Capacity 20. 5-17
| Severity | Date | Standard / narrative | Corrected |
|---|
| 3 | — |
748.399(a) - Records Available for Licensing-all active records immediately available for review and reproduction
While at the operation to conduct a heightened monitoring inspection, it took the operation two (2) hours to provide requested documents. |
— |
| 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
Boys' bathroom did not have soap accessible to them. |
— |
| 1 | — |
748.1341(b) - Initial Service Plan-Child's record must include documentation of advance notice to parents of planning meeting and any responses from the parents
Two child records did not have documentation of providing advance notice of service plan staffing to guardians. |
— |
| 4 | — |
748.2203(c) - Medication Error-Operation must meet documentation requirements within 24 hrs
The operation failed to document a missed dosage of medication within the required 24 hour time frame. |
— |
| 5 | — |
748.1101(b)(1)(B) - Children's rights-Adhere to the child's rights to be free of abuse, neglect, and exploitation
A staff member provided children in care with vape pens. |
— |
| 5 | — |
748.1101(b)(1)(B) - Children's rights-Adhere to the child's rights to be free of abuse, neglect, and exploitation
A child in care was improperly restrained by staff members. |
— |
| 4 | — |
748.930(b)(2) - Annual Training- Caregivers must have 2 hrs trauma informed care.
The employee file reviewed has delinquent training related to Trauma Informed Care. |
— |
| 4 | — |
748.2003(b)(2) - Administration of Medication-Store medication in the original container unless there is an additional container with the same label & instructions
During the inspection, one pill of Benztropine medication was found outside the container and inside the Ziplock bag where the medication bottles are stored. |
— |
| 4 | — |
748.2307(9) - Other Prohibited Punishments-subjecting a child to abusive or profane language
A staff member used profane language directed at a child in care. |
— |
| 5 | — |
748.685(a)(3) - Caregiver responsibility - being aware of and accountable for each child's on-going activity
Supervision was not appropriate when a staff member did not physically check on a child during the night. The child was in another child's bedroom for approximately 6.5 hours without the staff member knowledge. |
— |
| 3 | — |
748.2151(c)(3) - Medication record - must include reason medication was prescribed, for prescription medication
Three children in care were not given medication as prescribed. |
— |
| 4 | — |
748.2003(b)(3) - AP Administration of prescription medication-Administer medications according to instructions or a prescribing health-care professional's orders
One child's medication record had a missed dose on two medications due to the child having an appointment. Two other children had one missing dose documented without a reason. |
— |
| 4 | — |
748.191(3) - Required Postings-Post emergency and evacuation relocation plans in each building and living quarters used by children where all may view them
Residential Child Care Regulation observed the living area without any evacuation plan. The operation printed and posted the evacuation plan during the inspection. |
Yes |
| 5 | — |
748.685(a)(3) - Caregiver responsibility - being aware of and accountable for each child's on-going activity
Caregiver admitted to dealing with another situation at the outing and not being aware of two children in care thus leading to inappropriate behaviors between the two children. |
— |
| 4 | — |
748.2003(b)(10) - Administration of prescription medication-must not borrow or administer prescription medication to a child that is prescribed to another person
A child in care was administered another child's prescribed sleep medication. |
— |
| 3 | — |
748.3365(b)(2) - Bedding-must provide each child with a mattress cover or protector unless mattress is waterproof
During the walkthrough of the facility, it was observed that an occupied bedroom did not have a required waterproof matress or cover. |
Yes |
| 3 | — |
748.3365(b)(1) - Bedding-must provide each child with a clean and comfortable mattress
One of the mattresses was noted to be dirty and stained. |
— |
| 5 | — |
745.635(3) - AP Background ck determination - If provisionally eligible w/conditions or eligible w/conditions you must restrict duties per conditions/restrictions
The operation failed to provide the supervision required for a staff member's conditions on their eligibility to be present at the operation.A staff member with conditions was allowed to be alone in a room with the child in care, while the supervising staff remained in their office. |
— |
| 4 | — |
748.930(b)(4) - Annual Training- Caregivers must have 2 hours transportation safety training if caring for children younger than 9 yrs old.
The employee file reviewed has delinquent training related to transportation. |
— |
| 4 | — |
748.2003(b)(3) - AP Administration of prescription medication-Administer medications according to instructions or a prescribing health-care professional's orders
Two children in care stated they were not provided their prescribed inhalers when they requested from staff due to having breathing issues. |
— |
| 4 | — |
748.930(b)(3) - Annual Training- Caregivers must have 1 hour normalcy training.
The employee file reviewed has delinquent training related to Normalcy. |
— |
| 3 | — |
748.3301(a)(2) - Physical Site- Buildings must be clean and in good repair.
During walk through of the physical site it was noted that the backyard fence had broken plans and exposed nails. One of the toilets was observed to have a toilet seat that was too small for the toilet bowl. Metal grate in hallway is broken and dented exposing sharp edges. |
— |
| 4 | — |
748.507(1) - Employee general responsibilities-Demonstrate competency, prudent judgment, self-control in presence of children and when performing assigned tasks
During the investigation it was determined a caregiver did not demonstrate self-control when they cursed in front of children and made inappropriate comments to them. |
— |
| 4 | — |
748.930(b)(4) - Annual Training- Caregivers must have 2 hours transportation safety training if caring for children younger than 9 yrs old.
While reviewing one (1) employee record, it was observed that the employee does not have the total hours required for transportation training. |
— |
| 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 was not given her medication as prescribed. |
— |
| 3 | — |
748.1543 - Immunizations - must have accepable documentation
One child file did not have immunization record or proof of TB test. |
— |
| 3 | — |
748.3365(b)(2) - Bedding-must provide each child with a mattress cover or protector unless mattress is waterproof
One resident was laying on their bed without a mattress cover. |
Yes |
| 5 | — |
748.685(a)(4) - Caregiver responsibility - providing the level of supervision necessary to ensure each child's safety and well-being
Two children were seen riding bikes away from the operation with no staff supervision within auditory range or line of sight. Both children had high risk behaviors noted in their Service Plans and Admission Assessment, as well as supervision required outside being checked. Caseworkers did not approve unsupervised activities. |
— |
| 5 | — |
748.685(a)(3) - Caregiver responsibility - being aware of and accountable for each child's on-going activity
Staff involved was not aware children in care went into the laundry room alone and was observed on camera to not be supervising children in care. |
— |
| 4 | — |
748.2003(b)(5) - Administration of prescription medication-Ensure the child has taken the medication as prescribed
During the course of the investigation it was determined that a child in care did not receive their prescription medication as prescribed by a medical professional. |
— |
| 4 | — |
748.3301(f) - Physical Site-The grounds of the operation must be well maintained and free of hazards
Dog Feces, tall grass, and protruding nails on walkway were present in the yard. |
— |
| 3 | — |
748.2205(2) - Medication label error-Have the label on the medication container corrected as soon as possible, but no later than the next business day
Medication label does not reflect the dosage increase as indicated on the prescription. |
— |
| 5 | — |
748.1101(b)(1)(B) - Children's rights-Adhere to the child's rights to be free of abuse, neglect, and exploitation
During this investigation it was confirmed staff had an inappropriate relationship with a child in care. This same staff was aware of a child self-harming and did not report to hotline or other staff present to ensure the safety of the child. Additional staff involved were found to have provided child in care with illegal substances. |
— |
| 1 | — |
748.1703(a) - Menus-must maintain daily menus showing all meals and snacks that the operation prepares and serves
While reviewing menu for the last 90 days it was noted that snacks items were not listed. |
— |
| 3 | — |
748.2151(c)(6) - Medication record - must include name & signature of person who administered each medication
During the inspection, a psychotropic medication on one child's medication log was not documented as administered or refused, no med count was completed, and staff's signature was missing on 9/26. |
— |
| 5 | — |
748.1531(a)(2) - Medical care-A child in care must receive medical care as needed for injury, illness, and pain
Child in care reported having continued pain and discomfort, however, was not taken to see medical provider until the following day resulting in condition worsening. |
— |
| 2 | — |
748.949(b)(4) - Annual Training Documentation-Includes the trainer's name and qualifications, or the source of the training for self-instructional training
The operation provided compliance on 10.28.24 stating they will handwrite the missing information by 11.15.24. As of 11.19.24 this has not been completed, and training certificates are missing the name and qualifications of the instructor. |
— |
| 4 | — |
748.3391(a) - Bathrooms-Must be maintained in good repair & kept clean
The boys' bathroom shower was dirty during walkthrough of operation. |
— |
| 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 was not given medication as prescribed. |
— |
| 3 | — |
748.3443(a)(2) - Food Preparation-Food items must be stored on clean surfaces
Refridgerated food was not stored on clean surfaces. |
— |
| 3 | — |
748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
The Serious Incident Report provided by the operation contained an inaccurate date in the Agency Notifications section and a staff member who was present at the time of the incident was not included as a witness. |
— |
| 5 | — |
745.8411(b)(3) - Responsibilities - Provides access to all records
The operation failed to provide all serious incident reports related to the allegation being investigated. |
— |
| 4 | — |
748.2003(b)(3) - AP Administration of prescription medication-Administer medications according to instructions or a prescribing health-care professional's orders
One child's medication administration record documented that on two days medication was not given as prescribed. One day the PM medication dose was missed. On the second day, the AM medication dose was missed. |
— |
| 4 | — |
748.2151(c)(5) - Medication record - must include date (day/month/year) & time each medication was administered
Two children had medication records without the time of administration documented for one dose. |
— |
| 3 | — |
748.303(a)(6)(A) - Serious Incident-Report to Licensing no later than 24 hours after becoming aware that child is indicted, charged, or arrested or when police respond.
The operation failed to notify licensing of a physical altercation between children in care, where law enforcement responded and citations for all children involved were given |
— |
| 5 | — |
748.685(a)(4) - Caregiver responsibility - providing the level of supervision necessary to ensure each child's safety and well-being
Children in care were left at the operation for over one hour due to staff not communicating with one another and not having knowledge; therefore, children were alone at the operation. |
— |
| 4 | — |
748.941(d) - Training Criteria-A health-care professional or a pharmacist must lead the training in administering psychotropic medication.
While reviewing the training record of an employee, it was observed that the staff has not recieved administering psychotropic medication insturction from a health-care professional or a pharmacist. |
— |
| 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 was not given medication as prescribed. |
— |
| 3 | — |
748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
The medication count was documented incorrectly on two child medication logs. There was also conflicting information documented on the incident report when compared to medication logs. |
— |
| 4 | — |
748.2151(d) - Medication Record-must include accurate daily count of each prescribed medication, unless operate on a cottage home model
During the review of two (2) medication record it was discovered a prescribed medication count was documented incorrectly on the medication log. |
— |
| 5 | — |
748.685(a)(5) - Caregiver responsibility - being able to intervene when necessary to ensure child's safety
Staff did not properly intervene between children in care. |
— |
| 5 | — |
748.685(a)(5) - Caregiver responsibility - being able to intervene when necessary to ensure child's safety
Two (2) children in care were in a locked bedroom and engaged in sexual activity that resulted in the outcry of sexual assault. |
— |
| 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
Identified high risk behaviors do not include plan to address the risk for children in care. |
— |
| 3 | — |
748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
The incident report for a child in care s self-harm attempt was altered by operation staff during the inspection, minimizing the severity of the situation. |
— |
| 4 | — |
748.2203(a) - Medication Error-If prescription medication, contact a health-care professional immediately & follow health-care professional's recommendations
In reviewing the medication record, it was observed that a child was given the wrong medication on two prescriptions. A healthcare professional was not contacted regarding the incident and how to respond. |
— |
| 4 | — |
748.2307(9) - Other Prohibited Punishments-subjecting a child to abusive or profane language
A staff member used profane language in speaking to a child in care. |
— |
| 4 | — |
748.2203(c) - Medication Error-Operation must meet documentation requirements within 24 hrs
While reveiwng 1 of 5 child medication records, it was observed that a child's refusal of a presribed medication was not documented as a medication error. |
— |
| 5 | — |
748.685(a)(3) - Caregiver responsibility - being aware of and accountable for each child's on-going activity
Interview with staff concludes the child was not checked on within timeframe specified in Service Plan. The child's Service Plan states the child should have checks every 30 minutes. The Service Plan also states the child has high risk behaviors to include history of running away and suicidal behaviors. |
— |
| 4 | — |
748.930(b)(4) - Annual Training- Caregivers must have 2 hours transportation safety training if caring for children younger than 9 yrs old.
The employee file reviewed has delinquent training related to transportation. |
— |
| 4 | — |
748.2151(c)(5) - Medication record - must include date (day/month/year) & time each medication was administered
Two children had medication records without the time of administration documented for one dose. |
— |
| 5 | — |
748.685(a)(4) - Caregiver responsibility - providing the level of supervision necessary to ensure each child's safety and well-being
Children in care were left at the operation for over one hour due to staff not communicating with one another and not having knowledge; therefore, children were alone at the operation. |
— |
| 4 | — |
748.507(1) - Employee general responsibilities-Demonstrate competency, prudent judgment, self-control in presence of children and when performing assigned tasks
During the investigation it was determined a caregiver did not demonstrate self-control when they cursed in front of children and made inappropriate comments to them. |
— |
| 5 | — |
748.1101(b)(1)(B) - Children's rights-Adhere to the child's rights to be free of abuse, neglect, and exploitation
During this investigation it was confirmed staff had an inappropriate relationship with a child in care. This same staff was aware of a child self-harming and did not report to hotline or other staff present to ensure the safety of the child. Additional staff involved were found to have provided child in care with illegal substances. |
— |
| 4 | — |
748.930(b)(4) - Annual Training- Caregivers must have 2 hours transportation safety training if caring for children younger than 9 yrs old.
While reviewing one (1) employee record, it was observed that the employee does not have the total hours required for transportation training. |
— |
| 5 | — |
748.685(a)(3) - Caregiver responsibility - being aware of and accountable for each child's on-going activity
Interview with staff concludes the child was not checked on within timeframe specified in Service Plan. The child's Service Plan states the child should have checks every 30 minutes. The Service Plan also states the child has high risk behaviors to include history of running away and suicidal behaviors. |
— |
| 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
Boys' bathroom did not have soap accessible to them. |
— |
| 5 | — |
748.685(a)(5) - Caregiver responsibility - being able to intervene when necessary to ensure child's safety
Two (2) children in care were in a locked bedroom and engaged in sexual activity that resulted in the outcry of sexual assault. |
— |
| 3 | — |
748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
The incident report for a child in care s self-harm attempt was altered by operation staff during the inspection, minimizing the severity of the situation. |
— |
| 3 | — |
748.2151(c)(3) - Medication record - must include reason medication was prescribed, for prescription medication
Three children in care were not given medication as prescribed. |
— |
| 5 | — |
748.1101(b)(1)(B) - Children's rights-Adhere to the child's rights to be free of abuse, neglect, and exploitation
A child in care was improperly restrained by staff members. |
— |
| 4 | — |
748.2003(b)(3) - AP Administration of prescription medication-Administer medications according to instructions or a prescribing health-care professional's orders
One child's medication administration record documented that on two days medication was not given as prescribed. One day the PM medication dose was missed. On the second day, the AM medication dose was missed. |
— |
| 4 | — |
748.2003(b)(3) - AP Administration of prescription medication-Administer medications according to instructions or a prescribing health-care professional's orders
One child's medication record had a missed dose on two medications due to the child having an appointment. Two other children had one missing dose documented without a reason. |
— |
| 3 | — |
748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
The Serious Incident Report provided by the operation contained an inaccurate date in the Agency Notifications section and a staff member who was present at the time of the incident was not included as a witness. |
— |
| 3 | — |
748.1543 - Immunizations - must have accepable documentation
One child file did not have immunization record or proof of TB test. |
— |
| 3 | — |
748.3365(b)(2) - Bedding-must provide each child with a mattress cover or protector unless mattress is waterproof
One resident was laying on their bed without a mattress cover. |
Yes |
| 4 | — |
748.2307(9) - Other Prohibited Punishments-subjecting a child to abusive or profane language
A staff member used profane language in speaking to a child in care. |
— |
| 3 | — |
748.151(3) - Operational responsibilities - Maintain current, true, accurate, and complete records
The medication count was documented incorrectly on two child medication logs. There was also conflicting information documented on the incident report when compared to medication logs. |
— |
| 4 | — |
748.2003(b)(2) - Administration of Medication-Store medication in the original container unless there is an additional container with the same label & instructions
During the inspection, one pill of Benztropine medication was found outside the container and inside the Ziplock bag where the medication bottles are stored. |
— |
| 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
Identified high risk behaviors do not include plan to address the risk for children in care. |
— |
| 5 | — |
745.8411(b)(3) - Responsibilities - Provides access to all records
The operation failed to provide all serious incident reports related to the allegation being investigated. |
— |
| 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 was not given her medication as prescribed. |
— |
| 3 | — |
748.2205(2) - Medication label error-Have the label on the medication container corrected as soon as possible, but no later than the next business day
Medication label does not reflect the dosage increase as indicated on the prescription. |
— |
| 5 | — |
748.685(a)(5) - Caregiver responsibility - being able to intervene when necessary to ensure child's safety
Staff did not properly intervene between children in care. |
— |
| 4 | — |
748.930(b)(2) - Annual Training- Caregivers must have 2 hrs trauma informed care.
The employee file reviewed has delinquent training related to Trauma Informed Care. |
— |
| 4 | — |
748.2203(c) - Medication Error-Operation must meet documentation requirements within 24 hrs
While reveiwng 1 of 5 child medication records, it was observed that a child's refusal of a presribed medication was not documented as a medication error. |
— |
| 4 | — |
748.3301(f) - Physical Site-The grounds of the operation must be well maintained and free of hazards
Dog Feces, tall grass, and protruding nails on walkway were present in the yard. |
— |
| 3 | — |
748.3301(a)(2) - Physical Site- Buildings must be clean and in good repair.
During walk through of the physical site it was noted that the backyard fence had broken plans and exposed nails. One of the toilets was observed to have a toilet seat that was too small for the toilet bowl. Metal grate in hallway is broken and dented exposing sharp edges. |
— |
| 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 was not given medication as prescribed. |
— |
| 4 | — |
748.3391(a) - Bathrooms-Must be maintained in good repair & kept clean
The boys' bathroom shower was dirty during walkthrough of operation. |
— |
| 3 | — |
748.303(a)(6)(A) - Serious Incident-Report to Licensing no later than 24 hours after becoming aware that child is indicted, charged, or arrested or when police respond.
The operation failed to notify licensing of a physical altercation between children in care, where law enforcement responded and citations for all children involved were given |
— |
| 3 | — |
748.3443(a)(2) - Food Preparation-Food items must be stored on clean surfaces
Refridgerated food was not stored on clean surfaces. |
— |
| 5 | — |
745.635(3) - AP Background ck determination - If provisionally eligible w/conditions or eligible w/conditions you must restrict duties per conditions/restrictions
The operation failed to provide the supervision required for a staff member's conditions on their eligibility to be present at the operation.A staff member with conditions was allowed to be alone in a room with the child in care, while the supervising staff remained in their office. |
— |
| 4 | — |
748.2203(a) - Medication Error-If prescription medication, contact a health-care professional immediately & follow health-care professional's recommendations
In reviewing the medication record, it was observed that a child was given the wrong medication on two prescriptions. A healthcare professional was not contacted regarding the incident and how to respond. |
— |
| 3 | — |
748.3365(b)(2) - Bedding-must provide each child with a mattress cover or protector unless mattress is waterproof
During the walkthrough of the facility, it was observed that an occupied bedroom did not have a required waterproof matress or cover. |
Yes |
| 4 | — |
748.2003(b)(10) - Administration of prescription medication-must not borrow or administer prescription medication to a child that is prescribed to another person
A child in care was administered another child's prescribed sleep medication. |
— |
| 4 | — |
748.941(d) - Training Criteria-A health-care professional or a pharmacist must lead the training in administering psychotropic medication.
While reviewing the training record of an employee, it was observed that the staff has not recieved administering psychotropic medication insturction from a health-care professional or a pharmacist. |
— |
| 4 | — |
748.2151(d) - Medication Record-must include accurate daily count of each prescribed medication, unless operate on a cottage home model
During the review of two (2) medication record it was discovered a prescribed medication count was documented incorrectly on the medication log. |
— |
| 5 | — |
748.685(a)(3) - Caregiver responsibility - being aware of and accountable for each child's on-going activity
Supervision was not appropriate when a staff member did not physically check on a child during the night. The child was in another child's bedroom for approximately 6.5 hours without the staff member knowledge. |
— |
| 1 | — |
748.1341(b) - Initial Service Plan-Child's record must include documentation of advance notice to parents of planning meeting and any responses from the parents
Two child records did not have documentation of providing advance notice of service plan staffing to guardians. |
— |
| 4 | — |
748.191(3) - Required Postings-Post emergency and evacuation relocation plans in each building and living quarters used by children where all may view them
Residential Child Care Regulation observed the living area without any evacuation plan. The operation printed and posted the evacuation plan during the inspection. |
Yes |
346 inspection record(s) on file from TX-HHSC.