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Division of Oversight & Monitoring

161 Delaware Avenue, Delmar, New York 12054
TEL: 518-549-0200

February 25, 2014

David Armstrong, RN
Administrator
Lakeview New Hampshire NeuroRehabilitation Center
244 Highwatch Road
Effingham, NH 03882
Dear Mr. Armstrong:

Thank you for your February 21, 2014, response to the New York State Justice
Center for the Protection of People with Special Needs’ (Justice Center) January 21, 2014,
correspondence documenting the findings and recommendations shared during our
October 2013 visit to Lakeview New Hampshire NeuroRehabilitation Center (Lakeview).
The Justice Center has carefully reviewed your response and included attachments.

In response to the recommendations that Lakeview improve incident management
practices, the Justice Center notes the reported completion of formal, certified
investigations training, along with reported plans to appropriately modify incident
management policy and procedure. We also look forward to reviewing comprehensive
investigation reports and supporting evidence for those incidents recently reported to the
Vulnerable Person’s Central Register (VPCR).

Similarly, the Justice Center further noted that our recommendations related to
environmental enhancements and improved fire safety will result in decorative and
furnishing improvements in the Monterey 1 and 2 cabins, and that start of shift
maintenance checks will henceforth ensure that all fire extinguishers are charged, in place
and accessible.

Regarding the Justice Center’s recommendations concerning staffing and service
levels, Lakeview’s response referenced facility policies in place prior to the October 2013
visit and asserted that the agency had reliably adequate staffing and service levels. These
assertions were not supported by Justice Center observations, independent Justice Center
investigative activities, the reports of numerous Lakeview direct care staff members, or the

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findings of New Hampshire Bureau of Elderly and Adult Services (BEAS) investigations
now in our possession. While we note Lakeview’s position that a steadily increasing
number of employees have been retained by Lakeview, the Justice Center maintains the
finding that the staff on duty are not reliably able to satisfactorily respond to all resident
crises.

The Justice Center further maintains its finding that ample investigative evidence
was found to conclude that eyesight levels of supervision are not reliably maintained, due
in part to the reports of Lakeview staff members that eyesight supervision is neither
individually assigned nor documented when transferred to other staff. We further assert
that whenever 1:1 supervision is funded specifically to maintain resident safety, it may not
be reduced without a formally approved modification to the resident’s Behavior Support
Plan, Individual Service Plan and/or Individual Education Plan.

While we are aware of the reported initial confusion by the Lakeview administration
regarding Justice Center reporting requirements, the Justice Center recommendation
related to inadequate internal and external reporting of allegations of abuse and neglect
did not solely refer to matters occurring prior to our first telephone contact with the
facility. There were additional reporting failures, including one allegation called in to the
VPCR on December 30, 2013, by an outside party after family complaints of neglect made to
a case manager and an administrator did not elicit any response (or any incident report).
This and other investigations remain open in the VPCR. While we await receipt of the
facility investigation into this matter, Justice Center concerns will be shared with New York
funding agencies regarding Lakeview’s apparent refusal to take substantive steps to
improve internal and external reporting.
Please note that, consistent with the requirements of the regulations of the New
York State Commissioner of Education, Part 200.15(h), Lakeview staff and administrators
who care for residents placed or funded by New York State must be trained in required
reporting to the Justice Center Vulnerable Persons Central Register (VPCR) and New York
Social Services Law definitions of abuse and neglect. Residents from New York and their
guardians must similarly be provided with notice, educational materials and instruction
regarding these standards, consistent with the requirements of the regulations of the
Commissioner of Education, Part 200.15(j). Such training must be provided to staff upon
hire and at least annually thereafter, and to residents from New York at admission and at
least annually thereafter.

Finally, we reviewed the documentation provided in attachments to the Lakeview
response regarding the substance and propriety of services offered in the Young Adult
Program (YAP). This reported level of individualized service was not reflective of what we
viewed during the visit or what was found in the individual program records we reviewed.

We will return to Lakeview to verify the completion of reported corrective actions.
While at the facility, we will review services to adults receiving OPWDD transitional
funding to examine the YAP program in more depth. We will be in contact soon to arrange a
date for this visit.
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This letter concludes our correspondence regarding initial Justice Center findings,
but does not preclude the Justice Center from issuing a formal report of its review. These
findings have been shared with each of the New York agencies funding Lakeview
placements, as well as with relevant New Hampshire oversight agencies.
Respectfully,

CC:

James Delorenzo, NYSED
Megan O’Connor-Hebert, NYS-OPWDD
Emily Bray, Esq., NYS-OCFS

Randal L. Holloway, Unit Manager
Division of Oversight and Monitoring
Out of State Placements Unit

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