Unclear Oversight Yields Repeated Violations at Home for Troubled Youth
By Trey Bundy | The New York Times —
In Alameda County, there is just one emergency group-home shelter for emotionally disturbed teenagers. It is called Refuge, for Resource Environment for Underprivileged Groups Enterprise Inc., but according to state documents and former employees, it is anything but a safe haven.
Refuge, based in Oakland, has been cited 118 times for health, safety, personal rights and procedural violations during its 11-year existence, public records show. Violations included providing insufficient food and clothing, mishandling of residents’ money and medications, and abusive treatment by an inadequately trained staff.
On top of that, therapeutic support for the troubled young residents was all but nonexistent, two former employees say.
“Besides having a house and some food, I don’t know what other services they’re providing young people,” said Nicole Monroe, a former case manager in one of three six-bed Refuge homes in Oakland. “Not much was going on when I was working there.”
The troubles at Refuge, which serves young people who often come from backgrounds of abuse and neglect, illustrate the difficulties that state and local governments have in regulating facilities that care for the most vulnerable populations.
The state agency responsible for overseeing conditions inside group homes, the Community Care Licensing Division of the Department of Social Services, says that its inspectors look only for specific types of health, safety, procedural and personal rights violations, and that county social workers are responsible for assessing the quality of care.
County officials say it is the state’s job to assure that group homes function properly.
Despite the government fiscal crisis, the problems at Refuge do not appear to be entirely financial. The home receives $7,388 per resident each month from the state, thousands of dollars a month in Medi-Cal money for mental health services and $380,000 from Alameda County this year for keeping four emergency beds available at all times.
Ms. Monroe said her supervisor, Khea Gumbs, was often focused on money issues rather than client care. Ms. Monroe said Ms. Gumbs directed her to falsify reports to Medi-Cal each week in order to bill the state for more treatment than had been provided. Another former Refuge employee also said she received such directives. “When we did have to do our billing, we were told to inflate our time,” Ms. Monroe said. “If we spent five hours a week with one young person, we were asked to increase that to seven or eight.”
The other former employee said she told social service investigators about the issue, but the agency did not follow up. Ms. Gumbs and Jason and Dorothy Henderson, founders of Refuge, told The Bay Citizen that they did not want to comment for this article.
Many of the violations at Refuge, including those pertaining to food, clothing and client money, have been cited multiple times over the years.
Other, more isolated, violations involved interactions between residents and staff members. One youth was slammed into a wall in 2000; others were hit and cursed at by staff members in 2004, Community Care Licensing documents show.
In 2007, regulators substantiated claims that Refuge workers yelled at clients and “called them stupid.”
Child-welfare experts acknowledge that conditions at group homes are often subpar. Emotionally disturbed teenagers are among the most difficult populations to serve effectively, and many facilities struggle to retain qualified staff members and address residents’ behavioral problems. Still, the troubles at Refuge stand out.
“When you’re talking about multiple issues around food and kids’ rights, it makes me think, How often do we let a group home fall out of compliance?” said Sonja Lenz-Rashid, associate professor at the San Francisco State University School of Social Work. “When do we decide that it’s time” to suspend an institution or allow its license to be revoked?
Ms. Monroe and a colleague who was also a case manager at Refuge in 2009 discussed filing complaints while working at Refuge. Both said they resigned after heated disagreements with management regarding care.
In June 2010, months after resigning, they spoke with Damon King, a lawyer at the Youth Law Center in San Francisco, who filed a complaint with the Community Care Licensing Division. In September, state regulators again cited Refuge for numerous personal-rights violations based on the complaints of Ms. Monroe and her colleague, who did not want to be named for fear of repercussions at her new job.
The Community Care Licensing investigation in 2010 found that clients had been wrongfully denied outings, allowances and visits. The denial of those rights, along with the loss of television, music and phone privileges, often occurred for a month, Ms. Monroe and her colleague said.
“What all of these technical violations add up to is that this facility is not taking care of kids,” Mr. King said.
As they had done in previous years, regulators told Refuge administrators in 2010 to stop some of the home’s punitive practices and carry out more staff training. The division also scheduled quarterly inspections of Refuge for the next year, a far more intensive regimen than normal.
The division regulates 1,200 residential youth programs across California. It is budgeted to evaluate just 30 percent of such facilities each year, however, barring inspections resulting from specific complaints. Still, officials said, underperforming programs do not operate unchecked by state regulators.
“I think we are very confident that we are carrying out our mission to protect the residents of these facilities,” said Michael Weston, spokesman for the Department of Social Services.
But an October memo from Jeffrey Hiratsuka, deputy director of the Community Care Licensing Division, said the California budget crisis had weakened the agency’s ability to monitor residential programs.
“C.C.L.D. has been prioritizing its workload in order to cover the most critical mandates,” the memo stated. “However, the situation continued to worsen with the ‘no budget’ situation and C.C.L.D.’s ability to perform the most critical health and safety activities has further deteriorated.”
When the state does inspect facilities, spokesmen said, inspectors check only for compliance with state health, safety and procedural standards and rules regarding personal rights.
“When it comes to evaluating the overall quality of care of a facility, that is outside the scope of C.C.L.D.,” said Oscar Ramirez, also a spokesman for the Department of Social Services. “We could review whether treatment was given, but would not get into the quality of the treatment.”
That is the job of county social workers, Mr. Weston said. “A county social worker is assigned to every child,” Mr. Weston said.
Alameda County officials, however, said they relied on the state to assess group homes and had few options when young people required intensive services.
“The Refuge is a high-level group home,” said Sylvia Soublet, spokeswoman for Alameda County Social Services. “We don’t have very many programs that can handle clients of that level.”
The disconnect between state and county officials extends even to simple matters of fact. Alameda County officials said that despite years of citations against Refuge, state regulators in February recommended an increase in financial support for the home. But Mr. Weston said that the state’s audit of Refuge was continuing and that no such recommendation had been made.
“We depend on Community Care Licensing to let us know” about problems, Ms. Soublet added. “Unless a kid is telling us, we have no way of knowing what is going on in a facility.”