East Texas Open Door Inc

During the after-hours monitoring inspection, it was observed that the operation's posted evacuation diagrams did not have a specified shelter in place location for severe weather.

The caregivers did not de-escalate a heated altercation between two residents, which resulted in a child having a seizure and requiring emergency medical attention.

During the monitoring inspection, the thermometer located in the freezer was not at the required 0 degrees.

During a review conducted on March 25, 2024, it was determined that: (1) the Administrator failed to ensure compliance with the current HM Plan; and (2) 12 months had elapsed since the effective date of the plan. The heightened monitoring plan for this operation included a specific ?planned end date? at the 12-month mark by which the operation was expected to meet all heightened monitoring criteria necessary to move out of active heightened monitoring to a phase of ?post plan monitoring?. As a direct result of the administrator?s failure to ensure timely compliance with the heightened monitoring plan, this operation is now unable to successfully move to post-plan monitoring. Furthermore, the operation?s ?planned end date? must now be revised, and the period of heightened monitoring must be extended. Further details of the administrator?s failure to ensure compliance include the following: - Operation failed to demonstrate 6 months of successive compliance with the standard and contract requirements that led to heightened monitoring and - Operation was unable to meet compliance with Medium-High or High weighted licensing citations

During a review conducted on September 22, 2023, it was determined that: (1) the Administrator failed to ensure compliance with the current HM Plan; and (2) 12 months had elapsed since the effective date of the plan. The heightened monitoring plan for this operation included a specific ?planned end date? at the 12-month mark by which the operation was expected to meet all heightened monitoring criteria necessary to move out of active heightened monitoring to a phase of ?post plan monitoring?. As a direct result of the administrator?s failure to ensure timely compliance with the heightened monitoring plan, this operation is now unable to successfully move to post-plan monitoring. Furthermore, the operation?s ?planned end date? must now be revised, and the period of heightened monitoring must be extended. Further details of the administrator?s failure to ensure compliance include the following: - Operation failed to demonstrate 6 months of successive compliance with the standard and contract requirements that led to heightened monitoring and - Operation was unable to meet compliance with Medium-High or High weighted licensing citations

During the inspection, it was observed that the door to access the attic was unlocked and accessible to children who were permitted to be upstairs.

During the inspection, the bathroom in bedroom four had a paper towel dispenser but no paper towels.

During a walkthrough of the operation, I observed two freezers with non-working thermometers.

During the inspection, it was discovered the operation has not completed a severe weather drill in over 12 months.

During the investigation, it was observed that the operation's back gate was locked with a padlock. The emergency evacuation plan instructs children to meet at the large parking lot across the street, however, those who exit through the back door will not be able to open the gate without a key to the padlock.

During the investigation, it was observed that the operation's evacuation plan has one exit that leads directly through the kitchen.

It was relayed to Childcare Regulation that the spouse of a staff person at the facility began living at the operation in the beginning of August 2023. The Administrator confirmed this information to DFPS. A background check was not submitted prior to this person moving in.

A child in care received medication 4 hours later than it was to be received.

During an inspection, there was excessive dust and cob webs on vents, walls, and ceilings.

During the inspection, there was an unlocked box of over the counter medication on a book shelf in the conference room, which children have access to.

Three of the five children interviewed reported that a staff provoked children in care by making belittling and ridiculing comments and laughing at the children, which resulted in a staff being assaulted.

During a review conducted on March 17, 2023, it was determined that: (1) the Administrator failed to ensure compliance with the current HM Plan; and (2) 12 months had elapsed since the effective date of the plan. The heightened monitoring plan for this operation included a specific ?planned end date? at the 12-month mark by which the operation was expected to meet all heightened monitoring criteria necessary to move out of active heightened monitoring to a phase of ?post plan monitoring?. As a direct result of the administrator?s failure to ensure timely compliance with the heightened monitoring plan, this operation is now unable to successfully move to post-plan monitoring. Furthermore, the operation?s ?planned end date? must now be revised, and the period of heightened monitoring must be extended. Further details of the administrator?s failure to ensure compliance include the following: - Operation failed to demonstrate 6 months of successive compliance with the standard and contract requirements that led to heightened monitoring; and - Operation was unable to meet compliance with Medium-High or High weighted licensing citations.

During the inspection, there was a hole in the wall in bedroom 2.

During the inspection, there was a bottle of Scrub Free Total Bathroom Cleaner on a shelf in the living area.

During the inspection, the fire extinguisher in the attic/game room of the grey home had expired tags and reflected the last service date of Sept 2020.

During the inspection, the freezer combo in the grey home did not have a thermometer.

During the investigation, it was determined that the caregivers did not use the minimal amount of reasonable and necessary physical force during an EBI implementation as they can be seen, on video footage, sitting on and straddling the child.

During the investigation, it was discovered that the caregivers did not attempt to shield the restraint of a child from other residents that were present.

It was discovered through interviews with collaterals, that staff failed to supervise children accordingly, as staff member would fall asleep during their working hours.

During the inspection, I observed three missing medications documentation entries in one child's record.

During a review conducted on 9/16/22, it was determined that: (1) your operation?s administrator failed to ensure compliance with the current HM Plan(s); and (2) 12 months had elapsed since the effective date of the plan. The heightened monitoring plans for this operation included a specific ?planned end date? at the 12-month mark by which the operation was expected to meet all heightened monitoring criteria necessary to move out of active heightened monitoring to a phase of ?post plan monitoring?. As a direct result of the administrator?s failure to ensure timely compliance with heightened monitoring plans, this operation is now unable to successfully move to post-plan monitoring. Furthermore, the operation?s ?planned end date? must now be revised, and the period of heightened monitoring must be extended. Further details of the administrator?s failure to ensure compliance include the following: - Operation failed to demonstrate 6 months of successive compliance with the standard and contract requirements that led to heightened monitoring; and - Operation was unable to meet compliance with Medium-High or High weighted licensing citations, including having an open investigation.

During the walk through of the operation exposed wire was found near the central fire detector system.

On 5/30/22 there was a report of four clients testing COV-19 positive diagnosis. There was no documentation available for review of this incident during my inspection

Several children indicated staff threatened to physical harm children in care.

Staff ran a personal errand while transporting children in care.

Several children indicated staff uses profane language towards children in care.

There were three girls on this child. One straddling her torso, one holding her head, and one holding her ankles. This could have caused pain, panic, or breathing problems for the child being restrained.

The child did not have a post discussion with a caregiver after she was restrained by the children.

There was no documentation of this EBI restraint.

There has been nothing shared verbally or in writing by the children or staff that the situation was discussed with them.

The caregiver did not use prudent judgment when she asked the other residents to help her to physically control the child who had swallowed glass. The caregiver chose to look for more glass in the bedroom while this was happening. The victim child could have been seriously injured.

A caregiver asked the other children in the home to help her restrain a child who needed to be hospitalized. The restraint was conducted by untrained teenagers.

One of the four children read had no TB test or results in the chart.

One staff chose to use a restraint on a child when the situation, as written, did not constitute an emergency.

In one of the restraint reports, there was nothing under the "debriefing" section. In two other reports, the documentation was minimal and lacked detail.

At least one staff member has been dozing off during her graveyard shifts and has been seen sleeping by more than one child.

The general responsibilities of all employees regardless of whether they are counted in the child/caregiver ratio is to demonstrate competency and prudent judgement in the absence of a more specific rule requirement. In this incident the two children were involved in a verbal altercation 30 min prior to arriving back at the facility, once at the facility one of the children is refusing to take verbal direction from staff and is attempting to make contact with the second child. While staff offered a chance to go to a separate house that evening, the second child refused and chose to return to "White house". Even after staff observed the other child outside and heard her making derogatory comments, they allowed the second child to return to her assigned housing where the altercation occurred.

The medication boxes at both the White and Corner House was observed during today's inspection, and both were in locked closet but the boxes were not locked. When the individual boxes are not locked it operation is not meeting the requirement to have these medication double locked. Before I left each house I had the staff lock the combination boxes. The boxes were checked and observed as locked before I left each house.

It was determined that direct care staff were not allowing children in care to call their caseworkers.

One of four child records reviewed did not have a signed copy of the Child's Rights. There were two unsigned copies of the child's rights in the child records.

Medication errors were marked in the records, but the codes and details in the error logs were delayed by 3 days.

There were several things missing in the vans first aid kit, including: scissors, adhesive tape, tweezers, and gloves.

There were two beds in the gray house that were missing mattress protectors. These were not vacant beds, so the staff was going to locate mattress protectors.

One of the girl's initial service plan was completed 98 days after she was admitted. This needs to be done within 45 days, and it should be signed by the treatment team.

The preliminary service plan done for one child was not done in 72 hours-- it was 16 days late.

One of the girls' beds had two pillows and no pillow cases. This has become an ongoing problem.

In the child's record reviewed the initial service plan was not completed timely. The child was placed 6/4/21 and the plan was not completed until 8/3/21.

On the physical site walk-through, there was a bed in the white house had two pillows without cases.

There were several containers of juice and chips on the floor in the food pantry.

The last fire drill was done in November of 2020, so one would be needed in May 2021. There were no diaster drills on file. These also need to be done every 6 months.

There was no preliminary service plan completed for two children who were admitted on 6/8/21.

The policy with ETOD is to have kids in eye or ear shot -and to check on them every 15 minutes or more if it is in their plan.

One of the two child records read was missing a 14 day notice for a service plan.

In review of the serious incident reports, there was one report of a child being arrested that was not reported timely. The incident occurred 5/22/21 and was not reported until 5/24/21.

In review of the staff records, one staff had a total of 44 annual training hour for 2020. The operation had corrected the issue at the time of inspection by making the staff make up 6 additional hours of training in Jan 2021.

Bathroom shower in the Green House had black mold and soap scum on the walls, floor and shower door.

Although the serious incident was called in to SWI, no written report was given to the Abuse/Neglect investigator - after one month of requests.

The staff/medical liaison did not communicate pertinent information to Psychiatrist about the child, which likely would have made a difference in the child's medical/emotional health and treatment.

A staff member gave a child a double dose of her prescribed medication.