Adult Protective Services

REASON FOR INVESTIGATION

A complaint alleged a lack of service and investigation by county protective agencies, including the Sheriff's Department, the Senior and Adult Services Division of Sacramento County Health and Human Services Department (HHS) and the County Coroner's Office, to claims of fraud, coercion, mistreatment and abuse of dependent adults in an in-home care household.

BACKGROUND

The complaint arises out of a series of events that took place in one household in Sacramento County. In this household, one caregiver took in several different dependent adults over the course of several years. Upon taking them in, the caregiver would offer them food and shelter in exchange for virtually all of their monthly disability income. After the caregiver assumed control of their finances, the complainant alleged that the dependent adults were underfed, locked in a single room without toilet facilities, restricted from talking with or seeing other family members, and verbally and physically abused by the caretaker and others in the household. Since 1994, at least two adults have died at home while living in the household. The grandmother of a child who, at times, lived in the home, and the family of two brothers who lived in the home, both asked Sacramento authorities to investigate the facility and the condition of their family members.

Though providing care for dependent adults, the caregiver operated without a license. Therefore, no background checks were run on the caregiver or assistants. On numerous occasions several county agencies visited the household for various reasons. Responding agencies included the Sheriff's Department Elder Abuse Bureau detectives and Patrol deputies; HHS Adult Protective Services and Child Protective Services and the Fire Department. Finally, the County Coroner's Office performed autopsies on both persons who died in the home.

After several attempts to have the matter further investigated by the Sheriff's Department, the complaint was brought to the Grand Jury. The Grand Jury's investigation of this case focused primarily on the Sheriff's Department, HHS Adult Protective Services and the Coroner's Office.

The stated goals of the subject agencies are as follows:

The Senior and Adult Services Division's goal is to assess and intervene to protect at-risk elderly dependent, disabled persons and other senior and adult citizens who are mentally or physically challenged from abuse, neglect and exploitation in a way that preserves independence and self-determination. Adult Protective Services is one program in the Senior and Adult Services Division.

The goal of the Sheriff's Department's Elder Abuse Bureau is to protect and serve victims and investigate and arrest those who abuse, commit fraud, theft or any other crimes against those citizens who come under the Bureau's investigative purview because of age or mental or physical challenges.

The goal of the Sacramento County Coroner's Office is to conduct legally required and necessary investigations and autopsies of citizens who die under suspicious circumstances or are not under immediate medical care at the time of death.

PROCEDURES FOLLOWED

The Grand Jury interviewed staff and management of each agency; reviewed written materials, case records, and policies and procedures; took oral testimony; viewed video tapes and listened to audio tapes. Grand Jurors accompanied Senior and Adult Services case workers to view firsthand the interaction between case workers and dependent adults, visited the Sheriff's Department, the Coroner's Office, and the HHS Senior and Adult Services Division.

FINDINGS

1. Despite involvement with the dependent adults in this household, HHS Adult Protective Services was unaware of many facets of reported situations and closed cases prematurely.

2. In response to inquiries from the Grand Jury, the HHS Senior and Adult Services Division conducted a Quality Assurance Review of the In-home Supportive Services and the Adult Protective Services programs with respect to this investigation. This review cited numerous areas where procedures were not followed and made recommendations for corrective action.

3. Despite repeated contact with protective services agencies, no agency checked the licensing status of the household.

4. Based on the information they had at the time of their initial investigation, the Sheriff's Department's Elder Abuse Bureau responded to the extent required by Department policies and procedures.

5. The Sacramento County Coroner's Office responded appropriately and in accordance with autopsy procedures and investigations.

6. The Sheriff's Department's Elder Abuse Bureau and the HHS Adult Protective Services failed to interact closely when investigating this case.

7. HHS Senior and Adult Services case workers and supervisors did not follow their own policies and procedures as they relate to Adult Protective Services. Prior cases involving these dependent adults were closed without face-to-face meetings with the case worker and the dependent adult client.

CONCLUSIONS

1. The Sheriff's Department did little or no follow-up investigation of potential crimes of fraud, theft and misappropriation of money and property of others, insurance death benefit theft and theft of Social Security check funds.

2. The HHS Adult Protective Services failed to adequately investigate the cases of at least four victims of physical abuse, false imprisonment and fraud.

RECOMMENDATIONS

The Grand Jury recommends that:

1. The Sacramento Sheriff's Department Sexual and Elder Abuse Bureau add at least one investigator position.

2. HHS Senior and Adult Services Division:

a. Establish and conduct regular training of case workers, supervisors and administrators in state and departmental policies and procedures.
b. Provide specific and intensive training for case workers and case supervisors on how to investigate and what to look for when suspected evidence of abuse, fraud, false imprisonment or any other crime is noted.
c. Train case workers in interview techniques and assessment of the need to remove clients from the presence of the care giver thereby providing a confidential environment for the interview.
d. Develop procedures to obtain information from previously closed Adult Protective Services cases.
e. Review and follow up with the Sheriff's and Police Departments to ensure appropriate response by both agencies when abuse, fraud, or other crimes are present or suspected in adult abuse cases.
f. Review policies and procedures with staff regarding clients' living arrangements which require referral to Community Care Licensing.

RESPONSES REQUIRED

The Penal Code requires response to the recommendations contained in this report be submitted to the Presiding Judge of the Sacramento Superior and Municipal Courts by September 30, 1997, from:

Sacramento County Health and Human Services Department

Sacramento Sheriff's Department