Capacity 44. 5-17
| Severity | Date | Standard / narrative | Corrected |
|---|
| 3 | — |
748.311 - Serious Incident Documentation-Documented in written report
On 5/30/22 there was a report of four clients testing COV-19 positive diagnosis. There was no documentation available for review of this incident during my inspection |
— |
| 4 | — |
748.2151(b)(1) - Medication record - update cumulative record within 2 hours of administering medication
During the inspection, I observed three missing medications documentation entries in one child's record. |
— |
| 3 | — |
748.3365(c)(1) - Bedding-must provide each child with pillow/bed linens appropriate for temperature including pillowcase, top sheet, fitted or bottom sheet
On the physical site walk-through, there was a bed in the white house had two pillows without cases. |
— |
| 4 | — |
748.3115(3) - Fire Extinguisher-Must ensure fire extinguishers are serviced as required by manufacturer's instructions, or as required by fire inspector
During the inspection, the fire extinguisher in the attic/game room of the grey home had expired tags and reflected the last service date of Sept 2020. |
Yes |
| 4 | — |
748.2203(c)(2) - Medication Error-Document the medication error
Medication errors were marked in the records, but the codes and details in the error logs were delayed by 3 days. |
— |
| 3 | — |
748.2551(d)(1) - EBI Implementation-Caregiver must make every effort to protect the child's privacy, including shielding the child from onlookers
During the investigation, it was discovered that the caregivers did not attempt to shield the restraint of a child from other residents that were present. |
— |
| 5 | — |
748.2101(1) - Medication Storage-Store medication in a locked container
During the inspection, there was an unlocked box of over the counter medication on a book shelf in the conference room, which children have access to. |
— |
| 3 | — |
748.1107(a) - Child Rights parent contact-Allow contact between a child and his parent whose parental rights have not been terminated
It was determined that direct care staff were not allowing children in care to call their caseworkers. |
— |
| 2 | — |
748.2853(1) - EBI Documentation-Date and time the caregiver offered the post discussion to the child
In one of the restraint reports, there was nothing under the "debriefing" section. In two other reports, the documentation was minimal and lacked detail. |
— |
| 2 | — |
748.1335 - Initial Service Plan-Complete the initial service plan within 45 days after admission
One of the girl's initial service plan was completed 98 days after she was admitted. This needs to be done within 45 days, and it should be signed by the treatment team. |
— |
| 5 | — |
748.3301(a)(1) - Physical Site- Buildings must be structurally sound and not pose a risk to the health and safety of children.
During the inspection, it was observed that the door to access the attic was unlocked and accessible to children who were permitted to be upstairs. |
— |
| 4 | — |
748.507(1) - Employee general responsibilities-Demonstrate competency, prudent judgment, self-control in presence of children and when performing assigned tasks
The general responsibilities of all employees regardless of whether they are counted in the child/caregiver ratio is to demonstrate competency and prudent judgement in the absence of a more specific rule requirement. In this incident the two children were involved in a verbal altercation 30 min prior to arriving back at the facility, once at the facility one of the children is refusing to take verbal direction from staff and is attempting to make contact with the second child. While staff offered a chance to go to a separate house that evening, the second child refused and chose to return to "White house". Even after staff observed the other child outside and heard her making derogatory comments, they allowed the second child to return to her assigned housing where the altercation occurred. |
— |
| 4 | — |
748.1101(b)(4)(A)(v) - Children's rights- To be free from being subjected to remarks that belittle or ridicule the child or the child's family
Three of the five children interviewed reported that a staff provoked children in care by making belittling and ridiculing comments and laughing at the children, which resulted in a staff being assaulted. |
— |
| 3 | — |
748.3443(b)(2) - Food Preparation-Must have a thermometer in freezers & store frozen food at 0 degrees Fahrenheit or below
During the inspection, the freezer combo in the grey home did not have a thermometer. |
— |
| 2 | — |
748.1335 - Initial Service Plan-Complete the initial service plan within 45 days after admission
In the child's record reviewed the initial service plan was not completed timely. The child was placed 6/4/21 and the plan was not completed until 8/3/21. |
Yes |
| 4 | — |
748.2101(3) - Medication Storage-Store medication covered by Schedule II of the Texas Controlled Substances Act under double lock in a separate container
The medication boxes at both the White and Corner House was observed during today's inspection, and both were in locked closet but the boxes were not locked. When the individual boxes are not locked it operation is not meeting the requirement to have these medication double locked. Before I left each house I had the staff lock the combination boxes. The boxes were checked and observed as locked before I left each house. |
Yes |
| 5 | — |
748.685(a)(4) - Caregiver responsibility - providing the level of supervision necessary to ensure each child's safety and well-being
At least one staff member has been dozing off during her graveyard shifts and has been seen sleeping by more than one child. |
— |
| 3 | — |
748.125(d)(4)(D) - Suicide Screening- Must be administered every 90 days after admission for children 10 years of age or older in a GRO that is not a RTC.
The operation has not been administering suicide screenings every 90 days as required by minimum standards. |
— |
| 3 | — |
748.1583(a) - TB exam-Persons over 1 yr old who live, work, volunteer at facility have exam w/in 30 days, unless person had previous exam that meets requirements
One of the four children read had no TB test or results in the chart. |
— |
| 3 | — |
748.2855(a) - EBI Documentation-Caregiver must document EBI in child's record as soon as possible, but no later than 24 hours after initiation of the intervention
There was no documentation of this EBI restraint. |
— |
| 4 | — |
748.2551(a) - EBI Implementation-Must be an appropriate response to the behavior demonstrated, and de-escalation must have failed
One staff chose to use a restraint on a child when the situation, as written, did not constitute an emergency. |
— |
| 3 | — |
748.3395(b)(4) - Hand-washing-Provide hand-washing sinks equipped with soap & a personal towel, single-use disposable towels, or hot air hand dryers
During the inspection, the bathroom in bedroom four had a paper towel dispenser but no paper towels. |
— |
| 2 | — |
748.1331(a) - Preliminary Service Plan-Complete plan that addresses child's immediate needs within 72 hours of admission
The preliminary service plan done for one child was not done in 72 hours-- it was 16 days late. |
— |
| 5 | — |
748.685(a)(5) - Caregiver responsibility - being able to intervene when necessary to ensure child's safety
The caregivers did not de-escalate a heated altercation between two residents, which resulted in a child having a seizure and requiring emergency medical attention. |
Yes |
| 4 | — |
748.3233(b)(4)(E) - Evacuation-Emergency evacuation & relocation diagram includes 2 exit routes that are not doors or windows that require key to open from inside
During the investigation, it was observed that the operation's back gate was locked with a padlock. The emergency evacuation plan instructs children to meet at the large parking lot across the street, however, those who exit through the back door will not be able to open the gate without a key to the padlock. |
— |
| 4 | — |
748.535(2) - AP Child-care administrator responsibilities- Ensure the operation complies with current heightened monitoring plans, if applicable.
During a review conducted on March 17, 2023, it was determined that: (1) the Administrator failed to ensure compliance with the current HM Plan; and (2) 12 months had elapsed since the effective date of the plan. The heightened monitoring plan for this operation included a specific ?planned end date? at the 12-month mark by which the operation was expected to meet all heightened monitoring criteria necessary to move out of active heightened monitoring to a phase of ?post plan monitoring?. As a direct result of the administrator?s failure to ensure timely compliance with the heightened monitoring plan, this operation is now unable to successfully move to post-plan monitoring. Furthermore, the operation?s ?planned end date? must now be revised, and the period of heightened monitoring must be extended. Further details of the administrator?s failure to ensure compliance include the following: - Operation failed to demonstrate 6 months of successive compliance with the standard and contract requirements that led to heightened monitoring; and - Operation was unable to meet compliance with Medium-High or High weighted licensing citations. |
— |
| 4 | — |
748.507(1) - Employee general responsibilities-Demonstrate competency, prudent judgment, self-control in presence of children and when performing assigned tasks
The caregiver did not use prudent judgment when she asked the other residents to help her to physically control the child who had swallowed glass. The caregiver chose to look for more glass in the bedroom while this was happening. The victim child could have been seriously injured. |
— |
| 3 | — |
748.2851(b) - EBI Follow-Up-Caregivers involved in EBI must conduct a post discussion with child
The child did not have a post discussion with a caregiver after she was restrained by the children. |
— |
| 4 | — |
748.535(2) - AP Child-care administrator responsibilities- Ensure the operation complies with current heightened monitoring plans, if applicable.
During a review conducted on 9/16/22, it was determined that: (1) your operation?s administrator failed to ensure compliance with the current HM Plan(s); and (2) 12 months had elapsed since the effective date of the plan. The heightened monitoring plans for this operation included a specific ?planned end date? at the 12-month mark by which the operation was expected to meet all heightened monitoring criteria necessary to move out of active heightened monitoring to a phase of ?post plan monitoring?. As a direct result of the administrator?s failure to ensure timely compliance with heightened monitoring plans, this operation is now unable to successfully move to post-plan monitoring. Furthermore, the operation?s ?planned end date? must now be revised, and the period of heightened monitoring must be extended. Further details of the administrator?s failure to ensure compliance include the following: - Operation failed to demonstrate 6 months of successive compliance with the standard and contract requirements that led to heightened monitoring; and - Operation was unable to meet compliance with Medium-High or High weighted licensing citations, including having an open investigation. |
— |
| 4 | — |
748.3421(3) - Poisons-Ensure poisonous/flammable material is stored in an area that is inaccessible to children unless child is capable to use responsibly.
During the inspection, there was a bottle of Scrub Free Total Bathroom Cleaner on a shelf in the living area. |
Yes |
| 4 | — |
748.3421(3) - Poisons-Ensure poisonous/flammable material isstored in an area that is inaccessible to children unless child is capable to use responsibly.
During the inspection, I observed an unsecured and unattended gas can, containing gasoline, in the yard of one of the houses. |
Yes |
| 3 | — |
748.3301(a)(2) - Physical Site- Buildings must be clean and in good repair.
During the inspection, I observed the siding of the house was rotted out in several locations on both buildings, a bench in the back yard was used as an anchor for the volleyball net with a metal stake being stuck through the bench slats to bear the weight while being exposed in a way a child could injure themselves on it, the paint in the upstairs room of the kitchen building was cracked above a window, and the paint on the outside rear face of the house as incomplete. |
— |
| 3 | — |
748.1103(a) - Informing child of rights-Review rights with child/parents within 7 days of child's admission; provide child/parents with written copy of rights
Of the four child's records reviewed, one was missing a signed child's rights. |
— |
| 5 | — |
748.2453 - Emergency Behavior Intervention-Only a qualified caregiver may administer emergency behavior intervention, except short personal restraint
A caregiver asked the other children in the home to help her restrain a child who needed to be hospitalized. The restraint was conducted by untrained teenagers. |
— |
| 4 | — |
748.3351(1) - Interior Space-Provide living space, appropriate furnishings, & bathroom facilities that are safe, clean and maintained in good repair
During an inspection, there was excessive dust and cob webs on vents, walls, and ceilings. |
— |
| 5 | — |
745.641 - AP Background check results - Must receive notification prior to allowing subject to be present at your operation
It was relayed to Childcare Regulation that the spouse of a staff person at the facility began living at the operation in the beginning of August 2023. The Administrator confirmed this information to DFPS. A background check was not submitted prior to this person moving in. |
— |
| 3 | — |
748.3301(a)(2) - Physical Site- Buildings must be clean and in good repair.
During the inspection, there was a hole in the wall in bedroom 2. |
Yes |
| 4 | — |
748.2307(8) - Other Prohibited Punishments-humiliating, shaming, ridiculing, rejecting, or yelling at a child
Several children indicated that a staff member yelled and made shaming remarks to children placed at the operation. An incident of this was recorded and shared with the investigator. |
— |
| 4 | — |
748.2151(d) - Medication Record-must include accurate daily count of each prescribed medication, unless operate on a cottage home model
Two of four medication records reviewed, did not have an accurate medication count. |
— |
| 3 | — |
748.3365(c)(1) - Bedding-must provide each child with pillow/bed linens appropriate for temperature including pillowcase, top sheet, fitted or bottom sheet
One of the girls' beds had two pillows and no pillow cases. This has become an ongoing problem. |
Yes |
| 4 | — |
748.507(1) - Employee general responsibilities-Demonstrate competency, prudent judgment, self-control in presence of children and when performing assigned tasks
Staff ran a personal errand while transporting children in care. |
— |
| 4 | — |
748.3233(b)(3) - Evacuation-Emergency evacuation & relocation diagram must include designated location inside operation to take shelter from threatening weather
During the after-hours monitoring inspection, it was observed that the operation's posted evacuation diagrams did not have a specified shelter in place location for severe weather. |
— |
| 3 | — |
748.3443(b)(2) - Food Preparation-Must have a thermometer in freezers & store frozen food at 0 degrees Fahrenheit or below
During the monitoring inspection, the thermometer located in the freezer was not at the required 0 degrees. |
Yes |
| 5 | — |
748.3301(a)(3) - Physical Site- Buildings must comply with applicable building, plumbing, electrical, fire, and similar codes.
During the walk through of the operation exposed wire was found near the central fire detector system. |
Yes |
| 3 | — |
748.3239(b) - Evacuation-Must practice severe weather drill at least once every 6 months from date of last severe weather drill
During the inspection, it was discovered the operation has not completed a severe weather drill in over 12 months. |
— |
| 4 | — |
748.3233(b)(4)(C) - Evacuation-Emergency evacuation & relocation diagram includes at least 2 exit routes that are not through a kitchen or other hazardous area
During the investigation, it was observed that the operation's evacuation plan has one exit that leads directly through the kitchen. |
— |
| 5 | — |
748.2551(c)(2) - EBI Implementation-Caregiver must use the minimal amount of reasonable and necessary physical force
During the investigation, it was determined that the caregivers did not use the minimal amount of reasonable and necessary physical force during an EBI implementation as they can be seen, on video footage, sitting on and straddling the child. |
— |
| 5 | — |
748.2551(c)(2) - EBI Implementation-Caregiver must use the minimal amount of reasonable and necessary physical force
There were three girls on this child. One straddling her torso, one holding her head, and one holding her ankles. This could have caused pain, panic, or breathing problems for the child being restrained. |
— |
| 3 | — |
748.3443(b)(1) - Food Preparation-Must have a thermometer in refrigerators & store refrigerated food at 40 degrees Fahrenheit or below
During the inspection, I observed the refrigerator in the kitchen lacked a thermometer, one freezer thermometer read ten degrees Fahrenheit, the other freezer thermometer read four degrees Fahrenheit, and the deep freezer in the other building read fifteen degrees Fahrenheit. |
— |
| 3 | — |
748.3273(2) - First Aid Kits-Each one must contain adhesive tape
There were several things missing in the vans first aid kit, including: scissors, adhesive tape, tweezers, and gloves. |
— |
| 4 | — |
748.2307(9) - Other Prohibited Punishments-subjecting a child to abusive or profane language
Several children indicated staff uses profane language towards children in care. |
— |
| 3 | — |
748.311(3) - Serious Incident Documentation-Includes name, age, gender, and date of admission of the child or children involved
While reviewing the serious incident report provided, it was determined the documentation did not include the names of the children/adults involved in the incident. There were three children involved in the incident; however, the report only named one child. The incident occurred at the operation, and the staff present that witnessed the incident were not included on the report. |
— |
| 2 | — |
748.2851(c)(2) - EBI Follow-Up-Caregivers involved in EBI must make reasonable efforts to debrief with children in care who witness the incident
There has been nothing shared verbally or in writing by the children or staff that the situation was discussed with them. |
— |
| 5 | — |
748.685(a)(4) - Caregiver responsibility - providing the level of supervision necessary to ensure each child's safety and well-being
It was discovered through interviews with collaterals, that staff failed to supervise children accordingly, as staff member would fall asleep during their working hours. |
— |
| 4 | — |
748.535(2) - AP Child-care administrator responsibilities- Ensure the operation complies with current heightened monitoring plans, if applicable.
During a review conducted on September 22, 2023, it was determined that: (1) the Administrator failed to ensure compliance with the current HM Plan; and (2) 12 months had elapsed since the effective date of the plan. The heightened monitoring plan for this operation included a specific ?planned end date? at the 12-month mark by which the operation was expected to meet all heightened monitoring criteria necessary to move out of active heightened monitoring to a phase of ?post plan monitoring?. As a direct result of the administrator?s failure to ensure timely compliance with the heightened monitoring plan, this operation is now unable to successfully move to post-plan monitoring. Furthermore, the operation?s ?planned end date? must now be revised, and the period of heightened monitoring must be extended. Further details of the administrator?s failure to ensure compliance include the following: - Operation failed to demonstrate 6 months of successive compliance with the standard and contract requirements that led to heightened monitoring and - Operation was unable to meet compliance with Medium-High or High weighted licensing citations |
— |
| 3 | — |
748.3443(b)(2) - Food Preparation-Must have a thermometer in freezers & store frozen food at 0 degrees Fahrenheit or below
During a walkthrough of the operation, I observed two freezers with non-working thermometers. |
— |
| 3 | — |
748.151(2) - Operational responsibilities - Operate according to your approved plans, policies, and procedures
The policy with ETOD is to have kids in eye or ear shot -and to check on them every 15 minutes or more if it is in their plan. |
— |
| 3 | — |
748.1103(d) - Informing child of rights-Person being informed must sign statement indicating he read and understands the rights-signed copy filed in child's record
One of four child records reviewed did not have a signed copy of the Child's Rights. There were two unsigned copies of the child's rights in the child records. |
— |
| 4 | — |
748.535(2) - AP Child-care administrator responsibilities- Ensure the operation complies with current heightened monitoring plans, if applicable.
During a review conducted on March 25, 2024, it was determined that: (1) the Administrator failed to ensure compliance with the current HM Plan; and (2) 12 months had elapsed since the effective date of the plan. The heightened monitoring plan for this operation included a specific ?planned end date? at the 12-month mark by which the operation was expected to meet all heightened monitoring criteria necessary to move out of active heightened monitoring to a phase of ?post plan monitoring?. As a direct result of the administrator?s failure to ensure timely compliance with the heightened monitoring plan, this operation is now unable to successfully move to post-plan monitoring. Furthermore, the operation?s ?planned end date? must now be revised, and the period of heightened monitoring must be extended. Further details of the administrator?s failure to ensure compliance include the following: - Operation failed to demonstrate 6 months of successive compliance with the standard and contract requirements that led to heightened monitoring and - Operation was unable to meet compliance with Medium-High or High weighted licensing citations |
— |
| 5 | — |
748.1101(b)(4)(A)(ii) - Children's rights-The right to be free from being subjected to or threatened with corporal punishment, including spanking or hitting
Several children indicated staff threatened to physical harm children in care. |
— |
| 3 | — |
748.3365(b)(2) - Bedding-must provide each child with a mattress cover or protector unless mattress is waterproof
There were two beds in the gray house that were missing mattress protectors. These were not vacant beds, so the staff was going to locate mattress protectors. |
— |
| 4 | — |
748.2003(b)(5) - Administration of prescription medication-Ensure the child has taken the medication as prescribed
A child in care received medication 4 hours later than it was to be received. |
— |
| 3 | — |
748.1217(a) - Admission Assessment-Must provide initial evaluation of appropriate placement & ensure that necessary information for service planning is obtained
One of four child's records did not have a completed admissions assessment. |
— |
| 4 | — |
748.507(1) - Employee general responsibilities-Demonstrate competency, prudent judgment, self-control in presence of children and when performing assigned tasks
The general responsibilities of all employees regardless of whether they are counted in the child/caregiver ratio is to demonstrate competency and prudent judgement in the absence of a more specific rule requirement. In this incident the two children were involved in a verbal altercation 30 min prior to arriving back at the facility, once at the facility one of the children is refusing to take verbal direction from staff and is attempting to make contact with the second child. While staff offered a chance to go to a separate house that evening, the second child refused and chose to return to "White house". Even after staff observed the other child outside and heard her making derogatory comments, they allowed the second child to return to her assigned housing where the altercation occurred. |
— |
| 4 | — |
748.3421(3) - Poisons-Ensure poisonous/flammable material is stored in an area that is inaccessible to children unless child is capable to use responsibly.
During the inspection, there was a bottle of Scrub Free Total Bathroom Cleaner on a shelf in the living area. |
Yes |
| 3 | — |
748.1103(a) - Informing child of rights-Review rights with child/parents within 7 days of child's admission; provide child/parents with written copy of rights
Of the four child's records reviewed, one was missing a signed child's rights. |
— |
| 3 | — |
748.2855(a) - EBI Documentation-Caregiver must document EBI in child's record as soon as possible, but no later than 24 hours after initiation of the intervention
There was no documentation of this EBI restraint. |
— |
| 4 | — |
748.3115(3) - Fire Extinguisher-Must ensure fire extinguishers are serviced as required by manufacturer's instructions, or as required by fire inspector
During the inspection, the fire extinguisher in the attic/game room of the grey home had expired tags and reflected the last service date of Sept 2020. |
Yes |
| 4 | — |
748.3351(1) - Interior Space-Provide living space, appropriate furnishings, & bathroom facilities that are safe, clean and maintained in good repair
During an inspection, there was excessive dust and cob webs on vents, walls, and ceilings. |
— |
| 4 | — |
748.3421(3) - Poisons-Ensure poisonous/flammable material isstored in an area that is inaccessible to children unless child is capable to use responsibly.
During the inspection, I observed an unsecured and unattended gas can, containing gasoline, in the yard of one of the houses. |
Yes |
| 3 | — |
748.1107(a) - Child Rights parent contact-Allow contact between a child and his parent whose parental rights have not been terminated
It was determined that direct care staff were not allowing children in care to call their caseworkers. |
— |
| 4 | — |
748.535(2) - AP Child-care administrator responsibilities- Ensure the operation complies with current heightened monitoring plans, if applicable.
During a review conducted on March 25, 2024, it was determined that: (1) the Administrator failed to ensure compliance with the current HM Plan; and (2) 12 months had elapsed since the effective date of the plan. The heightened monitoring plan for this operation included a specific ?planned end date? at the 12-month mark by which the operation was expected to meet all heightened monitoring criteria necessary to move out of active heightened monitoring to a phase of ?post plan monitoring?. As a direct result of the administrator?s failure to ensure timely compliance with the heightened monitoring plan, this operation is now unable to successfully move to post-plan monitoring. Furthermore, the operation?s ?planned end date? must now be revised, and the period of heightened monitoring must be extended. Further details of the administrator?s failure to ensure compliance include the following: - Operation failed to demonstrate 6 months of successive compliance with the standard and contract requirements that led to heightened monitoring and - Operation was unable to meet compliance with Medium-High or High weighted licensing citations |
— |
| 3 | — |
748.1103(d) - Informing child of rights-Person being informed must sign statement indicating he read and understands the rights-signed copy filed in child's record
One of four child records reviewed did not have a signed copy of the Child's Rights. There were two unsigned copies of the child's rights in the child records. |
— |
| 3 | — |
748.1217(a) - Admission Assessment-Must provide initial evaluation of appropriate placement & ensure that necessary information for service planning is obtained
One of four child's records did not have a completed admissions assessment. |
— |
| 4 | — |
748.2003(b)(5) - Administration of prescription medication-Ensure the child has taken the medication as prescribed
A child in care received medication 4 hours later than it was to be received. |
— |
| 3 | — |
748.3301(a)(2) - Physical Site- Buildings must be clean and in good repair.
During the inspection, there was a hole in the wall in bedroom 2. |
Yes |
| 3 | — |
748.311(3) - Serious Incident Documentation-Includes name, age, gender, and date of admission of the child or children involved
While reviewing the serious incident report provided, it was determined the documentation did not include the names of the children/adults involved in the incident. There were three children involved in the incident; however, the report only named one child. The incident occurred at the operation, and the staff present that witnessed the incident were not included on the report. |
— |
| 5 | — |
748.685(a)(4) - Caregiver responsibility - providing the level of supervision necessary to ensure each child's safety and well-being
It was discovered through interviews with collaterals, that staff failed to supervise children accordingly, as staff member would fall asleep during their working hours. |
— |
| 5 | — |
748.3301(a)(1) - Physical Site- Buildings must be structurally sound and not pose a risk to the health and safety of children.
During the inspection, it was observed that the door to access the attic was unlocked and accessible to children who were permitted to be upstairs. |
— |
| 4 | — |
748.2551(a) - EBI Implementation-Must be an appropriate response to the behavior demonstrated, and de-escalation must have failed
One staff chose to use a restraint on a child when the situation, as written, did not constitute an emergency. |
— |
| 3 | — |
748.3239(b) - Evacuation-Must practice severe weather drill at least once every 6 months from date of last severe weather drill
During the inspection, it was discovered the operation has not completed a severe weather drill in over 12 months. |
— |
| 4 | — |
748.1101(b)(4)(A)(v) - Children's rights- To be free from being subjected to remarks that belittle or ridicule the child or the child's family
Three of the five children interviewed reported that a staff provoked children in care by making belittling and ridiculing comments and laughing at the children, which resulted in a staff being assaulted. |
— |
| 4 | — |
748.2307(8) - Other Prohibited Punishments-humiliating, shaming, ridiculing, rejecting, or yelling at a child
Several children indicated that a staff member yelled and made shaming remarks to children placed at the operation. An incident of this was recorded and shared with the investigator. |
— |
| 5 | — |
748.2101(1) - Medication Storage-Store medication in a locked container
During the inspection, there was an unlocked box of over the counter medication on a book shelf in the conference room, which children have access to. |
— |
| 3 | — |
748.3365(b)(2) - Bedding-must provide each child with a mattress cover or protector unless mattress is waterproof
There were two beds in the gray house that were missing mattress protectors. These were not vacant beds, so the staff was going to locate mattress protectors. |
— |
| 4 | — |
748.507(1) - Employee general responsibilities-Demonstrate competency, prudent judgment, self-control in presence of children and when performing assigned tasks
The caregiver did not use prudent judgment when she asked the other residents to help her to physically control the child who had swallowed glass. The caregiver chose to look for more glass in the bedroom while this was happening. The victim child could have been seriously injured. |
— |
| 4 | — |
748.2151(d) - Medication Record-must include accurate daily count of each prescribed medication, unless operate on a cottage home model
Two of four medication records reviewed, did not have an accurate medication count. |
— |
| 3 | — |
748.125(d)(4)(D) - Suicide Screening- Must be administered every 90 days after admission for children 10 years of age or older in a GRO that is not a RTC.
The operation has not been administering suicide screenings every 90 days as required by minimum standards. |
— |
| 3 | — |
748.3443(b)(1) - Food Preparation-Must have a thermometer in refrigerators & store refrigerated food at 40 degrees Fahrenheit or below
During the inspection, I observed the refrigerator in the kitchen lacked a thermometer, one freezer thermometer read ten degrees Fahrenheit, the other freezer thermometer read four degrees Fahrenheit, and the deep freezer in the other building read fifteen degrees Fahrenheit. |
— |
| 2 | — |
748.1335 - Initial Service Plan-Complete the initial service plan within 45 days after admission
In the child's record reviewed the initial service plan was not completed timely. The child was placed 6/4/21 and the plan was not completed until 8/3/21. |
Yes |
| 4 | — |
748.3233(b)(3) - Evacuation-Emergency evacuation & relocation diagram must include designated location inside operation to take shelter from threatening weather
During the after-hours monitoring inspection, it was observed that the operation's posted evacuation diagrams did not have a specified shelter in place location for severe weather. |
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| 4 | — |
748.3233(b)(4)(E) - Evacuation-Emergency evacuation & relocation diagram includes 2 exit routes that are not doors or windows that require key to open from inside
During the investigation, it was observed that the operation's back gate was locked with a padlock. The emergency evacuation plan instructs children to meet at the large parking lot across the street, however, those who exit through the back door will not be able to open the gate without a key to the padlock. |
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| 5 | — |
748.2453 - Emergency Behavior Intervention-Only a qualified caregiver may administer emergency behavior intervention, except short personal restraint
A caregiver asked the other children in the home to help her restrain a child who needed to be hospitalized. The restraint was conducted by untrained teenagers. |
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| 3 | — |
748.2551(d)(1) - EBI Implementation-Caregiver must make every effort to protect the child's privacy, including shielding the child from onlookers
During the investigation, it was discovered that the caregivers did not attempt to shield the restraint of a child from other residents that were present. |
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| 3 | — |
748.1583(a) - TB exam-Persons over 1 yr old who live, work, volunteer at facility have exam w/in 30 days, unless person had previous exam that meets requirements
One of the four children read had no TB test or results in the chart. |
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| 5 | — |
748.685(a)(4) - Caregiver responsibility - providing the level of supervision necessary to ensure each child's safety and well-being
At least one staff member has been dozing off during her graveyard shifts and has been seen sleeping by more than one child. |
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| 3 | — |
748.311 - Serious Incident Documentation-Documented in written report
On 5/30/22 there was a report of four clients testing COV-19 positive diagnosis. There was no documentation available for review of this incident during my inspection |
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| 2 | — |
748.2851(c)(2) - EBI Follow-Up-Caregivers involved in EBI must make reasonable efforts to debrief with children in care who witness the incident
There has been nothing shared verbally or in writing by the children or staff that the situation was discussed with them. |
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| 3 | — |
748.3443(b)(2) - Food Preparation-Must have a thermometer in freezers & store frozen food at 0 degrees Fahrenheit or below
During the inspection, the freezer combo in the grey home did not have a thermometer. |
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| 5 | — |
748.1101(b)(4)(A)(ii) - Children's rights-The right to be free from being subjected to or threatened with corporal punishment, including spanking or hitting
Several children indicated staff threatened to physical harm children in care. |
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308 inspection record(s) on file from TX-HHSC.
Licensed facilities near this one, highest compliance score first.