New York Health Department failed to conduct timely inspections of adult care facilities, audit says, leaving critical issues unresolved

New York State Health Department inspectors failed to conduct timely oversight of adult care facilities housing thousands of elderly and vulnerable residents, including many on Long Island, with auditors finding crumbling stairways and a half-empty bottle of vodka in a medical room, according to a report released Wednesday by state Comptroller Thomas DiNapoli's office.

Auditors looked at the oversight of assisted living residences for seniors and New Yorkers with disabilities, adult homes and respite care facilities between January 2018 and October 2024 and found the lack of prompt inspections jeopardized the health and safety of residents because critical problems, from mice droppings to expired food, were not quickly corrected. 

"Adult care facilities across the state have a responsibility to protect residents and deliver quality care," DiNapoli said in a statement. "Regular and routine inspections of these facilities, and correcting problems, ensure residents are not left in unsafe or unsanitary conditions. If the State Department of Health isn’t conducting timely inspections or following up to make sure violations are corrected, then vulnerable residents could be left at risk."

As of 2023, there were 534 adult care facilities statewide, including 105 on Long Island, serving 37,547 residents. Adult homes are not nursing homes, but rather long-term, nonmedical residences for individuals who can’t live alone because of a physical, mental or other limitation associated with age or other factors.

The Health Department's Division of Adult Care Facility and Assisted Living Surveillance is responsible for conducting unannounced inspections of these facilities every 12-18 months — depending on how they performed on their previous visit — and for initiating complaint investigations. The division has 79 full time employees.

But auditors found the department failed to complete full inspections within that time frame for 21 of 30 sampled facilities, including eight reviews that were initiated three to five years late.

Of the five Long Island facilities sampled, DOH did not complete a full inspection for four of those on time, including one that was 14 months behind schedule, the comptroller's office said.

Auditors conducted 20 site visits of adult care facilities and found a bevy of health and safety issues, including crumbling stairways, a half-empty bottle of vodka in a medical room, marijuana paraphernalia in an administrator's office, expired medication, refrigerators that were not cold enough, and dishwashers that were not hot enough, the report states.

At three Long Island locations visited by the comptroller's office — Atria Huntington, Brandywine Huntington Terrace and The Bristal at Bethpage — auditors found uncorrected violations that were noted in previous inspections, the report states. They included food stored past sell-by dates, cracked exterior walkways, overnight staffing below the minimum requirements and residue-covered medication carts, the comptroller's office said.

The three Long Island facilities did not respond to requests for comment.

In response to the report, the health department acknowledged delays in conducting inspections and correcting violations, citing staffing shortages and the pandemic as primary challenges.

Johanne Morne, the department's executive deputy commissioner, wrote that hiring has since increased while a tracking system was implemented to monitor the agency's compliance with inspection schedules.

Health department spokeswoman Marissa Crary told Newsday in a statement Wednesday that "substantial progress" had been made in returning to "normal surveillance timelines that were delayed due to the pandemic ... Throughout the public health emergency, adult care facilities were subject to comprehensive, focused infection control and complaint investigations, and in some cases, were the subject of enforcement actions."

As of July 2024, the health department's inspection backlog for Long Island adult care facilities was down to just one location, DiNapoli's office said.

Auditors also found:

• The health department failed to follow up on any of the citations issued in 30 inspection reports that were examined, covering 89 total violations;
• The department provided no evidence it investigated 18% of the 569 complaints it received during the five-year period, including residents confined to their rooms or hallways for extended periods and dirty or poorly maintained facilities;
• Health inspectors took longer than the mandated 30 days to investigate 13 separate complaints, with one taking 153 days to complete.

Richard Mollot, executive director of the Long Term Care Community Coalition, an advocacy group for nursing home and adult care facility residents, said the problems outlined in the report are not new.

"Some facilities are wonderful, but far too many provide poor conditions and inadequate monitoring and care to meet the needs of their residents," Mollot said in an interview. "It doesn’t have to be this way, but in the absence of good standards and effective monitoring and enforcement, predatory operators can take advantage of older and disabled adults with impunity. This also leads to an absence of public transparency which fosters the persistence of these problems and hobbles the ability of the public to make informed choices about these vital services."

Since 2021, the number of residents living in adult care locations statewide has increased almost 10%, state figures shows, while the number of facilities has dipped more than 2%.