| Severity | Date | Standard / narrative | Corrected |
|---|
| 5 | — |
749.607(1) - Employee and caregiver responsibilities-Competency, prudent judgment, self-control in presence of children and when performing assigned tasks
Foster parent failed to do their due diligence in not having the prescribed psychotropic medication filled in a timely manner. |
— |
| 3 | — |
749.1541(d) - Medication Record-Must document any non-prescription medication or supplement given and how often the child receives it
Foster parent did not have documentation for a non-prescription medication. |
— |
| 3 | — |
749.1301(a) - Preliminary Service Planning-Complete a preliminary service plan that addresses child's immediate needs within 72 hours of admission
A child's file was reviewed and the preliminary service plan was not completed. |
— |
| 4 | — |
749.1813(a)(1) - Infant requirements-A foster home may not use baby walkers with infants
A baby walker was being used for an infant in care. |
— |
| 2 | — |
749.3023(b) - Bedrooms-Bedroom used by foster child must have at least one source of natural light
A foster child is currently in a bedroom with no source of natural light. |
— |
| 3 | — |
749.3025(b)(1) - Before allowing the sharing of a bedroom, service planning team must determine there is no risk of harm to child.
Service plan had no documentation on the risk assessment of youth in care sharing bedroom with an adult in care. |
— |
| 5 | — |
749.607(1) - Employee and caregiver responsibilities-Competency, prudent judgment, self-control in presence of children and when performing assigned tasks
Agency staff did not use prudent judgment when removing a child from a foster home. |
— |
| 4 | — |
749.930(c)(4) - Annual Training- Caregiver's who administer psychotropic medication must complete psychotropic medication training annually.
Foster parent did not complete the designated training needed on time, while children were in care. |
— |
| 3 | — |
749.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
Foster parent filled out the medication logs for dates the child in care did not get administered the medication. |
— |
| 5 | — |
749.607(1) - Employee and caregiver responsibilities-Competency, prudent judgment, self-control in presence of children and when performing assigned tasks
Caregiver failed to comply with safety plan. |
— |
| 3 | — |
749.579(1) - Active child record-Ensure record is kept accurate and current
The child's monthly reports for June and July 2023, make reference to two other foster children in the foster home. |
— |
| 4 | — |
749.635(2) - AP CPA administrator responsibilities- Ensure that the operation complies with current heightened monitoring plans.
During a review conducted on August 8, 2023, it was determined that: (1) your operation?s administrator failed to ensure compliance with the current HM Plan; and (2) more than 12 months had elapsed since the effective date of the plan. As you know, the heightened monitoring plan for your operation included a specific ?planned end date? at the original 12-month mark by which your 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 plan, your operation was unable to successfully move to post-plan monitoring by the original ?planned end date? necessitating previous extension. Furthermore, due to your recent citations issued on August 7, 2023, your operation?s ?planned end date? must now be revised again, and the period of heightened monitoring must be extended again. Further details of the administrator?s failure to ensure compliance include the following: Your operation received a medium citation in a pattern/trend category on August 7, 2023. Specifically, the operation was cited for 749.151(3) for Leadership Responsibilities. The operation has pending corrections for this citation. - Operation failed to satisfy the conditions of the plan - 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. Finding: 749.635(2) ? The licensed administrator must ensure the operation complies with current heightened monitoring plan. |
— |
| 3 | — |
749.591(a)(1) - Unauthorized Absence ? Annual summary log must include name, age, gender, date of admission
The Annual summary log provided by the operation does not fulfill the requirements. There is pertinent information missing from the document. |
— |
| 5 | — |
749.2593(c)(2) - Supervision-Caregivers counted in child/caregiver ratio must provide a safe environment
Caregiver failed to provide a safe environment by leaving knife unattended in the kitchen. Child in care used knife to self-harm. |
— |
| 5 | — |
749.2593(a)(2) - Supervision-The caregiver is responsible for being aware of and accountable for each child's on-going activity
The caregivers left a child under their care unattended for over 30 minutes. The caregivers were not following the child's plan of service. |
— |
| 1 | — |
749.2470(9)(E) - Verification Certificate- Specifies the ages and gender(s) of foster children for which the home is verified
Foster home is verified for ages 2-5, however the home-study obtained reflects a different age range which is from ages 2-10. |
— |
| 3 | — |
749.503(e)(3)(A) - Serious Incident-Report to Licensing no later than 24 hours after awareness if an adult contracts a reportable communicable disease
During a Heightened Monitoring visit, it was disclosed that a foster parent tested positive for COVID and it was not reported to the Child Abuse or Neglect Hotline. The case manager was notified about the positive result over a week ago. |
— |
| 5 | — |
745.8641 - Requirements during evaluation or probation
Agency has not addressed the items on conditions four. |
— |
| 3 | — |
749.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
The operation falsified a record by utilizing the same document from a previous visit. The operation also back dated a document. |
— |
| 4 | — |
749.2913(b)(2) - Fire Extinguisher-Have a maintenance check once a year by a person qualified to inspect fire extinguishers.
A fire extinguisher was not maintenance within the one-year time frame. |
— |
| 2 | — |
749.1107(a)(4) - Child Admission Records-Include the names, addresses, and telephone numbers of siblings at admission
The names, addresses, and telephone numbers of siblings were not documented in child records at the time of admission. |
— |
| 5 | — |
749.1521(1) - Medication Storage-Store medication in a locked container
Foster parent did not have their own medication stored in a locked container. |
— |
| 4 | — |
749.2625 - Respite- must share information with babysitter, overnight care, and/or respite care provider before providing care for child
The respite provider was not provided with required information about the child being placed in the home. |
— |
| 4 | — |
749.2815(b) - Supervisory Visits-At least two supervisory visit per year must be unannounced
Supervisory visits reviewed for one home did not have unannouced visits in the past year. |
— |
| 1 | — |
749.535(a)(1) - Active records-All documentation in the record no later than 30 days after the occurrence or event
During a Heightened Monitoring visit a child's file was reviewed and the operation did not have documentation of the child's current therapy or counseling notes within the last six months. |
— |
| 3 | — |
749.931(c)(1) - Annual Training- Must include one hour of training on prevention, recognition, and reporting on child abuse, neglect, and exploitation.
Foster parent did not complete the designated training needed on time, |
— |
| 3 | — |
749.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
A supervisory foster home visit was conducted on October 3, 2023. A photograph of the foster homes front view was captured with a timestamp dated October 18, 2023. A signature of the supervisory review was signed on 10/4/2023. The operation falsified the documented by back dating the form to 10/4/2023. Multiple supervisory visit forms had discrepancies with information that was inaccurate with trainings and due dates. |
— |
| 3 | — |
749.1107(a)(7) - Child Admission Records-Include the child's immunization record
Immunization records were not in 2 child records at the time of admission or inspection. |
Yes |
| 3 | — |
749.2449(a)(6) - Interview For Foster Home Screening-Must include one interview by phone/in person or letter with child 12 yrs and older or adult children not in home
Foster parent's oldest adult daughter was no interviewed as part of the home screening process. |
— |
| 4 | — |
749.635(2) - AP CPA administrator responsibilities- Ensure that the operation complies with current heightened monitoring plans.
During a review conducted on February 8, 2024, it was determined that: (1) your operation?s administrator failed to ensure compliance with the current HM Plan; and (2) more than 12 months had elapsed since the effective date of the plan. As you know, the heightened monitoring plan for your operation included a specific ?planned end date? at the original 12-month mark by which your 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, your operation was unable to successfully move to post-plan monitoring by the original ?planned end date? necessitating previous extension. Furthermore, due to your recent citations issued on December 4, 2023, your operation?s ?planned end date? must now be revised again, and the period of heightened monitoring must be extended again. Further details of the administrator?s failure to ensure compliance include the following: Your operation received a high-weighted citation in a pattern/trend category on December 4, 2023. Specifically, the operation was cited for #749.151(3) Operational responsibilities - Maintain current, true, accurate, and complete records. The operation met compliance on December 12, 2023. - Operation failed to demonstrate 6 months of successive compliance with the standard and contract requirements that led to heightened monitoring. Finding: 749.635(2) ? The licensed administrator must ensure the operation complies with current heightened monitoring plan. |
— |
| 4 | — |
749.635(2) - AP CPA administrator responsibilities- Ensure that the operation complies with current heightened monitoring plans.
During a review conducted on February 6, 2023, it was determined that: (1) your operation?s administrator failed to ensure compliance with the current HM Plan; and (2) more than 12 months had elapsed since the effective date of the plan. As you know, the heightened monitoring plan for your operation included a specific ?planned end date? at the original 12-month mark by which your 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 plan, your operation was unable to successfully move to post-plan monitoring by the original ?planned end date? necessitating previous extension. Furthermore, due to your recent citations issued on January 10, 2023, your operation?s ?planned end date? must now be revised again, and the period of heightened monitoring must be extended again. Further details of the administrator?s failure to ensure compliance include the following: Your operation received a high weighted citation in a pattern/trend category on January 10, 2023. Specifically, the operation was cited for 749.607(1) Employee and caregiver responsibilities-Competency, prudent judgment, self-control in presence of children and when performing assigned tasks, as agency staff did not use prudent judgment when removing a child from a foster home. The operation met compliance on January 17, 2023. - 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 a High weighted licensing citation. Finding: 749.635(2) ? The licensed administrator must ensure the operation complies with current heightened monitoring plan. |
— |
| 3 | — |
749.1131 - You must complete a non-emergency admission assessment prior to admission
A child's file was reviewed and the admission assessment was not completed prior to the child being placed in the foster home. The placement was a non emergency. |
— |
| 4 | — |
749.635(2) - CPA administrator responsibilities- Ensure that the operation complies with current heightened monitoring plans.
During a review conducted on July 29, 2022 it was determined that: (1) your operation?s administrator failed to ensure compliance with the current HM Plan(s); and (2) more than 12 months had elapsed since the effective date of the plan. As you know, the heightened monitoring plans for your operation included a specific ?planned end date? at the original 12-month mark by which your 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, your operation was unable to successfully move to post-plan monitoring by the original ?planned end date? necessitating previous extension. Furthermore, due to your recent citations issued on June 2, 2022, your operation?s ?planned end date? must now be revised again, and the period of heightened monitoring must be extended again. Further details of the failure of your operation?s administrator to ensure compliance include the following: The operation received two medium-weighted citations in the pattern/trend categories on June 1, 2022. Specifically, the operation was cited for 749.1131 Admissions and 749.1301(a) Preliminary Service Plans. Additionally, the operation received two high-weighted citations on July 9, 2022, related to Chapter 745 as the result of not meeting the conditions of probation. - Operation failed to satisfy the conditions of the plan - 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. Finding: 749.635(2) ? The licensed administrator must ensure the operation complies with current heightened monitoring plans. |
— |
| 3 | — |
749.1003(b)(3)(F) - Children's rights-Adhere to the child's right to have personal care, hygiene, and grooming equipment/supplies and training in how to use
Two children in care disclosed they did not have toothbrushes. |
— |
| 3 | — |
749.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
A preliminary service plan document that was uploaded into the facilities database did not exude true and accurate information. |
— |
| 3 | — |
749.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
The agency did not maintain current and complete records for an agency home. |
— |
| 4 | — |
749.931(b)(3) - Annual Training- Must include 1 hour of normalcy.
Foster parent did not complete the designated training needed on time, |
— |
| 5 | — |
745.641 - AP Background check results - Must receive notification prior to allowing subject to be present at your operation
A relative of the foster parent had been staying on the property. The relative has provided childcare for the foster children. The relative did not have an approved background check. |
— |
| 5 | — |
749.3133(d) - Swimming pools-Pool gates self-closing/self-latching/locked when pool not used; keys inaccessible to kids under 12, poor swimmers or receiving tx svcs
An inspection was conducted. The padlock was observed hanging unlocked on the gate that leads to the pool. |
— |
| 1 | — |
749.2488(a)(10) - Rights and Responsibilities- Agency has responsibility to provide support to foster parents and inform them of available services
The agency is not being supportive and properly communicating with foster family. |
— |
| 5 | — |
749.607(1) - Employee and caregiver responsibilities-Competency, prudent judgment, self-control in presence of children and when performing assigned tasks
Foster parent grabbed a child in care by the wrist. |
— |
| 5 | — |
749.1463(b)(5) - Administration of Medication-Ensure the child has taken the medication as prescribed
Foster parent admitted that the foster child ran out of their psychotropic medication for several days. |
— |
| 3 | — |
749.2447(23)(A) - Foster Home Screening-Agency must request and assess home study and related documentation from CPA that previously studied the family
The agency did not assess all the deficiency documentation received from the home's previous CPA. |
— |
| 2 | — |
749.3023(b) - Bedrooms-Bedroom used by foster child must have at least one source of natural light
One of the foster children's bedroom had its only window boarded up. |
— |
| 4 | — |
749.1541(a) - Medication Record-Maintain cumulative record of prescription medications dispensed to child, include nonprescription meds for child under five yrs old
The caregiver is not keeping a medication log for the child's prescription medication. |
— |
| 5 | — |
749.3133(j) - Swimming Pools-bottom of the pool must be visible at all times
An inspection was conducted. The pool was observed to be in unsanitary conditions as it was filled with dirty water. |
— |
| 4 | — |
749.931(b)(3) - Annual Training- Must include 1 hour of normalcy.
A Beacon of Hope foster home did not complete a required annual training in a timely manner. |
— |
| 2 | — |
749.1107(a)(4) - Child Admission Records-Include the names, addresses, and telephone numbers of siblings at admission
The names, addresses, and telephone numbers of siblings were not documented in child records at the time of admission. |
— |
| 3 | — |
749.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
The agency did not maintain current and complete records for an agency home. |
— |
| 5 | — |
749.1521(1) - Medication Storage-Store medication in a locked container
Foster parent did not have their own medication stored in a locked container. |
— |
| 3 | — |
749.2449(a)(6) - Interview For Foster Home Screening-Must include one interview by phone/in person or letter with child 12 yrs and older or adult children not in home
Foster parent's oldest adult daughter was no interviewed as part of the home screening process. |
— |
| 4 | — |
749.2625 - Respite- must share information with babysitter, overnight care, and/or respite care provider before providing care for child
The respite provider was not provided with required information about the child being placed in the home. |
— |
| 4 | — |
749.1541(a) - Medication Record-Maintain cumulative record of prescription medications dispensed to child, include nonprescription meds for child under five yrs old
The caregiver is not keeping a medication log for the child's prescription medication. |
— |
| 5 | — |
749.3133(d) - Swimming pools-Pool gates self-closing/self-latching/locked when pool not used; keys inaccessible to kids under 12, poor swimmers or receiving tx svcs
An inspection was conducted. The padlock was observed hanging unlocked on the gate that leads to the pool. |
— |
| 4 | — |
749.635(2) - AP CPA administrator responsibilities- Ensure that the operation complies with current heightened monitoring plans.
During a review conducted on August 8, 2023, it was determined that: (1) your operation?s administrator failed to ensure compliance with the current HM Plan; and (2) more than 12 months had elapsed since the effective date of the plan. As you know, the heightened monitoring plan for your operation included a specific ?planned end date? at the original 12-month mark by which your 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 plan, your operation was unable to successfully move to post-plan monitoring by the original ?planned end date? necessitating previous extension. Furthermore, due to your recent citations issued on August 7, 2023, your operation?s ?planned end date? must now be revised again, and the period of heightened monitoring must be extended again. Further details of the administrator?s failure to ensure compliance include the following: Your operation received a medium citation in a pattern/trend category on August 7, 2023. Specifically, the operation was cited for 749.151(3) for Leadership Responsibilities. The operation has pending corrections for this citation. - Operation failed to satisfy the conditions of the plan - 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. Finding: 749.635(2) ? The licensed administrator must ensure the operation complies with current heightened monitoring plan. |
— |
| 5 | — |
749.607(1) - Employee and caregiver responsibilities-Competency, prudent judgment, self-control in presence of children and when performing assigned tasks
Caregiver failed to comply with safety plan. |
— |
| 3 | — |
749.3025(b)(1) - Before allowing the sharing of a bedroom, service planning team must determine there is no risk of harm to child.
Service plan had no documentation on the risk assessment of youth in care sharing bedroom with an adult in care. |
— |
| 5 | — |
749.607(1) - Employee and caregiver responsibilities-Competency, prudent judgment, self-control in presence of children and when performing assigned tasks
Foster parent grabbed a child in care by the wrist. |
— |
| 3 | — |
749.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
The operation falsified a record by utilizing the same document from a previous visit. The operation also back dated a document. |
— |
| 3 | — |
749.503(e)(3)(A) - Serious Incident-Report to Licensing no later than 24 hours after awareness if an adult contracts a reportable communicable disease
During a Heightened Monitoring visit, it was disclosed that a foster parent tested positive for COVID and it was not reported to the Child Abuse or Neglect Hotline. The case manager was notified about the positive result over a week ago. |
— |
| 3 | — |
749.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
Foster parent filled out the medication logs for dates the child in care did not get administered the medication. |
— |
| 3 | — |
749.579(1) - Active child record-Ensure record is kept accurate and current
The child's monthly reports for June and July 2023, make reference to two other foster children in the foster home. |
— |
| 3 | — |
749.1003(b)(3)(F) - Children's rights-Adhere to the child's right to have personal care, hygiene, and grooming equipment/supplies and training in how to use
Two children in care disclosed they did not have toothbrushes. |
— |
| 3 | — |
749.1541(d) - Medication Record-Must document any non-prescription medication or supplement given and how often the child receives it
Foster parent did not have documentation for a non-prescription medication. |
— |
| 3 | — |
749.591(a)(1) - Unauthorized Absence ? Annual summary log must include name, age, gender, date of admission
The Annual summary log provided by the operation does not fulfill the requirements. There is pertinent information missing from the document. |
— |
| 4 | — |
749.2815(b) - Supervisory Visits-At least two supervisory visit per year must be unannounced
Supervisory visits reviewed for one home did not have unannouced visits in the past year. |
— |
| 1 | — |
749.535(a)(1) - Active records-All documentation in the record no later than 30 days after the occurrence or event
During a Heightened Monitoring visit a child's file was reviewed and the operation did not have documentation of the child's current therapy or counseling notes within the last six months. |
— |
| 3 | — |
749.1301(a) - Preliminary Service Planning-Complete a preliminary service plan that addresses child's immediate needs within 72 hours of admission
A child's file was reviewed and the preliminary service plan was not completed. |
— |
| 4 | — |
749.2913(b)(2) - Fire Extinguisher-Have a maintenance check once a year by a person qualified to inspect fire extinguishers.
A fire extinguisher was not maintenance within the one-year time frame. |
— |
| 5 | — |
745.641 - AP Background check results - Must receive notification prior to allowing subject to be present at your operation
A relative of the foster parent had been staying on the property. The relative has provided childcare for the foster children. The relative did not have an approved background check. |
— |
| 5 | — |
749.607(1) - Employee and caregiver responsibilities-Competency, prudent judgment, self-control in presence of children and when performing assigned tasks
Foster parent failed to do their due diligence in not having the prescribed psychotropic medication filled in a timely manner. |
— |
| 2 | — |
749.3023(b) - Bedrooms-Bedroom used by foster child must have at least one source of natural light
One of the foster children's bedroom had its only window boarded up. |
— |
| 3 | — |
749.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
A supervisory foster home visit was conducted on October 3, 2023. A photograph of the foster homes front view was captured with a timestamp dated October 18, 2023. A signature of the supervisory review was signed on 10/4/2023. The operation falsified the documented by back dating the form to 10/4/2023. Multiple supervisory visit forms had discrepancies with information that was inaccurate with trainings and due dates. |
— |
| 2 | — |
749.3023(b) - Bedrooms-Bedroom used by foster child must have at least one source of natural light
A foster child is currently in a bedroom with no source of natural light. |
— |
| 3 | — |
749.1107(a)(7) - Child Admission Records-Include the child's immunization record
Immunization records were not in 2 child records at the time of admission or inspection. |
Yes |
| 1 | — |
749.2488(a)(10) - Rights and Responsibilities- Agency has responsibility to provide support to foster parents and inform them of available services
The agency is not being supportive and properly communicating with foster family. |
— |
| 4 | — |
749.931(b)(3) - Annual Training- Must include 1 hour of normalcy.
Foster parent did not complete the designated training needed on time, |
— |
| 4 | — |
749.635(2) - CPA administrator responsibilities- Ensure that the operation complies with current heightened monitoring plans.
During a review conducted on July 29, 2022 it was determined that: (1) your operation?s administrator failed to ensure compliance with the current HM Plan(s); and (2) more than 12 months had elapsed since the effective date of the plan. As you know, the heightened monitoring plans for your operation included a specific ?planned end date? at the original 12-month mark by which your 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, your operation was unable to successfully move to post-plan monitoring by the original ?planned end date? necessitating previous extension. Furthermore, due to your recent citations issued on June 2, 2022, your operation?s ?planned end date? must now be revised again, and the period of heightened monitoring must be extended again. Further details of the failure of your operation?s administrator to ensure compliance include the following: The operation received two medium-weighted citations in the pattern/trend categories on June 1, 2022. Specifically, the operation was cited for 749.1131 Admissions and 749.1301(a) Preliminary Service Plans. Additionally, the operation received two high-weighted citations on July 9, 2022, related to Chapter 745 as the result of not meeting the conditions of probation. - Operation failed to satisfy the conditions of the plan - 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. Finding: 749.635(2) ? The licensed administrator must ensure the operation complies with current heightened monitoring plans. |
— |
| 4 | — |
749.635(2) - AP CPA administrator responsibilities- Ensure that the operation complies with current heightened monitoring plans.
During a review conducted on February 8, 2024, it was determined that: (1) your operation?s administrator failed to ensure compliance with the current HM Plan; and (2) more than 12 months had elapsed since the effective date of the plan. As you know, the heightened monitoring plan for your operation included a specific ?planned end date? at the original 12-month mark by which your 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, your operation was unable to successfully move to post-plan monitoring by the original ?planned end date? necessitating previous extension. Furthermore, due to your recent citations issued on December 4, 2023, your operation?s ?planned end date? must now be revised again, and the period of heightened monitoring must be extended again. Further details of the administrator?s failure to ensure compliance include the following: Your operation received a high-weighted citation in a pattern/trend category on December 4, 2023. Specifically, the operation was cited for #749.151(3) Operational responsibilities - Maintain current, true, accurate, and complete records. The operation met compliance on December 12, 2023. - Operation failed to demonstrate 6 months of successive compliance with the standard and contract requirements that led to heightened monitoring. Finding: 749.635(2) ? The licensed administrator must ensure the operation complies with current heightened monitoring plan. |
— |
| 5 | — |
749.2593(c)(2) - Supervision-Caregivers counted in child/caregiver ratio must provide a safe environment
Caregiver failed to provide a safe environment by leaving knife unattended in the kitchen. Child in care used knife to self-harm. |
— |
| 3 | — |
749.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
A preliminary service plan document that was uploaded into the facilities database did not exude true and accurate information. |
— |
| 3 | — |
749.1131 - You must complete a non-emergency admission assessment prior to admission
A child's file was reviewed and the admission assessment was not completed prior to the child being placed in the foster home. The placement was a non emergency. |
— |
| 1 | — |
749.2470(9)(E) - Verification Certificate- Specifies the ages and gender(s) of foster children for which the home is verified
Foster home is verified for ages 2-5, however the home-study obtained reflects a different age range which is from ages 2-10. |
— |
| 4 | — |
749.635(2) - AP CPA administrator responsibilities- Ensure that the operation complies with current heightened monitoring plans.
During a review conducted on February 6, 2023, it was determined that: (1) your operation?s administrator failed to ensure compliance with the current HM Plan; and (2) more than 12 months had elapsed since the effective date of the plan. As you know, the heightened monitoring plan for your operation included a specific ?planned end date? at the original 12-month mark by which your 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 plan, your operation was unable to successfully move to post-plan monitoring by the original ?planned end date? necessitating previous extension. Furthermore, due to your recent citations issued on January 10, 2023, your operation?s ?planned end date? must now be revised again, and the period of heightened monitoring must be extended again. Further details of the administrator?s failure to ensure compliance include the following: Your operation received a high weighted citation in a pattern/trend category on January 10, 2023. Specifically, the operation was cited for 749.607(1) Employee and caregiver responsibilities-Competency, prudent judgment, self-control in presence of children and when performing assigned tasks, as agency staff did not use prudent judgment when removing a child from a foster home. The operation met compliance on January 17, 2023. - 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 a High weighted licensing citation. Finding: 749.635(2) ? The licensed administrator must ensure the operation complies with current heightened monitoring plan. |
— |
| 4 | — |
749.1813(a)(1) - Infant requirements-A foster home may not use baby walkers with infants
A baby walker was being used for an infant in care. |
— |
| 3 | — |
749.2447(23)(A) - Foster Home Screening-Agency must request and assess home study and related documentation from CPA that previously studied the family
The agency did not assess all the deficiency documentation received from the home's previous CPA. |
— |
| 5 | — |
749.3133(j) - Swimming Pools-bottom of the pool must be visible at all times
An inspection was conducted. The pool was observed to be in unsanitary conditions as it was filled with dirty water. |
— |
| 3 | — |
749.931(c)(1) - Annual Training- Must include one hour of training on prevention, recognition, and reporting on child abuse, neglect, and exploitation.
Foster parent did not complete the designated training needed on time, |
— |
| 5 | — |
749.1463(b)(5) - Administration of Medication-Ensure the child has taken the medication as prescribed
Foster parent admitted that the foster child ran out of their psychotropic medication for several days. |
— |
| 5 | — |
749.607(1) - Employee and caregiver responsibilities-Competency, prudent judgment, self-control in presence of children and when performing assigned tasks
Agency staff did not use prudent judgment when removing a child from a foster home. |
— |
| 4 | — |
749.930(c)(4) - Annual Training- Caregiver's who administer psychotropic medication must complete psychotropic medication training annually.
Foster parent did not complete the designated training needed on time, while children were in care. |
— |
| 5 | — |
745.8641 - Requirements during evaluation or probation
Agency has not addressed the items on conditions four. |
— |
| 4 | — |
749.931(b)(3) - Annual Training- Must include 1 hour of normalcy.
A Beacon of Hope foster home did not complete a required annual training in a timely manner. |
— |
| 5 | — |
749.2593(a)(2) - Supervision-The caregiver is responsible for being aware of and accountable for each child's on-going activity
The caregivers left a child under their care unattended for over 30 minutes. The caregivers were not following the child's plan of service. |
— |
| 3 | — |
749.931(c)(1) - Annual Training- Must include one hour of training on prevention, recognition, and reporting on child abuse, neglect, and exploitation.
Foster parent did not complete the designated training needed on time, |
— |
| 5 | — |
749.607(1) - Employee and caregiver responsibilities-Competency, prudent judgment, self-control in presence of children and when performing assigned tasks
Foster parent grabbed a child in care by the wrist. |
— |
| 5 | — |
749.3133(j) - Swimming Pools-bottom of the pool must be visible at all times
An inspection was conducted. The pool was observed to be in unsanitary conditions as it was filled with dirty water. |
— |
| 4 | — |
749.2913(b)(2) - Fire Extinguisher-Have a maintenance check once a year by a person qualified to inspect fire extinguishers.
A fire extinguisher was not maintenance within the one-year time frame. |
— |
| 4 | — |
749.931(b)(3) - Annual Training- Must include 1 hour of normalcy.
Foster parent did not complete the designated training needed on time, |
— |
| 5 | — |
749.2593(a)(2) - Supervision-The caregiver is responsible for being aware of and accountable for each child's on-going activity
The caregivers left a child under their care unattended for over 30 minutes. The caregivers were not following the child's plan of service. |
— |
244 inspection record(s) on file from TX-HHSC.