A Miami-Dade grand jury blasted the state for allowing troubled assisted living facilities to stay open instead of reaching into its arsenal to crack down on the worst abusers, including imposing steeper fines, shutting down troubled homes and weeding out rogue operators.

The report, released Thursday, put the blame squarely on the Agency for Health Care Administration for permitting dangerous homes to keep their doors open and not “doing a more effective job of enforcement.”

“Revoke the licenses. Impose the fines. Hit the offenders where it hurts most, in their pockets,” said the 33-page report, the result of a two-month investigation by the grand jury prompted by a Miami Herald series, Neglected to Death, published in May.

Citing an “explosion” in growth of ALFs in the past five years, jurors said the state needs to assume a greater role in protecting thousands of frail residents in the years to come, and encouraged AHCA to be more proactive in saving lives and tapping the resources of other state agencies.

“You’re the lead agency — then lead. Be a lead agency,” said Miami-Dade State Attorney Katherine Fernandez Rundle. “These are the most helpless and the most vulnerable.”

The Herald investigation found dozens of frail elders died from abuse and neglect — at least 70 since 2002 — while AHCA allowed nearly all of the homes to stay open.

The report, titled “ALFs: a Call for Greater Interagency Communication and a Cry for More Citizen Volunteers,” said that AHCA not only needed to get tougher on troubled homes, but ensure that those operators who squeeze out maximum profits while providing shoddy care “will not be allowed to operate in this state.”

Among the recommendations:

• AHCA needs to track all ALF administrators with troubled histories so that they can’t jump from home to home;

• AHCA needs to move faster when it finds homes are hurting their residents by cracking down on facilities with steep fines, suspensions and stripping them of their licenses;

• AHCA needs to work more closely with two agencies that investigate problems in homes — the Department of Children & Families and state Elder Affairs ombudsman program — since AHCA is the only agency that can discipline the facilities.

• DCF, the agency that takes abuse hotline calls, should pass on all complaints of elder abuse and neglect to the state Attorney General’s Office for possible prosecution.

• The ombudsman program, which consists of trained volunteers who advocate on behalf of vulnerable adults, must continue to do full-fledged inspections of ALFs and not limit its role to simply interviewing residents to see if there are problems.

• ALF residents should enjoy the same protections as those in nursing homes, including the right to appeal an eviction.

Elizabeth Dudek, secretary of AHCA, needed more time to read the report before commenting, said Shelisha Coleman, spokeswoman for the agency.

The grand jury report is the latest examination this year of an industry that has been the focus of a special Senate investigation and a governor’s task force — all calling for AHCA to take a tougher stance on homes that repeatedly break the law.

But jurors went out of their way to urge AHCA to focus on protecting residents, rather than simply ensuring homes abide by regulatory matters.

“The members of the grand jury heard repeatedly that AHCA is not in the business of closing facilities,” said jurors, adding that by “failing to take action, or even by taking action in an untimely manner, AHCA may be unwittingly putting other residents at risk of harm.”

The grand jury also went to great lengths to urge AHCA to make the ombudsman an intrinsic part of enforcement by reviewing the problems turned up by the trained volunteers during their visits to facilities — especially severe cases of abuse and neglect.

In fact, AHCA inspectors should go on their visits to homes armed with the ombudsman reports so that AHCA can better target specific problems, jurors said.

“Because ombudsman have more contact with the ALFs, have visited the ALFs on a more frequent basis and have investigated complaints from the residents of those ALFs, they have a more extensive knowledge of the performance of the ALFs over an extended period of time,” jurors said.

Though the grand jurors stressed the need for AHCA and the ombudsman to work together, getting them to do so could be a difficult hurdle.

The Herald found the ombudsman program had uncovered more cases of abuse and neglect in the past five years than it had seen in the previous three decades. But AHCA inspectors never investigated the vast majority of the cases, records show.

In fact, a state audit in 2008 found that AHCA couldn’t locate two-thirds of the complaints sent to the agency.

Larry Polivka, an expert on aging who chaired the governor’s task force, said he shared several concerns raised by jurors, especially the need to better track rogue operators — who often get fired and then simply move onto other homes.

“We need to know as much about the work history of these people as possible,” said Polivka, scholar-in-residence at Florida State University’s Claude Pepper Center. “We did hear evidence indicating that some folks who had records full of deficiencies, and worse, were still able to get jobs at facilities later. That’s putting people at risk.”

Jurors recommended the penalties be increased to a third-degree felony for caretakers who are caught punishing residents for complaining to inspectors.

Jurors also called for the state to increase educational requirements for administrators — now among the lowest in the country — especially for those who oversee specialized ALFs, like those for the mentally ill.

Citing the recent bust of a Miami ring that sold fake certificates to allow caretakers to work in ALFs, the panel strongly urged the state to examine all certificates of caretakers to make sure they weren’t forged. At least 20 people were arrested in the cash for credentials sting this week that showed caretakers were able to pay $20 to get certified in CPR, as well as Alzheimer’s and Down’s syndrome care.

In the end, “the constant message is that we have to stay vigilant,” said Rundle. “If we don’t have eyes and ears helping advocate for residents, it’s perilous to think what otherwise might happen.”