- Licensing Specialist: Clayton DeBoer.
- Facility visited from 1:00pm – 2:00pm for PRTF building. Census: 11. MARs checked for 5 residents. No licensing concerns noted during visit.
PRLU or OLTC
Visit Compliance Report
PRLU or OLTC
Notice of Incident
- Elopement
- Client eloped from facility and a search was immediately started and authorities notified. Once located, EMS came to facility and determined client did not need to go to ER. Per licensing email to facility on 6/2/22, client remains at facility and is doing fine.
PRLU or OLTC
Notice of Incident
- Maltreatment
- Client stated while at facility between 2018-2019, staff members would take him and other residents and pull their arms behind their backs, lift them off the ground, and hold them while they screamed in pain. He stated staff members would grab him by the neck and push his head forward and down to his crotch until he was grasping for air. He mentioned having to shower with the curtains open and staff members making fun of his and others private parts. Client stated a staff member had broken his fingers, bending them backwards until they snapped. He stated his fingers were purple for weeks and he received no medical treatment. Client disclosed that he was placed in a corner, his hair was grabbed, and his head yanked around.
- Child Abuse Hotline was called and accepted. Licensing call with CACD supervisor on 6/7/22: Supervisor stated no additional information was available as it pertains to licensing. Staff in report unknown. Report dates back 3-4 years.
PRLU or OLTC
Validation Survey
During the Validation Survey conducted from 5/9/22 – 5/16/22, the facility was found to be in compliance with program requirements.
PRLU or OLTC
Visit Compliance Report
- Licensing Specialist: Clayton DeBoer.
- Census: 12. Buildings and grounds conducted from 1:30pm – 3:00pm and MARs checked for 5 clients; No concerns noted.
PRLU or OLTC
Notice of Incident
- Maltreatment
- Client was being provided safety escort due to being physically aggressive towards peers outside when he spit in staff member’s face. Staff member then hit client with an open hand in his face. Staff member was terminated immediately, and client remains at facility.
- Child Abuse Hotline was called and accepted. Specialist visited facility on 3/7/22 to address incident. No video footage was available (facility does not have cameras). Facility staff provided termination papers on staff member, and signed sheets of recent retraining (“Self-Regulation”) that she had facilitated for most of staff, still lacking some night shift. Client was assessed by nurse with no issues and met with the neuropsychologist who noted client to be okay. Facility cited for 905.4g and 907.2.
PRLU or OLTC
Visit Compliance Report
Facility visited and records reviewed for 10 clients and 10 personnel.
PRLU or OLTC
Visit Compliance Report
Walkthrough conducted of Americana and Cabin 6 (visit cut short due to immediate notification of quarantine); MARs checked for 5 residents. No concerns noted.
PRLU or OLTC
Visit Compliance Report
- Census 13; Reviewed 7 medication logs. Most children were at school during the visit.
- Regs out of compliance –
- R908.8 – All evening dosages were pre-signed on the medication log. Ensure medication is only logged as dispensed and training is provided to nurses.
- R406.3 – Nurse came back to sign a noon and PRN dose while reviewing logs; Ensure medications are only logged as dispensed and training is provided to nurses.
- R406.5 – Prescription cream was left in child’s room. Corrected 11/10/21.
- TA –
- R911.6 – Hole in wall appeared to be in process of being repaired in room 9.
Medicaid Inspection of Care
On-Site Inspection
- Included: IOC (revised), CAP
- Multiple deficiencies noted. Plan of Correction required to be completed within 30 days.
Police Report
Information, Sex Crime
Detective received referral from Child Abuse Hotline on 8/13/21. Sent in by fax to hotline: Juvenile 1 is 10 yo and Juvenile 2 is 11 yo. J1 reported that J2 asked him to suck his penis in exchange for toys. J1 told him no and J2 continued to bribe him with toys and to “just let him do it.” J1 reported he did suck J2s penis 2 times and J2 sucked J1s penis 5-6 times. J2 said if J1 ever told anyone that he would punch him in the face. J1 reports another time where J2 asked J1 to pull his pants down; J1 told him no and J2 pushed him against the wall and tried to stick “it” in his butt. J2 denied any penetration or contact.
PRLU or OLTC
Visit Compliance Report
- Specialist conducted building and grounds inspection; Reviewed medication logs for 8 residents. Initials were missing from the logs on the date of 8/10/21 for all 3 residents. Found multiple items of clothing during walkthrough that contained drawstrings.
- Regs out of compliance –
- R911.15.f – Ensure all shoelaces, drawstrings, and cords are removed from belongings and are not accessible to residents. This was corrected on site at the time of visit.
- R406.4.d – Ensure initials of the person giving meds are on the med log. The nurse that was on duty advised that she normally fills these out at the end of the shift. Nurse agreed to fill them out when the meds are given. The Compliance Officer advised the Nurse Manager would re-train all staff on this procedure.
PRLU or OLTC
Visit Compliance Report
- Reviewed 10 personnel records. No regs noted out of compliance.
PRLU or OLTC
Visit Compliance Report
- Specialist viewed new building that will be in use in next couple of weeks, Extension of cabin 6. Also viewed cabin 6 and Americana.
- Regs out of compliance:
- R911.15.f – One clothing item found in room with drawstring. Correction date 12/7/20.
- Regs not correctable:
- R908.8 – Meds not logged for Sunday, 12/6/20 for 2 children at 5:30am.
PRLU or OLTC
Background Check Review, Visit Compliance Report
No regs out of compliance.
PRLU or OLTC
Visit Compliance Report
- Virtual walk thru was completed of Cabin 6, newest building on campus. Virtual walk thru was started in Americana Building but was discontinued due to technical difficulty.
PRLU or OLTC
Licensing Compliance Record
- Viewed cabins 4 and 6 and all areas used by children with no safety concerns viewed at visit.
- Reviewed 10 children’s records – no deficiencies noted.
- TA: agency plans to rebuild cabins for adolescent program for the dual diagnosis program that should begin in October
PRLU or OLTC
Licensing Compliance Record
- Viewed cabins 4 and 6 and all areas used by children with no safety concerns noted.
- Reviewed 10 Personnel files – social media confidentiality statement missing from all. Compliance date and date corrected listed as 06/23/19 for all.
PRLU or OLTC
Licensing Compliance Record
- Viewed Americana, Cabin 4, and Cabin 6, schools, and kitchen buildings and all areas used by children with no safety concerns cited.
- TA: Discussed that I will need a copy of actions taken to address bed bug report. Date corrected 4/1/19.
- Timber Ridge Plan of Correction. Bed bugs found by staff in 1 bed.
Police Report
Theft of Property
Caller advised Resident stole a van at facility at approximately 1330 hours, Staff had Resident blocked in at front gate. Resident had taken keys from Staffs locker(not locked); Resident later got out of van and returned inside the facility. Officer advised he would send the report to the Prosecutors Office to see about relocating Resident to a more secure facility. Officer also advised Staff to keep all vehicle doors locked and all keys locked up.
Police Report
Missing Person
Caller informed Officers that a Resident had left the facility at approximately 5:30 pm. Upon Officers arrival, Staff stated they had no one by the name the Caller gave, but stated a Resident at the facility had probably called and that last time she did this (2/15/19), she hid while several employees searched for her. Staff stated Resident had a brain tumor at a younger age and was very deviant. Staff and Officers located Resident walking on road in facility at approximately 7:15 pm; Resident stated she was fine and didn’t know why she was hiding.