Caring Heart Residential Care Services LLC

It was determined that a caregiver did not intervene when there was an altercation between three residents.

3 out of 3 staff files reviewed did contain proof of education.

The operation failed to report sexual abuse against a child in care by another resident.

Condition 1: Condition Met/Partially Due Condition 2: Condition Met Condition 3: not due Condition 4: Condition Met Condition 5: Condition Met/Partially due Condition 6: Condition Met Condition 7: Condition Met Per condition 1 and condition 5, the operation was supposed to provide documentation to Licensing by 9/1/2022. This documentation was received late on 9/8/2022 and 9/13/2022.

Condition 1: not due Condition 2: not due Condition 3: not due Condition 4: Condition Met Condition 5: not due Condition 6: Deficient/not met Condition 7: Condition Met The operation did not provide all required documentation to meet the condition regarding physical site repairs (Condition 6). The operation has not provided a sufficient plan to meet the requirements of Condition 6, a physical site tracking log, and other documentation.

Condition 1: not due Condition 2: not due Condition 3: not due Condition 4: Condition Met Condition 5: not due Condition 6: Deficient/not met Condition 7: Deficient/not met The operation did not have the probation notice posted near the entrance or anywhere in the operation. This was corrected once it was brought to the Director and Administrator's attention. Condition 7 states that the Administrator must submit to RCCR by 5:00 p.m. each Friday his/her schedule for the following week. The operation has not been providing their schedule by 5:00pm each Friday. Instead, it has been provided after the deadline at various times. The operation did not provide all required documentation to meet the condition regarding physical site repairs (Condition 6). The operation also did not provide it once it was developed.

Operation failed to send the required 14-day planning review notice in a timely manner.

The operation failed to report multiple serious incidents to licensing.

During review of medication records -A.H. On 1/11/22 and 1/26/2022 Dr. Thompson did a medication review for the child and he was prescribed Trazodone 100 mg 1 tab @ PM (PRN). Medication log reviewed for January shows the staff incorrectly wrote the wrong strength. On 2/8/2022 Dr. Thompson did a medication review for the child and changed the Trazodone 100mg to 50mg 1 tab @ PM (PRN). February and March Medication log shows the staff gave the correct dosage and strength for the child.

A caregiver displayed a lack of self -control when he punched a hole in a wall.

Several medication records reviewed were missing the reason the medication was prescribed.

There is a hole in a wall in the children's bedroom downstairs. The restroom downstairs has strong urine ordor.

Staff recorded an exchange between an adult asking a child what day the incident occurred, the child says that he believes it occurred on a Friday, and is then asked how he was "scratched" and then the adult says that "he scratches himself, then why are you saying they scratched you."

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 when the caregiver put a child in care at risk of physical harm when he slammed the child to the ground.

A caregiver slammed a child in care to the ground as a form of discipline which caused the child physical pain.

One of the bedrooms smelled of urine.

1 of the 6 children's medication records reviewed contained medication errors and there was no documentation of the errors.

One personal restraint documentation reviewed stated a child in care was restrained in the prone position for 5 minutes/Operation need to provide corrective action plan.

All residents interviewed stated they have either been hit by the staff or witnessed the staff hit another resident. Also, a staff stated they have heard the same staff yell at children in care and 3 of the 4 children interviewed stated the staff yells at them./Operation need to provide corrective action plan

Personal restraint documentation reviewed states that a prone restraint was performed on a child in care but it does not indicate it was used as a transitional hold./Operation need to provide corrective action plan

During the walk through it was observed that the 1st floor master bathroom was missing 4 light bulbs over the sink.

A caregiver used hitting as a method of discipline.

A caregiver placed a child in a closet as a method of discipline.

One personal restraint documentation reviewed stated a child in care was restrained in the prone position for 5 minutes

Medication record documentation states that a child in care was administered 2 separate medications that belonged to another person.

Personal restraint documentation reviewed states that a prone restraint was performed on a child in care but it does not indicate it was used as a transitional hold.

2 of the 3 staff files reviewed did not have a record of a TB screening

All residents interviewed stated they have either been hit by the staff or witnessed the staff hit another resident. Also, a staff stated they have heard the same staff yell at children in care and 3 of the 4 children interviewed stated the staff yells at them.

1 medication record reviewed was missing the time the medication was administered and the staff's initial/signature.

Several children's medication records reviewed shows that a children missed at least 1 dosage of medication. Also, a child's record reviewed shows that a child in care was not receiving the correct medication dosage.

2 medication records reviewed shows that medication was not disposed of after being discontinued.

Staff did not demonstrate prudent judgment when 2 residents were administered medications after the medications had been discontinued by the provider.

Several child records shows that children missed at least 1 dosage and there is no documentation as to why.

During the walk through it was observed that the 1st floor master bathroom was missing 4 light bulbs over the sink.

During the walk through at the operation it was observed that the bathrooms upstairs and downstairs had a urine smell. The backyard had a a pile of (10) rocks right outside the door (photos taken). The walls of the operation have writing through out the operation/home. 12/22 was provided due to the walls and writing.

The thermometer in the refrigerator was above 40 degrees (photo taken). Additionally, during the walk through the deep freezer stored in the garage did not have a thermometer. The Freezer attached to the refrigerator did not have a thermometer (photo taken).

3 children described restraints with their hands behind their back and being placed on their stomachs, 2 of the children stated that this is how restraints are done. 1 staff member stated that restraints were done with hands behind their backs. A different staff stated that she placed one of the children?s hands behind their back to retrieve a comb. The child stated that he was on the floor with his hands behind his back.

Caregivers failed to adhere to the child's rights to be free of abuse, neglect, and exploitation as defined in Texas Family Code 261.401 when 2 caregivers caused physical harm and injury to children in care.

2 caregivers used corporal punishment on children in care when they punched the child/ren.

The child-care administrator failed to provide oversight of staffing patterns, which resulted in the systematic failure, which in turn facilitated the physical abuse of a child in care by a caregiver that was previously believed to have physically abused a child in care before.

3 of the 3 children interviewed stated that a staff member pinches and pulls on the residents.

During initial walkthrough the refrigerator contained no food of substance, when addressed, staff stated the residents were having left over from the day before, there was no food cooking and only a cake in the refrigerator.

While conducting interviews, children stated they are allowed to play shooting games. During the walkthrough, a PS4 was observed with video games rated MA and 17. These are not appropriate to the children's needs.

It was learned during an interview at the children's school that a child in care arrived to school wearing a female's blouse. All residents at the operation are boys. The school provided the child with a change of clothing.

There was no documentation regarding a post restraint discussion.

Caregiver with a pending background check was present at the operation, supervising children and administering medication.

One restraint report reviewed did not include the type of restraint that was used.

The operation does not have an overall operation evaluation for emergency behavior interventions.

Several children's medication records reviewed did not have an accurate count.

A new staff member is not documenting his name and signature on the medication records.

Several children's medication record reviewed showed that children either missed doses of their medication or were not given at the correct time.

One child record reviewed did not have a documented TB test.

The permit holder failed to ensure compliance with minimum standards and rules and also failed to follow the conditions of a safety plan.

A caregiver failed to show prudent judgement when she slept while on shift. The caregiver was the only adult at the facility at the time and was responsible for the safety and well being of all the children

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 when the caregiver failed to properly supervise the children due to sleeping while on shift.

There is a white shelf in one of the residents closets downstairs that has a broken bottom shelf and the side is cracked as well. There is a basketball goal in the backyard that has a broken backboard, with sharp pieces of hard plastic surrounded the frame of the backboard.

CCI was unable to retrieve or view records while at the operation. Also, requested documentation was not immediately available.

While at the operation, CCI heard staff yelling and cursing at and in the presence of children.

During a walk though of the facility 2 out of the 4 bathrooms observed had toilets that where filthy and bathrooms held really strong urine odors.

There were 5 medication records missing for 3 children in care. There was no way to confirm that the medication was administrated.

From medication records it was determined that 2 children were given medication that was discontinued.

While reviewing medication records it was determined that 4 children did not receive their medication because the refills were not made in a timely manner. As a result, medication was not administered daily as instructed. There was also 1 child who did not receive the correct dosage, the medication was to be given once a day but was given twice a day by staff. .

EBI documentation stated that a prone restraint was used on a child in care.

During a visit at the operation, CCI observed an electric saw sitting just outside the front door of the operation.

All windows in the bedrooms and living quarters are nailed shut.

Night shift staff are signing the medication logs when it is the day shift staff that administers them.

Several staff stated the night shift pops out the 8am medication at night and the staff on day shift administers them.

A staff member has violated the conditions of a background check by administering medications and transporting children in care.

One of the service planned reviewed appeared to be copied and pasted. The verbiage in the service plan does not match the RTC.

After conducting several interviews it was learned that a staff member falls asleep during the night shift.

Multiple staff and residents stated that 2 children in care have a habit of running away.

A caregiver used corporal punishment on a child when she wrestled with the child and slammed the child to the ground.

During a restraint by a caregiver, a child in care was slammed to the ground and held down on his stomach with his arms behind his back while the caregiver used her bodyweight to keep the child down, causing the child pain.

The caregiver failed to use the minimal amount of force when slamming the child to the ground causing the child to have an injury under his eye.

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 when the caregiver caused physical harm and injury to a child when performing an improper restraint.

The caregivers failed to attempt to de-escalate a situation before performing a restraint on a child in care.

A caregiver antagonized children in care by using abusive language.