Boys Haven Of America

A referral was received by Residential Contracts to inform CCR that during a visit on 4/5/23, a medication log was observed to have a missing signature to show who had given a medication. During that same visit, the operation corrected the missing signature by having a particular staff sign the form. CCR cited the operation for this, but because this form was "corrected," at the inspection, the follow-up compliance date was dated 4/5/23. Several days later, the operation disclosed that the person who signed the medication log was not the one who gave the medication. The operation then had another staff sign the form and this form was sent to Residential Contracts.

A medication log dated 4/3/23, for the medication Doxycycline Hyclate 100MG, was missing the staff's signature/initials who administered the medication. This was observed by Heightened Monitoring - Residential Contracts during a visit on 4/5/23. The operation corrected the missing information prior to end of the HM Contracts visit.

During a review conducted on March 24, 2023, it was determined that: (1) the Administrator failed to ensure compliance with the current HM Plan; and (2) 12 months had elapsed since the effective date of the plan. The heightened monitoring plan for this operation included a specific ?planned end date? at the 12-month mark by which the operation was expected to meet all heightened monitoring criteria necessary to move out of active heightened monitoring to a phase of ?post plan monitoring?. As a direct result of the administrator?s failure to ensure timely compliance with the heightened monitoring plan, this operation is now unable to successfully move to post-plan monitoring. Furthermore, the operation?s ?planned end date? must now be revised, and the period of heightened monitoring must be extended. Further details of the administrator?s failure to ensure compliance include the following: - Operation failed to satisfy the conditions of the plan - Operation failed to demonstrate 6 months of successive compliance with the standard and contract requirements that led to heightened monitoring; and - Operation was unable to meet compliance with Medium-High or High weighted licensing citations.

A medication log for Hydroxyzine documents the medication was given at "8:6." The accurate time is missing from the log. This was observed during a visit by HM Contracts on 3/21/23.

The contract therapist transported children in a private vehicle and supervised children on a fishing trip as group therapy sessions without any operation staff present. The therapist did not have a BGC at the operation and would have required one due to the therapist's role changing from therapist present at the operation in official capacity to volunteer functioning in the role of a caregiver.

A therapist transported and supervised children in a private vehicle on a fishing trip without a qualified caregiver present.

It was discovered through interviews with children in care that staff member has been observed sleeping during their night shift on two occasions.

A child was unable to take Guanfacine on 2/5/23 and 2/6/23 because there were no refills available. The operation's attempts to have the medication refilled by contacting the doctor and pharmacist were unsuccessful. The operation should have contacted Star Health for assistance with this issue, as they were directed to do on 1/19/23 during a meeting with Heightened Monitoring.

A child in care refused to take Qelbree on 2/1/23 and 2/2/23 and refused to take Bupropion and Escitalopram on 2/2/23. There was no documentation on the medication record to reflect this.

Guanfacine and Carbamazepine were administered to a child in care on 2/7/23; however, staff did not document the dosage or the date and time it was given. This was observed by Contracts during a visit the same day.

During an HM visit on 1/11/23, a medication (Bupropion HCL XL 300 MG, AM dose) shows a remaining count of 12; however, the medication log shows a remaining count of 11. On 1/10/23, this AM medication is documented as being administered twice and on 1/11/23, the AM medication is not documented as being administered at all.

During an HM visit on 1/11/23, there was no medication log available for a child's medication (Pro-Air).

During an HM visit on 1/11/23, it was observed that a child's Metformin medication was not administered the evening of 1/7/23 as required. A child's Omeprazole AM medication shows it was last administered on 1/10/23 and after this, it required a refill. This medication was not refilled, and the child did not receive it on 1/11/23, as required.

Medication errors for the following incidents were not documented within the required time frame: - Bupropion HCL XL 300 MG - AM dose missed on 1/11/23 - Omeprazole - AM dose missed on 1/11/23 - Metformin - PM dose missed on 1/7/23 - Guanfacine - Missed doses on 1/4/23 - 1/6/23

Upon reviewing one child's record, there was no TB documentation.

During walkthrough, bathroom number two had a rusted shower rod, rusted towel rack, and a crack in door. Bathroom number 1 had a rusted towel rack.

During a review conducted on 9/23/2022, it was determined that: (1) the Administrator failed to ensure compliance with the current HM Plans; and (2) 12 months had elapsed since the effective date of the plan The heightened monitoring plans for this operation included a specific ?planned end date? at the 12-month mark by which the operation was expected to meet all heightened monitoring criteria necessary to move out of active heightened monitoring to a phase of ?post plan monitoring?. As a direct result of the administrator?s failure to ensure timely compliance with heightened monitoring plans, this operation is now unable to successfully move to post-plan monitoring. Furthermore, the operation?s ?planned end date? must now be revised, and the period of heightened monitoring must be extended. Further details of the administrator?s failure to ensure compliance include the following: - Operation failed to satisfy the conditions of the plan - Operation failed to demonstrate 6 months of successive compliance with the standard and contract requirements that led to heightened monitoring; and - Operation was unable to meet compliance with Medium-High or High weighted licensing citations.

In 1 of 2 child records reviewed, there were medication errors that were not documented in the child?s record; from 05-17-22 to 08-25-22.

2 of 2 safety plans did not include ten minute checks as noted to be completed. On three separate days, 15 minute checks were documented. Also, there was no names on the forms used.

One serious incident reviewed was missing the required follow-up/interventions on the incident report.

The required information of name, age, date of admission, and gender of the of the other child involved in an incident was not listed on one serious incident report reviewed.

The operation has been without a qualified full time Licensed Child Care Administrator since March 5, 2022.

2 of 2 child's file admission assessment was not completed timely.

During the inspection, a child's medication was not stored properly.

The child file reviewed during the inspection medication log was not documented accurately. The time the medication was given to the child was not documented as well as the amount remaining was documented incorrectly.

There was no serious incident post discussion completed for the child file reviewed during the inspection.

There was no serious incident report completed to review during the inspection for 1 of 2 residents, for an incident that occurred on 06-12-22. 1 of 3 serious incident reports reviewed during the inspection did not include all the requirements. The EBI report did not include the de-escalation attempts before and during the use of the EBI and the child's reaction to the strategies, the names of any witnesses to the EBI, including any child witness, the action of the caregiver took to facilitate the child to return to normal activities following the end of the intervention and the length of time the child was restrained.

The child file reviewed emergency behavior intervention report did not include the Supervisor's signature.

The emergency behavior intervention report for the child file reviewed did not include all the documented requirements. The EBI report did not include the de-escalation attempts before and during the use of the EBI and the child's reaction to the strategies, the names of any witnesses to the EBI, including any child witness, the action of the caregiver took to facilitate the child to return to normal activities following the end of the intervention and the length of time the child was restrained.

Two of four child records reviewed did not document the reason for placement on the placement agreement.

1 out of 3 staff records reviewed did not have the required test results for the TB test.

1 of 3 staff records reviewed did not have the required signed affidavit in the record.

One of three staff files reviewed did not have the required high school diploma or high school equivalency in the record.

Four of Four child's admission assessements reviewed was missing significant required information.

Four of four child records reviewed did not document the required known contraindications.

One of four child records reviewed did not have the required orientation documentation in the child's record.

The operation has not begun to maintain an annual unauthorized absence summary log.

Four of four child's records reviewed, the initial service plans were overdue and the service plan meetings have not been scheduled nor conducted.

Four of Four child records reviewed were observed to be missing significant information/documention to include therapy notes, psychotropic medication reviews, medication logs, medical and dental documention, and psychological evaluations.

Two of three staff records reviewed did not have a signed job description.

The operation does not have a qualified full time Licensed Child Care Administrator.

Two serious incident reports reviewed during the inspection did not include the date and time the operation notified the parent(s) and the appropriate law enforcement agency or the names of the persons spoken with regarding the child's absence.

A staff member tested positive for Covid, exposing eight children in care. The operation did not submit a report to Licensing and did not document a serious incident report.

During the inspection, a serious incident report that involved a AWOL child (inspection 3879356) was not available for review. A subsequent incident on a different date, involving 2 other AWOL children was not available for review.

During the inspection, an ex employee who resigned on 05-13-22, was listed on the People's List in CLASS.

The child's file reviewed admission assessment was not completed timely.

It was determined that a staff member at the operation would use profane language in front of the children.

It was determined that the operation did not document the unauthorized absence debriefing that was conducted once the children returned to the operation.

It was determined that the operation did not complete an addendum to the original serious incident report documenting the child's return to the operation.

It was determined that the operation did not call law enforcement to report an unauthorized absence of a child within the required time frame as set by minimum standards.

It was determined that the operation did not report to licensing the unauthorized absence of five children from the operation within the required time frame as set by minimum standards.

It was determined that the operation did not document the length of time that the child was gone from the operation in their serious incident reports.

During the inspection, one staff SAMA certificate did not include the date the training, the number of hours provided and the trainer's qualifications.

During the inspection, a serious incident report that involved a AWOL child was not available for review.

During the inspection, the child file reviewed did not contain the preliminary plan.

During the inspection, the citation provided on 03-02-22 inspection, regarding the child's service plan was not addressed.

One child record did not have correct dates for the last annual medical visit and next due date. There was no documentation regarding plans for high school completion, post secondary education and training and no documentation to address the child's trauma triggers, nor discussions with the child regarding sexually transmitted diseases and human reproduction.

During the inspection, 1 staff file did not complete EBI training timely.

The quarterly emergency behavior intervention report was not submitted to licensing within the required time frame.

It was determined the operation failed to ensure the prescription was issued from the pharmacy with the correct dosage instructions per the prescription received from the prescribing doctor and then ensuring that it was on the med log correctly.

20 Medication Administration Records were reviewed. A child had 5 incidences of missing a dosage and there were no corresponding medication error records. The child had another 8 incidences of missing a dosage (those were documented in a medication error). The child also went without one of the medications for 2-3 days due to the operation not refilling the medication timely. Another client in care didn't began taking one of the prescribed medications until 7 days later after the medication was prescribed. One of the clients medication was discontinued by the doctor and the client was still being administered the discontinued medication.

7 of 18 Medication Administration Records reviewed did not document the reasons for the prescription medications.

12 of 18 Medication Administration Records reviewed did not include the prescribing physician's name.

The service plans for 2 youth were completed without conducting service planning meetings, nor including the youth, a caregiver, or managing conservator. Administrative staff disclosed not having sent the required notifications nor having scheduled the service planning meetings. Two child records had no documentation of service planning meeting notifications.

During the walk through of the cottage, food in the fridge and pantry were observed to be minimal, however, the locked back pantry, refrigerator, and freezer were observed to be fully stocked. Some food items were observed to be expired.

A child's service plan documents sexually aggressive behavior, however, there are no plans to address safety.

A staff at the operation does not have required trainings. The staff was identified as a "med tech" and is at the facility for limited hours each week; however, the staff is not a contractor, but an employee of Boys Haven.

The annual fire inspection is not current and determined to be overdue.

1 of 2 child's records reviewed showed one child's service plan to be associated with another child which indicates that the child the plan was created for was based on the other's child's information.The child the plan was created for shows to have identified as receiving ID treatment, but the child doesn't actually recieve the services.

2 of 2 child records reviewed did not have the name of the designated persons listed, and thier were no face sheets on either of the child's records.

2 of 2 children's records reviewed did not list the children's high risk behaviors on the initial service plan or the review service plan and thier was no documentation of plans to address either of the child's behavior's in the plan.

1 of 2 child records reviewed preliminary plan was not completed within 72 hours.

1 of 2 child's records reviewed intial service plan was not completed within the required time frame.

2 of 2 child records reviewed did not have the required documentation of the advance notification of the service planning meeting.

1 of two child records reviewed did not have the required immunization record in the child's file. 2 of 2 child's records reviwed did not have the required tb test in the child's record.

The required annual health inspection is late and determined to be overdue since the last health inspection was conducted at the facility.

1 child medication log form showed that the child was not administered a dose of medication and their is no reason or medication error documented in the binder.

2 of 2 service plan reviews that were reviewed were missing the following:did not have all of the required signatures, didn't have all the participation dates, and didn't have the all the dates the plans were shared.

During the inspection, the Business Office Manager did not have a background check submitted or cleared prior to being allowed to be present at the operation.

During the inspection, a knife was observed on a child's bed.

The shower was not working in room #1 of the Steinhagen Cottage.

Following a serious incident regarding a child in care, the operation did not report the incident to licensing the Texas Abuse & Neglect Hotline.