Report of Inspection at the request of the Board of Private Alternative Adolescent Residential Programs Program: Ranch for Kids, PAP-LIC-580 144 Gateway Ave PO Box 116 Rexford MT 59930 Inspector: Jody Dalbec T.J. Hunt Date of Inspection: June 6, 2018 Date of Report: June 11, 2018 Site Inspection: 1. I Comments: Comments: 3. Comments: 4. II Comments: I Comments: Plan of operation as described in application fits with the appearance of the operation as laid out during walk through. The Ranch for Kids (RFK) is a twelve-month residential program for at-risk, internationally adopted children who are having difficulty transitioning into their new adopted families and culture. The program operates in the old Rexford School, under the direction of William (Bill) Sutley. The number of program participants is consistent with information submitted with application and provided by Administrator. At the time of the inspection, RFK had 24 program participants (16 males and 8 females]. Premise does not contain an area that could be used for corporal punishment, isolation or the ability to inflict physical pain as a disciplinary measure. Area does not exist. This information was veri?ed through staff and participant interviews. Buildings are equipped with ?re extinguishers, emergency exits plans and smoke detectors that are placed conspicuously. Smoke detectors, pull ?re alarms, fire extinguishers, fire sprinkler system, and camera security system were present throughout the building. Staff was advised during the inspection to post emergency exit plans, as none were present. Any noted deficiencies in most recent Deputy State Fire Marshalls report have been addressed. Last inspection by the State Fire Marshall was completed April 2018. No known deficiencies noted. RFK Inspection Report June 11,2018 Page20f11 6. I Comments: 7. I [3 Comments: 8. I Comments: 9. I Comments: 10. I Comments: 11. I [3 Comments: 12. I Program facilities are free from any major notable safety hazards or defects. No safety hazards or defects were noted during the inspection. If program is required to have periodic water quality testing and septic maintenance, verify these inspections are current. Ms. Eviene stated the building is connected to city water and sewer. Facility contains an adequately supplied first aid kit which is maintained and in good working order. Multiple first aid kits were viewed and appeared to be fully stocked and in good working order. Area medications are stored in a controlled area with limited access. All medications and medication logs are stored in a locked cabinet. Food preparation and serving areas are adequate to ensure nutritional needs of participants are met. All areas appeared adequate. Alternative Meal Plans (AMP) are provided to participants in the lowest levels. AMP meals are the same food and portions as regular meals, but are cooked without seasonings and are served without condiments. This information was confirmed through staff and participant interviews. Food preparation areas are operated in a clean and safe manner with all equipment, storage and serving tools in good working order. All areas appeared clean. Equipment and tools appeared to be in good working order. Vehicles used to transport participants and staff has emergency information contained in the vehicle. (Name, address, telephone of program and emergency phone numbers) RFK Inspection Report June 11,2018 Page 3 of 11 Comments: 13. I Comments: Emergency information is not contained in the vehicles used to transport program participants. Instead, this information is available to medical facilities electronically at all times. AlsoI medical releases are on ?le at the local medical facility. Veri?ed if any newly constructed buildings or remodeling has been done within the last 18-24 months. If so, determine if building, plumbing and electrical permits were received and proper inspections done upon completion of project. No new construction has occurred. Administrator Interview: [Note: Mr. Sutley was not present during the inspection. An interview was conducted with Sheetal Evjene, Office Manager. 1. Comments: Comments: Comments: Administrator explained policy for contraband check, including the circumstances in which searches will be conducted and the training of staff conducting search. Ms. Eviene explained staff member, Volsky, conducts searches for contraband of the participants when they enter the program. All belongings are searched and inventoried when participants arrive at RFK. Reviewed with Administrator at least two personnel files of employees to verify background checks are on file and fingerprint checks have been performed. Personnel files are stored in a locked cabinet in the RFK office. Copies of fingerprint cards were present in the ?les. Reviewed with Administrator at least two program participant?s files to verify they are kept within accordance of programs policy and federal and state laws for privacy. Program participant ?les are stored in a locked cabinet in the RFK office. Additional participant progress notes are also stored on google drive account. RFK Inspection Report June 11,2018 Page4of11 Comments: 5. Comments: I Comments: Reviewed with Administrator at least two program participant?s files to verify that each has an individual treatment plan in place. (at least one different from above two) Individual treatment plans were not found in the participant files. Review medication dispensation log to verify that kept up to date including information on missed or refused dosages and medication changes. Medication log is stored in the locked medication cabinet and was up to date at the time of the inspection. Verify with Administrator that copies of all professional staff certifications are maintained on the premise. Staff certifications and trainings were viewed in the personnel ?les. Staff Interviews - Combined answers of two staff members: 1. Comments: 2. Comments: Staff explained definition of inappropriate and appropriate behaviors of program participants. Staff explained appropriate and inappropriate behaviors and the use of the level system. Staff explained acceptable and unacceptable responses to inappropriate behaviors as well as acceptable consequences to inappropriate behaviors. The level system includes four levels (00. 0, 1, and 2). All participants begin at the highest level (2) with the most privileges when they enter the program. Strikes for misbehavior may result in a participant moving down a level, while acceptable behavior RFK Inspection Report June 11, 2018 Page 5 of 11 3. Comments: 4. Comments: Comments: Comments: 7. I Comments: results in the participant moving up a level. Level meetings are held weekly with staff members and participants in attendance. Staff verified training in these areas has occurred and does reoccur at least annually. Staff verified trainings occur regularly. Staff verified the purpose of physical labor (not for the sole purpose of punishment). Staff explained physical labor is used to teach work ethic and not used for the sole purpose of punishment. Staff verified necessary food, clothing, bedding, rest, toilet use or bathing facilities are not denied to participants as a form of punishment. Staff stated food. clothing, and other necessities are not withheld as a form of punishment. AMP meals are served to participants in the lowest levels. AMP meals are the same food and portions as regular mealsI but are cooked without seasonings and are served without condiments. One staff member stated if bed wetting is consistent, it results in removal of the mattress when necessary. Staff verified that verbal abuse, ridicule, humiliation, profanity, threats or other forms of degradation are not directed at participants or their families. Staff indicated this does not occur. Staff verified denial of visits or communication with parents/guardians does not occur for the sole purpose of punishment (program guidelines, activities, plans or court orders may require short periods where communication cannot occur). Staff veri?ed communication with parents is not withheld as a form of punishment. All parents are scheduled to call their child once per week. Staff explained some parents RFK Inspection Report June 11, 2018 Page60f11 I Comments: 9. I Comments: 10. I Comments: 11. I Comments: 12. I Comments: choose to not call their child while he/she is in a lower level and some parents do not communicate with their child at all while he/she is at RFK. Veri?ed locked confinements or placing participants in a locked room for non- therapeutic purposes are not used. Locked con?nements are not used at RFK. Veri?ed the administration of medication for disciplinary purposes, the convenience of staff or as a substitute for treatment services is not done. Staff verified medication is only administered as prescribed. Staff verified all punishment given to a participant is done with at least two staff members present. Staff stated punishment is imposed in the form of strikes and loss of privileges in the level system. Two or more staff members are always present at the level meetingi Veri?ed physical or mental suffering including pain to force compliance does not occur. Staff verified this does not occur. The use of passive restraint is explained and falls within the program rules (only used in a situation when an imminent threat to the participant, staff or others and only by trained staff? CPI and MANDT). Staff and program participants attend MANDT training at least twice per year. Mr. Sutlev and other staff members are certi?ed MANDT trainers. RFK Inspection Report June 11,2018 Page 7 of 11 13. I Comments: 14. I Comments: Staff explained use of short term time out for behavior modification methods employed at the facility. Short term time outs are utilized at times when necessary for behavior modification. Staff explained procedures for handling emergency situations such as suicide threat/attempt, assault or runaway. Emergency procedures were explained and are located in the policy manual. Staff stated the specific procedure may also depend on the individual participant. Participant Interviews - Combined answers of four participants 1. Comments: Comments: Participants explained how staff deals with inappropriate and appropriate behaviors of program participants. Participants con?rmed sometimes staff will talk to them or give them warnings when they are not following the rules. Participants described the use of strikes and the level system in response to appropriate and inappropriate behaviors. Participants acknowledge having access to routine and emergent medical services as needed, including mental health services. Participants confirmed they have unrestricted access to medical, dental, and mental health services. One participant was observed doing a neurotherapy treatment via skype during the inspection. Participants received handbook outlining expectations and acceptable standards of the program. RFK Inspection Report June 11, 2018 Page8of11 Comments: Comments: I Comments: Comments: 7. I Comments: None of the participants interviewed recalled receiving a student handbook. However, they all acknowledged the program expectations and rules were verbally explained to them when they entered the program. Participants verified the purpose of physical labor (not for the sole purpose of punishment). Participants explained ?work day? is held on Fridays. They often do community work projects or work at Mr. Sutley?s ranch. Participants verified physical labor is not used as a form of punishment. All participants interviewed stated they enioy work day. Participants verified necessary food, clothing, bedding, rest, toilet use or bathing facilities are not denied to participants as a form of punishment. Participants verified none of these necessities are denied or withheld as a form of punishment. Participants stated AMP meals are served to students in 0 and 00 levels. Participants verified AMP meals are the same food and portions as regular meals, but are cooked without seasonings and served without condiments. One participant stated AMP meals are ?gross? because there is no sugar in the oatmeal. Another participant stated AMP meals are ?healthier? than the regular meals. Participants verified that verbal abuse, ridicule, humiliation, profanity, threats or other forms of degradation are not directed at participants or their families. Participants verified this does not occur. Participants verified denial of visits or communication with parents/guardians does not occur for the sole purpose of punishment (program guidelines, activities, plans or court orders may require short periods where communication cannot occur). Participants verified weekly phone calls with their parents are scheduled. One participant stated she and her parents do not communicate at allI but this is by choice. Two participants also described recent in-person visits with their parents. One participant thought phone calls with parents may be restricted as punishment. RFK Inspection Report June 11, 2018 Page90f11 I Comments: 9. I Comments: 10. I Comments: 11. I Comments: 12. I Comments: However, staff verified it is always the parent?s decision whether or not to call their child. Locked con?nements or placing participants in a locked room for non-therapeutic purposes are not used. Participants verified this does not occur. The administration of medication for disciplinary purposes, the convenience of staff or as a substitute for treatment services in not done. Participants verified this does not occur. Participants verified all punishment given to a participant is done with at least two staff members present. Determine if corporal punishment is used. Participants veri?ed physical punishment does not occur. They described attending weekly meetings with at least two staff members to determine their level. Physical or mental suffering including pain to force compliance does not occur. Participants verified this does not occur. The use of passive restraint is explained and falls within the program rules (only used in a situation when an imminent threat to the participant, staff or others and only by trained staff? CPI and MANDT). Participants veri?ed staff members use passive restraints only in emergent situations. Participants also stated they attend regular MANDT trainings with staff. RFK Inspection Report June 11,2018 Page 10 of11 13. I Participant explained use of short term time out for behavior modification methods employed at the facility. Comments: Participants described the use of short term time outs for behavior modi?cationI which they referred to as ?Minutes? or ?Quiet Time?. RFK Inspection Report June 11, 2018 Page 11 of 11