Brenham State Support Living Center Compliance Review

BRENHAM, TEXAS -- The most recent report from the independent monitors regarding the Brenham State Supported Living Center's work towards compliance with the settlement agreement between Texas and the U.S. Department of Justice is now available.

The Brenham facility nor any of the other state supported living centers was required to be in 100% compliance with the settlement agreement by June of 2012.

In June 2009, when the State of Texas entered into the settlement agreement with the U.S. Department of Justice and agreed to broad systemic improvements, both parties fully expected and acknowledged it would take a number of years to complete.

In fact, the settlement agreement does not establish specific deadlines for achieving substantial compliance.

The first progress report by the independent monitors to the court was due at the four-year anniversary of the settlement agreement – June 2013. But an agreement with both parties and the court extended that deadline to June 2014.

Also, it is important to note the agreement requires that the monitors rate each of the 20 provision items as being either in substantial compliance or in noncompliance. It does not allow for intermediate ratings, such as partial compliance, progressing or improving. So a facility will receive a rating of noncompliance even when progress and improvements might have occurred.

Merely counting the number of substantial compliance ratings to determine if the facility is making progress does not provide the most accurate measure of progress. Not all provisional items are equal in weight or complexity. Some require significant systemic change to a number of processes, whereas others require only the facility to implement a single action.

The Brenham State Supported Living Center is now in compliance with 55 areas of the settlement agreement. The center gained compliance in 16 areas and maintained compliance in 39.

While Brenham still has a significant way to go to achieve full compliance, we think it’s important to note areas where the independent monitors observed progress:
· There was a continued decrease in the use of crisis intervention and chemical restraints. Cases where restraints were used were reviewed thoroughly, demonstrating substantial compliance in almost every area.

· The center’s process of investigating incidents and injuries improved. Tracking, trending and analysis of data surrounding those incidents and injuries improved significantly. Allegations of abuse and neglect were referred to law enforcement quickly and recommendations made from investigation of these allegations were tracked until closure.

· Acute care plans which outline nursing care services for an individual after an acute illness were exemplary. Each included specific procedures and protocols for staff to follow that assured each individual’s health care needs were met.

· Additional progress was made in increasing the number of certified behavior analysts on staff at the facility. The quality of behavior intervention program plans improved substantially from previous reviews. In cases where individuals presented with mental illness and behavioral challenges, behavior intervention program plans addressed both issues appropriately.

While there were a number of substantial improvements noted at Brenham, there are areas that still need improvement:
· Psychiatric assessments, dental evaluations and behavioral assessments for new admissions needed to be more timely and comprehensive.

· Mortality reviews conducted by the facility need to be more comprehensive and provide specific recommendations about any corrective actions or procedural changes that might be needed.

· Residents needed to be engaged in more functional activities in their homes and settings that are outside their vocational day programs.

· Discharge plans for residents transitioning into the community should include a more thorough identification of the protections, services and supports individuals will need to successfully transition into community living.

For more information on this report, click here.