VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Presbyterian Homes and Family Services operating as HumanKind
1903 Humankind Way
Lynchburg, VA 24503
(434) 384-3131

Current Inspector: Dawn Espelage (540) 759-8852

Inspection Date: April 13, 2022 , April 14, 2022 and April 21, 2022

Complaint Related: Yes

Areas Reviewed:

Provider Homes Children Services Additional Requirements for Specific Programs

Comments:

A complaint was received by VDSS Division of Licensing on 03/21/2022 regarding allegations in the areas of: children's services and provider homes. An unannounced complaint inspection was conducted on 04/13/2022 from approximately 9:00 am to 4:00 pm, 04/14/2022 from 9:00 am to 12:50 pm and on 04/21/2022 from 8:45 am to 1:45 pm at the office of Presbyterian Homes and Family Services operating as HumanKind located in Lynchburg. Additional documents were requested for review on 04/25/2022. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. The agency reported 33 children in care and 19 approved provider homes. The program director, quality control manager and case worker were available throughout the inspection to answer questions. The inspector reviewed 4 provider home records, 5 children records and interviewed 3 employees. The licensee's policies and procedures regarding monitoring administration of medication were reviewed. An exit meeting was conducted via telephone on 06/08/2022 to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the allegations; area(s) of non-compliance with standard(s) or law were: organization and administration and children's services. A violation notice was issued; any violation(s) not related to the complaint but identified during the course of the investigation can also be found on the violation notice. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. If the licensee wishes to provide a plan of correction: (i) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview. Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected. Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area. Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact NeShara Gaston, Licensing Inspector at 804 840-2526 or by email at Neshara.gaston@dss.virginia.gov.

Violations:

Standard #:	22VAC40-131-40-B
Complaint related:	Yes
Description:	Violation: Based on review of the licensee's policies and procedures regarding monitoring the administration of medication by foster parents, records for FC1, FC2, FC3, and FC4, and interviews with the case worker, the licensee failed to follow its own policies and procedures. Findings: * The licensee's "Medication" policies and procedures states, "Foster parents must document on a serious incident report, (SIR), on the med log if the medication was or was not given as prescribed." "SIRs are reviewed by the Program Director with attention to the need for corrective action to ensure the safety and wellbeing of residents." "A medication listing sheet will be maintained regarding all current medication and all changes." "Medications refusals, adverse reactions and omissions need an SIR documenting the incident, the medication name, dosage missed and reason for omission. Foster Parents should document medication given on the Medication Log Sheet with the exact dosage and time administered." "If there is a medication error or a child refused to take their medication, a Serious Incident shall be completed and the Case Worker notified within 24 hours." * During the licensing inspector's interview with the case worker on 4/14/22, when asked how medication administration was monitored for FC1, FC2, FC3 and FC4 while placed in FH1, the case worker stated, she would ask FP1 in FH1 during home visits about the children's medications being administered and FP1 would show her the closet where medication was stored. The response did not include medication policy requirements specified above. * The caseworker acknowledged during the 4/14/22 interview that she did not check behind the foster parent to ensure proper administration of medication and stated, "being so new, I didn't know I needed to check behind her." The caseworker stated, "I tried to get paperwork but she was terrible with paperwork" and "every month it was an issue with getting paperwork." The caseworker also stated during the interview she discussed concerns during monthly supervision with her supervisor. Child, FC1: * The record did not document the licensee monitored the administration of FC1's medications during his placement in FH1 from 4/28/21 to 2/16/22 to ensure the safety and well-being of FC1. * The intake assessment completed by the licensee, documents FC1 is prescribed, Thiamine 100 mg, daily, Ferrous Sulfate, 75 mg, daily and Multivitamin, oral daily. * Medical examination completed on 7/6/21 documents that FC1 should start Ketoconazole topical shampoo, 2%, every 3 days for 30 days. * The record documented medication logs for April 2021 and May 2021. The May 2021 medication log does not document FC1 was receiving the prescribed medication. No additional medication logs or serious incident reports regarding FC1's medications were documented in the record. * An addendum dated, 7/1/21 and signed by the case worker, documents, FP1 in FH1 reports that "medications ran out and there were no refills on the prescribed vitamins." The record does not document that FC1 started the Ketoconazole topical shampoo. Child, FC2: * The record for FC2 did not document the licensee monitored the administration of FC2's medications during his placement in FH1 from 4/28/21 to 2/16/22 to ensure the safety and well-being of FC2. * The "Initial Plan" of care completed by the licensee, documents that FC2 is prescribed Thiamin 100 mg, daily. * The record documents an addendum dated, 7/1/2021 and signed by the case worker, stating, "Foster parent reports there are no medication logs for May or June due to child running out of Thiamine HCL (Vitamin B)" and "Only administered as deemed necessary by foster parent." (Due to the limited space allowed by the DSS computer licensing system, the remainder of the violation is on a separate document and available upon request.)
Plan of Correction:	FH1 was closed on 03/24/2022. Licensee has updated their medication policies and procedures regarding monitoring the administration of medication by foster parents. Each foster parent will be trained in medication management prior to approval of provider home and annually thereafter. All approved provider homes will receive annual training by 9/15/2022. The Program Manager will work with the foster parent trainer to ensure trainings are provided and completed. The licensee has updated the Foster Parent Medication Management Training and Medication Management Quiz to include Serious Incident Reports completed by foster parents for medication refusals, adverse reactions, medication errors or omissions, within 24 hours.
Standard #:	22VAC40-131-40-M
Complaint related:	Yes
Description:	Violation: Based on review of the records for Foster Child (FC) FC3 and FC4, and interviews with the case worker, the licensee failed to provide interventions and follow-up services, as necessary. Findings: * FC3 and FC4 were placed with the licensee on 4/28/21 for foster care services and placed in Foster Home (FH) FH1, which is a 2 parent home. * FC3 and FC4's "Narrative Account of Placement Preparation" completed by the licensee and dated 4/28/21, documents FC3 and FC4 are malnourished and have complex medical needs. * A letter from the legal guardian was received by the licensee on 5/18/21 that outlines the medical needs for FC3 and FC4. According to the letter, a medical doctor has diagnosed FC3 and FC4 as Failure to Thrive and severely malnourished. Child, FC3: * The record did not document any follow up by the licensee regarding services and interventions to address the "seizure like activity" reported on 10/5/21 or any follow up by the licensee regarding the autism referral while placed in FH1 from 4/28/21 to 2/16/22. * Contact note dated, 10/5/21 with the case worker and foster parents (FP), FP1 and FP2 in foster home (FH) FH1, documents "FP" reporting FC3 has begun to have "seizure like activity" and "FP" will follow up with doctor for FC3 to be evaluated for seizure activity. * Quarterly Progress Reports (QPR) covering 4/28/21 to 7/27/21 and 7/27/21 to 10/25/21, documents an autism referral has been made to assess FC3's needs. QPR covering 10/25/21 to 1/23/22 does not document any follow up by the licensee regarding the autism referral. Child, FC4: * The record did not document the licensee's interventions and follow up services necessary to ensure FC4 attended recommended neurology appointment while placed in FH1. The case worker did not provide any additional information regarding why the neurological appointment did not take place while FC4 was placed in FH1. * Medical examination completed on 7/6/21 documents, FP1 in FH1 is reporting concerns to pediatric nurse practitioner that FC4 is possibly having seizures on a daily basis. * Medical progress note signed by pediatric nurse practitioner and dated, 8/5/21 documents, "gave foster mom UVA scheduling number to f/u on neuro referral sent 7/7/21." * Contact note dated, 10/5/21 with the caseworker, FP1 and FP2 in FH1 documents, "FP" reports FC4 had a neurology appointment, and FC4 is believed to be having seizures and more testing is needed. * Contact notes dated, 12/10/21, 12/21/21, 1/4/22, 1/11/22, and 1/25/22 with the case worker and FP1 in FH1, documents FC4 has not completed additional neurological testing as recommended per the 10/5/21 contact note. Contact note dated, 2/22/22 with the caseworker, FP1 and FP2 in FH5 documents FC4 is in need of a rescheduled neurology appointment.
Plan of Correction:	Program Manager was terminated on 04/18/2022 due to failure to maintain ultimate responsibility for the health, safety, and wellbeing of children under its custody, control, and direction. FH1 was closed on 03/24/2022. The licensee has developed the Regional Audit Specialist position requisition to be posted for employment by August 1, 2022. This position will assist the Program Director in ensuring the health, safety, and wellbeing of children under the licensee's custody. This will be accomplished through documentation, on-going monthly audits, ensuring all documentation regarding the above stated is present and up to date in the file. The Program Director will work with HR to ensure this is completed. FC3- Child followed up with medical doctor on 03/16/2022 for medical examination. No concerns regarding seizure activity or autism documented by provider. Dr. appointments completed on 04/21/2022 and 05/26/2022 with the same provider. No concerns of seizure activity or autism were documented by provider. FC4-On 10/08/2021 and 10/25/2021 AR3 requested records from UVA Pediatric Neurology and Epilepsy Clinic to review the appointment and provide any recommended services. No response from provider. On 03/09/2022, FC4 was examined at UVA Neurology Pediatrics Clinic. Concerns were noted and are being addressed.
Standard #:	22VAC40-131-290-F
Complaint related:	Yes
Description:	Violation: Based on review of the records for FC1, FC2 and FC3, the licensee failed to arrange for children to receive necessary medical treatment. Findings: Child, FC1: * The licensee failed to arrange for FC1 to receive necessary treatment to address vision concerns while placed in FH1 from 4/28/21 to 2/16/22. * Record documents a 6/22/21 contact note with the case worker, FP1 and FP2 in FH1 that documents, FC1 is having issues with his vision and covers left eye in an attempt to see better out of the right eye. Contact note for 11/4/21 with the case worker and FP1 and FP2 in FH1, documents FC1 is in need of an eye examination and contact note for "12/21/22" documents, a new referral was made for FC1 to have a vision examination. * Medical progress note dated 7/6/21 by pediatric nurse practitioner, documents FP1 in FH1 is concerned about FC1's vision. An Individualized Education Program (IEP) received by the licensee on 12/6/21, documents FP1 in FH1 reports FC1 is having vision difficulties. * During the licensing inspector's interview with the caseworker on 4/14/22, when asked, what is the status of FC1's eye examination, the caseworker stated, "I didn't know FC1's vision was so poor until he moved to a home with stairs." * FC1 was placed in FH5 on 2/16/22 and according to the 2/22/22 contact note with the caseworker and FP1 and FP2 in FH5 documents, FC1 has been falling down the stairs due to his vision issues. Child, FC2: * The licensee failed to ensure FC2's medical needs were addressed while placed in FH1 from 4/28/21 to 2/16/22 by ensuring arrangements were made for FC2 to be assessed for cerebral palsy. * FC2's record documents a quarterly progress review (QPR) covering 10/23/21-1/21/22, that documents the doctor has concerns that FC2 could have a form of cerebral palsy and has an appointment in January 2022 to assess. * The quality control manager, confirmed via email sent to licensing inspector on 4/26/22 that FH1 did not take FC2 to the January 2022 medical appointment. No additional information was provided by the licensee regarding the January 2022 medical appointment for FC2. Child, FC3: * The licensee failed to ensure FC3's medical needs were addressed while placed in FH1 from 4/28/21 to 2/16/22 by ensuring arrangements were made for FC3 to be assessed regarding the seizure like activity. * Record documents a 10/5/21 contact note with the case worker, FP1 and FP2 in FH1 that documents, "FP" reports FC3 has begun to have "seizure like activity and blacks out." The contact note also documents, "FP" will follow up with doctor for FC3 to be evaluated. * No additional information was provided by the licensee regarding FC3 being assessed regarding the "seizure like activity" while placed in FH1.
Plan of Correction:	FH1 was closed on 03/24/2022. Program Manager was terminated on 04/18/2022. FC1- On 03/28/2022, FC1 was examined by optometrist for an eye exam. Concerns were noted and were addressed. On 04/29/2022, FC1 was examined by optometrist for glasses. Concerns were noted and addressed. FC2- On 03/03/2022, FC2 was examined by medical doctor. No concerns for cerebral palsy noted. On 03/21/2022, FC2 began receiving services for developmental education through Infant and Toddler Connection. Concerns were noted and addressed. FC3- On 03/16/2022, 04/21/2022, and 05/26/2022, FC3 was evaluated by medical doctor. No concerns for seizure like activity noted. The Licensee has updated the Treatment Foster Care New Worker training with information on VAC 40-131-290-F. This training will be completed with all new staff by the Program Director and/or the Quality Control Manager. The licensee has developed the Regional Audit Specialist position requisition to be posted for employment by August 1, 2022. This position will assist the Program Director in ensuring the health, safety, and wellbeing of children under the licensee's custody. This will be accomplished through documentation, on-going monthly audits, ensuring all documentation regarding the above stated is present and up to date in the file. The Program Director will work with HR to ensure this is completed.
Standard #:	22VAC40-131-460-E
Complaint related:	Yes
Description:	Violation: Based on review of the record for FC1, FC2, and FC4, and interview with the case worker, the licensee failed to arrange for the children to receive recommended services. Findings: * FC1, FC2 and FC4 were placed in Foster Home (FH) FH1, which is a 2 parent home on 4/28/21 for foster care service and removed from FH1 on 2/16/22. Child, FC1: * The licensee failed to monitor services provided to ensure recommended services were arranged to meet FC1's developmental needs while placed in FH1 from 4/28/21 to 2/16/22. * Record documents an Individualized Education Program (IEP) with meeting date of 10/19/21 and received by the licensee on 12/6/21. The IEP documents, FC1 has significant language and speech deficits and described as non-verbal. The IEP documents, FC1 is severely delayed when compared to same age peers. * The case worker explained during a 4/14/22 interview with licensing inspector, that FC1 was "partially" discharged from services with Blue Ridge Therapy Associates due to the missed appointments. The case worker stated, "I don't think FP1 was taking FC1 to anything." * During the inspection on 4/21/22, a list of missed appointments for FC1 for clinical services with Blue Ridge Therapy Associates, Inc. was provided by the case worker. The list of missed appointments with Blue Ridge Therapy Associates, Inc. includes a total of 6 "no show" appointments for "ST feeding" and 16 "cancelled" appointments for "PT" from 6/18/21 to 12/28/21. Child, FC2: * The licensee failed to monitor services to ensure recommended services were arranged to meet FC2's developmental needs while placed in FH1 from 4/28/21 to 2/16/22. The record for FC2 did not document any follow up by the licensee to ensure FC2 attended a January 2022 cerebral palsy assessment. * The quality control manager, confirmed via email sent to licensing inspector on 4/26/22 that FH1 did not take FC2 to the January 2022 appointment. No additional information was provided by the licensee regarding the appointment. * FC2's quarterly progress review covering 10/23/21-1/21/22 documents doctor has concerns that FC2 could have a form of cerebral palsy and has an appointment in January 2022. * Contact note for 1/25/22 with the caseworker and FP1 in FH1 documents FC2 was released from "Infant and Toddler" pending the decision regarding a cerebral palsy assessment. Child, FC4: * The record documents a discharge note addendum from Blue Ridge Therapy Associates, Inc. dated 2/9/22. The note documents FC4 has been discharged and the reason for discharge is, "The family has not attended therapy for 2 months and not willing to contact us about continuing "ST." * FC4's record documented a medical report from VCU Health/VCU Medical Center with discharge date of 4/28/21 documenting, that FC4 will require intensive occupational therapy services to address deficits. * The record did not document follow up with FH1 or Blue Ridge Therapy Associates that ensured FC4 received recommended services while placed in FH1. During interviews with the licensing inspector on 4/13/22 and 4/14/22, the caseworker did not provide any additional information regarding the licensee ensuring FC2 received recommended services while placed in FH1. * During the interview with licensing inspector on 4/14/22, when asked why FC4 was discharged from services with Blue Ridge Therapy Associate, Inc. the case worker stated "FP1 was not taking FC4 to speech, occupational and physical therapy" and FC4 was discharged due to missed appointments.
Plan of Correction:	FH1 was closed on 03/24/2022. Program Manager was terminated on 04/18/2022. FC1- FC1 is scheduled for a speech evaluation on July 12, 2002 through Blue Ridge Therapy to address any language and speech deficits. FC2- On 03/03/2022, FC2 was examined by medical doctor. No concerns for cerebral palsy noted. On 03/21/2022, FC2 began receiving services for developmental education through Infant and Toddler Connection. Concerns were noted and addressed. FC4- On 03/16/2022, FC4 restarted physical therapy services with Blue Ridge Therapy. FC4 was evaluated by Blue Ridge Therapy and concerns were noted and are being addressed. The licensee has developed the Regional Audit Specialist position requisition to be posted for employment by August 1, 2022. This position will assist the Program Director in ensuring the health, safety, and wellbeing of children under the licensee's custody. This will be accomplished through documentation, on-going monthly audits, ensuring all documentation regarding the above stated is present and up to date in the file. The Program Director will work with HR to ensure this is completed. The Licensee has updated the Treatment Foster Care New Worker training with information on VAC 40-131-290-F. This training will be completed with all new staff by the Program Director and/or the Quality Control Manager. The licensee updated the Foster Parent Monthly Report of Progress to include verifying the type of services received that month. Please see attached.