State Cites Harbor Point for not training care staff, expired treatment plans

During an unannounced licensure renewal visit by the Virginia Department of Behavioral Health and Developmental Services (DBHDS), Harbor Point Behavioral Health Center was cited for multiple deficiencies, including those related to human rights regulations, education program regulations, therapy by authorized professionals, treatment care plans, medication errors, and medical care for injuries, among others. DBHDS found that the facility was non-compliant with human rights regulations after staff members engaged in a prohibited action that humiliated residents. Facility video footage showed “residents sitting in their doorways during snack time…[and] staff tossing snacks and fruit on the floor to the residents.” DBHDS wrote that “this action was humiliating, degrading, and abusive in nature.” Also, DBHDS wrote in the inspection report: “provider is FOUNDED for neglect based on the action viewed on the video.” DBHDS  also determined Harbor Point Behavioral violated state and federal regulations in the operation of education programs for children with disabilities because facility staff were permitted to provide educational services without proper training. DBHDS found that there was no evidence of training in the personnel records of 5 staff members providing paraprofessional services. Two of the five staff members were Mental Health Technicians providing paraprofessional services in the classroom, but DBHDS noted “there is no evidence of 8 hours of paraprofessional training in the personnel record.”  The DBHDS further found that the facility did not provide a  job description for paraprofessionals, even though the facility acknowledged that these teachers face the task of caring for up to 10 children, with emotional, intellectual, learning, or other health impairments, in the classroom. DBHDS  also cited Harbor Point for deficiencies related to therapy provided by unauthorized professionals.  In one case, a resident counselor’s progress notes were signed by a Licensed Supervisor who “is not the registered supervisor with the Va. Board of Counseling.”  Upon further review, the DBHDS also found that the individual therapy notes completed for six therapists conflicted with the routine observation notes. DBHDS noted that “According to the observation notes residents were participating in other activities and not with therapist psychotherapy group. Risk Manager reviewed videos of dates/time of when “therapy” was indicated but could not substantiate that this activity occurred.” The facility was also cited for treatment plan and assessment deficiencies. Following a tour of six of the facility’s patient units, the DBHDS found that many of the resident’s individual services plans (ISP) were not up to date and did not reflect changes in patient needs. DBHDS found “Many of the ISPs located in the units were expired. The MHT’s documentation should be based on current goals/objectives/interventions.” The DBHDS also found that nursing assessments were not up to date. In one case, a patient’s suicide risk assessment was not revised after the patient tried to choke himself. DBHDS also found that medication errors were not properly documented and unsecured medications were left out. During a review of Medication Administration Records and infirmaries, DBHDS found medication errors that were not documented for six clients. DBHDS found MARs that were not signed after administration of medications and sections on other MARs that were left blank. Also, DBHDS found “med cart[s], with contained lotions, drops, inhalers, birth control, were not locked in three of the nursing stations inspected.” Additionally, Harbor Point failed to properly document incidents of patient injury. In one case, there was no nursing note that described a patient’s injury and/or whether medical attention was provided following the incident. The provider agreed to update the Mental Health Technician job description to include paraprofessional duties and responsibilities and to provide re-education and re-training for staff regarding the cited deficiencies.