VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Embrace Foster Care
6345 Center Drive
Norfolk, VA 23502
(757) 847-9385

Current Inspector: Sherry Woodard (757) 987-0839

Inspection Date: April 24, 2023 , April 25, 2023 and April 27, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-131 ORGANIZATION AND ADMINISTRATION 22VAC40-131 PERSONNEL 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:

22VAC40-131-110 Received Date for Materials 22VAC40-131-180.M Documenting consideration of all information received (DMV record content Berry) 22VAC40-131-190.R Documenting key storage out of reach of children 22VAC40-131-250.L and M Documentation related to determining whether placement meets definition of emergency placement 22VAC40-131-340.B Initial Plan of Care, Measurability of objectives and strategies

Comments:

An unannounced monitoring inspection was conducted from 4/24/2023 to 4/27/2023 for records and documentation. An entrance conference was conducted on 4/24. Office settings and conditions were inspected onsite on 4/4/2023 by another Licensing Inspector prior to the inspection of records. A preliminary findings review was conducted on 5/5/2023 and an exit interview were conducted on 5/17/2023 by Teams Meet. Number of children in care: 43 Number of approved provider homes: 37 The licensing inspector completed a tour of the physical plant that included the office setting and conditions. Number of children?s records reviewed: 3 Number of provider homes reviewed: 6 Number of staff records reviewed: 3 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. Should you have any questions, please contact Dawn Caldwell, Licensing Inspector at 804-385-6864 or by email at dawn.caldwell@dss.virginia.gov

Violations:

Standard #:	22VAC40-131-180-J
Description:	Violation: Based on record review, the agency failed to include required elements in the Home Study for Foster Home 4 (FH4). Findings: 1)The Home Study located in the record for FH4 did not include a date of approval. 2)The findings were discussed during the preliminary findings review and Staff 1 and 2 (S1 and S2) reviewed the Home Study and acknowledged the findings. 3)The findings were reviewed during the exit interview and staff acknowledged the findings.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-131-180-J-2
Description:	Violation: Based on record review, the agency failed to gather required information prior to approving Foster Home 3 and 4 (FH3 and FH4). Findings: 1)The record of Foster Home 3 (FH3) included a Certificate of Approval documenting the home was approved 1/25/2023. ?Medical examination reports for Applicant 2 (A2), documenting a medical examination on 4/11/2022 and for Household Member 1 (HH1) documenting a medical examination on 12/21/2022 did not include the medical provider?s response to the question for the medical providers assessment of whether A2 had conditions that would affect the care of children. ?Medical examination report for A2, documenting a medical examination on 4/11/2022 and for HH1 documenting a medical examination on 12/21/2022 correcting to include the medical provider?s response to the question for the medical providers assessment of whether A2 and HH1 had conditions that would affect the care of children were received on 2/7/2023. 2)The record for FH4 included a Certificate of Approval documenting the home was approved on 2/27/2023. ?The record for FH4 contained a Virginia Department of Motor Vehicle (DMV) report for Applicant 1 (A1) dated 3/1/2023 ?The DMV report for A1 indicated the agency received the record on 3/3/2023. 3)Findings were discussed during the preliminary findings review. 4) Staff 1 and 2 (S1 and S2) reviewed the above referenced documentation and acknowledged the findings. 5) The findings were reviewed during the exit interview and staff acknowledged the findings.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-131-250-O
Description:	Violation: Based on record reviews, the agency failed to, within 30 days of the placement of Foster Children 1, 2, and 3 (FC1, FC2, and FC3), place in the file of the child written assessments containing all required elements specified in 22VAC40-131-250 G. Findings: 1) The record for FC1 contained a written assessment, dated 3/1/2023, that stated no medical information was provided. 2) The record for FC2 contained a written assessment that did not document information gathered prior to accepting the child for placement. The written assessment documented information collected after placement 3) The record for FC3 for FC3 contained a written assessment that documented the strength and needs of the birth parents as ?none.? 4) The findings were discussed during the preliminary findings review and Staff 1 and 2 (S1 and S2) reviewed documentation and acknowledged the findings. 5) The findings were reviewed during the exit interview and staff acknowledged the findings.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-131-260-B
Description:	Violation: Based on record reviews, the agency failed to complete Social Histories for Foster Children 1, 2 and 3 (FC1, FC2, and FC3) addressing required elements. Findings: 1) The Social History for FC1documented the medical, dental, and developmental status as ?unknown.? 2) The Social Histories for FC1, FC2, and FC3 Did not address the education and occupation of grandparents, aunts, and uncles or medical and psychiatric history as it relates to suitability of the child for placement 3) The Social Histories for FC1, FC2, and FC3 did not address the family structure. 4) The findings were discussed during the Preliminary findings review and staff acknowledged the findings. 5) The findings were reviewed during the exit interview and staff acknowledged the findings.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-131-290-C
Description:	Violation: Based on record reviews for Foster Children 2 and 3 (FC2 and FC3), the agency failed to obtain medical examination reports addressing required elements. Findings: 1) The record for FC2 documented a physical examination on 2/1/2023. The medical examination report did not address the child?s auditory or visual acuity or evidence the child was free from communicable disease. 2) The record for FC3 contained a physical examination report that did not address the child?s auditory acuity or evidence the child was free from communicable disease. 3) The findings were discussed during the preliminary findings review and Staff 1 and 2 (S1 and s2) reviewed the documentation and acknowledged the findings. 4) The findings were reviewed during the exit interview and staff acknowledged the findings.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-131-290-L
Description:	Violation: Based on record review, the agency failed to obtain medical examination reports that included written examiner comments addressing the applicant's or caretaker's mental and physical condition in relation to his ability to take care of a child. Findings: 1) The record for Foster Home 3 (FH3) contained a medical examination form for Applicant 1 (A1) that did not address the applicant?s mental and physical condition in relation to his ability to take care of a child. 2) The medical examination form for A1 in FH3 included a question asking for the medical providers assessment of whether the A1 had conditions that would affect the care of children. The medical provider answered ?Has a normal physical.? 3) Findings were discussed during the preliminary findings review and Staff 1 and 2 (S1 and S2) reviewed the medical examination form and acknowledged the findings. 4) The findings were reviewed during the exit interview and staff acknowledged the findings.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-131-340-E
Description:	Violation: Based on record review, the agency failed to address required elements in the individualized service plan (ISP), dated 3/19/2023, for Foster Child 1 (FC1) who was placed in treatment foster care. Findings: 1)The ISP for FC1 did not include a comprehensive assessment of the child?s emotional, social, behavioral, nutritional, psychiatric, or dental needs. 2) The ISP for FC1 did not include criteria for achievement for goals and objectives related to specific problem behaviors 3) The findings were discussed during the preliminary findings review and Staff 1 and 2 (S1 and S2) acknowledged the findings. 4) The findings were reviewed during the exit interview and staff acknowledged the findings.
Plan of Correction:	Not available online. Contact Inspector for more information.