Severe reports

Staff 1 was seen pushing and pulling Youth A throughout the incident.

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

[Staff 3] pushed [Child 1] multiple times as [Child 1] attempted to leave the room and engaged in a verbal altercation with [Child 1].

From the state's report. Substantiated. 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 facility is found in non-compliance as per video footage and interviews, Staff 1 dragged Youth A to her bedroom.

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

Corroborating statements found the facility has had issues with youth using drugs and alcohol while in care, including marijuana, vaping and on July 7, 2024, facility reported a medical emergency as youth was reported to have overdosed on fentanyl. [...] On an isolated incident, the youth was allegedly sexually assaulted by another resident while in care.

From the state's report. Substantiated. "[...]" marks text left out between sentences.

Noncompliance is also found when Staff 1 grabbed Youth A’s shirt and forcefully ripped it.

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

Staff 1 followed Youth A to the front door and stood directly next to her, while continuing to verbally antagonize Youth A. Youth A pushed 5 Staff 1 away and Staff 1 responded by pushing Youth A off the porch.

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

Based on the interview with Staff 1 and the video observation, Staff 1 pushed Youth A. Staff 1 has been trained in CPI and has been given the proper tools to use in this situation, but did not utilize them.

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

A child was left unsupervised with an unlocked medication cabinet, resulting in the child ingesting a significant amount of medication in a suicide attempt.

From the state's report. Risk level: High. Cited: 748.685(a)(4) - Caregiver responsibility - providing the level of supervision necessary to ensure each child's safety and well-being.

The facility is found in noncompliance as Staff 1 reported pushing Youth A away from her. [...] Staff 1 reported she “swiped her hands down and pushed her back”.

From the state's report. Violation established, special investigation. Cited: CCI Rule 400.4158 Intervention standards and prohibitions. "[...]" marks text left out between sentences.

Regarding the allegation that staff hit and kicked youth, staff yelled at youth and staff threw objects at youth, statements made during interviews by 2 of 6 staff and video footage of client pointing to alleged staff, corroborated that staff did hit and kick youth, staff yelled at youth and staff threw objects at youth.

From the state's report. Substantiated.

Staff 1 admitted to pushing Youth A.

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

The facility is found in non-compliance as per interviews conducted, video reviewed, and documentation reviewed Staff 4 6 inappropriately restrained Youth A by bear hugging him, which is not an approved restraint method.

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

Findings include: Review on December 9, 2024 at 12:20 p.m. of the Intake Information Form (IIF) for intake GA00181418 revealed that on the night of November 11, 2024, Resident #1 was admitted to the hospital due to ingesting 10 pills. [...] Additionally, Staff C indicated that he/she called 911 and the crisis line, and once the ambulance arrived, Resident #1 stated that he/she had broken into the medication room and took 10 pills.

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

Another staff member inappropriately touched child while sleeping on the couch in a common area.

From the state's report. Citation, complaint inspection. Cited: 55 Pa. Code § 3800.32.b Specific Rights.

The Facility is found in non-compliance per interviews with Staff, Youth, and documentation reviewed, Staff 1 did hit Youth A on the face and used derogatory language.

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

On video, a staff member was seen shoving a child to prevent them from going into the room of a peer.

From the state's report. Risk level: High. Cited: 748.2307(1) - Other Prohibited Punishments-any harsh, cruel, unusual, unnecessary, demeaning, or humiliating discipline/punishment.

[Staff 1] then dragged [Child 1] while they were face down to their bedroom".

From the state's report. Substantiated. Cited: 87072(C)(16). 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 facility is found in non-compliance as per interviews conducted, video reviewed, and documentation reviewed, Staff 1 got into a physical altercation with Youth A, which included Staff 1 punching Youth A multiple times as well as pushing him.

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

After reporting that another peer engaged in non- consensual sexual relations with them, Individual #1's mother reported that internal bruising was found during a medical exam.

From the state's report. Non-compliance, DBHDS human rights inspection. Cited: 12VAC35-115-50. B. (2) In receiving all services, each individual has the right to: 2. Be protected from harm including abuse, neglect, and exploitation..

While reviewing video of the incident a child was inappropriately restrained.

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.

Law enforcement arrived to assist facility with ensuring safety of clients. Furthermore, interviews also confirmed that [Child 1] was pushed by [Staff 2] into the wall when [Child 1] was running towards [Staff 2] during the crisis.

From the state's report. Substantiated (one of several allegations). Cited: 87072(C)(16). 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.

Resident B reported that they observed Staff A trying to move Resident A out of the door of their bedroom, that Staff A tried to push Resident A out of the way and Resident B thinks Staff A pushed Resident A on their arms.

From the state's report. Non-compliant, complaint visit. Cited: He-C 4001.22(b)(2) Program staff shall not use corporal punishment..

Child A was escalated, and staff A was viewed on the video initiating a restraint after the child kicked a trash can, but the child's behavior did not present as a danger of of others.

From the state's report. Citation, complaint inspection. Cited: 55 Pa. Code § 3800.202 Appropriate Use of Restrictive Procedures.

Any injuries resulting from the use of restraint and seclusion procedures; c.

From the state's report. Violation cited by DHS.

Based on the information gathered and obtained throughout the investigation it was determined a staff member slammed a child to the ground.

From the state's report. Risk level: High. Cited: 748.2307(1) - Other Prohibited Punishments-any harsh, cruel, unusual, unnecessary, demeaning, or humiliating discipline/punishment.

The facility is found in noncompliance as Staff 1 slammed Youth A into the wall per Youth A’s interview and video footage.

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

The organization Allegation: allegedly conducted their own investigation of the sexual abuse and stated the guth was tying about the allegation

From the state's report. Evidence supports non-compliance, DFS notice. Cited: Section 3 Abuse and/or Neglect Reporting; Section 4 Critical Incident and Incident Reporting.

During an investigation inspection and review of video footage from 12/01/2024, it was observed that a staff member struck a client during a restraint.

From the state's report. Out of compliance, investigation inspection. Cited: R380-80-6(1)(a)-(i) Client rights.

Entity #2 informed Human Rights Advocate via letter dated October 31, 2024, that it was determined the disposition was Founded, Level One, for Sexual Abuse. Entity #2 reported to Human Rights Advocate that Employee #1 was charged with 7 felony counts of VA Code 18.2-370.1, Taking Indecent Liberties with Child by Person in Custodial or Supervisory Relationships.

From the state's report. Non-compliance, DBHDS investigation. Cited: 12VAC35-115-50. B. (2) In receiving all services, each individual has the right to: 2. Be protected from harm including abuse, neglect, and exploitation..

Two staff members interviewed stated the staff did hit the child back as she was defending herself.

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..

Child in care was injured during an unnecessary restraint when excessive physical force was used.

From the state's report. Risk level: High. Cited: 748.2551(c)(2) - EBI Implementation-Caregiver must use the minimal amount of reasonable and necessary physical force.

Based on interviews conducted, video footage reviewed, and documentation reviewed, this violation is established regarding Staff 1 hitting Youth A on the back of the head.

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

The staff who spanked the minor was suspended from work the same day and terminated from employment on 11/06/24.

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

The facility is found in noncompliance as Staff 1 and Staff 2 were pulling Youth A’s arms when attempting to get Youth A into the restraint and Staff 1 pushed Youth A into his bedroom upon releasing Youth A from the escort hold per video footage.

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

The department received a complaint alleging concerns for a resident who told the complainant that a staff member threw them against the wall, and showed the complainant a bruise on their leg, which the resident believes happened because of this incident. The resident stated [Staff A] pulled them off their bed and pushed them to the wall because they were not following the rules and that [Staff A] put their arms on their back, and they could not move.

From the state's report. Non-compliant, complaint visit. Cited: He-C 4001.22(e) Program staff shall use restraint in accordance with RSA 126-U..

The agency is in non-compliance as per video review, Supervisor Y dragged Youth A across the floor several feet by her right arm.

From the state's report. Repeat violation established, special investigation. Cited: 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.

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

On 09/11/2024, Community Care Licensing received allegation that staff choked a minor while in care. [...] In regard to the allegation that staff ([Staff 1]) choked a minor ([Child 1]) while in care; it was specifically reported that on 09/09/2024, they witnessed [Child 1] get "choked" by a facility staff member (name not provided at the time of the disclosure). During investigation, confidential interviews disclosed that it was [Staff 1] that choked [Child 1] as well as physically pushing [Child 1]. [...] Confidential interviews also reported that San Bernardino County's Open Case Investigations (OCI) substantiated this incident for physical abuse against [Staff 1]. Based on the confidential interviews, a review of pertinent documentation and a review of video footage, the preponderance of evidence standard has been met, and the allegation that staff choked [Child 1] while in care is substantiated.

From the state's report. Substantiated. Cited: 87072(c)(1). "[...]" 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 Thursday, November 21st, 2024 at 9: AM, Licensing Program Analyst (LPA) Brittany Crass, made an unannounced, subsequent visit for the purpose of closing out a Case Management, regarding an incident that was reported to the Department on November 12th, 2024, involving the death of a client.

From the state's report. Deficiency cited at inspection.

LPA observed [Child 1] walked out of their bedroom and [Staff 2] and [Staff 3] pushed [Child 1] back into their bedroom while [Staff 8] held the door open.

From the state's report. Substantiated (one of several allegations). Cited: 84072(d)(18). 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 staff member sexually abused a child in the program, sending graphic TikTok messages and arranging meetings in the group home bathroom, and also left other children unattended during the abuse, sometimes in the same bedroom while they slept. The state determined the abuse was substantiated. Our summary of the state's report. The state's own wording follows.

Provider substantiated for sexual abuse and psychological abuse based on the following: Provider found inappropriate TikTok messages between Employee #1 and Individual #1 on Individual #1's phone that were sexually graphic in nature and which discussed meeting up in the group home bathroom on more than one occasion, along with references to sexual interactions which included oral sex and sexual intercourse. [...] While Employee #1 engaged in sexually abusing Individual #1, Employee #1 failed to provide services necessary to the health, safety, and welfare of other minor individuals residing in the group home, leaving those individuals unattended during the sexual encounters with Individual #1, and, at times, engaging in the abuse in the same bedroom with other individuals while they were sleeping. ?

From the state's report. Non-compliance, DBHDS human rights inspection. Cited: 12VAC35-115-50. B. (2) In receiving all services, each individual has the right to: 2. Be protected from harm including abuse, neglect, and exploitation.. "[...]" marks text left out between sentences.

Resident B witnessed the incident and reported observing Staff D pushing Resident A into the wall by his face.

From the state's report. Non-compliant, complaint visit. Cited: He-C 4001.22(b)(2) Program staff shall not use corporal punishment..

The video captures staff [Staff 1] push a resident against a wall and punch the resident's chest area.

From the state's report. Substantiated. 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 video shows staff [Staff 1] hit a resident in the face and the resident to immediately turn their face away.

From the state's report. Substantiated. 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 complainant stated that on the morning of November 2, 2024, Staff C struck Resident A on the back of their head and neck region. Staff A and B both stated Resident A had just been deescalated and was leaving the program kitchen, when Staff C struck Resident A in the back of their head and neck using an open hand strike.

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

In plain words: A report alleged that a staff member sexually abused a client at the facility by kissing him and touching his genitals over his clothing. The state issued a civil penalty to the program based on this finding of sexual abuse. Our summary of the state's report. The state's own wording follows.

On April 16, 2024, the Department received a complaint alleging a Blissful Living Group Home, Inc. (BLGHI) staff ([Staff 1]) (Reference Confidential Names form LIC811 dated 11/4/24) sexually abused a client in care. [...] A client alleged that while at her home, [Staff 1] sexually abused him by kissing him on the lips and fondling his genitals over his clothing. [...] Under Health and Safety Code (HSC) section 1548(f)(1)(F)(2), a violation the Department determines results in sexual abuse as defined in Section 11165.1 of the Penal Code to a child receiving care through a Short Term Residential Therapeutic Program (STRTP) there shall be a civil penalty of $2,500. [...] A copy of this report, Confidential Names form LIC811 dated 11/4/24, Appeal Rights and form LIC 421D(CRP) for a Civil Penalty Assessment - Death / Serious Bodily Injury / Physical Abuse were given to the facility representative.

From the state's report. Deficiency cited at inspection. "[...]" 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.

In video footage, Staff 2 is observed handling Child 1 in a rough manner and confiscating [Child 1] laptop/chrome book.

From the state's report. Substantiated. 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 investigation of the allegations, Staff member physically abused minor in care. [...] Confidential interviews indicated that staff hit the minor while in care during a visit to the hospital.

From the state's report. Substantiated. Cited: 80072(a)(3). "[...]" marks text left out between sentences.

During the investigation, it was found that a child in care was pushed by a staff member. Video footage of the incident was reviewed and showed a staff member pushing a child in care.

From the state's report. Risk level: High. Cited: 748.1101(b)(4)(A) - Children's rights-The right to be free from any harsh, cruel, unusual, unnecessary, demeaning, or humiliating treatment or punishment..

The staff used corporal punishment as a means to get a child to comply.

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..