VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Presbyterian Children's Home of Highland
425 Grayson Road
Wytheville, VA 24382
(276) 228-2861

Current Inspector: Jamie Morgan (276) 525-5656

Inspection Date: Feb. 1, 2022 , Feb. 4, 2022 , Feb. 7, 2022 , Feb. 11, 2022 and March 22, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-151 INTRODUCTION. 22VAC40-151 PROGRAMS AND SERVICES

Comments:

An unannounced focused inspection, in response to a facility self-reported incident, was initiated on 2/1/2022 onsite from 10:30 a.m. to 12:15 pm. An entrance conference was completed with the Program Director. The facility reported a census of eight (8) children in placement. The Licensing Specialist reviewed one (1) personnel record, conducted one (1) interview with staff, and reviewed video of the incident that is the subject of this inspection. The inspection continued with a desk review of one (1) foster child record and the facilities policies and procedures manuals on 2/4/2022 and 2/7/2022. An additional onsite visit was conducted on 2/11/2022 from 12:30 p.m. to 2:45 p.m. An Entrance Conference was conducted with the Executive Director and the Program Director. Three staff interviews were conducted. A preliminary findings review was conducted with the Executive Director, Administrative Director, and Program Director. Three (3) collateral contacts were interviewed by phone on 2/25/2022. An exit interview was conducted with the Executive Director, Administrative Director, and the Program Director on 3/22/2022 at 9:45 a.m. by video conference. There were three citations issued for violations of Standards for Children's Residential Facilities. Violations are documented on the Violation Notice. ** A separate document outlining a sequence of interactions observed in the video, referenced on the Violation Notice, was created and included with the violation notice and is available upon request." The facility submitted plan for corrections are documented on the violation notice.

Violations:

Standard #:	22VAC40-151-50-F
Description:	Violation: Based on the Licensing Inspector?s review of the facility?s policies and procedures, personnel file documentation, daily logs, and interviews, the facility failed to comply with its own policies and procedures. Findings: 1) The Licensing Inspector requested and received the facility?s policies and procedures from Staff 2 (S2) on 2/2/2022. 2) The Licensing Inspector reviewed the Employee Handbook, which outlines the facility?s Policies and Procedures. The handbook specifies the following pertaining to behavior management techniques and prohibitions: ? All direct care staff are trained in verbal intervention techniques; ? Physical Restraint is only used by staff members who have received training in this area and when a child is in danger of hurting himself/herself or others; ? All direct care staff members are trained ? other staff members may report positive or negative behaviors to the direct staff members; ? Only staff members certified in physical restraint may perform those techniques; ? All direct care staff shall be trained by the Program Director or designated certified trainer within their first seven days of employment and annually thereafter; ? All staff are responsible for helping with resident behavior; and ? All staff shall be proactive, using positive management techniques as much as possible. 3) An Orientation Checklist in the record for Personnel 1 (P1) documented P1?s date of employment as 8/18/2021. 4) During interviews with Staff 1 and 2 (S1 and S2) on 2/11/2022, S1 and S2 stated P1 did not receive training in physical restraint. 5) The daily log for R1 on 1/10/2022, signed by Staff 3 (S3), documents following dinner R1 ?..,had to be called down multiple times for not listening to staff instructions.? and ?He later gets into an argument with staff member and then goes to the office to call his uncle then gets into an altercation that occurred with staff member.? 6) During interview, S3 reported a disagreement occurred between R1 and P1 regarding R1?s use of a skateboard in the cottage and P1 requested that the staff office be unlocked and the skateboard be placed in the office. S3 unlocked the office. 7) During interview, Staff 3 (S3) reported being present in Webb cottage on 1/10/22 during an altercation between Resident 1 (R1) and Personnel 1 (P1). S3 reported leaving the office area to clean up in the kitchen area and to use the restroom. S3 reported while out of the office she heard what sounded like a ?bar fight?. 8) The Licensing Inspector reviewed video footage from 1/10/2022 and observed an interaction between P1 and R1. The Licensing Inspector did not observe S3 in the video footage. S3 reported being in the kitchen and restroom and hearing what sounded like a ?bar fight.?
Plan of Correction:	Staff will review the Policy and Procedures Manual to ensure that the language accurately reflects what is covered during the first seven days after employment and meets the requirements of the licensing standards. All new staff members will be trained by the PCHH certified behavioral management trainer in verbal and non-verbal techniques within the first seven days of employment as opposed to the current review of the policies and procedures in that area. A review of our guidelines on physical restraint will be reviewed during the first seven days and will continue to include the staff member signing a directive indicating that they understand they may not use any form of physical restraint until they have completed the training and certification in that area. A corrective action conference will be held with S3 to review the incident and cover with S3 how she could have helped deescalate the situation and reacted in a more proactive manner. In addition, all direct care staff will be retrained in behavior management with an emphasis understanding when it is your responsibility to intervene and help your fellow staff members deescalate situations. The Executive Director and the Administrative Director will be responsible for review of the Policy and Procedures Manual. The Program Director is responsible for the corrective action conference with S3 and scheduling and conducting the training sessions. Review of the Policy and Procedure Manual and the corrective action conference will be completed by 4/15/22. The training for all direct care staff members will be completed by 4/30/22.
Standard #:	22VAC40-151-820-5
Description:	Violations: Based on the facility?s voice message report to the Licensing Inspector and the Licensing Inspector?s review of a Serious Incident Report, observation of video footage, and interviews, the facility failed to ensure that Resident 1 (R1) was not subjected to actions that were humiliating, degrading, or abusive. Findings: 1) Staff 2 (S2) left a voice message for the Licensing Inspector on 1/11/2022 and stated ??we filed a CPS complaint against one of our employees over a incident that happened last night, he had an altercation with in Webb cottage?the employee ?putting his hands on the boy in a way he shouldn?t have.? 2) The record for R1 included a Serious Incident Report (SIR), signed by the Case Manager (CM). The SIR document documents an Incident date of 1/10/2022 at 8:00 p.m. in Webb Cottage and states ?? [R1] became upset and began to argue with staff. [R1] began to use inappropriate language and gestures and wanted to speak with his family. Staff allowed him to call his family and continued to argue with [R1]. The verbal conflict resulted in the staff becoming physical with [R1] pushed and then placed [R1] in a chokehold.? The SIR notated that no physical restraint was used. 3) Video documented interactions between P1 and R1 on 1/10/2022. The video did not include audio. 4) Collateral Contacts 1, 2, and 3 (C1, C2, and C3) were interviewed by phone on 2/25/2022. 5) C2 reported R1 called him on 1/10/2022. C2 stated he placed the call on speaker phone so C3 could hear. C2 stated he heard P1 call R1 and an [expletive] during the call. C3 stated she heard P1 say to R1: ?I?ll beat your [expletive]?, ?I don?t give an [expletive], and I?ll show your uncle where I?m really from.? 6) During interview with Staff 2 (S2) on 2/11/2022, S2 described the interaction between P1 and R1 as ?an attack? by P1.Staff 1 (S1) provided the Licensing Inspector photos of R1 taken after the incident. The photos documented injuries to R1?s neck and shoulder * *A separate document outlining a sequence of interactions observed in the video, referenced in the findings, was created and included with this violation notice and is available upon request**
Plan of Correction:	The facility will continue to train staff within the first seven days of employment on actions that are humiliating, degrading or abusive to our residents. The facility will ensure that all direct care staff members are trained in verbal and non-verbal behavior management techniques within seven days of employment and trained in physical restraint within 60 days of employment. All direct care staff members will be retrained in behavior management, including a review of actions that are humiliating, degrading or abusive to our residents. The Program Director is responsible for all aspects of this training. Staff training will be completed by 4/30/2022.
Standard #:	22VAC40-151-840-H
Description:	Violations: Based on the Licensing Inspector?s review of daily logs, interviews, and observation of video footage, interviews, and review of the daily log, the facility failed to ensure that a trained staff member managed the behavior of Resident 1 (R1). Findings: 1) During interview, Staff 1 and 2 (S2 and S3), reported P1 was not trained in the facility?s behavior management and restraint procedures. 2) The daily log for R1 on 1/10/2022, signed by Staff 3 (S3), documents following dinner R1 ?..,had to be called down multiple times for not listening to staff instructions.? And ?He later gets into an argument with staff member and then goes to the office to call his uncle then gets into an altercation that occurred with staff member.? 3) During interview, S3 reported a disagreement occurred between R1 and P1 regarding R1?s use of a skateboard in the cottage. P1 requested that the staff office be unlocked and the skateboard be placed in the office. S3 unlocked the office. S3 reported she left the office area to clean the kitchen area and use the restroom. 4) Video documented a sequence of interactions between P1 and R1 on 1/10/2022. The video did not contain audio. * *A separate document outlining a sequence of interactions observed in the video, referenced in the findings, was created and included with this violation notice and is available upon request**
Plan of Correction:	The facilty will put procedures in place that will ensure that all employees are trained in verbal and non-verbal behavioral management techniques within seven days of employment and will be trained in physical restraint within 60 days of employment. A corrective action interview will be held with S3 to review the incident and cover with S3 how she could have helped deescalate the situation and reacted in a more proactive manner. All direct care staff will be retrained in behavior management and instructed that only trained staff members can manage resident behavior per this standard. The changes in procedures, updating the Policy and Procedure manual, and the corrective action conference will be completed by 4/15//22. The training for all direct care staff members will be completed by 4/30/22.