The Ambience Residential Treatment Center

The operations permit does not have IDD or Autism as services the operation can treat.

The 4 SIRs reviewed had limited details regarding the incidents.

Front and Back exit doors can only be opened with the use of a staff's fingerprint. There is no written approval for these doorknobs on file from a fire inspector. The operation reports a fire inspector is scheduled to come out on 2/17/2025 to assess the doorknobs for approval.

During this investigation, it was found that the safety plan was not updated as needed after returning from the psych hospital.

During the course of the investigation, the operation was unable to provide the weekly screenings after the child returned to the operation.

During the course of this investigation, the operation was unable to provide a suicide screening conducted for a child that was exhibiting warning signs.

During this investigation, the operation was unable to provide documentation showing that the child met with the PLSP within 24 hours of returning to the operation.

The child's file was missing the required discharge documentation.

One employee fille reviewed during inspection was missing the education requirements

Staff filed review last EBI training was on 12/02/2023

Child records for medical reviews and documents were not current. Updated forms 2403 will need to be completed and filled out at every appointment and med appointment.

The Preventing and Recognizing Youth Sexual Abuse training was taken on 2/2/2023, and again on 6/10/2024, 129 days late. The Preventing and Recognizing Youth Sexual Abuse training was taken on 1/11/2023, and again on 6/11/2024, 153 days late. The Preventing and Recognizing Youth Sexual Abuse training was taken on 1/24/24 after the staff was counted in ratio on 12/25/23. The Preventing and Recognizing Youth Sexual Abuse training was taken on 5/21/2024 after the staff was counted in ratio on 5/11/2024. The Preventing and Recognizing Youth Sexual Abuse training was taken on 1/2/2024 after the staff was counted in ratio on 12/20/2023. The Preventing and Recognizing Youth Sexual Abuse training was taken on 1/2/2024 after the staff was counted in ratio on 12/24/2023.

The DFPS Trauma Informed Care Training was taken on 1/11/2023 and again on 6/11/2024, 152 days late. The DFPS Trauma Informed Care Training was taken on 5/18/2023 and again on 6/10/2024, 25 days late.

The DFPS Psychotropic Medication training was taken on 1/2/2024 after the staff was counted in ratio on 12/24/2023.

The form 2403 to document the 6/4/2024 Texas Health Steps medical exam was not completed in its entirety. Pages 6 and 8 were left blank resulting in required information left blank. The Visit Results (page 6) and Follow Up (page 8) were not documented. The form 2403 to document the 4/20/2024 Texas Health Steps dental exam was not completed in its entirety. Pages 2, 4, 6, 7,8 were left blank resulting in required information left blank. The Reason for Visit (page 2), Medication List (page 4), Visit Results (7) and Follow Up (page 8) were not documented. The form 2403 to document the 6/4/2024 Texas Health Steps physical exam was not completed in its entirety. Page 6 was left blank resulting in required information left blank. The Visit Results (page 6) were not documented. The form 2403 to document the 3/22/2024 ER Visit was not completed in its entirety. Pages 4,8, and 9 were left blank resulting in required information left blank. The Medications (page 4), Follow Up (page 8), Provider Information (page 9) were not documented. The form 2403 to document the 4/22/2024 medical exam was not completed in its entirety. Page 5 was left blank resulting in required information left blank. The form was not signed by the caregiver and/or DFPS staff.

The service plan completed on 6/24/2024 was reviewed and the service plan was not signed by the child, and he is able to write. The service plan does not address plans to implement the recommendations given for medical and mental health follow up recommendations by service providers. Signatures were also missing and not dated by Caseworker for child noting that they received and reviewed the recommended service plan for child.

Vehicle was missing a registration sticker. Registration (proof of purchase) paperwork stated 5/23/2023. It has been over a year since purchase date.

Multiple holes in the walls prompted a walk through. 8-10 inches in length and 4-5 inches in width. total number of holes 7. Multiple window blinds were also broken.

The operations health inspection expired on 04/21/24

There were physical site concerns during the walk through. -A room located upstairs electric plug was missing a cover. -Blinds and the kitchen and a room located upstairs were damaged. -There was water damaged on a ceiling located in room upstairs.

2 out of the 4 child's files reviewed 72-hour plans were missing signatures.

One staff file reviewed did not contain proof of education.

One staff members file reviewed did not contain documentation for reference checks.

The operation was not abiding by their pre-employment drug testing policy.

The operation has not removed a controlling person as prompted by licensing since 11/07/2023.

During the inspection, all second floor windows were observed locked/screwed shut not allowing windows to be opened.

During inspection, a child's bed was observed to be broken and not in good repair.

During the inspection, the operation was found to have an expired fire inspection.

During the walkthrough of the operation a child's room was observed to have no lighting in the closet and not enough lighting in half part of the room.

During inspection, bees were observed to be collecting behind the paneling of the house outside in the backyard.

Operation walls were not observed in good repair as holes were observed during the inspection of the operation.

During the time of inspection, the following was observed: an open package of bacon, an open package of sausage links, and unmarked meat.

Children are not being allowed privacy when making phone calls to their Case Workers.

A medication log is missing and there is no evidence that child took medication as prescribed.

During inspection, bees were observed to be collecting behind the paneling of the house outside in the backyard.

Operation walls were not observed in good repair as five holes were observed during the inspection of the operation.

During inspection, a med log for 1 child in care reviewed did not document the name and signature of the staff that administered the medication.

One employee fille reviewed during inspection was not found to have a notarized licensing affidavit.

The following was observed during the inspection, a package of expired ham, left over cream cheese in the original foil wrapper but exposed to other foods, 1 rotting tomato, open unwrapped sliced cheddar cheese log, unknown meat in an unmarked ziploc bag, and blueberries and bluberry debris in the freezer.

The operation has not completed an evaluation related to run aways for a six month period.

The operations annual summary log was observed to be missing a child's name, age, gender, and date of admission for 10/8/2023.

A debriefing is not being conducted and/or documented with children in care following running away and returning to the operation. This was observed for 17 incidents reviewed.

Caregivers did not provide a safe environment when 2 upstairs windows were broken and plywood was set loosely inside the window frame.

The operation did not report serious incidents related to law enforcement responding to incidents at the facility and children in care being arrested to the hotline and/or parents.

The operation is not conducting triggered reviews for 3 children in care who ran away 3 times in a 60-day period.

The operation did not have documentation to show the operation fire extinguishers were being inspected monthly.

At the time of the inspection, one of the upstairs bathrooms was found to not be maintained in good repair as the cabinet floor under the sink was observed warped and moldy.

During the walkthrough of the operation holes on the wall were observed in a child's room.

During the walk through of the operation the medication cabinet was not locked.

A child in care was left unsupervised due to the child care provider being locked out of the facility.

During the course of the investigation it was determined kids in care are subjected to profanity by staff.

During the course of the investigation it was determined that kids in care are subjected to yelling by staff.

During the course of the investigation it was determined that a child in care was subjected to corporal punishment by being pushed by staff.

There was no documentation stating the child in care was put in a restraint by a staff who advised he a placed the child in a restraint.

There were no supporting documents stating the child had taken the medications from the missing logs.

A staff admitted to a case worker to using an inappropriate restraint towards a child in care by placing his arms behind his back.

Multiple Medication logs were missing for 2/14/22-23 and 2-8-23.

There were 5 childrens records that did not have identifying information easily accessible.

There were children that were exposing themselves and the night caregiver did not take the appropriate preventative measures. The night caregiver was aware of the incidents and did not take steps to separate the children.

Staff member did not use self-control when redirecting children in care and tossed the child on the bed.

A serious incident report was not documented or provided for an incident in which children in care were having behavioral problems during the nighttime.

Operation did not report to licensing allegations of physical abuse towards a child in care.

Operation did not document EBI documentation on serious incident report.

There were several employees that are direct care staff that do not have their affidavits notarized.

The operation was observed to have chemicals stored under the kitchen sink.

The operation did not have any outdoor recreational equiment.

The operation did not submit their quarterly EBI for the third quarter as recommended at the 11/22/2022 monitoring inspection.

There was a drawer that was broken in one of the child's bedroom.