When state licensing inspectors visited a Homestead-area boarding house last year, they found signs of rats, an unsafe water source and ill-maintained electrical wiring and fire safety equipment.
A background check wasn’t part of the survey, but it would’ve revealed that an assistant director had criminal convictions for cocaine possession, burglary and carrying a concealed weapon.
State healthcare inspectors who visited the Young Residence Home in June discovered another problem: It was an unlicensed assisted-living facility.
The owner told regulators that the home provided only housing, not other services, for alcoholics, ex-convicts and people with mental health issues. But the inspector found that staff helped residents take medication.
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One person who had lived at the home for four years told authorities: “I don’t want to be here. We get little food, and it’s bad.”
The situation at the Homestead home is neither isolated nor unusual. Hundreds of congregate living facilities across Florida escape any state scrutiny because no agency regulates them. They have names like Home Sweet Home, House of Joy and Nurse’s Loving Heart. They call themselves shelters, rooming houses or “sober homes.” Some even receive Medicaid dollars.
Critics say these facilities are actually unlicensed ALFs, using a different name to avoid licensure and inspection — and to enhance their profits. An ALF, in addition to providing housing, can help with daily tasks like bathing, dressing and taking medication. To open one, an operator must pass a background check, pay fees and submit to inspections.
Last year, state healthcare regulators received more than 200 complaints about unlicensed activity and confirmed that 62 were, indeed, unlicensed ALFs, including 15 in Miami-Dade and Broward. These numbers have risen more than 60 percent from 2010. By June this year, the Agency for Health Care Administration had identified another 37 unlicensed homes around the state.
But critics say many others operate under the radar.
“These facilities could really almost act with impunity because of the lack of regulatory oversight,” said George Sheldon, a former secretary of the state Department of Children & Families.
The Young Residence Home in Homestead is an example of the problems created by a lack of oversight.
Police have been dispatched to the home — and its former location 10 minutes away — nearly 100 times since 2008. Nearly 40 incidents related to concerns that someone needed to be hospitalized because he was an imminent threat to himself or others. Fifteen were missing person cases, including a resident with bipolar disorder.
A woman staying in a trailer with Derril Young, the assistant director and son of one of the owners, told police he threatened her with a machete after a fight about their drug use. A second person told police that Young tried to punch him in the face and threatened to shoot him.
4 to a room
In Tampa, one shelter had been open for four years before healthcare inspectors visited last May. Located in a pair of bland, two-story apartment buildings, Touched by the Hand Outreach promised “moral, physical, mental, and most of all spiritual support” to those who were homeless, disabled or seeking rehabilitation.
Up to 40 people lived at the home, with as many as four to a bedroom, said Patrick Lewis, who lived and volunteered at the shelter and in June took over running the residence, now called Temple Terrace Boarding House.
Lewis is tall and lanky, and his arms are tattooed with demons and dragons. State records show that he and several other residents are registered sex offenders.
Owner Ruben Alvarez Jr., took boarders’ Social Security checks and food stamps and gave out a $54 monthly allowance — minus the cost of honey buns and soda from the neighborhood Save-A-Lot, Lewis said. Those who couldn’t make the $900 monthly rent were required to work at the shelter, he said.
“There wasn’t a whole lot I could do about it. At the time, I didn’t have a place to go,” Lewis said.
Alvarez also threatened residents, threw them out and started fights, Lewis said. At six feet and 300 pounds, bald with a full goatee, he was a formidable figure.
Authorities have been dispatched to the home more than 90 times since early 2012, not counting sex offender checks. At least five residents have been hospitalized under the Baker Act, which allows involuntary hospitalization of persons who are mentally ill and a threat to themselves or others. Officers reported that one man was suicidal and hadn’t taken his medication. Another scratched his own arm with a knife. A third drank his own urine out of a two-liter bottle because he “enjoys it.”
Police noted that the home was “unclean” and that raccoons, ducks, chickens, pigeons and doves were kept there.
A former employee of the shelter told authorities in April that bed bugs were climbing out of the walls, residents were forced to reuse paper plates to eat food that had expired two years earlier, and the owner was turning off the air conditioning and water. A mentally ill resident was providing medical care to other residents — some of whom had seizures, schizophrenia or AIDS.
The owner, the former staffer said in a complaint to AHCA, “makes one of the male residents ... perform sexual acts on him.”
When state healthcare inspectors visited the home a week later, they determined it, too, was an unlicensed ALF.
Alvarez, the owner, admitted to inspectors he knew state law required the home to be licensed, but said he never applied because he couldn’t pass the state’s background check. He had a long rap sheet dating back three decades, including multiple battery and assault charges. He was also a registered sex offender, and police records show he had a drug or alcohol addiction. Before opening the shelter, Alvarez had served five prison terms. He is back behind bars now, for failing to report to authorities as a sex offender.
AHCA said it hadn’t received complaints about Tampa’s Touched by the Hand before April. But the Department of Children & Families notified the agency six times that it suspected the shelter was an unlicensed ALF, including four times in the past two years, records show. DCF received 16 abuse reports for the facility, including allegations of asphyxiation, medical neglect, physical and mental injury, and sexual abuse. It didn’t find enough evidence to confirm the reports, but it made referrals to AHCA as early as 2009. Yet, AHCA didn’t send inspectors to the home after getting the notifications.
“What they saw didn’t constitute unlicensed activity, so a complaint investigation wasn’t opened,” said Polly Weaver, AHCA chief of field operations.
The agency said it has taken steps in recent years to formalize the DCF referral process and educate workers about how to recognize unlicensed ALFs.
What state can do
AHCA can impose fines of up to $1,000 a day when unlicensed ALFs continue to operate after getting notice from the agency.
The regulator fined just seven unlicensed providers since the beginning of 2012, though it has identified at least 93 in that time, according to agency records. More fines aren’t imposed because most stop providing services illegally once they’re notified, said Deputy Secretary Molly McKinstry.
Under Florida law, running an unlicensed ALF is a third-degree felony, with each day of operation counting as a separate offense.
AHCA hasn’t taken advantage of other permitted enforcement actions in recent memory, including filing injunctions, imposing emergency suspensions, sanctioning providers who knowingly refer to unlicensed ALFs, or reporting healthcare practitioners who don’t speak up about unlicensed facilities. The agency said it refers unlicensed facilities to law enforcement, but this only occurs in a fraction of cases, and Miami-Dade police said they haven’t received any recent referrals.
“Luckily this is not something where we have terrible cases all over the state in great volume,” McKinstry said. “Just because we’re not using every single tool in the toolbox doesn’t mean something isn’t happening. We have a process that we follow.”
The agency pushed to repeal a provision requiring it to establish local workgroups that convened multiple agencies to address unlicensed ALFs.
Until last year, Touched by the Hand and Young Residence Home were both licensed as “rooming houses,” allowing them to provide lodging but not other services. By law, inspectors from the Division of Business and Professional Regulation were required to refer any suspicions of individuals being neglected or unable to care for themselves to state regulators. But DBPR never made a single referral about any of the hundreds of licensed rooming houses to either AHCA or DCF since 2008, according to spokesperson Tajiana Ancora-Brown.
Legislators eliminated rooming house licenses as of last October because many homes were using them as a shield to run unlicensed ALFs, said State Representative Erik Fresen , R-Miami, who introduced the bill. Since then, no regulators have been required to inspect the homes.
“We need to go back to them and make sure they’re not operating,” Fresen said. “It probably would’ve been a good idea, if they didn’t, for AHCA to have notified local law enforcement in their areas. The Legislature’s intent for changing the statute was very clear.”
AHCA only acts if there is a complaint, said spokeswoman Shelisha Coleman.
“We’ve done exactly everything we can do within the law. We can’t go around the state knocking on everybody’s door checking to make sure they’re unlicensed,” she said.
When AHCA did a follow-up visit to Young Residence Home in June, it found the facility was no longer operating, Coleman said.
However, since that determination, police have been dispatched there at least six more times. They arrested co-owner Margaret Kirby-Gordon, Derril Young’s mother, for aggravated assault in July.
Meade Gordon, who lives in New York and owns the facility with his wife, said police were called frequently because patients requested to go to the hospital when they were sick or needed medicine. He denied the home assisted with medication and said Young no longer works there.
During a mid-August visit by the Miami Herald, at least two people still lived in the whitewashed, one-story home. A banner with the home’s name hung over the door, and weathered lawn furniture dotted the yard. Inside, African masks and a plaque urging residents to “Have Faith in God” adorned the walls of a darkened hallway. A young, barefoot woman said she was a staff member.
Informed of the goings-on, the state’s McKinstry said, “I think we might need to go back and look at that and see.”