 60 developmentally disabled clients in Spokane County. The state paid Aacres Washington approximately $700,000 per month, according to a DDA spokesperson.

In addition, two other Aacres Washington programs in Spokane County, serving another 68 clients, are currently in “stop placement” status, meaning they are not allowed to accept new clients because of issues with client care.

“We have lost confidence in Aacres Spokane,” said Evelyn Perez, the assistant secretary for DDA, in a written statement. “Not being in compliance with regulations and ensuring the health and safety of our clients is unacceptable.”

For some, the lost confidence comes as no surprise.

Aacres Washington took over after DSHS decertified SL Start and Associates in April last year. The company was providing in-home care for more than 200 developmentally disabled adults in King, Yakima and Spokane counties, until serious violations that “jeopardized clients’ health, safety and welfare,” according to the state, prompted the decertification and transfer of clients to Aacres Washington.

Both care providers are subsidiaries of Spokane-based Embassy Management LLC which is owned by Bregal Partners, a private equity firm. The transition sparked outcry from some families and disability advocates.

In an April 2018 letter to DSHS Secretary Cheryl Strange, Susan Kas, an attorney with Disability Rights Washington, wrote that she had “grave concerns about an unqualified provider continuing to deliver services to clients.”

That same month, the state’s developmental disabilities ombudsman, Betty Schwieterman, weighed in with her own letter.

“Embassy Management was permitted to transfer 182 DDA clients from one of its agencies to another without having any additional conditions to ensure client protections imposed by DDA,” Schwieterman wrote.

Tuesday’s termination of one of the contracts the state has with Aacres Washington followed an investigation by Residential Care Services (RCS), the DSHS arm that licenses and oversees in-home care providers, into a client death in February of this year.

According to that investigation, a copy of which the Northwest News Network obtained, the 64-year-old Aacres Washington client died suddenly after experiencing “shortness of breath and wheezing” at her gastroenterologist’s office prior to undergoing a colonoscopy.

It was later determined the client, whose name has not been released, ingested cleaning vinegar instead of the bowel preparation medication she had been prescribed prior to the procedure. The RCS investigation indicates an Aacres Washington staff member, who stayed overnight with the client prior to the colonoscopy, gave the client the vinegar, instead of the prep medicine, which were both stored in the client’s refrigerator.

According to the autopsy report, obtained by RCS, the woman’s death was the result of consuming the vinegar which killed and inflamed tissue in her esophagus, stomach and small bowel.

In addition, the investigation determined that Aacres Washington staff failed to get the client immediate medical attention after first realizing she may have ingested vinegar, and failed properly notify RCS following the death as required by law.

“This failure precluded the department from having immediate knowledge of alleged neglect of a vulnerable adult and delayed the department’s investigation … and placed all clients at risk of continued harm,” the investigation said.

In an email Tuesday, Embassy Management CEO Robert Efford said his staff was “personally devastated” by the client’s death.

“While we condemn the actions of an individual staff member who did not follow our procedures, we believe we have been fully transparent in our reporting on this highly unusual and troubling incident,” Efford wrote. “This incident in no way reflects our passion, commitment and resolve to our mission to safely serve individuals in their homes and communities.”

Efford added that his company is launching a medication safety campaign “to retrain and focus every staff on their responsibilities with medication support.”

The results of the investigation into the death were the culmination of months of problems involving this particular Aacres Washington supported living program, known as Spokane County #3. In October 2018, RCS found that staff failed for six days to ensure a client received medication to treat psychiatric symptoms. In May of this year, RCS imposed a $6,000 fine on Aacres Washington after determining that a staff member subjected three clients to isolation and mental abuse and that other staff and a supervisor failed to immediately report the misconduct.

In an Aug. 9 letter to Efford, RCS notified him the state was putting Spokane County #3 on a 90-day provisional certification based on “serious non-compliance with the laws and regulations.” Rather than letting the RCS process play out, DDA decided to cancel its contract with Spokane #3.

“We’re not waiting around for the end of 90 days, we’re terminating the contract a little more aggressively,” said Shaw Seaman, the chief of quality assurance and communications for DDA.

The agency will help the clients currently served by Aacres Washington Spokane #3 find other providers to serve them in their homes.

In a letter to families, Aacres Washington said its last day of service for clients of Spokane #3 will be no later than Nov. 7. “It is our goal that Direct Support staff currently working with each individual will choose to transition to the receiving agencies to ensure a continuity of care,” the letter said.

Tammie Corter with her son Tyler Groseclose who is severely autistic and non-verbal and a current client of Aacres Washington in Spokane.

Tammie Corter with her son Tyler Groseclose who is severely autistic and non-verbal and a current client of Aacres Washington in Spokane.

Courtesy Tammie Corter

Among those receiving the letter was Tammie Corter, whose 27-year-old son Tyler Groseclose is severely autistic and non-verbal and was previously a client of SL Start.

“I see this as maybe a blessing because I was ready for a change,” said Corter, who lives in Chelan County.

Corter said she had complained to RCS about the care her son was receiving from Aacres Washington.

“I’ve had issues with them keeping him clean, his hygiene,” Corter said. “He’d be covered in feces, he’d have skin break down and be bleeding.”

Corter said, in response to her complaints, the staff who work with her son were retrained.

Asked about the state’s decision last year to allow Aacres Washington to take over the care of her son and other SL Start clients, Corter said, “It sounds like a death could have been prevented.”

Meanwhile, DDA is defending that decision.

“The short answer to that is Aacres was certified, contracted and in good standing as a qualified provider,” Seaman said.

The future of the two other Aacres Washington programs in Spokane County is unclear.

“The pattern is not good,” said Schwieterman, the ombudsman. “The pattern shows that they’re not responding to the enforcement actions by Residential Care Services.”

Aacres Washington also serves clients in Clark, Pierce, Snohomish and Thurston counties. Last November, the company voluntarily ceased operations in King County citing a lack of affordable housing and challenges related to recruiting and retaining staff.