VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Skill Builders
1320 Francis Street
Norfolk, VA 23523
(757) 233-2896

Current Inspector: Sherry Woodard (757) 987-0839

Inspection Date: Dec. 16, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-131 ORGANIZATION AND ADMINISTRATION 22VAC40-131 PERSONNEL 22VAC40-131 CHILDREN'S SERVICES 22VAC40-131 ADDITIONAL REQUIREMENTS FOR SPECIFIC PROGRAMS 22VAC40-80 THE LICENSE. 22VAC40-191 Background Checks for Child Welfare Agencies

Comments:

An unannounced monitoring inspection was conducted on December 16, 2019 from 10:20 a.m. to 2:57 p.m. The agency continues to provide independent living arrangements (ILA). At the time of the inspection the agency reports 6 youth placed in ILA. During this inspection, three personnel records and two youth records were reviewed. An exit meeting was conducted with Staff S4 to discuss preliminary inspection findings before leaving the agency on December 16, 2019. An acknowledgment form was signed. Upon the receipt of the violation notice, the licensee should identify the necessary corrective action and develop a plan of correction for each violation. The plan of correction should include the following: The steps to correct noncompliance with the standard(s); measures to prevent re-occurrence of noncompliance; person(s) responsible for implementation and monitoring of preventative measure(s); and date by which noncompliance will be corrected. The licensee has five (5) calendar days from receipt of the inspection documentation to complete the section titled Plan of Correction, sign each page of the documentation and return it to the Licensing Office. The licensee should retain a copy to be posted at the facility. Results of the inspection documentation are subject to public disclosure and will be posted on the VDSS web site within 5 days, regardless of whether the Plan of Correction is completed.

Violations:

Standard #:	22VAC40-131-130-A-3
Description:	Violation: Based on review of the personnel record for Staff S3 and interview with Staff S4, the job description did not include a required element of this regulation. Findings: 1. The job title of the immediate supervisor was not documented in the job description for S3. 2. Staff S4 confirmed that the job description did not include the job title of the immediate supervisor.
Plan of Correction:	Corrected during the inspection, observed by the Licensing Specialist. The job description was revised to include this missing element. The long term corrective action was to review all current employee files to ensure standard compliance. Moving forward, all forms will be updated to include the job title of the immediate supervisor. This will be the responsibility of the Executive Director and Program Director.
Standard #:	22VAC40-131-130-A-3
Description:	Violation: Based on review of the personnel record for Staff S3 and interview with Staff S4, the job description did not include a required element of this regulation. Findings: 1. The job title of the immediate supervisor was not documented in the job description for S3. 2. Staff S4 confirmed that the job description did not include the job title of the immediate supervisor.
Plan of Correction:	Corrected during the inspection, the job description was revised to include the missing required element.
Standard #:	22VAC40-131-140-B
Description:	Violation: Based on review of the personnel record for Staff S3 and interview with Staff S4, the agency failed to document that S3, designated to assume the responsibilities of a position, met all qualifications for the position. Finding: 1. S3 did not meet all the qualifications for the designated position in the child-placing agency, based on the documentation in S3's personnel record. 2. During an interview with the Licensing Specialist, Staff S4 confirmed that the personnel record documentation did not reveal that S3 met the qualifications for the designated position.
Plan of Correction:	Corrected during the inspection, observed by the Licensing Specialist.
Standard #:	22VAC40-131-140-B
Description:	Violation: Based on review of the personnel record for Staff S3 and interview with Staff S4, the agency failed to document that S3, designated to assume the responsibilities of a position, met all qualifications for the position. Finding: 1. S3 did not meet all the qualifications for the designated position in the child-placing agency, based on the documentation in S3's personnel record. 2. During an interview with the Licensing Specialist, Staff S4 confirmed that the personnel record documentation did not reveal that S3 met the qualifications for the designated position.
Plan of Correction:	Corrected during the inspection, observed by the Licensing Specialist. The long term corrective actions to ensure continued monitoring of standard compliance will include two reviews of the employee's file prior to starting the position. This will be the responsibility of the Executive Director and Program Director.