The death of a 12-year-old boy at a North Carolina wilderness camp for troubled adolescents has been ruled a homicide, according to an autopsy report released Monday.

The boy died in February, less than 24 hours after having arrived at Trails Carolina, a for-profit program that has since lost its operating license. Trails Carolina has said the death appeared to be accidental and that staff members performed CPR after they found the boy unresponsive the morning after he arrived. He was inside a bivy, a one-person tent secured with an alarm.

The camp did not immediately provide a comment on the medical examiner’s findings, which listed the boy’s cause of death as “asphyxia due to smothering,” or the inability to get oxygen — “in this case due to covering the nose and mouth” with material that was not breathable.

The camp has said it routinely placed children in bivvies overnight for their safety when they arrived. The autopsy report said the inner mesh panel of the boy’s bivy was torn, so counselors sealed the outer, weather-resistant door panel instead, which was not the camp’s protocol.

The autopsy report, issued by the state chief medical examiner’s office, said bivvies typically include warnings against fully enclosing the weather-resistant outer layer “as it may lead to condensation and breathing restriction.”

Officials have identified the boy only by his initials, CJH. A spokesman for his family said the family had no comment.

No charges were announced. The Transylvania County Sheriff’s Office, which has been conducting a criminal investigation into the boy’s death, said it is reviewing the autopsy report and will discuss it with the local district attorney.

The autopsy report said there were no signs of trauma or sexual assault. The boy was found without pants, but his father told investigators that his son frequently slept that way.

There was also no evidence of a drug overdose or any natural causes that could have led to his death, the autopsy report said.

The asphyxia finding was a “diagnosis of exclusion, meaning all other reasonable causes of death” were ruled out, it said. The boy was “placed into this compromised sleeping position by other(s) and did not have the ability to reasonably remove himself,” the report said.

Meanwhile, counselors overseeing him could not check on him because of the bivy’s opaque outer panel, preventing them from potentially noticing a problem and helping him before it was too late.

“With this combination of factors, the death is best certified as homicide,” the report said.

Before its license was revoked, Trails Carolina, in Lake Toxaway, served children with behavioral issues and diagnoses such as attention-deficit/hyperactivity disorder, autism and post-traumatic stress disorder. A medical examiner’s report released with the autopsy findings said the boy who died had ADHD, anxiety, migraines and social challenges, including “a very hard time making friends.”

His parents had paid for two strangers to escort him from his home in New York to Trails Carolina, the medical examiner’s report said, referring to a common practice that the troubled youth industry uses to transport children to its programs.

That night, the boy was “restless and mumbling in his sleep,” the medical examiner’s report said. At one point, counselors took him out of his bivy and he fell asleep, it added. They then woke him up to put him back inside. In the morning, the report said, they found him cold to the touch with his head at the foot of the bivy.

This article was originally published on NBCNews.com