VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Extra Special Parents, INC.
1344 Maple Avenue SW
Roanoke, VA 24016
(540) 981-1776

Current Inspector: Dawn Espelage (540) 759-8852

Inspection Date: Oct. 25, 2022 and Oct. 31, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-131 ORGANIZATION AND ADMINISTRATION 22VAC40-131 PROVIDER HOMES 22VAC40-131 CHILDREN?S SERVICES 22VAC40-131 ADDITIONAL REQUIREMENTS FOR SPECIFIC PROGRAMS 22VAC40-191 BACKGROUND CHECKS FOR CHILD WELFARE AGENCIES

Technical Assistance:

22VAC40-131-180.M Documenting consideration of all information 22VAC40-131-180.J.2 Documenting assessments

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 10/25/2022 from 9:10 a.m. to 5:45 p.m. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of children in care: 16 Number of approved provider homes: 15 (5 newly approved since the last inspection) The licensing inspector completed a tour of the physical plant that included the office setting and conditions. Number of children?s records reviewed: 2 Number of provider home records reviewed: `6 Number of interviews conducted with staff: 3 An exit meeting was conducted on 10/31/2022 by Teams Meeting with the Lead Clinical Specialist, Co-Chief Executive Officer, and the State Treatment Foster Care Director. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. 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 Dawn Caldwell Licensing Inspector at 804-385-6864or by email at dawn.caldwell@dss.virginia.gov

Violations:

Standard #:	22VAC40-131-370-M
Description:	Violation: Based on record review, the agency failed to maintain required documentation in provider the records for Provider Homes 2, 3, and4 (PH2, PH3, and PH4). Findings: 1) During review of the record of PH2, references were not located 2) During review of the record of PH2, documentation of 90 day monitoring was not located. 3) During reviews of the record of PH3 and PH4, out of state CPS search results were not located. 4) The findings were discussed during the preliminary findings review. Staff 2 (S2 reviewed the record and Staff 3 and 4 (S3 and S4) reviewed the agency?s online system for documentation. 5) References and the 90 day monitoring report for PH2 and out of state CPS search results for PH3 and PH4 were located and provided to the Licensing Specialist for review. 6) During the preliminary findings review, S2 acknowledged the documentation was not filed in the records. 7) Findings were reviewed during the exit interview.
Plan of Correction:	Training conducted with all staff associated with the child files and family files to ensure all documentation completed on the digital filing system is printed and placed in the correct spot of the physical file within 48 hours. Admin assistant will ensure any missing items are completed within 48 hours as well.