A St. Cloud mental health treatment center for children and teens has been sanctioned by the state for chronic health and safety violations, including routinely failing to prevent young patients from “head-banging” so persistently that it caused concussions.

In a highly unusual move, the Minnesota Department of Human Services (DHS) placed the St. Cloud Children’s Home’s license on conditional status for three years, citing the “nature, chronicity and severity” of the violations.

The home, a 60-bed residential treatment center operated by Catholic Charities of the Diocese of St. Cloud, was sanctioned for violating 33 state rules governing the health and safety of vulnerable young patients.

The head-banging was so persistent and severe that at least three children suffered multiple concussions and head trauma, investigators said. Another patient was allowed to climb onto the roof several times, suffering burns to both feet, according to a licensing order issued last week.

Children also frequently were subjected to an unusual form of punishment known as “freeze” that was not therapeutic or approved by a mental health professional. During freeze, children who were noncompliant or aggressive were forced to sit in an assigned area for at least 24 hours, even after they had calmed down. They would eat their meals at the “freeze spot” and only return to their rooms at night. One child spent 35 days in freeze in a four-month period, investigators found.

Stephen Pareja, executive director of Catholic Charities of the Diocese of St. Cloud, said his organization plans to appeal the licensing order because the state failed to take into account improvements made in patient care and safety in the past year. The center stopped using the freeze technique nearly a year ago because it was “ineffective,” Pareja said, and has since hired counselors who are specially trained in preventing crises and de-escalating conflicts among patients, he said.

Since hiring more crisis counselors last fall, the center has had a significant reduction in violent incidents. Last year, the number of calls from the treatment center to the St. Cloud Police Department fell by 35 percent, the center said.

“I see this [order] is an opportunity for us to learn from the incidents that DHS has brought to our attention,” Pareja said. “We have been and continue to make improvements.”

The state’s action, however, marks the second time in four years that the center’s license has been placed on conditional status for failing to protect children from serious harm. In early 2012, the site was hit with 46 licensing violations, after state inspectors found that unsupervised children were having sex with each other on the facility grounds. In one incident, a patient was forced to have oral sex by another patient while a staff member played a video game, records show.

The scope and number of repeat violations cited in the latest order alarmed mental health advocates. More than half of the 33 rule violations in the state’s recent order were for repeat violations, including some that date as far back as 2007, state records show.

“How many citations does it take to close a program?” asked Roberta Opheim, state ombudsman for mental health and developmental disabilities. “There are enough major violations here that concern the dignity and respect of the children being served that I wonder how long DHS licensing will allow this to go on.”

Last October, regulators found that staff members “at all levels of authority” were aware that children were repeatedly banging their heads against walls, but failed to take action. When the children banged their heads, the noise could be heard throughout one of the facility’s cottages. At least two of the children received emergency medical treatment. They also sustained black eyes, swollen faces, headaches and abrasions, regulators found.

Children were endangered in other ways as well. Last year, a 12-year-old child who had a history of self-injurious behavior was able to climb atop the roof five times — at one point, even jumping off the roof. On one occasion, the child suffered second-degree burns from walking on the roof without shoes. Another child fractured a finger but did not receive proper medical care for eight days, resulting in surgery to repair the finger, regulators found.

The center failed to comply with state rules on the use of psychotropic medications, regulators found.

In multiple cases, patients began the use of psychotropic drugs without staff documentation that side effects were being monitored. The home also failed to administer a patient’s prescribed antidepressant drug for three days in September 2015 because the medication had run out.

Pareja said the center is rolling out a new health records software system that should prevent medication errors and gaps in documentation. “Our documentation is not always as robust as we would like it to be,” he said. “We’ve identified that as a difficulty and a challenge.”

It is rare for state-licensed facilities to have their licenses placed on conditional status. Such a step is taken only after inspectors find “repeated and serious” violations of licensing standards, DHS said.

Of 20,000 programs licensed by DHS, a total of 476 programs and just four children’s residential facilities have been hit with such sanctions from 2012 to 2016, state records show. “We intend to monitor the [St. Cloud Children’s Home] closely and provide technical assistance as needed,” a DHS spokeswoman said.