Great Lakes Center for Autism Treatment & Research

Violation established, special investigation : CCI Rule 400.4159 Youth restraint; pregnant youth; reduction, prevention;

The facility is found in noncompliance as evidenced by interviews with staff and documentation; evidence supports the allegations of Staff 1 placing Youth A in a chokehold in the Whirlpool room as evidenced by two other staff present. This technique is prohibited for behavior management and places the youth in harm’s way. 11 TECHNICAL ASSISTANCE: Technical assistance was offered regarding the facility developing a system of peer feedback for staff. This could involve having each staff member provide feedback on the staff they work with annually or no longer than every 6 months. This feedback will help provide appropriate information for staff’s annual evaluations and help identify potential issues with specific staff who may be struggling to provide appropriate care for the youth in the program.

Violation established, special investigation : CCI Rule 400.4157 Behavior management

The facility is found in noncompliance as evidenced by interviews with staff and documents. Evidence supports the finding of Staff 1 not following the behavior support plan specifically the action of protecting Youth A’s dignity by blocking line of sight of other peers in the environment when Youth A has disrobed. The second 22 specific action not followed is Staff 1’s “snatching” the blanket from Youth A when the plan outlines staff are to prompt “my turn” every 10 seconds until the item is relinquished. TECHNICAL ASSISTANCE: Technical assistance was offered regarding the facility ensuring each staff understands the youth’s behavior plan. It was suggested this could be accomplished through a sign-off sheet of the staff acknowledging they understand the appropriate interventions for the youth they will be assigned to each shift. Another action that could be taken is to assign the same staff to the same youth as much as possible thus allowing the staff to demonstrate their knowledge of the youth’s plan. Another action would be for the shift supervisor to write out a staff review for the shift with a focus on the staff’s interventions used so the staff can demonstrate their knowledge of the plan.

Violation established, special investigation : CCI Rule 400.4158 Intervention standards and prohibitions

The facility is found in violation as per interviews conducted, staff reported Staff 2 was inappropriate in his verbal interactions with and around Youth A as he made threatening comments and cussed. Staff 2 admitted he was frustrated and used inappropriate language because of the lack of support from staff present and inability for another IRTII trainer or manager to cover for him so he could leave the situation since he was the sole target of Youth A’s repeated aggression. TECHNICAL ASSISTANCE: - All staff on the floor (regardless of training status) should be trained regarding use of the walkie-talkie for communication, how to call for safety separations, etc. They should be made aware they are able to call for back- up whether an IRTII trainer instructs them to or not considering the trainer may be occupied with the crisis. - Safety Care should be trained as early as possible during the onboarding process as newer staff expressed feeling unsafe and unprepared to handle or help in crisis situations on the floor prior to their official shift trainings being completed. (i.e. one new staff reported she hadn’t been trained yet but was shadowing someone and a crisis broke out. The staff reported feeling very vulnerable and unsafe because she didn’t have any tools to prepare her for the situation.) - The facility should consider establishing a consistent and thorough training protocol/process for IRTII trainers to follow for new staff. One new staff reported trainers are not ...

Repeat violation established, special investigation : CCI Rule 400.4109 Program statement

The facility is found in violation as per interviews conducted and documentation reviewed, Staff 1 did not follow Youth A’s treatment plan regarding tablet use, did not follow Youth A’s toileting protocol, and did not follow the facility’s cell phone policy.

Violation established, special investigation : CCI Rule 400.4127 Staff to resident ratio

The facility is found in violation as per documentation reviewed, it is unclear when Staff 1 completed observation checks on Youth A, or whether those checks met the requirement of variable interval checks not to exceed 15 minutes since 15-minute timeframes are prefilled on the youth data sheets. Based on Staff 2’s interview and the incident report completed; it seems clear checks were not completed as required since Youth A was sitting in his own feces long enough for it to be dried on his skin. 6 TECHNICAL ASSISTANCE: • The facility was provided technical assistance regarding Youth A’s Service Plan Monitoring Prompts as it stated, “During sleep hours, staff will visually check on [Youth A] every 15 minutes”. Facility was notified they needed to ensure all youths’ plans coincide with the requirements of the rule, which includes variable interval checks not to exceed 15 minutes whenever a youth is in their bedroom (not just during sleeping hours). • The facility should also update their youth data sheets to be consistent with the licensing rule. Currently, the times are pre-filled with 15 minute intervals, which does not meet the requirement of the licensing rule as it is unknown when the staff completed the visual check since the staff do not fill out the time they completed the check. For example, a staff could complete a check at 1 pm (between 1-1:15pm time slot) and not complete another check until 1:30pm (between 1:15-1:30pm timeslot). The staff would meet the ...

Violation established, special investigation : CCI Rule 400.4158 Intervention standards and prohibitions

The facility is found in violation as per interviews conducted and documentation reviewed, Staff 1 had inappropriate contact with Youth A as Complainant reported Staff 1 slapped Youth A multiple times, and Staff 1 admitted to pushing Youth A’s arms away from 4 him. Neither of these are approved techniques trained by the facility.

Violation established, special investigation : CCI Rule 400.4109 Program statement

The agency is found in non-compliance as per interviews conducted, tour observation conducted, and documentation reviewed, the agency is a secure facility, and a youth was able to exit the facility without supervision due to a faulty door.

Violation established, special investigation : R 400.158 Discipline

The facility is found in noncompliance for the use of corporal punishment as evidence supports Staff 1 engaged in corporal punishment when he placed his feet under Youth A causing him to fall in what appears to be an attempt to cause a negative consequence to stop his attempted kicking. This type of behavior is not allowed to be used by rule and facility policy.

Violation established, special investigation : R 400.4112 Criminal history check, subject to requirements; staff

Staff 1 and Staff 2 were deemed unsuitable.

Violation established, special investigation : R 400.4109 Program statement

The facility is found in noncompliance as Staff 1 failed to complete an incident report and other required actions after Youth A was injured, Staff 1 failed to follow safety separation procedure, Staff 1 and Staff 2 failed to report their relationship to administration as required, and Staff 1 and Staff 2 failed to follow agency phone policy.