Fostering Life Youth Ranch, LLC

During a review conducted on February 7, 2024, it was determined that: (1) your operation?s administrator failed to ensure compliance with the current HM Plan; and (2) more than 12 months had elapsed since the effective date of the plan. As you know, the heightened monitoring plan for your operation included a specific ?planned end date? at the original 12-month mark by which your 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, your operation was unable to successfully move to post-plan monitoring by the original ?planned end date? necessitating previous extension. Furthermore, due to your recent citations issued on January 4, 2024, your operation?s ?planned end date? must now be revised again, and the period of heightened monitoring must be extended again. Further details of the administrator?s failure to ensure compliance include the following: Your operation received a high weighted citation in a pattern/trend category on January 4, 2024. Specifically, the operation was cited for 748.685(a)(4) Caregiver responsibility - providing the level of supervision necessary to ensure each child's safety and well-being. The operation met compliance on January 10, 2024. - 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 high weighted licensing citations. Finding: 748.535(2) ? The licensed administrator must ensure the operation complies with current heightened monitoring plan.

A caregiver shoved a child in care on the shoulder during an argument.

A caregiver engaged in a verbal altercation with a child in care, yelling at and shaming the child.

One out of three service plans reviewed did not have psychological recommendations documented in the service plan.

Staff failed to implement an EBI restraint when a child in care was engaging in self-harm. Additionally, staff failed to de-escalate the behaviors and provoked escalation when an intervention could have prevented the injuries.

Caregivers created an unsafe environment for an escalated child by verbally provoking the child until law enforcement was called to intervene by arrest.

Direct Care Staff and Administrative staff failed to follow the directives included in a child's service plan which calls for contact with the child's caseworker outside of normal business hours when the child is escalated.

Multiple children in care were denied the right to contact their caseworker.

A child in care was not given one medication for 3 days in a row and was also not given a lunch dose of another medication.

A child in care has not been given two doses of her Clonidine medication.

During a review conducted on August 8, 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.

Two staff failed to follow the operations policies and procedures. One staff brought into the operation their personal prescribed medication. The second staff failed to follow policy by allowing children into the kitchen.

A child in care was given another child in care's medication.

There were four children in care with medication errors that did not have a full explenation of what the errors were.

A child in care was administered prescription medications which were prescribed to another child in care.

Child received medical attention for an injury to the knee three days prior to child reporting they had slipped and fell in the shower. The incident, of the child falling in the shower was not documented and medical attention was not provided. Staff failed to use prudent judgement when decided to not document the incident or offer medical attention knowing that the child had received an injury three days prior to reporting the fall.

A child in care was injured at the operation and had to be transported to the hospital via ambulance and the managing conservator was not notified of the child's injury.

A child in care was injured at the operation and had to be transported to the hospital via ambulance and Licensing was not notified of the child's injury.

A child in care injured her knee at the operation and was transported to the hospital via ambulance the attending physician provided orders that the child receive a follow up within two days with the child's primary care physician. The operation did not take the child for a follow up appointment.

During a review conducted on 2/6/2023, it was determined that: (1) your operation?s administrator failed to ensure compliance with the current HM Plan(s); and (2) more than 12 months had elapsed since the effective date of the plan. As you know, the heightened monitoring plans for your operation included a specific ?planned end date? at the original 12-month mark by which your 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, your operation was unable to successfully move to post-plan monitoring by the original ?planned end date? necessitating previous extension. Furthermore, due to your recent citation issued on January 20, 2023, your operation?s ?planned end date? must now be revised again, and the period of heightened monitoring must be extended again. Further details of the failure of your operation?s administrator to ensure compliance include the following: The operation received a High weighted citation in a pattern/trend category on January 20, 2023. Specifically, the operation was cited for 748.685(a)(3) Caregiver responsibility - being aware of and accountable for each child's on-going activity. The operation met compliance on January 30, 2023. - 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. Finding: 748.535(2) ? The licensed administrator must ensure the operation complies with current heightened monitoring plans.

A child in care was intimidated by staff regarding allegations of a previous investigation. Children in care were offered incentives to provide information to staff regarding activity on the unit.

The time medication was administered was not documeted for at least two children in care and for several of there medications.

A child in care was given a full tablet instead of a half tablet as prescribed by the doctor

A child in care was placed in a short personal restraint in a bedroom, between two wooden beds. During the restraint, the child complained of not being able to breathe. After the restraint, the was observed with scratches on her face and bruising on her wrist and was later taken to the doctor for complaints of pain in her chest and arms.

A child in care was subject to a short personal restraint for throwing a water bottle and hitting staff. The staff member failed to utilize any form of de-escalation prior to implementing the restraint. Other staff present noted that de-escalation strategies should have been attempted prior to the restraint.

A caregiver performed a short personal restraint on a child in care as a means to get a child to comply in a non-emergency situation. The caregiver grabbed the child's arm so that the caregiver could remove photographs from the child's hand.

A caregiver implemented an emergency behavior intervention on a child in care through a short personal restraint in a non-emergency situation.

During an outing, staff allowed two children with histories of elopements, to be out of visual range supervision. Staff were also unaware the children had taken keys to the operation's vehicle.

A child in care was taken into police custody following a motor vehicle accident on October 22, 2022. The operation did not report the incident until October 24, 2022.

During a review conducted on August 5, 2022, it was determined that: (1) your operation?s administrator failed to ensure compliance with the current HM Plan(s); and (2) more than 12 months had elapsed since the effective date of the plan. As you know, the heightened monitoring plans for your operation included a specific ?planned end date? at the original 12-month mark by which your 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, your operation was unable to successfully move to post-plan monitoring by the original ?planned end date? necessitating previous extension. Furthermore, due to your recent citation issued on May 18, 2022, your operation?s ?planned end date? must now be revised again, and the period of heightened monitoring must be extended again. Further details of the failure of your operation?s administrator to ensure compliance include the following: The operation received a medium-high weighted citation in a pattern/trend category on May 18, 2022. Specifically, the operation was cited for 748.2307(8) Other prohibited Punishments. The operation met compliance on June 2, 2022. - 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. Finding: 748.535(2) ? The licensed administrator must ensure the operation complies with current heightened monitoring plans.

A caregiver failed to comply with the operation's tobacco and e-cigarette policy by vaping in an operation owned vehicle when children were not in the vehicle.

A caregiver yells and uses profanity in the presence of children in care.

A caregiver failed to follow the operation's policies and procedures by bringing tobacco products onto the campus and into the facility.

Three children in care accessed and used an e-cigarette lost by an employee in the facility.

There were two missed medications. One on 1/8/2022 and one on 1/9/2022.

This standard is being tasked as a follow up to inspection 3854778. There have been 12 different medications given in inproper dosages to children in care according to the instructions on the label. These medications were either not given to children at all or were given in a higher dosage than prescribed.

A child in care was given another child in care's medication.

A caregiver did not complete a pre-employment drug screening prior to having contact with children in care.

Emergency behavior Intervention for a child in care documentation was not fully completed within 24 hours. Missing information includes any injuries the child sustained during the intervention and the action the caregiver took to help the child return to normal activity.

An emergency behavior incident report did not include a documented review by the supervisor of the incident within 72 hours.

A caregiver pushed a child in care.

Children in care with histories of elopement disassembled a lock and eloped from the facility while unsupervised by caregivers.

Two Medication Logs were lacking information. The operation failed to document the reason for medication on the medication logs pertaining to prescription medication. The evidence and supporting photos were issued to the investigator before the initiation of this investigation.