Texas › Goldthwaite › New Horizons Ranch Residential Treatment Center

New Horizons Ranch Residential Treatment Center

Child care center · 850 F M 574 W, Goldthwaite, TX 76844 · License 40724

0Compliance score
Poor

Capacity 68. 6-17

Violation history (384)

Severity	Date	Standard / narrative	Corrected
4	—	748.1101(b)(4)(A)(vii) - Children's rights- Free from demeaning behavior to embarrass/control/harm/intimidate/isolate the child It was noted in this investigation that a child in care was grabbed by the front of the shirt.	—
4	—	748.2455(a)(2) - Emergency Behavior Intervention-Basis for EBI is an emergency situation or to administer medication Four children described examples of being restrained for not following directions or situations that were not an emergency.	—
5	—	748.685(a)(4) - Caregiver responsibility - providing the level of supervision necessary to ensure each child's safety and well-being During the investigation it was determined that the caregiver in charge failed to supervised children by falling sleep and not checking on them after waking up. As a result the children ran away from the operation.	—
4	—	748.2907(5) - Triggered Reviews-Must include a written plan for reducing the need for emergency behavior intervention The triggered review completed did not contain information required throughout standard 748.2907.	—
3	—	748.399(a) - Records Available for Licensing-all active records immediately available for review and reproduction Records were requested on 12/4/23 (by email), on 12/7/23 (by email), and on 12/18 (by email & by phone). Records were provided by the operation on 12/18/23.	—
3	—	748.303(a)(10)(A) - Serious Incident-Report to Licensing no later than 24 hours after awareness that a child contracts reportable communicable disease A report to licensing that a child contracted a communicable disease was not made within 24 hours.	—
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 child did not have a TB test documented in their record. The child was at a doctor's appointment and recieved a test today. The results will be done in 48 hours.	Yes
4	—	748.2463(1) - Emergency Behavior Intervention-Never used as punishment It was noted during an investigation that a child in care was being restrained which resulted in a child being restrained inappropriately as the child in care resisted.	—
4	—	748.2003(b)(3) - AP Administration of prescription medication-Administer medications according to instructions or a prescribing health-care professional's orders A child in care's prescription label was altered by a staff member. The instructions stated take 1 tablet by mouth every morning but morning was mark through and night was written by pen.	—
5	—	748.2551(c)(2) - EBI Implementation-Caregiver must use the minimal amount of reasonable and necessary physical force A child in care received a serious physical injury during a restraint.	—
4	—	748.685(b)(5) - Caregiver responsibility - when deciding how close to supervise, takes into account the child's physical, mental, emotional, and social needs A child with a history of struggling with medical compliance, was made responsible for monitoring their blood sugar levels. The child was also able to sneak snacks, as other children in care reported.	—
3	—	748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records The incident report was not accurate to the true events of the actual incident. A staff member denied monitoring a restraint even though the incident report indicated the staff did monitor a restraint.	—
4	—	748.685(b)(4) - Caregiver responsibility - when deciding how close to supervise take into account the surrounding circumstances, hazards, and risks During the course of the investigation, it was determined that a hazardous item was left in reach of a child.	—
3	—	748.125(d)(4)(C) - Suicide Screening- Must be administered every 30 days after admission for children 10 years of age or older in a residential treatment center. A child in care was missing several months of suicide screenings.	—
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. In two seperate houses, the cleaning supplies in the bathroom cabinet were assessable to children in care.	Yes
4	—	748.2455(a)(2) - Emergency Behavior Intervention-Basis for EBI is an emergency situation or to administer medication The basis for a child in care being restrained was for noncompliance and not an emergency situation or to administer medication.	—
4	—	748.2307(9) - Other Prohibited Punishments-subjecting a child to abusive or profane language It was noted during the investigation that profane language was used during an incident that had escalated on a child in care.	—
5	—	748.1101(b)(1)(B) - Children's rights-Adhere to the child's rights to be free of abuse, neglect, and exploitation The operation/staff failed to provide the level of monitoring and oversight necessary to help ensure a child's compliance with their diabetic treatment regimen. Staff was not aware of the child's supervision needs during blood sugar checks, which directly led to the child being hospitalized.	—
4	—	748.125(d)(4)(E) - Suicide Screening- Must be administered immediately if the child exhibits warning signs that necessitate a suicide screening be conducted. The suicide screening indicates it was done 13 days late.	—
4	—	748.1337(b)(1)(H)(i) - Initial Service Plan-For child who exhibits high risk behaviors, include plans to minimize risk of harm to self or others 2 children's service plans noted high-risk behaviors but did not include specific plans that address these behaviors.	—
3	—	748.313(3)(B) - Serious Incident child absent without permission-document notice to parents and law enforcement about child's absence and subsequent location/return 3 serious incident reports regarding an unauthorized absence did not have the time and/or date of the notification to the case worker and/or law enforcement officer and the names of those they spoke to.	—
3	—	748.2151(c)(6) - Medication record - must include name & signature of person who administered each medication 4 out of 10 medication logs did not have the required signature of the person who administered the dose.	—
4	—	748.2307(9) - Other Prohibited Punishments-subjecting a child to abusive or profane language During the course of the investigation, it was found and corroborated by 4 children in care and 2 staff members, that a staff member yelled, "Shut the fuck up", to children in care during "Med box", as the children were being loud and had already been asked multiple times to be quiet. Additionally, 1 case worker also stated to being informed that their child has overheard a staff cursing to a child on one occasion.	—
4	—	748.3563(d) - Protective Surfacing-Must ensure 9 inches of the loose-fill materials are maintained at all times The swings and playground area did not have 9 inches of loose-fill materials.	—
5	—	748.1337(b)(1)(H)(i) - Initial Service Plan-For child who exhibits high risk behaviors, include plans to minimize risk of harm to self or others A child with high-risk behaviors noted did not have a plan to address these behaviors in their service plan.	—
5	—	748.2551(c)(1) - EBI Implementation-Caregiver must minimize risk of physical discomfort, harm, or pain to the child It was noted that during an investigation, a child was not properly restrained.	—
5	—	748.1553 - Child must be immediately treated by health prof, contact emergency svs or take child to ER for injury/illness requiring treatment by a health prof. An investigation determined a child should have received medical attention on 8/18/24, but was not seen until 8/19/24.	—
3	—	748.2151(c)(6) - Medication record - must include name & signature of person who administered each medication A caregiver was administering medication without having a signature on the medication file.	—
4	—	748.2151(d) - Medication Record-must include accurate daily count of each prescribed medication, unless operate on a cottage home model During an unanounnced follow up inspection 2 out of 3 medical logs for children in care did not have an accurate count of medications.	Yes
4	—	748.2151(d) - Medication Record-must include accurate daily count of each prescribed medication, unless operate on a cottage home model The medication count for a child in care was did not have an accurate count of the prescribed medication.	—
3	—	748.1331(f) - Preliminary Service Plan-Implement and follow the preliminary service plan During the course of the investigation, it was determined that a preliminary service plan indicated that a child requires "constant supervision" due to self-harming behaviors. This plan was not followed when this child was left unattended for a couple of minutes giving this child an opportunity to run away with another resident.	—
4	—	748.507(1) - Employee general responsibilities-Demonstrate competency, prudent judgment, self-control in presence of children and when performing assigned tasks Upon reviewing letters and pictures from a caregiver it was determined that the caregiver has maintained an inappropriate relationship with a child in care.	—
5	—	748.2551(c)(2) - EBI Implementation-Caregiver must use the minimal amount of reasonable and necessary physical force Four children described excessive force being used during restraints, such as being slammed against a wall or floor, arms twisting back, and being bent over.	—
4	—	748.507(1) - Employee general responsibilities-Demonstrate competency, prudent judgment, self-control in presence of children and when performing assigned tasks A staff member allowed children to go to an unauthorized outdoor area. As a result, the children ran away and committed inappropriate physical contact with each other.	—
4	—	748.2551(a) - EBI Implementation-Must be an appropriate response to the behavior demonstrated, and de-escalation must have failed A child in care that was not in danger or a danger to others was restrained inappropriately by a caregiver.	—
3	—	748.125(b) - All employees and caregivers must be aware of and follow your operation's policies and procedures A few of The Ranch's policies were not followed regarding this incident. -Night staff members were sleeping. -Staff sleeping was not reported, and staff is trained to report this. -Concerns that hadn't been handled and needed more attention were not relayed to higher-up Supervisors/chain of command.	—
5	—	748.2303(a) - Corporal Punishment-May not use/threaten corporal punishment, such as hitting/spanking, forced exercise, holding physical position, unproductive work. Three children in care were forced to do exercise as discipline	—
5	—	748.2601(a) - Personal Restraint Monitor-Qualified caregiver monitors child for signs of physical distress & ensures ample respiration, circulation, well-being A child in care assisted staff by monitoring a restraint conducted on another child in care.	—
3	—	748.685(c)(6) - Implement and follow the children's service plans. Staff was unaware of a child's medical needs outlined in the service plan, which resulted in the child's medical needs not being properly met.	—
5	—	748.2551(c)(2) - EBI Implementation-Caregiver must use the minimal amount of reasonable and necessary physical force A child in care was seriously bruised from a restraint conducted by a caregiver.	—
3	—	748.393(b)(3) - Active child record - Ensure record is kept accurate and current A child's service plan contained inaccurate and outdated information and instructions for supervision	—
3	—	748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records 1 child's service plan contained the name of two other individuals. Additionally, the unauthorized absence log contained the wrong staff member's name responsible for a child who ran away.	—
4	—	748.2455(a)(2) - Emergency Behavior Intervention-Basis for EBI is an emergency situation or to administer medication Three out of four restraint reports noted a child being restained for a non emergency situation.	—
4	—	748.1531(d) - Medical care-Obtain follow-up medical treatment as recommended by the health-care professional It was found that the child in care was not seen for a follow up medical appointment as it was requested by the ER doctor at the time of discharge.	—
4	—	748.2455(a)(2) - Emergency Behavior Intervention-Basis for EBI is an emergency situation or to administer medication A staff member used emergency behavior intervention on a child in care for a non-emergency situation.	—
4	—	748.2307(9) - Other Prohibited Punishments-subjecting a child to abusive or profane language Three children and two staff stated that staff will use curse words around children. Staff said they will repeat what children say as a way to have them rethink their own words.	—
4	—	748.2551(b)(2) - EBI Implementation-The caregiver must consider the permitted types of emergency behavior intervention A child in care was restrained for only being verbally aggressive.	—
3	—	745.651(1) - Background Check Validation - You must inactivate a subject who is no longer associated with your operation within 7 days of leaving 7 previous staff members who are no longer employed at the operation were not inactivated within 7 days of unemployment. The administrator inactivated these staff during the inspection.	Yes
4	—	748.2551(a) - EBI Implementation-Must be an appropriate response to the behavior demonstrated, and de-escalation must have failed A staff member restrained a child without attempting de-escalation.	—
4	—	748.685(b)(5) - Caregiver responsibility - when deciding how close to supervise, takes into account the child's physical, mental, emotional, and social needs A child with a history of struggling with medical compliance, was made responsible for monitoring their blood sugar levels. The child was also able to sneak snacks, as other children in care reported.	—
4	—	748.2463(1) - Emergency Behavior Intervention-Never used as punishment It was noted during an investigation that a child in care was being restrained which resulted in a child being restrained inappropriately as the child in care resisted.	—
3	—	748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records 1 child's service plan contained the name of two other individuals. Additionally, the unauthorized absence log contained the wrong staff member's name responsible for a child who ran away.	—
4	—	748.1101(b)(4)(A)(vii) - Children's rights- Free from demeaning behavior to embarrass/control/harm/intimidate/isolate the child It was noted in this investigation that a child in care was grabbed by the front of the shirt.	—
4	—	748.507(1) - Employee general responsibilities-Demonstrate competency, prudent judgment, self-control in presence of children and when performing assigned tasks Upon reviewing letters and pictures from a caregiver it was determined that the caregiver has maintained an inappropriate relationship with a child in care.	—
4	—	748.2455(a)(2) - Emergency Behavior Intervention-Basis for EBI is an emergency situation or to administer medication The basis for a child in care being restrained was for noncompliance and not an emergency situation or to administer medication.	—
5	—	748.2551(c)(1) - EBI Implementation-Caregiver must minimize risk of physical discomfort, harm, or pain to the child It was noted that during an investigation, a child was not properly restrained.	—
3	—	748.2151(c)(6) - Medication record - must include name & signature of person who administered each medication A caregiver was administering medication without having a signature on the medication file.	—
5	—	748.2601(a) - Personal Restraint Monitor-Qualified caregiver monitors child for signs of physical distress & ensures ample respiration, circulation, well-being A child in care assisted staff by monitoring a restraint conducted on another child in care.	—
4	—	748.2455(a)(2) - Emergency Behavior Intervention-Basis for EBI is an emergency situation or to administer medication Three out of four restraint reports noted a child being restained for a non emergency situation.	—
5	—	748.2551(c)(2) - EBI Implementation-Caregiver must use the minimal amount of reasonable and necessary physical force A child in care received a serious physical injury during a restraint.	—
4	—	748.1531(d) - Medical care-Obtain follow-up medical treatment as recommended by the health-care professional It was found that the child in care was not seen for a follow up medical appointment as it was requested by the ER doctor at the time of discharge.	—
3	—	748.399(a) - Records Available for Licensing-all active records immediately available for review and reproduction Records were requested on 12/4/23 (by email), on 12/7/23 (by email), and on 12/18 (by email & by phone). Records were provided by the operation on 12/18/23.	—
3	—	748.125(b) - All employees and caregivers must be aware of and follow your operation's policies and procedures A few of The Ranch's policies were not followed regarding this incident. -Night staff members were sleeping. -Staff sleeping was not reported, and staff is trained to report this. -Concerns that hadn't been handled and needed more attention were not relayed to higher-up Supervisors/chain of command.	—
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. In two seperate houses, the cleaning supplies in the bathroom cabinet were assessable to children in care.	Yes
5	—	748.685(a)(4) - Caregiver responsibility - providing the level of supervision necessary to ensure each child's safety and well-being During the investigation it was determined that the caregiver in charge failed to supervised children by falling sleep and not checking on them after waking up. As a result the children ran away from the operation.	—
4	—	748.2551(a) - EBI Implementation-Must be an appropriate response to the behavior demonstrated, and de-escalation must have failed A child in care that was not in danger or a danger to others was restrained inappropriately by a caregiver.	—
4	—	748.3563(d) - Protective Surfacing-Must ensure 9 inches of the loose-fill materials are maintained at all times The swings and playground area did not have 9 inches of loose-fill materials.	—
4	—	748.2455(a)(2) - Emergency Behavior Intervention-Basis for EBI is an emergency situation or to administer medication A staff member used emergency behavior intervention on a child in care for a non-emergency situation.	—
3	—	748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records The incident report was not accurate to the true events of the actual incident. A staff member denied monitoring a restraint even though the incident report indicated the staff did monitor a restraint.	—
4	—	748.2003(b)(3) - AP Administration of prescription medication-Administer medications according to instructions or a prescribing health-care professional's orders A child in care's prescription label was altered by a staff member. The instructions stated take 1 tablet by mouth every morning but morning was mark through and night was written by pen.	—
5	—	748.2551(c)(2) - EBI Implementation-Caregiver must use the minimal amount of reasonable and necessary physical force Four children described excessive force being used during restraints, such as being slammed against a wall or floor, arms twisting back, and being bent over.	—
3	—	748.2151(c)(6) - Medication record - must include name & signature of person who administered each medication 4 out of 10 medication logs did not have the required signature of the person who administered the dose.	—
4	—	748.2455(a)(2) - Emergency Behavior Intervention-Basis for EBI is an emergency situation or to administer medication Four children described examples of being restrained for not following directions or situations that were not an emergency.	—
4	—	748.2307(9) - Other Prohibited Punishments-subjecting a child to abusive or profane language Three children and two staff stated that staff will use curse words around children. Staff said they will repeat what children say as a way to have them rethink their own words.	—
3	—	748.125(d)(4)(C) - Suicide Screening- Must be administered every 30 days after admission for children 10 years of age or older in a residential treatment center. A child in care was missing several months of suicide screenings.	—
3	—	748.303(a)(10)(A) - Serious Incident-Report to Licensing no later than 24 hours after awareness that a child contracts reportable communicable disease A report to licensing that a child contracted a communicable disease was not made within 24 hours.	—
4	—	748.2151(d) - Medication Record-must include accurate daily count of each prescribed medication, unless operate on a cottage home model The medication count for a child in care was did not have an accurate count of the prescribed medication.	—
5	—	748.2551(c)(2) - EBI Implementation-Caregiver must use the minimal amount of reasonable and necessary physical force A child in care was seriously bruised from a restraint conducted by a caregiver.	—
5	—	748.1553 - Child must be immediately treated by health prof, contact emergency svs or take child to ER for injury/illness requiring treatment by a health prof. An investigation determined a child should have received medical attention on 8/18/24, but was not seen until 8/19/24.	—
3	—	748.393(b)(3) - Active child record - Ensure record is kept accurate and current A child's service plan contained inaccurate and outdated information and instructions for supervision	—
4	—	748.2551(b)(2) - EBI Implementation-The caregiver must consider the permitted types of emergency behavior intervention A child in care was restrained for only being verbally aggressive.	—
3	—	748.1331(f) - Preliminary Service Plan-Implement and follow the preliminary service plan During the course of the investigation, it was determined that a preliminary service plan indicated that a child requires "constant supervision" due to self-harming behaviors. This plan was not followed when this child was left unattended for a couple of minutes giving this child an opportunity to run away with another resident.	—
4	—	748.2907(5) - Triggered Reviews-Must include a written plan for reducing the need for emergency behavior intervention The triggered review completed did not contain information required throughout standard 748.2907.	—
3	—	748.313(3)(B) - Serious Incident child absent without permission-document notice to parents and law enforcement about child's absence and subsequent location/return 3 serious incident reports regarding an unauthorized absence did not have the time and/or date of the notification to the case worker and/or law enforcement officer and the names of those they spoke to.	—
3	—	748.685(c)(6) - Implement and follow the children's service plans. Staff was unaware of a child's medical needs outlined in the service plan, which resulted in the child's medical needs not being properly met.	—
4	—	748.2151(d) - Medication Record-must include accurate daily count of each prescribed medication, unless operate on a cottage home model During an unanounnced follow up inspection 2 out of 3 medical logs for children in care did not have an accurate count of medications.	Yes
4	—	748.685(b)(4) - Caregiver responsibility - when deciding how close to supervise take into account the surrounding circumstances, hazards, and risks During the course of the investigation, it was determined that a hazardous item was left in reach of a child.	—
4	—	748.2307(9) - Other Prohibited Punishments-subjecting a child to abusive or profane language During the course of the investigation, it was found and corroborated by 4 children in care and 2 staff members, that a staff member yelled, "Shut the fuck up", to children in care during "Med box", as the children were being loud and had already been asked multiple times to be quiet. Additionally, 1 case worker also stated to being informed that their child has overheard a staff cursing to a child on one occasion.	—
3	—	745.651(1) - Background Check Validation - You must inactivate a subject who is no longer associated with your operation within 7 days of leaving 7 previous staff members who are no longer employed at the operation were not inactivated within 7 days of unemployment. The administrator inactivated these staff during the inspection.	Yes
4	—	748.2551(a) - EBI Implementation-Must be an appropriate response to the behavior demonstrated, and de-escalation must have failed A staff member restrained a child without attempting de-escalation.	—
5	—	748.2303(a) - Corporal Punishment-May not use/threaten corporal punishment, such as hitting/spanking, forced exercise, holding physical position, unproductive work. Three children in care were forced to do exercise as discipline	—
4	—	748.1337(b)(1)(H)(i) - Initial Service Plan-For child who exhibits high risk behaviors, include plans to minimize risk of harm to self or others 2 children's service plans noted high-risk behaviors but did not include specific plans that address these behaviors.	—
5	—	748.1337(b)(1)(H)(i) - Initial Service Plan-For child who exhibits high risk behaviors, include plans to minimize risk of harm to self or others A child with high-risk behaviors noted did not have a plan to address these behaviors in their service plan.	—
4	—	748.2307(9) - Other Prohibited Punishments-subjecting a child to abusive or profane language It was noted during the investigation that profane language was used during an incident that had escalated on a child in care.	—
4	—	748.507(1) - Employee general responsibilities-Demonstrate competency, prudent judgment, self-control in presence of children and when performing assigned tasks A staff member allowed children to go to an unauthorized outdoor area. As a result, the children ran away and committed inappropriate physical contact with each other.	—
5	—	748.1101(b)(1)(B) - Children's rights-Adhere to the child's rights to be free of abuse, neglect, and exploitation The operation/staff failed to provide the level of monitoring and oversight necessary to help ensure a child's compliance with their diabetic treatment regimen. Staff was not aware of the child's supervision needs during blood sugar checks, which directly led to the child being hospitalized.	—
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 child did not have a TB test documented in their record. The child was at a doctor's appointment and recieved a test today. The results will be done in 48 hours.	Yes
4	—	748.125(d)(4)(E) - Suicide Screening- Must be administered immediately if the child exhibits warning signs that necessitate a suicide screening be conducted. The suicide screening indicates it was done 13 days late.	—
5	—	748.2551(c)(2) - EBI Implementation-Caregiver must use the minimal amount of reasonable and necessary physical force Four children described excessive force being used during restraints, such as being slammed against a wall or floor, arms twisting back, and being bent over.	—
4	—	748.2455(a)(2) - Emergency Behavior Intervention-Basis for EBI is an emergency situation or to administer medication The basis for a child in care being restrained was for noncompliance and not an emergency situation or to administer medication.	—

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

Inspections (288)

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

Nearby alternatives

Facility	Score	City	Distance
Little Blessing Child Care Center	0	Goldthwaite	—

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