State officials have cited a residential treatment facility for children with 19 violations including abuse, understaffing, and not controlling youth who bit and attacked each other more than a dozen times last year, according to documents obtained by The Greenville News.
The state Department of Health and Environmental Control also cited the facility for insufficient snacks and menu problems, for failing to adequately watch over the children and for maintenance issues.
DHEC, which licenses Palmetto Pee Dee Behavioral Health in Florence, issued the citations in the wake of allegations reported by The Greenville News in December and earlier this month.
Adrianna Bradley, a spokeswoman for DHEC, said the violations were found after three visits of the facility on Dec. 13, Dec. 28 and Jan. 5.
She said the facility remains under investigation and must submit plans of correction for each of the violations. According to DHEC regulations, violations can result in monetary penalties ranging from several hundred dollars to several thousand dollars, depending on the classification of the violation and whether it is a repeat offense.
Halle Mechling, business development director for Palmetto Pee Dee, submitted a statement on behalf of the facility saying it strives to "maximize the safety of our patients."
"Like all healthcare providers we are subject to unannounced inspections," the statement read. "The facility takes all feedback we receive seriously and constantly explores how we can improve the services we deliver.
"We are certainly mindful that over the course of treating more than 100 patients annually, irregular and unpredictable events can occur. In each of these situations, including the recent DHEC inspections, the facility works to learn from these incidents and enhance the quality of our care, if applicable."
The News earlier this month reported that current and former workers at the facility alleged that children at the facility have been hurt after altercations with staff, were given inadequate food and programming, and the facility often has been short-staffed.
Workers also said the aging facility has suffered a host of maintenance problems, including broken laundry equipment, malfunctioning showers and mold.
Training has been inadequate, workers have been forced to work 16-hour shifts, staph infections and scabies have been found at the facility, and children there have been subjected to verbal abuse by staff, the concerned workers told the newspaper.
Those allegations came after DHEC confirmed it was looking into complaints by a Columbia mother that her autistic child had lost excessive weight at the facility and had been bitten repeatedly while there, with one of the wounds becoming infected, The News reported Dec. 12.
Workers allege a host of problems at children's facility
The first of the investigation results released this week dealt with those allegations.
The findings do not name any resident, parent or staff member, but the summary appeared to mirror the Columbia mother's allegations that her son's weight had dropped from 132 pounds to 96 pounds and that he had been bitten four to five times by other residents during the past four months.
Among the investigation's findings was that a diet order for the resident was not available for review. The facility's administrator told DHEC the resident's diet was not addressed upon admission. The mother told the newspaper that at one point she provided a list of food her son would eat and pestered the staff to buy peanut butter.
DHEC reported 14 incidents in which the resident was attacked and injured by other residents.
"These injuries included kicking, punching, and biting and occurred during each of the three shifts," the agency's report stated. "The Administrator stated that the clients in Resident A's unit need more care/supervision and are less independent than other units. However, all units are staffed the same, regardless of the condition of the residents."
The DHEC report noted a number of the incidents, including a body audit of the adolescent on Oct. 8 that observed five bite marks on the youth's back but offered no explanation for how they got there.
On Oct. 30, DHEC reported, a bite mark on an arm was observed after he was bitten by another resident. Later that night, staff reported bite marks on his back after being bitten by a roommate, according to DHEC.
On Nov. 21, the youth was bitten in the upper shoulder/upper back while in class, DHEC reported. The next day, DHEC reported, he was bitten on the left hand by another resident while in group.
There were 23 other children or adolescents on the same unit as the resident who was repeatedly attacked, according to DHEC, and others on the unit also had been attacked or had attacked others. Some, the agency said, were "out of control," according to staff.
"The facility did not staff sufficiently to provide supervision for all residents as determined by the condition of the residents," the agency concluded.
Using staff log sheets, DHEC cited certain dates and shifts in which it said staff was insufficient for the unit, including one shift during which only two staff were present.
Documentation for another shift, DHEC found, was "unavailable for review."
The investigation also found multiple violations with the resident's individual treatment plan, which it found lacked descriptions of the resident's nutritional needs, social and recreational activities and visits by health care providers. DHEC noted that the resident's weight dropped to 99 pounds and his nutritional needs had not been coordinated even though the facility had documented his weight loss.
According to the mother of the autistic youth, her son was placed in Palmetto Pee Dee by the Lexington-Richland Disabilities and Special Needs Board. The agency previously said it could not comment on individual cases due to federal health privacy laws.
Altogether, DHEC cited the facility for 10 violations, including two Class 1 violations, the most serious type. According to DHEC's website, Class 1 violations "present an imminent danger to the health, safety, or well-being of the persons in the facility."
Liane Hughes Turner, the mother of the autistic boy who first called attention to the facility over her son's weight loss and bites, said what has happened at the facility is "just so sad."
"Management is allowing this to happen," she said. "That's where the fix needs to start."
She said she is "counting the days" until her son is moved from the facility, though she said the facility now appears to be doing better at caring for him. She suggested DHEC conduct more unannounced visits and follow-up with their findings to be sure planned corrections are implemented.
The second investigation, in December, looked at 11 allegations, citing the facility for six of them.
It again cited the facility for understaffing as well as for violating a facility policy of having residents within sight or sound observation of staff and conducting welfare checks of residents no more than every 15 minutes.
It noted one case in which a resident had attempted suicide, having been found on the floor, blue in the face with a shirt tied around their neck.
It also cited the facility for a case of abuse in which a resident said they were physically abused by a female staff member on Nov. 25 after calling the resident "stupid."
DHEC' reported that, "Resident then stated that 'Staff Member A got into my face and I pushed her and that's when she punched me in the face, grab my hair and hit my head on the rail.' There were two witnesses present that separated the staff from the resident."
The facility was cited over menu or snack issues, including snacks that were "not suitable for the residents," including one snack offering that consisted of just saltines.
The facility also was cited for a number of maintenance issues, including missing faucet knobs, a hole in the wall, malfunctioning fire doors, brown stains on the ceiling, dead insects and dust.
DHEC could not verify allegations of a staff member choking a resident, of marijuana found at the facility, of a lack of hygiene products or of the presence then of mold or a staph infection. The report said it could find no documentation of the choking incident and that it found storage containers with adequate hygiene supplies. Staff said they did not know anything of a staph infection, according to the report, and DHEC found no mold in the facility.
Workers previously told The News that the mold was sometimes painted over. Some workers told the newspaper that they bought hygiene items themselves to help the children because such products were either in short supply or were locked up.
An investigation on Jan. 5 again cited the facility for understaffing, finding a staff of two on one unit's shift and four on another unit's shift that dwindled to one by the end of the shift after workers left.
Four of the 19 violations were repeat instances, DHEC reported.
"Palmetto Pee Dee Behavioral Health strives to continually improve our quality of care and maximize the safety of our patients," the facility said in its statement. "The facility is licensed by the State of South Carolina Department of Health and Environmental Control (DHEC) and fully accredited by The Joint Commission, whose rigorous accreditation and clinical quality assessment protocols are widely respected throughout the healthcare industry. We also operate a robust quality improvement program."
Mechling said in her response earlier this month that the workers' allegations were "dubious" and said in a statement to the newspaper that the residents’ care was the company’s highest priority.
Children there are referred from a variety of sources, including local disabilities boards, although the center is not a qualified provider of the state Department of Disabilities and Special Needs, and it does not oversee its care.
Palmetto Pee Dee is owned by Universal Health Services, the largest facility-based behavioral health provider in the nation, with more than 230 facilities in 37 states, according to its website. UHS facilities, according to its website, outperformed the industry in 2015 in Joint Commission surveys and many were recognized as "Top Performers" in key metrics.
Mechling said federal regulations prohibit facility officials from discussing details of the care and treatment of any individual.