Creighton Oaks Residential Treatment Center
License Information
- Status
- Licensed
- License #
- 1721455
- Expires
- August 19, 2026
- Licensed Capacity
- 71 children
- Licensing Agency
- Texas HHSC
Data from Texas HHSC. Updated 2/24/2026.
State recordsInspection History
308 records- routine#862294795
2 violations found (1 high, 1 medium severity).
Fire Inspection-Must have fire inspection at least once every 12 months from date of last fire inspection
HighThe CLASS system shows the most recent fire inspection was 04-09-2024. The operation had records of requests to have the inspection completed by 04-09-2025. The FIre marshall inspected the operation on 04-16-2025 and the operation didn't pass. The operation had a change in management and got a passing inspection on 10-06-2025.
748.3101(2)Corrected 2025-10-08Evacuation-Must practice severe weather drill at least once every 6 months from date of last severe weather drill
MediumThe operation had no documentation of any emergency drills in over six months.
748.3239(b)Corrected 2025-10-22 - routine#862294794
No violations found. All areas in compliance.
No violations
- routine#862294793
2 violations found (2 medium severity).
Pre-Employment-You must document in the employee record each references name, relation, date completed, info obtained and name of interviewer.
Medium2 of 3 employee files did not have documented reference checks.
748.753(d)(1)Corrected 2025-04-22Personnel records-Personnel records-Include evidence of valid professional licensures, certifications, or registrations required for the position.
MediumWhile reviewing files it was found that multiple items were missing.
748.363(5)Corrected 2025-04-22 - routine#862294792
No violations found. All areas in compliance.
No violations
- routine#862294791
No violations found. All areas in compliance.
No violations
- routine#862294790
No violations found. All areas in compliance.
No violations
- complaint#862383187
1 violation found (1 high severity).
Caregiver responsibility - providing the level of supervision necessary to ensure each child's safety and well-being
HighA child in care obtained bullets from the operations van.
748.685(a)(4)Corrected 2025-02-25 - routine#862294789
No violations found. All areas in compliance.
No violations
- routine#862294788
No violations found. All areas in compliance.
No violations
- complaint#862383186
No violations found. All areas in compliance.
No violations
- complaint#862383185
No violations found. All areas in compliance.
No violations
- routine#862294787
No violations found. All areas in compliance.
No violations
- complaint#862383184
2 violations found (2 high severity).
EBI Implementation-Caregiver must minimize risk of physical discomfort, harm, or pain to the child
HighWhile reviewing video of the incident a child was inappropriately restrained.
748.2551(c)(1)Corrected 2025-02-26Children's rights-Adhere to the child's rights to be free of abuse, neglect, and exploitation
HighA 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.
748.1101(b)(1)(B)Corrected 2025-02-26 - routine#862294786
No violations found. All areas in compliance.
No violations
- complaint#862383183
No violations found. All areas in compliance.
No violations
- routine#862294785
No violations found. All areas in compliance.
No violations
- complaint#862383182
No violations found. All areas in compliance.
No violations
- complaint#862383181
No violations found. All areas in compliance.
No violations
- self-report#862383180
No violations found. All areas in compliance.
No violations
- routine#862294784
1 violation found (1 high severity).
AP Administration of prescription medication-Administer medications according to instructions or a prescribing health-care professional's orders
HighA child in care did not receive two doses of their morning medication.
748.2003(b)(3)Corrected 2024-12-13 - assessment#862398163
1 violation found (1 medium severity).
Serious Incident-Report to parents no later than 6 hours after determining unauthorized absence of a child 13 years old or older.
MediumThe operation did not report a child in care unauthorized absence to Licensing or their parent within the allotted timeframe per minimum standards.
748.303(a)(10)(B)Corrected 2024-11-15 - routine#862294783
No violations found. All areas in compliance.
No violations
- complaint#862383179
No violations found. All areas in compliance.
No violations
- routine#862294782
No violations found. All areas in compliance.
No violations
- assessment#862398162
No violations found. All areas in compliance.
No violations
- routine#862294781
No violations found. All areas in compliance.
No violations
- routine#862294780
No violations found. All areas in compliance.
No violations
- complaint#862383178
No violations found. All areas in compliance.
No violations
- complaint#862383177
No violations found. All areas in compliance.
No violations
- routine#862294779
No violations found. All areas in compliance.
No violations
- self-report#862383176
3 violations found (3 high severity).
Food Preparation-Food and drinks must be of safe quality, stored, prepared, and served under sanitary & safe conditions
HighThere were several food items observed to be expired and without expiration dates in the library refrigerator/freezer.
748.3445(a)Corrected 2024-10-08Caregiver responsibility - providing the level of supervision necessary to ensure each child's safety and well-being
HighDuring the course of the investigation, it was revealed that multiple children in care stole equipment with the intent to sell, indicating insufficient supervision and increased risk to their safety.
748.685(a)(4)Corrected 2024-11-08Water-A thermostat must control the temperature of hot water accessible to children, so the temperature is no higher than 120 degrees Fahrenheit
HighThe bathroom sink and shower water in room 2 of the Green house was observed to with no hot water.
748.3315Corrected 2024-10-08 - routine#862294778
No violations found. All areas in compliance.
No violations
- routine#862294777
No violations found. All areas in compliance.
No violations
- routine#862294776
1 violation found (1 medium severity).
Fire Extinguisher-Must keep documentation of annual inspection and/or purchase of new fire extinguishers at operation for review
MediumFire extinguisher on the second floor of the green house expired in August of 2024.
748.3117(b)Corrected 2024-09-24 - complaint#862383175
1 violation found (1 high severity).
Serious Incident-Report to Licensing as soon as aware of allegations or indications of abuse, neglect, or exploitation of a child
HighA child made an outcry of physical abuse to multiple staff by a staff member that was not reported.
748.303(a)(3)(A)Corrected 2024-10-25 - complaint#862383174
No violations found. All areas in compliance.
No violations
- self-report#862383173
No violations found. All areas in compliance.
No violations
- complaint#862383172
No violations found. All areas in compliance.
No violations
- routine#862294775
No violations found. All areas in compliance.
No violations
- complaint#862383171
No violations found. All areas in compliance.
No violations
- routine#862294774
No violations found. All areas in compliance.
No violations
- routine#862294773
No violations found. All areas in compliance.
No violations
- complaint#862383170
2 violations found (2 high severity).
Interior Space-Provide living space, appropriate furnishings, & bathroom facilities that are safe, clean and maintained in good repair
HighIt was observed that a broken dresser in Bedroom 5 of the green house has not been removed.
748.3351(1)Corrected 2024-09-13Physical Site-The building must be free of rodents and insects
HighThe green house was observed to have dead wasps in the light fixture.
748.3301(h)Corrected 2024-09-13 - self-report#862383169
No violations found. All areas in compliance.
No violations
- self-report#862383168
1 violation found (1 medium severity).
All employees and caregivers must be aware of and follow your policies and procedures
MediumA staff member admitted to sleeping on shift.
748.126(b)Corrected 2024-08-30 - routine#862294772
No violations found. All areas in compliance.
No violations
- complaint#862383167
No violations found. All areas in compliance.
No violations
- routine#862294771
No violations found. All areas in compliance.
No violations
- routine#862294769
No violations found. All areas in compliance.
No violations
- routine#862294770
No violations found. All areas in compliance.
No violations
- routine#862294768
No violations found. All areas in compliance.
No violations
- complaint#862383166
2 violations found (2 high severity).
Children's rights-Adhere to the child's rights to be free of abuse, neglect, and exploitation
HighThe allegation is related to a DFPS abuse/neglect investigation.
748.1101(b)(1)(B)Corrected 2024-08-30Corporal Punishment-May not use/threaten corporal punishment, such as hitting/spanking, forced exercise, holding physical position, unproductive work.
HighA staff member admitted to hitting a child in care.
748.2303(a)Corrected 2024-08-30 - routine#862294767
No violations found. All areas in compliance.
No violations
- complaint#862383165
No violations found. All areas in compliance.
No violations
- routine#862294766
No violations found. All areas in compliance.
No violations
- routine#862294765
No violations found. All areas in compliance.
No violations
- complaint#862383164
No violations found. All areas in compliance.
No violations
- complaint#862383163
No violations found. All areas in compliance.
No violations
- self-report#862383162
No violations found. All areas in compliance.
No violations
- routine#862294764
No violations found. All areas in compliance.
No violations
- complaint#862383161
No violations found. All areas in compliance.
No violations
- complaint#862383160
No violations found. All areas in compliance.
No violations
- complaint#862383159
No violations found. All areas in compliance.
No violations
- complaint#862383158
No violations found. All areas in compliance.
No violations
- complaint#862383157
No violations found. All areas in compliance.
No violations
- complaint#862383156
No violations found. All areas in compliance.
No violations
- routine#862294763
No violations found. All areas in compliance.
No violations
- routine#862294762
No violations found. All areas in compliance.
No violations
- routine#862294761
No violations found. All areas in compliance.
No violations
- complaint#862383155
2 violations found (1 high, 1 medium severity).
Medical care-A child in care must receive medical care as needed for injury, illness, and pain
HighA child in care did not receive immediate medical attention after receiving burns to their arms.
748.1531(a)(2)Corrected 2024-07-31All employees and caregivers must be aware of and follow your policies and procedures
MediumA child in care had a prohibited item which wasn't locked back up and resulted in another getting injured.
748.126(b)Corrected 2024-07-31 - routine#862294760
No violations found. All areas in compliance.
No violations
- complaint#862383154
No violations found. All areas in compliance.
No violations
- routine#862294759
No violations found. All areas in compliance.
No violations
- complaint#862383153
No violations found. All areas in compliance.
No violations
- complaint#862383152
1 violation found (1 high severity).
Employee general responsibilities-Demonstrate competency, prudent judgment, self-control in presence of children and when performing assigned tasks
HighA staff member drove children in care around with confiscated drugs in the glovebox.
748.507(1)Corrected 2024-07-19 - routine#862294758
No violations found. All areas in compliance.
No violations
- complaint#862383151
No violations found. All areas in compliance.
No violations
- complaint#862383150
No violations found. All areas in compliance.
No violations
- complaint#862383149
No violations found. All areas in compliance.
No violations
- routine#862294757
No violations found. All areas in compliance.
No violations
- self-report#862383148
No violations found. All areas in compliance.
No violations
- complaint#862383147
No violations found. All areas in compliance.
No violations
- routine#862294756
No violations found. All areas in compliance.
No violations
- routine#862294755
No violations found. All areas in compliance.
No violations
- complaint#862383146
No violations found. All areas in compliance.
No violations
- complaint#862383145
No violations found. All areas in compliance.
No violations
- complaint#862383144
No violations found. All areas in compliance.
No violations
- complaint#862383143
No violations found. All areas in compliance.
No violations
- self-report#862383142
No violations found. All areas in compliance.
No violations
- routine#862294754
No violations found. All areas in compliance.
No violations
- complaint#862383141
No violations found. All areas in compliance.
No violations
- routine#862294753
No violations found. All areas in compliance.
No violations
- routine#862294752
No violations found. All areas in compliance.
No violations
- routine#862294751
No violations found. All areas in compliance.
No violations
- complaint#862383140
No violations found. All areas in compliance.
No violations
- complaint#862383139
No violations found. All areas in compliance.
No violations
- self-report#862383138
No violations found. All areas in compliance.
No violations
- complaint#862383137
No violations found. All areas in compliance.
No violations
- routine#862294750
No violations found. All areas in compliance.
No violations
- routine#862294749
No violations found. All areas in compliance.
No violations
- self-report#862383136
No violations found. All areas in compliance.
No violations
- self-report#862383135
No violations found. All areas in compliance.
No violations
- routine#862294747
No violations found. All areas in compliance.
No violations
- routine#862294748
No violations found. All areas in compliance.
No violations
- complaint#862383134
No violations found. All areas in compliance.
No violations
- routine#862294746
No violations found. All areas in compliance.
No violations
- complaint#862383133
No violations found. All areas in compliance.
No violations
- self-report#862383132
No violations found. All areas in compliance.
No violations
- complaint#862383131
No violations found. All areas in compliance.
No violations
- complaint#862383130
No violations found. All areas in compliance.
No violations
- complaint#862383129
No violations found. All areas in compliance.
No violations
- routine#862294745
No violations found. All areas in compliance.
No violations
- routine#862294744
No violations found. All areas in compliance.
No violations
- routine#862294743
No violations found. All areas in compliance.
No violations
- self-report#862383128
No violations found. All areas in compliance.
No violations
- routine#862294742
No violations found. All areas in compliance.
No violations
- routine#862294741
No violations found. All areas in compliance.
No violations
- routine#862294740
No violations found. All areas in compliance.
No violations
- routine#862294739
No violations found. All areas in compliance.
No violations
- routine#862294738
No violations found. All areas in compliance.
No violations
- complaint#862383127
1 violation found (1 high severity).
Emergency Behavior Intervention-Never used as a means to get a child to comply
HighAn incident report, dated 9/11/23, described a 12-year-old being restrained for attempting to runaway into the woods.
748.2463(3)Corrected 2024-04-16 - complaint#862383126
No violations found. All areas in compliance.
No violations
- self-report#862383125
No violations found. All areas in compliance.
No violations
- routine#862294737
5 violations found (1 high, 3 medium, 1 low severity).
Documentation of searches-Document the reason for the search in the child's record
LowWhile reviewing search records for children's rooms/possessions it was observed that required information was missing from the reports.
748.1117(3)Corrected 2024-03-15Suicide Screening- Must be administered every 30 days after admission for children 10 years of age or older in a residential treatment center.
MediumWhile reviewing the screenings it was found they were not being completed within 30 days of the last screening.
748.125(d)(4)(C)Corrected 2024-02-27Initial Service Plan-Include instructions to caregivers about level of supervision required
HighWhile reviewing files it was found the supervision section did not include information about day to day supervision requirements in the home or supervision outside the home.
748.1337(b)(1)(D)(ii)Corrected 2024-03-15Admission Assessment-Must provide initial evaluation of appropriate placement & ensure that necessary information for service planning is obtained
MediumWhile reviewing files it was observed that the admission assessments did not contain all required information.
748.1217(a)Corrected 2024-03-15Admission Documentation-Identification of child's high risk behaviors and related safety plan staff and caregivers will implement
MediumWhile reviewing the files, children did not have safety plans in place at the time of admission.
748.1205(a)(12)Corrected 2024-03-15 - complaint#862383124
No violations found. All areas in compliance.
No violations
- self-report#862383123
No violations found. All areas in compliance.
No violations
- routine#862294736
No violations found. All areas in compliance.
No violations
- complaint#862383122
No violations found. All areas in compliance.
No violations
- self-report#862383121
No violations found. All areas in compliance.
No violations
- routine#862294735
No violations found. All areas in compliance.
No violations
- routine#862294734
2 violations found (1 high, 1 medium severity).
Food Preparation-Food items must be covered when stored in the refrigerator
MediumDuring the walkthrough of the operation food was observed in refrigerator unsealed in two different units. Staff was asked to throw away several pounds of bad cheese during the walk through.
748.3443(a)(6)Corrected 2024-03-08Poisons-Ensure poisonous/flammable material is stored in an area that is inaccessible to children unless child is capable to use responsibly.
HighDuring the walkthrough of the operation various cleaning chemicals were observed unsecured in the kitchen drawers and under the kitchen sink.
748.3421(3)Corrected 2024-03-08 - self-report#862383120
No violations found. All areas in compliance.
No violations
- routine#862294733
No violations found. All areas in compliance.
No violations
- self-report#862383119
1 violation found (1 high severity).
Child/caregiver ratio-Caregiver may care for 5 children if any require tx svcs, 8 children if not; children under 5 yrs old count as 2 children
HighAfter speaking with multiple caregivers and residence, I became aware that a caregiver was not present during the incident and the operation was out of ratio with 15 residents and 2 staff members.
748.1003(a)Corrected 2024-03-13 - complaint#862383118
No violations found. All areas in compliance.
No violations
- complaint#862383117
No violations found. All areas in compliance.
No violations
- self-report#862383116
No violations found. All areas in compliance.
No violations
- complaint#862383115
1 violation found (1 high severity).
Physical Site-Equipment and furniture must be safe for children and must be kept clean and in good repair
HighPhotos were reviewed of exposed nails and screws on a bedframe, broke outlet cover and holes in the walls.
748.3301(i)Corrected 2024-04-05 - complaint#862383114
No violations found. All areas in compliance.
No violations
- complaint#862383113
No violations found. All areas in compliance.
No violations
- complaint#862383112
1 violation found (1 high severity).
Employee general responsibilities-Demonstrate competency, prudent judgment, self-control in presence of children and when performing assigned tasks
HighA staff member made inappropriate comments regarding a child's physical ability and inappropriate comments regarding sexuality.
748.507(1)Corrected 2024-04-11 - complaint#862383111
No violations found. All areas in compliance.
No violations
- self-report#862383110
No violations found. All areas in compliance.
No violations
- routine#862294732
No violations found. All areas in compliance.
No violations
- routine#862294731
No violations found. All areas in compliance.
No violations
- self-report#862383109
1 violation found (1 medium severity).
Operational responsibilities - Maintain current, true, accurate, and complete records
Medium1 service plan referenced the child by a name other than their own and 3 entries on the unauthorized absence log had information pertaining to a different child than the one being discussed.
748.151(3)Corrected 2024-02-14 - complaint#862383108
No violations found. All areas in compliance.
No violations
- complaint#862383107
No violations found. All areas in compliance.
No violations
- complaint#862383106
No violations found. All areas in compliance.
No violations
- routine#862294730
No violations found. All areas in compliance.
No violations
- routine#862294729
No violations found. All areas in compliance.
No violations
- routine#862294727
No violations found. All areas in compliance.
No violations
- routine#862294728
No violations found. All areas in compliance.
No violations
- complaint#862383105
No violations found. All areas in compliance.
No violations
- complaint#862383104
No violations found. All areas in compliance.
No violations
- routine#862294726
No violations found. All areas in compliance.
No violations
- routine#862294724
No violations found. All areas in compliance.
No violations
- routine#862294725
No violations found. All areas in compliance.
No violations
- routine#862294723
No violations found. All areas in compliance.
No violations
- self-report#862383103
No violations found. All areas in compliance.
No violations
- complaint#862383102
No violations found. All areas in compliance.
No violations
- complaint#862383101
No violations found. All areas in compliance.
No violations
- routine#862294722
No violations found. All areas in compliance.
No violations
- routine#862294721
No violations found. All areas in compliance.
No violations
- routine#862294720
No violations found. All areas in compliance.
No violations
- complaint#862383100
No violations found. All areas in compliance.
No violations
- complaint#862383099
No violations found. All areas in compliance.
No violations
- complaint#862383098
No violations found. All areas in compliance.
No violations
- complaint#862383097
No violations found. All areas in compliance.
No violations
- complaint#862383096
No violations found. All areas in compliance.
No violations
- complaint#862383095
No violations found. All areas in compliance.
No violations
- complaint#862383094
No violations found. All areas in compliance.
No violations
- routine#862294719
No violations found. All areas in compliance.
No violations
- complaint#862383093
No violations found. All areas in compliance.
No violations
- complaint#862383092
No violations found. All areas in compliance.
No violations
- complaint#862383091
No violations found. All areas in compliance.
No violations
- complaint#862383090
2 violations found (2 high severity).
Children's rights-Adhere to the child's rights to be free of abuse, neglect, and exploitation
HighIt was found during the investigation that vehicle keys were left unsecured which resulted in children in care stealing the operation van.
748.1101(b)(1)(B)Corrected 2023-12-05Medication Storage-Store medication covered by Schedule II of the Texas Controlled Substances Act under double lock in a separate container
HighDuring the investigation it was found the office door, which is the second lock for medications, was left unlocked and children in care were able to access the office.
748.2101(3)Corrected 2023-12-05 - routine#862294718
No violations found. All areas in compliance.
No violations
- routine#862294717
No violations found. All areas in compliance.
No violations
- complaint#862383089
No violations found. All areas in compliance.
No violations
- self-report#862383088
2 violations found (1 high, 1 medium severity).
Serious Incident-Report to Licensing no later than 6 hours after determining unauthorized absence of a child 13 yrs old or older.
MediumOne incident report on 10/15/23 involving a teenager in care, was called in past the 6-hour required timeframe for reporting to the A/N hotline for an unauthorized absence and Law Enforcement was not contacted. For another unauthorized absence incident involving two other children in care, on 10/14/23, law enforcement was also not contacted.
748.303(a)(10)(A)Corrected 2023-12-11Initial Service Plan-For child who exhibits high risk behaviors, include plans to minimize risk of harm to self or others
HighThree children's service plans reviewed were missing some high risk behaviors although it is noted in other sections of the plan that the children have history of unsafe behaviors such as verbal and/or physical aggression, substance use, delinquency, threats of self-harm and harm to peers, and/or run away. There was also no documentation of known triggers for the children on the plan.
748.1337(b)(1)(H)(i)Corrected 2023-12-11 - routine#862294716
No violations found. All areas in compliance.
No violations
- complaint#862383087
No violations found. All areas in compliance.
No violations
- self-report#862383086
No violations found. All areas in compliance.
No violations
- complaint#862383085
No violations found. All areas in compliance.
No violations
- routine#862294715
No violations found. All areas in compliance.
No violations
- routine#862294714
No violations found. All areas in compliance.
No violations
- routine#862294713
2 violations found (2 high severity).
Bathrooms-Must be maintained in good repair & kept clean
HighDuring the walk through of the operation, multiple bathrooms were found to have trash on the floors, urine on and around the toilets and soap on the floors.
748.3391(a)Corrected 2023-10-11Interior Space-Provide living space, appropriate furnishings, & bathroom facilities that are safe, clean and maintained in good repair
HighDuring the walkthrough each of the bedrooms were observed to be unclean, with beds unmade, clothing and shoes throw around the room.
748.3351(1)Corrected 2023-10-11 - self-report#862383084
No violations found. All areas in compliance.
No violations
- routine#862294712
No violations found. All areas in compliance.
No violations
- complaint#862383083
No violations found. All areas in compliance.
No violations
- complaint#862383082
1 violation found (1 medium severity).
Serious Incident Documentation-Includes interventions made during and after the incident, i.e. medical interventions, contacts made, other actions
MediumDuring the investigation, required documentation couldn't be provided for a serious incident.
748.311(8)Corrected 2024-03-15 - complaint#862383081
No violations found. All areas in compliance.
No violations
- self-report#862383080
No violations found. All areas in compliance.
No violations
- complaint#862383079
No violations found. All areas in compliance.
No violations
- self-report#862383078
No violations found. All areas in compliance.
No violations
- routine#862294711
No violations found. All areas in compliance.
No violations
- routine#862294710
No violations found. All areas in compliance.
No violations
- complaint#862383077
No violations found. All areas in compliance.
No violations
- complaint#862383076
No violations found. All areas in compliance.
No violations
- routine#862294709
No violations found. All areas in compliance.
No violations
- complaint#862383075
No violations found. All areas in compliance.
No violations
- self-report#862383074
No violations found. All areas in compliance.
No violations
- routine#862294708
No violations found. All areas in compliance.
No violations
- routine#862294707
No violations found. All areas in compliance.
No violations
- self-report#862383073
No violations found. All areas in compliance.
No violations
- routine#862294706
No violations found. All areas in compliance.
No violations
- routine#862294705
No violations found. All areas in compliance.
No violations
- routine#862294704
No violations found. All areas in compliance.
No violations
- self-report#862383072
No violations found. All areas in compliance.
No violations
- self-report#862383071
No violations found. All areas in compliance.
No violations
- self-report#862383070
No violations found. All areas in compliance.
No violations
- self-report#862383069
No violations found. All areas in compliance.
No violations
- self-report#862383068
No violations found. All areas in compliance.
No violations
- routine#862294703
No violations found. All areas in compliance.
No violations
- self-report#862383067
No violations found. All areas in compliance.
No violations
- routine#862294702
1 violation found (1 high severity).
Physical Site-Windows & doors must be in good repair & free of broken glass or hazards
HighA portion of two door frames were observed to be broken. One of the doors was observed to have broken door handle.
748.3301(c)Corrected 2023-08-22 - routine#862294701
1 violation found (1 high severity).
Training on administering psych. medication must be instructor-led. The instructor must be a health-care professional or pharmacist.
HighWhile reviewing 4 staff files it was discovered staff were not receiving instructor-led pre-service psychotropic medication training by a health-care professional.
748.869(c)Corrected 2023-08-24 - routine#862294700
No violations found. All areas in compliance.
No violations
- routine#862294699
No violations found. All areas in compliance.
No violations
- self-report#862383066
No violations found. All areas in compliance.
No violations
- routine#862294698
No violations found. All areas in compliance.
No violations
- complaint#862383065
No violations found. All areas in compliance.
No violations
- self-report#862383064
No violations found. All areas in compliance.
No violations
- self-report#862383063
No violations found. All areas in compliance.
No violations
- self-report#862383062
No violations found. All areas in compliance.
No violations
- routine#862294697
No violations found. All areas in compliance.
No violations
- routine#862294696
No violations found. All areas in compliance.
No violations
- complaint#862383061
No violations found. All areas in compliance.
No violations
- complaint#862383060
No violations found. All areas in compliance.
No violations
- routine#862294695
No violations found. All areas in compliance.
No violations
- self-report#862383059
No violations found. All areas in compliance.
No violations
- routine#862294694
No violations found. All areas in compliance.
No violations
- complaint#862383058
No violations found. All areas in compliance.
No violations
- complaint#862383057
No violations found. All areas in compliance.
No violations
- complaint#862383056
No violations found. All areas in compliance.
No violations
- self-report#862383055
No violations found. All areas in compliance.
No violations
- self-report#862383054
No violations found. All areas in compliance.
No violations
- complaint#862383053
No violations found. All areas in compliance.
No violations
- complaint#862383052
No violations found. All areas in compliance.
No violations
- complaint#862383051
No violations found. All areas in compliance.
No violations
- routine#862294693
No violations found. All areas in compliance.
No violations
- complaint#862383050
No violations found. All areas in compliance.
No violations
- complaint#862383049
No violations found. All areas in compliance.
No violations
- routine#862294692
No violations found. All areas in compliance.
No violations
- complaint#862383048
No violations found. All areas in compliance.
No violations
- self-report#862383047
No violations found. All areas in compliance.
No violations
- complaint#862383046
1 violation found (1 medium severity).
All employees and caregivers must be aware of and follow your policies and procedures
MediumA staff was observed sleeping by a Department staff and operation staff.
748.126(b)Corrected 2023-10-06 - complaint#862383045
No violations found. All areas in compliance.
No violations
- complaint#862383044
No violations found. All areas in compliance.
No violations
- complaint#862383043
No violations found. All areas in compliance.
No violations
- routine#862294691
No violations found. All areas in compliance.
No violations
- complaint#862383042
No violations found. All areas in compliance.
No violations
- complaint#862383041
No violations found. All areas in compliance.
No violations
- complaint#862383040
No violations found. All areas in compliance.
No violations
- complaint#862383039
1 violation found (1 high severity).
AP Serious Incdt-Report to Licensing no later than 24 hours after injury/illness that warrants treatment by a medical professional or hospitalization
HighSeveral children were caught intentionally inhaling axe body spray. This incident was never reported by the agency to Licensing.
748.303(a)(2)(A)Corrected 2023-07-20 - complaint#862383038
No violations found. All areas in compliance.
No violations
- routine#862294690
No violations found. All areas in compliance.
No violations
- complaint#862383037
No violations found. All areas in compliance.
No violations
- complaint#862383036
No violations found. All areas in compliance.
No violations
- routine#862294689
No violations found. All areas in compliance.
No violations
- complaint#862383035
No violations found. All areas in compliance.
No violations
- self-report#862383034
No violations found. All areas in compliance.
No violations
- routine#862294688
No violations found. All areas in compliance.
No violations
- routine#862294687
No violations found. All areas in compliance.
No violations
- routine#862294686
No violations found. All areas in compliance.
No violations
- self-report#862383033
No violations found. All areas in compliance.
No violations
- self-report#862383032
No violations found. All areas in compliance.
No violations
- complaint#862383031
No violations found. All areas in compliance.
No violations
- complaint#862383030
No violations found. All areas in compliance.
No violations
- complaint#862383029
No violations found. All areas in compliance.
No violations
- routine#862294685
No violations found. All areas in compliance.
No violations
- complaint#862383028
No violations found. All areas in compliance.
No violations
- complaint#862383027
No violations found. All areas in compliance.
No violations
- routine#862294684
No violations found. All areas in compliance.
No violations
- routine#862294683
No violations found. All areas in compliance.
No violations
- complaint#862383026
1 violation found (1 high severity).
Other Prohibited Punishments-subjecting a child to abusive or profane language
HighA caregiver admitted to using inappropriate/profane language about a child in care in their presence.
748.2307(9)Corrected 2023-04-05 - routine#862294682
No violations found. All areas in compliance.
No violations
- routine#862294681
No violations found. All areas in compliance.
No violations
- self-report#862383025
No violations found. All areas in compliance.
No violations
- routine#862294680
No violations found. All areas in compliance.
No violations
- self-report#862383024
No violations found. All areas in compliance.
No violations
- self-report#862383023
No violations found. All areas in compliance.
No violations
- routine#862294679
No violations found. All areas in compliance.
No violations
- self-report#862383022
No violations found. All areas in compliance.
No violations
- routine#862294678
No violations found. All areas in compliance.
No violations
- self-report#862383021
No violations found. All areas in compliance.
No violations
- routine#862294677
No violations found. All areas in compliance.
No violations
- routine#862294676
No violations found. All areas in compliance.
No violations
- self-report#862383020
2 violations found (2 medium severity).
EBI Documentation-Must include the specific emergency behavior intervention administered
MediumDocumentation provided only listed a two-person restraint as being used, but no specifics.
748.2855(a)(4)Corrected 2022-11-28EBI Follow-Up-Caregivers involved in EBI must conduct a post discussion with child
MediumDocumentation provided stated the post discussion was held with the child and a staff that was not involved in the restraint.
748.2851(b)Corrected 2022-11-28 - self-report#862383019
No violations found. All areas in compliance.
No violations
- routine#862294675
No violations found. All areas in compliance.
No violations
- complaint#862383018
No violations found. All areas in compliance.
No violations
- routine#862294674
No violations found. All areas in compliance.
No violations
- complaint#862383017
No violations found. All areas in compliance.
No violations
- routine#862294673
No violations found. All areas in compliance.
No violations
- complaint#862383016
1 violation found (1 medium severity).
Caregiver Supervision-Provide oversight of caregivers to protect children's health, safety and well-being
MediumAll staff stated there were all in different location when the incident occured.
748.683(1)Corrected 2022-08-09 - routine#862294672
No violations found. All areas in compliance.
No violations
- routine#862294671
No violations found. All areas in compliance.
No violations
- routine#862294670
No violations found. All areas in compliance.
No violations
- routine#862294669
No violations found. All areas in compliance.
No violations
- routine#862294668
No violations found. All areas in compliance.
No violations
- self-report#862383015
1 violation found (1 high severity).
AP Administration of prescription medication-Administer medications according to instructions or a prescribing health-care professional's orders
HighTwo of seven children's medication file reviewed revealed a medication being administered not according to the label/order.
748.2003(b)(3)Corrected 2022-04-14 - routine#862294667
No violations found. All areas in compliance.
No violations
- routine#862294666
No violations found. All areas in compliance.
No violations
- routine#862294665
No violations found. All areas in compliance.
No violations
- routine#862294664
No violations found. All areas in compliance.
No violations
- routine#862294663
10 violations found (5 high, 3 medium, 2 low severity).
Interior Space-Provide living space, appropriate furnishings, & bathroom facilities that are safe, clean and maintained in good repair
HighBathroom sink for bedrooms two and three in Peach House are slow draining. Bathroom sink for bedroom six in the Grey House is also slow draining.
748.3351(1)Corrected 2021-09-29Treatment Director-Facility providing treatment services to 25 or more children or to more than 30% of children in care must have treatment director
HighThe facility does not have a treatment director.
748.601Corrected 2021-09-29Food Preparation-Must have a thermometer in freezers & store frozen food at 0 degrees Fahrenheit or below
MediumThe deep freezer in the kitchen does not have a thermometer.
748.3443(b)(2)Corrected 2021-09-29Pre-Service Training- All caregivers must have 5 hrs of training on complex trauma of trafficking victims, 2 hrs pre-service and rest within 90 days
HighPolicy does not indicate complex trauma training for caregivers of human trafficking victims.
748.4653(a)(3)Corrected 2021-09-29Food Preparation-Must have a thermometer in refrigerators & store refrigerated food at 40 degrees Fahrenheit or below
MediumThe right refrigerator is at 50 degrees Fahrenheit
748.3443(b)(1)Corrected 2021-09-29Policies and procedures to submit - Tobacco and e-cigarette
HighThe agency's policy does not address tobacco and e-cigarette.
748.103(b)(13)Corrected 2021-09-29Admission Assessment-At admission, must include child's legal status
LowThe admissions assessment does not include the child's legal status.
748.1217(b)(1)Corrected 2021-09-29Records Available for Licensing-all active records immediately available for review and reproduction
MediumThere was no active record available for the operations administrator.
748.399(a)Corrected 2021-09-29Operation must adopt the DFPS drug testing policy or have its own that meets or exceeds criteria for model policy
HighDrug polices do not address all information provided in the model drug testing policy.
745.4151(a)Corrected 2021-09-29Admission Documentation-Includes date of admission
LowThe date of admission is not listed on the admission documents.
748.1205(a)(5)Corrected 2021-09-29
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