Census: 22. Buildings and grounds conducted, and MARs checked for 5 clients. No licensing concerns noted. The cafeteria is getting new windows tomorrow.
PRLU or OLTC
Visit Compliance Report
PRLU or OLTC
Visit Compliance Report
Census: 23. Buildings and grounds conducted, and MARs checked for 5 clients. No licensing concerns noted.
PRLU or OLTC
Visit Compliance Report
Buildings and grounds visit; Issues from last visit have been corrected. MARs were checked and no issues were found. The facility was clean and well kept.
Medicaid Inspection of Care
On-Site Inspection
- Included: IOC (revised), Reconsideration Determination Letter
- Multiple deficiencies noted. Plan of Correction required to be completed within 30 days.
PRLU or OLTC
Revisit Survey, Validation Survey with POC
- Regs out of compliance –
- E 004 – Facility failed to ensure a comprehensive emergency preparedness (EP) plan was reviewed and updated at least annually and operationalized to prepare for resident and staff safety in the event of a potential emergency or disaster situations.
- Plan of Correction – EP plan will be developed by 11.19.21 and will be reviewed every 2 years or sooner if any changes are needed.
- During the Revisit Survey conducted on 11/29/21, the facility was found to be in compliance with program requirements.
PRLU or OLTC
Visit Compliance Report
- No regs noted out of compliance. Specialist reviewed med logs for 4 kids with no issues found.
- TA –
- R912.6 – No toilet tissue was found in two of the bathrooms. Staff was notified and this was corrected on site.
PRLU or OLTC
Complaint Survey with POC, Revisit Survey
- Complaint #AR00026550 unsubstantiated.
- Regs out of compliance –
- N 148 – Facility failed to ensure specific time limit for restraint order was on the physician’s order for 3 clients who had ESI orders.
- N 165 – Facility failed to ensure a client placed in a physical restraint was continuously monitored for physical/psychological well-being for Client #1.
- N 167 – Facility failed to ensure a physician or permitted licensed practitioner evaluated the resident’s well-being immediately after the restraint was removed for 2 clients.
- Plan of Correction – Ten-minute time limit placed on all physician orders; Re-training on ESI monitoring and evaluations after ESIs.
- A revisit was conducted for all deficiencies cited on 05.13.21; All deficiencies have been corrected and no new noncompliance was found.
- Survey Team Composition and Workload Report –
- Surveyor 1 onsite 11.5 hours 8am – 6pm; 5.5 travel hours, 1 off-site report prep hours (05/11/21 – 05/13/21).
- Surveyor 2 onsite 11.5 hours 8am – 6pm; 8.5 travel hours, 5.5 off-site report prep hours (05/11/21 – 05/13/21).
- One surveyor onsite 5.5 hours 8am – 6pm; 6.5 travel hours, 1 off-site report prep hours (07/01/21).
PRLU or OLTC
Notice of Incident
- Injury – Staff Abuse
- While client was playing basketball with peer, staff thought client was being too aggressive and believed to restrain client. Client reported that Staff put him in a restraint and threw him against plexiglass where it left a bruise on an unknown part of client’s body. Client reported that staff grabbed his arm and pressed his fingers in his arms leaving red marks, however it is unknown when that happened or if it left injuries at the time. No follow-up details.
PRLU or OLTC
Visit Compliance Report
- Regs out of compliance –
- R911.15.f – Viewed drawstrings in clothing items on unit 1 and 3.The items were removed from the units during the walkthrough. Corrected 4.27.21.
- TA –
- R908.8 – One medication was not documented as given; all others had documentation of nurse giving medication. Facility stated they are using a new electronic system and if it is not signed off on in a certain amount of time, the option to sign disappears. The facility will discuss with IT getting the time frame for signature changed.
- R910.1 – Viewed missing lower board on the left side of the fence, the board needs repaired or replaced.
PRLU or OLTC
Notice of Incident
- Elopement
- Clients 1 & 2 were participating in a kickball game in front of the facility when both clients ran into the woods. Staff attempted to stop them and were unable to catch them. Client 1 was found by Monticello PD at 8:30 pm; Client 1 was unharmed and placed on elopement precautions.
- Agency was contacted for information on Client 2.
Police Report
Runaway
Officer dispatched to facility for 2 Runaways; Staff stated the 2 Juveniles walked away from facility into the woods. Officers circulated the area with negative results. Both Juveniles were later found in the late evening of 4/19/21 and early morning of 4/20/21.
Police Report
Fire Alarm
Fire Department was contacted; Alarm company called back to cancel.
Police Report
Other
New arrival at facility; Juvenile escorted by DHS, refusing to go in facility.
PRLU or OLTC
Licensing Compliance Record
- 912.4 – areas with rust and mildew in bathroom on hall 3. No corrected date listed.
- 908.6 – Ensure all controlled substances are double locked. Second lock in medication room unlocked at time of visit.
- 911.15.f – Clothing items with drawstrings found in 3 children’s rooms.
- 604.1g – need BC for resident, need court order for resident.
- 904.1.i – immunization record not on file for resident.
- 908.8 – not correctable – ensure medication is logged as dispensed.Noon dose not logged.
Police Report
Other Radio Log
Caller asking for police to report to the facility to talk to a group of kids acting up.
Police Report
Other
Parent of a Juvenile at facility called stating she could not make contact with her child, and is upset that it is the second night in a row that she cannot make contact with someone at the site.
Police Report
Disturbance
Caller stated that one of the clients were acting out; Caller advised they needed police for a little while until individual was removed.
Police Report
Other
Caller advised that a Juvenile locked himself in a vehicle and will not get out; Caller wants Officer to drive through parking lot to scare him to get out.
Police Report
Fire Alarm
Fire Department was contacted; No other info.
Police Report
Fire Alarm
Fire Department was contacted; No other info.
PRLU or OLTC
Licensing Compliance Record
- 915.5, 105.5, 915.5, 105.5 – Reviewed 10 personnel files with 4 deficiencies found.
Police Report
Battery Third Degree, Criminal Mischief First Degree
Juvenile was in therapist’s office for intake evaluation; At the end of evaluation, Juvenile was told she would not be leaving the building. Juvenile began punching window in the office, damaging the window blinds. Therapist attempted to place Juvenile in an ESI twice, but Juvenile got loose and began punching Therapist in the head several times. Other staff then assisted with the ESI.
Police Report
Fire Alarm
West kitchen smoke; Cancelled per alarm company.
PRLU or OLTC
Licensing Compliance Record
- Viewed all areas of building and grounds used by children, reviewed medication logs, and fire/emergency drills logs with no safety concerns noted at visit.
Police Report
Fire Alarm
Fire alarm contacted fire department; Canceled by alarm company.