Texas Health and Human Services Commission Child-Care Licensing Investigation Report Operation Information and Allegations: Operation #: Southwest Key Programs Inc - Casa El Presidente 1517766 Investigation #: 2462100 IMPACT Case Id: 0 IMPACT Call Id: 71105941 Intake(s): Intake Number Intake Date Received 2462100 07/02/2018 Investigator's Name: FABIAN DE LA PENA Extension Granted: No Allegation Type Standard/Law Violation Illegal Operations Suicide Attempt Child Death Serious Harm/Injury Critical Injury Child Arrest Illness Requiring Hospitalization Child Run Away Caregiver Drug Abuse Endangering Person Child Sexual Aggression Child on Child Physical Abuse Abuse/Neglect Physical Abuse Abuse/Neglect Sexual Abuse Abuse/Neglect Emotional Abuse Abuse/Neglect Physical Neglect Abuse/Neglect Medical Neglect Abuse/Neglect Neglectful Supervision Abuse/Neglect Exploitation # Children involved: 0 # Children involved: 0 Intake Priority: Priority 3 - minor violations of the law or minimum standards that involve low risk to children Investigation Priority: Priority 3 - minor violations of the law or minimum standards that involve low risk to children Date Priority Changed: Reason Priority Changed: Allegation Description: There are concerns due to a youth attempting to run away Investigation Persons: Reporter: See TAC 745.8483 Victim(s): Texas Health and Human Services Commission Child-Care Licensing Investigation Report Perpetrator(s): Name Perp Disposition Admin Review Release Hearing Investigation Documentation: Initiation Information: Initiation Date: 07/12/2018 Type of Initiation: Face to Face Information Obtained: On 07/12/2018 I spoke with Osman at SWK El Presidente and informed him of the reason for speaking with him. Osman remembered me when I spoke with him regarding another investigation. Osman indicated that he remembers an incident in which he tried to run away. Osman explained that he was upset that another youth named Andy had been bothering him. As per Osman, Andy had touched hit buttocks one time but didn't remember when. (this incident is related to IN #2457486). Osman commented that he told staff and that the staff changed him to another room. As per Osman, he tried to climb the fence and the staff talked him out of out. Osman mentioned that staff carried him back into the building. Osman explained that staff had to carry him because he was trying to free himself and run away. As per Osman, he only remembers he name of 2 staff, staff 'Eduardo" and staff "Jesus: Osman commented that after that they took him to go see his counselor Brandon. Osman did not know how long he was carried for back into the building. Osman commented that he was not taken to a supply closet. Osman mentioned that a youth had taken one of his pair of shoes that was in the room one time and threw them in the toilet as a prank. Osman commented that he told a staff member and staff gave him a new pair. As per Osman, he had another pair of shoes and the youth threw the old pair in the toilet. Osman explained that staff are always watching them and that they are never left alone. Osman mentioned that staff even watch them at night and normally staff care for up to 7 children each. Osman commented that prior to that he has never tried to run away before and is doing well. Observations Made During Inspection: Inspection(s): 3692732 On 07/12/2018 Investigation inspection was conducted. Service plan was reviewed and did not indicate any special supervision level. Walkthrough was conducted. Operation was observed free of visible health, fire or safety hazards. Playground where Osman tried to climb the fence was observed. Operation has an 8 foot fence around the playground. Background checks were current. Contact List: Type Date To:/With Texas Health and Human Services Commission Child-Care Licensing Investigation Report Phone Call 08/21/2018 Exit Interview On 08/21/2018 contact was made with Guadalupe Renteria. Ms. Renteria was informed that the operation was receiving one deficiency due to 3 staff carrying youth Osman. Due process was discussed with Ms. Renteria. Phone Call 08/17/2018 Carolina Torres - Assistant Shift Leader On 08/17/2018 I spoke with Carolina Torres via telephone and explained the reason for speaking with her. Ms. Torres is an assistant shift leader at SWK El Presidente. Ms. Torres indicated that she began this role in July 2018. As per Ms. Torres, when the children are outside, staff ensure that children do not go play too close to the fence in order to minimize any risk to the children. Regarding the allegations, Ms. Torres explained that she remembered the youth named Osman but did not recall too much about the incident in which he tried to climb the fence. As per Ms. Torres, she only remembers that the youth tried to climb it one day and that the youth was brought back into the building by staff. Ms. Torres mentioned that she does not recall who the staff that brought Osman back inside were. As per Ms. Torres, Osman was not able to actually leave the property. Ms. Torres mentioned that at no point did Osman every voice to anyone that he wanted to try to escape or that he was going to attempt to. Ms. Torres mentioned that Osman did not have any incidents in which he tried to escape. Ms. Torres mentioned that Osman is no longer in the facility. Face to Face 08/13/2018 Risk Staffing On 08/13/2018 Risk staffing was conducted with inspector Erina Torres. It was explained to Ms. Torres I was still pending a staff but that citation was going to be recommended due to the youth being carried back to the building after attempting to run away. A medium-risk was recommended as the operation due the operation having several previous investigations regarding restraints. Phone Call 08/13/2018 Carolina torres - Attempt On 08/13/2018 an attempt to speak with Carolina Torres was made; however, there was no answer. A voicemail was left. Face to Face 08/10/2018 Carolina torres - Attempt On 08/10/2018 I attempted to speak with Carolina Torres; however, there was no answer. A voicemail was left. Face to Face 08/07/2018 Israel - Youth Interview was conducted by Ruben Cantu at SWK Combes due the youths being transferred from SWK El Presidente. I made face to face contact with Israel at Southwest Key Programs Inc - Combes #1517766 on 08/07/2018. I introduced myself Israel and then explained the purpose of the visit and the role of Licensing. I observed Israel to be appropriately dressed and also presented proper hygiene. After engaging in further discussion with the Israel to establish rapport, Israel agreed to be interviewed. Israel told me he is 9 years old. Israel said was at Casa El Presidente for about a month. Israel said they treated him well. Israel said they met all of his basic needs. Israel said they would feed him three times a day and said they would also give him snacks. Israel said when they did not follow the rules they would file a report. Israel said no one mistreated him verbally or physically at Casa El Presidente. Israel said he was not afraid of anyone there at that facility. Israel explained that was not aware of any incidents at El Presidente in which a youth attempted to run away from the playground. Texas Health and Human Services Commission Child-Care Licensing Investigation Report Face to Face 08/07/2018 Luis - Youth Interview was conducted by Ruben Cantu at SWk Combes due to the youth being transferred there from SWK El Presidente. I made face to face contact with Luis at Southwest Key Programs Inc - Combes #1517766 on 08/07/2018. I introduced myself Luis and then explained the purpose of the visit and the role of Licensing. I observed Luis to be appropriately dressed and also presented proper hygiene. After engaging in further discussion with the Luis to establish rapport, Luis agreed to be interviewed. Luis told me he is 7 years old. Luis said he did not know how long he was at Casa El Presidente but mentioned it was over 20 days. Luis said they treated him well. Luis said he had all of his basic needs met. Luis said they would feed them but said he did not know how many times per day. Luis said he would follow the rules but others that did not would get a report filed. Luis said nothing else happened if they did not follow the rules. Luis said was not mistreated verbally or physically by anyone at the facility. Luis said he was not afraid of anyone there. Luis said supervision is good at Casa El Presidente and said they treated them well. Luis did not remember any incident with any children trying to escape or trying to jump a fence. Face to Face 08/07/2018 David - Youth Interview was conducted by Ruben Cantu at Southwest Key Combes due to the youth being transferred from Southwest key El Presidente. I made face to face contact with David at Southwest Key Programs Inc - Casa El Presidente #1517766 on 08/07/2018. I introduced myself David and then explained the purpose of the visit and the role of Licensing. I observed David to be appropriately dressed and also presented proper hygiene. After engaging in further discussion with the David to establish rapport, David agreed to be interviewed. David told me he was 10 years of age. David said he was at Casa El Presidente for over two months. David said they treated him well. David said if he did not follow the rules they would file a report that would in turn delay their case. David said they would also remove privileges like not letting them go outside. David said he would get three meals a day and three snacks a day as well. David said he was not verbally or physically mistreated by any of the staff. David said he was not afraid of anyone there. As per David, he did not remember any youth trying to run away from El Presidente. Other 07/13/2018 EBI Training Training for Carolina Torres, Jesus Gomez and Eduardo Ramirez was reviewed and observed to be in compliance. Other 07/12/2018 Incident Report On 07/12/2018 the incident report was reviewed. Incident report was done on 07/1/2018. The report indicates that youth Osman attempted to climb the fence while in outdoor recreation for no apparent reason. The incident report indicates that staff attempted to de-escalate the situation and tried to get the youth to come down and the youth explained that he was going to escape. The report explained that the youth eventually came down and staff walked him back inside. An addendum was added on 07/02/2018 and stated that Clinician Brandon Hinojosa witnessed the incident in which Osman attempted to climb the fence. The addendum indicates that Mr. Hinojosa witnessed the minor being carried back into the program by three staff. It also explains that the youth Texas Health and Human Services Commission Child-Care Licensing Investigation Report was taken to the supply closet to give him a new pair of sneakers as 2 days ago a youth had thrown his shoes in the toilet and he had been promises new ones. The addendum also explains that youth verbalized not wanting to escape anymore after getting his shoes. Face to Face 07/12/2018 Eduardo Ramirez - Youthcare Worker On 07/12/2018 I spoke with Eduardo Ramirez at SWK El Presidente and explained the reason for speaking with him. Mr. Ramirez is a youthcare worker at the operation and has been working for the operation for 5 months. As per Mr. Ramirez, he works for the 1st shift. Mr. Ramirez explained Mr. Ramirez that his job is to supervise children in care. Regarding the allegations, Mr. Ramirez explained that he remembers an incident in which Osman tried to run away from the operation. As per Mr. Ramirez, he was outside in the playground supervising children. Mr. Ramirez explained that he saw the youth going towards one of the fences. Mr. Ramirez commented that the youth tried to get under the fence. Mr. Ramirez commented that Osman was brought back inside. Mr. Ramirez commented that he carried Osman back into the building due to Osman trying to get out. Mr. Ramirez mentioned that it took about a minute to carry Osman back in. Mr. Ramirez added that the staff helping him was Carolina. Mr. Ramirez explained that hes had no other issues with that youth. Mr. Ramirez explained that Osman sometimes throws tantrum but that overall he does well in the center. Mr. Ramirez indicated that he was not aware being on any special supervision when he tried to run away. Face to Face 07/12/2018 Carolina Torres - Attempt On 07/12/2018 I attempted to speak with Carolina Torres; however, I was advised that she was not in at this time. Face to Face 07/12/2018 Jesus Gomez - Youthcare worker On 07/12/2018 I spoke with Jesus Gomez at SWK El Presidente and informed him of the reason for speaking with him. Mr. Gomez is a youthcare worker and has been in the facility for 2 and a half months. Mr. Gomez is in the 2nd shift. Mr. Gomez job is to care for children in the facility, including outside in the playground. Regarding the allegations, Mr. Gomez mentioned that he does remember an incident regarding the youth Osman. Mr. Gomez explained that he was outside supervising the youths when he spotted Osman walking towards the fence. Mr. Gomez mentioned that he called out to Osman and that Osman did not respond. As per Mr. Gomez, he started walking towards the youth and Osman tried to climb the fence. Mr. Gomez mentioned that they convinced Osman to get down. Mr. Gomez commented that he carried Osman back inside. Mr. Gomez added that Carolina Torres helped him bring back Osman inside and that they carried him for about 20 seconds. Mr. Torres explained that Osman was struggling to get out when they carried him. Mr. Gomez mentioned that when they took him inside they spoke with him about the incident and the youth calmed down. Mr. Gomez mentioned that the clinician arrived and took Osman. Mr. Gomez mentioned that Osman is a nice kid and that he was not aware of any other incidents with him trying to climb the fence. Other 07/12/2018 Video - Attempt On 07/12/2018 I attempted to review video; however, I was advised that there was no video available for the incident as they had switched security system and could no longer get the video for when the incident had occurred. Face to Face 07/12/2018 Osman - Youth Texas Health and Human Services Commission Child-Care Licensing Investigation Report On 07/12/2018, I spoke with Osman at SWK El Presidente and informed him of the reason for speaking with him. Osman remembered me when I spoke with him regarding another investigation. Osman indicated that he remembers an incident in which he tried to run away. Osman explained that he was upset that another youth named Andy had been bothering him. As per Osman, Andy had touched hit buttocks one time but didn't remember when. (this incident is related to IN #2457486). Osman commented that he told staff and that the staff changed him to another room. As per Osman, he tried to climb the fence and the staff talked him out of out. Osman mentioned that staff carried him back into the building. Osman explained that staff had to carry him because he was trying to free himself and run away. As per Osman, he only remembers he name of 2 staff, staff 'Eduardo" and staff "Jesus.: Osman commented that after that they took him to go see his counselor Brandon. Osman did not know how long he was carried for back into the building. Osman commented that he was not taken to a supply closet. Osman mentioned that a youth had taken one of his pair of shoes that was in the room one time and threw them in the toilet as a prank. Osman commented that he told a staff member and staff gave him a new pair. As per Osman, he had another pair of shoes and the youth threw the old pair in the toilet. Osman explained that staff are always watching them and that they are never left alone. Osman mentioned that staff even watch them at night and normally staff care for up to 7 children each. Osman commented that prior to that he has never tried to run away before and is doing well. Face to Face 07/12/2018 Brandon Hinojosa - Clinician On 07/12/2018 I spoke with Brandon Hinojosa at SWK El Presidente. Brandon is the clinician for Osman. Mr. Hinojosa commented that Osman is a good child, but has a habit of copying the behaviors of other youths. Mr. Hinojosa commented added that he has talked to Osman about curbing his mimicking. Mr. Hinojosa commented that Osman has been physically aggressive with other youths in other incidents, but has been getting better behavior wise. Regarding the allegations, Mr. Hinojosa explained that he was present when Osman tried to run away. Mr. Hinojosa explained that he was on his way to the playground because he had a scheduled session with Osman. As per Mr. Hinojosa, when he was about t go outside he saw 3 staff members carrying Osman back inside. Mr. Hinojosa mentioned that he did not know who the staff were. Mr. Hinojosa added that Osman was being carried horizontally and facing forward. Mr. Hinojosa added that Osman was observed to be angry and pouting. Mr. Hinojosa divulged that staff put Osman down and took him to the supply room for some shoes. Mr. Hinojosa explained that apparently 2 days prior some youths had put Osmans shoes in the toilet. Mr. Hinojosa explained that after that he took Osman for regular season. MR. Hinojosa explained that Osman expressed that he had gotten upset about the shoes and that is why he tried to run away. Osman also expressed frustration about being in the shelter away from his family. Mr. Hinojosa explained that Osman was put on 1 to 1 supervision for a week but then moved back to regular supervision a week later due not having any behavioral issues. As per Mr. Hinojosa, Osman was on regular supervision when the incident occurred. According to Mr. Hinojosa, Osman has never tried to run away prior to the incident. Face to Face 07/12/2018 Daniel Corodoba - Shift Leader On 07/12/2018 I spoke with Daniel Cordoba at SWK El Presidente and informed him of the reason for speaking with him. Mr. Cordoba is a shift leader at the operation. Regarding the allegations, Mr. Cordoba commented that he is aware of the incident in which Osman attempted to climb the fence when his group was outside. As per Mr. Cordoba, he did not witness the incident but instead was told by staff. Mr. Cordoba added Texas Health and Human Services Commission Child-Care Licensing Investigation Report that the incident had occurred during rec time in the afternoon. As per Mr. Cordoba he will attempt to get me the video of the incident. Face to Face 07/12/2018 Guadalupe Renteria - Director On 07/12/2018 I spoke with Guadalupe Renteria at SWK El Presidente and informed her of the reason for speaking with her. Ms. Renteria is the director for the operation. Ms. Renteria commented that she is somewhat familiar with the incident with Osman. Ms. Renteria explained that she would provide the information regarding the incident. As per Ms Renteria, Osmans clinician, Brandon Hinojosa, was present when he tried to jump the fence would have more information. Ms. Renteria added that she would provide the information on which staff were present during the incident. As per Ms. Renteria, there are some issues in retrieving the video due to switching to a new system. As per Ms. Renteria, Mr. Cordoba is working on trying to retrieve the video. Investigation Findings: Disposition (if A/N): Explanation of Disposition: On 07/02/2018 a P3 standard investigation was received alleging that 6 year old youth Osman had attempted to run away by climbing the playground fence. Based on the preponderance of the evidence obtained throughout the investigation, one deficiency related to the investigation will be cited. Youth Osman attempted to run away by climbing the fence while in the playground. Youth had no previous history of running away and had not expressed any intent to do so. Osman was not any sort of specialized supervision during the incident. Staff were able to notice that Osman was trying to climb the fence and were able to bring him back down. Operation will be cited for standards 748.2551(a) as youth was carried by three staff and brought back into the building. Staff indicated that youth was carried due to trying to run away. Osman and staff indicated that he struggled when he was carried. Standards do not permit a youth to be carried by multiple people during an Emergency Behavior intervention. As per staff, it was a short personal restraint as it lasted less than a minute. Staff did have current EBI training. Recommended Action: Routine monitoring Action Dates: Notification to Provider: 08/22/2018 Investigation Complete: 08/21/2018 Investigation Closed: 09/04/2018