VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Pentecostal Children's Home DBA Appalachian Foster Care Alliance
308 Coeburn Ave SW
Norton, VA 24273
(276) 437-0170

Current Inspector: Jamie Morgan (276) 525-5656

Inspection Date: Oct. 5, 2022 and Oct. 13, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-131 GENERAL PROVISIONS 22VAC40-131 ORGANIZATION AND ADMINISTRATION 22VAC40-131 PERSONNEL 22VAC40-131 PROVIDER HOMES 22VAC40-131 CHILDREN?S SERVICES 22VAC40-131 ADDITIONAL REQUIREMENTS FOR SPECIFIC PROGRAMS 22VAC40-80 THE LICENSE 22VAC40-80 THE LICENSING PROCESS 22VAC40-191 BACKGROUND CHECKS FOR CHILD WELFARE AGENCIES

Technical Assistance:

22VAC40-131-370.6 provider home documentation, requirement for dates of receipt of background checks

Comments:

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 10/5/2022 from 11:30 a.m. to 5:40 p.m. A preliminary findings review was completed with the Program Director and an Acknowledgement of Inspection form was signed and left at the facility on the date of inspection. Number of children in care: 6 Number of approved provider homes: 4 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: 2 Number of staff records reviewed:1 Number of interviews conducted with staff: 1 An exit interview was conducted via a Teams Meeting on 10/13/2022 at 3:00 p.m. with the Program 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 804-385-6864 or by email at dawn.caldwell@dss.virginia.gov

Violations:

Standard #:	22VAC40-131-110
Description:	Violation: Based on record reviews and interview, the agency failed to indicate the date received on all materials and information received. Findings: 1) Documents for provider homes 1 and 2 (PH1 and PH2) were reviewed. The following documents did not include the date received: Application Sworn Disclosures Tuberculosis Screenings Health Statements 2) Staff 2 (S2) was interviewed. 3) Findings were discussed during the preliminary findings review. S2 acknowledged the findings. 4) Findings were reviewed during the exit interview and S2 acknowledged the findings.
Plan of Correction:	AFCA staff will verify receipt of all incoming documents with a date stamp. Paper documents received will be stamped by hand, and electronic documents received will be electronically stamped in accordance with standard 22VAC40-131-(2)-110. All documents received will be uploaded to the electronic record of the agency in a timely manner
Standard #:	22VAC40-131-160-B-10
Description:	Based on record reviews and interview, the agency failed to maintain required documents in the record for Staff 1 (S1). Findings: 1) The record for S1 did not include a current job description. 2) Staff 2 (S2) was interviewed. 3) The findings were discussed during the preliminary findings review. Staff 2 (S2) located the document, provided it to the licensing specialist, and acknowledged it had not been placed in the record. 4) The findings were reviewed during the exit interview and S2 acknowledged the findings.
Plan of Correction:	AFCA Program Director will verify and maintain all required documentation for current employees as well as any future new hires, in employee files within the electronic records of the agency
Standard #:	22VAC40-131-180-J-2
Description:	Violation: Based on record reviews and interview, the agency failed to address required elements in the home studies for provider homes 1 and 2 (PH1 and PH2). Findings: 1) Home studies for PH1 and PH2 did not document the assessment of the provider home applicant?s understanding of the importance of establishing and enforcing rules to encourage desired behavior and discourage undesired behavior. 2) Home studies for PH1 and PH2 did not document bedrooms of children in care were not used as passageways and had doors for privacy. 3) Staff 2 (S2) was interviewed. S2 reported PH1 and PH2 were interviewed during the home study process and all applicants have an understanding of the importance of establishing and enforcing rules to encourage desired behavior and discourage undesired behavior. 4) S2 was interviewed. S2 reports bedrooms in the homes of P1 and P2 are not used as passageways and have doors for privacy. 5) Findings were discussed during the preliminary findings review and S2 acknowledged the findings. 6) Findings were reviewed during the exit interview and S2 acknowledged the findings.
Plan of Correction:	AFCA staff will assess, verify, and document all Provider Homes in accordance to standard 22VAC40-131-(5)-180-J-2 and upload all required documentation for Provider Homes within the electronic records of the agency in a timely manner. Violation:
Standard #:	22VAC40-131-250-M
Description:	Violation: Based on record reviews and interview, the agency failed to arrange preplacement visits for Child 1 and 2 (C1 and C2) in the prospective foster home. Findings: 1) The placements for C1 and C2 did not meet the definition for emergency placement. 2) The written report required by 22VAC40-131-250.O documented no pre-placement visits were completed for C1 and C2 due to scheduling conflicts. 3) Staff 2 (S2) was interviewed. S1 informed the licensing specialist that the local department requesting the placements for C1 and C2 did not feel pre-placement visits were necessary as the children knew the provider home parents through previous contacts in the school setting. 4) Findings were discussed during the preliminary findings review. 5) Findings were reviewed during the exit interview and S2 acknowledged the findings.
Plan of Correction:	AFCA staff will work with referring agencies to ensure that all referrals which do not meet the definition for emergency placement will have a documented pre-placement visit with any prospective foster home prior to placement in accordance with standard 22VAC40-131-(6)-250-M.
Standard #:	22VAC40-131-360-E-3
Description:	Violation: Based on record review, the agency failed to document required elements in the discharge summary for Child 2 (C2). Findings: 1) The discharge summary, dated 6/30/2022, for C2 did not include the name of the individual the child was discharged to. 2) The findings were discussed during the preliminary findings review. Staff 2 (S2) provided the licensing specialist with the name of the individual to whom the child was discharged. 3) S1 acknowledged the findings. 4) The findings were reviewed during the exit interview and S2 acknowledged the findings.
Plan of Correction:	AFCA staff will obtain and document the name of the individual to whom any child is being discharged to and the information will be included in the Discharge Summary of each child and uploaded to the electronic records of the agency in accordance with standard 22VAC40-131-(6)-360-E-3.
Standard #:	22VAC40-131-370-M
Description:	Violation: Based on record reviews, the agency failed to maintain documentation in the record for Provider Homes 1 and 2(PH1 and PH2). Findings: 1) The record for PH1 did not contain tuberculosis screening or test results for the applicants and household members. 2) The record for PH1 did not contain documentation of completed training required by 22VAC40-131-210. 3) The record for PH2 did not contain documentation that the home was in compliance with 22VAC40-131-190. 4) The findings were discussed with Staff 2 (S2) during the preliminary findings review. S2 located the documentation and provided to the licensing specialist. 5) S2 acknowledged the documentation was not maintained in the records for PH1 and PH2. 6) The findings were reviewed during the exit interview and S2 acknowledged the findings.
Plan of Correction:	AFCA staff will obtain and upload all required documentation for Provider Homes within the electronic records of the agency in accordance with standards 22VAC40-131-(6)-370-M, 22VAC40-131-210, and 22VAC40-131-190.
Standard #:	22VAC40-131-370-N
Description:	Violation: Based on record reviews, the agency failed to maintain required documentation in the record for Child 1 and 2 (C1 and C2). Findings: 1) The records for C1 and C2 did not contain a placement agreement or foster home agreement. 2) The record for C1 did not contain a quarterly progress review, documentation of a dental exam, or documentation of a medical exam. 3) The findings were discussed during the preliminary findings review. Staff 2 (S2) located and provided them to the licensing specialist. 4) S2 acknowledged the findings. 5) The findings were reviewed during the exit interview and S2 acknowledged the findings.
Plan of Correction:	AFCA staff will obtain and upload all required documentation for Child Files within the electronic records of the agency in accordance with standard 22VAC40-131-(6)-370-N.