San Marcos Treatment Center

An x-ray concluded that a child in care had a fractured finger, and the injury was not reported to the hotline until after the required timeframe.

After the review of video footage, it was observed in the common room that there were 12 children to 2 staff members.

Staff was not properly informed of supervision levels regarding children in care.

During the course the investigation, it was determined a caregiver failed to intervene timely during an altercation which resulted in minor injuries to a child in care.

During the investigation, it was found that seven out of seven children reported that different staff have used profane language/multiple curse words towards the children in care in a derogatory way and/or have said inappropriate derogatory comments towards and around children in care. Other collaterals reported staff may use profane language out of reflex or by accident around children in care, but usually not near or away from the children in care.

4 children interviewed mentioned that during the incident one staff member directed profane language toward a child in care.

A direct care staff has been working at the operation without an active background check. This staff's background check was inactivated as of 6/16/22. [The operation was recently cited for background check results on 3/17/22].

A child was able to obtain staff's prescription medication from a staff member's personal backpack while at the operation.

1 child's file documented the child had a dental exam 7 months prior to being placed, however, the operation did not have documentation to prove this exam took place.

2 out of 3 affidavits for employment were completed after the date of hire.

While reviewing the operations background checks, it was observed that a Psychatrist has an inactive background check as of 03/17/20. This Psychatrist is currently employed with this operation.

A staff member was noted to have placed a limb (hand and arm) around a child?s neck.

A staff member?s actions were noted to have escalated a situation, which ultimately resulted in at least one child in care being inappropriately restrained.

A staff member?s actions were noted to have presented a genuine threat of substantial harm from physical injury to the child when the staff member placed the child in an inappropriate restraint.

Physician Progress Notes completed for 4 weeks did not have the correct medications for the client being treated. The medications were from a previous client and were not deleted when the template was used for the next client.

A child in care was injected with Medroxyprogesterone 150MG on 1.31.22 without consent from their medical consenter.

A child in care did not receive medical care as needed for an injury when the child had an incident on 1/8/22 of punching walls and did not have an X ray of his hand until 1/11/22, where it was discovered the child had a fractured finger. Following X-rays the child did not see a doctor for their fractured finger until 1/25/22.

Hand sanitizer was left accessible to a child in care who then ingested the hand sanitizer.

A child in care was restrained five times in a six day period. The triggered review documentation associated with these incidents did not include all elements of an initial service plan, or a review of the records/orders associated with the emergency behavior interventions.

One of three staff files reviewed did not have a signed/dated statement indicating the employee is responsible for reporting suspected child abuse, neglect, or exploitation to the Texas Abuse and Neglect Hotline, and to the operation?s administrator or administrator?s designee.

Staff did not demonstrate continuity of care with a child that was displaying multiple physical symptoms. The child went to the emergency room on 8/2/21. Multiple staff that worked with the child in the week following their emergency room visit were not informed of how to monitor the child or what the ER discharge paperwork reported would prompt a need for immediate medical attention. In a week the child continued to lose weight and medical issues progressively worsened.

Two of three child files reviewed did not have dental needs addressed in their master treatment plan.

One of three staff files reviewed did not have a signed and dated statement that they must immediately report suspected child abuse, neglect, or exploitation.

Three of the three child files reviewed did not have specific information about how each child's cultural identity needs would be met. There was a generic statement in all three records about having weekly meeting with the unit manager to address cultural identity issues.

Three out of three child records reviewed did not have a placement agreement with parent's signature.

One of three master treatment plans reviewed did not have documentation that parents were notified two weeks in advance of the meeting.

A child in care was restrained when they were peeling paint off a wall and would not listen to staff when asked to stop