Author Topic: Trails Carolina - new program  (Read 44950 times)

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Joel

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Edited: Wednesday, October 06, 2010
« Reply #90 on: July 07, 2010, 11:21:19 AM »
Edited: Wednesday, October 06, 2010
« Last Edit: October 07, 2010, 03:58:24 PM by Joel »

Offline Froderik

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Re: Trails Carolina - new program
« Reply #91 on: July 07, 2010, 11:23:19 AM »
I'm seeing red.  :D
« Last Edit: December 31, 1969, 07:00:00 PM by Guest »

Offline Anne Bonney

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Re: Trails Carolina - new program
« Reply #92 on: July 07, 2010, 11:24:00 AM »
Quote from: "Froderik"
I'm seeing red.  :D

 :seg:
« Last Edit: December 31, 1969, 07:00:00 PM by Guest »
traight, St. Pete, early 80s
AA is a cult http://www.orange-papers.org/orange-cult.html

The more boring a child is, the more the parents, when showing off the child, receive adulation for being good parents-- because they have a tame child-creature in their house.  ~~  Frank Zappa

Offline Ursus

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Trails Carolina - client abuse (from V500, V512, V522, V537)
« Reply #93 on: July 07, 2010, 12:18:05 PM »
Here is pertinent text from the Statement of Deficiencies regarding the client abuse incident of 12/23/2009 (from V500, V512, V522, V537, my apologies if I've missed some stuff):


From V 500 · 27D .0101(a-e) Client Rights - Policy on Rights:

    Based on review of facility records, and interviews, the facility failed to implement their policy requiring and ensuring the Department of Social Services (DSS), in the county where services are provided, was notified of all allegations of resident abuse by health care personnel, affecting one of four sampled clients (#4). The findings are:

    A review of facility records on 3/1/10 revealed an incident report dated 12/23/09 and 2 incident reports dated 12/24/09 addressing a restraint of Client #4 which occurred on 12/23/09. The report by the Facility Manager dated 12/23/09 stated he "restrained (Client #4) to ground and held until staff intervened." The attached Physical Intervention report also completed by the Facility Manager on 12/23/09 revealed, in the section asking if the student was injured during the intervention, Client #4 got a "bloody lip trying to bite staff."

    Review on 3/1/10 of the 2 incident reports completed 12/24/09 revealed Staff #1 and Staff #2 witnessed the Facility Manager strike Client #4 during the restraint on 12/23/09. The incident report by Staff #1 revealed he "saw
[the Facility Manager] hit [Client #4] in the face ... and observed [Client#4] had blood in his mouth." The incident report by Staff #2 revealed the Facility Manager "took student to ground and punched [Client #4] in the lip."

A review on 3/1/10 of an internal investigation report revealed the Executive Director(ED) was out of town and learned of allegations by Client #4 and Staff #1 and #2 in a phone call from the Admissions Director(AD) on 12/23/09. The AD was in charge of facility in the absence of the ED. The AD documented an interview at approximately 4:30 PM on 12/23/09 with Client #4, during which Client #4 told him he had hit the Facility Manager in the face and the Facility Manager hit him back in the face.

Review on 3/1/10 of facility policy and procedures for reporting allegations of abuse revealed: "Policy: The therapist shall provide a leadership role in the identification, reporting, and follow-upon child abuse issues. ... Procedures: ...3. The therapist will receive supervision from a clinical supervisor and the Executive Director to determine if there is enough data to warrant a "reasonable suspicion" that a student has been the victim of abuse. That is all that is required for a suspected report. ... 6. c. Documentation will be made on the Abuse, Neglect, and Dependency Report, Attachment 2 and will be forwarded to the Department of Social Services (DSS)."

Review of facility records on 3/1/10 revealed no Abuse, Neglect, and Dependency Report, Attachment 2 was on file, nor was there documentation that such a report had been forwarded to DSS.

Interviews with Staff #1 and the Facility Manager on 2/26/10, and with Staff #2 on 3/4/10, confirmed that the Facility Manager actively participated in the restraint of Client #4 on 12/23/09, and that Client #4 was injured as a result of the Facility Manager's participation. The Facility manager admitted to punching Client #4 in the face, and both Staff #1 and Staff #2 revealed their belief that the punch was intentional, and not accidental.

During interviews with the Executive Director and Human Resources Manager on 2/26/10 and 3/1/10, staff were asked to locate and provide documentation of any in-house investigation or other documentation pertaining to the restraint of Client #4 on 12/23/09. Staff were able to produce incident reports regarding the incident, a summary of the AD's interview with Client #4 on 12/23/09, and a timeline documenting the ED's contacts along with a brief summary of those contacts regarding the 12/23/09 incident. Staff failed to provide verification of an in-house investigation, other than the interview with Client #4, and were unable to produce the Abuse, Neglect, and Dependency Report, Attachment 2. Staff also acknowledged no report had been filed with DSS, nor had a report been filed with the Health Care Personnel Registry.[/list]

From V 512 · 27D .0304 Client Rights - Harm, Abuse, Neglect:

    Based on record review and interviews, facility staff failed to protect 1 of 4 clients audited from abuse (#4). The findings are:

    Review of client records on 2/26/10 revealed Client #4 was admitted to the facility on 9/19/09, with diagnoses of Bipolar Disorder, Disruptive Behavior Disorder, and Intermittent Explosive Anger Disorder. Review further revealed, Client #4 graduated from the program on 1/13/10.

    Review of staff records on 2/26/10 revealed the Facility Manager was hired 4/1/08. Review further revealed, his Crisis Prevention Intervention (CPI) training was effective 1/10 through 1/11.

    Review on 2/25/10 of incident reports dated 12/24/09 revealed the following:

    1) Staff #1's incident report stated: "Client #4 grabbed the rope from Staff #2 and refused to let go. Client #4 then began to kick Staff #2 in the legs, bit and punched him (Staff #2) in the face and body. The Facility Manager attempted to verbally de-escalate Client #4 but was unsuccessful. Client #4 was taken to the ground by the Facility Manager and was assisted by Staff #1 and #2. Client #4 was released and immediately attacked the Facility Manager again. The facility Manager "took student (Client #4) to ground and punched
[Client #4] in the lip." Staff #1 and #2 joined in a hold a second time. Client #4 was released a second time. Client #4 approached the Facility Manager a third time and continued to punch and kick. The Facility Manager attempted verbal de-escalation again and took Client #4 to the ground. Client #4 was released almost immediately."

2) Staff #2's incident report stated: "...Group was dropping near bear hang when [Client #4] refused to give bear rope to staff [Staff #1] and threatened to hit [Staff #1] in the face if he took it. [Staff #1] told student that he needed to take rope. [Client #4] then hit [Staff #1] in the face and continued a physical attack hitting, kicking, and biting [Staff #2]. [Staff #2] used deflection to avoid injury and tried to verbally de-escalate the situation. Staff [Facility Manager] was walking by and tried to verbally de-escalate student [Client #4]. [Client #4] said it was none of [Facility Manager] business and if he didn't leave then he [Client #4] would hit and kick [Facility Manager] was well. [Facility Manager] said he would not leave and that [Client #4] could not hurt staff at which time [Client #4] stopped hitting staff and began to kick and hit staff [Facility Manager]. [Facility Manager] told [Client #4] to stop hitting and kicking and when [Client #4] did not [Facility Manager] layed hands on [Client #4] grabbing his collar and lowering him to the ground. The time was 4:30 PM. Staff [Staff #2] intervened to separate staff and student taking control of student [Client #4's] legs to keep staff [Facility Manager] from getting kicked. [Staff #2] immediately called staff [Staff #1] to take control of [Client #4's] legs to allow him [Staff #2] to control [Client #4's] upper body to release staff [Facility Manager]. Staff [Facility Manager] did not release control so [Staff #2] called for a release. All staff released control. [Client #4] then continued to attack staff [Facility Manager] hitting and kicking. Staff [Staff #2] had called for support on the radio at 4:45 PM. Staff [Facility Manager] grabbed student [Client #4] by the collar of his shirt and quickly lowered him to the ground. Staff [Staff #2] attempted to intervene with staff [Staff #1] when [Staff #2] saw [Facility Manager] hit [Client #4] in the face after being hit by [Client #4]. [Staff #2] took control of [Client #4] with [Staff #1] assisting and observed that [Client #4] had blood in his mouth. Support showed up at this time. All staff released control of [Client #4]. [Client #4] then began to follow staff [Facility Manager] and attempt to assault him. The time was 5:15 PM. [Facility Manager] took [Client #4] by the shirt front again and pushed him to the ground, and then released him..."

3) The Facility Manager's incident report dated 12/23/09 reported: "Observed student (Client #4) yelling kicking and punching staff. Went to observe and try to defuse the situation. Client turned on me with verbal, kicking punching and biting." The intervention used included "Restrained to ground and held until staff intervened."

Review on 2/25/10 of Facility Managers physical intervention report dated 12/23/09 revealed the following:
a) Behavior That Necessitated the Physical Intervention: "Punching and kicking staff- verbal abuse."
b) Positive and Less Restrictive Alternatives Used or Considered: "Talking and reasoning."
c) What Danger Necessitated the Intervention? "Several punches and kick."
d) Precipitating Factors of the Intervention: "Escalated student assaulting 2 staff."
e) Was The Student Injured During the Physical Intervention? "Yes. Bloody lip trying to bite staff."
f) Description of Plan to Minimize Future Physical Interventions: Minimize contact and ask for support in situations."

Review on 2/25/10 of the Director of Admissions investigative report dated 12/23/09 revealed the following: "...According to [Client #4], {Staff #2] was making his life difficult with the bear bag ropes and so he decided to kick him. [Staff #2] asked him to stop and he did not and walked off. [Client #4] reported that [Staff #2] tackled him and was holding him down, so in defense, he began hitting him. [Staff #2] then was holding him down and so [Client #4] continued to kick him and get him to give him the rope. [Facility Manager] came down from cabin 1 and told [Client #4] to stop hitting [Staff #2]. [Client #4] told him (Facility Manager) that it was none of his business and that he would do what he wanted. He (Client #4) kept hitting and punching [Staff #2] and [Facility Manager] intervened and restrained him. [Client #4] reports that when he got back up that he went after [Facility Manager] many times and [Facility Manager] restrained him again. [Staff #2] at this point had his legs. He (client #4) said that he went after [Facility Manager] in frustration and hit him in the face and that [Facility Manager] hit him back in the face."

Record review on 2/26/10 revealed, neither a 24 Hour Initial Report nor a 5-Working Day Report to Health Care Personnel Registry (HCPR) had been completed.

Interview with Staff #1 on 2/25/10 revealed, there were teeth marks in Client #4's lip. "He bit his lip when he was hit (by the facility manager)." Interview further revealed Client #4's injury was the result of the hit. Interview further revealed, the facility manager did not utilize approved restrictive intervention techniques.

Interview with Staff #2 on 3/4/10 revealed, he witnessed the facility manager punch Client #4 in the mouth. "He (facility manager) was pushing him (Client #4) at the same time and popped him, he did not wind up and clock him." Interview further revealed, Client #4 had a bloody lip which was associated with the hit. Interview further revealed, the facility manager did not utilize approved restrictive intervention techniques. "He (facility manager) pushed him (Client #4) down by the shirt...there was force but it wasn't a slam to the ground."

Interview with the facility manager on 3/1/10 revealed, "I grabbed him (Client #4) by the shirt and put him down...[Staff #1] and [Staff #2] grabbed his (Client #4) feet. [Staff #1] let go of his (Client #4) right hand and I took one right on the nose. I popped him (Client #4)...light fist on the chin. It's really bothered me ever since, I liked the kid."

Client #4 was unable to be interviewed. He was no longer at the facility.

Interview with the Executive Director on 2/25/10 revealed, "My understanding is [facility manager] struck [Client #4]. [Facility manager] confirmed this."

During interview with the Executive Director on 3/4/10, she acknowledged Client #4's parents were contacted and no other authorities were informed of the incident. Interview further revealed, the facility sought clinical consultation about the incident and were told it was unnecessary to contact Department of Social Services and HCPR due to it not meeting the criteria for abuse.

A protection plan was completed by the facility on 3/4/10, which included the following:
"1. All Trails personnel who have any interaction with Trails clients will have restrictive intervention training."
"2. All Trails staff whether direct care or support will have training on a typical client profile and types of behaviors to expect."
"3. Employee evaluations will include a section on interactions with Trails students."
"4. Trails will review with all staff protocols for reporting a staff if they believe that there has been any interaction they deem appropriate or demeaning. Identified staff member will then review the incident and take appropriate disciplinary action."

(This deficiency constitutes a Type B rule violation. An administrative penalty of $200.00 is per day will be imposed for failure to correct within 45 days.)[/list]

From V 522 · 27E .0104(e10) Client Rights - Sec. Rest. & ITO:

    Based on record review and interviews, the facility failed to ensure interventions exceeding 15 minutes were authorized only by the responsible professional or another qualified professional who is approved to use and to authorize the use of the restrictive intervention based on experience and training, effecting 1 of 4 clients audited (#4). The findings are:

    Review of Physical Restraint Reports on 3/1/10 revealed the following physical restraints of Client #4 which exceeded 15 minutes:
    9/19/09 at 7:30 PM for 30 minutes
    9/20/09 at 4:00 PM for 30 minutes
    9/20/09 at 5:50 PM for 48 minutes
    9/22/09 at 8:30 PM for 45 minutes
    9/23/09 at 12:15 PM for 30 minutes
    9/23/09 at 1:00 PM for 30 minutes
    9/29/09 at 4:10 PM for 20 minutes
    1/15/10 at 5:11 PM for 28 minutes, and 34 seconds.

    The review further revealed no documentation on the Physical Restraint Reports or on file elsewhere of authorization for restraints lasting longer than 15 minutes by the responsible professional (QP) or another qualified professional who is approved to use and to authorize the use of the restrictive intervention based on experience and training.

    During interview with the Executive Director (ED) on 3/4/10, The ED was asked to locate and produce verification of authorization by a QP for physical restraints exceeding 15 minutes in length. She was unable to provide the requested verification. The ED acknowledged that staff were not seeking authorization from the QP for extended restraints.

From V 537 · 27E .0108 Client Rights - Training in Sec Rest & ITO:

    Based on record review and interviews, the facility failed to ensure physical restraint was employed only by staff who had been trained and had demonstrated competence in the proper use of and alternatives to these procedures, and were retrained and had demonstrated competence at least annually, effecting 1 of 4 client's audited (#4). The findings are.

    A review of policy and procedures on 2/26/10 revealed the facility staff utilize the Crisis Prevention Intervention (CPI) system for employing physical restraints, and that physical restraints may be employed on an emergency basis, when a client provides a danger to himself or others, and inflicts significant property damage.

    A review of incident reports on 3/1/10 revealed 3 incident reports describing the Facility Manager taking Client #4 to the ground twice during a single incident at approximately 4:30 PM on 12/23/09. Client #4 received a cut in his mouth as a result of a punch by the Facility Manager during the physical restraint. Further review of the incident reports also revealed the Facility Manager took the client down by"grabbing his collar and lowering him to the ground."

    A review of staff personnel records on 3/1/10 revealed no evidence on file that the facility manager had participated and demonstrated competence in CPI Training between his hire date of 4/1/08 and January, 2010.

    During interviews with staff conducted on 2/26/10 and 3/4/10, administrative staff were asked to locate and provide verification of training within a year prior to the 12/23/09 incident in CPI for the Facility Manager. Staff were unable to produce verification of the required training for the Facility Manager.

    Interviews with Staff #1 and the Facility Manager on 2/26/10, and with Staff #2 on 3/4/10, confirmed that the Facility Manager actively participated in the restraint of Client #4 on 12/23/09, and that Client #4 was injured as a result of the Facility Manager's participation.The interview with the Facility Manager on 2/26/10 also revealed that the Facility Manager had received NCI training from a previous employer, but he was not current in any kind of restraint training at the time of the incident.
« Last Edit: December 31, 1969, 07:00:00 PM by Guest »
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Offline DannyB II

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Re: Trails Carolina - client abuse (from V500, V512, V522, V
« Reply #94 on: July 07, 2010, 12:53:06 PM »
Quote from: "Ursus"
Here is pertinent text from the Statement of Deficiencies regarding the client abuse incident of 12/23/2009 (from V500, V512, V522, V537, my apologies if I've missed some stuff):


From V 500 · 27D .0101(a-e) Client Rights - Policy on Rights:

    Based on review of facility records, and interviews, the facility failed to implement their policy requiring and ensuring the Department of Social Services (DSS), in the county where services are provided, was notified of all allegations of resident abuse by health care personnel, affecting one of four sampled clients (#4). The findings are:

    A review of facility records on 3/1/10 revealed an incident report dated 12/23/09 and 2 incident reports dated 12/24/09 addressing a restraint of Client #4 which occurred on 12/23/09. The report by the Facility Manager dated 12/23/09 stated he "restrained (Client #4) to ground and held until staff intervened." The attached Physical Intervention report also completed by the Facility Manager on 12/23/09 revealed, in the section asking if the student was injured during the intervention, Client #4 got a "bloody lip trying to bite staff."

    Review on 3/1/10 of the 2 incident reports completed 12/24/09 revealed Staff #1 and Staff #2 witnessed the Facility Manager strike Client #4 during the restraint on 12/23/09. The incident report by Staff #1 revealed he "saw
[the Facility Manager] hit [Client #4] in the face ... and observed [Client#4] had blood in his mouth." The incident report by Staff #2 revealed the Facility Manager "took student to ground and punched [Client #4] in the lip."

A review on 3/1/10 of an internal investigation report revealed the Executive Director(ED) was out of town and learned of allegations by Client #4 and Staff #1 and #2 in a phone call from the Admissions Director(AD) on 12/23/09. The AD was in charge of facility in the absence of the ED. The AD documented an interview at approximately 4:30 PM on 12/23/09 with Client #4, during which Client #4 told him he had hit the Facility Manager in the face and the Facility Manager hit him back in the face.

Review on 3/1/10 of facility policy and procedures for reporting allegations of abuse revealed: "Policy: The therapist shall provide a leadership role in the identification, reporting, and follow-upon child abuse issues. ... Procedures: ...3. The therapist will receive supervision from a clinical supervisor and the Executive Director to determine if there is enough data to warrant a "reasonable suspicion" that a student has been the victim of abuse. That is all that is required for a suspected report. ... 6. c. Documentation will be made on the Abuse, Neglect, and Dependency Report, Attachment 2 and will be forwarded to the Department of Social Services (DSS)."

Review of facility records on 3/1/10 revealed no Abuse, Neglect, and Dependency Report, Attachment 2 was on file, nor was there documentation that such a report had been forwarded to DSS.

Interviews with Staff #1 and the Facility Manager on 2/26/10, and with Staff #2 on 3/4/10, confirmed that the Facility Manager actively participated in the restraint of Client #4 on 12/23/09, and that Client #4 was injured as a result of the Facility Manager's participation. The Facility manager admitted to punching Client #4 in the face, and both Staff #1 and Staff #2 revealed their belief that the punch was intentional, and not accidental.

During interviews with the Executive Director and Human Resources Manager on 2/26/10 and 3/1/10, staff were asked to locate and provide documentation of any in-house investigation or other documentation pertaining to the restraint of Client #4 on 12/23/09. Staff were able to produce incident reports regarding the incident, a summary of the AD's interview with Client #4 on 12/23/09, and a timeline documenting the ED's contacts along with a brief summary of those contacts regarding the 12/23/09 incident. Staff failed to provide verification of an in-house investigation, other than the interview with Client #4, and were unable to produce the Abuse, Neglect, and Dependency Report, Attachment 2. Staff also acknowledged no report had been filed with DSS, nor had a report been filed with the Health Care Personnel Registry.[/list]

From V 512 · 27D .0304 Client Rights - Harm, Abuse, Neglect:

    Based on record review and interviews, facility staff failed to protect 1 of 4 clients audited from abuse (#4). The findings are:

    Review of client records on 2/26/10 revealed Client #4 was admitted to the facility on 9/19/09, with diagnoses of Bipolar Disorder, Disruptive Behavior Disorder, and Intermittent Explosive Anger Disorder. Review further revealed, Client #4 graduated from the program on 1/13/10.

    Review of staff records on 2/26/10 revealed the Facility Manager was hired 4/1/08. Review further revealed, his Crisis Prevention Intervention (CPI) training was effective 1/10 through 1/11.

    Review on 2/25/10 of incident reports dated 12/24/09 revealed the following:

    1) Staff #1's incident report stated: "Client #4 grabbed the rope from Staff #2 and refused to let go. Client #4 then began to kick Staff #2 in the legs, bit and punched him (Staff #2) in the face and body. The Facility Manager attempted to verbally de-escalate Client #4 but was unsuccessful. Client #4 was taken to the ground by the Facility Manager and was assisted by Staff #1 and #2. Client #4 was released and immediately attacked the Facility Manager again. The facility Manager "took student (Client #4) to ground and punched
[Client #4] in the lip." Staff #1 and #2 joined in a hold a second time. Client #4 was released a second time. Client #4 approached the Facility Manager a third time and continued to punch and kick. The Facility Manager attempted verbal de-escalation again and took Client #4 to the ground. Client #4 was released almost immediately."

2) Staff #2's incident report stated: "...Group was dropping near bear hang when [Client #4] refused to give bear rope to staff [Staff #1] and threatened to hit [Staff #1] in the face if he took it. [Staff #1] told student that he needed to take rope. [Client #4] then hit [Staff #1] in the face and continued a physical attack hitting, kicking, and biting [Staff #2]. [Staff #2] used deflection to avoid injury and tried to verbally de-escalate the situation. Staff [Facility Manager] was walking by and tried to verbally de-escalate student [Client #4]. [Client #4] said it was none of [Facility Manager] business and if he didn't leave then he [Client #4] would hit and kick [Facility Manager] was well. [Facility Manager] said he would not leave and that [Client #4] could not hurt staff at which time [Client #4] stopped hitting staff and began to kick and hit staff [Facility Manager]. [Facility Manager] told [Client #4] to stop hitting and kicking and when [Client #4] did not [Facility Manager] layed hands on [Client #4] grabbing his collar and lowering him to the ground. The time was 4:30 PM. Staff [Staff #2] intervened to separate staff and student taking control of student [Client #4's] legs to keep staff [Facility Manager] from getting kicked. [Staff #2] immediately called staff [Staff #1] to take control of [Client #4's] legs to allow him [Staff #2] to control [Client #4's] upper body to release staff [Facility Manager]. Staff [Facility Manager] did not release control so [Staff #2] called for a release. All staff released control. [Client #4] then continued to attack staff [Facility Manager] hitting and kicking. Staff [Staff #2] had called for support on the radio at 4:45 PM. Staff [Facility Manager] grabbed student [Client #4] by the collar of his shirt and quickly lowered him to the ground. Staff [Staff #2] attempted to intervene with staff [Staff #1] when [Staff #2] saw [Facility Manager] hit [Client #4] in the face after being hit by [Client #4]. [Staff #2] took control of [Client #4] with [Staff #1] assisting and observed that [Client #4] had blood in his mouth. Support showed up at this time. All staff released control of [Client #4]. [Client #4] then began to follow staff [Facility Manager] and attempt to assault him. The time was 5:15 PM. [Facility Manager] took [Client #4] by the shirt front again and pushed him to the ground, and then released him..."

3) The Facility Manager's incident report dated 12/23/09 reported: "Observed student (Client #4) yelling kicking and punching staff. Went to observe and try to defuse the situation. Client turned on me with verbal, kicking punching and biting." The intervention used included "Restrained to ground and held until staff intervened."

Review on 2/25/10 of Facility Managers physical intervention report dated 12/23/09 revealed the following:
a) Behavior That Necessitated the Physical Intervention: "Punching and kicking staff- verbal abuse."
b) Positive and Less Restrictive Alternatives Used or Considered: "Talking and reasoning."
c) What Danger Necessitated the Intervention? "Several punches and kick."
d) Precipitating Factors of the Intervention: "Escalated student assaulting 2 staff."
e) Was The Student Injured During the Physical Intervention? "Yes. Bloody lip trying to bite staff."
f) Description of Plan to Minimize Future Physical Interventions: Minimize contact and ask for support in situations."

Review on 2/25/10 of the Director of Admissions investigative report dated 12/23/09 revealed the following: "...According to [Client #4], {Staff #2] was making his life difficult with the bear bag ropes and so he decided to kick him. [Staff #2] asked him to stop and he did not and walked off. [Client #4] reported that [Staff #2] tackled him and was holding him down, so in defense, he began hitting him. [Staff #2] then was holding him down and so [Client #4] continued to kick him and get him to give him the rope. [Facility Manager] came down from cabin 1 and told [Client #4] to stop hitting [Staff #2]. [Client #4] told him (Facility Manager) that it was none of his business and that he would do what he wanted. He (Client #4) kept hitting and punching [Staff #2] and [Facility Manager] intervened and restrained him. [Client #4] reports that when he got back up that he went after [Facility Manager] many times and [Facility Manager] restrained him again. [Staff #2] at this point had his legs. He (client #4) said that he went after [Facility Manager] in frustration and hit him in the face and that [Facility Manager] hit him back in the face."

Record review on 2/26/10 revealed, neither a 24 Hour Initial Report nor a 5-Working Day Report to Health Care Personnel Registry (HCPR) had been completed.

Interview with Staff #1 on 2/25/10 revealed, there were teeth marks in Client #4's lip. "He bit his lip when he was hit (by the facility manager)." Interview further revealed Client #4's injury was the result of the hit. Interview further revealed, the facility manager did not utilize approved restrictive intervention techniques.

Interview with Staff #2 on 3/4/10 revealed, he witnessed the facility manager punch Client #4 in the mouth. "He (facility manager) was pushing him (Client #4) at the same time and popped him, he did not wind up and clock him." Interview further revealed, Client #4 had a bloody lip which was associated with the hit. Interview further revealed, the facility manager did not utilize approved restrictive intervention techniques. "He (facility manager) pushed him (Client #4) down by the shirt...there was force but it wasn't a slam to the ground."

Interview with the facility manager on 3/1/10 revealed, "I grabbed him (Client #4) by the shirt and put him down...[Staff #1] and [Staff #2] grabbed his (Client #4) feet. [Staff #1] let go of his (Client #4) right hand and I took one right on the nose. I popped him (Client #4)...light fist on the chin. It's really bothered me ever since, I liked the kid."

Client #4 was unable to be interviewed. He was no longer at the facility.

Interview with the Executive Director on 2/25/10 revealed, "My understanding is [facility manager] struck [Client #4]. [Facility manager] confirmed this."

During interview with the Executive Director on 3/4/10, she acknowledged Client #4's parents were contacted and no other authorities were informed of the incident. Interview further revealed, the facility sought clinical consultation about the incident and were told it was unnecessary to contact Department of Social Services and HCPR due to it not meeting the criteria for abuse.

A protection plan was completed by the facility on 3/4/10, which included the following:
"1. All Trails personnel who have any interaction with Trails clients will have restrictive intervention training."
"2. All Trails staff whether direct care or support will have training on a typical client profile and types of behaviors to expect."
"3. Employee evaluations will include a section on interactions with Trails students."
"4. Trails will review with all staff protocols for reporting a staff if they believe that there has been any interaction they deem appropriate or demeaning. Identified staff member will then review the incident and take appropriate disciplinary action."

(This deficiency constitutes a Type B rule violation. An administrative penalty of $200.00 is per day will be imposed for failure to correct within 45 days.)[/list]

From V 522 · 27E .0104(e10) Client Rights - Sec. Rest. & ITO:

    Based on record review and interviews, the facility failed to ensure interventions exceeding 15 minutes were authorized only by the responsible professional or another qualified professional who is approved to use and to authorize the use of the restrictive intervention based on experience and training, effecting 1 of 4 clients audited (#4). The findings are:

    Review of Physical Restraint Reports on 3/1/10 revealed the following physical restraints of Client #4 which exceeded 15 minutes:
    9/19/09 at 7:30 PM for 30 minutes
    9/20/09 at 4:00 PM for 30 minutes
    9/20/09 at 5:50 PM for 48 minutes
    9/22/09 at 8:30 PM for 45 minutes
    9/23/09 at 12:15 PM for 30 minutes
    9/23/09 at 1:00 PM for 30 minutes
    9/29/09 at 4:10 PM for 20 minutes
    1/15/10 at 5:11 PM for 28 minutes, and 34 seconds.

    The review further revealed no documentation on the Physical Restraint Reports or on file elsewhere of authorization for restraints lasting longer than 15 minutes by the responsible professional (QP) or another qualified professional who is approved to use and to authorize the use of the restrictive intervention based on experience and training.

    During interview with the Executive Director (ED) on 3/4/10, The ED was asked to locate and produce verification of authorization by a QP for physical restraints exceeding 15 minutes in length. She was unable to provide the requested verification. The ED acknowledged that staff were not seeking authorization from the QP for extended restraints.

From V 537 · 27E .0108 Client Rights - Training in Sec Rest & ITO:

    Based on record review and interviews, the facility failed to ensure physical restraint was employed only by staff who had been trained and had demonstrated competence in the proper use of and alternatives to these procedures, and were retrained and had demonstrated competence at least annually, effecting 1 of 4 client's audited (#4). The findings are.

    A review of policy and procedures on 2/26/10 revealed the facility staff utilize the Crisis Prevention Intervention (CPI) system for employing physical restraints, and that physical restraints may be employed on an emergency basis, when a client provides a danger to himself or others, and inflicts significant property damage.

    A review of incident reports on 3/1/10 revealed 3 incident reports describing the Facility Manager taking Client #4 to the ground twice during a single incident at approximately 4:30 PM on 12/23/09. Client #4 received a cut in his mouth as a result of a punch by the Facility Manager during the physical restraint. Further review of the incident reports also revealed the Facility Manager took the client down by"grabbing his collar and lowering him to the ground."

    A review of staff personnel records on 3/1/10 revealed no evidence on file that the facility manager had participated and demonstrated competence in CPI Training between his hire date of 4/1/08 and January, 2010.

    During interviews with staff conducted on 2/26/10 and 3/4/10, administrative staff were asked to locate and provide verification of training within a year prior to the 12/23/09 incident in CPI for the Facility Manager. Staff were unable to produce verification of the required training for the Facility Manager.

    Interviews with Staff #1 and the Facility Manager on 2/26/10, and with Staff #2 on 3/4/10, confirmed that the Facility Manager actively participated in the restraint of Client #4 on 12/23/09, and that Client #4 was injured as a result of the Facility Manager's participation.The interview with the Facility Manager on 2/26/10 also revealed that the Facility Manager had received NCI training from a previous employer, but he was not current in any kind of restraint training at the time of the incident.


No wonder Joel, Che, DJ and all the other ex-staff here, are not staff any more. Most would have failed miserably in that altercation, tell me I'm wrong.
Having a kid bite, kick, punch and verbally assault you repetitively, DJ depending on how many staff are on duty, you don't get to always walk away.
No this is not black and white but will see when all the facts are on the table.
Really nice when you can sit back and arm chair quaterback situations like this.
« Last Edit: December 31, 1969, 07:00:00 PM by Guest »
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Offline Che Gookin

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Re: Trails Carolina - new program
« Reply #95 on: July 07, 2010, 01:46:46 PM »
Quote
1) Staff #1's incident report stated: "Client #4 grabbed the rope from Staff #2 and refused to let go. Client #4 then began to kick Staff #2 in the legs, bit and punched him (Staff #2) in the face and body. The Facility Manager attempted to verbally de-escalate Client #4 but was unsuccessful. Client #4 was taken to the ground by the Facility Manager and was assisted by Staff #1 and #2. Client #4 was released and immediately attacked the Facility Manager again. The facility Manager "took student (Client #4) to ground and punched [Client #4] in the lip." Staff #1 and #2 joined in a hold a second time. Client #4 was released a second time. Client #4 approached the Facility Manager a third time and continued to punch and kick. The Facility Manager attempted verbal de-escalation again and took Client #4 to the ground. Client #4 was released almost immediately."

Not sure why they were playing tug of war with a kid, they probably could have easily just let go of the rope, and backed away from the kid and let him have the rope.

Quote
2) Staff #2's incident report stated: "...Group was dropping near bear hang when [Client #4] refused to give bear rope to staff [Staff #1] and threatened to hit [Staff #1] in the face if he took it. [Staff #1] told student that he needed to take rope. [Client #4] then hit [Staff #1] in the face and continued a physical attack hitting, kicking, and biting [Staff #2]. [Staff #2] used deflection to avoid injury and tried to verbally de-escalate the situation. Staff [Facility Manager] was walking by and tried to verbally de-escalate student [Client #4]. [Client #4] said it was none of [Facility Manager] business and if he didn't leave then he [Client #4] would hit and kick [Facility Manager] was well. [Facility Manager] said he would not leave and that [Client #4] could not hurt staff at which time [Client #4] stopped hitting staff and began to kick and hit staff [Facility Manager]. [Facility Manager] told [Client #4] to stop hitting and kicking and when [Client #4] did not [Facility Manager] layed hands on [Client #4] grabbing his collar and lowering him to the ground. The time was 4:30 PM. Staff [Staff #2] intervened to separate staff and student taking control of student [Client #4's] legs to keep staff [Facility Manager] from getting kicked. [Staff #2] immediately called staff [Staff #1] to take control of [Client #4's] legs to allow him [Staff #2] to control [Client #4's] upper body to release staff [Facility Manager]. Staff [Facility Manager] did not release control so [Staff #2] called for a release. All staff released control. [Client #4] then continued to attack staff [Facility Manager] hitting and kicking. Staff [Staff #2] had called for support on the radio at 4:45 PM. Staff [Facility Manager] grabbed student [Client #4] by the collar of his shirt and quickly lowered him to the ground. Staff [Staff #2] attempted to intervene with staff [Staff #1] when [Staff #2] saw [Facility Manager] hit [Client #4] in the face after being hit by [Client #4]. [Staff #2] took control of [Client #4] with [Staff #1] assisting and observed that [Client #4] had blood in his mouth. Support showed up at this time. All staff released control of [Client #4]. [Client #4] then began to follow staff [Facility Manager] and attempt to assault him. The time was 5:15 PM. [Facility Manager] took [Client #4] by the shirt front again and pushed him to the ground, and then released him..."

Sounds to me like they all got pumped up way too quickly. The kid started with threatening to kick everyone's ass and at that point they all could have backed up and let him have the rope.

Hard to say from the content of the reports as neither of them give a reason as to why the staff members absolutely had to regain control of this bit of rope. From the sounds of it the rope might be one of those rope swing thingies and they were either worried  about the kid trying to go tarzan on them or trying to hang himself. The reports should state the reasoning behind why it was necessary for the rope to be demanded from a kid who was threatening physical violence. Common sense dictates that when someone is saying, "Try to take it and i'll hit you," that you are inviting some sort of response when you tell them that you need to take the rope.

They may well have a reason for demanding it beyond enforcing the will of the program or screwing up and forgetting the basics of de-escalation. If they did have a reason it didn't show up in these two blurbs.


Incident seems fairly tame to me though. I can't remember ever needing 3 other people to restrain anyone.
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Offline Che Gookin

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Re: Trails Carolina - new program
« Reply #96 on: July 07, 2010, 01:49:21 PM »
Quote
The review further revealed no documentation on the Physical Restraint Reports or on file elsewhere of authorization for restraints lasting longer than 15 minutes by the responsible professional (QP) or another qualified professional who is approved to use and to authorize the use of the restrictive intervention based on experience and training.

During interview with the Executive Director (ED) on 3/4/10, The ED was asked to locate and produce verification of authorization by a QP for physical restraints exceeding 15 minutes in length. She was unable to provide the requested verification. The ED acknowledged that staff were not seeking authorization from the QP for extended restraints.

err.. so if you restrain him for 14 minutes, let him up.. restrain him all over again it is ok?

Gotcha.
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Offline Ursus

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Trails Carolina - client abuse/injury
« Reply #97 on: July 07, 2010, 02:16:46 PM »
Quote from: "Che Gookin"
Quote
1) Staff #1's incident report stated: "Client #4 grabbed the rope from Staff #2 and refused to let go. Client #4 then began to kick Staff #2 in the legs, bit and punched him (Staff #2) in the face and body. The Facility Manager attempted to verbally de-escalate Client #4 but was unsuccessful. Client #4 was taken to the ground by the Facility Manager and was assisted by Staff #1 and #2. Client #4 was released and immediately attacked the Facility Manager again. The facility Manager "took student (Client #4) to ground and punched [Client #4] in the lip." Staff #1 and #2 joined in a hold a second time. Client #4 was released a second time. Client #4 approached the Facility Manager a third time and continued to punch and kick. The Facility Manager attempted verbal de-escalation again and took Client #4 to the ground. Client #4 was released almost immediately."
Not sure why they were playing tug of war with a kid, they probably could have easily just let go of the rope, and backed away from the kid and let him have the rope.

Quote
2) Staff #2's incident report stated: "...Group was dropping near bear hang when [Client #4] refused to give bear rope to staff [Staff #1] and threatened to hit [Staff #1] in the face if he took it. [Staff #1] told student that he needed to take rope. [Client #4] then hit [Staff #1] in the face and continued a physical attack hitting, kicking, and biting [Staff #2]. [Staff #2] used deflection to avoid injury and tried to verbally de-escalate the situation. Staff [Facility Manager] was walking by and tried to verbally de-escalate student [Client #4]. [Client #4] said it was none of [Facility Manager] business and if he didn't leave then he [Client #4] would hit and kick [Facility Manager] was well. [Facility Manager] said he would not leave and that [Client #4] could not hurt staff at which time [Client #4] stopped hitting staff and began to kick and hit staff [Facility Manager]. [Facility Manager] told [Client #4] to stop hitting and kicking and when [Client #4] did not [Facility Manager] layed hands on [Client #4] grabbing his collar and lowering him to the ground. The time was 4:30 PM. Staff [Staff #2] intervened to separate staff and student taking control of student [Client #4's] legs to keep staff [Facility Manager] from getting kicked. [Staff #2] immediately called staff [Staff #1] to take control of [Client #4's] legs to allow him [Staff #2] to control [Client #4's] upper body to release staff [Facility Manager]. Staff [Facility Manager] did not release control so [Staff #2] called for a release. All staff released control. [Client #4] then continued to attack staff [Facility Manager] hitting and kicking. Staff [Staff #2] had called for support on the radio at 4:45 PM. Staff [Facility Manager] grabbed student [Client #4] by the collar of his shirt and quickly lowered him to the ground. Staff [Staff #2] attempted to intervene with staff [Staff #1] when [Staff #2] saw [Facility Manager] hit [Client #4] in the face after being hit by [Client #4]. [Staff #2] took control of [Client #4] with [Staff #1] assisting and observed that [Client #4] had blood in his mouth. Support showed up at this time. All staff released control of [Client #4]. [Client #4] then began to follow staff [Facility Manager] and attempt to assault him. The time was 5:15 PM. [Facility Manager] took [Client #4] by the shirt front again and pushed him to the ground, and then released him..."
Sounds to me like they all got pumped up way too quickly. The kid started with threatening to kick everyone's ass and at that point they all could have backed up and let him have the rope.

Hard to say from the content of the reports as neither of them give a reason as to why the staff members absolutely had to regain control of this bit of rope. From the sounds of it the rope might be one of those rope swing thingies and they were either worried  about the kid trying to go tarzan on them or trying to hang himself. The reports should state the reasoning behind why it was necessary for the rope to be demanded from a kid who was threatening physical violence. Common sense dictates that when someone is saying, "Try to take it and i'll hit you," that you are inviting some sort of response when you tell them that you need to take the rope.

They may well have a reason for demanding it beyond enforcing the will of the program or screwing up and forgetting the basics of de-escalation. If they did have a reason it didn't show up in these two blurbs.


Incident seems fairly tame to me though. I can't remember ever needing 3 other people to restrain anyone.
I agree re. the personal dynamics before things got out of hand. This is why I have some serious questions as to what means of deescalation were involved, if any, and why I think the kid may have even felt provoked or goaded into an altercation.

It's really unclear as to why it was so damn necessary to insist that the kid do whatever with the rope, particularly since he gave ample warning of his annoyance and refusal to comply prior to the exchange becoming physical.

Nothing was mentioned in the Statement of Deficiencies regarding a safety concern that necessitated the kid's cooperation with the rope. And I kinda suspect that, had there been any, at least one if not all of the three staff involved would have mentioned it in their incident reports.
« Last Edit: December 31, 1969, 07:00:00 PM by Guest »
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« Reply #98 on: July 07, 2010, 02:28:51 PM »
Edited: Wednesday, October 06, 2010
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Offline Whooter

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Re: Trails Carolina - new program
« Reply #99 on: July 07, 2010, 02:29:50 PM »
If the kid had just given the rope back this would have all been avoided.

If the kid had not resorted to physical violence then none of his would have ever occurred.

The staff fill out reports for just about everything even if a kid trips and scraps his knee.  Anyone who worked for a program, daycare etc. that deals with kids knows this.  They also typically get a verbal from the other kids just to verify everything.  Very little goes on that doesn't get documented.
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Offline Che Gookin

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Re: Trails Carolina - new program
« Reply #100 on: July 07, 2010, 02:35:34 PM »
Ehh, that's why they should have asked the staff involved the following question, "Was the the immediate health and safety of the the resident involved at harm of serious injury or death?" I already know what happened here, it was a power struggle gone bad. Such is wont to happen in just about every corner of the world. Personally, I find the whole issue bizarre in the sense that the state is whining at the program for not having trained people to do restraints over 15 minutes long.

Seems to me the state has its priorities completely backwards. Rather than the total time of certain restraints, they should be concerned about the number of restraints for one individual and they should be asking some hard questions about the handling of this individual. It may well be the kid is just one crazy little bastard. There are those out there that are practically uncontrollable no matter who is working with them in what setting. I've dealt with a few of those and believe me, they definitely make your day way more interesting.

However, regardless of how violent the youth is for whatever reason, the program is the responsible party. They are the ones obligated to find ways to deal with this youth that are nonviolent. Restraining a kid is a violent means of suppressing a behavior. There is no nice way to dance around the issue of a restraint. Many systems try to color it up as a means of "assisting a client in a physical means to help them control their behavior". However, the reality of the issue is a restraint is nothing more than that good old fashion exertion of physical force upon a person. Once you go down the road of a restraint you take the risk of killing the kid or injuring him.

This seems to be overlooked in their report.

Just seems to me the state investigators are worried more about stupid shit like having restraints last more than 15 minutes, when it appears the easy way around that one is to restrain a kid for 15 minutes, let him up, and then do it all over again. Seems to me they ought to be taking more of an interesting in the actual number of holds for one specific resident rather than the procedural rigamarole of not having trained professionals who are certified to conduct a hold that lasts over 15 minutes.

I guess when you get right down to it this is why I don't trust or support crap like HR 911. Too many obvious bus sized loopholes.
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Offline Ursus

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Offline Ursus

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Trails Carolina - Visit Report
« Reply #102 on: July 11, 2010, 07:43:04 PM »
Here's a Visit Report by Lon, done prior to the alleged client abuse/injury event described at length above, and yet not posted on his site 'till after Trails Carolina was able to graduate the kid in question. Interesting timing, perhaps...

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Visit Reports
Posted: Jan 19, 2010 11:15


TRAILS CAROLINA WILDERNESS THERAPY PROGRAM

Lake Toxaway, NC
Mark Oerther
Director of Admissions
888-387-2457
http://www.trailscarolina.com


Visit by Lon Woodbury, November 10, 2009

Nestled in a secluded valley in North Carolina on 33 rural acres, this wilderness therapy program at first glance presents a very pastoral picture. Even the old buildings look rustic rather than run down (It used to be a summer camp). I understand the stream running through their property contains trout, and I was surprised that it ran clear and you could see the bottom, contrary to most rivers and streams I've seen in the South. Their horses were friendly, gentle and well fed, and like just about every North Carolina rural property I have ever seen, it has a pond, which is just below the main Lodge.

We had a chance to talk with some of the students, and they looked alert, were friendly and obviously getting a lot out of their experience there. One of the boys did a demonstration in handling a horse, explaining every step of how he could control the horse without touching it but simply with body and hand signals. He was the one who, when he arrived, was afraid of horses and the most he could see ever accomplishing would be to someday pet a horse. When asked, all the boys agreed that their horse had become one of their best friends.

The girls were equally impressive. They were open and outgoing. One girl had been there 104 days (close to a record) and had what is sometimes called a "wilderness glow." She had considerable and serious personal problems before arriving, and it seemed to me that she felt so much better about herself from her experience that she couldn't help but sport a bright smile that seemed quite genuine.

The program is a minimum of 28 days, but most students take longer before they are ready to move on to either a boarding school or home. The property I described above operates as a base, but the students spend most of their time in the field, hiking and camping in the surrounding national forest lands. Part of the curriculum is basic wilderness skills such as starting a fire with a bow drill (which teaches persistence) and other wilderness skills that teach self reliance and team-work. But this is just the surface.

The whole program draws on multiple elements, each of which can be drawn on to match the individual needs of the students. In addition to the wilderness therapy experience, which itself is a powerful change element, the students have regular sessions with the therapists, equine therapy and a generic positive peer culture, as opposed to the text book Positive Peer Culture (PPC). In addition the program adds a sophisticated approach to experiential academics which supplements their wilderness and outdoor experience in a way to relate academic topics such as biology, history, etc., to what the students are doing in their day to day program. I had a chance to visit with the Academic Dean and his creative ability to "think outside the box" is impressive. The program is registered as a non-public school by the state of North Carolina, and students can earn up five credits during their time there. In addition to being a non-public school, the program is licensed as a Therapeutic Habilative Facility and a Mental Health Program by the state of North Carolina.

All groups are single sex, and the optimum size is fairly small, consisting of 6 to 8 students. This enhances their ability to develop an individualized program to meet the varying needs of each student. They have a girls group, a boys group and a young boys group. Since it is individualized, the groups can be equally effective when the groups are smaller than the optimum when enrollments dictate smaller groups.

A lot of emphasis is made to carrying out a parallel program for parents. This includes weekly parent conference calls which include all the parents associated with a specific student group, and at least two on-campus parent seminars during a child's stay. The staff reported that a frequent remark by graduating students is how much their parents had changed while the student had been in the program. This success was explained by two things: (1) the parents develop a peer group of their own for support at the same time the students are developing their peer group, and (2) the focus of the parent on-campus seminars and weekly phone conferences are to look at the parents' patterns and how to make them more supportive of what their children need. From comments by graduating students and their parents, it seems to be working.

The program is about ready to celebrate their first anniversary and has obviously come a long way in a short year. By the way, the name "TRAILS" stands for Trust, Respect, Accountability, Integrity, Leadership and Service. The name itself is a good description of what this wilderness therapy program is trying to teach their students.


Copyright ©2010, Woodbury Reports, Inc.
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Offline Troll Control

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Re: Trails Carolina - new program
« Reply #103 on: July 15, 2010, 12:36:19 PM »
Any updates on this shithole facility with the shitbag child-punching staff?
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Re: Trails Carolina - new program
« Reply #104 on: July 15, 2010, 01:58:34 PM »
Quote from: "Dysfunction Junction"
Any updates on this shithole facility with the shitbag child-punching staff?

Your higher education really shines though when we have you on the ropes DJ.  What was that again a PhD?  Whoops lol.



...
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