Meridell Achievement Center

An inappropriate restraint was completed by a staff on a child. Staff lunged at the child tackling the child to the ground. A proper hold could not be completed, but staff continued to wrestle with the child for 30-45 seconds until another staff responded.

During the course of the investigation, a staff member admitted they did not intervene when an altercation took place between two children in care.

Grates in 4 of the doors at the gym were found to be bent. The pool was found to be dirty and the bottom could not be seen. Trash was foun through out all of the buildings.

Two children were observed arguing and then one of the children ran over to the other child's table to try and hit the second child. One of the staff placed themselves in between the two children and the other staff grabbed the child by the arms and jerked them back away. Staff admitted the restraint was inappropriate.

Children interviewed consistently mentioned a staff member mumbling profane language and derogatory words under his breathing about the children in care.

Children interviewed stated a particular staff member yelled/raised her voice at them triggering a conflict.

It was determined staff were unable to restrain the child using techniques that were approved by the facility. The staff and 3 collateral witnesses verified this information.

The staff in question stated they did an escort when the victim refused to leave the Dayroom. 3 Collateral Staff stated an escort was done because the victim refused to leave the Dayroom.

During the investigation, it was discovered that a child's records was not documented accurately.

Documentation reviewed determined a child was assessed and concerns of a serious injury were suspected on 7/29/30 but the child was not given treatement until 7/30/24. Upon Follow up it has been determined the facility will continue with their current protocols.

A caregiver failed to adhere to the child's rights to be free of abuse, neglect, and exploitation as defined in Texas Family Code 261.401.

Through the course of the investigation it was determined a child was called a brat in front of other staff and children.

Review of the backgrounds found an employee had their background inactivated on 7-9-24 and is still having access to children in care.

Three of Seven Units were found to have repairs needed, peeling paint, broken furniture, broken or missing air vents, and trash in several rooms and on the grounds around the homes.

It was determined that staff caring for children do are not easily able to access the Service Plans for the children they are caring for.

In conducting a walk through of the facility a clogged toilet with feces, mildew in the bathroom, and toilet paper covered in bodily fluids.

Three out of five collateral interviews stated the facility has been out of ratio. Another collateral made the statement "when the facility is in ratio" indicating there are times the facility is out of ratio.

Through interviews of children and staff as well as documentation provided, it is determined one of the units on campus was out of ratio on 9/13 and 9/14.

Multiple walls in units had derogatory writing on them. There were several bathrooms that had trash items in the sinks. One ceiling vent had what appeared to be mold or heavy dust on it. A bulletin board was observed to be broken in one of the rooms. Multiple units had large areas of peeled paint on the doors and walls.

Treatment Plans, Interviews, and video were reviewed during the investigation and determined children were to be checked on every 15 minutes and two of those checks were missed.

3 Staff Charts were reviewed did not have Licensing Affidavits.

During the walkthrough of the operation childrens bathrooms were observed with mildew in the shower and bathroom sinks have excessive gunk.

During the interview, both the Administrator and the therapist stated the resident was left unsupervised.

A child in care sustained a fracture to their hand as confirmed by X Rays results that were provided to the operation on 5/11/24. The operation did not report this to Licensing until 5/14/24.

In reviewing the investigation it was found a person that was not a qualified caregiver was interacting with children and was left to supervise the children.

Three out of five children interviewed stated a staff member will cuss at them.

Documenation and interviews verified the child was recommended for a follow-up on 1/23/24 and did not receive it.

During the walk through a staff was observed in the Nurse's Station on their personal phone while 4 chidlren were out in the Day Room alone.

In reviewing the Admission Assessment, Preliminary Service Plans, and Initial Service Plans, several items that are required were found not to be included.

In reviewing Serious Incidents it was found a fght occurred in which a child was iinjured and taken to the doctor, but never reported.

In reviewing background checks if was found two employees did not have active backgrounds checks.

Interviews validated there was no documentation written for the restraint.

Interviews from 6 persons validated that staff yelled at children when behaviors started to escalate.

5 staff and 2 children stated staff yell at children in care.

3 staff and 3 children noted staff are passive aggressive and/or rude towards the children.

The operation was out of ratio during the day on at least 3 occurrences in 1-2 units.

The operation was out of ratio overnight on at least 3 occurrences in 1-2 units.

3 staff and 1 child stated staff use profane language around and/or towards the children in care.

A physical altercation occurred on 3.28.24 in a unit that was out of ratio. Due to this, a child had to call the code to get additional staff to respond. Not having enough staff to respond to codes was brought up numerous times during interviews with children and staff. Additionally, an incident occurred where a child was left in a unit for approximately 15 minutes without a staff. The nurse was double covering that day and staff believed the nurse was inside, however, she had left to check on the other unit.

Four of the Seven Units were observed out of ratio and a group was observed out of ratio while walking to dinner.

It was determined children were exposed to explicit content when a staff member screened their phone to the television.

It was noted during a walkthrough that multiple bathrooms had feces on the walls. One room had a rotten food product in the sink. Food smears were noted in multiple rooms.

Documentation determined the victim was walking away from the situation when the staff chose to restrain the child.

It was found the staff involved in this case had EBI training 7/27/23 which expired in January and did not have current training at the time of the incident.

Staff were iinterviewed and were unaware and unable to tell the protocol of knowing which staff would handle incidents and which would monitor the kids.

Based on documentation and interviews with staff, it was determined that the operation is changing the staffing schedules and adding more staff and are providing licensing different schedules.

Through interviews with children and staff, it was determined that staff are cursing directly at children to get them to comply.

Through interviews, it was determined that two units were out of ratio having 20 residents with 2 staff and 11 residents with 2 staff.

Through interviews with staff, it was determined that the operation is completing incident reports but are not making reports to the hotline.

Review of the documentation and CLASS verified it was made known a child had a serious injury on 12/5/23 but the Hotline was not notifiied until 12/11/23.

During the walkthrough of the operation a child was observed in his room alone with no caregiver within visual or auditory range of the child.

During the walkthrough trash was observed throughout the walkthrough of Liberty Hall.

Throughout the course of the investigation multiple staff admitted to the operation being out of ratio. Nurses at the operation were working as direct care givers and as nurse at the same time while being counted in ratio.

During the course of the investigation several staff stated children would wet their beds and not get clean sheets. There was a bedroom observed during the walk through with soiled linens.

Throughout the course of the investigation multiple staff and children admitted that staff use profanity around the children.

A caregiver yelled at a child in an untherapeutic way after the child had run away from the operation.

An unsafe environment was created when all staff intervened in one incident leaving other children with previous physical altercation issues unsupervised allowing a third altercation between the two children.

In the course of the investigation it was determined staff was doing other duties and was not aware of the childrens' actions allowing them to leave the premises.

In the course of the investigation it was found a staff member left the key to all doors accessible to a child in care allowing them the opportunity to elope from the facility.

A child went to the emergency room on 8/19/23 after having a seizure. Another child went to the emergency room on 9/17/23 after having a seizure. Another child went to urgent care on 8/12/23 for a fractured finger. These incidences were not reported to Licensing.

During the walk-through of Eagle unit located in Liberty Hall, it was noted that one child s pillow was complete stained and had red circular stains on it. Please refer to 748.3015, if applicable.

It was determined that Bunk House was out of ratio, 17:2, for more than 15 minutes as one staff was in the Nurse s station conducting administrative duties and speaking to children individually, and another staff left Bunk House to drop off her personal items in the Admin building. A nurse was in the Med room performing medication/administrative duties.

It was documented and made known that a child was not adequately supervised as they were able to open locked doors, leave the unit and climb the building?s roof multiple times without staff being aware he was absent from the unit. It was also recorded that the child was able to leave the unit and jump the property?s fence in which resulted in injuries.

Operation did not have required No Trespassing signs posted at entrance of facility.

Caregivers conducted an unwarranted restraint on a child in care as the child was running away.

10 of 10 serious incident reports were reviewed and none documented the operation's address or phone number, or the child's date of admission as required.

Two staff files were reviewed for EBI training documentation and both were missing documentation verifying annual EBI training was completed.

Three out of ten staff files reviewed were missing the signed policy related to reporting abuse and neglect.

During the inspection, two of six child files reviewed did not identify the level of observation required in the preliminary service plan.

In reviewing the Initial Service Plan there was no direction on supervision provided.

During the investigation, documents reviewed show the census and staffing schedule show several days in February where the Hacienda unit was out of ratio.

During the investigation, documents reviewed show the census and staffing schedule show several days in February where the Hacienda unit was out of ratio.

7 of 8 direct care staff files pulled are missing 1 or all of the annual required trainings: Normalcy, Trauma Informed Care and EBI

During the inspection, it was found that the Administrator doesn't have a background check under this operation.

Six out of six child records reviewed did not include issues that could escalate the child in cares behavior in the preliminary service plan.

Five mattresses in seventeen rooms inspected had torn mattress and mattress covers. One of the mattresses was being used by a child and it was replaced at the time of inspection.

Six out of six child records reviewed failed to incorporate individualized and specific goals or instructions to caregivers how to accomplish those goals.

Four out of ten child records did not list the known allergies or chronic conditions in a prominent place on the child file and one child record reviewed did not list a medication allergy.

Six out of six child files reviewed did not have documentation showing two weeks advance notice to the parents for the initial service plan.

Six out of six child records reviewed did not document an invitation for the parent or child to participate in the development of the service plan.

During the inspection thirteen out of sixteen bathrooms had mildew.

Four out of four discharged child records reviewed failed to include the circumstance of the discharge.

During the investigation, it was determined the operation was not in compliance in regard to ratio on numerous occasions the last month and a half. Specifically, the operation was out of compliance 19 times out of a 16 day time period.

During the investigation, it was determined the operation was using unqualified employees as caregivers on the unit due to staffing shortages. These employees were not properly trained in SAMA, normalcy, and/or trauma informed care. 8 staff training records were reviewed. 6 out of 8 records did not have proper SAMA training, 2 out of 8 records did not have normalcy training, and 3 out of 8 records did not have TIC training.

3 of 5 staff's certificates submitted for review, specifically in regard to SAMA, did not have the trainers' qualifications documented.

During the course of the investigation, it was determined that caregivers are not following the child/caregiver ratio expectations on a regular basis. It was noted 1-2 caregivers are left to supervise up to 17 children.

During the course of the investigation, it was determined that caregivers reported they were unsure how to handle the emergency situation and did not have proper training.

During the course of the investigation, it was determined a child in care was physically abused by a caregiver when he was choked.

A child in care tested positive for a communicable disease on 7/10/22, the illness was not reported until 7/12/2022.

During the course of the investigation it was determined an incident requiring medical attention was not reported timely.

During the investigation it was made known that a staff member calls the children in care "tubby tubby" and "ugly".

Based on preponderance there is evidence that children have slept on the hall floor on an unelevated mattress.

It was discovered during investigation a staff member shoved a child in care during a verbal discussion. The video footage showed the incident to be valid. Compliance was completed at time of inspection.

A child in care was to receive follow-up within 1 week from 1.16.22. No follow-up was completed.

When reviewing documents, it was determined that at least one child tested positive for COVID and was not called in on time.

It was determined that a child in care had a fractured hand on 9/3/2021. This was not reported to RCCR until 9/7/2021.

A staff member was observed on video to swing and hit a child in care multiple times, wrestled with the child and placed the child in an improper restraint where the child appeared to be knocked to the ground and have the staff member's arm across their neck.

A caregiver was observed on video placing a child in care in a supine restraint that lasted over 4 minutes.

The video of this incident showed that a caregiver got in a child's face for about 18 seconds and did not make any attempts to de-escalate the situation. The child also had stopped the destructive behavior when the caregiver walked into the room so the EBI use may not have been necessary.

A caregiver was observed on video using an improper restraint that was not a permitted technique allowed by the operation.

Several nurses were observed on video to not intervene when a child was placed in a supine hold and when another caregiver was hitting a child. They also did not continuously observe the child during the restraint to ensure safety and were observed leaving the room multiple times leaving the escalated caregiver alone with the child.

The medication room door was broken and staff did not ensure it was properly closed and a child was able to enter the room and obtain and ingest OTC medication.