The Commonwealth of Massaehusetts Department of Early Education and Care 1 Washington Street, Suite 20, Tannton, Massachusetts 02780 January 29, 2016 Melissa Connors Chamberlain International School 36 Plymouth Street Middleboro, MA 02346-1104 Intake Number: 72653 Dear Melissa, This letter is in reference to the intake number above. EEC has carefully reviewedall information collected regarding this matter, and it was noted there were regulatory issues which you did not appropriately identify and/or correct. The attached Statement of Outstanding Compliance Issues details the regulatory non-compliances that must still be addressed by you. Please complete the form with a specificplan to-address the issues, and submit the completed form to your licensor within 14 days. Should you have'any questions, please contact me at 508-828-5025. Sincerely, Miguel Ortega, LSW Residential and Placement Licensor CC: Diane Wilson The Commonwea/th of Massachusetts - Department ofEar/y Education and Care 1 Washington Street, Suite 20, Taunton, Massachusetts 02780 Date: January 29, 2016 INVESTIGATION REPORT Incident 72653 Facility 4904015 Name of Facility: Chamberlain. International School Address: 36 PLYMOUTH ST, MIDDLEBORO, MA. 02346-1 104 Intake Date: 11/17/2015 Report Date: 12/29/2015 Facility Description: This residential group home has a licensed capacity to serve up to 6 adolescents, ranging in age from 11 to 18 years old. The residential school serves male and female clients, typically characterized as suffering from a range of emotional and behavior difficulties and/or learning disabilities. Reason for Investigation: The assistant program director notified this Office that on 2015, an incident occurred in which a ear?old female resident - and required an emergency rescue response from police and emergency medical technicians. Investigation Activities: A scheduled visit- to the school occurred on December 8, 2015. Additional information was obtained via email and attachments and telephone contacts. Interviews: Materials Reviewed: Incident Reports _15) Diane Wilson, Assistant Program Director Lisa Reid, Assistant Program Director Serious Incident Report (-15) Dan VanDerlip, Education Supervisor Internal Investigation Report Lawrence Mutty, Clinical Director Incident Re ort 15 Xiaofang (Gloria) Lou, Teacher Gina Santos, Program Support Coordinator Close Watch Policy and Plan Heidi Duarte, Student Team Manager Daily Planning and Review Notes Determinations: It appears that the direct care staff followed the Chamberlain School's policies and protocols in place at the time of the reported incident. The Chamberlain School needs to develop and implement a general safety plan to protect residents, from the local environmental risks posed by the nearby river, wooded hunting areas, and highways. The staff followed the resident due to the resident's tendency towards - Once a resident has attempted a particular methodology to self-harm, an individual safety plans need to be developed to protect that resident from engaging in that particular behavior. The resident was discharged on _2015 from and transferred to Investigation Findings: The resident was enrolled into the Chamberlain School residential ro ram in _2013 with a dia osis of Accordin to the internal investi ation re ort rior to -1dmission', .?Iad During .stay at Chamberlain School, the resident had . Incident reports that were submitted on ?20 1 5 revealed that on _2015 at approximately-the resident The staff, alerted by noise and then silence from the bathroom, entered after the resident did not respond to the staff questions. As soon as it was discovered that two staff went -to look for - while a third staff noti?ed the shift supervisor. After approximately twenty minutes of searching to no avail, the police were noti?ed that the The olice summoned an ambulance and the .was transported to the hOSpital On 2015, the resident was transferred ospital. was discharged from ?Hospital on? 2015 and returned to the Chamberlain School. According to the The day after her discharge from ?Hospital, 2015, the resident was transported to the school building that is located at 227 Bedford Street, Middleboro, MA, which is also route 18 and 28. According to the assistant program director, Ms. Reid, the resident was. placed on close watch status upon arriving to school. According to the Close Watch Policy and Plan, increased supervision is utilized when a resident displays behavioral and/or concerns, such as depressive and self-injurious ideations or actions in the absence of suicidal ideation,- - Staff are required to keep the resident within sight at all times during the day and evening shifts, noting and reporting any exacerbation of The policy states, "Further speci?c treatment plans and behavioral interventions appropriate for the individual student may be instituted by the person instituting the Close Watch and will be written into the Close Watch Plan. According to the assistant program director and clinical director, there was no written Close Watch Plan. There was no written caution in regard to the -ncident and the need to ensure the resident does not According to the incident re ort dated? 201 5, the resident asked to use the bathroom and then 1hmd this school buildin is a wooded area. The staff ran but - d. A supervisor was immediately contacted. Staff searched for the resident According to the clinical director, in view of the- incident, he positioned himself near the After 45 minutes, the police were informed that the resident - According to the incident report, several staff searched for the .for a roximatel 1 1/2 hours. Meanwhile, it a ears the resident mana ed to reach The resident reportedly The resident reportedly called a former staff person, who immediately contacted cation Supervisor, Mr. VanDerlip. The police were noti?ed and went to - . Upon questioning the resident, the police decided that the resident should have reportedly returned to the program at approximately On ?2015, after the resident, now in a classroom on the transitioned to another building for lunch, the .entered a bathroom and reportedly broke a mirror. The resident complied with the staffs directive to exit the bathroom however, while .was in the foyer-jegan to threaten staff. At some point, 'physically attacked Ms. Duarte, the Student Team Manager. Other staff came to assist as the resident grabbed onto Ms. Duarte?s arm and hair and began kicking. - was placed into a physical restraint. In accordance with the resident's school district?s provisions, the assault was reported to the police. By the time the Middleboro police arrived to the school, .was already released from the sical restraint. The olice spoke to the resident. It was re orted that On ?2015, it was documented in the Dail Plannin and Review Notes that the resident was On the morning of the day of the reported incident, ?2015, the resident refused to go to class. walked around the campus followed by a staff. The clinician and the clinical director took over the monitorin of the resident. The resident entered a maintenance shed and sat in a corner behind a snow blower. Mr. Mutty, the clinical director, stated that he and the clinician were positioned in a manner that would enable them to intervene if .attempted to access any items in the shed. The clinical director stated that the shed is typically locked, but one of the maintenance personnel must have obtained a tool and forgot to lock the shed. After approximately 20 minutes, the resident was redirected to another area of the grounds by .clinician and the clinical director. The clinician was able to eventuall persuade the resident to return to the school building, but .refused to go to class. .blassroom teacher remained with-in a room adj acent to the classroom. At some point, the resident_ closely followed by the teacher. The resident Due to concerns regarding tendency toward impulsive behaviors, although the staff was in close proximity to the resident, the Middleboro and Bridgewater police were called. as - Upon arrival, the iolice, along with Heidi Duarte, the Student Team Manager, assessed the resident's Reportedly, the Middleboro and Brid ewater olice indicated that The Middleboro police transported the resident back to the Chamberlain School. the resident was brought to the #3 Pleasant Street . ,Dorm. An associate teacher, Ms. Linda Mello remained with for approximately 1 1/2 hours. At Gloria Lou, the language teacher, went to relieve Ms. Mello. At this time the resident immediately began to Ms. Lou immediately followed while Ms. Mello notified the program support coordinator, Ms. Santos. The closely followed by Ms. Lou. Each time Ms. Lou ot close to the resident As eportedly removed her shoes, threw them and punched a mailbox. Meanwhile, Ms. Santos_ safe distance in front of the resident. In res onse, the resident The girl reportedly mana ed to As Ms. Lou was making her way it appeared the -laid down on the ground. Then it appeared that slid out of View. When Ms. Lou she observed that the Ms. Lou attempted to persuade the The resident kept repeating, good bye" and began to Ms. Santos, who was right behind Ms. Lou imrnediatel dialed 911. Ms. Duarte and Mr. VanDerlip arrived onto the scene. Ms. VanDerlip ?while Ms. Duarte immediatel in an attem to reach the however at this time, but Ms. Duarte was not able to maintain visual contact while Mr. VanDerlip verbally directed Ms. Duarte toward the resident, but Ms. Both the resident and Ms. Duarte were placed in. an ambulance and covered in warming blankets and transported'to-Hospital. After 2015. the resident was dischar ed from Conclusions: It is concerning that the resident attempted to .2015, resulting in implemented to prevent upon .return to the pro ram The ?rst full da ?w on There Was no preventative plan in place authorizing staff to physically intervene. It is admirable that the program is attern ting to reduce physical restraints, but when a resident's pattern of behavior puts risk of harm, a preventative plan must be in place. It was also disconcerting to learn that there is no general safety plan in place in which staff are informed of geographic risk areas, such as the river and its proximity to the main campus and the school building on route 18. Also, the staff should be aware of the wdoded areas in which seasonal hunting is allowed. General preventative action plans should be developed for staff to implement when residents are entering such areas . without authorization. Also, the maintenance crew must be reminded to lock the shed. Still, the direct care staff should be commended for their commitment to the safety of the residents in their care. In this instance the resident remained Within the visual supervision of several staff And Ms. Duarte, although ill advisedl disilaied a heroic character when she? Non-compliances: Please refer to the attached Statement of Non?compliances." Investigator Jerry Tripp Statement of Compliance Issues Intake Number: 72553 Date 'of Report: 1/29/2016 Program information: Licensee Information: Program 4904015 - Licensee ID: 1400330 Program Name: Chamberlain Internationat School Licensee Name: Chamberlain International School 36 PLYMOUTH ST 1 PLEASANT ST MIDDLEBORO, MA 02346?1104 MIDDLEBORO, MA Telephone: 5089477825 Licensee Telephone: 5089477825 Outstanding Compliance Issues tStatement of Non?ComplianCe Corrective Action Plan Date Resolved Regulation the resident on m2: 2015 stated they were not aware of any prior incident in which ??the resident attempted to injure ?or attempted to thowever, had just returned from I flicensee must ensure a team will identify residents' needs and develop individual service plans for meeting those needs, including safety and behavior management needs. The licensee must explain all service plans land updates to all child care personnel responsible for implementing the 3 service plan on a daily basis. Print Date: 3129l2016 Page 1 3.0700) In an effort to avoid physical restraints, residents are able to walk off grounds. The close proximity of the campus and school building to route 18 poses a risk to residents' safety when they leave the school and residential buildings without staff authorization. The facility is also surrounded by wooded areas, some of which are used seasonaiiy for hunting. Staff should be made aware of the path ?of the river and woods, and instructed to remain cognizant of the potential risks posed by these areas to residents in emotional distress. The maintenance. staff mast be aware of the risks posed ,?by failing to look the maintenance shed. A general safety plan for staff to foltow .when residents proceed towards risky areas without staff consent needs to be . developed or revised and enhanced. Jerry Tripp have reviewed the above non~cyorripliances and have specified my plan and date of 4 7 SIGNATURE: If: if.? riff orrection for each outstanding compliance issue. DATE: [7 I Print Date: 111 112016 Page 2 CHAMBERLAIN INTERNATIONAL SCHOOL PO Box 778 1 Pleasant Street Brigittenstraat 3c Middleboro, MA 02346 3512 Utrecht The Netherlands 5083474825 +3 13925143519 William Schulpen-Doherty Executive Director Melissa S. Connors, Esq, Ed (ABD), MBA Program Director Chamberlain International School Corrective Action Plan: Intake 72653 February 3, 2016 3.05 Chamberlain has developed a CPS [Collaborative Problem Solving) Strategy Plan. This tool is used to provide students with individualized plans to help with lagging skills. This format is used to record Plan meetings, plans for 1 to 1 supervision or development of a Safety Plan. The safety plan will be used to address any changes to supervision or programming which is needed to address any immediate safety concerns. This plan is developed by the treatment team, or in the case of an emergency situation by the therapist or shift supervisor. All team members sign off the plan. Additionally for Safety Plans, the form is required to be transferred from shift to shift with each staff member assigned to the student signing off that they are aware of the plan. Additionally, these strategy plans, are reviewed as part of Morning and Afternoon Interdepartmental meetings to ensure all updates are communicated between shifts. 3.07 3.07 (10) 1. Training has been created to alert all staff to the environmental hazards surrounding each of our buildings. This training includes maps of all areas with hazards clearly identified. These trainings are being conducted in staff meetings during the month of February. Maintenance faculty are now required to keep the locked when not in use. An Emergency Interventions Policy has been developed. All faculty are trained it this during the Environmental Hazards Training. was Student Name: CPS (Collaborative Problem Solving) Strategy Plan A CPS Strategy Plan is a tool designed to provide students with an individualized plan to help with an identi?ed lagging skill(s). The Student Team Manager or designee will develop this plan in collaboration with the student and treatment team. The Student Team Manager is required to collect signatures, share document with the treatment team, and send copy to the Office. The Office will assure document is ?led in" student treatment records. REMEMBER - No matter what type of plan, follow the Plan stepsll Gather information and share with the student what you are noticing. - Share staff concerns with the student and explain why. Listen to the student concerns and needs and empathize. Summarize and restate the problem. Collaborate on Possible Solutions. Choose a Plan and DETAIL THAT PLAN below. The following Plan has been developed on (date) and will be reviewed on or before (date) Proactive Plan (Plan A Proactive Plan is developed in collaboration with the individual student to increase assist in developing effective coping strategies to assist with challenging behaviors or lagging skills. Safety Plan A Safety Plan is developed in collaboration with the individual student to provide extra support. 1:1 Coverage The treatment team and collateral agencies have determined the individual student requires a heightened level of direct supervision which necessitates assigning a staff member to provide 1:1 coverage. This CPS Strategy Plan identi?ed above has been developed to assist the student in the following area (deScribe challenging behavior, safety concerns or lagging skills identified to be addressed): The Treatment Team has identified the following plan in collaboration with the student. Please check off areas addressed in the plan and provide details. Community Acces Describe any plan or modification to community outings: Home Visitation~ Describe any changes to visitation schedule: Peer Interaction Describe any recommendations/plans involving his peers Supervision/Support Plan Describe in detail areas where student requires increase in supervision or extra support: 1. Transition times, before and after school between classes:_ 2. Cafeteria/lunch time: 3. Physical Education/Field Activities: 4. While in the classroom during the school day: 5. While in the dorm during the afternoon/evening: 6. Environmental Hazards Concerns: Dorm Student Feedback or Concerns with Plan: Clinlcran House Manager Teacher Student Team Manager Nurse Education Supervisor/Director Residential Supervisor] Director Administration Strategy Plan, page 3 Sign off sheet: (use more sheets as needed) ATE - CATION IGNATURE *Start Safety PlanW Chamberlain International School Chamberlain International School Environmental Hazards Training Chamberlain International School consists of many buildings spread out over various campuses. As such, each location has different environmental hazard considerations. It is important that all faculty members be aware of hazards which may exist in each location to ensure they can fully be prepared to address student safety and act in accordance with the Emergency Interventions Protocols. Attached to this policy are maps of each of the locations. Each map has Environmental Hazards clearly labeled: Main Campus 0 Taunton River is less than mile Northwest up Plymouth St. Plymouth St crosses it at the bridge and it runs behind the open ?eld on the right side of the road. Additionally, it runs to the left of the bridge behind the residential houses. 1? Wooded areas border all main campus buildings. There are times that seasonal hunting is allowed on these lands. 0 Plymouth St can be heavily traveled and cars do not always observe the posted speed limit 0 Route 18 is one mile south on Plymouth St. This is a heavily traveled road. 225 and 227 Bedford St 0 This building is situated on Route 18. This road is heavily traveled 0 There is a wooded area behind the building 0 The Taunton River runs behind the building through the woods 60 Bedford St. 7 The building is situated on Route l8 which is a heavily traveled road 0 This building is also in close proximity to Route 44 and the Middleboro Rotary which are all heavily traveled 17 Prospect St There is a smaller river, The Nemasket that runs south of this building near the YMCA This building is in close proximity to several heavily traveled roads, Route 28, Route 105 and Route 495 1 Pleasant St Phone: 508?947-7825 no. 130x 7752 Fax: 503-947-0944 Middlebom, MA 02346 Email: chamberlainschool.org Website: Main Campus 1 Pleasant St. El; 34 in .aiegja a v1" 1} ?1333}, . 23;; w: C131 -. "5:5 l' 7 (2396 Gigi?lav {Shamoellmn Imematmnei Sen-ml? 3: i in. Mam Ediende: an Map M138 M325 Gmgi? HAZARDS Taunton River approx" mile North on Plymouth St Wooden areas surrounding all buildings may include seasonal hunting 0 Route 18 1 mile South on Plymouth St 0 Plymouth St can be a heavily traveled road with unpredictable traf?c 0 225 227 Bedford St Educational and Recreational Buildings h- i I 3r Map Boogie Hazards: - This building is located on Route 18. This is heavily traveled Wooded areas to the rear of the building 0 Taunton River East on Route 18 60 Bedford St Automotive Shop imam Jami-ts 1:3? 4. Beasts; 5 h??ddg??bqu MA . was Map {?31152 Goggles PM Hazards: Building is located on Route 18 which is heavily traveled 0 Route 44 and Middleboro Rotary is west of the building. Both of these are heavily traveled. 17 Prospect St. Dorm Hazards: 9oz? Cf my . 4kg: ?31 3} L7 c? ?329 ?2?qu a; a? 4% we {1:157Hanrezmd Eugermaraez ?esta-h" Tamera YMCA '11: . Map age; i? Google ~?gf4 - Building is in close proximity to several heavily traveled roads, Route 105, Route 28 and Route 495 Nemasket River is South on Route 28 META Train station a short distance away in down Route 105 Chamberlain International School Use of Emergency Interventions Chamberlain International School?s treatment and care philosophy is heavily focused on self- direction and guidance as well as students? learning effective emotional regulation and coping skills. To that end, a number of different procedures and modalities are used to ensure calm, structure, and caring throughout the days and nights. Occasionally, demonstration of emotional or behavioral instability. During these times, faculty is expected to carefully monitor the student at all times. If at any time, the student engages in a behavior that may cause signi?cant injury to him/her or others or is life threatening the faculty member is ALWAYS expected to act. Staff are held to the duty of safety ?rst. Faculty are expected to take whatever action is deemed necessary in order to protect the student from the serious threat of injury while at the same time not putting themselves in a life threatening situation. Emergency procedures may only be used as an intervention of last resort following a series of efforts by staff to promote less restrictive problem-solving AND only in emergency situations to prevent students from seriously harming themselves or others. When these behaviors occur without prior warning, the duty to employ less restrictive diversions is negated. Staff members are trained in de-escalation techniques as well as in employing treatment plans to lessen the incidence and severity of emergency situations. Chamberlain does not teach speci?c emergency intervention techniques. Rather, staff are to utilize judgment and training in determining that a life threatening situation is at hand and that they have a duty to prevent it. Incidents like students attempting to access an environment hazard, run or walk in the road around traf?c, or smash and use materials or glass to injure others or self would be treated as situations where the staff will physically keep the student from access. 1 Pleasant; Phone: 508-947?7825 Po. Box 773 Fax. sewer-0944 Middieboro, MA 02346 Email: chambei'lainscliool.org Website: