The Brown Schools Rehabilitation Center

Risk level: Medium High : 748.1003(a) - 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

It was observed 2 Direct Care staff supervising 13 residents at lunch and were out of ratio while the other Direct Care staff took a lunch break.

Risk level: Medium High : 748.1003(a) - 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

It was determined the unit was out of ratio.

Risk level: Medium High : 748.3301(h) - Physical Site-The building must be free of rodents and insects

During the investigation, dead insects were observed enclosed in a ceiling light fixture in the break room and nurse’s station. It was also observed a large spider web above the child’s bed. The inspector observed two small black specks in the cabinet with the children's cereal and on the floor by the TV room which appeared to be consistent with rat droppings.

Risk level: Medium : 748.3301(a)(2) - Physical Site- Buildings must be clean and in good repair.

During the investigation the inspector observed a black substance on the caulking and grout in both shower areas which appeared to be consistent with mold. The inspector also observed black sticky substance emerging through cracks between the floor tiles in the bedrooms of the children. It was also observed a ceiling light fixture or camera is damaged. The hallway floor near the TV room contained visible dust and debris and required sweeping.

Risk level: Medium High : 748.1005 - Child/caregiver ratio-Each group must have enough caregivers for that group who are not caring for other children or doing administrative work

Through inspector eye witness and additional interviews with staff it was reported the nurses are being counted in ratio while completing nursing duties and administrative work.

Risk level: Medium Low : 748.1331(b)(2) - Preliminary Service Plan-For child receiving treatment services, include a description of child's immediate educational, medical, and dental needs

During the course of the investigation, it was observed the master service plan, the initial nursing treatment plan, and the initial clinical review documents did not contain information regarding self-management of child's illness .

Risk level: Medium High : 748.1005 - Child/caregiver ratio-Each group must have enough caregivers for that group who are not caring for other children or doing administrative work

It was determined there were only 2 staff present for multiple hours with 18 children. 2 additional staff were present but were providing 1:1 care and unable to be counted in ratio.

Risk level: Medium High : 748.930(b)(3) - Annual Training- Caregivers must have 1 hour normalcy training.

It was observed 2 out of 2 staff files reviewed did not contain the required 1 hour of Normalcy training.

Risk level: Medium High : 748.930(b)(2) - Annual Training- Caregivers must have 2 hrs trauma informed care.

It was observed 2 out of 2 staff files reviewed did not contain the required 2 hours of Trauma Informed Care training.

Risk level: Medium High : 748.3391(a) - Bathrooms-Must be maintained in good repair & kept clean

It was observed the unit's showers had mildew on the ceilings and grout, as well as two cockroaches in the shower.

Risk level: Medium High : 748.930(a)(2) - Caregivers at operations with 25 or more children or 30% or more of their population receiving treatment services must have 50hrs annual training

It was observed 2 out of 2 staff files reviewed did not have the required annual training hours or courses.

Risk level: Medium High : 748.2551(b)(2) - EBI Implementation-The caregiver must consider the permitted types of emergency behavior intervention

A child was inappropriately restrained by a staff member who placed their arm around the child's neck.

Risk level: Medium High : 748.2455(a)(2) - Emergency Behavior Intervention-Basis for EBI is an emergency situation or to administer medication

A child was restrained for attempting to walk out of the cafeteria without permission which does not constitute an emergency situation where the child or others safety was at risk. The child was not on any safety plan or precautions at the time of the restraint.

Risk level: Medium High : 748.1003(a) - 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

It was determined staff were out of ratio when a physical altercation occurred between children in care. 2 children, 3 staff, and parent stated the ratio was 2:15 when the incident occurred.

Risk level: High : 748.2307(15) - Other Prohibited Punishments-using or threatening to use emergency behavior intervention as discipline or punishment

During the investigation, a staff member reported that they used a threat of a personal restraint as tool for disciplining the child.

Risk level: High : 748.1531(a)(2) - Medical care-A child in care must receive medical care as needed for injury, illness, and pain

It was reported that on 11/5/24, a child in care punched a wall at school and this required medical attention. The same child was found to be punching a window at the gym later that same day. It was found this child sustained two finger fractures to the right hand with callous formation and didn’t receive a cast/splint until 11/8/24.

Risk level: Medium High : 748.303(a)(2)(A) - AP Serious Incdt-Report to Licensing no later than 24 hours after injury/illness that warrants treatment by a medical professional or hospitalization

It was found that the incident occurred on 11/5/24 and staff were aware of the child’s right-hand injury on this day, however the incident wasn’t reported to the A/N Hotline until 11/8/24.

Risk level: Medium : 748.311(4) - Serious Incident Documentation-Includes names of all adults involved and their role in relation to the child(ren)

It was found that sections [748.311(2), (4), (5), (7), and (8)] of the incident report documentation were missing required information.

Risk level: High : 748.2461(b)(1) - Short Personal Restraint-Caregiver may not use a prone or supine restraint

During the course of the investigation, a staff member and a child reported that the child was restrained briefly on their back (in a supine position).

Risk level: Medium High : 748.2307(9) - Other Prohibited Punishments-subjecting a child to abusive or profane language

Several people interviewed reported a staff member used profane language following a personal restraint in front of a children in care.

Risk level: High : 748.2303(a) - Corporal Punishment-May not use/threaten corporal punishment, such as hitting/spanking, forced exercise, holding physical position, unproductive work.

2 children interviewed mentioned a staff threatened at least 1 child with corporal punishment.

Risk level: High : 748.2307(14) - Other Prohibited Punishments-withholding food that meets the child's nutritional requirements

A staff threw away a child's food in response to the child spitting at their feet.

Risk level: High : 748.2461(b)(3) - Short Personal Restraint-Caregiver may not use restraint that obstructs child's airways or impairs child's breathing

While a child was being restrained by staff, another staff choked the child.

Risk level: High : 748.2461(a)(2) - Short Personal Restraint-Caregiver must use minimal amount of reasonable and necessary physical force

A child received a bloody, swollen nose during a restraint due to a staff member banging their head on the ground.

Risk level: Medium High : 748.2455(a)(1) - Emergency Behavior Intervention-Before using EBI, the caregiver must attempt less restrictive interventions that prove to be ineffective

Instead of permitting other staff to manage and defuse the situation, a staff member exacerbated the situation by intervening even though they were aware the child was upset with them.