Seven Days and Vermont Public Radio compiled regulatory complaints, inspection reports and
fines assessed by Vermont’s Department of Disabilities, Aging and Independent Living for every
residential care home and assisted living residence operating in the state since January 1, 2014.
Complaints
Anyone can report a concern about a
facility to the Division of Licensing and Protection’s survey and certification complaint
system. In most instances, inspectors make an unannounced visit to the facility to determine
whether allegations are substantiated or unsubstantiated.
Unsubstantiated reports are exempt from disclosure under the Public Records Act. So are residents’
identities and medical details. Many of the complaint documents we received were partially or nearly
entirely redacted.
For this database, we summarized the total number of allegations, and the total number that were
substantiated, for each facility. For clarity, we considered each individual allegation to be one
“complaint.”
Inspections
Inspection reports detail each instance when a home was not in line with regulations. Each such
finding counts as a citation against the facility. Citations are assigned a letter grade to indicate
the severity and scope of the violation.
The federal Centers for Medicare & Medicaid Services uses the same severity and scope grading system
to calculate scores for every nursing home in the U.S., calculating a rating from one to five stars.
Vermont residential care and assisted living facilities are subject to a similar assessment
framework — and the same severity and scope letter assessments. The state posts inspection reports
online, but our records requests revealed gaps. Of the 794 facility inspections between January 1,
2014, and September 30, 2019, 150 — nearly 20 percent — were never posted to its website.
To compile the citation data, we downloaded inspection documents available on the state’s website,
matched them up with a list of all inspections conducted since January 2014 and requested the ones
that were missing. We manually recorded each citation and the letter grade associated with it, then
digitally “mapped” those citations to their respective sections of the state regulations. The
result: a dataset that allowed us to determine the citations issued most frequently, the range of
severity grades of the citations facilities received and which homes repeatedly failed to comply
with state regulations.
To convert those letters to violation severity scores, we assigned point values according to the
scoring system that the Centers for Medicare & Medicaid Services uses, where A, B and C count for
zero points, and L counts for 150.
|
Scope |
| Severity |
Isolated |
Pattern |
Widespread |
| Immediate jeopardy to resident health or safety |
J
50
|
K
100
|
L
150
|
| Actual harm that is not immediate jeopardy |
G
20
|
H
35
|
I
45
|
| No actual harm with potential for more than minimal harm that is
not immediate jeopardy |
D
4
|
E
8
|
F
16
|
| No actual harm with potential for minimal harm |
A
0
|
B
0
|
C
0
|
Source: Center
for Medicare and Medicaid Services (PDF)
Using this scoring system, homes with several relatively minor citations do not accumulate very many
violation points. Homes with a few very severe citations might accumulate hundreds of points.
To adjust for facilities that have opened or closed since 2014, we calculated the number of years of
our time window that each facility was open, then divided each facility’s cumulative point total by
the number of years. We used “1” for any facility that opened within the past year. This allowed us
to calculate an average number of violation points that each facility accumulated per year it was
open.
That figure determines a facility’s position on the Average Annual Facility Violation Scores graphic
on the database.
Fines
The Division of Licensing and Protection can fine homes that repeatedly fail to come in line with
regulations. We requested all fines that the state imposed from 2014 through November 19, 2019. The state issued
six fines, totaling $86,989, to six facilities. The largest fine, for $70,590, was to Maple Ridge
Memory Care in Essex Junction in 2017; the smallest, for $600, was to Thompson Residential Home in
Brattleboro, also in 2017.