- Licensing Specialist: Clayton DeBoer.
- Facility visited from 12:00pm – 1:00pm. Census: 47. MARs reviewed for 5 residents. No licensing concerns noted during visit.
PRLU or OLTC
Visit Compliance Report
PRLU or OLTC
Children's Records Review, Visit Compliance Report
- Licensing Specialist: Chelsea Vardell.
- Facility visited from 11:50 – 15:00. Census: 46. The Licensing Specialist completed a children record review for 4 residents. Walkthrough completed and MARs reviewed for 3 residents.
- Regs out of compliance –
- R911.6 – Room 202 closet boards should be removed as they can be easily removed by hand exposing nails. Due date: 6/1/22.
- R1014.6 – Escape diagram on the SRU unit is missing. Due date: 6/1/22.
- TA –
- R904.1.p – Individual therapy notes have not been added to the resident’s charts in several weeks. Please ensure that all therapy notes are documented in the resident’s files in a timely manner.
- Regs not correctable –
- R904.1.o – Resident was missing a physician order for 3 chemical restraints and 2 physical restraints, and another resident was missing a physician order for 1 physical restraint.
- R902.10 – All required admission information was obtained the day after admission and not at the time of admission in the file of 1 resident.
- R902.10.b – A description of the reasons for the admission of 1 resident was not obtained at the time of admission (Section for this information was left blank on the admission paperwork).
- R905.17 – Resident was missing restraint justification packets for 1 physical restraint and 1 chemical restraint.
PRLU or OLTC
Notice of Incident
- ER Visit (Insect Bite)
- Client sustained an insect bite while playing outside and was taken to the ER. No follow-up details.
PRLU or OLTC
Notice of Incident
- ER Visit (Accidental Injury)
- Client complained of pain to his foot after a peer stepped on it while playing outside. Client was taken to the ER. No follow-up details.
PRLU or OLTC
Notice of Incident
- ER Visit (Peer Altercation)
- Client complained of pain in his wrist following an altercation with a peer on a previous day. Client was taken to the ER. No follow-up details.
PRLU or OLTC
Notice of Incident
- ER Visit (Peer Altercation)
- Client was in an altercation with another peer and began to complain of pain to his thumb. Client was taken to the ER.
- Licensing follow-up on 6/1/22: Camera footage was reviewed, and no licensing concerns were noted.
PRLU or OLTC
Visit Compliance Report
- Licensing Specialist: Clayton DeBoer.
- Facility visited from 10:00pm – 11:00pm. Census: 50. Halls observed, and all were within ratio. One injured child was sleeping in room with staff observing. MARs reviewed for multiple residents.
- TA –
- R911.6 – Towels seen in room 401 that appeared to be used to soak up leaking water from air conditioner.
PRLU or OLTC
Notice of Incident
- ER Visit (Laceration)
- Client threw a rock through a window of the school building and attempted to climb through it, in which he sustained a 4-inch laceration to the back of his lower leg. Staff applied a pressure bandage and client was taken to the ER.
- Licensing follow-up on 5/19/22: Video footage was reviewed, and staff ratio was noted to be 4:12 in the classroom. During the visit, the window was observed to be boarded up with no signs of broken glass inside or outside the facility. Staff reported the quoted estimated time of repair is 3-4 weeks.
PRLU or OLTC
Notice of Incident
- Client was taken to the ER due to an altercation with peers in which he sustained a gash to his bottom lip and the bridge of his nose. Nurse noted visible swelling to both areas.
- Licensing follow-up on 5/23/22: Video footage was reviewed in which 2 clients began to swing punches towards one another. Staff observed immediately breaking up the fight and assisting client. Staff to client ratio within licensing limits.
PRLU or OLTC
Notice of Incident
- Elopement (1)
- Client took a staff members badge, which staff immediately retrieved. Client then climbed a fence, jumped on an AC unit, and climbed on the roof. Client then jumped from the front of the building and eloped. Staff attempted to pursue, and police were notified. No follow-up details.
PRLU or OLTC
Notice of Incident
- Elopement (2)
- Client eloped from the facility with a peer after he climbed a fence, jumped on an AC unit, and got on top of the roof. Client then jumped from the front of the building and eloped. Staff attempted to pursue, and police were notified. No follow-up details.
PRLU or OLTC
Notice of Incident
- ER Visit 1 (Hand Pain)
- Client complained of pain to his hand from an injury prior to being placed at facility. Client was taken to the ER. No follow-up details.
PRLU or OLTC
Notice of Incident
- ER Visit (Self-inflicted Injury)
- Client was taken to the ER after complained of pain due to punching “something” 2 days prior. No follow-up details.
PRLU or OLTC
Notice of Incident
- ER Visit 2 (Hand Pain)
- Client was taken to the ER after reporting hand pain to the APRN. No follow-up details.
PRLU or OLTC
Notice of Incident
- Elopement (1)
- Client was in his unit when 3 peers opened the exterior door to the unit to get him. Staff pursued as all 4 residents eloped from the property. Police were notified.
- Licensing follow-up on 5/10/22: Camera footage review found that staff was out of ratio due to a staff member leaving her assigned area. Additionally, staff on the unit did not take proper actions when her key fob was taken by the residents, nor did she provide the level of supervision necessary to ensure the safety of the residents. The residents were found in Jackson, TN; They will not be allowed to return to the facility.
PRLU or OLTC
Notice of Incident
- Elopement (2)
- Client eloped with 2 peers from his unit using a key fob they forcibly took from staff. Client was able to get a fourth resident, and all 4 residents eloped from the facility. Police were notified.
- Licensing follow-up on 5/10/22: Camera footage review found that staff was out of ratio due to a staff member leaving her assigned area. Additionally, staff on the unit did not take proper actions when her key fob was taken by the residents, nor did she provide the level of supervision necessary to ensure the safety of the residents. The residents were found in Jackson, TN; They will not be allowed to return to the facility.
PRLU or OLTC
Notice of Incident
- Elopement (3)
- Client eloped with 2 peers from his unit using a key fob they forcibly took from staff. Client was able to get a fourth resident, and all 4 residents eloped from the facility. Police were notified.
- Licensing follow-up on 5/10/22: Camera footage review found that staff was out of ratio due to a staff member leaving her assigned area. Additionally, staff on the unit did not take proper actions when her key fob was taken by the residents, nor did she provide the level of supervision necessary to ensure the safety of the residents. The residents were found in Jackson, TN; They will not be allowed to return to the facility.
PRLU or OLTC
Notice of Incident
- Elopement (4)
- Client forcibly took a staff member’s badge/key fob from her hand. Client returned to his room and later exited the hall with his peers and eloped from the facility. Police were notified.
- Licensing follow-up on 5/10/22: Camera footage review found that staff was out of ratio due to a staff member leaving her assigned area. Additionally, staff on the unit did not take proper actions when her key fob was taken by the residents, nor did she provide the level of supervision necessary to ensure the safety of the residents. The residents were found in Jackson, TN; They will not be allowed to return to the facility.
PRLU or OLTC
Notice of Incident
- ER Visit (Peer Altercation)
- Client was in an altercation with his peer in which he sustained a forehead injury. Client was taken to the ER. No follow-up details.
PRLU or OLTC
Notice of Incident
- Maltreatment
- Report received stating that client has been mixing and selling prescription drugs in the facility and it’s unknown how the child got ahold of the drugs (the drugs are not from his prescription).
- Child Abuse Hotline was called and accepted. Licensing follow-up on 5/9/22: Specialist will debrief with the CACD investigator after interviews are conducted. Specialist requested that the client’s room and belongings be immediately searched for any medication.
PRLU or OLTC
Notice of Incident
- ER Visit (Accidental Injury)
- Client injured his ankle while playing basketball and was taken to the ER via ambulance.
- Licensing follow-up on 5/9/22: Specialist requested the x-ray results via email. Results showed no fracture or dislocation.
PRLU or OLTC
Notice of Incident
- Elopement
- Client eloped from the facility after an altercation with his peer. Client kicked open doors while running through the facility and eventually left the premises. Staff kept the client in line of sight at all times. No follow-up details.
PRLU or OLTC
Notice of Incident
- Maltreatment (2)
- Client eloped off his unit with a peer after staff had fallen asleep, allowing the residents to take his key fob. Staff member was placed on immediate suspension.
- Child Abuse Hotline was called and accepted. Licensing follow-up: On 5/5/22, Specialist emailed the facility to determine the outcome of the camera review and the amount of time between the residents eloping and when staff became aware. On 5/10/22, Specialist reviewed the camera footage and discussed the incident with staff.
PRLU or OLTC
Notice of Incident
- Maltreatment (1)
- Client eloped off his unit with a peer after staff had fallen asleep, allowing the residents to take his key fob. Staff member was placed on immediate suspension.
- Child Abuse Hotline was called and accepted. Licensing follow-up: On 5/5/22, Specialist emailed the facility to determine the outcome of the camera review and the amount of time between the residents eloping and when staff became aware. On 5/10/22, Specialist reviewed the camera footage and discussed the incident with staff.
PRLU or OLTC
Visit Compliance Report
- Licensing Specialist: Chelsea Vardell.
- Facility visited; Census: 61. MARs reviewed for 2 SRU residents and 1 PRTF resident.
- Regs out of compliance –
- R911.6 – Light cover in bedroom 202 is missing, leaving the fluorescent light bulbs exposed. Station 1 quiet room had damage to the lower part of the right wall, causing shards of wood to be exposed. SRU bathroom shower stall appeared to have a dark matter in the ceiling of the entrance to the shower. The specialist was unable to determine if this was mold or dirt. Due date for all concerns: 4/29/22.