FACILITY REPORT SILVER OAK ACADEMY JULY - SEPTEMBER, 2009

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1 MARLANA R. VALDEZ Director STATE OF MARYLAND OFFICE OF THE ATTORNEY GENERAL JUVENILE JUSTICE MONITORING UNIT FACILITY REPORT SILVER OAK ACADEMY JULY - SEPTEMBER, 2009 Facility: Silver Oak Academy 999 Crouse Mill Road Keymar, Maryland Facility Administrator: James Bednark Date(s) of Visit: July 27, September 2 and October 2, 2009 Reported by: Philip J. Merson Senior Monitor Persons Interviewed: Silver Oak Administrators, Directors, Direct Care Staff and Youth. DJS Office of Inspector General, DJS Child Advocate, Carroll County State Attorney s Office, Carroll County Department of Social Services and Carroll County Office of the Public Defender. Date of Report: November 2009.

2 INTRODUCTION The Silver Oak Academy (SOA) is a privately owned staff secure residential program owned and operated by Rite of Passage, Inc. The Maryland Department of Juvenile Services (DJS) licenses the facility. DJS licensed the facility to house no more than 48 delinquent male youth and began admitting youth into the program on July 6, As of October 2, there were 16 youth at the facility. The facility is located in northern Carroll County in Keymar, Maryland on the grounds of the former Bowling Brook Academy. SUMMARY OF CRITICAL FINDINGS DJS did not record the facility s incidents in the DJS Incident Reporting Database until this Office notified DJS. Subsequent to beginning these database entries, the facility still failed to report some physical restraints to DJS. The facility s program may not be appropriate for some of the youth referred by DJS. Some staff are not reporting suspected child abuse. Silver Oak s medical department did not maintain an altercation/injury log until notification by this Office. Subsequent to that date, the facility still did not enter some youth listed as restrained in reports into the Altercations Log. A youth with an AWOL history, including an AWOL from the Rite of Passage facility in Arizona in April of this year, attempted to escape from Silver Oak on September 17. Another youth attempted to escape from Silver Oak on September 26 and claimed he was hurt during a restraint. On September 27, staff restrained the youth again and he alleged staff abused him. The Department of Juvenile Services Office of the Inspector General did not assist police or child protective services in the investigation of an alleged physical child abuse until notified by this office. A youth with a documented knee injury was forced to run 3 miles. 1. Population FINDINGS As of October 2, there were 16 youth in the program. According to DJS ASSIST, 6 of the youth are from Baltimore City, 2 are from Baltimore County, 2 are from Howard County, 2 are from Carroll, 2 are from Prince Georges, 1 is from Charles and 1 is from Calvert. During a monitoring visit on October 2, the Monitor discovered one youth in the program who had not been entered into the DJS ASSIST population record. The youth had been at Canyon State, a Rite of Passage facility in Arizona since July 15, and DJS transferred him to Silver Oak on September 24. His new placement had never been Silver Oak Academy 2

3 recorded. The youth was transferred to SOA even though he had escaped from Canyon State on August 13. Many SOA youth have been adjudicated delinquent for serious charges including: 1 st Degree Assault, Handgun Violations, Robbery with a Deadly Weapon, Carjacking, Robbery, Theft, Escape and Illegal Drug violations. At least 10 of the youth had histories of AWOL and/or Escape. One had spent 9 months in an adult facility for Armed Robbery until the court waived his case down to Juvenile Court on September 8, He started the Silver Oak program on July 6, Applicable Standard DJS Incident Report Policy MGMT (T)he Program s management staff shall ensure a DJS Incident Reporting Form is completed, entered into the DJS Incident Reporting Database and electronically forwarded to OIA by 9:00a.m. the next business day. If access to the DJS Incident Reporting Database is not available, the DJS Incident Reporting Form shall be faxed to the attention of the OIA Administrator by 9:00 a.m. the next business day following the incident. 2. Staffing a. Staff:Youth Ratio The staff:youth ratio is very good at this time due to the low number of youth in the program. Currently, there is at least one staff person for every 5 youth.. b. Staff Training A DJS Quality Improvement Audit on July 28 indicated several staff still needed required training in specific areas required by COMAR. DJS auditors examined 10 personnel files and the report said compliance was 70% at best in the required areas for training. 3. Safety and Security a. Aggregate Incidents As noted below in section c, there are some concerns about SOA and DJS not reporting incidents correctly; however, the following data was obtained from the DJS Incident Report database on October 1, after the facility began reporting incidents directly into the database. The period covered is from July 1 through September 30, Silver Oak Academy 3

4 Primary Designations of Incidents (determined by the precipitating event according to DJS): Physical Restraints: 1 Alleged Physical Abuse: 1 Alleged Inappropriate Conduct/Comments by Youth: 7 Attempted Escapes: 2 Note: There were 11 total physical restraints for the reporting period; including incidents not labeled primarily as restraints by DJS (2 of those incidents were not reported to DJS). b. Escapes/Physical Abuse Some youth at SOA with histories of escape and violence may jeopardize the safety of the community. A youth attempted escape from the facility on September 17, and staff captured him trying to leave the grounds. 1 The youth had a history of AWOL s and escape. He had escaped from the Rite of Passage/Canyon State facility in Arizona and reportedly attempted to escape three more times since his admission to Silver Oak on July 6. Following the most recent incident, DJS sent the youth to the Charles Hickey School (secure detention), but when the youth went to court, Silver Oak accepted him back into the program. According to the DJS Incident Report, the youth then tried to incite a riot at the facility and police finally removed him on September Another youth attempted to escape from the facility on September 26 and alleged he was hurt during a restraint. 3 On September 27, the same youth was again restrained and alleged physical abuse. 4 He complained that his neck was hurt when staff slammed him on the bathroom floor. The DJS Incident Report said the youth had hurt his neck the previous day during football practice, but no incident report indicated a previous injury. The Silver Oak Director said no incident report was submitted for the football injury because there was no specific injury noted at the time and the complaint was just general in nature. The nurse failed to report the allegation of abuse to CPS as required. When the youth told the nurse he was abused, she said, She could not report it since staff informed her he was injured in a football game the previous day. 5 Silver Oak administration did report the allegation to CPS. In that investigation, the youth told the investigator the nurse had lied about his injury. According to the CPS 1 DJS Incident Report Number DJS Incident Report Number DJS Incident Report Number DJS Incident Report Number Ibid. Silver Oak Academy 4

5 investigator s report, the youth said he told the nurse he hurt his neck from the restraint but she wrote in her report he injured his neck while playing football. The nurse told the investigator [the youth] came to her on September 27 at 8 a.m. reporting he strained his neck while playing football the night before Later that day, about 1 p.m. [the youth] claimed he was restrained by staff and his neck was sore. Carroll County Child Protective Services investigated the September 27 allegation. However, DJS/OIG and CPS did not collaborate and CPS did not consider information from the restraint and alleged injury from the September 26 incident. JJMU contacted the Carroll County Child Advocacy Center, DJS/OIG and Carroll County Child Protective Services. The three agencies re-opened and began coordinating their investigation. Applicable Standards DJS Mission Statement The Department of Juvenile Services ensures the safety of the community and the well-being and safety of the youths under DJS care, and holds juvenile offenders accountable to victims and communities Maryland Family Law Not withstanding any other provision of law, including any law on privileged communications, each health practitioner, police officer, educator, or human service worker, acting in a professional capacity in this State who has reason to believe that a child has been subjected to abuse, shall notify the local department or the appropriate law enforcement agency DJS Services Standards of Conduct [The Inspector General] is responsible for contact with officials, other agencies, and appropriate government bodies regarding the operation of the [OIG]. c. Incident-Related Procedures, Practices, and Reporting During the quarter, several issues regarding incident reporting arose, including incident reports missing from the DJS reporting database and apparent confusion about what types of restraints SOA must report to DJS. Although Silver Oak has been admitting youth since July 6, checks throughout August of the DJS Incident Report database did not display any incidents for the facility. Facility records showed that a restraint incident had been reported to DJS on August 1, but DJS never entered it in the database. This office contacted DJS twice in early September expressing concern that the database continued to reflect no incidents for Silver Oak. On September 17, DJS/OIG responded and said they had discovered Silver Oak incidents entered under the incorrect facility. Two September restraint incidents were reported internally and listed in the facility s Altercation Log but were not reported to DJS or in the database. The director said no DJS Incident Report was completed because the restraint did not take the Silver Oak Academy 5

6 youth to the floor. Both restraints involved struggles with youth who staff placed in shoulder supports and escorted to a de-escalation room. The director said DJS told him he only needed to do a DJS Incident Report for a restraint that went to the floor. He agreed to contact DJS OIG for clarification on Incident Reporting. On October 6, DJS advised they would be following up with training on reporting incidents with the facility. (Also, see discussion of September 27 restraint and reporting issues in b. above.) d. Behavior Management Plan According to the Silver Oak Youth Handbook, the program utilizes a behavioral management progression for our young men, which emphasizes the use of low-level, cognitive-behavioral based interventions to address inappropriate behaviors. The program also uses Positive Peer Culture and Guided Group Meetings. There are four levels for youth at the facility. The Rookie Status encompasses youth in orientation, the Intern Status is the next level, the Ram Status is after Intern, and the Block R level is the top level for youth. Youth at the R Block level, must lead by example and exemplify all Silver Oak Academy norms. When youth fail to comply with the program, the Behavior Management System encourages a corrective response to be made and then to return to program within a short period of time. The Time-out Program isolates the youth from the rest of the group for at least 10 minutes, but no longer than 30 minutes, until he is processed by staff to determine if he understands why he was in time-out. If the youth continues to act inappropriately, staff places him in the Refocus Program. The Refocus Program places a youth in a separate dorm and is an, independent element developed to address individual students who are not able to function within the Cognitive Academy Model Program. The population in the facility has increased significantly from 6 to 16. But aggressive incidents and attempted escapes spiked in September, raising concerns about the reasons for the increase. The director explained that during the first couple of months Rite of Passage seeded youth from their program in Arizona. Those youth were supposed to be role models and help establish a positive peer culture for future youth. However, he continued, In the last 30 days, we have admitted more students directly from various detention centers with less demonstrated progress. One of the youth in the program had been involved in the violent riot/escape event at the hardware secure Victor Cullen Center on May 27. The court had previously adjudicated the youth as delinquent for a Handgun Violation, Resisting Arrest and Escape. A review of the Altercation Log revealed he was also involved in 4 of the 14 altercations at Silver Oak from 9/11 through 10/1. I questioned if the facility was fully aware of this youth s past and the director advised that they were. He felt the program at SOA could meet the youth s needs. Another staff advised me that the main issue with the youth was his 1 ST grade reading level but the director said special education Silver Oak Academy 6

7 instructors were working with the youth and meeting his needs. This office will monitor closely the progress of this youth. Applicable Standard Code of Maryland Law, Human Services Article for Juvenile Services The Department shall serve children in the juvenile services system with programming that assists children to develop competencies to become successful members of society. 4. Physical Plant and Basic Services a. Fire Safety The State Fire Marshal completed an inspection on January 14, Another inspection is due in January of According to records at the facility on September 2, the facility had completed only one fire drill since first admitting youth on July 7. The record indicated the facility completed a drill on July 29. The facility was made aware of COMAR regulations and a follow-up monitoring visit on October 2 revealed fire drills were completed on 7/29, 8/28 and 9/28. b. Physical Plant The facility is in excellent general condition, free of debris and environmental hazards. There were no problems observed with chemical and hazardous substance storage. c. Basic Services The Carroll County Department of Environmental Health completed a health inspection of the kitchen and facility on January 29, The certificate expires on December 31, During a monitoring visit on September 2, I the refrigerators, freezers, storage and food preparation areas were inspected. The kitchen supervisor was maintaining temperature control sheets and the equipment appeared safe and sanitary. There were no complaints from youth relating to their meals or snacks. The youth appeared to wear appropriate and comfortable clothing. There were no complaints from youth relating to their clothing. There is a large gymnasium, football field, outdoor track and other open areas for adequate recreation and outdoor activities. There are sufficient rooms for private discussion, visiting and counseling. Silver Oak Academy 7

8 5. Education a. Type III School (school within or operated by the facility) 1. Records According to the principal at the facility, the education department does request school records within 5 days of placement. There were some initial problems with obtaining records but according to the Group Life Manager, the program now receives records in a timely fashion. 2. Special Education Special Education faculty fully assess youth for educational or learning disabilities. There are five youth with Individual Education Plans. However, one youth is reading at a first grade level and his frustration has led to inappropriate behavior and physical restraints. The program s ability to meet this youth s educational needs is questionable. Applicable Standard COMAR Each licensee shall collaborate with the placing agency to ensure that each child of mandatory school age who has not earned a high school diploma or certificate of completion under COMAR 13A is receiving an appropriate elementary or secondary school education. 3. Classes Youth participate in class within 24 hours of admission and attend classes for at least 3 hours/day. Classrooms have sufficient space and skilled personnel to allow youth to pursue individual learning goals. There is appropriate instructional material and equipment. Observations of a class on October 2 revealed youth on task, engaged and involved in meaningful educational work. They watched a movie about nutrition and shared personal experiences with the rest of the class. b. General Educational Development Program (GED), College Courses, No youth are enrolled in the GED program. c. Vocational Education According to Silver Oak administrators, the youth must participate in one of their certified vocational programs. As of October 2, the program offered training in Horticultural/Environmental Planning, Occupational Safety and Cardiopulmonary Silver Oak Academy 8

9 Resuscitation. The facility has completed construction of the Workforce Development Building and students will soon be training in culinary arts, computer graphics, metal fabrication, barbering and the construction building trades. Youth participate in Community Service activities with Habitat for Humanity, Goodwill, the Taneytown Recreation Center, the Carroll County Agricultural Center and the Chamber of Commerce. 6. Rehabilitative and Recreational Programming a. Therapeutic Program The facility relies strongly on the Positive Peer Culture and mandatory Guided Group Meeting models for treatment. According to the Youth Handbook, on-site case managers develop individual treatment service plans that integrate as-needed services for anger management, gang realization, chemical awareness and victim empathy. b. Recreational Programming The program emphasizes participation in various athletic programs. Weightlifting and football are currently strongly encouraged. There are 2 hours of structured recreational and leisure programming daily, 1 hour of large muscle exercise (outside when possible), a posted schedule, off-campus trips and life skills training. The football team has been competing with other private and public high schools. The team recently played Fort Hill High School in Allegheny County, Maryland. A citizen from the area who had observed the game contacted the Monitor s Office to congratulate the Silver Oak players and coaches. She said they displayed exceptional sportsmanship qualities. The Athletic Director from Fort Hill and he corroborated the citizen s comments, saying the team was very well mannered and the youth displayed a high degree of sportsmanship. c. Parental Involvement Youth had no complaints about making and receiving telephone calls or mail services as required by COMAR. The facility schedules weekly family visits. 7. Medical a. Basic Medical Services According to the administration, youth receive prompt physical exams, including dental, vision and immunizations within 30 days of admission. They also receive prompt and thorough substance abuse and suicide screening. Youth have timely access to sick Silver Oak Academy 9

10 call services and medication administration appears to be accurate. The facility properly secures medications and logs reveal timely distribution of medication. The medical department contacts Individual physicians regarding medication within 3 days of admission. Record keeping appears comprehensive and accurate. A youth interviewed on October 2 complained that although he had a knee injury with torn cartilage, the staff forced him to run 3 miles each morning. The youth said the doctor had examined his knee and told him he had torn cartilage but his position as the football team s center did not require extensive knee movement and he should be okay to play. The youth said he was okay with everything except the long run. Following discussion with the facility s football coach, he agreed to limit the youth s running to 1 mile and not to force him to run at all if necessary. The Monitor contacted both the youth s parent and his DJS case manager to ensure they were aware of the situation. A September 2 visit revealed that the facility s medical section did not have an Altercations Log for incidents. During the visit debrief, the purpose of the log was explained, and the nurse agreed to contact DJS to determine proper protocol for setting up the log. During a later visit, the Director said he was not aware of any COMAR regulations that required the establishment of an Altercations Log. After a lengthy discussion, he checked with the nurse and found that the Medical Section had already established an Altercations Log. Applicable Standards COMAR states, The licensee shall provide services designed to meet the children's needs for guidance, learning, and personal development. Each child shall: 1) Be treated with courtesy and respect;. 2) Be treated with warmth and caring; 3) Receive positive recognition;. 4) Be spoken to and treated in an age appropriate manner; and. 5) Be protected from mental and physical abuse. Department of Juvenile Services Policy RF states, Department of Juvenile Services (DJS) employees shall maintain the safety and security of youth, employees and visitors by ensuring that accurate youth information and other pertinent information is recorded through the documenting of events. 8. Youth Advocacy, Internal Monitoring and Investigation a. Youth Advocacy DJS has assigned a Child Advocate to the facility and youth are aware of the grievance process. However, one youth reported to the Monitor that he felt under a lot of pressure by the staff at the facility because he was a high level youth with high expectations. He felt staff were unfairly holding him accountable for the behavior of other youth but he did not file a grievance or complain because one of the Silver Oak program s non-negotiables is that youth cannot complain about the program or staff. Silver Oak Academy 10

11 The Youth Handbook explains both the DJS and an internal grievance system, but two of the non-negotiables listed for Guided Group Meetings (GGM s) are complaining about staff and the program. According to staff, those non-complaint rules only apply to the GGM s and they do not supersede the youth s ability to file a grievance. In response to questions, the DJS Child Advocate said the youth understand their rights to file grievances. b. Internal Monitoring The DJS Program Evaluator audited the employee and youth files at the facility on July 14, 15 and 28. DJS also interviewed youth and inspected the physical plant. The reader may find the results of the audit in a DJS Office of Quality Assurance and Accountability report dated August 17, RECOMMENDATIONS 1. DJS must capture incidents properly and accurately in the Incident Reporting Database. 2. DJS should not place or retain a youth in the Silver Oak program unless the program is meeting the youth s needs. 3. All staff must be aware of their responsibilities to report suspected child abuse. 4. The facility must maintain an altercation/injury log for youth and enter all physical restraints into the log. 5. The Department of Juvenile Services Office of the Inspector General must assist police or child protective services as necessary in any facility investigations of alleged physical child abuse. 6. Staff should not force youth to endure physical pain. Silver Oak Academy 11