Severe reports

The facility is found in violation as per interviews conducted, video footage reviewed and documentation reviewed Staff 1 pushed Youth A multiple times on or around his stomach.

The facility is found in violation as per interviews conducted, video reviewed and documents reviewed, Staff 2 and Staff 5 witnessed Staff 1 pushing Youth A in the van and did not report the concerns as required by the child protection law and the facility’s policies.

From the state's report. Repeat violation established, special investigation; Violation established, special investigation. Cited: CCI Rule 400.4158 Intervention standards and prohibitions; CCI Rule 400.4131 Compliance with child protection law;.

The agency is found in noncompliance because Manager 3 failed to provide for the needs and protection of Youth A when she did not evaluate Youth A’s request to transfer off Unit 3B, which resulted in Youth A sustaining injuries during a physical assault on Unit 3B the day after his transfer request.

From the state's report. Repeat violation established, special investigation. Cited: CCI Rule 400.4126 Sufficiency of staff.

The facility is found in noncompliance as Staff 2 reported she witnessed Staff 1 push Youth A into his bedroom with both hands however did not report the suspected abuse/neglect per the facilities reporting policy to Centralized Intake.

From the state's report. Violation established, special investigation. Cited: CCI Rule 400.4131 Compliance with child protection law; development of plan.

During the August 8, 2026 incident, Staff 7 was seen pulling Youth A forcefully by his arm through a door while Staff 2, Staff 3, Staff 15 6, and Staff 9 were present and could have assisted in an appropriate restraint.

From the state's report. Repeat violation established, special investigation. Cited: CCI Rule 400.4159 Youth restraint; pregnant youth; reduction,.

The agency is in non-compliance as per video review, interviews and documentation reviewed, staff were pulling on Youth A’s shirt and dragged him by his shirt into his room.

From the state's report. Repeat violation established, special investigation. Cited: CCI Rule 400.4158 Intervention standards and prohibitions.

The agency is found in non-compliance as per interviews with Youth A, Youth B, and Staff, as well as video review, Supervisor pushed Youth A into his room onto the floor, which is not an approved SCM Technique.

From the state's report. Violation established, special investigation. Cited: CCI Rule 400.4158 Intervention standards and prohibitions.

Based on interviews conducted, video footage reviewed and documentation reviewed there is a violation established regarding Staff 2 pushing and punching Youth A, and Staff 2 putting his arm around Youth A’s neck while Youth A was on his bed resulting in visible bruising on Youth A’s neck.

Based on interviews, video footage, and documentation reviewed, staff were determined to have inappropriately restrained Youth A, as Staff 2 held Youth A on the floor and on his bed, and lifted and carried Youth A to his bedroom.

From the state's report. Repeat violation established, special investigation. Cited: CCI Rule 400.4158 Intervention standards and prohibitions; CCI Rule 400.4159 Youth restraint; pregnant youth; reduction, prevention;.

Technical Assistance: The agency’s restraint policy allows for the use of certain techniques such as strikes and kicks, however these tactics are in direct violation of rule 400.10169(1)(a) that prohibits the use of corporal punishment.

From the state's report. Violation established, special investigation. Cited: 400.10177.

The facility is found in non-compliance per staff and youth interviews, as well as documentation reviewed that Staff 6 tackled, pushed and attempted to punch Youth A before being pulled off by multiple staff members.

From the state's report. Violation established, special investigation. Cited: CCI Rule 400.4158 Intervention standards and prohibitions.

On May 13, 2026, Community Care Licensing (CCL) received allegations that staff pushed minor on bed and that staff put minor in a "choke" hold. [...] LPA reviewed video #2 and observed [Child 1] walking in the hallway with [Staff 1] behind them and LPA observed [Staff 1] shove [Child 1] as they were walking back to their bedroom. Based on confidential interviews, records reviewed and videos observed, the preponderance of evidence standards has been met and the allegations that staff pushed minor on bed and that staff put minor in a "choke" hold are substantiated.

From the state's report. Substantiated. Cited: 87072(c)(16). "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.

Staff 13’s pulling Youth H by the shirt was not an approved CPI intervention.

From the state's report. Repeat violation established, special investigation. Cited: CCI Rule 400.4159 Youth restraint; pregnant youth; reduction,.

Behavior Management: Resident injured during a physical restraint performed by facility staff.

From the state's report. Substantiated complaint. Cited: 340:110-3-154.2(b)(1) behaviors that could cause physical pain, such as shaking, striking, spanking, grabbing, yanking, pulling, pushing ....

The facility is found in non-compliance as per interviews conducted, video reviewed, and documentation reviewed concluded the incident on 04/10/2026 Staff 4 pushed Youth A and the incident on 04/12/2026 Staff 3 held and pushed Youth A into her room.

The facility is found in non-compliance as per interviews conducted, video reviewed, and documentation reviewed, staff inappropriately restrained Youth A by holding her arms and legs and carrying the youth, which is not an approved restraint method per CPI.

From the state's report. Violation established, special investigation. Cited: CCI Rule 400.4158 Intervention standards and prohibitions; R 400.4159.

The report indicated that [Resident 3] contacted the Administrator, [Staff 2], and [Staff 2] directed [Staff 3] to take [Resident 1] to the emergency room for a "rape kit." The incident report further indicates that [Resident 2] and [Resident 3] were the alleged perpetrators of the assault. A review of the discharge paperwork from the hospital confirmed that [Resident 1] was evaluated for sexual assault and had contusions. In an interview over the telephone, [Staff 2] originally reported being unaware that there were any allegations of sexual or physical assault. [...] I need to speak to you asap because apparently a staff member sat and watch this happened and laugh... we really need the cameras." In an interview, [Staff 3] reported that [Staff 5] was the overnight behavioral health technician (BHT) and that [Resident 1] reported that [Staff 5] watched the assaults occur and did not intervene.

In an additional interview over the telephone, [Staff 2] reported never stating being unaware that there were any allegations of sexual or physical assault. [Staff 2] reported being aware only of the physical assault and not the sexual assault.

From the state's report. Deficiency cited, complaint and compliance (annual). Cited: R9-10-711.B.1. Resident Rights B. An administrator shall ensure that: 1. A resident is treated with dignity, respect, and consideration;; R9-10-716.A.7.b. Behavioral Health Services A. An administrator shall ensure that: 7. A resident does not: b. Share any space, participate in any activity or .... "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.

Spoke with [Former client 3] again and this time she reported staff #1 slammed her head into the wall and staff #2 pulled her by hair and pushed her back on couch [...] [Former client 3] reported that both staff #1 and staff #2 assaulted her Interviews on 7/22/26 and 7/27/26 the Director reported: She was aware that [Former client 3] reported that staff #1 hit her to her DSS legal guardian [...] She did not know that the allegation from [Former client 3] required an IRIS because the police had not been called

From the state's report. Deficiency cited, complaint survey. Cited: V 367| 27G .0604 Incident Reporting Requirements. "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.

A review of the video revealed that facility staff observed the assault and gave minimal crisis communication and verbal de-escalation instructions.

From the state's report. Substantiated (one of several allegations).

Given that [the staff person] did not intervene to protect [the alleged victim] as multiple youth chased him/her, sprayed him/her with water, and physically assaulted [the alleged victim] including punching [the alleged victim] in the stomach causing [the alleged victim] to bend over and grab his/her stomach and another occasion when [the alleged victim] was hit with a skateboard in the groin appearing to make [the alleged victim] scream and cover his/her groin with his/her hands, there was a preponderance of the evidence that there was a failure to supply [the alleged victim] with necessary care required for [the alleged victim]’s physical or mental health and a failure to protect [the alleged victim] from conditions or actions that seriously endangered [the alleged victim]'s physical or mental health when reasonably able to do so.

From the state's report. Maltreatment determined as to neglect of an alleged victim by a staff person.. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.

The department's review of video footage, along with interviews with Staff A, Staff B, and Resident A, confirmed that Staff A had pushed Resident A.

From the state's report. Non-compliant, complaint visit. Cited: He-C 4001.22(b)(11) Program staff shall not use rough handling on residents, including but not limited to, grabbing, pushing, pulling, and dragging..

A child was injured he had a bruise on his jawline due to a restraint.

From the state's report. Risk level: High. Cited: 748.2551(c)(1) - EBI Implementation-Caregiver must minimize risk of physical discomfort, harm, or pain to the child.

Video footage obtained of a restraint showed staff dragging a child out of their room by their foot, which showed a disregard for the risk of physical discomfort or pain.

From the state's report. Risk level: High. Cited: 748.2551(c)(1) - EBI Implementation-Caregiver must minimize risk of physical discomfort, harm, or pain to the child.

A caregiver pushed a child in care.

From the state's report. Risk level: High. Cited: 748.1101(b)(4)(A)(ii) - Children's rights-The right to be free from being subjected to or threatened with corporal punishment, including spanking or hitting.

This Department has investigated the complaint allegations that staff has an inappropriate relationship with youth in care, staff did not prevent youth from consuming alcoholic beverages, and staff did not prevent youths from self-harm.

No witnesses reported observing conduct they believed constituted grooming for the purpose of sexual abuse however, confidential interviews showed possible psychological grooming in the context of establishing emotional connections with youth in care leading youth to not follow other staff directions as required by the program rules and policies.

From the state's report. Substantiated (one of several allegations); Substantiated. Cited: 87072(c)(15).

The staff initiated a physical restraint after the client threw water on the staff. During the physical restraint, a staff laid on the client's legs, resulting in the client sustaining a fractured foot. <br/>

From the state's report. Out of compliance, complaint, investigation inspection. Cited: R380-80-5(4) Provider shall protect clients from abuse, prevent abuse.

On March 24, 2026, three clients (C1-C3) ran away from the facility, climbed into dumpsters, and ingested unknown items. Staff called 9-1-1 and took [Child 1] to an emergency room after s/he repeatedly vomited.

From the state's report. Violation cited by DHS. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.

In plain words: A former client reported that a staff member put arms around the neck, lifted, and slammed the client to the ground. The client left the facility, and the guardian later reported the client had injuries and police involvement. Our summary of the state's report. The state's own wording follows.

"[Staff #9] went behind and put his arms around my neck picked me up and slammed me to the ground." [...] [Former client 7] eloped from the facility. [...] We (facility staff) called the police after the 2nd time [Former client 7] left. After the police left, he and staff #9 finished the shift. [...] Approximately one hour later around 4pm, [Former client 7]'s legal guardian/mother called and said Emergency Medical Services (EMS) and law enforcement made contact with [Former client 7] and he had an injury to his forehead and shoulders. [...] She had not called law enforcement because [Former client 7] “had already made contact with them (law enforcement)." [...] She received a call from the Assistant Program Director who informed her [Former client 7] had eloped and a handgun was involved " proceeded to the house (facility)." [...] She was told when [Former client 7] saw staff #9's handgun he left the facility and threw the metal somewhere on the side of the road.

From the state's report. Deficiency cited, complaint and follow-up survey, Type A1 violation. Cited: V 512} 27D .0304 Client Rights - Harm, Abuse, Neglect. "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.

It was confirmed that a staff member used corporal punishment by hitting a child on the buttocks.

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

In plain words: { summary: Six staff members failed to protect a child who had a history of self-harm. The child was found hanging in a bathroom and died by suicide. } Our summary of the state's report. The state's own wording follows.

Based on observation, record reviews and interviews, 6 of 8 audited paraprofessional staff (#1, #2, #4, #5, #6 and #9) failed to protect client from harm and neglect affecting 1 of 1 deceased client ([Deceased client 9]). [...] "She has an extensive history of self-injurious behaviors, suicidal ideation and at least three reported suicide attempts." Review on 3/19/26 of the North Carolina (NC) Incident Response Improvement System (IRIS) revealed: [...] "On March 15, 2026, (Executive Vice President) received a call from Chief Executive Officer (CEO) informing me that a client [Deceased client 9] had attempted suicide at the Cornerstone Treatment Facility (facility). [...] "Staff reported that [Deceased client 9] was found ina bathroom hanging from the shower curtain rod by a ligature. [...] "Based on all information gathered, [Deceased client 9] died as a result of suicide by ligature. [...] "She [Deceased client 9] had previously cut herself a week or two before this incident."

From the state's report. Deficiency cited, complaint and follow-up survey, Type A1 violation. Cited: V 512} 27D .0304 Client Rights - Harm, Abuse, Neglect. "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.

On 4/17/26, Former Staff #1 hit him in the stomach [...] Left the facility on 4/18/26 and on 4/19/26 because on 4/17/26, Former Staff #1 hit him in the stomach Review on 4/23/26 of the Incident Response Improvement System (IRIS) revealed:

From the state's report. Deficiency cited, annual and complaint survey, Type A2 violation. Cited: V 366. "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.

Based on consistent confidential interviews and pertinent documentation, the allegation that staff ([Staff 1]) inappropriately restrained minor ([Child 1]) is substantiated.

From the state's report. Substantiated (one of several allegations). The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.

On December 3, 2025, the Department received a complaint alleging the licensee physically abused minor in care. [...] **Continued on page 2** *****This is an amended report of the report issued June 4, 2026***** **Continued from page 1** During the investigation, confidential interviews and record review provided consistent and detailed descriptions of the physical abuse. [...] Based on confidential interviews and record review, the preponderance of evidence standard has been met and the allegation that LC physically abused [Child 1] in care is substantiated.

From the state's report. Substantiated. Cited: 83072(d)(11). "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.

During the inspection, investigative interviews with several clients disclosed a staff member making inappropriate sexual and homophobic remarks.

During the inspection, investigative interviews revealed that a client had eloped from the facility. Upon return, the provider failed to conduct a search of the client who had concealed a box opener on their person and ultimately self harmed with it, cutting their arm and neck.

During the inspection, investigative interviews revealed that a client had swallowed a battery. The provider did not seek immediate medical attention or send the client to the Emergency Room.

From the state's report. Out of compliance, complaint, investigation inspection. Cited: R380-80-6(1)(a)-(i) Client rights; R380-80-5(4) Provider shall protect clients from abuse, prevent abuse.

Allegations of Inhumane Treatment on or about July 2025, in that a student with a severe Traumatic Brain Injury (TBI) was allegedly placed in seclusion for weeks and instructed to use a bucket with a trash bag as a toilet.

A youth reportedly took hand sanitizer from a teacher's desk and ingested an unknown quantity, leading to an emergency room visit.

From the state's report. Evidence supports non-compliance, DFS notice. Cited: Chapter 3, Section 23 Child and Family (Parent, Guardian) Rights; Chapter 3, Section 18 Facility Health and Safety Requirements.

In plain words: { summary: A former client damaged an office door while a staff member called the emergency services. The staff member and former clients reported that physical fights and verbal threats occurred between them. The staff member confirmed he accidentally hit a former client in the face during the commotion. } Our summary of the state's report. The state's own wording follows.

While staff #1 was on the telephone with 911, [Former client 2] caused property damage by punching and kicking the office door. [...] "Staff #1 punched me in my face and ended up with a busted lip and messed up eye." [...] They had stopped fighting but staff #1 kept “talking junk" and punched his brother in the face and they started fighting again. [...] "He [staff #1] would jokingly say how he would hurt me and my brother- how he would choke us out, stab us, shoot us, try to kill, punch us and slam us against the wall. [...] Staff #1 punched [Former client 1] trying to get to him. [...] "[Staff #1] hit my brother to get to me. He (staff #1) hit me and we started fighting." [...] "[Staff #1] called the police." Cc [...] The kid said something about his mom, [staff #1] punch the kid. [Staff #1] don't hit first unless he have to. can't recall the name of the kid." [...] Staff #1 confirmed he did hit [Former client 1] open handed by accident in the face in all the commotion.

From the state's report. Deficiency cited, complaint survey, Type A1 violation. Cited: V 512) 27D .0304 Client Rights - Harm, Abuse, Neglect. "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.

Staff B reported they reviewed camera footage and witnessed Staff C push Resident A. Staff D reported they witnessed Staff C shove Resident A into their bedroom during the overnight shift from May 20 to May 21, 2026.

From the state's report. Non-compliant, complaint visit. Cited: He-C 4001.22(b)(11) Program staff shall not use rough handling on residents, including but not limited to, grabbing, pushing, pulling, and dragging..

Enhanced Civil Penalty package for a violation that is determined to have resulted in the death of a client was approved on 05/18/2026. Pursuant to the Enhanced Civil Penalty law, Health & Safety Code section 1548 (e)(3)(A) for the death of a client receiving care at a transitional housing placement provider the Department issues an immediate civil penalty of $7,500.00. [...] A copy of this report and a Civil Penalty Assessment - Death/Serious Bodily Injury/Physical Abuse (Form 421-D) was provided to the Administrator.

From the state's report. Deficiency cited at inspection. "[...]" marks text left out between sentences.

During the inspection, the investigator determined that the provider failed to summon emergency medical services for a minor client who was rendered unconscious and sustained severe head and facial injuries during a physical assault. Rather than summoning emergency medical transport, the provider elected to call a non-medical transport company to take the client to the hospital, delaying medical treatment

From the state's report. Out of compliance, investigation inspection. Cited: R380-80-5(4) Provider shall protect clients from abuse, prevent abuse.

A report that a staff member hit a youth twice during a restraint.

From the state's report. Evidence supports non-compliance, DFS notice. Cited: Chapter 3, Section 24 Discipline.

The agency is found to be in non-compliance as per interviews, documentation and video review, it was found that Staff 1 physically assaulted Youth A and Staff 1 also bit Youth A on his right arm on 3/24/2026.

From the state's report. Repeat violation established, special investigation. Cited: CCI Rule 400.4158 Intervention standards and prohibitions.

It is found that Former Staff 1 hit Youth A with a walkie talkie more than once and pulled out strands of Youth A’s hair.

From the state's report. Repeat violation established, special investigation. Cited: CCI Rule 400.4158 Intervention standards and prohibitions.

Additional Non-Compliance Found During Investigation: Behavior Management: Staff used an improper restraint technique.

From the state's report. Found during a substantiated complaint investigation. Cited: 340:110-3-154.2(a)(2) behavior management methods;.

Record review on 5/4/26 revealed the Child 1's Behavior Management Report #14642, dated 4/12/2026 at 4:20 p.m., indicated Child 1 attempted to strangle himself with a computer cord.

From the state's report. Deficiency cited, complaint survey. Cited: A 170 41.10 Active Treatment.

Program staff reported an allegation that a staff member physically abused a resident at the program. Resident A reported to their clinician that Staff F had punched and kicked them and that other staff were rough when restraining them. Staff A confirmed that, while Resident A was in an approved restraint, they observed Staff F punch Resident A a few times, walk around the group of staff and then kick Resident A a few times before leaving the area. Staff C confirmed that they observed Staff F hitting and kicking Resident A repeatedly while Resident A was in an approved restraint conducted by other staff members, and described yelling for other staff to help while shielding Resident A with their body.

From the state's report. Non-compliant, compliance visit. Cited: He-C 4001.22(b)(1) Program staff shall not abuse or neglect residents..

The facility is found in violation as per video footage reviewed, Staff 1 pushed Youth A in the cafeteria on 3/26/26.

From the state's report. Violation established, special investigation. Cited: CCI Rule 400.4158 Intervention standards and prohibitions.

In plain words: { summary: During an incident, a child bit a staff member, and the child was later taken to the hospital. A video showed the staff member putting the child in a chokehold. Police later arrested the staff member on charges of cruelty to children and assault. } Our summary of the state's report. The state's own wording follows.

During this process, Resident #2 bit Staff B. Lastly, the IIF stated that Staff B was arrested on cruelty to children allegations and Resident #2 was transported to the hospital for evaluation and treatment. [...] Staff A further stated that Resident #2 stated that Staff B choked Resident #2 and he/she could not breathe. [...] Review on June 10, 2026 of the ring camera video revealed that Staff B was seen on the ground with Resident #2 in what appeared to be a chokehold. [...] Review on June 12, 2026 of the police report, dated April 5, 2026 that at approximately 1900 hours Staff B was arrested on allegations of aggravated assault, cruelty to children in the first degree, and 3 counts of cruelty to children in the 3rd degree for allegedly placing Resident #2 in a chokehold while punching Resident #2 for an extensive period of time in the presence of three juveniles.

From the state's report. Deficiency cited, severity D, incident survey. "[...]" marks text left out between sentences.

In plain words: { summary: The state received a report that a child was sexually assaulted by another child outside a cottage during an overnight shift due to a lack of supervision. The state found the allegation substantiated. } Our summary of the state's report. The state's own wording follows.

On January 26, 2026, Community Care Licensing (CCL) received an allegation that due to lack of supervision, minors engaged in inappropriate sexual activity while in care. It was reported that while [Child 1] and [Child 2] were residents at Fred Finch Youth Center San Diego, during an overnight shift, [Child 2] convinced [Child 1] to go out of a resident cottage and [Child 1] was taken behind a building, where [Child 2] pushed [Child 1] onto the ground, held [Child 1]'s arms down, and sexually assaulted [Child 1], although [Child 1] allegedly said no. [...] Based on consistent confidential interviews, the allegation that due to lack of supervision, minors engaged in inappropriate sexual activity while in care is SUBSTANTIATED because the preponderance of the evidence standard has been met.

From the state's report. Substantiated. Cited: 80078(a). "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.

Evidence supports the allegations of Youth A being inappropriately restrained by Security Staff 2 when Security Staff 2 placed his hand around the throat of Youth A along with Security Staff 2 utilizing a tripping method on Youth A, which is not an approved restraint technique.

From the state's report. Violation established, special investigation. Cited: CCI Rule 400.4159 Youth restraint; pregnant youth; reduction, prevention;.

In plain words: { summary: Medical and police records showed potential bodily fluid on a child in the program during an exam. The child reported that a staff member gave them a THC vape pen during a sexual assault. The state found that the facility failed to respond to the sexual assault and provide necessary care because four staff members did not report it until the child called for help. } Our summary of the state's report. The state's own wording follows.

A. Maltreatment: Regarding Sexual Abuse Information provided in [the alleged victim]’s medical record and in law enforcement information showed that during [the alleged victim]’s SANE exam, speckled fluorescence appeared under ultraviolet light that indicated potential bodily fluid. [...] Sexual abuse includes threatened sexual abuse.) Regarding Neglect The [the alleged victim] provided consistent information that [the staff person] provided [the alleged victim] with a THC vape pen during the time of the sexual assault. [...] Additionally, given that [the alleged victim] called and reported the sexual assault him/herself, after four staff persons with various levels of authority failed to report the incident, and that without [the alleged victim] reporting the incident him/herself the alleged sexual assault would have not been investigated there was a preponderance of the evidence that the facility failed to respond to a sexual assault and supply [the alleged victim] with necessary care and services.

From the state's report. Maltreatment Determined as to sexual abuse and neglect of an alleged victim by a staff person.. "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.

The purpose of the inspection was to deliver complaint findings for the above allegations of staff handled youth in a rough manner.

From the state's report. Substantiated.

In plain words: { summary: A child in the program reported that two staff members punched, choked, and spit on her. The program did not suspend the staff members while looking into the claim, and reports to the state registry were delayed. } Our summary of the state's report. The state's own wording follows.

4/23/26 revealed: 3/31/26, Former client (FC) #6 self-injurious behaviors (SIB)/suicidal ideation (SI!) 4/1/26, [Former client 6], SI and elopement 4/2/26, the facility was notified by CPS of client #1's allegation that she was punched and spit on by staff #9 and staff #2 during an incident on 4/15/26, client #4, attempted elopement and jumped out of a moving van 4/16/26, client #1 altercation with peer (client #4) over use of colored pencils; physical altercation between client #1 and client #3; client #1 physical aggression with staff; restrictive intervention due to hitting, spitting on and biting staff (staff #1), and included allegation that staff #1 was abusive and hit client #1 multiple times. [...] One Suicide Attempt, suspect (Former client #6) on scene on 3/31/26. [...] One Physical Assault, suspect on scene on 6/16/26 (client #1). [...] 4/18/26, submitted on 4/21/26, clients #2 and #3 elopement.

"Internal Investigation Summary: On April 2,2026, a social worker (Department of Social Services Investigator) contacted Executive Director [ED/Licensee] and reported that [client #1] alleged she had been physically assaulted by staff (#2 and #9), specifically stating that [staff #2] choked her and [staff #9] punched her in the face An internal investigation was initiated following this report. [...] No documentation of HCPR notification for client #1's allegation that staff #2 and staff #9 "choked and punched client #1 in the face" and spit in client #1's face. [...] "It wasn't until she (client #1) bit me (staff #2) that [staff #9] pinched her (client #1) nose...(client #1) had my arm...[client #1] bit me twice, she had my arm in her mouth until [staff #9] was pinching her (client #1] nose." She and staff #9 were together during the incident, "[Staff #9] never hit her (client #1)."

Had not been suspended nor received any disciplinary action regarding client #1's allegation that staff #2 and #9 choked, punched and spit on client #1. [...] She worked on 3/19/26 and was in the back of the facility with the other clients (#1, #2, #4, #5, and [Former client 6]) during the incident when client #1 alleged that staff #2 and #9 choked, punched and spit on client #1. [...] The ED/Licensee completed the HCPR report for client #1's allegation that staff #2 and #9 choked, punched and spit on client #1.

From the state's report. Deficiency cited, complaint and follow-up survey. Cited: V 367] 27G .0604 Incident Reporting Requirements; V 132; V 132. "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.

"They (staff) put you on 1:1 when you self-harm." [...] Clients were placed on 1:1 "only when you do self-injurious behaviors." [...] "On my 3rd day (1/27/26), there was an incident where [Former client 6] got into the kitchen and grabbed a knife and threatened me. had to remove another client (#5) and took her to [sister facility A] and [Former client 6] cut herself." [...] During an incident on 1/27/26, [Former client 6], who needed 1:1 supervision, was able to obtain a knife and use it to cut herself. [...] Staff #7 left the clients on the van with the Staff #2, who was shadowing, and then later, while [Former client 6] was agitated, left the facility without a backup staff to relieve her.

From the state's report. Deficiency cited, annual and complaint survey, Type A1 violation. Cited: V 315) 27G .1902 Psych. Res. Tx. Facility - Staff. "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.