Texas NeuroRehab Center

It was found that sections [748.311(2), (4), (5), (7), and (8)] of the incident report documentation were missing required information.

During the course of the investigation, a staff member and a child reported that the child was restrained briefly on their back (in a supine position).

Several people interviewed reported a staff member used profane language following a personal restraint in front of a children in care.

While a child was being restrained by staff, another staff choked the child.

2 children interviewed mentioned a staff threatened at least 1 child with corporal punishment.

Instead of permitting other staff to manage and defuse the situation, a staff member exacerbated the situation by intervening even though they were aware the child was upset with them.

A child received a bloody, swollen nose during a restraint due to a staff member banging their head on the ground.

A staff threw away a child's food in response to the child spitting at their feet.

During an interviews staff stated that a child was escorted from the school building back to the Sierra Unit. This walk would take over 1 minute making it a personal restraint which is required to be documented.

The facility was unable to provide documentation to show which trainings the staff took with the required information.

During a restraint, a staff used excessive force to take a child to the ground, causing the child to chip a tooth upon impact.

During the inspection, it was observed two caregivers were left with fifteen children for approximately ten minutes. This was corrected when the third caregiver returned to the unit.

A staff member has been working at the operation since 12.26.23 with an inactive background check.

During interviews 3 out of 3 children stated staff use profane language around them. 2 staff memebers also admitted to using profane language.

During the course of the investigation, it was determined that a child in care had their arm held behind their back during an emergency behavior intervention.

During the course of the investigation, it was determined that the caregiver used more force causing injury to a child.

During the course of the investigation, it was determined that the caregiver used a type of restraint that was not allowed.

This standards was found deficient as part of a DFPS investigation.

The incident occurred on 1.23.24 and the child made the allegations the same day during the debriefing. However, the incident was not reported to Licensing until 2.29.24.

The incident took place on 12.17.24 but was not reported to licensing until 12.27.24.

During the investigation, it was determined that the operation failed to submit the serious incident report within the required timeframe. The incident occurred on 12/22/23 and was reported to Licensing on 12/26/23.

Mold was observed in the Sierra unit showers.

A child in care was hit and choked by a staff member. This incident meets Texas Family Code and Texas Administrative Code definition of abuse.

It was discovered the child was administered the wrong medication accidently, one they were documented to be allergic to. The child did not have a reaction to the medication, so it was added to their daily medication regimen.

It was observed in the gym that three window panels were missing/broken, It was also found that one of the closets in the gym was unlocked and a hole in the ceiling along with the light fixture was not turning on properly was observed.

It was observed on the sidewalk outside of the gym there were animal feces in dog bags.

It was observed in the gym that there was no fire extinguisher found in the vicinity. This was corrected during the inspection when the maintenance worker sent a picture to the administrator of the fire extinguisher being posted in the gym.

Two children in care spent several days creating a hole big enough to escape unnoticed. During the time the children in care eloped, caretakers conducted routine 15-minute checks and marked them in their rooms.

The facility failed to provide RCCL Inspectors with a serious incident report or formal facility report for the incident. Requests for an incident report were made on 06/15/2023, 06/28/2023, and 07/19/2023, requests were made in person and through email.

The incident was reported to the hotline sixteen hours after the children in care were noticed missing and not reported within six hours. During the course of the investigation, it was noticed that only one victim was reported missing when two children in care eloped from the facility.

It was found that three future time and signature were documented in a medication record prior to administering the medication. One medication record had the incorrect count documented. It was also found that one medication record was missing information on who disbursed the medication.

It was determined that a nurse had multiple medications ready to disburse hours prior to the time the medication is labeled to be administered.

8 noted times on 6 medication records/logs did not document administered medication.

There was no Keeping Children Safe poster located anywhere in the Chaparral Unit.

During the walk-through of the cafeteria, it was noted that pork was kept uncovered in the freezer, a stainless-steel container of peaches in juice were kept uncovered on a cart located in a hallway in the cafeteria and a bowl of food was uncovered in the refrigerator located in the cafeteria entrance.

There were two staff members 13 resident in the Sierra Unit. As per staff the nurse was counted in ration. There were 14 residents to 2 staff members in the Chaparral Unit. Both nurses were seen in the locked nurse s station administering medication.

It was reported that all showers in the Chaparral and Sierra Unit were not in working condition as of three week prior to this date. Children in care take turns every other day to take showers in another building not subject to regulation.

It was determined that a child was restrained by staff in a wooded area in an attempt to stop them from elopement. This area was reported to be an open field with extensive brush, trees, frontage including thorns. After multiple attempts to restrain the child, there were four reported physical altercations between staff and child in where they fell on to the described brush. As such, the staff sustained several injuries.

It was concluded that a staff member subjected a child to an unnecessary EBI as a means to comply.

During the course of this investigation, it was determined that a staff member conducted an unnecessary EBI and used unnecessary strength forcing a child in care to the ground causing a bruise on their face. It was determined that the child was not a danger to self and/or others.

Both Chaparral and Sierra Unit walls had extensive peeling.

During the course of this investigation, it was determined that a child in care was improperly restrained and not documented.

During the monitoring inspection, four staff files were reviewed. It was noted that four of the four staff files did not provide documentation regarding Normalcy training. 748.749(b)(5): One of the four staff files reviewed had training certificated that did not specify the training hours.

During a walk through of the operation, 9 large cans, an unopened box of ravioles and a plastic jar of liquid were observed to be expired in the Cafeteria's pantry area.

During the monitoring inspection, four staff files were reviewed. One staff file did not contain a signed and dated statement in where an employee must immediately report any suspected incident of child abuse, neglect, or exploitation to the Texas Abuse and Neglect Hot line and to the operation s administrator and/or administrator s. 748.831(b): The same staff file did not contain orientation documentation.

During a follow up inspection, one frozen food item and several refridgerated condensed dairy cartons were observed to be expired in the Cafeteria and the same condensed dairy cartons observed also had mold on the outside of the lid area and were not of good quality.

Two children in care reported that they were served spoiled/rotten milk and that this may have been due to staff leaving the milk out of the refrigerator after use for a period of time as the milk had not been expired yet, but that it was spoiled and bad/rotten tasting. Two children in care also reported the food was not good. Staff leaving foods that should be refrigerated out for a period of time can be dangerous and may cause food-borne illnesses.