Texas › Waller › Divine Children's Care Home

Divine Children's Care Home

Child care center · 40018 HIGHWAY 290 BUSINESS, Waller, TX 77484-8171 · License 1741334

0Compliance score
Poor

Capacity 8. 8-17

Violation history (256)

Severity	Date	Standard / narrative	Corrected
5	—	745.4151(c)(5)(A) - Drug testing procedures-All drug testing will at a minimum screen for marijuana, cocaine, opiates, amphetamines, and phencyclidine (PCP) Drug test results did not specify what the employee was screened.	—
3	—	748.363(8) - Personnel records - Include a Pre-Employment Affidavit for Applicants for Employment as specified in Texas Human Resources Code ?42.0563 Missing Pre-Employment Affidavit for Applicants	—
4	—	748.930(b)(1)(A) - Annual Training-Caregivers in operations other than cottage homes must have 4 hrs of EBI every 6 months. One of the two reviewed employee files revealed that one employee had not completed the emergency intervention training required every six months, and the most recent training was completed over a year ago.	—
4	—	748.2151(c)(8) - Medication record-must include reasons for administering psychotropic medication or non-prescription medication/supplement for a child under 5 years Medication log was missing information regarding the reason for the medication, signatures of caregiver and side effects.	—
2	—	748.1437(1) - Discharge/Transfer Documentation-Must include date and circumstances of discharge or transfer Childs discharge documentation records did not have the time or the person whom he was discharge to.	—
4	—	748.2051(3) - Medication Self-Administration-Must consult health-care professional who prescribed medication and document his/her concerns in child's record A child is self administrating medication however the child records did not have documentation from the doctor, or parent that he is allowed to administered this medication .	—
3	—	748.1205(a)(12) - Admission Documentation-Identification of child's high risk behaviors and related safety plan staff and caregivers will implement One child record did not have high risk behaviors identified and how the operation will implement the safety of the chilld.	—
3	—	748.103(b)(1) - Policies and procedures to submit - Related to record keeping, including where records will be located. The operation's policy and procedures regarding records and record keeping does not specify a records retention timeframe. Additionally the policy and procedure indicates records will be provided to the managing conservator and/or guardian upon request.	—
3	—	748.363(5) - Personnel records-Personnel records-Include evidence of valid professional licensures, certifications, or registrations required for the position. In reviewing the personnel records, there was no proof of education for all three staff.	—
3	—	748.3301(a)(2) - Physical Site- Buildings must be clean and in good repair. It was observed in Room 1, a hole in the door. Work order was submitted.	—
1	—	748.4111(a) - Transportation records-Must maintain on file at the operation the name of each driver and a copy of that person's valid driver's license Employee file did not have a copy of its driver s license in the personnel file.	—
4	—	748.863(a)(5) - Pre-Service Training- Caregivers who administer medication must have psych medication training before administering psych meds. Two out of two records were missing instructor led training regarding administration of psychotropic medication.	—
2	—	748.1209(b)(1) - Child Orientation-Include policies on visitation, including family visitation & overnight visitation The orientation documentation does not include information regarding the operation's policies regarding family visitations, gifts, or the education program.	—
1	—	748.1347(b) - Initial Service Plan-PLSP must sign and date the plan; If PLSP disagrees with any portion of the plan, he must document issue(s) before signing it Child files reviewed were missing the required signatures on the service plan.	—
3	—	748.363(6) - Personnel records- Include copy of a cleared tuberculosis screening conducted prior to the person having contact with children in care. Record shows employee received pre-service training on 7/15/23, with TB test results received on 7/21/13, after contact with children in care	—
3	—	748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records Record indicates employee received Orientation, 40 hours of pre-service training, and 8 hours of EBI training all in one day.	—
3	—	748.363(6) - Personnel records-Include notarized Licensing Affidavit for Applicants for Employment form as specified in Human Resources Code, 42.059 Employee record did not have a notarized employment affidavit in their file.	—
2	—	748.1337(b)(1)(A)(v) - Initial Service Plan-Include educational needs and how needs will be met; include any school evaluations or recommendations A child service plan did not document appropriated school goals.	—
2	—	748.1331(a) - Preliminary Service Plan-Complete plan that addresses child's immediate needs within 72 hours of admission child preliminary service plan was not completed.	—
2	—	748.3701(a) - Recreation responsibility-Must provide daily indoor/outdoor recreational & other activities appropriate to needs, interests, and abilities of children The operation?s recreation schedule did not provide the required outdoor daily activities.	—
3	—	748.453(a)(1) - Unauthorized Absence ? Annual summary log must include name, age, gender, date of admission Operation runaway log did not have the information needed.	—
1	—	748.1437(2) - Discharge/Transfer Documentation-Must include date and time the child was informed of his discharge or transfer A child's discharge did not document when he was informed of the non-emergency discharge.	—
2	—	748.915(b)(1) - Pediatric CPR training documentation must include the participant's name. It was observed that no require training for one staff.	—
2	—	748.1437(3) - Discharge/Transfer Documentation-Must include name, address, telephone number, and relationship of person to whom child is discharged A childs discharge did not have the infomartion address, phone to whom he was release to.	—
3	—	748.1217(a) - Admission Assessment-Must provide initial evaluation of appropriate placement & ensure that necessary information for service planning is obtained The operation did not have an Admission Assessment form developed in their record. Admission Assessment must be completed prior to a nonemergency admission.	—
4	—	748.2151(c)(5) - Medication record - must include date (day/month/year) & time each medication was administered Medication records were missing information when the medication was administered and by whom it was administered.	—
3	—	748.151(2) - Operational responsibilities - Operate according to your approved plans, policies, and procedures The operation's search document form does not include fields or prompts for the reason for the search, what was searched, the results of the search, or the resolution of the search.	—
3	—	748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records Multiple records at the operation were not true and accurate and had contradicting information.	—
3	—	748.4651(a) - Pre-Service Training- If operation provides certain amount of tx svcs, caregiver must have 40 hours experience in operation that provides same tx svcs Record shows staff received 40 hours of pre-service training in one day.	—
3	—	748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records Two service plans had unclear information regarding the staff's responsibilities if and when a resident goes AWOL. The AWOL annual summary log listed "NA" for the hotline intake report number and Police report number despite both being applicable.	—
3	—	748.303(a)(10)(A) - Serious Incident-Report to Licensing no later than 6 hours after determining unauthorized absence of a child 13 yrs old or older. Operation failed to report a child unathorized absent to lisencing.	—
3	—	748.105(9) - Personnel Policies - Must require those with access to information about a child be informed of their responsibility to maintain confidentiality. Agency policy addresses HIPAA rules only. All child information must be kept confidential and accessible only to authorized personnel	—
4	—	748.2051(3) - Medication Self-Administration-Must consult health-care professional who prescribed medication and document his/her concerns in child's record A child is self administrating medication however the child records did not have documentation from the doctor, or parent that he is allowed to administered this medication .	—
2	—	748.1209(b)(1) - Child Orientation-Include policies on visitation, including family visitation & overnight visitation The orientation documentation does not include information regarding the operation's policies regarding family visitations, gifts, or the education program.	—
2	—	748.915(b)(1) - Pediatric CPR training documentation must include the participant's name. It was observed that no require training for one staff.	—
3	—	748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records Multiple records at the operation were not true and accurate and had contradicting information.	—
3	—	748.1205(a)(12) - Admission Documentation-Identification of child's high risk behaviors and related safety plan staff and caregivers will implement One child record did not have high risk behaviors identified and how the operation will implement the safety of the chilld.	—
2	—	748.1437(3) - Discharge/Transfer Documentation-Must include name, address, telephone number, and relationship of person to whom child is discharged A childs discharge did not have the infomartion address, phone to whom he was release to.	—
1	—	748.4111(a) - Transportation records-Must maintain on file at the operation the name of each driver and a copy of that person's valid driver's license Employee file did not have a copy of its driver s license in the personnel file.	—
3	—	748.105(9) - Personnel Policies - Must require those with access to information about a child be informed of their responsibility to maintain confidentiality. Agency policy addresses HIPAA rules only. All child information must be kept confidential and accessible only to authorized personnel	—
3	—	748.3301(a)(2) - Physical Site- Buildings must be clean and in good repair. It was observed in Room 1, a hole in the door. Work order was submitted.	—
3	—	748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records Two service plans had unclear information regarding the staff's responsibilities if and when a resident goes AWOL. The AWOL annual summary log listed "NA" for the hotline intake report number and Police report number despite both being applicable.	—
3	—	748.151(2) - Operational responsibilities - Operate according to your approved plans, policies, and procedures The operation's search document form does not include fields or prompts for the reason for the search, what was searched, the results of the search, or the resolution of the search.	—
5	—	745.4151(c)(5)(A) - Drug testing procedures-All drug testing will at a minimum screen for marijuana, cocaine, opiates, amphetamines, and phencyclidine (PCP) Drug test results did not specify what the employee was screened.	—
4	—	748.863(a)(5) - Pre-Service Training- Caregivers who administer medication must have psych medication training before administering psych meds. Two out of two records were missing instructor led training regarding administration of psychotropic medication.	—
4	—	748.2151(c)(8) - Medication record-must include reasons for administering psychotropic medication or non-prescription medication/supplement for a child under 5 years Medication log was missing information regarding the reason for the medication, signatures of caregiver and side effects.	—
1	—	748.1437(2) - Discharge/Transfer Documentation-Must include date and time the child was informed of his discharge or transfer A child's discharge did not document when he was informed of the non-emergency discharge.	—
2	—	748.1331(a) - Preliminary Service Plan-Complete plan that addresses child's immediate needs within 72 hours of admission child preliminary service plan was not completed.	—
3	—	748.363(8) - Personnel records - Include a Pre-Employment Affidavit for Applicants for Employment as specified in Texas Human Resources Code ?42.0563 Missing Pre-Employment Affidavit for Applicants	—
3	—	748.363(6) - Personnel records- Include copy of a cleared tuberculosis screening conducted prior to the person having contact with children in care. Record shows employee received pre-service training on 7/15/23, with TB test results received on 7/21/13, after contact with children in care	—
4	—	748.2151(c)(5) - Medication record - must include date (day/month/year) & time each medication was administered Medication records were missing information when the medication was administered and by whom it was administered.	—
2	—	748.1337(b)(1)(A)(v) - Initial Service Plan-Include educational needs and how needs will be met; include any school evaluations or recommendations A child service plan did not document appropriated school goals.	—
2	—	748.1437(1) - Discharge/Transfer Documentation-Must include date and circumstances of discharge or transfer Childs discharge documentation records did not have the time or the person whom he was discharge to.	—
3	—	748.4651(a) - Pre-Service Training- If operation provides certain amount of tx svcs, caregiver must have 40 hours experience in operation that provides same tx svcs Record shows staff received 40 hours of pre-service training in one day.	—
3	—	748.303(a)(10)(A) - Serious Incident-Report to Licensing no later than 6 hours after determining unauthorized absence of a child 13 yrs old or older. Operation failed to report a child unathorized absent to lisencing.	—
3	—	748.1217(a) - Admission Assessment-Must provide initial evaluation of appropriate placement & ensure that necessary information for service planning is obtained The operation did not have an Admission Assessment form developed in their record. Admission Assessment must be completed prior to a nonemergency admission.	—
4	—	748.930(b)(1)(A) - Annual Training-Caregivers in operations other than cottage homes must have 4 hrs of EBI every 6 months. One of the two reviewed employee files revealed that one employee had not completed the emergency intervention training required every six months, and the most recent training was completed over a year ago.	—
3	—	748.103(b)(1) - Policies and procedures to submit - Related to record keeping, including where records will be located. The operation's policy and procedures regarding records and record keeping does not specify a records retention timeframe. Additionally the policy and procedure indicates records will be provided to the managing conservator and/or guardian upon request.	—
3	—	748.363(5) - Personnel records-Personnel records-Include evidence of valid professional licensures, certifications, or registrations required for the position. In reviewing the personnel records, there was no proof of education for all three staff.	—
3	—	748.453(a)(1) - Unauthorized Absence ? Annual summary log must include name, age, gender, date of admission Operation runaway log did not have the information needed.	—
2	—	748.3701(a) - Recreation responsibility-Must provide daily indoor/outdoor recreational & other activities appropriate to needs, interests, and abilities of children The operation?s recreation schedule did not provide the required outdoor daily activities.	—
3	—	748.363(6) - Personnel records-Include notarized Licensing Affidavit for Applicants for Employment form as specified in Human Resources Code, 42.059 Employee record did not have a notarized employment affidavit in their file.	—
1	—	748.1347(b) - Initial Service Plan-PLSP must sign and date the plan; If PLSP disagrees with any portion of the plan, he must document issue(s) before signing it Child files reviewed were missing the required signatures on the service plan.	—
3	—	748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records Record indicates employee received Orientation, 40 hours of pre-service training, and 8 hours of EBI training all in one day.	—
3	—	748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records Record indicates employee received Orientation, 40 hours of pre-service training, and 8 hours of EBI training all in one day.	—
1	—	748.1347(b) - Initial Service Plan-PLSP must sign and date the plan; If PLSP disagrees with any portion of the plan, he must document issue(s) before signing it Child files reviewed were missing the required signatures on the service plan.	—
4	—	748.2151(c)(8) - Medication record-must include reasons for administering psychotropic medication or non-prescription medication/supplement for a child under 5 years Medication log was missing information regarding the reason for the medication, signatures of caregiver and side effects.	—
2	—	748.1331(a) - Preliminary Service Plan-Complete plan that addresses child's immediate needs within 72 hours of admission child preliminary service plan was not completed.	—
4	—	748.2151(c)(5) - Medication record - must include date (day/month/year) & time each medication was administered Medication records were missing information when the medication was administered and by whom it was administered.	—
3	—	748.1217(a) - Admission Assessment-Must provide initial evaluation of appropriate placement & ensure that necessary information for service planning is obtained The operation did not have an Admission Assessment form developed in their record. Admission Assessment must be completed prior to a nonemergency admission.	—
4	—	748.2051(3) - Medication Self-Administration-Must consult health-care professional who prescribed medication and document his/her concerns in child's record A child is self administrating medication however the child records did not have documentation from the doctor, or parent that he is allowed to administered this medication .	—
3	—	748.363(8) - Personnel records - Include a Pre-Employment Affidavit for Applicants for Employment as specified in Texas Human Resources Code ?42.0563 Missing Pre-Employment Affidavit for Applicants	—
3	—	748.363(6) - Personnel records-Include notarized Licensing Affidavit for Applicants for Employment form as specified in Human Resources Code, 42.059 Employee record did not have a notarized employment affidavit in their file.	—
1	—	748.4111(a) - Transportation records-Must maintain on file at the operation the name of each driver and a copy of that person's valid driver's license Employee file did not have a copy of its driver s license in the personnel file.	—
3	—	748.4651(a) - Pre-Service Training- If operation provides certain amount of tx svcs, caregiver must have 40 hours experience in operation that provides same tx svcs Record shows staff received 40 hours of pre-service training in one day.	—
3	—	748.3301(a)(2) - Physical Site- Buildings must be clean and in good repair. It was observed in Room 1, a hole in the door. Work order was submitted.	—
3	—	748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records Two service plans had unclear information regarding the staff's responsibilities if and when a resident goes AWOL. The AWOL annual summary log listed "NA" for the hotline intake report number and Police report number despite both being applicable.	—
3	—	748.363(5) - Personnel records-Personnel records-Include evidence of valid professional licensures, certifications, or registrations required for the position. In reviewing the personnel records, there was no proof of education for all three staff.	—
2	—	748.1337(b)(1)(A)(v) - Initial Service Plan-Include educational needs and how needs will be met; include any school evaluations or recommendations A child service plan did not document appropriated school goals.	—
1	—	748.1437(2) - Discharge/Transfer Documentation-Must include date and time the child was informed of his discharge or transfer A child's discharge did not document when he was informed of the non-emergency discharge.	—
3	—	748.303(a)(10)(A) - Serious Incident-Report to Licensing no later than 6 hours after determining unauthorized absence of a child 13 yrs old or older. Operation failed to report a child unathorized absent to lisencing.	—
3	—	748.103(b)(1) - Policies and procedures to submit - Related to record keeping, including where records will be located. The operation's policy and procedures regarding records and record keeping does not specify a records retention timeframe. Additionally the policy and procedure indicates records will be provided to the managing conservator and/or guardian upon request.	—
3	—	748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records Multiple records at the operation were not true and accurate and had contradicting information.	—
4	—	748.863(a)(5) - Pre-Service Training- Caregivers who administer medication must have psych medication training before administering psych meds. Two out of two records were missing instructor led training regarding administration of psychotropic medication.	—
2	—	748.1437(3) - Discharge/Transfer Documentation-Must include name, address, telephone number, and relationship of person to whom child is discharged A childs discharge did not have the infomartion address, phone to whom he was release to.	—
2	—	748.915(b)(1) - Pediatric CPR training documentation must include the participant's name. It was observed that no require training for one staff.	—
3	—	748.1205(a)(12) - Admission Documentation-Identification of child's high risk behaviors and related safety plan staff and caregivers will implement One child record did not have high risk behaviors identified and how the operation will implement the safety of the chilld.	—
4	—	748.930(b)(1)(A) - Annual Training-Caregivers in operations other than cottage homes must have 4 hrs of EBI every 6 months. One of the two reviewed employee files revealed that one employee had not completed the emergency intervention training required every six months, and the most recent training was completed over a year ago.	—
2	—	748.3701(a) - Recreation responsibility-Must provide daily indoor/outdoor recreational & other activities appropriate to needs, interests, and abilities of children The operation?s recreation schedule did not provide the required outdoor daily activities.	—
3	—	748.105(9) - Personnel Policies - Must require those with access to information about a child be informed of their responsibility to maintain confidentiality. Agency policy addresses HIPAA rules only. All child information must be kept confidential and accessible only to authorized personnel	—
2	—	748.1437(1) - Discharge/Transfer Documentation-Must include date and circumstances of discharge or transfer Childs discharge documentation records did not have the time or the person whom he was discharge to.	—
3	—	748.151(2) - Operational responsibilities - Operate according to your approved plans, policies, and procedures The operation's search document form does not include fields or prompts for the reason for the search, what was searched, the results of the search, or the resolution of the search.	—
3	—	748.363(6) - Personnel records- Include copy of a cleared tuberculosis screening conducted prior to the person having contact with children in care. Record shows employee received pre-service training on 7/15/23, with TB test results received on 7/21/13, after contact with children in care	—
5	—	745.4151(c)(5)(A) - Drug testing procedures-All drug testing will at a minimum screen for marijuana, cocaine, opiates, amphetamines, and phencyclidine (PCP) Drug test results did not specify what the employee was screened.	—
2	—	748.1209(b)(1) - Child Orientation-Include policies on visitation, including family visitation & overnight visitation The orientation documentation does not include information regarding the operation's policies regarding family visitations, gifts, or the education program.	—
3	—	748.453(a)(1) - Unauthorized Absence ? Annual summary log must include name, age, gender, date of admission Operation runaway log did not have the information needed.	—
4	—	748.2051(3) - Medication Self-Administration-Must consult health-care professional who prescribed medication and document his/her concerns in child's record A child is self administrating medication however the child records did not have documentation from the doctor, or parent that he is allowed to administered this medication .	—
3	—	748.363(8) - Personnel records - Include a Pre-Employment Affidavit for Applicants for Employment as specified in Texas Human Resources Code ?42.0563 Missing Pre-Employment Affidavit for Applicants	—
2	—	748.1331(a) - Preliminary Service Plan-Complete plan that addresses child's immediate needs within 72 hours of admission child preliminary service plan was not completed.	—
3	—	748.151(2) - Operational responsibilities - Operate according to your approved plans, policies, and procedures The operation's search document form does not include fields or prompts for the reason for the search, what was searched, the results of the search, or the resolution of the search.	—

Severity 5 = most serious. Source: official state record.

Inspections (80)

80 inspection record(s) on file from TX-HHSC.

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