- ER Visit (Peer Altercation 1)
- Resident complained of pain in the back of the head after having an altercation with peer. Resident taken to ER. No follow-up details.
PRLU or OLTC
Notice of Incident
PRLU or OLTC
Notice of Incident
- ER Visit (Peer Altercation 2)
- Resident complained of knuckle pain after altercation with peer. Resident taken to ER. No follow-up details.
PRLU or OLTC
Visit Compliance Report
- Census 63. Facility will have Covid Clinic on 11/23/21 for vaccinations. Door has been updated with new locks and gate in courtyard was extended to the ground to ensure residents could not slide underneath. Specialist reviewed MARs for 4 residents.
- Regs out of compliance –
- R912.4 – Bathroom toilet curtain at nurse station 1 had a brown substance splattered on it. Please wash the curtain. Corrected 11/10/21.
- R1012.4 – Bathroom on SRU 200 hall needs cleaned; Strong odor of urine was coming from toilet stall. Corrected 11/10/21.
- Regs not correctable –
- R1008.3 – Two residents MARs showed medication administered for today at 1400 even though it was only 12:20pm.
- R1007.2 – Specialist discussed incident where resident was left alone sleeping on unit for 34 minutes. Staff responsible for supervision was given disciplinary action and completed camera review with staff to discuss what actions should have been taken.
PRLU or OLTC
Notice of Incident
- ER Visit (Accidental Injury)
- Resident complained of right ankle pain stating he twisted it while playing basketball outside. Resident taken to ER for evaluation. No follow-up details.
PRLU or OLTC
Notice of Incident
- Staff Neglect
- Resident was left alone on unit asleep for 34 minutes as he was mistakenly left by staff during a transition.
- Child Abuse Hotline was called, not accepted. Specialist followed up 11/10/21 in person; No further details.
PRLU or OLTC
Notice of Incident
- ER Visit (Peer Altercation)
- Resident was in altercation with several peers when he sustained injuries to his face. He refused nurse assessment, so he was transported to ER.
- Specialist emailed facility follow-up questions; Staff stated the staff/child ratio was 3:14 and 5 residents were involved in the altercation. Camera footage was reviewed by management, and it was determined that staff did respond quickly and appropriately.
PRLU or OLTC
Notice of Incident
- ER Visit (Accidental Injury)
- Resident was playing with peer when he fell and hit his head and back on the floor. Resident complained of not being able to move or feel his limbs. Ambulance was called and resident was transported to ER. No follow-up details.
PRLU or OLTC
Notice of Incident
- ER Visit (Self-Harm)
- Resident became upset and punched a window at nurse’s station. The window busted and cut the resident’s hand. Resident was transported to ER.
- Specialist emailed facility to determine plan for replacing window with glass alternative. Staff stated there is a plan to fix the window, but the type of glass has not been determined. Staff clarified the original material of window was Lexan NOT glass. The material is supposed to be a psychiatric safe glass alternative but was still able to break and injure resident.
PRLU or OLTC
Visit Compliance Report
- Specialist reviewed 3 children’s records.
- TA –
- R1002.3 – Specialist discussed with staff the criteria that should be met for a resident to be placed in the SRU program.
- Regs not correctable –
- R1003.11.d – Two residents did not have current medications listed on their treatment plans.
- R1003.11.a – One resident did not have a diagnosis related to their sexually maladaptive behavior listed on the treatment plan.
- R905.17 – One resident has a chemical restraint ordered by a physician but there is no ESI packet in the resident’s chart.
- R1002.13 – Please ensure information is obtained at the time of admission (missing information listed).
PRLU or OLTC
Notice of Incident
- Maltreatment
- Hotline was received reporting that client accused staff member of choking him during a restraint hold on 11/5/21.
- Child Abuse Hotline was called and accepted. Staff member was suspended on 12/23/21 until the investigation is completed. Specialist followed up with facility staff on 12/27/21 for additional information. Specialist reviewed restraint packet on 1/19/22 but was unable to review video footage due to length of time before it was reported. Review of camera by staff reportedly showed no choking so it was not reported to the Child Abuse Hotline. Specialist provided technical assistance that all allegations should be immediately reported to the hotline. Investigator updated specialist on 2/9/22 that the case has been closed as unsubstantiated. Facility reports that the staff member is no longer employed with the facility.
Police Report
Missing Person
Missing person; “Subject has been returned.”
PRLU or OLTC
Notice of Incident
- Complaint
- Complaint states that resident was admitted to program at the facility when he had no history of sexually deviant behaviors.
- Specialist visited facility on 11/5/21 and reviewed resident’s chart. The chart noted the resident had a pattern of sexually deviant behaviors prior to placement at the facility so he was placed in program at intake. On 11/8/21, specialist spoke with the reporter and discussed their concerns about the resident’s placement.
PRLU or OLTC
Notice of Incident
- Elopement (1)
- Resident eloped out of hall door as staff member was trying to exit out of it. Resident was followed by staff who convinced the resident to return to the facility willingly. No follow-up details.
PRLU or OLTC
Notice of Incident
- Elopement (2)
- Resident eloped under a gate while transitioning to his classroom before staff could intervene. When under the gate, resident pushed through an exterior gate that was not locked due to maintenance/housekeeping taking items to the dumpster. Staff spoke to resident (about 1000ft off property) and convinced him to return; The resident complied. No follow-up details.
PRLU or OLTC
Notice of Incident
- ER Visit
- Resident was involved in a car accident with a staff member during transport. Resident was taken to ER.
- Specialist followed up via email: Facility reported that both resident and staff sustained no major injuries and were rear ended by another driver. Staff provided Specialist with a copy of the vehicle insurance, staff’s current position at the agency, reason for transport, and a copy of the staff’s driver license. No licensing concerns were noted.
PRLU or OLTC
Visit Compliance Report
- Specialist completed partial buildings and grounds walkthrough. Specialist discussed elopements from 2 incidents and viewed door. The door does not have new lower locks as the other doors do and parts for the door are scheduled to be installed 11/1/21. Video footage was labeled incorrectly in their system, so the specialist was not able to view it (staff couldn’t locate footage).
- TA –
- Delay in reporting incidents to Licensing Specialist until 10/27/21. Staff stated staff responsible for reporting were out of the office that day. Facility reported they would come up with a system to ensure timely reporting if staff are out of office.
PRLU or OLTC
Notice of Incident
- Elopement
- Resident kicked open the door which leads to the front lobby and ran out of the door eloping from the facility.
- Staff continue to stand in front of the doors needing reinforcements during transition times of residents. Specialist visited facility and viewed the door; Repairs should be completed to the door on 11/1/21.
PRLU or OLTC
Notice of Incident
- ER Visit
- Resident began complaining of lower, middle abdomen pain and pain when urinating. Resident taken to ER. No follow-up details.
PRLU or OLTC
Notice of Incident
- Maltreatment
- A nurse responded to resident screaming/crying in the day room. After bringing resident to the nurse’s station, resident communicated that a staff member threw him into a chair in the day room.
- Staff member was placed on immediate suspension pending the results of the investigation. Child Abuse Hotline was called and accepted. Specialist visited facility to discuss incident. Due to a system error, video footage was not viewed. The staff and DCFS investigator had watched the video the previous day and concluded that the alleged staff did not shove the resident in a chair nor harm the resident. Nursing notes show no injury to resident.
PRLU or OLTC
Notice of Incident
- Elopement (1)
- Resident kicked open hall door and eloped from the property. Facility notified police and resident’s guardian.
- Specialist met with staff at facility to discuss; The door on hall has still not been reinforced due to a delay in shipping of the new part. The part is scheduled to be delivered on 10/29/21 and installed on 11/1/21.
PRLU or OLTC
Notice of Incident
- Elopement (2)
- Resident ran through hall door and eloped from the property. Facility notified police and resident’s guardian.
- Specialist met with staff at facility to discuss; The door on hall has still not been reinforced due to a delay in shipping of the new part. The part is scheduled to be delivered on 10/29/21 and installed on 11/1/21.
PRLU or OLTC
Notice of Incident
- Elopement (1)
- Resident eloped through hall door. Facility notified police and resident’s guardian.
- Specialist met with staff at facility to discuss; The door on hall has still not been reinforced due to a delay in shipping of the new part. The part is scheduled to be delivered on 10/29/21 and installed on 11/1/21.
PRLU or OLTC
Notice of Incident
- Elopement (2)
- Resident eloped through hall door. Facility notified police and resident’s guardian.
- Specialist met with staff at facility to discuss; The door on hall has still not been reinforced due to a delay in shipping of the new part. The part is scheduled to be delivered on 10/29/21 and installed on 11/1/21.
PRLU or OLTC
Notice of Incident
- Elopement
- Resident eloped from facility after pushing past staff and going out the front door by lobby. Facility notified police and the resident’s guardian.
- Follow-up: Facility is still awaiting replacement parts for the magnetic doors of the facility as they are on back order due to pandemic. UPDATE: Door has now been upgraded with a second magnetic lock.
PRLU or OLTC
Notice of Incident
- Elopement, ER Visit
- Residents (3) eloped from the facility at 20:55 after they busted through the door leading to the cafeteria, then kicked through the door leading to the front entrance of building. Facility reported the elopement to police and notified guardian.
- After eloping, the residents were involved in the theft of a vehicle, a high-speed pursuit by local police, a car crash, then a foot pursuit. One resident was taken to ER for injuries sustained during the incident and was discharged with a sprained left ankle. Another resident was noted to have multiple scratches on his body, busted lip, two chipped teeth, and sprain to right ankle. Resident was then discharged to the care of his mother after filing an AMA (Against Medical Advice) at 3:15am on 10/18/21.