The Kentucky agency that oversees youth care facilities said it will permanently remove children from the Louisville youth residential treatment facility where a 7-year-old boy suffocated to death in July and will also revoke its license to operate.
The action against Brooklawn, a psychiatric residential treatment facility, comes after an investigation into the death of Ja’Ceon Terry, 7, on July 17, the Kentucky Cabinet for Health and Family Services said in a statement Thursday.
The Jefferson County Coroner’s Office ruled the boy’s death a homicide by “positional asphyxia” in September. An NBC News investigation into the facility revealed allegations of wrongdoing at the site and at its sister campus several years before Ja’Ceon died.
In a statement to NBC News, Uspiritus said it is "completely devastated" by Ja’Ceon's death and has made changes to its operation in the months that have followed.
"In the five months since, we have made extensive changes to prevent serious harm, including dismissing employees, retraining staff, and increasing supervision," Uspiritus said in the statement. "We have also worked cooperatively with all investigations, including those by local law enforcement.”
The monthslong investigation by the Cabinet’s Office of Inspector General and Department for Community Based Services cited several “failures” at the Brooklawn facility.
It found that Brooklawn did not maintain staffing ratios required to assure that residents were adequately supervised; failed to “prohibit cruel and unusual disciplinary measures including verbal abuse, ridicule or humiliation”; and didn’t record and keep records of accidents or other incidents that posed threats to residents and staff.
“These areas of non-compliance ultimately led to the death of a child,” the inspector general said in a letter sent to Uspiritus on Thursday.
Uspiritus can appeal the license revocation, Susan Dunlap, a spokesperson for the agency, said Thursday, adding that the failures cited in the statement of deficiencies are preliminary "until the appeal window for the licensee has expired."
The state, which stopped placing children in foster care at Brooklawn following Ja’Ceon’s death, directed Uspiritus to safely transition any children who remain at Brooklawn to alternative placements within 15 days.
Uspiritus said in its statement that it disagrees with the Cabinet's decision but will “fully comply with the state’s order to move the seven children remaining in our care from these cottages within 15 days."
"We will begin this process after these children celebrate the holidays and open their many gifts so generously provided by donors and supporters," the statement said.
On the day Ja’Ceon died, a program manager recalled being told that the child had been held in a chokehold by two employees and that he began to vomit, according to a source with knowledge of the encounter.
The facility said that immediately after the incident it “dismissed” the two employees who it says were involved and the state suspended new foster care placements at Brooklawn.
Police and state officials say they are still investigating Ja’Ceon’s death, and no charges have been filed.
“Today’s action should give clear warning that the cabinet will aggressively investigate and take action when Kentuckians in its care are harmed or exploited,” Eric Friedlander, secretary of the Kentucky Cabinet for Health and Family Services, said in a statement. “This outcome is necessary, but nothing we do will bring back Ja’Ceon Terry.”
“The cabinet is charged with the safety and well-being of vulnerable Kentuckians, especially children, and that’s why we have taken steps to revoke Brooklawn’s license.” Freidlander said. “What took place at Brooklawn is a tragedy.”