State health inspectors issued a cease and desist order on Tuesday to the operator of an unlicensed group home in northwest Reno after removing a woman from the bed-bug infested house in an ambulance last week.
Health inspectors who conducted an emergency inspection on Friday found Silver State Behavioral Health Inc. was illegally housing the woman, who needed a higher level of care than the group home is licensed to provide.
The home on Kings Row, however, remains open. The operator cleaned and treated for bed bugs over the weekend and continues to house the remaining six residents, who don’t need that higher level of medical care.
Inspectors who visited the house on Friday found a bed-bug infestation, strong odors throughout the house and soiled conditions. A total of seven people were living in the four-bedroom house, according to state inspectors.
Although inspectors found deplorable conditions at the house, it was the fact one of the residents needed a higher-level of care that prompted the cease and desist letter, not the condition of the home.
“It didn’t appear the assistance she was receiving was adequate,” said Joe Pollock, deputy administrator of the Nevada Division of Public and Behavioral Health.
A city of Reno code inspector also visited the house on Friday.
“I only went in the living room, but you could see bed bugs up on the walls,” said Joe Henry, senior code inspector for the city of Reno. “When you see bed bugs in broad daylight, it means you have a whole bunch of them because usually they wait until cover of darkness to come out.”
Henry ordered the operator of the home to immediately treat the house for bed bugs. An exterminator was seen at the house over the weekend, while the residents were staying in a motel. The residents returned to the home on Monday.
Larry Carter, the owner of Silver State Behavioral Health Inc., did not return a phone call for comment on Tuesday.
Under the cease and desist order, Silver State Behavioral Health must find new living arrangements for the female client who requires a higher level of care.
However, because the remaining six clients at the house appear not to need a higher level of care, there’s little the state can do if the residents choose to remain at the house, Pollock said.
Speaking in general terms, and not about the situation at the Kings Row house, Pollock said the state has no regulatory authority over private clients who need supportive living services that don’t rise to the level of licensed cared.
“It would be considered a private residence. They would be living in squalid conditions in a private residence,” Pollock said. “It’s an unfortunate example of what could happen.”
A state group home license is required for operators who care for clients who need 24-hour supervision, medication to be administered and help with daily tasks such as bathing.
The house on Kings Row appears to operate in a regulatory black hole, accepting clients who need supported living services, but not the more hands-on care. Their clients are eligible for Medicaid and food assistance but are not also clients of the state’s mental health or developmental services agencies. That means no state officials inspect the house on a regular basis.
Since 2014, Silver State has billed Medicaid for $514,110, according to records obtained by the Reno Gazette-Journal.
The city also tends to refer code complaints to the state, believing the state is the regulatory agency for group homes. That means complaints can bounce around from agency to agency without resolution.
State and city officials are meeting next week to discuss the issue, Henry said.
“They are making money,” Henry said of the operator of the home. “So, if they are making money off of people, then they have to meet a certain level of expectation. We need to figure out that fine line of who is going to take care of it and who is going to inspect.”
State officials said they are also concerned about the regulatory gap and are researching to determine the extent of the problem.
“We are very troubled by that,” said Chrystal Main, spokeswoman for the Department of Health and Human Services.
Complaints about the Kings Row home began trickling in last August, but no immediate action was taken.
The first complaint came from a neighbor worried the home was operating illegally. The state health licensing agency sent letters to the operator asking for information on what type of clients it was serving and closed the case after being satisfied the home wasn’t operating illegally, Pollock said.
Another complaint came in September. An elder abuse ombudsman from the state visited the home in December and documented dirty conditions, problems with medication being tracked and dispensed and bed bugs.
The bed bug complaint was referred back to the city, and the state health licensing agency again determined the home was’t exceeding its license. The state licensing agency closed the case without inspecting the conditions of the house.
“When it says dirty, it’s hard for us to send resources for a complaint on a facility being dirty because everybody has a different gauge for what is dirty,” Pollock said.
The elder abuse ombudsman closed her case because the resident who was the subject of the complaint said he would be moving out of the house, Pollock said. That resident, however, is still living at the Kings Row home.
Then on March 4 another complaint came in, prompting Pollock’s division to schedule Friday’s inspection of the home, which ultimately resulted in the cease and desist letter.
The house, however, remains open. Mike Maurice, a friend of two of the residents, said they stayed overnight in a motel while the exterminator treated for bed bugs over the weekend. They moved back into the house on Monday.
“He’s back there and he says it seems like they cleaned it up,” Maurice said of his friend. “They seem happy for now.”