JAMES MAY choked to death at the breakfast table of his care home, and no one was there to help him. Caregivers at the home where May lived, The Circle-Los Altos in Walnut Creek, were supposed to prevent the severely mentally retarded and autistic 51-year-old man from choking on food. But the only worker in the home on the day he died had just run out the front door in pursuit of May's twin brother, leaving May and the home's four other residents unsupervised.

Two workers were supposed to be on duty that day. But the other caregiver was running late for work, records show.

So May was left alone to grab a sausage off another resident's plate, according to licensing records documenting his September 1999 death. He was without air for 10 minutes when the paramedics arrived. He went into a coma and never regained consciousness, licensing records show.

More than six years later, The Circle-Los Altos and two other homes owned by the same care provider remain open.

The home is one of many identified in this newspaper's investigation that are still open and still collecting state dollars for providing care despite troubles that ranged from long lists of licensing violations and police calls to abuse, neglect and deaths. They are part of a state system that demands little of them.

Some 26,000 of California's 200,000 developmentally disabled residents — people who are mentally retarded, have Down syndrome,

are autistic or have other disabilities — get some type of community-based care, state data show, and many of them are in licensed care homes like The Circle-Los Altos, which are in residential neighborhoods all over the state.

Many have been placed in care homes over the past dozen years, as the state emptied its institutions. Two state institutions for developmentally disabled people closed in the late 1990s and a third, Agnews Developmental Center in San Jose, is slated for closure in the near future.

Many people are getting good services and leading happy lives in the community, those who work with them say.

But others are being poorly cared for, according to the investigation of 300 care homes in Alameda, Contra Costa and San Mateo counties, which included more than 100 interviews and analysis of thousands of pages of public licensing reports and other documents spanning back to 1999.

The investigation shows a care system whose low standards, poor funding and limited oversight spell trouble for the more severely disabled people it is now expected to serve — people the system was never set up for in the first place.

And it shows that the state agency ultimately responsible for the welfare of the developmentally disabled — some of the state's most vulnerable people - has little direct involvement in their care.

It found:

-A private, for-profit care system that doesn't require any special expertise of the people who own, operate or staff care homes.

- Care rates that are so low that those who own the homes say they struggle to stay in business, provide proper care and hire and keep qualified caregivers.

-A system that was not set up for the more severely disabled people it is increasingly expected to help — people who are autistic, have criminal histories, are dually diagnosed with a mental illness and developmental disability and seniors.

-Fragmented oversight that routinely lets troubled care providers off the hook for even the worst offenses.

Thousands of citations?

The state agency that directly oversees the care homes — Community Care Licensing — issued citations for more than 3,300 deficiencies over a five year period this newspaper looked at, for everything from missing background checks and first aid cards to inadequate food for clients and abuse and neglect. But the citations seldom came with any material repercussions.

Between 1999 and 2003, homes were fined a total of $24,300, records showed less than the $25,000 a nursing home monitored by the state health department's licensing arm would be fined for a single death it was found responsible for.

Even homes that were cited for abusing clients or for failure to properly supervise their charges faced little punishment, licensing records show: Most were told only to come up with plans to fix the problems. Over the five years, the state shuttered just 20 homes of the 300 in the investigation.

But even those punishments aren't necessarily final. Care providers whose homes were closed can apply to open new ones, after a two-year break.

And workers whose conduct gets them banned from care homes can apply to modify the ban after a year.

James May was one of 17 people who died in the three counties' care homes between 1999 and 2004 whose deaths were detailed in licensing and police reports. In most of those cases, licensing workers investigated deaths but did not hold the homes responsible. But a physician specializing in the care of developmentally disabled people who examined the records says that caregivers' actions may have contributed to some of the deaths.

State licensing officials investigated May's death, said they planned to identify The Circle-Los Altos as a "problem facility" and threatened legal action to shut the home down. But they never followed through, records show.

Instead, licensing cited the home for violating May's personal rights and for failure to supervise him properly. Licensing officials allowed its owner to write a plan to fix the problems, as they would for any deficiency at a care home. They also monitored the home closely, a state social services spokeswoman said. The home has been in compliance with regulations since, she said.

"Anytime a person dies, you have to give cause, to show that's not the norm," the care home's owner, Arthur "Duke" Green, said during a brief interview at the home, in which he called May's death unexpected.

"That's what we did. Just make sure somebody was around all the time."

A conference with licensing officials as a prelude to closure was scheduled in December 2000 but not held, records show.

Licensing officials did only a partial inspection of the home in 2001 and none in 2002, records show. No 2003 records were available for the home, and the state did not have additional reports detailing incidents in the home.

Officials at the Regional Center of the East Bay, the non-profit agency that placed May in the home, called the problems that caused his death part of a "broad staffing issue" in the community care system due to a lack of funding. And the Mays' half-brother, Michael May, defended the home.

"What happened with James was — it was sad. It shouldn't have happened," May says. "On the other hand, if you go there and see the demands, you realize that nothing is perfect."

Limited oversight?

The state agency that is ultimately responsible for care for developmentally disabled people, the Department of Developmental Services, has delegated its responsibility to 21 nonprofit community agencies called regional centers, which are in charge of assessing people's need for services, arranging for those services to be provided and paying the bills for them. Regional centers also monitor those services.

Care providers say they feel the regional centers have too much power and too little oversight from the state. Some accuse regional center workers of dumping clients the care providers can't handle into their homes and refusing to take them back when troubles occur.

But it's hard to know exactly what actions the regional centers take, because their records are legally exempt from public disclosure. State officials say they got the exemption to protect client privacy and because regional centers are not public agencies.

All the state will release is the number of deaths and other types of incidents. But those numbers aren't broken down by where the incidents occurred — at a family home, care home or state institution — or, in the case of deaths, how a person died.

Regional center directors say they lack the power they need to make sure everyone gets proper care. They say they must work with everyone who wants to open a care home in their area, and can only cut off the flow of vulnerable people and the dollars that follow them under the most dire circumstances.

Regional Center of the East Bay Executive Director Jim Burton, whose agency works with 13,000 developmentally disabled people in Alameda and Contra Costa counties, has hundreds of open care home beds but few places that meet the needs of some of his most disabled clients, more of whom have autism and other severe medical and behavioral problems than ever before. And he lacks the funding to create those resources.

Many care providers feel the state has done little to help them in their struggle to provide care.

Except for two raises for caregiver pay, in 1997 and 1998, the state has not increased care provider rates in two decades, according to one regional center director. Even with those raises, the state estimates average caregiver pay at $10 an hour, competitive with fast food outlets and less than the roughly $16 an hour starting pay at state institutions.

The state approved a 3 percent rate increase for next year, which care providers say is far less than they need.

Care providers also complain the state offers little guidance on how they might best run their homes on the money the state pays.

But the state expects far less of the care homes than it does of the institutions it is directly responsible for.

Training gap?

Caregivers working with the same population in five state-run institutions must take at least 150 hours of training before they can even walk through the door, and those who do jobs their community counterparts routinely perform — like passing out medications — need 1,500 hours of training.

In contrast, community caregivers get just 70 hours of training, while they are on the job.

And it is the same training for everyone, regardless of the clients' level of disability.

Even if caregivers had more training, they don't always have the power to protect their charges from harm. They cannot lock the doors in their care homes. And if a client decides to leave, they don't have the right to stop them, care providers say.

So when clients spin out of control or disappear, their caregivers often call 9-1-1, police records show. Often, they are sent to county psychiatric hospitals that are not set up to care for them, say those who run them.

Caregivers call 9-1-1 when a client is victimized or when they commit a crime, records show. But often, the criminal justice system fails them, too.

Even care providers admit they are not equipped to handle everyone.

"We probably need some type of locked facility, not run by us," says Wardell Jackson, president of the Association of California Care Operators, which represents 75 care providers.

"We're not ready to handle some of the consumers coming out of the state hospital."

Contact Michele R. Marcucci at mmarcucci@angnewspapers.com.