By Daymond Steer
EFFINGHAM – Lakeview NeuroRehabilitation Center plans to appeal the New Hampshire Department of Education's decision to shut down its special education program. Meanwhile, an investigator does not believe Lakeview can make needed improvements in a "reasonable period of time."
Lakeview is an 88-bed residential facility in Effingham that cares for individuals with physical, neurological, cognitive and behavioral impairments. It has a main house and smaller units called cabins on its campus. It also operates a school that serves students with special needs in grades one through 12, from ages 8 to 21.
In a letter dated April 10, Commissioner of Education Virginia Barry informs Lakeview Chief Operating Officer Tina Trudel that the department of education is ordering the "cessation of operation" of the special education program and that New Hampshire districts that place students at Lakeview must find a new place to send their students in 60 days from last Friday.
Barry said the department monitored the program for six months. The decision affects 19 students, including two day students from New Hampshire.
"Despite detailed letters identifying areas of non-compliance and the steps necessary to correct implementation of the New Hampshire rules, the Special Education program of the Lakeview School has consistently failed to comply," wrote Barry. "This non-compliance has been severe and long-lasting."
Barry said Lakeview's teachers lack the "appropriate credentials and or endorsements" and that the school also has failed to show curriculum or lesson plans on which their high school diplomas are based.
Trudel, in a written statement to The Conway Daily Sun, said they plan to appeal the DOE's decision.
"Within the next few days, Lakeview NeuroRehabilitation Center will file its appeal of the N.H. Department of Education's recent order and request a fair hearing where Lakeview will demonstrate its strong good faith effort to address all stated concerns resulting in compliance with all regulations and relevant educational standards," said Trudel. "During this time, we will continue to work diligently to enhance services and supports to all within our care."
At the end of last year, Gov. Maggie Hassan ordered a series of reviews of Lakeview and the Department of Health and Human Service's handling of Lakeview over the years. The governor made those moves after the Disability Rights Center lodged complaints detailing, among other things, the case of a patient named J.D. who died in 2012 after suffering what the center called "horrific" neglect.
In December, a review team found a number of deficiencies regarding staffing, supervision, communication, crisis management, training and more. Lakeview created a "Plan of Correction" to address those deficiencies, and the New Hampshire Department of Health and Human Services accepted the plan in March.
The governor also ordered an independent consultant to look at Lakeview's quality of service and New Hampshire's oversight and monitoring of Lakeview. Kathryn du Pree of Crosswinds Consulting was hired to do that work. Her reports were released Monday.
One of du Pree's reports is called "Review of the Quality of Services at Lakeview NeuroRehabilitative Center and the Center's Capacity for Quality Improvement" and that report is 66 pages long. The other, "Review of New Hampshire's Oversight and Monitoring of the Services Provided by Lakeview NeuroRehabilitative Center," is about 25 pages.
In her quality of services report, du Pree says Lakeview's plan of correction, which was accepted by the state, is "lacking in many basic areas."
"Its mission and programing approach is not clear, the staffing remains insufficient, its involvement of families is poor, and its quality assurance area is significantly under resourced," wrote du Pree.
"It is of significant concern that many families are dissatisfied with the care provided to their children yet feel they often have no other alternatives. I do not believe Lakeview will be able to successfully implement and sustain its (Plan of Correction) within a reasonable period of time."
However, Lakeview cannot be closed quickly, she said, because there would be over 60 people who need to be placed somewhere else. Elsewhere in the same report, du Pree said patients were injured because Lakeview wasn't able to keep them contained — they leave the facility and get hurt or become exposed to the cold.
"Lakeview is not assuring the safety of its residents at the current time, and its plan for crisis management does not indicate improved comprehensive analysis or strategies to accomplish this," wrote du Pree.
Du Pree said Lakeview is making efforts to improve but those are not enough.
As for the governor, Hassan has directed DHHS to immediately start implementing du Pree's recommendations, including restructuring the DHHS licensing unit — including staffing and rules — improving coordination between DHHS divisions and Area Agencies, maintaining a freeze on New Hampshire admissions to Lakeview, and continuing a monitoring program that DHHS started in response to a complaint issued last September.
"We have a responsibility to ensure that we are doing everything possible to protect the health and safety of our most vulnerable citizens," said Hassan. "These reports make clear that we can and must do better.
According to Hassan, the state will direct Lakeview to create an advisory group that includes residents and family or guardians of patients to ensure input from those Lakeview serves. The DHHS review team will also reassess the shortcomings in Lakeview's Plan of Correction consistent with inadequacies outlined in the report, including staffing deficiencies, the structure of the Rapid Response Team, and implementation timelines and deadlines for Lakeview.
Near-term actions include identifying and addressing staffing needs within the department to support its licensing division and continued monitoring of the stability of Lakeview's operations. Over the long term, DHHS will review existing rules and establish new rules and protocols for licensing unique facilities like Lakeview; streamline communication and information between those responsible for oversight; continue the department's quality assurance review of its oversight responsibilities; and evaluate the data being collected from the monitoring program, according to Hassan's office.
Karen Rosenberg, a staff attorney with the Disability Rights Center in Concord, is happier with du Pree's report than the corrective action plan that was accepted by the state in March, but she is unhappy that Lakeview won't be shut down immediately.
"There's no excuse for our state to allow a facility like this to continue to operate under a corrective action plan that doesn't have a reasonable likelihood of success," said Rosenberg, saying Lakeview places patients' health and well-being at risk.
Du Pree made the following recommendations if Lakeview is to remain open:
• New Hampshire continues its own freeze on admissions until substantial improvement is made and sustained for at least six months. Lakeview becomes a facility that identifies its mission to provide short-term stabilization and assist individuals to improve their behaviors serving individuals for no more than 18 months. This gives the state time to develop a community-based alternative.
• Lakeview continues its new practice of not accepting referrals if it does not have well-trained and sufficient staffing.
• Lakeview develops meaningful performance measures and achieves them.
• Lakeview commits sufficient resources to its quality assurance department to carry out its critical functions
• Lakeview establishes a participant and family advisory committee to advise on policy.
• Lakeview regularly determines participant and family satisfaction and acts on recommendations for improvement.
• New Hampshire identifies experts in person-centered planning to train the staff at Lakeview.
• New Hampshire develops enhanced rules and oversight of the facility.