DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF HEALTH SERVICE REGULATION ROY COOPER MANDY COHEN, MD, MPH GOVERNOR SECRETARY MARK PAYNE DIRECTOR March 2, 2017 Ms. Jennifer A. HollowellaWarren, Executive Director Recovery Connections Community P.O. Box 1386 Black Mountain, NC 28711 rconnectcom@aol.com Dear Ms. Hollowell?Warren: Thank you for the cooperation extended during an announced site visit to your facility on February 20, 2017. The visit was based on information given to this agency in January 2017 which questioned whether the facility located at 1384 Old Fort Road, Fairview NC is required to be licensed under Following is the definition of a licensable facility pursuant to NCGS122-C: Definitions. The following definitions apply in this Chapter: (14) ?Facility? means any person at one location whose primary purpose is to provide services for the care, treatment, habilitation, or rehabilitation of the mentally ill, the developmentally disabled, or substance abusers, and includes: A "licensable which is a facility that provides services to individuals who are mentally ill, developmentally disabled, or substance abusers for one or more minors or for two or more .. A previous review by our Section of a different Recovery Connections Community site in 2012 determined that Recovery Connections Community met the criteria for exclusion from licensure pursuant to NCGS This statute states: 122C-22. Exclusions from Eicensure; deemed status. All Of the following are excluded from the provisions of this Article and are not required to obtain iicensure under this Article: non?profit facilities established for the purposes of shelter care and recovery from alcohol or other drug addiction through a 12?step, self?help, peer role modeling, and self? governance approach. MENTAL HEALTH LICENSURE CERTIFICATION SECTION TEL 919?855?3795 - FAX 919?715v8078 LOCATION: 1800 UMSTEAD DRIVE -WILLIAMS BUILDING - RALEIGH, NC 27603 MAILING ADDRESS: 2718 MAIL SERVICE CENTER - RALEIGH, NC 27699-2718 AN EQUAL AFFIRMATIVE ACTION EMPLOYER Page 2 of 2 March 2, 2017 Ms.Jennifer A. Hollowell-Warren Recovery Connections Community Joy Allison conducted a site visit of 1384 Old Fort Road, Fairview, NC on February 20, 2017. In addition, she met with you, Phillip Warren, Operations Director, Cole Dunlap, Facility Manager, and Bobby Mickerson, Public Relations/Office Manager plus three senior peer support leaders on that same day. The following information about the purpose and function of Recovery Connections Community was provided to Joy Allison during that meeting: 0 There are three locations: 0 1384 Old Fort Road Fairview NC 0 15 East Mountain Way, Asheville NC 0 ?The Farm? in Angier, NC . The program is advertised as a chance to be with others who are working on sobriety. The residents are offered support and opportunity. 0 A senior peer leader lives in each home. They are not considered staff, are not paid, and do not have training such as CPR, first aid, blood borne pathogens, or de-escalation. if there is an emergency, they are instructed to call 911. Their role is to help other residents with the daily running of the home. 0 There are no client records and no treatment plans. 0 Medications are self-administered and there are no medication administration records 0 Residents attend NA and/or AA meetings to assist in recovery. 0 This is a volunteer program. Residents can leave at any time. 0 Recovery Connection Community utilizes a peer role modeling, self-governance approach for people seeking recovery from drug addiction. 0 Recovery Connections Community is a non-profit 501(c)3 organization that does not receive federal or state funding Based on the information presented above, it appears that no mental health, developmental disability or substance abuse services are being provided in this setting. Additionally, the facility meets the exemption criteria in Therefore this setting does not require licensure pursuant to NCGS 122C. This is applicable for all three locations. Please note that this opinion is based solely on the facts represented. Changes regarding the facts or program as represented will require further consideration by this agency and a separate determination would be required. Please contact this office if you have any questions. Sincerely, Stephanie Gilliam, Chief Mental Health Licensure Certification Section MENTAL HEALTH LICENSURE CERTIFICATION SECTION TEL 919?855-3 795 FAX 919?715v8078 LOCATION: I800LMSTEAD DRIVE -WILLIAMS BUILDING NC 27603 MAILING ADDRESS: 2718 MAIL SERVICE CENTER RALEIGH, NC 27699-2718 03 AN OPPORTUNITY ACTION EMPLOYER Division of Health Service Regulation Mental Health Licensure and Certi?cation Section Report for Record Facility Name Recovery Connections Community License Number: 1384 Old Fort Road, Fairview, NC, 28730 County: Buncombe Contact Personts): Jennifer Hollowell Warren, Phillip Warren Contact Numbercs): (828) 774-2724 PUFPOSE 01? Contact: unlicensed facility Contact Notes: 1/30/17-Received emaii regarding a possibie unlicensed facility in Buncombe Co. did not recognize the address but recognized the agency as Recovery Connections Community. This program is well known in the Buncombe County area and has been in operation for several years. I have visited several of their homes/programs in the past. In September of 2012, this Section determined that Recovery Connections Community was included in licensure exclusion. was asked to go out again since this specific address was not listed as one of their homes in past reports and to see if they have aitered their program in any way since our last visit in June 2014. 2/20/17-Arrlved unannounced at facility located at 1384 Old Fort Road, Fairview, NC. Noticed a van in the driveway with the Recovery Connections Community logo on the side. Met with 3 residents who were home at the time. All were very cordial. Information gathered: -this is a sober living home ?there is no staff but there is a peer support facility manager. He was identified as Cole Dunlap. They stated Mr. Dunlap would be back later in the day and gave me his phone number. ?the full program lasts for approximately 2 years ?they have 12 step meetings such as AA and NA. At this point, they stated that they would preferthat direct any further questions to Mr. Dunlap. i left my card with them and left the home. 2/20/17-Received a call from Jennifer Hollowell Warren regarding my visit to the home. She agreed to meet with me whenever and wherever I chose. We met at her office which is right down the road from the home. Present at the meeting, Ms. Warren, President and CEO, Phillip Warren, Operations Director, Cole Dunlap, Facility Manager, Bobby Mickerson, Public relations/Office manager and Intake Coordinator, as well as 3 senior peer support leaders. The only 3 paid staff are Ms. Warren, Mr. Warren and Mr. Dunlap. All other ?staff? are peer support leaders. Information gathered included: -This is the same program that has been in operation for several years. ?They have 3 locations: 1384 Old Fort Road, Fairview, NC, 15 East Mountain Way, Asheville, NC and ?The Farm? which is located in Johnston C0. in Angier, NC. ?1384 Old Fort Road can house 15 residents, ali maie. There are currently 12 residents there. -15 East Mountain Way can house 7 residents, all female. There are currently 4 residents there. -?The Farm? is coed. There are 2 residences on the property. One residence can house 8 females, the other can house 11 maies. -This is a peer run, peer support and peer led program with emphasis on 12 step recovery. Oversight is by a board of directors, 6 of whom are in recovery. -They have 501C-3 status as a non-profit. -Being in this program is advertised as chance to be with others who are working on sobriety?. The residents are provided with ?support? and ?opportunity?. Recovery Connections Community Page 2 of 2 Residents are referred from various sources such as detox centers, hospitals, drug courts, public defenders, occasionally through a county DSS (not often), etc. ?The assessment process consists of completion of the application and an autobiography (hopefully outlining where they are in their recovery journey, what they hope to attain, etc.). Afterthat is received and reviewed, the agency will telephone the person and discuss his/her background, the program, expectations, etc. -They will screen out anyone with a history of sexual offenses, arson and violence. Violence in the program is automatic grounds for dismissal. The applicant must be physically able to work and have no recent history of suicide attempts. They cannot be taking any medications that have any kind of street value. ?There is no length of stay. The program is a 2 year program but, after a resident graduates they can stay involved with the program, if they choose to do so, for as long as they feel that they need the support. -The agency provides all transportation once a resident is admitted to the program. The residents can have a car during the last phase of the recovery program (phases included). All transportation within a 30 mile radius is free, 30100 miles is $50.00,100 miles or more is $100. can send money for cigarettes, transportation fees, etc. Otherwise, clients have no expenses. ?There are no client records, no treatment plans, no MARS. A resident folder consists of their application, their autobiography, a TB test and national criminal background check (both are required prior to admission), intake forms which include house rules, clothing inventories, resident rights, medical and confidentiality consent forms, etc., as well as possibly some ?consequence reports? (If someone breaks some house rules they may have extra duties assigned or lose privileges such as phone calls, home visits, etc.). "Medications are self-administered. Meds are locked up in one central location. No one is allowed to have medications on their person or in their room. There is a set time for meds to be taken. The medication cabinet is opened buy the senior peer support leader, and it is up to each individual resident to come and get their medications when it is time to take it. No one administers medications. They might remind a resident that he/she needs to come and take their med but, it is not administered to them. No ?mood altering? medications are allowed. The agency handles all refills for each resident. ?Each home has a senior peer leader living there. This person is not considered ?staff?. They are not paid. They are either: currently in the program and close to graduation or have just recently graduated. They are there to help the other residents as might be needed with the daily running of the home. They have no training (CPR, First Aid, blood borne pathogens, de- escalation, etc.). if anything should happen, they are instructed to cail 911. -Everyone has chores in the home and everyone has a job. The agency has contracts within the community, mainiy with assisted living homes. They provide services at the homes such as iawn care, cooking, laundry, etc. Ail monies earned through work go directly to the agency to pay for room and board until they are in their last phase ofthe program. At that time, the money earned is given to the resident to help them with learning to budget, getting an apartment or car, etc. ?All residents apply for food stamps. The food stamp money is used to purchase food for the home in which they live. The residents make out their menus for the week, go grocery shopping, take turns cooking and make lunches to take to work for the upcoming week. ?It is strictly a volunteer program. If someone chooses to leave they are asked to wait 24 hours to ?think it over? stating that often people will change their mind. If it is at night, they are asked to wait until the morning. If they do not choose to wait, they are free to go. The agency has no authority to try to detain them or to go after them. (The agency states that they are looking at changing their policy to provide transportation should someone choose to leave. They are becoming uncomfortable with someone who chooses to leave, just walking away, especially at night. They might start providing transportation to the nearest bus station, open store, etc.). ?They are aiso iooking at modifying their program from an advertised 2 year program to a program of 6 month intervais. Each 6 months they would evaluate the resident and see if they want to continue in the program. (A 2 year commitment is often times hard for a person in recovery to grasp and the thought is that 6 months mig it be easier to understand and work with). -Groups are held in the evening after everyone gets home from work. Group is different every evening. One evening a week is ?process group?, another evening is ?conflict resolution group?, NA or AA will be 2 or 3 evenings a week (or more), etc. (schedule included). Ail groups are peer led. They also offer animal therapy, life skills and vocational training and the opportunity to continue your education if desired (program components included). As presented, this program appears to continue to meet the G.S.122C-22 (a)(9)licensure exemption. Joy Allison Licensure and Training Consultant 2/22/17 Date: Employee name/title: INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY P. 0. BOX 2508 CINCINNATI, OH 45201 1 0 2012 Mcation Number; DLN: 17053005444042 RECOVERY CONNECTIONS COMMUNITY Contact Person: 65 CHESTNUT HILL RD SUSAN MALONEY 31210 BLACK MOUNTAIN, NC 28711 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: Form 990 Required: Yes Effective Date of Exemption: April 12, 2011 Contribution Deductibility: Yes Addendum Applies: NO Dear Applicant: We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 25?2 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations; We determined that you are a public charity under the Code secti0n(s) listed in the heading of this letter, . Please see enclosed Publication 4221-PC. Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization. Letter 947 RECOVERY CONNECTIONS COMMUNITY Sincerely, Holly D. Paz Director, Exempt Organizations Rulings and Agreements Enclosure: Publication 4221-PC Letter 947 ?Kn/a. Fng. . [a any Jerk: Li" I Wt lb?i lev~ PFacility Name: Surveyor Name: Q35 Surveyor Discipline . LI ?n Observation Dates: From To d0 ?my I jy Rule/Concern Documentation 5?0 ?u i . @05me hQVillxn . :1ng w? 3 .1?d ALLA I 4 qume. WILLIS )chcc. LL add new) I K) I aw: by IDLL: LL 9 LLW. ELLA .ngek, aqu ,Lb \LebLIaIerm. L7 {3.31am ?Le? 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'10 111011 111111 mama, 119111511111 1131135111111, 110 01115111? 1 (03 (112171 111.11,, a 151511117310 ?Wt 11?: 141/1111 01611111 1611?; W11 01 1111/11 1C1 1-10: 1317111071" 111:; 1 @mkwad {1111(m1owa1 1R ?1gb 151111; 3531111 61m 11/391111 17 ?ack 61 01151 041M {4311941 11-11% 31 112111113 117 1111,1111 (6119101 ?11 1&1 Wuo?m?L 21C 13(19 3; 111 h, 2P 43) 4130 11011, 59100561 (1 01ng711?51 (1511] ?131011: 1:11:11111u1191131z11123 1 [11(1' M91 1001111113 31100 (511111 11111312611 10191111211? 51151111111912.1111 POLkL?fbr \211113? 01ch Igmd 1E Surveyor Worksheet Spreadsheet 10/00 AJ/wwl/k? . '0an Led RVIOVCI 989?? (Mm; b2 ML HAL 3L, Unlicensed Facility Processing (created9/8/2016) . . 9 pig?. Effective July 1, 2016 all unlicensed facility allegations will be stored elec onically in a secure location LD lot on the share drive (S:\MHL\Licensure Training\Unlicensed Facility). Paper copies of the applications will continue to be kept in the Raleigh office until further notification. The primary purpose of the onsite visit is to determine if the facility is providing licensable services as demonstrated by some or all of the following: Medications are administered as evidenced by the presence of a medication administration record, central storage of medications inaccessible to clients. hit) 0 Coordination of medical and mental health appointments \L?g 0 Provision of recreational or community supports. 0 Transportation is being provided. - Presence of a treatment plan, progress notesMaintenance of client records. EAM 31; LID: L) bindJudd 0M Supervision Is occurring during the day or overnight staffing 15 being provided f? ?90 0 Group activities are occurring big; 8mg}! 0 The client?s residence at the facility Is contingent upon receiving treatment. o?k tails. {:1ng AU WK 0 Presence of a contractual agreement for money for services 391* 1:4th - The provider Is receiving the client?s 55! check i .. [g Vupport Support staff receives allegation report (typically via fax) and gives hard copy to LT Program QW- Manager. II LT Program Manager Responsibilities . Bi?; 0 Review allegation, check MFF and ensure allegation should be investigated. l3? 0 Scan application to share drive. '0 #9 Create folder on share drive based on address of allegation or facility name (if possible). ,1 . Enter preliminary information on the unlicensed facility tracking log. i 0 Email LT consultant indicating there is a pending allegation/investigation. I. "7 LT Consultant Responsibilities . 0? . (Y7 . Retrieve email from LT Program Manager. My 0 Retrieve allegation from share drive' either save to drive or print as neededProceed WIth unlicensed facIlIty Investigation process. 5r (L?wp 1:91?; :11. Investigations Resulting in Cease Desist m5" 9 nil! CLT Consultant Respons ibili ties FIRM 0 Discuss case with LT program manager. {Inq?v? . Writes a report for record (R4R) and saves to the share drive. Scan all non-disclosed notes and save to share drive. 0 Complete unlicensed facility tracking log. wk? . -. I xv ?930From: 01/30/2017 09:41 #392 Printed: 0113012017 Hotline Call Detail Report 01/30/17 07:44 3 ?5 CATEGORY DESCRIPTION CA information STAFF NAME BAKER, LYNN lnta ke Detail INTAKE NUMBER INVESTIGATED STATUS Provider Detail PROVI to PROVIDER NAME FACILITY NOT NAMED PROVIDER TYPE xx1 - UNDEF PROVIDER ADDRESS FACILITY NOT NAMED ROAD - RALEIGH - NC MEQICARE ID Call Notes Facility/location; Non-licensed substance abuse recovery home Recovery Connectlons Community aka Mountain Way Recovery.- 1384 Old Fort Road, Fairview. NC 28730, directions off of 74. take Old Fort Rd east, 90 7miles. Drive goes up a hill. Facility tvisible fromthe road. . i . item stale-s dim-l amt-1mm emetic; . liq-r tut t1 Findings: DES had been to the facility. Vaya Health heard of the fam ily but didn't monitor the facility Owner?of home was su osedl Philli Ge ett of Gennett Lumberful?ll/t WU ?ick Hut "yawn? 3&Clts: 10-15 people are In the fee based on what was seen In terms of people comIng and going from The ning of-17 an adult showed it at a nei hbors home. The - saiiyas from the faculty howed no signs of any functional disabIlity but probable? eported the people?m the fac were "yelling" and "hit" people. The yelling was frequently heard and the people I sounded distressed. The ing to leave the facility but was "locked" into the story balcony." Staff took ad :Iothes and would not let hIm leaveWescape-d" by jumping off the third floor balcony-sad neighbor?s phone to contact a family member and the police. Three 8080 cars showed up at the driveway of the facility and unk family member oicked up the male and took him away N00 Nit-J- WI 0le \Wfb 5115\314? ?flux 34541:. Ui?u} it- 00'? ?Ni {captains AIM luau/I bLNd, DB). vUt) bib Ll V4 :{Wi {Al/My? *b maxg Wild and soul immune 1?34 4359?? WW luv? . was lL/ lb tum-ls um We ail mil. but my 59 0'0. We; We? No he; m?w \qml-elm/n tum it is have all?; in" MEL 3&2 tr {Nimi- HDtLine.rpt 10/99 Page 1 off Weekly Schedule (Starting 2/20/17) Monday Catharsis and Commitment (7pm) Tuesday 12p leader Meeting at Chestnut 5p~6p Anger Management/Grief and Loss (Phillip Michael House; house led) - 7p-8p Education Group (Phillip Michael House; Phillip) Wednesday 9a-l la Group/Individual Sessions (Jessica Holly House; Phillip) 5p?6p Serious Function 8p Shiela?s Bible Study (optional) Thursday 9a-l la Group/Individual Session (Jessica Holly House; Phillip) - 8p Process Group Frida Outside Meeting Saturday 5p~6p Community Rules Meeting Outside Meeting Free Night - Outside Meeting Te rm i ogv ?Whig? Eli/l Recovery connections community has a language of its own. We regularly use many words and phrases that someone brand new in the program would not understand. We have prepared the following list of de?nitions in order to help you better comprehend what is going on around you. Acting Out - Exhibiting inappropriate behavior. Bad Rapping - Talking negatively about someone. Bench The place a resident is asked to sit when he/she needs some time to think or calm down, writing a clean up or when waiting to be processed out of the program. Blown Away Being verbally reprimanded for negative behavior individually or as a group. Caught UP Being involved in an inappropriate verbal exchange with another resident. (Usually happens when one reacts without thinking a situation through.) Chain of Command The procedure you follow when asking questions or passing information; your leader to their leader to staff member to director. Clean UP Writing down anything and everything that you have done all the rules you have broken while in the program in order to clean your slate. It may include what you know about someone else and the rules he or she has broken. Confrontation on the Floor Taking an issue or Problem directly to the person with whom you are having the issue. Contract Partner A peer in the Program with whom you keep secrets and break rules. Covering your Back Always having someone with you to be able to witness your actions; Passing everything you see, hear, think, and feel in order to avoid getting caught up in situations that could have been avoided. Dirty When you have violated rules in the program or contracted up with someone, Whether it has been discovered or not. Ear Jacking - listening to conversations that do not involve you. A Encounter? Letting someone in catharsis 8t commitment group know why you are angry with them, what concerns you about them, or what you perceive their character defects to be. Evening Meeting A quick recap of the day?s events and a way to check in and see how everyone is doing. This meeting positive note. A meeting attended by all residents in lifestyle phase and under. Detention Being on the move for up to three days as a consequence for breaking a rule and/ or behaving inappropriately. Feedback Asking questions or arguing when a leader or senior person addresses you or asks you to do something. Any response other than is considered inappropriate. Good Money? Giving good advice or positive feedback. Gut Flip? What you feel inside when you know you are doing something wrong or someone else around you is doing something wrong. Hair Cut? When you verbally reprimanded by a leader (usually for inappropriate behavior. A leader must have their back covered when giving a ?hair cut?. Jammed UP Getting caught up in a situation that could have been avoided. Hit - A donation; saicited by the in-kind donations department. Hemmed UP getting in trouble. Karum Shot Making an indirect statement about someone else while you are talking to another person. It is intended to ??ip their gut? Leader A peer in an authoritative position who is able to give guidance and direction to younger residents in the program. Morning Mee?ng A meeting attended by all residents in lifestyle phase and under. It is designed to help you begin your day in a positive manner. OK The appropriate response when addressed by anyone in the program. On The Bench Taking a seat in a designated area in order to process whatever situation you are currently involved in. It is nearly always used as a consequence or the place residents are asked to go when they are intending to leave the program. On the ?oor Being on the main floor of the facility? not in a personal area. On the move Working and staying busy around the facility. Shooting 3. Curve? Asking one leader a question and being told no, and then going to another person hoping for a different answer. Shooting Shots? Pointed comments designed to impact the person they are directed towards. Spending Good Money? Sharing your experience with someone in order to help them learn. Walking the walk, not just talking the talk. Splitting Leaving the program against clinical advice. ?Takin a Seat?? Bein asked to sit on the bench because ou are in to leave the program, you need to write a cleanup, or because you are involved in a volatile situation and need some time to cool off and think. Community A person in the first phase of the program. 1 Under my Witlg? To take personal interest in a resident; to raise them in the program by teaching them the rules and regulations of the program as well as sharing their personal experience, strength and hope. Your Program The current state of your recovery. The way you go about following the rules of the program and practicing integrity, or doing the right thing when no one is looking. WP - A strength in our 12 Step Chailenge Group which helps the resident see patterns in their past that they cannot see for themselves. Passing? Giving information regarding situations involving yourself or other residents to leaders 'm the house. The Purpose is to save someone?s life. You should practice Passing everything you see, hear, think and feel. Peer- Someone in the same Phase of the Program as you; someone who entered the Program around the same time as you did. Plugging In - Sharing your thoughts and feelings With another resident in the Program. Poking Holes - Talking badly about the Program. Processing Information? Sharing thoughts and feelings with others in order to help work through situations or Problems you may be facing. Proposal A written request for something you wish to have or do in the Program. Pull?UP ?Correcting someone, or having someone correct you, when you see a rule being broken. You should Practice Pulling uP before you Pass. Raised in the Program Bringing someone uP in the Program by guiding them and teaching them. Resident Program Participant. Suspension More than three days of extra duty; a consequence for serious infractions. RCC?Recovery Connections Corporation. Seminar - An afternoon meeting, usually after lunch, on a toPic relating to recovery. This meeting is to give residents a chance to check in and let each other know how they are. it is intended to continue their day on a Positive note. Residents in Lifestyle Phase and under are required to attend. 3AA it 3? F: @Lum?cg ?hupmb{{j:U WM 2% 3M (0AA CREATED APRIL 11, 2011 PROGRAM COMPONENT S: Peer Role Modeling- the community is the agent of change; residents act as role models for other residents teaching and learning from each other; all residents participate in the available opportunities: the structured environment and daily routines, seminars, groups and peer counseling in order to develop healthy habits, coping skills and a new, productive recovery lifestyle. Substance Addiction Assessments - on-going comprehensive assessments will be collaboratively developed by certified and/or licensed professionals and peer support specialists, as well as senior residents, and will be provided to all residents Life Skills and Vocational Training? residents learn to be responsible in a number of areas that lead to manageability of their own lives; all residents participate in both in?house and outside job placements after a period of initial adjustment to the community before choosing a program ?major? and streamlining their recovery programs. Community Support Groups and Resources Residents will interact with and give back to the greater community through volunteer service and will develop an outside support group by mandatory participation in self-help lZ-step meetings in order to develop spiritual connections with others and their higher power. Animal and Equine Therapy? various types of pets, rescue animals and horses will be utilized for residents to learn to care for and become responsible and develop powerful therapeutic connections for mutual love and healing. Education residents must be working toward individualized, mutually agreed upon educational goals and may have the opportunity to pursue certi?cation as substance abuse counselors if desired. Continuing Care and Relapse Preventionw a continuum of care is provided; residents will step?down to transitional housing after an initial graduation and must serve as mentors to younger residents during this time. Following program completion, a discharge and relapse plan will be developed in which residents will be strongly encouraged to participate in outpatient group and aftercare recreational and social activities. ..35 3.3: 333; Jam Mission Statement ?Recovery Connections Community is a recovery oriented system of care that provides various levels of service to persons with substance use disorders and process addictions. The program emphasis will be on building community, rebuilding healthy relationships, developing a strong sense of self, productive habits, and a foundation of life skills to promote long-lasting recovery. This will be accomplished through Peer Role Modeling, and substance abuse assessments, a connection to community support resources, animal therapy and a focus on aftercare and nurturing relationships with others.? g? a E, {a Jennifer A. Hollowell, MA, CPSS Executive Director Phillip J. Warren, CPSS Operations Director Recovery Connections Community PO Box 1386 Black Mountain, NC 28711 Voice: 828?776?2724 Fax: 866?644-7823 MAIN OFFICE: 65 Chestnut Hill Road Black Mountain, NC 28711 E?mail: rconnectcom@aol.com Website: FACILITY LOCATIONS Recovery Connections Community Facility Locations: Asheville, NC 28805 Black Mountain, NC 28711 Angier, NC 27501 DAILY SCHEDULE 6:00 am Be on ?oor ready to work, community phase is on the move 6:30 am Breakfast 7:00 am Morning Free Time 7: 15 am Morning Meeting 7:30 am Work 10:00 am 15 minute Break 12:00 pm Lunch 12:30 pm Seminar 1:00 pm Work 2:30 pm 15 minute Break 4:30 pm Free Time 5:30 pm Dinner 6:00 pm On the Move - Community Phase and DetentionfSuspension 8:00 pm Evening antion 10:00 pm Evening Meeting 10:30 pm Bedtime *Evening Meeting and Bedtime will be after Evening unction* . i Wt .443? new i arr- -. w. a3. 11was 13?, .. Program Phases COMMUNITY PHASE Day One to Three Months The COMMUNITY PHASE is the initial stage of the Recovery Connections Community program. During this phase the resident will become familiar with his surroundings, other residents in the program, and most importantly, the rules, policies and procedures that will need to be followed. In this phase a comprehensive initial assessment will be completed. FOUNDATION PHASE Three to Six Months Following the community phase, the resident should have a pretty good feel for what is happening in the program and what direction he is headed in his personal recovery program. In the FOUNDATION PHASE the resident will be expected to take on more responsibility and personal accountability. He has the opportunity to earn privileges and will have a more active role in the community, assisting the newer residents in the program. He will become familiar with outside resources and will start vocational training and outside self?help meetings. Additionally, he will start to work on mutually agreed upon goals. LIFESTYLE PHASE Six to Twelve Months In the LIFESTYLE PHASE the resident should be very accustomed to the guidelines of the program. At this phase he will begin accepting more responsibility for the proper guidance and development of newer residents and act as a role model in the community. He should be moving toward an understanding of his personal issues and the skills he needs to deal with them. At this time, he will choose a ?major? and produce an individualized action plan with that major as a primary focus. PREPARATION PHASE Twelve to Eighteen Months The PREPARATION PHASE continues the focus on the development of reSponsibilities and accountability by using the tools he has learned and putting them into action in his own life as well as within the community. This is a very critical stage of development where supervision, counseling and guidance is given on a more personal and individualized basis. Activities will be revised to include individual interests as well as career and educational goals. The resident will graduate from the clinical portion of the program at the completion of this phase. ?fem Gift,? SOCIETY PHASE (INITIAL AF TERCARE) Eighteen to Twenty-four Months The SOCIETY PHASE is the most critical stage of development. At this point the resident learns to balance his new direction in life while maintaining interaction with the core of the program. The structure of the transitional housing will be less demanding and restrictive than the long term facility. This is a required portion of the program as it is necessary to continued success when the resident completes the program. CONTINUING CARE (AFTERCARE) Post Graduation The AF TERCARE PHASE of the program is an optional, but strongly encouraged portion of the program that provides residents with the opportunity to continue their connection with the program. It is important for residents to give back what has been given to them, so they can keep what they got, so to speak. atg??- 5:11: am biggie Admission Information Referral Sources: 1) Self? through the internet and word of mouth; 2) Criminal Justice System as an alternative to incarceration. 3) Treatment centers and detox facilities Exclusionarv Criteria: No one convicted of arson or a sexual offense, no one with a long history of violence, and no one who is diagnosed as having a disorder or with an extensive history will be accepted into the program. We would prefer not to take people placed on INTENSIVE PROBATION as it makes service in our organization dif?cult. If the judgment cannot be changed, we will consider admission on a case by case basis. The Primary Criteria for acceptance is the sincere desire to change your life and the willingness do whatever it takes to achieve that goal. APPLICATION PROCESS: 1. Complete an application packet. 2. Write an ?autobiography?? give details of your life from as far back as you can remember up to and including your decision to complete our application and seek long term recovery. This is very important information that will be reviewed and referred to many times throughout your participation in the program. 3. Complete phone interview with intake coordinator Ian Hays (828)-776-2724 BE SURE TO INCLUDE CURRENT CONTACT INFORMATION so we can arrange a convenient time to conduct a personal interview either by telephone or in person. Please be sure to include a working telephone number and the best time to make contact. If you are working with a referring agency, we will contact them to make arrangements for your interview. During the application and interview process, there may be additional information that may be required prior to a final determination of acceptance into the Recovery Connections Community program. We will work very closely with you and any community agencies to obtain the required information and expedite the application process. Application Procedures and Admission Process UPON ACCEPTANCE: 1. Applicants are required to submit a one-time entry fee of $150. This fee is non?refundable. 2. Arrangements will be made to have you transported to Recovery Connections Community housing. Many agencies provide transportation to our housing. However, we may have to arrange for transportation through alternate agencies or by staff members or residents. In either case, you need to be prepared so that you may be transported immediately upon acceptance. 3. Storage space is limited in our housing; therefore we request that you only bring enough clothing to last a week. You will be provided with clothing while in our program but we must allow a few days for proper sizing. DO NOT BRING any clothing promoting substance use or racial overtones. Such articles are not a part of our philosophy and will not be permitted. 4. Bring a minimal supply of personal hygiene products, toothbrush, soap, deodorant, etc. You will receive additional supplies once you are settled. 5. Bring no more than three pairs of shoes: 1?Dress, 1?Sneakers, 1?Work. DO NOT BRING: jewelry, money, cell phones or any personal items that you consider valuable. There will be no need for these items, and we cannot be responsible for the loss of these items. *Only pictures of immediate family are allowed in the initial phase of the program* CLOTHING INVENTORY Due to the overwhelming amount of clothing and gifts being sent to program residents from outside the organization, we are forced to limit what is allowed to be sent from home. Upon entering RCC, it is recommended that each person bring adequate clothing to get them through the ?rst phase of the program. The following list must be strictly adhered to. Any items over the amount speci?ed will be disposed of accordingly! The personal items should be kept to the following: 10 pairs of pants (including 1 or 2 pair of slacks) lO shirts (including 1 or 2 dress shirts) 10 t-shirts 2 dresses 1 suit 1 pair of pajamas or 1 nightgown/1 robe 1 pair of slippers 1 pair of ?ip-?ops 1 purse AND wallet Make-up (necessities only) Necessary toiletries/hygiene items 10 pair of underwear, 10 pair of socks, 5 bras 1 large winter coat 1 jacket 1 AA Book/ 1 NA Book 1 Bible 1 Journal 4 pictures (no signi?cant others included) NO more than 3 pair of shoes, 1 pair needs to be work shoes or work boots NO more than 2 hats ID Social Security Card, Picture ID NOTE: DO NOT BRING JEWELRY, WA CH, ELECTRONICS (cellphones, laptops, ere), LETTERS, BOOKS, MAGAZINES, MONEY, CREDIT CARDS, ADDRESS BOOKS OR ANYTHING NOT LISTED IN THE ABOVE INVENTORY. Ladies clean out your purses or you will lose the contents! If you do not have all of the above items, we will do our best over the following weeks to assure that you receive the clothing items you require. *You WILL NOT be allowed to request any items to be sent from home until your ?rst family visit, which is when you make lifestyle phase (approximately 6 months). Birthday and Christmas gifts will be dealt with on a request basis. A resident must request what they would like to be sent from home as a gift on these holidays. Residents should notify family of these conditions prior to entering RCC. Failure to comply can result in accountability. Recovery Connections Community will not be responsible for any personal items left behind if you leave against staff advice. You will be given one business day to make arrangements to pick up your belongings, after that they will be delivered to a local charity as a donation or disposed of in the local land?ll. You are encouraged not to bring anything of sentimental value! I understand that if I bring items other than those speci?cally listed above, the items will be disposed of at the time of my entry into the program. The list above is all-inclusive; there are no exceptions. Print Name (Signature) Date Witness Date Black Mountain, NC 28711 (828) 776-2724 E?mail: rconnectcom@aol.com APPLICATION FOR ADMISSION SUBMHTEDBY: DATE Name: Last: First: Middle: Sex: SSN: State: DL Status: DOB: Most Recent Address: City: State: Zip: Height: Weight: Hair Color: Color: Distinguishing Marks: (Tattoos, Sears, etc.) Marital Status: Married: Divorced: Single: If married, Spouse?s Name Do you have any children? How Many? Child?s Name Who is the child staying with Child?s Age In Case of Emergency, Notify: Phone Relationship to Applicant: Parent?s Name: Phone Address: City: State: Zip: ((344! done my SIS: an Criminal Justice Information Applications may be submitted and a determination to accept or reject the applicant will be made prior to the scheduled court date. However, all legal proceedings must be completed prior to establishing residency in a Recovery Connections Community facility. Failure to disclose pending legal action(s) is grounds for immediate dismissal from the program. Are you a convicted felon? Do you have any outstanding warrants? Do you have any outstanding charges? When is your court date? Are your represented by an attorney? Attorney?s Name: Phone Address: City: State: Zip: Are you on supervised probation? If yes? in what county and state? Probation Information: Of?cer?s Name: Address: City/State/Zip: Last Seen/Spoken With: Is your probation of?cer aware that you are seeking long term help? Are you obligated for child support payments? Are payments current? County: Case worker Name: Medical History Information Do you have any medical conditions that will limit your activities? If yes, explain: Are you taking any prescription medication(s)? If yes, list all: Have you ever experienced or been diagnosed as having any of the following: Seizures TB Diabetes Hepatitis Heart Disease Epilepsy Cirrhosis High BP Are you currently under the care of a physician? Doctor?s Name: Phone Reason(s) for current treatment: Have you ever been hospitalized in a mental institution? Hospital Name: Date(s): Reason: Have you ever tried to commit suicide? If yes explain: Have you been tested for Date: Result: Are you a veteran? Do you qualify for medical bene?ts? wee? s32} (gfwi: Educational Information Did you graduate from high school? Year: If not, highest grade completed? Did you earn a Year: Have you had any college or vocational school training? Name of College/School: Location: Degree/Certi?cate Received: Year: Employment Information What is your primary occupation? How Long? Do you enjoy this type of work? What type of work would you like to do? Substance Abuse History Drug(s) of Choice: Date Last Used: How long have you been using drugs? How long have you been using alcohol? Other drugs used or tried? How Often? How Often? Have you been in recovery before? List prior programs below Prior programs tried? Dates: Dates: Dates: How old were you when you ?rst used drugs and/or alcohol? Have you ever used drugs intravenously? Ewe/w Wm (loam-ML} Recovery Connections Community PO Box 1386 Black Mountain, NC 28 711 RELEASE OF INFORMATION AUTHORIZATION Client Name: Date of Birth: Social Security Number: I, hereby authorize (Client?s Name) (Facility, Physician, and address of person releasing information) to release/exchange speci?ed information in my client record to: (Recipient Name and Address) This data shall include (Nature Extent of Information) Specify Time Period: mSummary of Evaluation Assessment Acquired Immunode?ciency Admission Assessment/Screening (Aids History Treatment) Alcohol or Drug History Action Plan Diagnosis Progress Notes Medication History Discharge Summary Evaluation Evaluation History Financial Information ?g Human Immunode?ciency (Virus) Educational Information (History Treatment) Attendance Other: i understand this information will be used for: Evaluation Action Planning Referral Case Management Services Continuity of Care Other: I hereby request and authorize the above named agency, organization or individual which possesses information relative to the client named above to release information, as speci?ed, to the agency, organization or individual named on the request. i understand that the information to release may include information regarding drug abuse, alcohol abuse, sickle cell anemia, or or information. 1' certi?z this authorization is made freely, voluntarily and without coercion. I understand that the information to be released is protected under state and federal laws and cannot be rte?disclosed without my further written consent unless otherwise provided for by state and federal law. This consent shall be validfor aperiod not to exceed one year. lfurther acknowledge that I may revoke this consent, in writing, at ANY time except to the extent that action based on this consent has been taken. Client: Legal Representative: Date: Witness: Person Releasing Information: Date: Ewe/w $255k Recovery Connections Community does not allow residents to take the following medications: Morphine Dilaudid Vicodin Lortab Codeine Buprenorphine Demerol Percocet Oxycodone Methadone Darvon Darvocet Mebaral Nembutal Phenobarbital Seconal Valium ProSom Flurazepam Triazolam Klonopin Librium Ativan Restoril Xanax Dexedrine Adderall Strattera Ritalin Cylert Medadate Concerta Ephedrine Seroquel Haldol Clozaril Risperdal Thorazine Flexeril Cycoflex Zanaflex Soma Skelaxin Elavil Remeron Tofranfl Lithium Trazadone Pamelor Sinequan Recovery Connections Community doesn?t allow the medications listed above and will most likely not accept any that may cause similar reactions. We have found that certain over the counter medications have the potential for abuse. We only allow clients to take that are provided by the facility, and ordered by a doctor. Residents are not permitted to bring in or hold their own OTC medications. Please call us if you have a question about a client?s medication. Often, it is possible to replace one unacceptable medication with one that is acceptable to us and just as effective for the client?s condition. If this is the case, this must take place before admission in order to ensure efficacy. **We will accept Geodon, Abilify, Depakote, and Zyprexa** Resident signature: Date: Consequence Report Name: Date: Tvpe of Consequence: Detention Duration Suspension Duration Other Description of Resident's Overall Attitude/Demeanor: Angry Agitated Withdrawn Sad/Depressed Resentful Guilty Emotional Confused Agreeable Non?Communicative Other: Reason for Consequence: Response/Concerns Addressed bv Resident About Consequence: Signature of Resident: Signature of Peer Counselor: Signature of ?Nitness: Signature of Staff: Recovery Connections Community Jennifer A. Holiowell MA, CPSS PO Box 1386 President/CEO Black Mountain, NC 28711 Corporations Division Page 1 of 1 North Camilla Elaine F. Marshall DEPARTMENT Secretary SECRETARY OF Erma BMW Meier-l. s1; Les-3 Account Login Click Here To: Register View Document Filings Corporate Names Legal: Recovery Connections Community Non-Profit Corporation Information Sosld: 1198418 Status: CurrentnActive Annual Report Status: Current Citizenship: Domestic Date Formed: 4/12/2011 Registered Agent: Hollowell, JenniferAnn Corporate Ad resses Malling: 65 Chestnut Hill Road Black Mountain, NC 28711 Principal Of?ce: 65 Chestnut Hill Road Black Mountain. NC 28711 Reg Of?ce: 65 Chestnut Hill Road Black Mountain, NC 28711 Reg Mailing: 65 Chestnut Hill Road Black Mountain, NC 28711 gov/ Search/profcorpf 9732943 02/21/2017 Rules and P?s Explain Rules a) No leaking if you overhear something you shouldn?t know, keep it to yourself. b) No dumping? Don?t vent negative feelings in group ?there is a group for that (process group) or go and talk to your leader if you need to talk. c) No bad rapping Speaking negatively about another resident. d) No poking holes Don?t speak negatively about the program to peers, new comers, outside sources or those less senior to you. Speak to your leader if you have questions or concerns. e) Keep it on the You can only speak for yourself, don?t speak for anyone else. Keep it positive Try to stay positive no matter what. Frequently Asked Questions Explain the P?s a) Pull?up Verbally inform somebody when they are breaking a rule then move on. b) Pass Informing leadership when and why you pull-up someone, c) Participate Do not isolate, participate in what we are doing (don?t get caught up though). d) Process Make sense of what is happening and how it applies to you and what you are doing. e) Plug?in Reach out to someone and get to know them tell them where your at. Division of Health Service Regulation Mental Health Licensure and Certification Report for Record License Facility Name: Recovery Connections (as later identified)__# Number: Contact Method: Telephone Site Visit K4 Meeting Contact Person: .. . - Contact Number(s): Purpose of Contact: Licensure- Contact Notes: Received a complaint on 5/9/14, via CIU, regarding a possible unlicensed facility in Haywood County (Waynesville). The address was given as 1207 East Street, Waynesville, NC. The complaint centered around a possible substance abuse facility that: -was/is working the participants 16 hours/day, 7 days/week ?food stamps are being turned over to the program administrator and there was very food in the house -participants were not paid for their hours worked On 5/29/14 I went, unannounced, to the address listed for the home. This address turned out to be the Haywood Count office for the Smoky Mtn. Ctr. was told that?as an employee there but-NBS in a meeting outside of the office that particular afternoon. I left my name and number and asked that-give me a call when. returned to the office. I spoke with?on 5/30/14. .explained that the program was in Buncombe County, not Haywood, and gave me the correct address. After learning about the program, I recognized it as Recovery Connections, 3 program that have been to on many occasions. This is a substance abuse after care program that centers around the 12 step treatment program. They have both male and female homes in Buncombe County. They describe themselves as a ?12 step, non-profit agency that is governed by peers as role models?. In the past (my last visit to this program was 9/20/12) it was determined r-lton BackuthoyAllisoMl?x/ly Documents?lR4R~Recovery Connections-5?29-14do: Division of Health Service Regulation Mental Health Licensure and Certification that this program was included in GS. 122C-22 which excludes them from licensure. I discussed this with- ?tated that-frequently receives complaints about this program from participants and does not know where to turn with the complaints except to us (Iicensure). I explained that some of the complaints may be valid but licensure was not always the only place to turn. (Example, one of these complaints centered around food stamps which licensure would not deal with. If the participant felt that there was an abuse of food stamps they would be better served to contact DSS for possible food stamp fraud. A previous complaint centered around bed bugs at one of the homes. This should be referred to the county health department, not licensure, etc). Given the information provided during previous visits to these homes and this agency and 6.8. 1220-22 I did not attempt another visit to the identi?ed home in Buncombe County. Employee name/title: Joy M. Allison Date: 6/9/14 H'on Backup?doyAllison?My Documents\R4R-Recovery Connections-5-29-14doc ?3 GSHUEHM aiziapm INTAKE UNIT +gi97157724 T?wz L059 North Carolina Department of Health and Human Services Division of Health Service Regulation - Complaint Intake Unit Pat McCrory Aldona Z. W031 Ml). Governor Ambassador (Rat) Secretary DHHS Drexdal Pratt Division Director MEMORANDUM To: Ms. Janet Spivey Mental Health Mountains From: Deborah Smith, RN. Nurse Consultant Complaint intake Unit Division ofI?lealth Service Regulation Date: 05/08/14 Re: Unlicensed Faciliiy The Complaint Intake Unit with the Division ofl'Iealth Service Regulalion received the attached complaint infonnatiOn. 011): Division does nor have jurisdiction to invesrigate these concerns. Please handle as you deem apprOpriate. Complaint Intake limi Tel Fax 919 755-7724 LocaLiOn: l205 Ums?tead Drive Raleigh, NC 27603 Mailing Address: 2711 Mail Service Center - Raleigh, NC 27699 EN: An Equal Opportunity/ Af?rmmive Action Employer NTAKE ?3137357724 7~072 pggz/JDZ p-059 Hot Line 05/05/14 Deb mom .5 Blah Win .Nc Unlicensed Facility; Reporter from LME Smoky Mountain Center 1207 East Street Waynesville, NC 28786. Phone number Biz-2546626. . . . . lQecovery Connection run essma restdentIC and Phillip Warren Operation Director. stated one client had been in months and left. Another client had been in facility for months. Both client did not provide names. 80th clients stated had to work jobs 16 hours a day seven days a week. Clients were not trained for patient care aide, cook or housekeeper robs Clients were not paid? the home was paid for hours clients worked. Clients stated attend one group meeting. Persons eXplaan character ?Iaws of client which was not helpful. more harmful to the clients Every client Signed up for food stamps and the stamps go to the administrator and to the administrator's home Food did not come to house for the clients. Clients stated the house barley had any food for the clients Clients are reprimanded and made to work additional werk Division of Health Service Regulation Mental Health Licensure and Certification Report for Record License Facility Name: Recovery Connections Community Number: Contact Method: Telephone Site Visit [3 Meeting Contact Person(s): Contact Number(s): Purpose of Contact: operating an unlicensed facility Contact Notes: Received a complaint regarding the possible operation of an unlicensed facility (Recovery Connections Community) in Buncombe County. Visited the facility, reportedly operating at 2940 US Highway 70, in Black Mountain, NC, unannounced on 8/17/11 Met with 2 residents of the facility who described the home as a ?halfway house?. The home is currently housing 4 women (plus one infant). The women have jobs in the community and are reportedly trying to stay clean and sober. They have completed various other treatment programs and have "graduated" to this Transitional or Halfway House setting. They are responsible for themselves in terms of cleaning, cooking, going to work, shopping, etc. They pay room and board There is no treatment at the home. No treatment plans, progress notes. etc. Medications are locked for the safety of everyone in the home. The residents are totally responsible for their own meds. They have to keep the prescriptions ?lled, remember to take the meds, etc. Reportedly, no one assists them in any way with the exception of unlocking the med cabinet if someone wants their meds. Reportedly, there were no During my visit, the ladies called the Program Manager to come to the house and join us. Jennifer Hollowell and Phillip Warren joined us. Both were very cordial and open to discussion regarding the program and any future plans for their agency. We discussed licensure and the possible routes that might need to be explored should the decision be made to seek licensure The agency is currently operating 2 other Transitional Housing programs in the county (in addition to this one). They have a total capacity of 27. At this time, there is no treatment at any of the homes. Ms Hollowell operates a DWI assessment program (Recovery C:\Documents and for Record 908 doc Division of Health Service Regulation Mental Health Licensure and Certi?cation Connections, LLC) in Black Mountain where some of the residents attend. She is aware of licensure requirements (having worked for 2 other licensed facilities in the county for several years). She states that she may want to pursue licensure of one or more of the homes in the future. (States that she is aware that she cannot pursue any changes at the home at 2940 US Highway 70 at this time since this is the home that the resident with the infant is currently residing in. She states she is not interested in operating a program for women and their children?one option under 27G.4100-and will not make any changes to that home until that particular resident has moved. We discussed the various types of licensure that she may be interested in pursuing, (276.4100, 4300, .56OOE) including the possible exclusion from licensure as outlined in I left my card and instructed Ms. Hollowell to contact me if I could be of any service. (Also gave her a copy of the statute regarding 1220- 22(a)(9) Will follow-up with her in a few weeks to see if anything has changed regarding the nature ms and the possible need for licensure. Notified complainant Wm findings Employee name/title: Joy Allison Date: 8/19/11 Cz'iDocumenls and for Record 9-08doc UTFZY-H FROM-COMPLAINT INTAKE UNIT +9197157724 T455 North Carolina Department of Health and Human Services Division of Health Senricc Regulation Complaint Intake Unit 2711 Mail Service Center - Raleigh, North Carolina 27699-2701 Prat; Director Ecvu'ly Eavcs Perduc, Governoz Rim C. orton, Branch Manager Lanicr M. Camila, Phone: (800) 624?3004 (9?19) 855-4500 Fax: (919) 715-7724 FAX COVER SHEET Recipient?s Fax Number: 828?670-5040 Agency/Organization: DHSR Mental Health Name of Individual: Scott Conrad From: Renee Filippucci?Kotz Section Name: DHSR/Complaint Intake Unit Subject: Unlicensed facility Message: . Number of Pages (melucuzngm sheet) 2 Dane 39599917 27 11 CONFIQENTIALITY NOI II. II 7 The docimie'nt accompanying this telewm contains CONFIDEB: A MAI ION buiongmg sender that IS LEGALLY PRIVILEGED Ihe Informauim in miended f9if the use. of the 9r; entity li?ted above If you are uni the intended xeclpicnt, you hie nereb} noti?ed that any 9, copying; distribution, use Qr taking of unit action or rename on the tele'a; united CONFIDENTIAL INFORMATION l5 strictly prohibited II {on be?: 1 'ecejyeti felecapg in gar please notify by telephone immediately to arrange fer the geturn 9f- the engine! Isansac?nn . . . a Location: 1205 Unnamed Drive DotOLbea Dix Hospital Campus . Raleigh, NC. 27603 #3 An Equal Opportunity Af?mmnv: Action Employer U. 3I1579M FROM-COMPLAZNT 002/002 Hotline Call Detail Report RECEIVE DATE 07/27/11 RECEIVE 13:26 CALLER CATEGORY DESCRIPTION STAFF NAME FILIPPUCCI-KOTZ, RENEE Intake Detail INVESTIGATED STATUS Provider Detail PROVIDER IQ PROVIDER NAME PROVIDER TYPE PROVIDER ADDRESS MEDICA ID Call Notes CalIer stated 8 Jennifer HoIIowelI is representing her as a therapeutic community, but she is not licensed. Caller stated there are 12 clients in a 2 bedroom house. Caller stated there is also a baby Caller stated tne name is Recovery Connections Community. The address Is 2940 Highway 70, Black Mountain. can is? 10/89 Page oft 3 LP 2 .1122?) 354242! A. 2 I . 15? 51.1.? it?? ?4?22? .z'rir??222212 ?32Liuuc/L J5 J2 3 ?f ?Ci?wI293 2 ?22? ?51 Ji?2?2 2221:1222? 22229;: ?27Jkl?qd/?j ,2 :2 :37?.ng i 4. HolIoweII, MA, LPC, NCC, CCIS, CS 4C 2 Pi evident/CEO i I .i if MmyJane LPCS, MAC, LC4S, CC Consultant/ Vice President J. PSS i 1 Operations Manager 2 Recovery Connections Community PO BOX II I -. Black MountamJNCE?m ,7 \Voice: 828? 474?3439 2U .3 bLqu {Ix/Buff) I 222222.222 022,212 ?35; 65 (33222222 2222 22222 2 2 - E?mcnil: Website FACILITY LOCATIONS Recovery Connections Community Women?s Facility Recovery Connec ti on?s i Communl ty Com Jennifer A. Hollowell, MA, LPC, NCC, CCS, CSAC President/CEO Mary Jane Mc Gill, MA, LPCS, MA C, LCAS, CCS Consultant/ Vice President Phillip J. Warren, 5 i Operations Manager ms LA Recovery Connections Community PO BOX r-r-rw-e?x. 1/ Emil? Rance: MAIN 65 Chestnut Hill ad/ Biack Mountain, NC 28711 E-maii: rconnectcom@aoi.com Website FACILITY LOCATIONS Recovery Connections Community \Vomen?s Facility CREATED APRIL 11, 2011 Recovery Connections L1.) Communi ty meagre/4M COMPONEN T5: lVIilieu Therapy- the community is the agent of change; residents act as role models for other residents teaching and learning from each other; all residents participate in the available opportunities: the structured environment and daily routines, seminars, groups and peer counseling in order to develop healthy habits, coping skills and a new, productive recovery lifestylez?rv no Substance ?gorng comprehensrv assessments treatr@ plans will be collaborati and clinical services will be prov1 ed to all resr ents by both certified and/or licensed professionals and peer support specialists, as well as senior residents. Life Skills and Vocational Training? residents learn to be responsible in a number of areas that lead to manageability of their own lives, all residents participate in both inwhouse and outside job placements after a period of initial adjustment to the community before choosing a program ?major? and streamlining their recovery programs. Community Support Groups and Resources- clients will interact with and give back to the greater community through volunteer service and will develop an outside support group by mandatory participation in self-help l2?step meetings in order to develop spiritual connections with others and their higher power. Animal and Equine Therapy? various types of pets, rescue animals and horses will be utilized for residents to learn to care for and become responsible and develop power?il therapeutic connections for mutual love and healing. Education - residents must be working toward individualized, mutually agreed upon educational goals and may have the opportunity to pursue certi?cation as substance abuse counselors if desired. Continuing Care and Relapse Prevention a continuum of care is provided, residents will step?down to transitional housing after an initial graduation and must serve as mentors to younger residents during this time. Following program completion, a discharge and relapse plan will be developed in which residents will be strongly encouraged to participate in outpatient group and aftercare recreational and social activities. Recovery Connections Comuni ty Mission Statement ?Recovery Connections Community is a recovery oriented system of care that provides various levels of service to persons with substance use disorders and process addictions. The program emphasis will be on building community, rebuilding healthy relationships, developing a strong sense of self, productive habits, and a foundation of life skills to promote long? ?lasting Wll'l be accomplished through milieu therapy,a substance abuse treatment ?/connection to community support resouices, animal a tercare and nurturing relationships With others.? 6:00 am 6:30am 7:00 am 7:15am Black Mountain, NC Men?s Facility Asheville, NC Transitional Housing Facilities Recovery Connections Communi ty DAILY SCHEDULE Be on ?oor ready to worlg community phase is on the move Breakfast Work/On the move Morning Meeting ork/On the Move 15 minute Break Lunch Seminar Work 15 minute Break Free Time Dinner Work/On the Move Evening Function 11:00 pm Evening Meeting 11:30 pm Bedtime Recovery Connections Communi ty Program Phases COMMUNITY PHASE Day One to Three Months The COMMUNITY PHASE is the initial stage of the Recovery Connections Community program. During this phase the resident will become familiar with her surroundings, other residents in the program, and most importantly, the rules, policies and procedures that willpeed to be followed?n this phase a comprehensive assessment will be completed in order to develop an initial . FOUNDATION PHASE Up to Six Months Following the community phase, the resident should have a pretty good feel for what is happening in the program and what direction he is headed in his personal recovery program. In the FOUNDATION PHASE the resident will be expected to take on more responsibility and personal accountability. He has the opportunity to earn privileges and will have a more active role in the community, assisting the newer residents in the program. He Will become familiar rmmde resources and start vocational traininrJ and outsrde self?help meetings. LU Lu UuLuLu A UV UVLL Additionally, he will start to work on mutually agreed upon goals in a new treatment plan. LIFESTYLE PHASE Six to Twelve Months In the LIFESTYLE PHASE the resident should be very accustomed to the guidelines of the program. At this phase she will begin accepting more responsibility for the proper guidance and development of newer residents and act as a role model in the community. She should be moving toward an understanding of her personal issues them. At this time, she will choose a ?major? and produce an individualized treaWannvith that major as a primary focus. PREPARATION PHASE Twelve to Eighteen Months The PREPARATION PHASE continues the focus on the development of responsibilities and accountability by using the tools he has learned and putting them into .action in his own life as well as within the community This 1s a very critical stage of development where supervis1 counseling and guidance 1s given on a more personal and individualized ba?s Treatment plans will be evised to include individual interests as well as career and educational goals Wad from the clinical portion of the program at the completion ofthis phase. Recovery Connections Community SOCIETY PHASE (INITIAL AFTERCARE) Eighteen to Twenty?four Months The SOCIETY PHASE is the most critical stage of development. At this point the resident learns to balance his new direction in life while maintaining interaction with the core of the program I he structure of the transitional housing will be less demanding and restrictive than the long term facilitpThis 1s a required portion of the program as it is necessary to continued success when the reSident completes the program CONTINUING CARE (AFTERCARE) Post Graduation The AFTERCARE PHASE of the program is an optional, but strongly encouraged portion of the program that provides residents with the opportunity to continue their connection with the program. It is important for residents to give back what has been given to them; so they can keep what they got. so to speak. Recovery Connections Community Admission Information Referral Sources: 1) Self" through the internet and word of mouth; 2) Treatment Community; 3) Criminal Justice System as an alternative to incarceration. Exclusiormrv Criteria: No one convicted of arson or a sexual offense, no one with a long history of violence, and no one who is diagnosed as having a disorder or with an extensive history will be accepted into the program. We would prefer not to take people placed on INTENSIVE PROBATION as it makes service in our organization dif?cult. If thejudgment cannot be changed, we will consider admission on a case by case basis. The Primary Criteria for acceptance is the sincere desire to change your life and the willingness do whatever it takes to achieve that goal. APPLICATION PROCESS: 1. Complete an application packet. 2. Write an ?autobiograpliy?- give details of your life from as far back as you can remember up to and including your decision to complete our application and seek long term recovery treatments This is very important information that will be reviewed and referred to many times throughout your participation in the program. 3. Provide Criminal Background Check? for every state in which you have resided. BE SURE TO INCLUDE CURRENT CONTACT INFORMATION so we can arrange a convenient time to conduct a personal interview either by telephone or in person. Please be sure to include a working telephone number and the best time to make contact, If you are working with a referring agency, we will contact them to make arrangements for your interview. During the application and interview process, there may be additional information that may be required prior to a final determination of acceptance into the Recovery Connections Community program. We will work very closely with you and any community agencies to obtain the required information and expedite the application process. Recovery Connections Community' Application Procedures and Admission Process UPON ACCEPTANCE: 1. Applicants are required to submit a onetime entry fee of $100. This fee is non-refundable. 2. Arrangements will be made to have you transported to a Recovery Connections Community facility. Many agencies provide transportation to our facilities. However, we may have to arrange for transportation through alternate agencies or by staff members or associates. In either case, you need to be prepared so that you may be transported immediately upon acceptance. 3. Storage space is limited at our facilities; therefore we request that you only bring enough clothing to last a week. You will be provided with clothing while in our program but we must allow a few days for proper sizing. Do not bring any clothing promoting substance use or racial overtones. Such articles are not a part of our philosophy and will not be permitted. 4. Bring a minimal supply ofpersonal hygiene products, toothbrush, soap, deodorant, etc You will receive additional supplies once you are settled. 5. Bring no more than three pairs of shoes: 1?Dress, 1?Sneakers, 1?Work. 6. Provide results of TB test administered within the last 6 months. DO NOT BRING: jewelry, money or any personal items that you consider valuable. There will be no need for these items, and we cannot be responsible for the loss of these items. of children and parents can be sent to you after the ?rst phase of the program. You cannot have pictures of spouses or signi?cant others until you reach the proper phase** Recovery Connections Community CLOTHING INVENTORY Due to the overwhelming amount of gifts, items, services being sent to program associates from outside the organization, we are forced to limit what is allowed to be sent from home Upon entering RCC, it is recommended that each person bring adequate clothing to get them through the ?rst phase of the program. The following list must be strictly adhered to. Any items over the amount speci?ed will be disposed of accordingly! The personal items should be kept to tlzefollowing: 10 pairs of pants (including 1 or 2 pair of slacks) 10 shirts (including 1 or 2 dress shirts) 10 t-shirts 2 dresses 1 suit pair of pajamas or 1 nightgowm?l robe 1 pair of slippers 1 pair of ?ip-?ops 1 purse AND wallet Make?up (necessities only) Necessary toiletries/hygiene items 10 pair of underwear, 10 pair of socks, 5 bras 1 large winter coat 1 jacket 1 AA Book/ 1 NA Book 1 Bible 1 Journal 4 pictures (no signi?cant others included) NO more than 3 pair of shoes, 1 pair needs to be work shoes or work boots NO more than 2 hats 1D Social Security Card, Picture 11) NOTE: DO NOT BRING JEWELRY, WATCH, STUFFED AAFIAMLS, LETTERS, BOOKS, M4 GAZINES, MONEY, CREDIT CARDS, ADDRESS BOOKS OR ANYTHING NOT LISTED IN THE IN TEN TOR Y. Ladies Clean out your purses or you will loose the contents! If you do not have all of the above items, we will do our best over the following weeks to assure that you receive the clothing items you require. WILL NOT be allowed to request any items to be sent from home until your first family visit, which is when you make lifestyle phase (approximately 6 months). Birthday and Christmas gifts will be dealt with on a request basis. An associate must request what they would like to be sent from home as a gift on these holidays. Residents should notify family of these conditions prior to entering RCC. Failure to comply can result in accountability. Recovery Connections Community will not be responsible for any personal items left behind if you leave against clinical advice. If you would like, you can bring a $50 non?refundable deposit (receipt will go in ?le) to have your belongings mailed to your home address. Otherwise you will be given one business day to make arrangements to pick up your belongings, after that they will be delivered to a local charity as a donation or disposed of in the local landfill. You are encouraged during your stay to not bring anything of sentimental valueli I understand that if I bring items other than those speci?cally listed above, the items will be disposed of at the time of my entry into the program. The list above is all-inclusive; there are no exceptions. Print Name (Signature) Date Witness (Legal Representative) Date Recovery Connections Communi ty 65 Chestnut Hill Road Black Mountain, NC 28711 (828)-7 74?0424 e?mail: rconnectcom@aol ,com APPLICATION FOR ADMISSION SUBMITTED BY: DATE: Recovery Connections Co :ii? an i ty Application for Admission Pagcl [)ate: Name: Last: First: Middle: Sex: SSN: State: ?Status: DOB: Most Recent Address: City: State: Zip: Height: Weight: Hair Color: Color: Distinguishing Marks: (Tattoos, Scars, etc.) Marital Status: Married: Divorced: Single: If married, Spouse?s Name 7 Do you have any children? How Many? Child?s Name Who is the child staying with Child?s Age In case of Emergency, Notify: Phone #1 Relationship to Applicant: Parent?s Name: Phone Address: City: State: Zip: Recovery Cosmec tions Admission Application Page 2 Criminal Justice Information Applicalions may be submiried and a deierminaiion io accept or reject the applicant will be made prior to {lie scheduled court date. Hon-fever, all legal proceedings must be completed prior to establishing residency in a Recovery Connections Community facility. Failure to disclose pending legal action(s) is immediate dismissal from the program. Do you have any outstanding warrants? Do you have any outstanding charges? When is your court date? Are your represented by an attorney? Attorney?s Name: Phone Address: City: State: Zip: Are you on supervised probation? If yes, in what county and state? Probation Information: Of?cer?s Name: Address: City/ State/ Zip Phone Last Seen] Spoken With: Is your probation of?cer aware that you are seeking long term treatment? Are you obligated for child support payments? Are payments current? County: Case worker Name: Recovery Connec tions Comuni ty Admission Application Page 3 Medical History Information Do you have any medical conditions that will limit yOur activities? If yes: explain: Are you taking any prescription medication(s)? If yes, list all: Have you ever experienced or been diagnosed as having any of the following: Seizures TB Diabetes Hepatitis Heart Disease Epilepsy Cirrhosis High BP Are you currently under the care of a physician? Doctor?s Name: Phone Reason(s) for current treatment: Have you ever been hospitalized in a mental institution? Hospital Name Date(s): Reason: Have you ever tried to commit suicide? If yes explain: Have you been tested for Date: Result: Are you a veteran? Do you qualify for medical benefits? Cbnnections Admission Application A 1 age?: Educational Information Did you graduate from high school? Year: If not= highest grade completed? Did you earn a Year: Have you had any college or vocational school training? Name of College/ School: Location: Degree/Certi?cate Received: Year: Employment Information What is your primary occupation? How Long? Do you enjoy this type of work? What type of work would you like to do? Substance Abuse History Drug(s) of Choice: Date Last Used: How long have you been using drugs? How Often? How long have you been using alcohol? How Often? Other drugs used or tried? Have you been in treatment before? List prior programs below: Prior programs tried? Dates: Dates: Dates: How old were you when you ?rst used drugs and/ or alcohol? Have you ever used drugs intravenouslygag tam-a2: (1 i 1 i A. is??w?f?tmr?m Recovery Connections Community 65 Chestnut Hill Road Black Mountain, NC 2871] RELEASE OF INFOJWA TION AUTHORIZATION Client Name: Date of Birth: Social Security Number: I, hereby authorize (Clients Name) (Facility, Physician, and address of person releasing niforination) to release/exchange specified information in my client record to: (Recipient Name and Address) This data shall include (Nature Extent of Information) Specify Time Period: __Summary of Evaluation Treatment Acquired Admission Assessment/ creening (Aids History Treatment) Alcohol or Drug History Treatment Treatment Plan Diagnosis Progress Notes Medication History Discharge Stumnary Evaluation Evaluation History Financial Information Human Immunode?ciency (Virus) Educational Information (History Treatment) Attendance Other: I understand this information will be used for: Evaluation Treatment Planning Referral Case Management Services Continuity of Care Other: I hereby request and authorize the above named agency, organization or individual i-i-rhich possesses information relative to the client named above to release iiy?Oi-mation, as Speci?ed, to the agency, organization or individual named on the request. I understand that the information to release may include infomiation regarding drug abuse, alcohol abuse, siclcle cell anemia, or or information. I certify this authorization is made ?nely, voluntarily and without coercion. I understand that the iiy?bimaa?on to be released is protected under state and federal laws and cannot be reudisclosed without my?n'ther written consent unless otlzenvise provided for by state and federal law. This consent shall be valid for a period not to exceed one year, I further acknowledge that I may revoke this consent, in writing, at/LM" time except to the extent that action based on this consent has been taken. Client: Legal Representative: Date: Witness: Person Releasing Information: Date: ., Black Mountain, NC 28711 Recovery Connections Community does not allow residents to take the following medications: 0 Opioids Often prescribed to treat pain. Morphine Dilaudid Vicodin Ativan Lortab Codeine Buprenorphine Demerol Klonopin Percocet Oxycodone Methadone Darvon Darvocet 0 Central Nervous System (CNS) Depressants Used to treat anxiety and sleep disorders. 1 1. Hal UILUI (ILED License Veri?cation Page 1 of2 Search Names First Last Jennifer Hollowell's Certifications Print This Page Enter the ?rst and last name of the individual. If the CSAC individual is credentialed by the NCSAPPB, his/her Issue Date ?5/19/2000' name will appear after the query. Please click on the . t' name produced by the query and the substance abuse Ion 7/ 1/201 2 professional?s status with the Board will be displayed. a CCS Please note that a query might produce several results should the ?rst and/or last name ?eld not be completed Issue Date ?9/10/2005l in its entirety. Also, a query might not produce any results if the individual?s name is spelled incorrectly. Expiration Date: 1/1/2012 Approvals will only be listed for counselors who are currently seeking a credential. lfa counselor is already NO aDDl?OvalS Were fully credentialed, it is likely that no approvals will be found unless that counselor is currently pursuing an additional credential. Approvals Key: REG REGISTRANT is a person who completes ali requirements to be registered wit the Board and is supervised by a certified clinical supervisor or clinical supervisor intern. REG-L LCAS REGISTRANT is a person who completes all requirements to be registered with the Board in pursuit of the LCAS credential and is supervised by a certified clinical supervisor or clinical supervisor intern INT INTERN is a Registrant who successfully completes 300 hours of Board-approved supervised practical training in pursuit of credentialing as a substance abuse counselor. is a LCAS Registrant who successfuily completes 300 hours of Boardwapproved supervised practical training in pursuit of licensur?e as a clinical addictions Specialist. DISCIPL Disiplinary Action by the Board. Please contact the Board office for further details. Disclaimer: .org/veri?cationsteve/indexhtm 08/1 81/2011 5'55.? 5? 5 (555152") ?Ravi? 5: 55153553155 fj_5,~ 53m}. 83:: 3553 if? 55 553 5251?; 5522.3: 5555.5} VERIFICATION OF LICENSU RE DATE: 5/4/2011 To Whom it May Concern: This is to certify the following information, maintained in the records ofthe North Carolina Board of Licensed Professional Counselors. is correct based on records available for the referenced Health Care Practitioner listed below: License Type: Licensed Professional Counselor License Number: 5105 License Name: Jennifer Ann Hollowell License Status: ACTIVE - LPC License Standing: Issuance Date: 12/2/2005 Expiration Date: 6/30/2013 lf License Status is listed as active then license is in good standing with the North Carolina Board of Licensed Professional Counselors. lf License Status is listed as anything other than active please contact the Office for additional information. Disciplinary action will be indicated in the License Status section as Revoked, Suspended, or Probation. This verification was obtained via the North Carolina Board of Licensed Professional Counselors? website. Wo?a?my); ?Lau/agq (mew 0L: CM {21 OLA L5 L70 7LML LLWMULUL ?10;qu (if @213 HEEL OHM NJ (LL-L D101 P5861 (EKP it; rju Sigh . 1 \j i Facility Name: Contact Method: Contact Person(s): Contact Number(s): Purpose of Contact: Licensable Facility Contact Notes: Division of Health Service Regulation Mental Health Licensure and Certification Report for Record License Recovery Connections Community Number: MHL Telephone El SiteVisit Meeting Jennifer Hollowell, Phillip Warren Was asked to again visit this program to determine if they are licensable. Have visited this agency on several previous occasions due to complaints from the community that they might be operating a substance abuse facility without a license. Have not been able to determine that they are providing treatment and have not required licensure. Was again asked to visit and see if their program has changed since my last visit (August, September 2011) and to see if licensure can be of any assistance. Arrived at the facility, unannounced, on 9/5/12. Found 3 residents at the home. One was asleep, one was not interested in speaking with me and one agreed to talk about the program. escribed the program as transitional housing. Stated that the residents were required to work on a job that the agency ?nds for them, work on their education (if needed and they were interested), attend 12 step programs and attend all probation appointments. Everyone in the home has responsibilities regarding cooking, cleaning, etc. The home is led by peers who have been in the program longer. There is no actual ?staff?. The senior peers live in the home. They typically have or 3 years with the program. The agency provides them with all transportation. They ca their own car after they have been in the program for ?a while?. mated- was not sure how long). it is a voluntary program and they can leave at any time. Their medications are locked up in one central location. No one is Facilities\Recove'y Connections Community-R4R-9?2-3?12doc Division of Health Service Regulation Mental Health Licensure and Certification allowed to have any medications on their person or in their rooms. There is a set time for medications to be taken. The medication cabinet is opened by the senior peer and it is up to each individual resident to come and get their medi when it is time to take it. administers medicationitated that the might reminc?f - for ets to come and ge edication but 3 never forced to take it if doesn't want to. The agency handles all re?lls. There are no When a new resident comes to the program, they will go to the main of?ce initially for papen~ork. They must agree to have a background check and a TB skin test before they can enter the program. Once they enter, they go to one of two houses-one for males, one for females. They are assigned jobs at various sites within the community. A typical day includes chore assignments at the house and going to their job. In the evenings they attend NA or AA meetings (either at the house or at local churches within the community), have sessions at the house including recovery papenivork, journaling, house meetings regarding their day, problems they are having with others in the house, with sobriety, with family/community, etc. 12 step literature was observed throughout the house. He states that they go to at least four 12 step meetings a week, sometimes more. I attempted to contact the operators of the program but found out that Ms. Hollowell was out of town due to a death. Made an appointment to meet with her on 9/20/ 12 Met with Jennifer Hollowell and Phillip Warren on 9/20/12. They stated that they have 4 houses, one for males, one for females and two coed. Initially. new residents must go to either the male or female house but they have the option to move to a coed house if they choose to do so, after a year in the program and if there is a vacancy. They described the program the same as I found it last year and the same as the resident had explained on my site visit on 9/5/12. This is a peer led, 12 step program that requires sobriety, responsibility and accountability. When I was at the program last year, they stated that they were non- profit. I discussed the possibility of a letter of determination that they were indeed registered as a non-profit with the IRS and the Treasury Department. Mr. Warren agreed to look into that possibility which would include them in GS. 122C-22 Mr. Warren stated that they had received their non-profit status and presented me with a copy of the letter from the IRS. At this time, I do not see any evidence that this program meets the criteria of licensure as outlined in GS. Facilities\Recovery Connections Community-R4R-9-20-12doc Division of Health Service Regulation Mental Health Licensure and Certification Joy M. Allison 10/1/12 S:\Mountains\Unlicensed Facilities\Recovery Connections Community-R4R?9p20?12doc INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 RECOVERY CONNECTIONS COMMUNITY 65 CHESTNUT HILL RD BLACK MOUNTAIN, SC 28711 ug BE Lt Dear Applicant: DEPARTMENT OF THE TREASURY Emiloier Identification Number: i DLN: 17053005444042 Contact Person: SUSAN MALONEY Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 31210 S??iel?21.; a; g? Form 990 Required: Yes Effective Date of Exemption: April 12, 2011 Contribution Deductibility: Yes Addendum Applies: NO We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522wof the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this .letter. Please see enclosed Publication Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization. Letter 947 RECOVERY CONNECTIONS COMMUNITY Sincerely, Holly O. Paz Director, Exempt Organizations Rulings and Agreements Enclosure: Publication Letter 947 7? wHw?? 999 PN wfu QEQFU $6??ngan . i. 9 9 FE LEW. :rk. \Nm/nawu 0%er wow 1.x. ?1 dwu-?Wind:- . .5 no (CK WKL MCMM UWZEK '3 KS 6 Muoa?ux 0L 03% @101;de K0 Tab-mm 13K R.) w. ae?f?? w?wkfa?gs?bx a MK ?$de mum?: Lug rm Lg) K0 <2.sz @419?MILL 0K1. Car}: kuK (L MLKS AFKK :50 an KL had/KL. f" JKK COW OLKK Km, MKMK INK KQK v. ?Km ?we: UL) \th mm DC KL 3mm?; (ML CKC f?K; KZ 03 (Lug 0" 5W Unlicensed Facility: Cease Desist When the MHLC receives information regarding a facility providing licensable services without a license, a surveyor or surveyors perform an onsite visit to assess the status of the facility. The primary purpose of the onsite visit is to determine if the facility is providing iicensable services as demonstrated by some or all of the following: 1. Medications are administered as evidenced by the presence of a medication administration record, central storage of medications inaccessible to clients. 55310 KPM 2. Coordination of medical and mental health appointments 3. Provision of recreational or community supports. 35%me Amie 4. Transportation is being provided. [4,6,5 5. Presence of a treatment plan, progress notes, or NP 6. Maintenance of client records. wnhbiip prelim- koala with ?lb WW (Lifer/J hmfw?A 7. Supervision is occurring during the aim3 or Movgrnight staf?ng is being provided . 8. Group activities are occurring @M?in no luggage-is my? Wk hag, (umgw w-IU?n immi (/63ngng ?9 9. The client?s residence at the facility is contingent upon receR/ing treatment. 33341:? ?3 i 10. Presence of a contractual agreement for money for servicesr Law/95 film 11. The provider iS receiving the client?s SSI check m, use Maw/Ar 019m 6 i? Ow sums Mitt If it is determined that the facility appears to be providing lice sable services without a license, Lows the Mental Health Licensure Certification Section will take the following actions to ensure the facility ceases operation. Unlicensed facilities includes those programs never issued a license and programs with licenses that have been revoked and appeals exhausted 1. The team leader will draft a cease and desist letter for the Section Chiefs signature. The team leader sends the cease and desist letter and the report for record to the Section Chief for her review. 2. After review and signature by the Chief, the letter will be mailed certi?ed to the operator of the unlicensed home. 3. The cease and desist letter will be copied to the: accountability team leader (b)"local management entity local Department of Social Services local law enforcement agency local magistrate?s of?ce NC Council of Community Programs 4. After the certi?ed mailing receipt is returned with date of delivery, the team leader and/or branch manager will work with the local management entity and the local Department of Social Services to ensure the facility is not continuing to operate. If necessary, an on?site visit to the facility by section staff will be scheduled to determine the operational status of the facility. 5. If the facility is found to be operating, the assistant attorney general?s of?ce will be noti?ed. The assistant attorney general will contact the local district attorney and advise them of facts of the case. The assistant attorney general will determine if injunctive relief is to be sought or other legal measures taken. R:\Mental Manual 10?4?2011.doc Page 70 of 94 +9ll37'5?724 001/002 North Carolina Department of Health and Human Sat-vices Division of Health Service Regulation 0 Complaint Intake Unit Tel - Fax 919?715-7724 711 Mail Service Ceoter Raleigh, North Cm'ohna 27 699?271 1 Beverly Pcrdue, Governor Lanier M. Caaslcr, Rita C. Horton, Branch Manager MEMORANDUM TO: Scott Conrad Mental Health Licensure Section? Mountains From: D?iborah Smith. Pod Complaint Intake Unit Division ochalth Service RCg?Ulalion Date; 01/04/l2 Re: Complaint Referral The Complaint lmake Unit with the Division of Health Service Regulation the almcbed complaint information. Our DiVision docs have jurisdiction to invcsogatc these concerns. Pleas: handle as you deem appropriate. Location: 1205 Umstoad Drive - Dorothcn Dix I'lospltal Cm?npus - Raleigh, C. 17603 Ar. Equal Oppommiry Af?rmat vc Acnou Employer 01-04?12 new cpov?cowumr NTAKEUNIT .gigrisim 7-35;; Ln?; Hotline Call Detail Report ww- RECEIVE DATE 01/04/12 BECEIVE 10222 CAL ER on STAFE NAME SMITH, DEBORAH Um?; M) 0g THUG intake Di 5 W6 W6 NUMBER Willi? (M7 6f) . ?1 Luv? Slur Provider PROV ID PROVIDEB NAME EROVIDER TYPE PROVIDES ADDRESS MEDICARE lD Cali Notes Received call on 01/03/12. Callers name: Phone numbe Caller stated three tacilities are operating with no license: 1. Recovery Connection Community 15 East Mountian Way Ashville NC - veil. . No on hind: - 2. Recovery Connection Community 1076 Old us Highway 70 Black Mountain, NC. row For. sixty; 3. Recovery ConnectionCommunity 2940 US Highway 70 Black Mountain, NC. Bli?l ll . ??l?f'ut VA. . . - Caller stated there is the male in facility that is not suppose to have any contact with anyone. Caller stated the web site indicates that the clients not place phone calls. send letters or have contact Caller is concerned that the male client name not provided) is leaving the faciity and and leaving letters in family members mail box and was observed in local grocery store. Caller is concerned for the safety of family member if male client is allowed to leave facility and contact family member. Caller stated has called and was not able to reach President/CEO Jenifer A. Holiowel! or Consultant President Mary Jane McGill. Caller request someone investigate to ?nd out if facilties are working without license and what will happen to clients it are made to stop taking clients and close. Caller continued to express concern for family member if client. male) is let out to facility. Caller would like to hear from surveyor. ?oiLinaml 10199 Page i o? Customer Display Page 1 of 1 Customer Display - _M_aa A ent EE 0111 1? Histo Attachments 6 set 1, S2 C?GalieryUZ) 70%? ??gsotsafg??: None 1076 Old us Hwy 70 Black Mountain, NC 23711 List: $279,000 2 Firm: 1261 Agt: 548502277 Area I County - Buncombe City I Comm: Black Mountain I "i Subdivision: None Inside City: Yes Bedrooms: 3 Range: 1600-1900 Baths: 2 Apx Yr. Built: 1934 Half Baths: 0 Taxes: 1910 Deed Bki'Pg: 3985 681 Tax Year: 2010 CondoITH Lvl: Zoning: O-l Assoc FeeIPer: Deed Rest: No Owner: Berry Natalie PIN: 060953659600000 Apx Acres: .59 Lot Dim: State Rd: Yes Road th: Rd Maint Agrmt: No Maint Agrmt S: Fin SF: 1.058 Apx 2nd Fin SFApx BSMT Fin SF: 0 Apx UnFin BSMT SF: 760 Handicap Acc: No Elementary: BLACK Middle School: CHARLES OWEN High School: CHARLES OWEN ROOM APX LEVEL ROOM APX LEVEL Living Rm: MBR: Dining Rm: BR 2: Great Rm: BR 3: Family Rm: BR 4: Kitchen: BR 5: Laundry: Bath 1: 112 BA 1: Bath 2: 112 BA 2: Bath 3: Bonus Rm: Other: Interior Features: Built-ins Ceiling Fan(s) Fireplace - Wood Formal Dining Rm . Smoke Detector(s) Storage Area . Window Treatments Workshop Exterior Features: Deck(s) Fencing?Full Fencing?Privacy . Outbuilding(s) . Storm Door(s) Appliances: Dishwasher Microwave . Range Refrigerator Does Not Convey: - Style: 2 Story w/basement . Historical Traditionai Ext Finish: Brick Bsmtand: Bas Full Un?nished GarageICrpt: Garage Det Floors: Ceramic Tile Hardwood Slate Roof: Architectural Shingle Rolled Rubber Heating: Gas Forced Air . Cooling: Central Water: City Sewer: Public Const. Type: Site Built Porch: Lot Desc: Level Mountain View Trees Street: Paved Drive: Paved Docs On File: Aerial Lead Based Paint Discl. Res. Prop Disctosure Financing: Cash Conventional FHA Showing Inst: Con?rm Req. Before Show MLS-Showing Service Seller Rep: Not Primary Residence . Owned more than 1 year Directions: l-40 To exit 64(Black Mtn), on hwy 9 to 3rd light. onto US 70 continue about 1 mile to on old US 70 at Dukes Degs, go through blinking light to the second drive past Cut'n Up barber shop. Remarks: Beautiful historic brick home in convenient location, yet private with large evergreen trees surrounding property. Hardwood ?oors throughout home. loads of historic character. Well maintained w/ some wonderful updates, inciuding a beautiful sun room, lovely bathroom addition, and important features like water sealed basement that is dry, clean ,and very usable. Also has a great detached garage/workshop space. ?re pit, and complete fencing. Prepared For You By: Heidi King Phone: (828) 669-1072 204 East State Street Of?ce Ph: (828) 669-1072 . a _d Black Mountain, NC, 28711 Cell Ph: (828) 231-8737 ?11 B931 Email: heidl@greybeardrealty.com Web Site: EALTY Listing Provided By: GreyBeard Realty Firm: GreyBeard Realty - - - - Information herein deemed reliable but not guaranteed - - - - Copyright 2008 North Carolina Mountains MLS 01/24/2012 01:30 PM 1/24/2012 Customer W/Gallery Page 2 of 4 Photo Gallery A490549A Master Bedroom - - information herein deemed reliabie but not guaranteed Copyright 2012 North Carolina Mountains MLS 01/24/2012 01:37 PM Prepared By: Heidi King disn 1/24/2012 Page 1 of] Allison, Joy From: To: Allison. Joy Subject: Jennifer Hollowell Attachments: Joy, We received the attached Final Order Monda . I know that this will not stop what is going on across the street but with recently awarding 8 additional Women?s beds (which increases that population to 24) and the 10 veterans women beds, at least this may slow down the antics that are continuing to go on. We are now gearing up for the women and children and really would have this all over with. This email and any ?les transmitted with it are con?dential and are intended solely for the use of the individual or entity to which they are addressed. This communication may contain material protected by HIPAA legislation (45 CFR, Parts 160 164) or by 42 CFR Part 2. If you are not the intended recipient, be advised that you have received this email in error and that any use, dissemination. forwarding, printing or copying of this email is strictly prohibited. If you have received this email in error. please notify the sender by replying to his email and then delete the email from your computer. Thank you! 5:37.301: NORTH CAROLINA BEFORE THE NORTH CAROLINA SUBSTANCE ABUSE PROFESSIONAL PRACTICE BOARD NORTH CAROLINA SUBSTANCE ABUSE) PROFESSIONAL PRACTICE BOARD, Petitioner coxsm onnsn v. EC No. 132?10 et a1. 3 JENNIFER A. HOLLOWELL, Respondent THIS MATTER is before a Panel of the Ethics Committee ("the Panel") of the North Carolina Substance Abuse Professional Practice Board ("the Board"), pursuant to Chapter 1503 of the North Carolina General Statutes; 21 N.C.A.C. 68.0600, and N.C. Gen. Stat. ?90~113.44; with the consent of Respondent Jennifer A. Hollowell, in lieu of a formal hearing in North Carolina Substance Abuse Professional Practice Board v. Jennifer A. Hollowell, OAH File No. 12 SAP 01106, or otherwise. The Board, with the consent of Hollowell, makes the following FINDINGS OF FACT: 1. Petitioner North Carolina Substance Abuse Professional Practice Board (?the Board"), was established by G.S. 90?113.32, and is recognized as the registering, certifying, and licensing authority for substance abuse professionals described in the Practice Act. The Board was established to safeguard the public health, safety, and welfare, to protect the public from being harmed by unqualified persons, to assure the highest degree of professional care and conduct on the part of credentialed substance abuse professionals, to provide for the establishment of standards for the education of credentialed substance abuse professionals, and to ensure the availability of credentialed substance abuse professionals of high quality to persons in need of these services. The Board, under authority granted by the Practice Act regulates Board-credentialed persons offering substance abuse counseling services, substance abuse prevention services, or any other substance abuse services fOr which the Board may grant registration, certification or licensure. 2. Hollowell is certified by the Board as a Certified Substance Abuse Counselor Certificate No. 1661, approved May 19, 2000. Hollowell is also certified by the Board as a Certified I Clinical Supervisor Certificate No. 341, approved September 10, 2005. 3. Hollowell is a citizen and resident of Buncombe County, North Carolina; and is neither a minor nor an incompetent person. Hollowell currently resides at 65 Chestnut Hill Road, Black Mountain, NC 28711 Hollowell was formerly known as ?Jennifer Welker." 4. Hollowell was during times relevant to this proceeding an employee, officer and director of Recovery Ventures Corporation and served as its Therapeutic Director. 5. A client, who will be referred to hereinafter as John Doe was admitted to a program run by RVC which generally runs for two (2) years until completion. 6. While still a client of RVC and Hollowell, Doe and Hollowell began a personal relationship, which the Board alleges, and Hollowell denies, involved ?sexual activity" or ?sexual contact? as those terms are defined in 21 NCAC 63.0101(33) and (34). 7. For purposes of this Consent Order, no finding is made as to whether Hollowell had ?sexual activity? or "sexual contact" with Doe while he was still a client. 8 . Hollowell 5 relationship with Doe during the period of time when he was a client was such that it could impair professional judgment or increase the risk of'exploitation of'a client, and ittdid impair her professional judgment. 9. RVC primarily secures the funds to maintain the group homes; pay salaries to 5 employees; feed the clients, and provide medical care and therapy for the clients, through contracts with business entities in the Buncombe County area. In general, business entities pay RVC under contract for client labor provided by RVC. 10. RVC also supports itself through contributions either made directly, or after solicitation by clients working for RVC in their in?kind contribution program. RVC clients and/or staff would solicit from third parties in kind donations for use by RVC and its clients. 11. Hollowell at times inappropriately diverted to her personal use, and to the use of her family, items donated for use by RVC and its clients; and used food purchased with RVC's client? 5 food stamp benefits for her and her family's personal use. 12. Hollowell used therapuetic community assets for personal use. Hollowell's personal use of therapeutic community assets denied the use of those assets to clients of RVC. 13. Beginning as early as 2004, and continuing thereafter, Hollowell had clients of RVC provide personal services at her residence, such as cleaning her residence; cooking for her and her 2 family; babysitting her children; landscaping; making home repairs and improvements; taking care of her numerous animals (including, variously, dogs, cats, birds, lizards, and goats; and run personal errands, such as picking up groceries, driving her children around, changing the tires on her car, and color coordinating her closet. 14. Hollowell did not pay for the personal services rendered by her clients, except, perhaps, on an irregular basis; and continued to use client labor for personal services after repeated warnings that the conduct was unacceptable. 15. In spite of the warning of the Board, and the instructions of Board, Hollowell continued.to have clients perforntpersonal services at her residence, including babysitting her children, cooking, cleaning, landscaping, animal care and home improvement work. 16. Hollowell's use of client labor for personal services was a serious misuse of her professional relationship for personal advantage. 17. Hollowell?s use of clients' labor for her own benefit denied those clients the full benefit of the programs at RVC, and could have reduced the clients chances of completing the program, and could actively cause harm to the clients. 18. On April 12, 2011, shortly after her termination by RVC, Hollowell caused a nonprofit corporation, Recovery Connections Community to be formed, and Hollowell, through RCC, began providing services in a community setting through RCC. 19- The Board contends, and Hollowell denies the following disputed statements, but by agreement and without Hollowell's admission, the following disputed statements may be used for purposes of determining the appropriateness of the discipline to be imposed under the terms of this Consent Order. These disputed statements are: a. That Hollowell permitted Doe to drive clients of RVC and RCC when she knew he was not licensed to drive, exposing both Doe and the other clients to risk. b. That Hollowell acting directly, or through Doe, and other individuals acting on Hollowell?s behalf, solicited RVC clients, seeking to have thenlleave RVC and come to without pr0viding advance notice to RVC that she was soliciting the client: and exposing those clients who were at RVC on probation, to risk of probation revocation and incarceration. The Board contends that Hollowell engaged in acts relating to client solicitation that violated her obligations under 21 NCAC c. That Hollowell, or others actinchIher behalf, solicited 3 donations for RCC while falsely asserting that it was a nonwprofit corporation within the meaning of 501(c)(3) of the Internal Revenue Code. d. That Hollowell interfered with the investigation of the Board, by encouraging potential witnesses to give false statements to the Board. e. That Hollowell, in a general sense, while at RVC, failed to maintain appropriate boundaries between herself and her clients in ways that have negatively impacted their progress in treatment; has used and exploited her clients for her personal benefit; has abused and otherwise treated clients in a way not primarily for the benefit of the clients, and in many cases to their immediate and actual detriment; has exposed clients to environments harmful to them; all in violation of her obligations of the rules and regulations of the Board. BASED UPON THE FOREGOING FINDINGS OF THE BOARD CONCLUDES AS A MATTER OF LAW: 1. 21 NCAC 68.0509 provides that [tjhe professional shall avoid.dua1 relationships that could impair professional judgment or increase the risk of exploitation of a client.? 2. 21 NCAC provides that ?[t]he substance:abuse professional shall not engage in or solicit sexual activity or sexual contact with a former client for five years after the termination of the counseling or consulting relationship.? [At the time Doe graduated from the program, the prohibition only extended for two years after termination of the counseling or consulting relationship, and that two year prohibition is applicable in this case.] 3. 21 NCAC 68.0509(d) provides that ?[t]he substance abuse professional shall not misuse his or her professional relationship for sexual, financial, or other personal advantage. 4. By virtue of the conduct described above regarding a relationship withla client, Hollowell violated her obligations under 21 NCAC 21 NCAC and 21 NCAC and is subject to discipline under the provisions of 21 NCAC 68.0601i4). 5. If true, permitting Doe to drive clients when she knew he a licensed is also grounds for discipline under the provisions 21 NCAC and 21 NCAC 6. Hollowell' diversion of in kind donations intended for RVC and its clients? use to her and her family?s personal use, is in violation of her obligations under 21 NCAC her obligations under 21 NCAC and her obligations under 21 4 NCAC 7. The foregoing described conduct relating to in kind contributions are grounds for discipline under the provisions of 21 NCAC 21 NCAC 21 NCAC 8. Hollowell's use of clients' labor for her own benefit is in violation of her obligations under 21 NCAC and in violation of her obligations under 21 NCAC 9. Hollowell" 5 use of clients' labor for her own benefit could have denied those clients the full benefit of the programs at RVC, reducing the clients chances of completing the program, and actively causing harm to the clients, in violation of her obligations under 21 NCAC 21 NCAC and 21 NCAC 68.0507tc). 10 . Hollowell' actions as described above, [the truth of which she admits with respect to Findings of Fact 1-18, and denies with respect to Finding of Fact 19 (except that she admits Finding of Fact 19 solely for purposes of imposing discipline)], are grounds for discipline under 21 NCAC and 11. Hollowell? actions as described above, [the truth of which she admits with respect to Findings of Fact 1-18, and denies with respect to Finding of Fact 19 (except that she admits Finding of Fact 19 solely for purposes of imposing discipline)], violate her obligations under 21 NCAC 68.0507ta) and 21 NCAC 21 NCAC and are grounds for discipline under the provisions of 21 NCAC and 12 .. Hollowell' actions as described above, [the truth of which she admits with respect to Findings of Fact 1*18, and denies with respect to Finding of Fact 19 (except that she admits Finding of Fact 19 solely for purposes of imposing discipline)], are in.violation of her obligations under 21 NCAC 68.0507(c) i 21 NCAC and are grounds for discipline under 21 NCAC 13. The foregoing described conduct, [the truth of which she admits with respect to Findings of Fact 1~18, andtdenies with respect to Finding of Fact 19 (except that she admits Finding of Fact 19 solely for purposes of imposing disciplinel]. is grounds for discipline under the provisions of 21 NCAC 68.0601. 14. The appropriate discipline to be imposed against Hollowell, on account of the rules violations described in paragraphs 1-18 of the Findings of Fact, above, is permanent revocation of all of the licenses and certifications granted by the Boar . Further, the appropriate discipline to be imposed with respect to the rules violations described in paragraph 19 of the Findings Of Fact, and which Hollowell only admits for the purposes of imposition of discipline, is permanent revocation of all of the licenses and certifications granted by the Board. 15. By agreement, each party shall bear its own costs incurred in connection with the Board's investigation and the pending Office of Administrative Hearings proceeding. WHEREFORE, based upon the foregoing FINDINGS OF FACT and CONCLUSIONS OF LAW, and with the consent of the parties, pursuant to the authority set forth in N.C.G.S. 90?113.33, it is hereby ORDERED, ADJUDGED AND DECREED AS FOLLOWS: 1. The credentials granted by the Board, including Hollowell's certification by the Board as a Certified Substance Abuse Counselor Certificate No. 1661, approved.May 19, 2000: and her certification by the Board as a Certified Clinical Supervisor Certificate No. 341, approved September 10, 2005; are hereby permanently revoked, effective as of the date of execution of this Consent Order by the Board. 2. Each party to this proceeding shall bear their own costs, and the Board shall bear its own costs of investigation and the pending Office of Administrative Hearings proceeding. 3. This Consent Order fully resolves all issues before the Administrative Law Judge appointed to hear North Carolina Substance Abuse Professional Practice Board v. Jennifer A. Hollowell, OAH File No. 12 SAP 01106, and the Board will dismiss that proceeding, without prejudice. This the day of 2012. NORTH CAROLINA SUBSTANCE ABUSE PROFESSIONAL PRACTICE BOARD By: Name: Its President 15. By agreement, each party shall bear its own costs incurred in connection with the Board's investigation and the pending Office of Administrative Hearings proceeding. WHEREFORE, based upon the foregoing FINDINGS OF FACT and CONCLUSIONS OF LAW, and with the consent of the parties, pursuant to the authority set forth in N.C.G.S. 90-113.33, it is hereby ORDERED, ADJUDGED AND DECREBD AS FOLLOWS: 1. The credentials granted by the Board, including Hollowell's certification by the Board as a Certified Substance Abuse Counselor . Certificate No. 1661, approved May 19, 2000: and her certification by the Board as a Certified Clinical Supervisor Certificate No. 341, approved September 10. 2005: are hereby permanently revoked, effective as of the date of execution of this Consent Order by the Board. 2. Each party to this proceeding shall bear their own costs, and the Board shall bear its own cost: of investigation and the pending Office of Administrative Hearings proCeeding. 3. This Consent Order fully resolves all issues before the Administrative Law Judge appointed to hear North Carolina Substance Abuse Professional Practice Board v. Jennifer A. Hollowell, OAH File No. 12 SAP 01106, and the Board will dismiss that proceeding, without prejudice. This the day of 40447 2012. NORTH CAROLINA SUBSTANCE ABUSE PROFESSIONAL PRACTICE BOARD Name: Its President - 38 39Vd OMW SIQN 179:: SIAIENBNT 0? CONSENT I, Jennifer A. Hollowell, do hereby certify that I have read the foregoing Consent Order in its entirety, that I have consulted with counsel concerning the contents and effect of the same, and that I voluntarily accepts that there is a factual basis for the findings of fact set forth herein, other than those designated as disputed; and that those findings of fact are legally sufficient to support the findings, conclusions and discipline provided for therein, and that I assent to the terms of the Consent Order. 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The primary purpose of the onsite visit is to determine if the facility is providing licensable services as demonstrated by some or all of the following: 1. Medications are administered as evidenced by the presence of a medication, N33 administration record, central storage of medications inaccessible to clients. Coordination of medical and mental health appointments Lie?) Jim with?) Provision of recreational or commu 11:14 supports. Transportation is being provided. Q9 air my 55,; vim 1.53? ,l DMAL Presence of a treatment plan, fgogress notes, or Maintenance of client recordsc lva 7 Supervision is occurring during day or overnight staf?ng is being provided Group activities are occurring tits . The client' 5 residence at the fa my lS contingent upon receIV/ttreatmentO 10. Presence of a contractual agreement for money for serv1ces 11. The provider is receiving the client? $51 check 63 If it is determined that the facility appears to be providing licensable services without a license, the Mental Health Licensure Certi?cation Section will take the following actions to ensure the facility ceases operation. Unlicensed faolities includes those programs never issued a license and programs With licenses that have been revoked and appeals exhausted 1. The team leader will draft a cease and desistletter for the Section Chief?s signature. The team leader sends the cease and desist letter and the report for record to the Section Chief for her review. 2. After review and signature by the Chief, the letter will be mailed certi?ed to the operator of the unlicensed home. 3. The cease and desist letter will be copied to the: accountability team leader local management entity local Department of Social Services local law enforcement agency local magistrate?s of?ce NC Council of Community Programs 4. After the certi?ed mailing receipt is returned with date of delivery, the team leader and/or branch manager will work. with the local management entity and the local Department of Social Services to ensure the facility is not continuing to operate. If necessary, an on-site visit to the facility by section staff will be scheduled to determine the operational status of the facility. 5. If the facility is found to be operating, the assistant attorney general?s of?ce will be noti?ed. The assistant attorney general will contact the local district attorney and advise them of facts of Page 70 of 94