PALM BEACH COUNTY, Fla. — A residential mental health treatment facility for children was ordered by the state to stop accepting certain residents, after one resident died at the facility.
The Agency for Health Care Administration (AHCA) claims in a 27-page order that employees at The Children’s Place at HomeSafe violated multiple policies in the days leading up to a 15-year-old’s suicide.
WATCH: Staff ordered to stop accepting certain patients after resident's death
Per the order, the facility can’t admit new clients with “history of self-harm, suicidal ideations or suicide attempts” until the order is lifted.
The order came down Monday, just over three weeks after a resident was found dead by hanging in their bathroom.
According to the order, the resident was being treated for depression, anxiety and other psychiatric conditions; they had a history of trauma, self-harm and suicidal ideation with “numerous Baker Acts.”
The resident was first admitted to the facility on Jan. 16, according to the order.
AHCA inspectors found multiple policies meant to keep residents safe from self-harm were broken.
The agency found staff at The Children’s Place didn’t properly communicate and document the resident’s comments about depression, self-harm, and death in the days leading up to their suicide on the evening of Feb. 1.
According to AHCA’s investigation, which is detailed in the order, the resident told an employee on Jan. 26 that that they were “depressed and thinking of harming oneself.” The employee was able to work with the resident and get them to feel better. The resident went on an outing to Miami with staff and other residents on Feb. 1.
On the ride home from that outing, according to the order, the resident “began getting anxious” and crying, and had made a comment that they “did not want (their) parents to see (them) get buried.”
Once again, the resident appeared to feel better after speaking with a staff member, who described them to investigators as “back to normal after we talked.”
AHCA wrote that the staff member and their supervisor did not follow communication protocols after the incident, to insure that the resident had the proper support.
That night, as AHCA discovered in the facility’s logbooks, no one had physically seen the resident in their room for nearly two hours.
Staff are required to check on residents in their rooms every 15 minutes.
According to the order, there were no documented checks on the resident between 9:30 p.m. and 11 p.m. on Feb. 1, and during the 9:30 p.m. check, “the staff did not document actual visual checks of the resident” but saw that their bathroom light was on.
The resident was found dead in their bathroom after not responding to staff during the 11 p.m. check.
AHCA inspectors also found the building contained door locks and large hinges where residents could potentially hang themselves. The order notes that administrators at The Children’s Place had told the agency they are taking steps to remove the unsafe ligatures in the building.
In addition to the suicide, the order notes that during a Feb. 10 survey of the facility, three residents were “AWOL.”
WPTV reviewed calls for service from The Children’s Place to the Palm Beach County Sheriff’s Office and found that “missing person” calls from the facility’s address have increased steadily over the past few years.
The records show nine missing person calls in 2022, 26 in 2023, and 38 in 2024.
Not even two months into 2025, the sheriff’s office has received 17 missing person calls from the facility’s address.
“These deficient practices are not isolated events, but systemic in nature, and in violation of the minimum requirements of law,” the order says of the overall condition in the facility.
WPTV made contact with HomeSafe via email. We are still waiting for their response to a list of questions.
Prior to February’s investigation, AHCA had not inspected The Children’s Place at HomeSafe since September of 2022, according to the agency’s records.
The inspection found “no deficiencies.”
