{"id":627794,"date":"2026-09-26T05:00:14","date_gmt":"2026-09-26T05:00:14","guid":{"rendered":"https:\/\/www.newsbeep.com\/il\/627794\/"},"modified":"2026-09-26T05:00:14","modified_gmt":"2026-09-26T05:00:14","slug":"state-cites-mental-health-alfs-over-deaths-care-conditions","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/il\/627794\/","title":{"rendered":"State cites mental health ALFs over deaths, care conditions"},"content":{"rendered":"

\"A<\/p>\n

The former site of Alfonso\u2019s ALF, 17010 SW 100th Ave., which state regulators shut down in the summer after two residents died. The facility was one of 16 Miami-Dade ALFs that house and care for people with mental illness that have or had been litigating with the state to stay open, state records show.<\/p>\n

Carl Juste<\/p>\n

cjuste@miamiherald<\/p>\n

Adults with severe mental illness were sent to live at Alfonso\u2019s ALF in Miami for their own protection. Community mental health agencies oversaw their care. Florida taxpayers footed the bill.<\/p>\n

Here\u2019s what the state got for its money:<\/p>\n

Health inspectors found one man \u2014 unable to communicate with his caregivers due to a language barrier \u2014 left untreated on a recliner while he wheezed for four hours. He later died. Another resident died after caregivers made no \u201cimmediate\u201d efforts to help him when he, too, couldn\u2019t breathe, state records say.<\/p>\n

Living conditions were dreadful: A man was given a pillow with a black garbage bag for a pillowcase. Another man slept with a urinal hanging off his bed, and a bucket underneath to empty the urinal, records say. Residents had no closets, no lamps, no nightstands.<\/p>\n

Alfonso\u2019s license was set to expire in August 2024. But for almost two years, it continued to operate, its six beds housing mostly residents with chronic and severe mental illness, while the Florida Agency for Health Care Administration, or AHCA, documented a catalog of violations.<\/p>\n

Yet while one state agency was running out of patience with the home, Miami-Dade mental health treatment centers, dispensing Medicaid and other state dollars, had clients living there, and several other homes like it.<\/p>\n

At present, the owners of 16 Miami-Dade ALFs that house and care for people with mental illness are litigating with the state to stay open, records show.<\/p>\n

\u201cThe conditions in these homes are intolerable and despicable,\u201d said former Miami-Dade Mental Health Court Judge Steve Leifman. \u201cBut if the state shuts them down, the residents have nowhere to go.\u201d<\/p>\n

\"Retired Retired Miami-Dade Mental Health Court Judge Steve Leifman AL DIAZ adiaz@miamiherald.com <\/p>\n

Alfonso\u2019s was one of the Miami-Dade assisted living facilities that had been in litigation with the state to keep their doors open. The homes \u2014 often single-family residences converted into ALFs \u2014 are paid to house people with chronic and severe mental illness. Such residents are among the most difficult to manage, and healthcare providers are loath to see the homes shuttered.<\/p>\n

\u201cAHCA wants to close these facilities, and they\u2019re being prevented because we need them \u2014 albeit with horrific conditions,\u201d said Frank Rabbito, former chief operating officer of WestCare, a national mental health provider with programs in Miami-Dade. \u201cThe stalemate has to be broken.<\/p>\n

\u201cWe are dealing with human beings,\u201d added Rabbito, now the non-profit\u2019s senior executive advisor. \u201cWe\u2019re supposed to be better than tolerating bad conditions. We\u2019re supposed to fix them.\u201d<\/p>\n

On Sept. 17, board members for Thriving Mind, the privately run mental health service manager in Miami-Dade, discussed their concerns about conditions in assisted living facilities that house people with persistent mental illness. Some members said it\u2019s often difficult to do better with the money the state pays.<\/p>\n

\u201cALFs with a mental health license are far more challenging than one with a regular license,\u201d said board member William Delaney, vice president of Psychcare\/Beacon Health Options in Miami. By \u201cregular license,\u201d he was referring to traditional ALFs that house frail elders with dementia and infirmities of aging, but generally not behavioral disorders.<\/p>\n

Said Luis Collazo, Thriving Mind\u2019s board chair and director of Palm Breeze Assisted Living Facility, which houses people with mental illness: \u201cThere is no other place to put [them]. \u201cIt\u2019s a tough population. You can\u2019t put them in a locked-down facility or a psych hospital.\u201d<\/p>\n

There is no standard formula for reimbursing ALFs that care for people with mental illness. Rates can vary widely, depending on the funding stream, which can include Social Security or federal disability income, state public assistance programs such as Medicaid, and dollars from community behavioral health organizations.<\/p>\n

The current market rate for an assisted living bed in Miami-Dade is around $3,400 to $3,600 per month, said Laura Naredo, Thriving Mind\u2019s CEO.<\/p>\n

By contrast, one Medicaid program pays as little as $15.75-per-day \u2014 $472.50 for 30 days \u2014 for an ALF bed for a behavioral health client. Another Medicaid program for people with mental illness can pay as much as $2,400 per month.<\/p>\n

Matching a client with a bed can hinge on \u201ca number of factors, including an individual\u2019s needs, facility capabilities, regulatory requirements and available funding,\u201d Naredo said. But records suggest regulatory requirements have seldom interfered with an ALF\u2019s ability to remain open.<\/p>\n

Living in a shed<\/p>\n

In recent months, Florida regulators have documented scores of violations at the homes throughout South Florida. Caseworkers at state-funded agencies help place them there; they see the same things inspectors see.<\/p>\n

During a visit to one home in January, inspectors found a man \u2014 who needed help to walk, bathe, eat, dress, use the bathroom and transfer from place-to-place \u2014 living in a backyard electrical and air-conditioning shed at Serenity Breeze ALF, 12200 SW Second St.<\/p>\n

Other residents, all with significant special needs, were stashed behind a \u201chidden door that resembles a mirror with a bookshelf in front at the end of the hallway,\u201d an AHCA report said. Licensed for six, the Miami ALF housed 10.<\/p>\n

A woman who identified herself as the home\u2019s owner, but declined to disclose her name, said \u201cwhat AHCA wrote in that report was not accurate. Nothing AHCA said or did was legal. We\u2019re in litigation, and there is a reason for that.\u201d<\/p>\n

At Paradise Villa, a six-bed home in Cutler Bay that houses people with mental illness, a man died when the two caregivers on shift were unable to perform CPR, an AHCA report said.<\/p>\n

The man had fallen to the floor from his wheelchair and stopped breathing, the daughter of another resident told inspectors in December 2025 \u2014 the date of the incident is redacted in AHCA\u2019s report.<\/p>\n

Nobody rendered CPR until rescue workers, responding to a call from the daughter, arrived. \u201cI did not give him [CPR],\u201d one caregiver said. \u201cI panicked\u2026I was very nervous.\u201d<\/p>\n

\"A Paradise Villa, an assisted living facility at 21164 SW 92nd Place, Cutler Bay, Florida. The ALF\u2019s license status is listed as \u2018in litigation\u2019 by state health regulators after a resident died after falling to the floor from his wheelchair and stopping breathing, the state report says. The ALF caregivers did not render CPR, the report said, waiting until rescue workers arrived. Carl Juste cjuste@miamiherald <\/p>\n

Paradise Villa\u2019s license status also is listed as \u201cin litigation.\u201d<\/p>\n

Paradise Villa\u2019s owner declined to comment for this article.<\/p>\n

In late June, inspectors reported a \u201csevere\u201d scabies infestation at Green Life Assisted Living in Pompano Beach that affected more than half of 40 residents who were interviewed. The parasitic outbreak, which had gone on for months, caused itching, body rashes and \u201csevere skin irritation,\u201d a report said. One resident also reported bed bugs, though the report said staff didn\u2019t change the bedsheets.<\/p>\n

On the day of the inspection, the temperature inside the home, licensed to house 71 residents with mental illness, was 81.3 degrees.<\/p>\n

Green Life\u2019s license is listed as \u201cin review.\u201d<\/p>\n

\u201cAre we back in the Middle Ages?\u201d asked Broward Public Defender Gordon Weekes, whose office represents indigent clients facing involuntary psychiatric commitment, many of whom are placed in homes like Green Life. \u201cAre we not even attending to basic cleanliness?\u201d<\/p>\n

\"Gordon Gordon Weekes, Broward County public defender Miami Herald file <\/p>\n

Green Life\u2019s administrator, who would not disclose her name, said the air conditioner broke the morning of the inspection, and was fixed by later that day. She said it was \u201cvery common\u201d for ALFs to experience scabies outbreaks, and she believed the parasites were introduced to the facility through a resident who\u2019d been in a nursing home.<\/p>\n

The administrator said she expects the home\u2019s license to be cleared following the next inspection.<\/p>\n

Small homes, big problems<\/p>\n

At one home with a mental health license, NOA ALF, state inspectors counted three toothbrushes in a bathroom that appeared to serve five residents, records show. Inspectors documented hair and debris on the toothbrushes, which were \u201cworn and unclean.\u201d The holders were \u201cdusty and dirty,\u201d with visible residue.<\/p>\n

When inspectors asked about them, NOA\u2019s administrator said residents enjoyed using filthy toothbrushes: \u201cI know [the] toothbrushes need to be changed,\u201d the administrator said, \u201cbut [the residents] like to have their toothbrushes like that,\u201d a May 19 AHCA report said.<\/p>\n

Another inspection found a male caregiver sleeping in a female resident\u2019s room \u2013 a \u201cClass 1\u201d violation, among the state\u2019s most serious.<\/p>\n

The most severe violations documented that April involved the deaths of three residents. Details of the three deaths are scarce and heavily redacted in the state report, though the inspection says all three residents were \u201cfound unresponsive\u201d and later pronounced dead.<\/p>\n

Caregivers performed CPR on one of the deceased clients, already long dead, who had signed a do-not-resuscitate order, the report said.<\/p>\n

The resuscitation efforts occurred after the woman was \u201cfound on the floor pulseless and not breathing,\u201d a report said. When rescue workers arrived, she was already so \u201cstiff\u201d that her arms, bent at the elbow, protruded in the air.<\/p>\n

A second resident \u2014 none of the clients are identified in AHCA\u2019s report \u2014 was in rigor mortis by the time a caregiver found her and began CPR.<\/p>\n

A third resident also was found unresponsive in his room. No details are included in the inspection, and the dates of death for all three were removed from the report.<\/p>\n

NOA\u2019s owner could not be reached by the Herald for comment.<\/p>\n

Though NOA is small at 1,419 square feet, homes like it play an outsized role in Florida\u2019s system of care for both frail elders and younger people with mental illness.<\/p>\n

Florida created adult congregate living facilities, now ALFs, in 1975. It was the first state in the country to develop community homes for elders who didn\u2019t need the intensive care of a nursing home.<\/p>\n

A decade later, the Legislature agreed to license a subset of homes for the care of people with severe mental illness \u2013 thousands of whom were being released from state psychiatric hospitals, largely to save money.<\/p>\n

\u2018Cheap, easy, unregulated\u2019<\/p>\n

The policy was considered visionary and humane: People with treatable mental illnesses would be given care outside grim, isolated institutions and live in home-like settings in real communities.<\/p>\n

From the beginning, the reality failed to match the promise.<\/p>\n

Fifteen years ago, then-Miami-Dade Mental Health Court Judge Leifman called the homes \u201ca cheap, easy, unregulated system of care\u201d filled with dangerous, decrepit homes.<\/p>\n

Little has changed, he said in a recent interview, other than his retirement last year. \u201cThe most vulnerable get treated the worst,\u201d he said.<\/p>\n

It\u2019s no secret, Leifman said, that some of the homes with the worst records stay in business thanks to the largess of the state of Florida, whose social service agencies move residents in, sometimes without their consent.<\/p>\n

Naredo, Thriving Mind\u2019s CEO, said state and local health administrators have a responsibility to vet assisted living facilities that accept people with mental illness and special needs. Thriving Mind oversees 40 Miami-Dade mental health agencies.<\/p>\n

\u201cThey should be doing due diligence to ensure that homes are safe, licensed and meeting standards,\u201d she said.<\/p>\n

Ideally, Naredo said, community mental health agencies should receive \u201calerts\u201d or other warnings when health regulators are trying to strip a home\u2019s license.<\/p>\n

\u201cUnfortunately, that doesn\u2019t exist in the state of Florida,\u201d she said. \u201cThat definitely is a gap within the system.\u201d<\/p>\n

AHCA officials did not respond to the Herald\u2019s queries.<\/p>\n

A failure to communicate<\/p>\n

AHCA administrators fined Alfonso\u2019s ALF, 17010 SW 100th Ave., 13 times since 2016, for a total of $76,500. And while many of the deficiencies involve record-keeping or other less-serious infractions, some violations represented \u201can immediate danger to residents\u2026 or [carried] a substantial probability that death or serious physical\/emotional harm will result,\u201d the state reports said.<\/p>\n

Alfonso\u2019s owner did not respond to messages from the Miami Herald and could not be reached.<\/p>\n

Beginning in late 2025, Alfsonso\u2019s had been the subject of three scathing AHCA inspections.<\/p>\n

An April 20 inspection identified 15 infractions, including six that were among the state\u2019s most severe. Ten of the violations had been uncorrected from a prior inspection.<\/p>\n

The next month, health administrators announced they would not renew Alfsonso\u2019s license, citing 31 violations from November 2025 through April 2026, some of them severe.<\/p>\n

The notice said residents were living in threadbare conditions, without space to hang their clothes and lacking nightstands and lamps. The home had moved residents into a nearby space that was operating without a license, the notice said.<\/p>\n

The most serious allegations involved the deaths of two clients, identified only as Resident 1 and Resident 7. The deaths were detailed in a 79-page administrative complaint AHCA filed against the home.<\/p>\n

Resident 1 needed help with virtually every aspect of his daily life: eating, bathing, going to the bathroom, moving around. He required a special diet and help taking his medications.<\/p>\n

He fainted on Jan. 1, his eyes rolling back. A cardiologist at a hospital ordered the next day that a prescribed blood pressure medication be discontinued.<\/p>\n

But for more than two months, the home administered the drug to him, even increasing its dosage, a report said.<\/p>\n

Inspectors arrived at the home early on the morning of Nov. 21, 2025, and found the man sitting at a table \u201cbreathing coarsely with a loud wheezing sound.\u201d<\/p>\n

When asked if he was alright, the man could only say \u201cwheezing,\u201d one of a few words the Haitian immigrant could say in English. For the next four hours, staff left him in a recliner, waiting for a caseworker to take him for treatment.<\/p>\n

While they waited, staff gave him a pill unrelated to his shortness of breath, the report said. And when asked why he administered a heart drug for wheezing, a caregiver replied, \u201cI didn\u2019t care what he said; I made the decision when to give him the medication.\u201d<\/p>\n

Staff at Alfonso\u2019s had discussed moving him to a home where he could communicate with caregivers, the report said. Instead, they negotiated an increase in their rent payment with the man\u2019s case management agency from $2,500 per month to $3,000.<\/p>\n

The higher rent didn\u2019t pay for a translator.<\/p>\n

Two months later, records say that, while again sitting in the recliner, he gasped for air, his \u201ceyes went white, and he slid out of his chair and fell to the floor.\u201d<\/p>\n

He died.<\/p>\n

Health inspectors claim that the actions of Alfonso\u2019s caregivers also led to the death of Resident 7, who had chronic obstructive pulmonary disease, a life-threatening lung condition, as well as bipolar disorder.<\/p>\n

He had trouble breathing on May 9, 2025. When emergency rescue was called, they found him breathing through a nebulizer without medication in it. His oxygen saturation was 50 percent, a level well below the 95 to 100 percent considered safe.<\/p>\n

A state report concluded: \u201cThe facility failed to make immediate medical arrangements for Resident #7, who was having difficulty breathing, which resulted in the resident being transported to the hospital, where he died.\u201d<\/p>\n

The state accused the home of using Wite Out and other methods to alter documents.<\/p>\n

In March, AHCA fined the home $20,000, then another $39,500 in May. That month, AHCA informed Alfonso\u2019s owners it would refuse to renew the home\u2019s license. The state closed it this summer.<\/p>\n

Say nothing<\/p>\n

In southwest Miami-Dade, a neighbor called police after she found the body of a woman drifting in a lake face-down about a mile from Lago Place ALF, a June 13 report said.<\/p>\n

\"A Lago Place, an assisted living facility at 10711 SW 52nd Terrace in Miami-Dade, where a resident drowned in a lake behind the home, according to a June 2026 state report. State regulators cited the home, saying in a report, \u2018There was no immediate response by facility staff to search for and account for all the residents in the facility after there was a reported missing person.\u2019 Carl Juste cjuste@miamiherald <\/p>\n

The AHCA report suggests the unidentified woman likely had been missing for hours from Lago. A neighbor told police he thought he saw a manatee surfacing on the lake at 5:30 a.m.<\/p>\n

When the floating object was identified as a person, the neighbor\u2019s wife asked a Lago caregiver through a language translation app if anyone was missing. She was told no, the report said.<\/p>\n

A gated chain link fence between the ALF, on Southwest 52nd Terrace, and the backyard lake had been broken, a report said.<\/p>\n

\u201cThere was no immediate response by facility staff to search for and account for all the residents in the facility after there was a reported missing person,\u201d the report said.<\/p>\n

Inspectors cited the home for failing to \u201censure that the facility records [about the incident] were not falsified.\u201d<\/p>\n

Lago Place\u2019s owner, who could not be reached by the Herald for comment, also refused to give inspectors video documenting when the deceased woman left the building, the report said.<\/p>\n

A resident told health inspectors earlier this month clients were verbally abused and forbidden to speak with state monitors who were investigating a resident\u2019s death.<\/p>\n

\u201cDon\u2019t say anything to them,\u201d the owner of the home was overheard telling a caregiver during the investigation.<\/p>\n

Though Lago Place\u2019s license is \u201cin litigation,\u201d to stay open, it still houses residents with mental illness under the care of the state.<\/p>\n

Miami Herald reporters Ana Claudia Chacin, Shirsho Dasgupta, Milena Malaver and Linda Robertson contributed to this report.<\/p>\n

This story was originally published September 25, 2026 at 12:58 PM.<\/p>\n","protected":false},"excerpt":{"rendered":"The former site of Alfonso\u2019s ALF, 17010 SW 100th Ave., which state regulators shut down in the summer…\n","protected":false},"author":2,"featured_media":627795,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[163,521,85,46],"class_list":["post-627794","post","type-post","status-publish","format-standard","has-post-thumbnail","category-healthcare","tag-health","tag-healthcare","tag-il","tag-israel"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/627794","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/comments?post=627794"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/627794\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media\/627795"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media?parent=627794"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/categories?post=627794"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/tags?post=627794"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}