TEXAS DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES

Transcription

1 TEXAS DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES COMMISSIONER John J. Specia, Jr. Dr. Cassie Schmidt, CEO 120 Bert Brown Road San Marcos, TX Operation # San Marcos Treatment Center REGULAR AND CERTIFIED MAIL, RETURN RECEIPT REQUESTED # Dear Dr. Schmidt: The purpose of this letter is to inform you of the decision made by the Department of Family and Protective Services (DFPS) to place the following child-care operation on corrective action- evaluation: Name:San Marcos Treatment Center Operation #: Address: 120 Bert Brown Road, San Marcos, TX Tex. Hum. Res. Code authorizes DFPS to take corrective action against an operation that does not comply with the minimum standards, rules, Chapter 42 of the Texas Human Resources Code, or the specific terms of the permit. 40 Tex. Admin. Code sets forth the circumstances when DFPS may take a form of remedial action against an operation. DFPS applied this rule to the decision to take remedial action against your operation as follows: Based on repeated deficiencies related to child/caregiver ratio, medication issues, and inappropriate punishment/discipline of residents in their care, San Marcos Treatment Center is being placed on evaluation. 40 Tex. Admin. Code provides the factors that DFPS considers when deciding which type of remedial action to take against an operation. Based on its application of this

2 Page 2 rule, DFPS has determined that corrective action- evaluation is the appropriate form of remedial action to take against your operation: Evaluation was chosen based on the operation's compliance history and severity of deficiencies. The deficiencies cited are listed below: Date Standard/ Rule/Law Standard/Rule/Law Description 06/25/ (c) Medication Record-Must include accurate daily count of each prescribed medication 05/15/ (a) Child/caregiver ratio-must employ an adequate number of caregivers to meet children's needs and consider amount of supervision needed 03/27/ (b)(1) Disciplinary Measures-must be consistent with operation policies and procedures 03/27/ (8) Other Prohibited Punishments-humiliating, shaming, ridiculing, rejecting, or yelling at a child 11/15/ (b)(2) Administration of Medication-Store medication in the original container unless there is an additional container with the same label & instructions 09/26/ (b)(5) Medication Record-Must include date (day, month, year) & time each medication was administered 08/30/ (b)(5) Medication Record-Must include date (day, month, year) & time each medication was administered 08/10/ (a)(3) Caregiver responsibility - being aware of and accountable for each child's on-going activity 07/05/ (a) Child/caregiver ratio-caregiver may care for 5 children if 06/18/ (a) Immunizations-Each child must meet and continue to meet the applicable immunization requirements 06/07/ (2)(D) Child-care administrator responsibilities-assigning tasks to caregivers that do not conflict/interfere with caregiver responsibilities 06/06/ (a) Child/caregiver ratio-caregiver may care for 5 children if

3 Page 3 04/30/ (a) Child/caregiver ratio-caregiver may care for 5 children if 04/30/ (a)(2) Child/caregiver ratio-must employ adequate number of caregivers to meet their responsibilities regarding supervision of children in /30/ (2)(D) Child-care administrator responsibilities-assigning tasks to caregivers that do not conflict/interfere with caregiver responsibilities 04/26/ (a) Child/caregiver ratio-caregiver may care for 5 children if 03/27/ (c) Disciplinary Measures-goal must be to teach a child acceptable behavior and self-control; caregiver must explain reason for discipline when imposed 03/27/ (1) Other Prohibited Punishments-any harsh, cruel, unusual, unnecessary, demeaning, or humiliating discipline/punishment 03/27/ (9) Other Prohibited Punishments-subjecting a child to abusive or profane language 03/23/ (a) Child/caregiver ratio-caregiver may care for 5 children if 03/23/ (8) Other Prohibited Punishments-humiliating, shaming, ridiculing, rejecting, or yelling at a child 03/08/ (a) Child/caregiver ratio-caregiver may care for 5 children if 03/08/ Child/caregiver ratio-includes only qualified caregivers working directly with a child or group of children 03/04/ (a) Child/caregiver ratio-caregiver may care for 5 children if 03/04/ (a)(1) Child/caregiver ratio-must employ an adequate number of caregivers to meet child/caregiver ratios 03/04/ (8) Other Prohibited Punishments-humiliating, shaming, ridiculing, rejecting, or yelling at a child The conditions placed on your operation during this corrective action period are as follows: You must comply with all of the conditions in the corrective action plan and correct the minimum standards that were deficient.

4 Page 4 You must post this letter in a prominent place near all public entrances of the operation. You must establish and maintain compliance with all Licensing statutes, rules, and minimum standards. 1. The operation must submit a plan to address ratio issues. This plan will include protocols and actions taken during crisis situations, early morning shift transitions, evenings, weekends, and routine staff breaks/lunch. The operation must submit a plan to identify how they will ensure ratio is maintained during the above situations and that their protocols and needed actions are being followed by staff. 2. The administrator or designee must make three random checks each day to various units to ensure ratios are being met. This would equal 21 random checks per week. At least ten (10) of these checks must occur after 4 PM. Five (5) checks must be conducted during the morning shift when children are getting ready for school. These random checks will occur the duration of the Corrective Action period. The administrator or designee will document the following: date, time, names of staff with their position, names of children each staff is responsible for, names of children who are on special precautions, and results to include whether or not the unit was in ratio and what actions were taken as a result when unit was not in ratio. In addition, you must document any nurse that is counted in ratio and who was assigned to nursing duties while the nurse was in ratio. The documentation must be available for Licensing to review on 7/25/ The Administrator or designee will develop a form to be filled out at the beginning of each shift by the person in charge of their shift. This form will include unit name, name of residents, names of staff assigned for that shift, names of children on one to one ratio, and names of staff assigned to residents who are on one to one. The form will be updated to include any changes that may have happened during that shift that would affect ratio. This form will also include documentation on how any identified issue with ratio was addressed. Forms with any out of ratio occurrences will be reviewed by the Administrator or designee. The operation will identify a system on how often these forms will be reviewed by the Administrator or designee. All forms will be made available for Licensing to review.

5 Page 5 4. Three hours of training on Subchapter G: Child/Caregiver Ratios of Minimum Standards for GRO's and Subchapter M: Discipline and Punishment will be provided to all staff and all staff must be provided a copy of Subchapter G and Subchapter M. Curriculum for this training will be submitted to Licensing by 7/25/13. Curriculum for Subchapter G must include several scenarios in which ratio could be affected (ie: one to one supervision, staff breaks, and transporting children in care). The curriculum for Subchapter M must include several scenarios where children's behavior will be just cause for staff to utilize appropriate discipline techniques (ie: child cussing at staff, refusing to follow directives, appropriate interaction with residents, and de-escalation techniques). A list of dates/times of training will be submitted to Licensing one week after the curriculum has been reviewed and approved by Licensing. Staff sign in sheets and certificates of completed training must be in each staff's personnel file and available for licensing to review. All staff should be trained by 10/25/ All staff responsible for dispensing medication must attend a 2 hour training course on GRO Minimum Standards Subchapter L, Medication and the operation's policy on medication storage and destruction, and medication record keeping. Curriculum for this training will be submitted to Licensing by 7/25/13. A list of dates/times of training will be submitted to Licensing one week after the curriculum has been reviewed and approved by Licensing. Staff sign in sheets and certificates of completed training must be in each staff's personnel file and available for Licensing to review. All staff should be trained by 8/31/ The administrator or designee must randomly review fifteen (15) medication logs per week for the duration of the Corrective Action. Each record must be reviewed for that week. The Licensed Child Care Administrator (LCCA) or designee must check the medication log(s) to determine if the medication was administered according to prescription label, the running count is accurate, and if it was appropriately documented per Minimum Standards. The LCCA or designee must document the name of the child's medication record reviewed, date and time of review, and errors/issues during the review, as well as documentation of any actions taken as a result of errors/issues found. This documentation must be available for Licensing to review by 7/25/13. You must keep documentation demonstrating compliance with these conditions at your operation. This documentation must be available for review by licensing staff during an inspection or investigation of your operation. A licensing representative will inspect your operation to determine if it is meeting the corrective action conditions. These inspections will be unannounced. As provided in Tex. Hum. Res. Code , you must allow licensing representatives into your operation during operating hours to investigate, inspect and evaluate.

6 Page 6 DFPS may revoke your permit if your operation continues to be deficient with minimum standards, rules, laws or permit restrictions, or if you fail to comply with the above conditions during the corrective action period. The corrective action period is scheduled to begin on 07/25/2013 and will end on 01/25/2014. You have the right to request an administrative review if you disagree with DFPS' decision to place your operation on corrective action. To request an administrative review, you must send a written statement that includes your reason for dispute to Willie Salas, Regional Manager, P.O. Box 23990, San Antonio, TX 78223, FAX (512) within fifteen (15) days of receipt of this letter. You may also expedite the begin date of your corrective action period by sending a written statement that includes your decision to waive your right to an administrative review before the 15-day timeframe to submit your request expires. Sincerely, ERIKA MARTINEZ Licensing Supervisor (210) x3992 Enclosure(s): Letters and compliance history report