ZACHARY, La. (WAFB) - The Zachary community home from which a patient escaped in August before entering a nearby house and being shot by the owner is operating with a provisional license after investigators from the Louisiana Department of Health (LDH) found several “deficiencies” that may have contributed to the incident.
LDH found the Andover Group Home on Sutter Lane was out of compliance with several conditions required to maintain its status as a provider of services in the Medicaid program. Among the listed issues were governing body and management issues, client protection issues, facility staffing issues, client behavior and facility practice issues, and health care services issues.
When investigating the circumstances that led to the escape and subsequent shooting, LDH found the resident shot displayed “eloping behaviors” almost daily before the shooting that were not properly documented.
Records obtained by WAFB show the resident left the home before, on Saturday, July 24, when he ran to a neighboring home and attempted to gain entry.
“No interventions were immediately implemented in the home to ensure the safety and well-being of [the resident] after the incident," LDH found.
After further investigation, LDH found that on the night of the shooting none of the patients housed at the facility were given their medication before the escape because there was no CMA staff on duty. That same night the resident was reported to be running through the home stripping off his clothing. Staffers told LDH the resident was last seen around 11:30 p.m. when he entered his bedroom, at which point staff began caring for clients on the opposite end of the building.
LDH found an alarm sounded at the home at the time the patient escaped, but none of the staff returned to check on the resident and failed to perform a headcount.
Staffers at the home failed to even notice the resident was gone until an officer knocked on the door and prompted them to do a headcount. The officer later confirmed with staffers the resident suffered multiple gunshot wounds to the chest, back, and hand after attempting to enter the nearby home.
LDH also found staffers at the facility failed to properly investigate reports of abuse or remove staffers being investigated for abuse allegations from the facility. Among those claims were the appearances of lacerations that were not properly reported, claims that staffers pushed a patient out of a wheelchair, and medications not properly being distributed.
The home was issued a notice in September giving staffers until November to complete the necessary training and make changes to procedures to maintain their Medicaid Provider Agreement.
An LDH spokesperson confirmed the facility has done so and is subject to additional monitoring surveys until September 2020 when the provisional license expires.
The group home has a record of violations as shown by previous reporting done by WAFB.
Records obtained from 2015 through 2019 show one man who stayed at the home had 19 documented falls and eight visits to the emergency room in one year. Other previous listed violations from LDH include failures to report incidents to family members, caretakers giving clients wrong medications, and the group home being understaffed multiple times.
During one inspection visit, LDH records show the home was understaffed and the inspector wrote they had to flag down staff in another room because a situation between two disabled clients was getting out of hand and nobody was there to stop it.
EBRSO told WAFB deputies have responded to 14 calls at the home since 2015.
LDH said in a statement previously provided to WAFB that past inspection reports of the Andover Home show issues at the home have been fixed. The full statement reads:
“The Louisiana Department of Health surveys health care facilities such as group homes every 9-15 months as part of our standard monitoring. In addition, the Department responds to complaints by doing additional investigations.
The home must submit a corrective action plan that details how that deficiency will be addressed for each deficiency identified during an investigation.
Some deficiencies that are severe and egregious are termed Immediate Jeopardy. These deficiencies must meet three criteria: (1) noncompliance (2) caused or created a likelihood of serious harm, and (3) immediate action is necessary to prevent the occurrence. In these situations, the facility must respond immediately to remove the threat. Failure to comply can result in the loss of that provider’s license.
The past inspection reports of the Andover home show that all deficiencies identified by the Louisiana Department of Health were corrected.”
A spokesman for the East Baton Rouge Parish Sheriff’s Office says no charges were filed against the homeowner who shot the home’s resident and all files have been turned over to the DA’s office for review.
The Andover Community Home is one of seven homes that are a part of the Louise S. Davis Residential Facilities group.