TEXAS DEPARTMET OF FAMILY AD PROTECTIVE SERVICES COMMISSIOER Anne Heiligenstein Dr. Cassie Schmidt, CEO 120 Bert Brown Road San Marcos, TX 78666 Operation #827335 San Marcos Treatment Center Investigation # 1462856 Dear Dr. Cassie Schmidt, CEO: Your operation, San Marcos Treatment Center located at 120 Bert Brown Road, San Marcos, TX 78666, was recently investigated because the Department received a report concerning possible deficiency or deficiencies of the Minimum Standard Rules or the law. Specifically, the report states the following that led to this investigation: The report alleges a child in care suffered an arm injury, in an emergency behavior intervention. The applicable laws, administrative rules or Minimum Standard rules have been evaluated and findings are below: 3635 SE MILITARY DR, SA ATOIO, TX 78223
Page 2 Inspection Start Date Standard/Rule Description 748.2851(c)(2) involved in EBI must make reasonable efforts to debrief with children in care who witness the incident 748.2455(a)(2) Intervention-Basis for EBI is an emergency situation or to administer medication 748.2451(a)(2) Intervention-Use personal restraint only if policies permit and requirements of this subchapter are met 748.2853(4) EBI Documentation-Content of the post discussion, if applicable 748.2605(a)(5) Personal Restraints Prohibited-Restraints that twist or place the child's limb(s) behind the child's back Specifics Deficient? Comply By The restraint documentation shows no evidence of debrief with a child in care who witnessed the restraint. The investigation interview evidence reveals a staff member held a child in care's arms back, behind the child in care's shoulders. Direct care staff admitted holding the child in care's arms in a "handcuff" position. TA Given 3635 SE MILITARY DR, SA ATOIO, TX 78223
Page 3 748.2463(1) Intervention-ever used as punishment 748.2455(a)(1) Intervention-Before using EBI, the caregiver must attempt less restrictive interventions that prove to be ineffective 748.2551(c)(1) EBI Implementation-Caregiver must minimize risk of physical discomfort, harm, or pain to the child 748.2851(c)(1) involved in EBI must debrief with each other about incident as soon as possible after situation has stabilized and technical assistance was given. The evidence indicates direct care staff held a child's arm in an unauthorized position. Witnesses saw the child in care before, during and after the restraint and claim the child in care was not in discomfort. The restraint documentation shows no evidence of inter-staff post restraint debrief and one care giver involved indicated this did not occur. Y 3635 SE MILITARY DR, SA ATOIO, TX 78223
Page 4 745.615(a)(6)(A) Required background check - Each person at least 14 years of age, other than a client in care, who counted in child-to-caregiver ratios 748.2851(b) involved in EBI must conduct a post discussion with child The Technical Assistance provided for these standards described below: Standard/Rule Description 748.2851(c)(2) involved in EBI must make reasonable efforts to debrief with children in care who witness the incident 748.2605(a)(5) Personal Restraints Prohibited-Restraints that twist or place the child's limb(s) behind the child's back 748.2551(c)(1) EBI Implementation-Caregiver must minimize risk of physical discomfort, harm, or pain to the child 748.2851(c)(1) involved in EBI must debrief with each other about incident as soon as possible after situation has stabilized Technical Assistance Given Licensing will work with the operation to ensure all parties to an emergency behavior are debriefed to bolster measures to reduce restraint. Licensing will work with the operation to address proper restraint technique during follow up activities. Licensing advised the operation on the importance of proper restraint technique and making sure the children in care are not in discomfort. Licensing will work with the operation to ensure all parties to an emergency behavior are debriefed to bolster measures to reduce restraint. 3635 SE MILITARY DR, SA ATOIO, TX 78223
Page 5 If an inspection was conducted as part of this investigation, you received an inspection report form. Failure to maintain compliance on an ongoing basis may result in remedial actions. If you disagree with the actions or decisions of the licensing staff, you may request an administrative review within 15 days of the receipt of this letter by writing Willie Salas, MC 278-5, PO box 23990, San Antonio, TX 78223-0990. FAX: 210-304-7747. If you have any other questions or need additional information, please contact me. Sincerely, ADREW PERRETTA Licensing Representative (210) 854-3129 Enclosure(s): cc: 3635 SE MILITARY DR, SA ATOIO, TX 78223