Ownership/Operator History of Comprehensive at Williamsville

Staffing:

Comprehensive at Williamsville has a Care Compare 2-star (out of 5 stars) staffing rating; below average.17 This number is seen as a decrease compared to prior years.

Quality Measures:

Comprehensive at Williamsville has a Care Compare 3-star (out of 5 star) rating for quality measures, which are primarily based on facility self-reported data.18

Ratings:

Care Compare ranks Comprehensive at Williamsville as an overall 1-star facility (out of 5 stars), much below the average. Comprehensive at Williamsville is ranked in the worst quintile for the NYS Nursing Home Quality measure and has ranked the worst since 2016.19

Federal and State Enforcement:

Comprehensive at Williamsville recently agreed to pay state fines due to the violations that occurred in December, 2020 ($2,000), October, 2020 ($12,000) and May, 2020 ($14,000). They were also ordered to pay one federal fine in the last 3 years in August, 2021 ($9,750). These stemmed from various regulatory deficiencies, many of which dealt with their handling of the COVID-19 pandemic inside their facility.

Prior to the pandemic, the largest fine paid by Comprehensive at Williamsville were state fines during June, 2016 for multiple deficiencies ($21,000) and February ,2016 ($20,000) for quality of care.

Ownership Background Through Today

The not-for-profit Catholic Health System owned and operated St. Francis Home of Williamsville (“St. Francis”) for many years. It was reported that St. Francis and two Adult Homes, St. Elizabeth’s Home of Lancaster and St. Vincent’s Home of Dunkirk, were experiencing financial loss. 20 In January, 2014, it was announced that Ephram Lahasky and his partners at Comprehensive Healthcare Management Services LLC21 were buying St. Francis and the two

17 CMS Provider October 1, 2022 18 Id. 19 NYS DOH Nursing Home Quality Initiative: https://www.health.ny.gov/health_care/medicaid/redesign/nursing_home_quality_initiative.htm 20 Drury, Tracey, “New owner sees promise in Catholic Health nursing homes”, Buffalo Business First, January 17, 2014, https://www.bizjournals.com/buffalo/news/2014/01/17/new-owner-sees-promise-in-catholic.html . 21Ephram Lahasky, Joshua Farkovits, David Gast, Sam Halper

Adult Homes.22 On May 13, 2014, an application for change in ownership for Comprehensive at Williamsville was received by the DOH.23 On December 12, 2014 the ownership change was contingently approved and the official takeover of operations, according to available records, occurred in May, 2015.24

Comprehensive Healthcare Management Services LLC closed on the two Adult Homes25 on March 7, 2016 and renamed them Symphony Manor of Lancaster26 and Symphony Living at Dunkirk. 27 In December, 2017, it was reported that Symphony Living at Dunkirk would close, leaving 3 dozen seniors and their families to search for new homes by December 31, 2017.28 The DOH lists Symphony Living at Dunkirk as voluntary closed January 7, 2018. 29 Shortly after the purchase of Symphony Manor at Lancaster, the DOH conducted its periodic annual inspection and found serious violations of state minimum standards.30 During its next annual inspection period from April, 2017 to September, 2017, the DOH identified deficiencies that were classified as Immediate Jeopardy/Endangerment, the most serious category.31 On November 15, 2017, a new temporary operator was appointed to run the Adult Home, ending Comprehensive Healthcare Management Services’ control.32 In December, 2017, it was announced that Comprehensive was seeking to sell the adult home.33

22 Drury, Tracey, “New owner sees promise in Catholic Health nursing homes”, Buffalo Business First, January 17, 2014, https://www.bizjournals.com/buffalo/news/2014/01/17/new-owner-sees-promise-in-catholic.html . 23 CON Project # 141213-E https://apps.health.ny.gov/facilities/cons/nysecon/ProjectInformation.action 24 Id. With final approval letter sent on April 29, 2015. 25 Adult Homes are known as Adult Care Facilities. Adult Care Facilities provide long-term, non-medical residential services to adults who are substantially unable to live independently due to physical, mental, or other limitations associated with age or other factors. There are multiple types of Adult Care Facilities. For more information; https://www.health.ny.gov/facilities/adult_care/intro.htm. 26 In CELJ obtained documents from the DOH via FOIL request, the sole owner of operations was Ephram Lahasky. Broadway Lancaster Realty, LLC was the owner of the property. Members of Broadway Lancaster Realty, LLC were listed as: Jeffrey Arem (10%), Raphael Lichtschein (22.5%), Joshua Farkovitz (22.5%), Ephram Lahasky (22.5%) and David Gast (22.5%). 27 See, Drury, Tracey, “Catholic Health Completes Sale on 2 Adult Homes”, March 17, 2016, Buffalo Business , March 17, 2016, , https://www.bizjournals.com/buffalo/news/2016/03/17/catholic-health-completes-sale-on-2-adulthomes.html and https://www.bizjournals.com/buffalo/news/2014/05/22/li-nursing-home-operator-confident-onturning-st.html. 28 Drury, Tracy, Shutdown looms for Dunkirk adult home,” Buffalo Business First, December 12, 2017 https://www.bizjournals.com/buffalo/news/2017/12/12/shutdown-looms-for-dunkirk-adult-home.html . 29 https://www.health.ny.gov/facilities/adult_care/docs/acf_do_not_refer_list.pdf . It was also reported that Symphony Living at Dunkirk was closing due to the cost of updating the sprinkler and call bell system. Both of which were a requirement of the purchase of the facility. See “Symphony Living closing doors due to inability to fulfill agreements”, Observer, December 30, 2017, https://www.observertoday.com/news/topstories/2017/12/symphony-living-closing-doors-due-to-inability-to-fulfill-agreements/. 30 For example DOH found on 62 shifts between 4/3/2016 and 5/25/2016 were not covered by any staff qualified to administer basic first aid.; at least 18 residents missed approximately 102 doses of prescribed medications because the medications were not in the facility at the time assistance was scheduled to be provided. DOH Event ID# 2WXV11, June 24, 2016. 31 Upon identification of the Immediate Jeopardy deficiencies, DOH remained at the facility for over 40 days, pending the correction of those deficiencies. DOH Event ID YRBA11, November 14, 2017. 32 Letter dated November 15, 2017, issued to facility residents and family members. 33 Drury, Tracy, “Shutdown looms for Dunkirk adult home,” Buffalo Business First, https://www.bizjournals.com/buffalo/news/2016/03/17/catholic-health-completes-sale-on-2-adult-homes.html

In order to operate a nursing home, the DOH must approve the prospective operator through the Certificate of Need (“CON”) application process.34 The members of Comprehensive Healthcare Management Services LLC filed the CON application to become the new operators of St. Francis, to be renamed Comprehensive Rehabilitation and Nursing Center at Williamsville. The new operators would also hold interest in the company that owned the real estate. The CON stated the facility was currently operating at a loss due to excess staffing costs and that the proposed members would implement staffing reductions where overages existed and renegotiate the labor costs. In addition, the CON details that facility expenses were expected to decline from a reduction in salaries and wages and fringe benefits.35

Comprehensive Healthcare Management Services members:

Ephram “Mordy” Lahasky (33.33% member) has at least 5% or greater ownership interest nationally in 61 nursing homes as detailed in Care Compare.36 This is an under count as Mr. Lahasky has testified he owns three nursing homes in NYS, several hundred nursing homes outside of NYS, that includes approximately 65 homes via his ownership interest in Diversicare.37 It has been reported that he invested in the nursing home business in 2012, through Benjamin Landa, who at the time lead SentosaCare.38 In addition to his nursing home investments, he operates medical transport businesses such as Sinai Transportation, a NYC ambulette company and Emergency Ambulance Service. Mr. Lahasky attempted to purchase 3 nursing homes in Vermont, even removing his name and adding his wife to the list of prospective operators.39

Sam Halper (33.34% member) has at least 5% or greater ownership in 7 nursing homes as detailed in Care Compare.40 As of August 9, 2022, Sam Halper who has a 10% ownership stake in Comprehensive was indicted on charged of conspiracy to defraud the United States as well as other health care related fraud charges with several others. 41 Comprehensive Healthcare Management Services, LLC. was named in the superseding indictment. Although this indictment relates to

34 For additional information on the CON process, visit: https://www.health.ny.gov/facilities/cons 35 CON #141213 at page 11 36 CMS Provider October 1, 2022 37 See AG Verified Petition at #40 https://ag.ny.gov/sites/default/files/orleans_nh_petition.pdf 38 See Marketwatch report, March 23, 2022, https://www.marketwatch.com/story/all-you-hear-about-is-the-badstuff-ephram-lahasky-has-a-new-investment-model-for-americas-nursing-homes-regulators-have-questions11648041864 . 39 See Brouwer, Derek, Investors with Questionable Records Want to Buy Five Vermont Nursing Homes Will the State Let Them?”, Seven Days (Published July 21, 2021, updated December 26, 2021). https://www.sevendaysvt.com/vermont/investors-with-questionable-records-want-to-buy-five-vermont-nursinghomes-will-the-state-let-them/Content?oid=33429007 and “Private Equity Group Drops Bid to Purchase Five Vermont Nursing Homes”, https://www.wehmeyerre.com/private-equity-group-drops-bid-to-purchase-fivevermont-nursing-homes/ 40 CMS Provider October 1, 2022 41 Press Release, US Attorney’s Office Western District of Pennsylvania, Five Individuals and Two Nursing Facilities Indicted on Charges of Conspiracy to Defraud the United States and Health Care Fraud, (August 9, 2022). https://www.justice.gov/usao-wdpa/pr/five-individuals-and-two-nursing-facilities-indicted-chargesconspiracy-defraud-united