Tree of Life RTC

A record review of a child's admission assessment contained information regarding another resident.

During a walkthrough inspection of the operation, milk, hot dog and hamburger buns, wheat bread, and tortillas were found past the sell or use by date. The operation disposed of the expired items while inspector was present.

During a walkthrough of the operation the door to the casemanagers office was locked and unable to be accessed.

During a walkthrough of the operation, the windows in the bedroom do not have natural light to the room as the windows are now blocked with privacy panels due to an add-on room to the house for the case manager.

During a follow-up walk through conducted at the operation, the sink in the bathroom remains leaking and the blind in the second bathroom downstairs is still broken.

The evacuation floor plans hung in the operation do not reflect an acurate depiction of the exit route or shelter in place location.

During a walkthrough conducted at the operation, there was a broken electrical outlet, water leaking under a bathroom sink, exposed wiring inside a bathroom, broken window blind, screens that were torn on the porch area, broken tiles, and room transitions that pose a tripping hazard.

During a walk-through of the operation, there was several containers of over the counter medications that were expired.

It was determined that the operation did not report three different incidents with a particular child.

It was determined that one bedroom did not have blinds on the window,

A staff member did not follow the operations policy to check for a body part to ensure the child's presence in the facility

A staff at the operation did not provide adequate overnight supervision checks which resulted in the child's subsequent AWOL, involvement in criminal activity, and injury.

Caregivers failed to notify licensing of a child in care of an incident involving the child sustaining an injury.

Staff failed to provide adequate supervision which caused a child in care to sustain injuries.

The service plan reviewed did not have specific level of supervision for when the child is participating in outside activities.

Operation was out of ratio as one of the children required 1 to 1 supervision at the time of the incident.

Caregivers failed to notify the parent of a child in care of an incident involving the child sustaining an injury.

The refrigerator's thermometer was not at 40 degrees or below. There was also food in the freezer that was not properly stored but it was corrected at inspection.

The vehicle used to transport children was observed to have the check engine and tire pressure light on.

It was determined that the operation did not follow the safety plan in place to ensure the safety of a resident with known high-risk behaviors.

Three of three records reviewed does not have a clear determination of how they will meet the needs of the children in care.

It was determined that the operation does not have a treatment director.

It was determined that one bed wood panels were not secure, and a chair was observed to have broken wood pieces.

One of two records reviewed did not contain a pre-employment screening assessment.

The service plan reviewed did not have specific level of supervision.

Expired medication was observed stored in the medication cart and not properly discarded. It was also noted the cart was full and expired medication were falling out.

Staff admitted they were not drug tested prior to starting position at the operation.

Staff did not have training for administering medication and no training for psychotropic medication.

An active staff list was provided during the investigation inspection. A current employee that was hired on 11/21/2021 shows an inactive employment background check status since 08/25/2023.

Several holes were observed in walls/closet during the walk through. In addition, an exposed electrically socket was observed in a downstairs bathroom.

One of two records reviewed was missing the duration of placement, family involvement, and social history.

One of two employee records reviewed is missing an affidavit.

One of two employee records reviewed does not contain the correct proof of HS diploma or GED.

It was determined that the operation has been without an administrator for 90 days. The operation stated that they have two options that they will be sending an offer letter to by this week. Depending on which one accepts, the anticipated start date will be at the beginning of September.

Two of three staff records reviewed did not contain proof of graduating high school or college.

Five of five assessments reviewed did not have the complete school history of each child. They also didn't include the reason child was removed or placed at previous homes or RTCs.

One of three staff records did not contain an affidavit.

Five of five assessments reviewed did not provide determination of how the operation will meet each child's needs, just states that they can.

Five of five records reviewed did not contain a suicide screening.

Five of five assessments reviewed does not have a description of the actual behaviors.

One of five plans reviewed did not contain the possible side effects of the medication.,

Five of five admission assessments reviewed did not provide a clear understanding of why the child was placed in your care.

Four of five assessments reviewed did not indicate if the children had any criminal history.

Two of three employee records reviewed did not contain suicide prevention training.

During the walk-through, it was observed that a bathroom door was split open, one hole in the wall, one door has been kicked at the bottom, wooden rods in closet can be easily removed, electrical plug is not connected to wall, and one dresser was missing the drawer.

The operation's vehicle has been in the shop for a week and there is no emergency vehicle available.

Three of five assessments had the same information as to the circumstances of why the child was placed in care.

One of three staff records reviewed indicated that he was exempt from pre-service training due to receiving it at previous employment. There is no documentation of these trainings being completed.

One of three staff records reviewed indicated that they are using a TB test from 2019 when they started working here 12/2022. The employee has no previous history of working at a GRO/RTC/CPA.

Five of five plans reviewed did not have a designated person for each child.

The plan was not signed or dated by the Treatment Director.

The treatment director is only present once a week at the operation. The treatment director needs to work at least 30 hours a week at the operation to meet the full-time status.

The sink handle in one of the bathrooms was loose. A tool was observed being used to assist with operating a washing appliance. Two doors were observed with physical breaks and cracks. One bedroom dresser was observed with broken handles. Multiple foundational issues were also observed.

The admission assessment does not contain the child's behavior, why he is in placement, the address/phone numbers for child's caseworker and foster parents. The admission assessment also did not contain the child's behavioral levels while at school.

The admission assessment did not contain the reason for previous placements.

The discharge paperwork was missing the child's service plans for the last 12 months and the child's list of medications.

It was determined that the operation does not currently have an administrator.

It was determined that a caregiver was 20 years old working with children 13 years old and older.

While working for Tree of Life, the administrator was also listed at another facility that was not contiguous.

The operation has a bedroom downstairs that has 2 windows however there is an office being built therefore there is no outside exposure to natural light.

One of two records reviewed did not include the child's current level of functioning.

It was determined that the orientation provided did not include how to make complaints.

One of the two records reviewed did not include the history of other placements, neonatal history, criminal history, school history, or skills/special interest

Three of eight medication logs did not have the accurate count of medication administered.

During inspection, it was noted that the Health and Sanitation permit for the operation has expired and needs to be renewed.

During inspection, it was noted that the discharge plan of 1 child did not include the name, address, telephone number, and relationship of the person to whom the child is discharged.

During inspection, it was noted that a CPR Certificate of a staff did not contain an expiration and/or renewal date as determined by the organization providing the certificate.

During inspection, it was noted that there was no copy of the car insurance of the operation's vehicle.

During inspection, it was noted that 2 out of 2 children's files reviewed did not contain an initial/updated service plan.

During inspection, it was noted that the training log for one staff did not contain a certificate, letter, or a signed and dated statement of successful completion from a training source on trainings held for the year 2021.

There was no documentation about the severe weather drills.

One of two records reviewed did not contain a notarized affidavit.

There is no documentation regarding pre-service training for one of two employee records reviewed.

One of two employee records still does not have a signed copy of the operational policies.

One of two records reviewed did not contain a job description. The one job description reviewed needs more information in regards to the employee position.

One of two records did not contain documentation of training for the administering of medication.

The locks on the window in a child's room is broken. Door handle missing on one door.

The child's service plan was not updated. The last service plan made available was dated 8/9/2021.

Staff failed to appropriately supervise a child in care. The child has been involved in several accounts of physical and verbal aggression incidents. Staff have not taken into account the child's mental, emotional and social history and have not been able to prevent the incidents involving this child.

It was determined that a caregiver placed a child in a chokehold.

It was determined that the caregiver was not properly trained in EBI.

Caregivers failed to adhere to the child's rights to be free of abuse, neglect, and exploitation as defined in Texas Family Code Section 261.001.

It was determined that a caregiver placed a child in a chokehold and slammed him against the wall, hitting the child's head. The child was not provided with medical care and has a history of a traumatic brain injury.

It was determined that there was no serious incident report documented.

It was determined that the caregiver did not use appropriate disciplinary measures.

It is determined that the administrator was not working full-time at the operation. She was working another job as a CPS Investigator.

It was observed that two children in care was left with a caregiver/case manager that has an expired CPR certificate.

One of two records reviewed did not contain a job description.

There was no documentation about the severe weather drills.

There was no documentation of a training for the administering of medication.

There is no documentation regarding pre-service training for one of two employee records reviewed.

One of two records reviewed did not contain a notarized affidavit.

One of two employee records did not have a signed copy of the operational policies.

It was determined that two caregivers do not have CPR certification.

The window in the back bedroom does not have locks.

Two of two records reviewed did not contain the child's understanding of being in placement.

Two of two records reviewed did not contain the services the operation plans to provide for the child.

Two of two records reviewed did not contain how to make complaints to outside agencies.

During the inspection, it was observed that the home should be sanitized before accepting children.

Three of three employee records did not contain a signed/dated statement of the operational policies.

Three of three records did not contain orientation.

During the inspection, it was observed that over five windows do not have screens to protect against insects/bugs.

The assessment does not specify how to meet the needs of child's history of drug abuse.

It was determined that four employee records did not consist the operational policies.

The severe weather drill form did not include a spot to document the length of time for the evacuation or relocation to take place.

The assessment does not specify how or if the child?s family will be involved.

The emergency evacuation plan and relocation plan shows one exit route through the laundry room, but there is not a door in the laundry room to be able to exit the home.

After reviewing the medication log I observed that there was not a space for the reason the medication was prescribed.

After reviewing the personnel records one of the staff did not have their high school diploma or transcripts in their file.

The floor plan used for the emergency evacuation and relocation diagram does not match the layout of the home.

The assessment does not specify about the child?s understanding of placement.

During a walkthrough of the operation I observed a window on the outside of the back porch has a screen that appeared to be torn and coming open.

One of the staff members personnel records was missing a job description.

The policies and procedures contained conflicting information regarding whether the operation will allow staff to take children away from the operation on overnight visits. The preservice training policy (page 29) includes the name of another operation.

During a walk through of the facility I observed exposed wires near the shed in the back yard. The floor paneling from kitchen to bedroom is loose and lifts up. The dresser in one of the bedrooms was missing a door knob and appears to have unfinished paneling at the top. The hanging rods inside the closets are loose and can be removed. The upstairs bathroom has a hole on the side of the vanity where the toilet paper holder was located. The bathroom downstairs has a door for piping that does not shut well and is hanging.

The orientation was missing from the child's record.

The menu does not contain any substitutes.

After reviewing the medication log space I observed that the log was missing the prescribing health care professional.

One child record observed did not have a copy of their rights.