Open Arms Open Hearts Foundation, LLC

During inspection, it was noticed that 4 of 4 of the reviewed records were without medication side effects in their 72 hr prelimary service plan.

The operation has not reported EBI quarter 2 ? April through June.

A staff member initiated a restraint (by placing her hands on the child in care and began pulling him out of the car) for non-compliance which led to a nosebleed.

During inspection of staff files it was noted that 1 out of 4 staff files reviewed did not have report abuse and neglect form.

It was noted that 3 out of 4 child records did not have TB test result in their file.

upon review of records it was notice that medication was not administered on the date prescribed by the doctor on Aug 11th. Medication was administered on Aug 17th after it was delivered to the operation on Aug 13th. The delivery is according to medication documentation from pharmacy.

Upon review of admission assessment it was noticed the signature page was incorrect with dates signed. The cover page of the assessment had an incorrect date of admission for child

A child's medication was not increased as per the psychological, for a month.

A child's medication record was not in the medication binder for 3 days and the administered medication was not recorded.

Two medication records were observed without a treating physicians name and one did not include what the medication was prescribed for.

A damaged pill was included in the count of the medication administered to a child.

Missing telephone number, physical address , age, gender, admission date, resolution of the incident, names of witnesses.

Time of restraint is missing

It was noted in the victim's service plan stating specialized level of care is required and recent incident reports noted that the victim has a history of aggression.

It was noted that the staff stated they were not present at the beginning of the fight between the residents and were unable to intervene.