Guards at the Adelanto Immigration and Customs Enforcement Processing Center, the country’s largest privately run immigration detention facility, have allowed immigrants detained there to regularly hang “nooses” of braided bedsheets in their cells, despite multiple suicide attempts over the past year, according to a report made public Tuesday by the Department of Homeland Security’s Office of Inspector General.

The finding comes from a scathing “alert” based on an unannounced visit in May to the California detention center. During that visit, federal inspectors found guards improperly putting immigrants in disciplinary segregation without first going through a formal disciplinary hearing, guards improperly shackling detainees, doctors checking off medical forms without actually visiting detainees, detainees going so long without dental care they lost teeth, and some detainees waiting dangerously long for medical care, which was so insufficient in the facility that it could be blamed for three deaths.

The immigrants at the facility had been detained for illegally crossing the border or living in the U.S. illegally, and most were accused of no other crimes.

The report found that 15 out of 20 cells inspected had these “nooses.” Some detainees said they could be unfurled to create a sense of privacy in their cells or serve as a clothesline, but in an interview, one detainee told inspectors, “I’ve seen a few attempted suicides using the braided sheets by the vents, and then the guards laugh at them and call them ‘suicide failures’ once they are back from medical.”

In March 2017, one man had died from suicide using a bedsheet noose, according to the report. Afterward, there were two more suicide attempts involved bedsheets. There were seven suicide attempts in total from December 2016 to October 2017. “ICE’s lack of response to address this matter at the Adelanto Center shows a disregard for detainee health and safety,” the report concluded.

The haphazard use of segregated detention violated ICE standards too. Guards were found to have used it without following proper protocol, and detainees with limited English were not told in Spanish why they were being detained separately.

One detainee with a disability requested to be placed on “administrative segregation” but was instead placed in disciplinary segregation, where he was kept in his wheelchair for nine days, never leaving to sleep in a bed or brush his teeth. “We also observed medical staff just looking in his cell and stamping his medical visitation sheet rather than evaluating the detainee,” the report said.

Medical care seemed persistently negligent:

From November 2017 to April 2018, detainees filed 80 medical grievances (about 34 percent of all grievances filed) with the center for not receiving urgent care, not being seen for months for persistent health conditions, and not receiving prescribed medication. Four of the 13 detainees we interviewed reported waiting weeks and months to see a doctor. They also reported that their appointments were sometimes canceled with no explanation, and that they were then placed back on the waiting list for a future appointment. In 2017, the medical unit conducted a quality improvement investigation and identified 60 to 80 clinic appointments that were canceled because contract guards were not available to take detainees from their cells to their appointments.

ICE’s review of three deaths in the center since 2015 blamed “medical care deficiencies related to providing necessary and adequate care in a timely manner.”

ICE oversees the facility, which holds nearly 2,000 adults, but it is operated by the Geo Group. The group is supposed to follow standards set by the government, but the Adelanto Center has been the subject of numerous complaints, and last year, about 35 detainees held a hunger strike over the conditions.

According to the New York Times, ICE said it was “implementing corrective actions” to make sure the center meets requirements and that it would conduct a “full inspection of the facility.”

But the problem is likely not limited to Adelanto, as ICE has come to rely increasingly on these private contractors to manage their facilities. The stringent immigration policies of the Trump administration has led to a rapidly growing detainee population, which has put a strain on the already existing facilities. According to the Times, there are more than 40,000 immigrants in detention in the U.S.