State sanctions drug-treatment program for ‘serious exploitation’

An investigation by the state Department of Health and Human Services into a Greensboro substance-abuse treatment provider has found evidence of “serious exploitation” of clients in violation of a state rule providing “protection from harm, abuse, neglect or exploitation,” resulting in a $6,000 fine.

The chief of the state mental health licensure & certification section also informed Ready 4 Change CEO Christal Smith in a Sept. 4 letter that, based on finding “conditions in the facility [to be] detrimental to the health and safety of the clients,” the state is suspending admissions indefinitely. In a separate letter, the state notified Smith of an intention to revoke the agency’s license.

Similar concerns were raised by clients and a former employee of United Youth Care Services, another drug-treatment program in Greensboro. The state Department of Health and Human Services investigated UYCS concurrently with Ready 4 Change. SarahLewis Peel, a spokesperson for DHHS said she could not comment on when the Division of Health Service Regulation might release a report, but said United Youth Care Services is the subject of an ongoing Medicaid fraud investigation involving multiple agencies.

An Aug. 15 report by the state Division of Health Service Regulation found that Ready 4 Change exploited at least 13 current and former clients enrolled in two substance-abuse outpatient programs through an alleged scheme involving substandard housing. A redacted copy of the report obtained by TCB states that a transitional housing coordinator “solicitated the clients from jails, homeless shelters and various other places to receive substance abuse services, and in turn the clients would be provided housing in substandard apartments in a complex overseen by” the agency’s “corporate compliance officer,” who is not named in the report.

The report documents multiple failures and breaches, including contracting with a licensed psychologist with no knowledge or experience in substance abuse to sign off on comprehensive clinical assessments; failing to report two client deaths earlier this year; and failing to train staff on client rights and
confidentiality.

Tim Vincent of Ready 4 Change said the agency is appealing the findings and has hired a lawyer to file litigation against the state to fight the proposed license revocation, suspension of client admissions and fine. Vincent, who declined to provide his title on Wednesday, has continually maintained that Ready 4 Change holds no responsibility for housing the clients.

Clients and staff interviewed by state investigators indicate otherwise.

Multiple clients and a licensed clinical addiction specialist reportedly told investigators that “the corporate compliance officer of the substance-abuse facility was also the director of the transitional housing program.”

One client told investigators that a transitional housing coordinator expressly linked eligibility for the drug-treatment program with access to housing.

“If you have 3 negative urine screens in a row, they (the THC) will kick you out of the program (substance abuse) and kick you out of housing,” the report quotes the client as saying.

An unidentified staff person told investigators they “felt that the clients were attending the ubstance-abuse facility in order to receive housing.”

“My understanding was they (the licensee and the CCO) had it (transitional housing) under another name because the program (substance abuse) can’t run housing,” they said.

The “licensee” for Ready 4 Change is unnamed in the Aug. 15 report, but the Sept. 4 letters notifying the agency of state action identify the licensee as CEO Christal Smith, who is Vincent’s wife. Vincent declined to say who Ready 4 Change’s corporate compliance officer is, but based on the person’s authority and male gender pronouns used in the report, that person is likely Vincent himself. Notes from an investigative interview with Smith quote her as saying, “He (the CCO) has to draw the line,” and states that “she had informed the CCO numerous times to stop addressing housing issues while at the substance abuse facility.”

Corporate filings for Ready 4 Change and Transitioning Minds, the purported transitional-housing entity, show that Smith is the incorporator of both. Vincent’s Facebook page as recently as Aug. 30 indicated that he worked at both Ready 4 Change and Transitioning Minds. A document obtained by TCB that was generated by the assistant manager at Grandview Pointe Apartments identifies 13 apartments as “Transitioning Minds units.” The report by the state Division of Health Service Regulation cites the leasing manager at the apartments as saying that “the CCO paid the monthly rent for clients” in the substance-abuse programs.

When confronted with these congruencies, Vincent told TCB: “I think we’re at the point where I need to let [the attorney] handle it. These are false allegations. I think at this point as far as getting the truth out there, we’ll have to get all this out in court.”

‘I felt like I was not safe in my environment’

Phylesha Edmonds, a former client at Ready 4 Change, told TCB that Tracy Holt, the housing director at Transitioning Minds, abruptly disappeared soon before she learned that Edmonds would have to leave Grandview Pointe Apartments on Aug. 30.

“She was the overseer of the housing; they claim that housing has nothing to do with Ready 4 Change, but we know how that goes,” Edmonds said. “They also tell you that you have to go class or you’ll get kicked out of the program, so if one doesn’t have anything to do with the other, why are they making threats?”

Edmonds said she was one of 13 or 14 clients of Ready 4 Change, many with children, who were evicted from Grandview Pointe Apartments. Brett Byerly, the executive director of the Greensboro Housing Coalition, said his agency paid for about 10 families to stay in hotels the week after the eviction.

“I’m really furious,” Edmonds said before learning that the housing coalition would pick up the slack. “I have an autistic son who’s 13, a son who’s 15 who’s going through suicidal thoughts. We don’t need this. To sleep in a car — that’s going to be traumatizing to them.”

A licensed clinical addiction specialist interviewed on Aug. 8 told investigators that “she felt that some clients attended the program at the facility only to remain in housing” and “ramp[ed] up” their substance use “prior to urine drug screens.”

Interviews with Ready 4 Change clients revealed that their housing accommodations were plagued with a host of problems, according to the report:

• “The apartments subleased by the transitional housing program were overcrowded;
• “They were infested with bedbugs and roaches;
• “The water and power were frequently disconnected;
• “The air conditioning was not working in some apartments;
• “Males and females that were unfamiliar with each other were placed in the same apartment with no locks on their bedroom doors;
• “Clients were not provided with keys to lock their apartment doors, which resulted in belongings being stolen.”

Sabrina Peace-Hughes, a 64-year-old client of Ready 4 Change confirmed some of the information in the report during an interview at the agency on Wednesday.

“Things were really bad for a while,” Peace-Hughes said. “There was a rat problem.”

Peace-Hughes also confirmed that she was exposed to drug use in the housing.

“Everybody in the apartment was using,” she said. “I felt like I was not safe in my environment. I ended up going back to treatment…. Eventually I was put in another apartment. I was the only female. A couple guys were drinking. I just stayed in my room.”

Despite the challenges of her housing situation, Peace-Hughes spoke highly of Ready 4 Change, noting that she has been clean for 11 months.

Peace-Hughes was formerly a client at UYCS. “It was totally different,” she said. “This is 150 times better.” She added that she would recommend Ready 4 Change “to anyone.”

Investigators cited an unidentified staff member as saying “she felt like” Smith and Vincent “had taken advantage of the clients at the facility by offering substandard housing to entice them to attend the facility programs.”

An unidentified licensed professional counselor told investigators: “I don’t think people with the same issues need to be living together… those with issues (substance abuse) do not need to live together without more structure.”

Investigators also uncovered dubious practices with regards to assessing clients and documenting participation in the program.

Despite having no contact with the substance-abuse clients, a licensed psychologist interviewed by investigators in mid-August said that “she was paid weekly to sign the service notes and the comprehensive clinical assessments (CCAs) that were completed by the therapists and the clinical director.” She told investigators that she had never worked with substance-abuse clients and was not aware of the standard of care for substance-abuse clients, but that she understood that she had to sign the service notes and clinical assessments for the facility to get paid.

Investigators also said the clinical director told them the licensed psychologist had been signing service notes and clinical assessments since before she took the position.

When investigators addressed the matter with Smith, she was incredulous.

“She said that (no experience with substance abuse)?” Smith reportedly said to investigators. “Are you freaking kidding to me? Oh my gosh. Jesus, father to God. I don’t believe she actually said that.”

Asked about the report, Vincent told TCB: “That’s untrue. For her to get her license, she has to be qualified to work with substance abuse clients.”

At least two other staff members said they were pressured to sign off on services that had not been provided to clients.

In one case, an unidentified staff member told investigators that when clients showed up late for a group session or left early, she marked their names off the attendance sheet.

“She felt that clients that didn’t attend at least half the program hours should not get credit for attending and the program should not bill for them,” the report says. “She had been instructed by the licensee approximately a couple months ago to not cross off names on the attendance sheet because the program billed for clients that attended regardless of how long they were present.”

The staff member told investigators she continued to cross clients’ names off the attendance sheet in defiance of the licensee.

Smith denied ordering the staff member to falsify the attendance sheets in an interview with investigators.

“I’m very clear with clients and staff,” she said. “You can’t come and leave…. We have to be able to bill for the entire time.”

State investigators also found that Ready 4 Change failed to report two client deaths earlier this year.

Vincent said staff members merely forgot to complete the final step.

“They were reported,” he said. “It’s once you’re completing the process. It’s in the system. There’s another step you go through that was not completed that gives you a thumbs up or a check.”

Then he added another detail not mentioned in the official report: The clients had been discharged from treatment before they died, he said.