Officer stood by while MEMS transported homicidal juvenile to acute facility.
Police Report
Assist Agency
Police Report
Battery
Officer spoke with staff, who stated a juvenile was yelling and threatening another student and staff intervened. Shortly after, juvenile hit staff, resulting in injury (wound to ear, sore and swollen jaw).
PRLU or OLTC
Maltreatment, Notice of Incident, Self-Injury, Visit Compliance Report
- Maltreatment, Self-inflicted Injury
- Client exited school building and refused to return inside; Staff initiated a personal restraint and escorted client inside. After continuing unsafe behaviors, client was placed in locked seclusion. Client broke his glasses and punched the door several times while in seclusion. Client calmed once a different staff member spoke to him. While placing the client in seclusion, client hit a staff member in the face and staff pushed client back into the seclusion area, then client slipped and fell. The push was called in to the Child Abuse Hotline. Nurse noted abnormality to client’s left pinky finger and was sent to the ER. Diagnosis: Closed nondisplaced fracture of 5th metacarpal bone. Soft cast placed on client’s hand.
- Licensing follow-up: Licensing reviewed camera footage and witness statements. Licensing observed staff member blocking the seclusion room doorway to prevent client from leaving. As the staff member was attempting to close the door, the client was swinging at staff, and both lost their balance. When client lost his balance, staff was able to place the client in locked seclusion. Complaint unfounded.
PRLU or OLTC
Buildings and Grounds, Children's Records Review, Personnel Record Review, Visit Compliance Report
- Licensing Specialist: Kendra Rice.
- Buildings & Grounds conducted from 11:45am – 12:45pm. Census: 34. Chestnut, Mabee, and Sturgis House observed. Chestnut House had 3 visible holes in the ceiling due to a pipe busting in the sprinkler system; Repairs were completed on 12/1/22 and the contractor is scheduled to repair the ceiling on 12/6/22 or 12/7/22. In Mabee House, a noise was heard in a bathroom vent when the light was turned on; Specialist informed staff.
- Licensing reviewed 6 resident files from 12:45pm – 2pm. No licensing concerns noted.
- Licensing reviewed 4 personnel files from 2pm – 3:15pm. No licensing concerns noted.
- Regs out of compliance –
- 9.911.6 – Light cover had visible crack in bedroom #7 and bathroom #1 had a black substance on the shower curtain (Chestnut House). Correct by 12/9/22.
- 9.911.7 – Licensing shall be notified of any changes to buildings that affect usage, size, capacity, or structural changes.
PRLU or OLTC
Notice of Incident, Suicide Attempt, Visit Compliance Report
- Suicide Attempt
- Client refused to take his evening medication and began banging his head against a door and kicking walls. After behavior continued, client was placed in a personal restraint and then locked seclusion. While in seclusion, client attempted to choke himself. Client later received chemical restraint (injection of Chlorpromazine 25 mg). Nurse assessed client after incident; No injuries noted. Client placed on eyeball precaution due to his suicidal remarks and actions.
- Licensing follow-up: Licensing reviewed camera footage on 12/07/22 with no licensing concerns noted. As of 12/07/22, client was taken off eyeball precautions and remains on close observation precautions.
Police Report
Disturbance
QRTP – Staff advised officer he was threatened by a juvenile, who stated “I’ll burn ya ass up.” Juvenile admitted to stating that, but meant “burn” to mean he would insult staff.
Police Report
Disturbance
QRTP – Juvenile became upset because he didn’t want to share a gaming console. After a peer had calmed down and began helping staff cook, juvenile attempted to touch everyone’s food and kicked the kitchen cabinets. Juvenile was put in a restraint, during which staff stated he accidentally head butted juvenile.
PRLU or OLTC
Notice of Incident, Self-Injury
- Self-inflicted Injury
- A peer reported to staff that client had hurt herself with a razor blade she found in the trash at a hotel she was in with her grandparents (during her therapeutic home visit). Client had deep cuts in both her thighs. Wound care provided and client sent to the ER. Client returned from ER with new medication, 6 stitches to L lower extremity and R extremity was cleaned, no stitches required. Client placed on front of house and eyeball status.
- Licensing follow-up: This incident did not happen at the facility.
PRLU or OLTC
Notice of Incident, Self-Injury, Visit Compliance Report
- Self-inflicted Injury
- Client received “Pause time” in his room for telling a peer that an elderly couple on a TV commercial were his parents. Client became upset and after refusing to calm down, he was restrained and placed in unlocked seclusion. Client was placed in locked seclusion after becoming defiant, hitting his fist against the door and threatening peer. Another restraint was initiated after client attempted to choke himself. Once client calmed down, nurse noted an injury to his index finger on his left hand from punching the window in the seclusion room (“sore left hand”). On 11/22/22, client was assessed and refused pain medication. Staff will monitor for changes.
- Licensing follow-up: Licensing will follow-up with the facility regarding client’s behavior patterns and staff’s struggles with behavior management with this client. Licensing visited the facility and viewed camera footage; No licensing concerns noted.
Police Report
Battery Third Degree
QRTP – Juvenile stated that he and a peer got into a fight on the school bus, in which peer punched juvenile in the face. Peer initially stated he didn’t punch juvenile, but later admitted to punching him after juvenile was in his face and breathing on his neck. Juvenile was taken to a medical facility for evaluation of his injury.
PRLU or OLTC
Licensing Follow Up, Notice of Incident, Suicide Attempt
- Licensing (Suicide Attempt)
- Client became upset with staff after receiving consequences for his behavior. Client threw a laundry basket top at staff and threatened staff, then began focusing on a peer and walked towards peer. Client was placed in a restraint, then locked seclusion. Client attempted to choke himself while in seclusion and was restrained. Nurse assessed client after the incident and noted some redness to his upper arms. Client had a small bruise on his wrist that he stated was from something else, not the hold. Client denied pain medication and was placed on eyeball due to suicidal statements.
- Licensing follow-up: Client was placed on eyeball (suicide precautions) and remains at facility.
PRLU or OLTC
Licensing, Notice of Incident, Self-Injury
- Licensing (Self-inflicted Injury)
- Client reported to staff that he had hit a wall the day before. Upon evaluation on 11/4/22, client’s knuckles were swollen/red. Facility will continue client’s current medications, provide ice packs, and monitor his injury to determine if an x-ray is needed.
- Licensing follow-up: Specialist sent email to facility to determine if or when client will receive x-ray. On 11/7/22, the facility advised client was not x-rayed.
Police Report
Battery
Upon officers arrival, staff member stated he was punched in the shoulder by juvenile after staff told the juvenile he needed to go to bed. Juvenile admitted to punching staff member because staff was blaming stuff on him. A court date was set for juvenile.
PRLU or OLTC
Licensing, Notice of Incident, Self-Injury
- Licensing (Self-inflicted Injury)
- Client became upset after being placed on RS. Client was not following staff instructions to stay in his room, and began throwing items, yelling, & cursing at staff. Staff placed client in restraint due to unpredictable behavior, then in locked seclusion. Client began banging his head on the wall in seclusion and then placed his hands around his neck. Staff entered and client was placed in another restraint. After client calmed down, nurse noted a small, reddened area to client’s neck.
- Licensing follow-up: Client remains at facility.
PRLU or OLTC
Licensing, Notice of Incident, Self-Harm
- Licensing (Self-inflicted Injury)
- Client self-harmed with a staple on her forearm and legs due to having suicidal thoughts. Client willingly gave staff the staple and she was placed on eyeball. Nurse noted superficial scratches to client’s forearm and upper thighs. Client denies pain/discomfort.
- Licensing follow-up: Client placed on eyeball (suicide watch) and remains at facility.
Police Report
Disturbance
Upon officers arrival, staff advised juvenile 1 was being disrespectful and threatening to jump on staff members. Staff also stated J1 turned over some chairs and tables, but fixed them once he was aware the police were called and had since calmed down. J1 stated he alerted staff that J2 got 2 juices, and when he opened the refrigerator, he hit J2s leg and he complained about it.
PRLU or OLTC
Monitor Visit, Visit Compliance Report
- Licensing Specialist: Clayton DeBoer.
- Buildings & Grounds conducted for Sturgis for follow-up on deficiencies cited on 09/07/22. Deficiencies have been corrected.
- TA –
- 9.912.4 – Bathrooms had some rust on metal fixtures and some grime on the walls; Maintenance order was placed during visit.
Police Report
Suicide Attempt
Upon officers arrival, juvenile was awaiting transport on MEMS truck. Juvenile was alert and breathing, and officer observed a bright red mark encircling her neck. Staff advised that during shower time, juveniles 10 minutes was up and when she went to check on her, juvenile would not respond and staff found her laying in the floor, red and purple in the face. Staff called for help and removed a white string and towel from juveniles neck. Juvenile was transported to Children’s Hospital by MEMS.
PRLU or OLTC
Licensing, Notice of Incident, Suicide Attempt
- Licensing (Suicide Attempt)
- Client asked staff to set a timer for 10 minutes so she wouldn’t stay in the shower for too long. When the timer went off, staff went into the bathroom to let client know. When client didn’t respond, staff opened the door and found client lying on the floor with a piece of towel around her neck. The towel was removed from her neck and 911 was called. Nurse noted purple bruising to neck, petechiae to face, and numerous scratches & cuts to upper thighs. Client was transported to the ER via ambulance.
- Licensing follow-up: Email from facility states client is being transported to an acute facility.
Police Report
Assault
QRTP – Upon officers arrival, staff stated 3 juveniles began causing a disturbance around 0330. J1 destroyed property (TV and monitor), J2 destroyed property (TV and monitor) and attacked staff, and J3 was not charged but did incite J1 & J2. Staff also stated she was struck with a piece of the TV screen, causing minor lacerations to her hand. Deputies detained J3 and arrested the other 2. All 3 were transported by MEMS to Children’s Hospital for mental evaluations.
PRLU or OLTC
Licensing, Notice of Incident, Suicide Attempt
- Licensing (Suicide Attempt)
- Client asked staff if she could talk to them, and staff said later. Client then went to the bathroom and sat there until staff asked if she was okay and she didn’t answer. Staff opened the door and client was sitting on the floor with her shirt over her face and a clothing string around her neck. Client was placed in a personal restraint to remove string from neck. Nurse noted a faint line to client’s neck. Client was placed on supportive status in addition to the already present 1:1 status.
- Licensing follow-up: Client already on eyeball (constant supervision) status. Client was able to calm down without further incident and remains at facility.
PRLU or OLTC
Technical Assistance, Visit Compliance Report
- Licensing Specialist: Clayton DeBoer.
- Licensing discussed a concern that was brought to the attention of PRLU with agency staff. Licensing discussed that PRLU holds no position on the re-admittance of a resident after they have been to an acute placement.
PRLU or OLTC
Licensing, Notice of Incident, Self-Injury
- Licensing (Self-inflicted Injury)
- Client punched the floor last night and injured her right hand. Nurse noted limited range of movement due to pain and bruising/discoloration to hand. Client was transported to the ER; Recommendations forwarded to physician and treatment orders received.
- Licensing follow-up: Client taken to emergency care for x-ray.
PRLU or OLTC
Maltreatment, Notice of Incident
- Dual (Maltreatment)
- Facility informed Licensing that video was reviewed on 9/6/22 of the evening of 8/24/22 and indicated a staff member pushed a client. The staff member was placed on leave after the video was reviewed but was allowed to return to work and was retrained. The staff member was later placed on leave after the hotline report was accepted for investigation.
- Licensing follow-up: Facility visited on 9/28/22 and incident was reviewed with Program Manager. Video review showed staff member push client into a wall inside the seclusion room.
PRLU or OLTC
Licensing, Notice of Incident, Suicide Attempt
- Licensing (Suicide Attempt)
- Client became agitated with staff due to being redirected from bullying a peer. Client then wrapped a sleeve around her neck in an attempt to commit suicide. Nurse noted red marks around the front and side of client’s neck. Client reported eyeball precautions aren’t enough for her, and physician ordered 1:1 observation and for staff to stay within 3ft with constant client contact.
- Licensing follow-up: Client placed on eyeball (constant supervision) and client will remain 3ft from staff at all times.