|
Texas Department of
Protective and Regulatory Services
Child Care Inspection
10/18/02 to 12/23/02
Below is a summary of the department's
violations:
Violation No. 1: Caregiver did not
follow facility’s policies and procedures in handling misbehavior of
resident, resulting in restraint and death of a child.
Violation No. 2: Caregivers used
restraint and punishment when this resident refused to stop talking
and exiting a tent.
Violation No. 3: Restrain used did not
meet the definition for an emergency situation.
Violation No. 4: No information found
indicating what other preventative, de-escalative, less restrictive
techniques were tried and prove ineffective at defusing the
situation before restraining Chase.
Violation No. 5: Unreasonable,
unnecessary force used. No one monitored the child’s breathing or
other signs of physical distress.
Violation No. 6: Restraint
inappropriately implemented using technique that obstructed child’s
airways, impairing breathing.
Violation No. 7: Inappropriate
restraint obstructed view of child’s face.
Violation No. 8: Inappropriate
restraint restricted child’s ability to communicate.
Violation No. 9: Caregivers did not act
to ensure child’s safety or privacy.
Violation No. 10: Caregivers did not
release child from restraint when health emergency occurred or when
child started vomiting and failed to provide treatment.
Violation No. 11: Caregivers did not
tell the child what actions would be taken to de-escalate the
situation every 15 minutes, or when he would be released from the
restraint.
Violation No. 12: No documentation to
support the need for a restraint (nothing constituting an
emergency.)
Violation No. 13: Caregivers did not
document what de-escalating strategies other than verbal directions
were used during restraint.
Violation No. 14: Caregivers did not
document length of restraint.
Violation No. 15: Caregivers did not
comply with facility’s policy re disciplinary problems.
Violation No. 16: Disciplinary measures
used on the child were physically damaging.
Violation No. 17: Disciplinary measures
used were not individualized to meet the child’s needs.
Violation No. 18: Resident was
subjected to cruel and unnecessary punishment when he was restrained
for talking.
Violation No. 19: Resident subjected to
remarks that belittled him “Boy, who are you calling boy?”
Violation No. 20: Documentation was
missing on 3 days on medical charts documenting prescribed
medications.
Violation No. 21: Medications were not
administered according to instructions on the label or according to
doctor’s orders, written and signed by the doctor within 72 hours.
Violation No. 22: Admission acceptance
documents completed after the child was admitted (he was admitted
10/8/02, assessment was on 10/17/02, the child died on 10/14/02 – 6
days after entering the program, 3 days after he died).
Violation No. 23: Three caregivers
indicated they were not provided with information about resident’s
immediate needs or anger problem.
Violation No. 24: Plan of service
reviewed for Chase did not address specific strategies to meet his
needs, including instructing staff.
Violation No. 25: Three caregivers
interviewed said they were not aware of nor had been provided with a
copy of the plan of service on the resident.
Violation No. 26: The administrator was
cited for not ensuring the facility complied with minimum standards.
Violation No. 27: The facility did not
provide licensing with changes of names, addresses, phone numbers,
and title of officers/executive committee of governing board.
Violation No. 28: Based on the number
of violations in the investigation, the facility was not managed
according to policies adopted by the governing body.
|
