Auburn Otda April 2006

George E. Pataki Governor

NEW YORK STATE OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE 40 NORTH PEARL STREET ALBANY, NY 12243-0001

Robert Doar Commissioner

April 7, 2006 Mr. Roger Newman Deputy Commissioner NYC DHS/Family Services 33 Beaver Street New York, New York 10004 Dear Mr. Newman: A complete inspection was conducted at the Auburn Adult Family Residence on January 26, 27, 30 and 31 and March 15 and 16, 2006. Although the majority of the items were in compliance with Part 900 of Title 18 NYCRR, several findings indicate non-compliance with these regulations. Attached is the report of that inspection. Any items of non-compliance must be corrected immediately and notification of correction must be submitted detailing the corrective action taken. Where this is impossible, a written plan must be submitted detailing the corrective actions of all outstanding findings. The plan for corrective action must be submitted to this office within 30 days of the receipt of this report.

In the event that an endangering condition exists and OTDA has found that the health, safety, or welfare of the public or any individual is in imminent danger, OTDA may issue an “Order of Correction” to correct such condition immediately or within any specified period of less than 30 days. If notification of the correction to the findings are not received or the findings remain outstanding without an approved plan for correction within the time period specified, OTDA may deny or withhold reimbursement for allowable expenses as defined in Section 900.15(c) of Title 18 NYCRR. Also attached to this report is the Inspector’s Comments and Recommendations (ATTACHMENT A), General Maintenance Items (ATTACHMENT B) and the Confidential Resident and Staff Findings (ATTACHMENT C) noted during our inspection. The facility’s response to these attachments must be included in the facility’s overall response to this report. COMMENTS:

During our inspection, we noted that routine maintenance in the building has improved; and the insect and rodent control program has been successful. Additionally, we observed a fire drill on March 15, 2006 in which participation by residents and staff was timely. "providing temporary assistance for permanent change"

However, we must note that the heat delivered to this facility is not sufficient in temperature to properly warm the majority of the rooms. The rooms were very cold as noted in this report in Finding #20. Many of the rooms are in need of window replacement since they are very drafty. Please evaluate the feasibility of providing the Auburn facility with its own heating system (separate from Cumberland Hospital) to eliminate the condition of residents being placed in unhealthy cold rooms. We bring this to your attention as a priority concern as it remains an outstanding issue that has been cited in our inspection report over the past 4 years. If you have any questions regarding the information contained in the attached inspection report or to request an electronic copy of this report, please contact Sam Foriest at (212) 961-8234 or e-mail at: [email protected]. Sincerely, Jeff Barnes Jeff Barnes Director, Shelter Services Enclosure cc:

Robert Skallerup, DHS-CO James Russo, DHS-CO Julia Moten, DHS-CO Franca Okeya, DHS-CO Babatunde Salau, DHS-CO Bethzaida Vazquez, Director, e-mail: [email protected]

JB/su

"providing temporary assistance for permanent change"

OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE REPORT DATE: 04/07/06 REPORT OF INSPECTION FACILITY NAME: Street Address: City:

Auburn Adult Family Residence 39 Auburn Place Brooklyn, New York 11205

COUNTY:

Kings

INSPECTION SCOPE

INSPECTOR NAMES

INSPECTION DATES

PROGRAM:

Shirley Haines

January 26, 27, 30, & 31 2006

ENVIRONMENT:

Carol Whaley

March 15 and 16, 2006

"providing temporary assistance for permanent change"

INSTRUCTIONS FOR SUBMITTING DEPARTMENT OF HOMELESS SERVICES (DHS) FAMILY SHELTER INSPECTION RESPONSES VIA E-MAIL OR HARD COPY FOR DEPARTMENT OF HOMELESS SERVICES SHELTERS ONLY • Once NYS OTDA completes a facility inspection report, a copy of the report will be e-mailed to the facility’s Program Administrator at DHS and to the facility with e-mail capability. •

A hard copy of the facility’s inspection report will also be mailed to the facility.

•

The facility’s response to the inspection report should be complete and include responses to the Facility’s Findings, Inspector’s Comments and Recommendations (Attachment A) and the Maintenance Deficiencies (Attachment B).

The facility’s follows:

response

to

the

inspection

report

should

be

addressed

as

a) The facility’s response to the Facility’s Findings must be typed in bold in the Facility’s Response Box located below OTDA’s Corrective Action. b) The facility’s response to the Inspector’s Recommendations (Attachment A) must be typed in bold under each recommendation. c) The facility’s response to Maintenance Deficiencies (Attachment B) must be typed in bold after each maintenance item. d) The facility’s response to the “Confidential Resident and Staff Findings” (Attachment C) must be addressed according to the specific individual and finding as noted on the attachment. The facility’s hard copy response to the inspection report must be mailed to their Program Administrator at DHS or e-mail the response to the Program Administrator at [email protected] and [email protected]. (Note: all facility responses to the inspection report must be forwarded to DHS for their approval before they are forwarded to OTDA.) •

After the DHS Program Administrator has reviewed and approved the facility’ response, a copy will be sent, via hard copy to Jeff Barnes, Office of Temporary of Disability Assistance, Bureau of Shelter Services, 40 North Pearl Street, 9th Floor, Albany, New York 12243 or e-mail: [email protected].

•

OTDA will review all facility responses for compliance and, if necessary, request DHS and the facility to submit additional information.

"providing temporary assistance for permanent change"

REPORT OF INSPECTION REPORT DATE: 04/07/06 FACILITY NAME: Auburn Adult Family Residence VIOL REGULATION NUMBER 1 900.3(e) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: New York City Department of Homeless Services (DHS) failed to submit to the Office of Temporary and Disability Assistance (OTDA) a request to renew the approval of the facility’s Operational Plan. (Previously cited 11/15/01, 12/20/02, 01/09/04 & 02/14/05) CORRECTIVE ACTION: DHS must submit a request to renew the approval of the facility’s Operational Plan. The request must be submitted on OTDA’s current automated Part 900 Operational Plan CD format. A copy of the new OTDA Operational Plan CD format was given to the facility during the inspection or an additional copy may be requested by contacting OTDA.

DHS and Facility’s Response: (DHS and the facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 2 900.5(a)(7)&(b) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to ensure that all security officers have current state certifications, as required by the Department of State Security Guard Act Licensing, Registration, Training and Insurance Act of 1993. Fifty-eight security officers from the firm FJC Security lacked copies of up-to-date State certificates. See Attachment C for names. CORRECTIVE ACTION: Facility administrative staff must ensure that all FJC Security officers have current State certification. Documentation of security officers’ certification and training must be maintained on premises at all times for OTDA review and inspection. See OTDA approved Security Guards forms, Page A12.1.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

"providing temporary assistance for permanent change"

VIOL REGULATION NUMBER 3 900.6(h)(1) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to obtain copies of all resident preliminary health screen examination forms at the point of admission or within 24-hours after admission to the facility. Fifteen of the nineteen family case records reviewed lacked copies of medical screen health forms. See Attachment C for names. (Previously cited 02/14/05) CORRECTIVE ACTION:

The facility’s social services staff must obtain and maintain a copy of all family members’ preliminary health screen forms at the point of admission or within 24-hours after admission to the facility. (Refer to OTDA forms, page C50.) Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 4 900.9(b) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to provide adult families with an up-to-date facility handbook. CORRECTIVE ACTION:

The facility must provide adult families with a copy of the facility’s rules setting forth their rights and responsibilities while residing in the facility. The handbook must be revised to reflect adult families. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 5 900.10(c)(1)(i) & 900.14(a) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to conduct a preliminary needs intake and assessment of all families. Thirteen of the nineteen family case records reviewed lacked a preliminary needs determination of the other adult family member; or the preliminary needs determination was not done within ten days of their eligibility date. See Attachment C for names. (Previously cited 02/14/05) "providing temporary assistance for permanent change"

CORRECTIVE ACTION: The social services staff must meet with all families within two days of the family’s admission date to conduct at a minimum, a preliminary needs intake review, or a comprehensive assessment including all adult members. In all cases, a comprehensive intake and assessment must be completed within 10 days of the family’s admission date. See OTDA approved forms, “Family Case Record Admission/Assessment, Page C2.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 6 900.10(c)(1)(ii) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to review and revise all families BiWeekly/Independent Living Plans (ILP’s) on a bi-weekly basis; or revise their plan as necessary to obtain permanent housing. Nine of the nineteen family case records reviewed lacked all resident adult’s signature and an assessment of their needs. See Attachment C for names. (Previously cited 02/14/05) CORRECTIVE ACTION:

The facility’s social services minimum, bi-weekly to review Independent Living Plan. All on the plan and signed by the approved forms, page C7.

staff must meet with all families, at a and revise the Service and Bi-Weekly/ family members’ needs must be addressed adult members of the family. See OTDA

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 7 900.10(c)(1)(i)&(ii) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED:

FINDING: The facility failed to ensure that one of the Housing Stability Plus (HSP) certified families complied with housing search requirements. The family’s Service/Independent Living Plan (SP/ILP’s) lacked the number of required housing searches on the SP/ILP. See Attachment C for name. "providing temporary assistance for permanent change"

CORRECTIVE ACTION: The facility’s social services staff must ensure that all certified HSP families comply with housing search requirements and indicate the required number of housing searches on the SP/ILP. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 8 900.10(c)(1)(iii); 900.10(c)(4) & 900.15(c)(4)(v) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to refer all family members to the appropriate service agency within 30 days of each family’s needs assessment. Six of the nineteen family case records reviewed failed to demonstrate that all adult family members were referred to programs that will enable them to become self sufficient, nor were they referred within a timely manner. See Attachment C for names. (Previously cited 02/14/05) CORRECTIVE ACTION: The facility’s social services staff must continuously assess the needs of all family members and refer such members to the appropriate service agency within 30 days of each assessed need throughout the families’ stay. See OTDA approved forms, Page C14.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 9 900.10(c)(2)(ii)(a) & 900.14(a) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to document sufficient housing assistance for all families. Fourteen of the nineteen families’ case records reviewed lacked complete housing intake plans, since the date was omitted from the housing intake plan, had missing housing notes or housing notes were not up-to-date. See Attachment C for names. (Previously cited 02/14/05) CORRECTIVE ACTION: The facility’s social services staff must ensure that all families housing intake plans are completed within ten days of the families’ admission date and document appropriate and concise housing notes at least monthly which is to be filed in the housing section of the case record. Once a family is HSP certified, additional housing notes are to be documented including problems "providing temporary assistance for permanent change"

that the family may encounter which prevents them from obtaining permanent housing timely.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 10 900.10(c)(2)(ii)(c) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to assist all eligible adult residents to engage in some type of self-help initiative. At the time of the inspection, there were 318 adult residents residing in the facility, of which 258 were eligible to participate in self-help initiatives. Only 33 of the 258 eligible adults or thirteen percent (13%) were participating in self-help initiatives. (Previously cited 12/20/02, 01/09/04 & 02/14/05) CORRECTIVE ACTION: Federal welfare requirements state, “That at least 50 percent of a state’s welfare families must now participate in work and other activities aimed at self-sufficiency.” The facility’s social services staff must assist all eligible adult residents to participate in self-help initiatives. Adult residents with special needs, which exempt them from participation in selfsufficiency activities, must be thoroughly documented in the family’s case file. (Please refer to OTDA approved Family Activity Forms pages P29 through P31.)

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 11 900.11(a)(1) & 900.14 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to maintain an accurate record of all admissions and discharges of families. CORRECTIVE ACTION: Although administrative staff maintains an “Ins and Outs Log”, the number of admissions and discharges could not be determined. The facility’s administrative staff must maintain a complete chronological admission and discharge registry on all families admitted to and discharged from the facility. (See OTDA approved Chronological Admissions and Discharges Registry forms.)

"providing temporary assistance for permanent change"

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 12 900.11(a)(1) & 900.14 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to monitor families signing in and out on a daily basis. Resident’s Pass Control In/Out form does not adequately reflect residents’ activity of entering and exiting the facility. CORRECTIVE ACTION: The facility’s administrative staff must institute a procedure assigning each family a Sign In/Out form by room numbers that adults must sign as they enter and exit the facility. The form is to be initialed by facility staff or security officers verifying the entry or exit of each adult. The Sign In/Out forms are to be reviewed daily; and families’ presence, absence, approved passes or curfew violation is to be indicated on the daily census form. See next finding #13 below. (See OTDA approved form Page A-6)

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 13 900.11(a)(1) & 900.14(a) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to maintain an accurate daily residents. (Previously cited 01/09/04 & 02/14/05)

census

of

all

its

CORRECTIVE ACTION: The facility’s administrative staff must maintain an accurate daily census of all its residents which includes the documentation of the presence and absence of all adult family members from the facility on a daily basis. The census document must clearly distinguish all adult absences, approved absences, discharges, curfew violations and total billing days per family per month in which reimbursements are claimed. Information of residents’ presence or absence is to come from the Residents’ Sign In/Out logs. See finding #12 above. (See OTDA approved form Page A-5)

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

"providing temporary assistance for permanent change"

VIOL REGULATION NUMBER 14 900.11(a)(3) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to ensure that adequate and appropriate electronic surveillance equipment was installed to view the grounds, facility, and activities of the residents in order to lessen the risk of resident injury, prevention of theft and prevention of unauthorized persons from entering the facility. (Previously cited 11/15/01, 12/20/02, 01/09/04 & 02/14/05) CORRECTIVE ACTION: The facility must install an electronic security surveillance system that will cover the entrance door, perimeter of the building and lobby of first floor. The surveillance system must have recording capabilities and the system must also allow for playback while the system continues to record. If the system is not digital, storage space must be available for the tapes to be securely stored for a minimum of 14 days.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 15 900.11(a)(4) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to maintain emergency information on each family at the front desk or in the ASW’s office. CORRECTIVE ACTION: The facility must ensure that emergency information is accessible and available at all times to ASW’S when social services staff is gone for the day. A copy of family emergency information must be filed in a secure location at the front desk or in the ASW’s office. See OTDA approved model form P. A-4.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 16 900.11(a)(5) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING:

The facility failed to attach a resolution statement to all incident report forms when documenting incidents. CORRECTIVE ACTION: The facility’s administrative staff must ensure that when an incident occurs, an incident report form is completed along with a resolution "providing temporary assistance for permanent change"

statement. All incidents and resolution attachments must be centrally maintained in a binder and made available for OTDA review and inspection. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 17 900.13(c)&(e) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to provide special medically prescribed dietary or nutritional meals for residents with special needs. Residents who suffer from diabetes, high blood pressure and other medically diagnosed conditions are not provided medically appropriate meals for breakfast, lunch or dinner.

CORRECTIVE ACTION: The facility’s administrative staff must ensure that the contracted vendor “Maramont” provides substitute meals for residents with special dietary needs. The facility must prepare and maintain a list of residents who have special dietary needs and ensure that the vendor provides the appropriate meals. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 18 900.14(a) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to ensure that adequate procedures are in place to automate the facility’s records in accordance with standards set by the department. (Previously cited 12/20/02, 01/09/04 & 02/14/05)

CORRECTIVE ACTION:

Although the facility began the process of providing computers to staff, additional computers and printers are still needed for administrators and case work staff. The additional computers, printers and Internet access will enhance services to resident adults seeking employment and obtaining permanent housing. The facility must institute a plan that will ensure that an automated system will be installed in a timely manner.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

"providing temporary assistance for permanent change"

VIOL REGULATION NUMBER 19 900.5(a)(1) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The door to the mattress/bed frame storeroom is missing near room 247C.

"providing temporary assistance for permanent change"

CORRECTIVE ACTION: The facility must certify to this office that the mattress storeroom door (near room 247C) is fitted with a code compliant door that separates it from the corridor.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 20 900.5(a)(4); 900.12(e)(14) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: At the time of inspection, the heat throughout the facility was found to be substandard concerning room heating and cold weather infiltration as follows: (Previously cited 01/09/04, 2/14/05) a.

Approximately 90% of the apartments were found to be excessively cold during the inspection: Many residents put mattresses in the windows in order to prevent the cold air from penetrating the room.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

b.

The plastic covering provided to residents to insulate the windows was not sufficient enough to stop cold air drafts from entering through the windows.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

c.

Many residents put plastic on the wall to prevent cold air from infiltrating through the bricks: Especially in Rooms 703, 749 and 646-1.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

CORRECTIVE ACTION: Correct all of the above specified findings and maintain the facility in compliance with applicable codes and regulations. VIOL REGULATION NUMBER 21 900.5 (a)(6) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: "providing temporary assistance for permanent change"

During this inspection, it could not be determined, whether the rain infiltration through the ceilings/walls (in units 371 and 263) has been corrected. CORRECTIVE ACTION: The facility must certify to this office that the infiltration problem into rooms 371 and 263 has been corrected.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 22 900.5(b)(2) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: Only the Tuesday to Saturday tour had documentation certified fire safety coordinator was on-duty.

verifying

that

a

CORRECTIVE ACTION: The facility must document that a sufficient number of staff are trained as a fire Safety Coordinator, in order to provide 24-hour coverage seven days per week. Submit documentation with a recent staff schedule.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

VIOL REGULATION NUMBER 23 900.11 (b)(3) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to produce documentation that a staff member trained in basic first aid was on-duty at all times. Only the Monday to Friday 8:00AM 4:00PM tour had a staff person on-duty with a First Aid Certificate. CORRECTIVE ACTION: The facility must ensure that at all times at least one member of the staff must be a nurse or certified in basic first aid. Please submit certificate along with a current staff schedule.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

"providing temporary assistance for permanent change"

"providing temporary assistance for permanent change"

VIOL REGULATION NUMBER 24 900.12(e)(8) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: Approximately 90% of the resident bedrooms were not provided with a shade or other appropriate window covering. (Previously cited 10/03/94, 06/13/95, 07/18/96, 03/28/97, 04/14/99, 11/15/01, 12/20/02 01/09/04, 02/14/05) CORRECTIVE ACTION: The facility must apartment windows.

provide

privacy

shades

or

a

window

covering

for

all

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

"providing temporary assistance for permanent change"

ATTACHMENT A INSPECTOR’S COMMENTS AND RECOMMENDATIONS 1. Housing Assistance for All Families Employed families must have a developed service plan/independent living plan regardless of housing subsidy eligibility status. The SP/ILP must include: •

A plan to search for housing, including the completion of a weekly housing search sheet which advises the specialist of the family’s housing search progress and other housing issues as necessary;

•

Agree to an amount of funds to be saved for broker’s fees, first month’s rent, security deposit and other necessary expenses;

•

Agree to a time frame for saving the necessary fees and deposits; and,

•

Providing proof to the specialist on a weekly basis of such savings.

Any type of housing assistance, whether developed by the family or facility staff, must be documented in the family’s case file. Non-compliant families are to be referred to the facility director to ensure that appropriate sanctions are undertaken.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

"providing temporary assistance for permanent change"

ATTACHMENT B MAINTENANCE DEFICIENCIES PLEASE TYPE YOUR CORRECTIVE ACTION RESPONSE IN BOLD UNDERNEATH EACH ITEM 1)

Units were found to be excessively cluttered, dirty and or messy. The families in these units may require intervention for ADL skills by social services personnel: 828, 744, 614, 264 and 256.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

2)

Walls dirty/disrepair and/or graffiti on wall: Rooms 822 823, 733 and 526.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

3)

Apartment unit with ripped mattresses or problems with frames: Room 526 (frame held together by string and mattress were sunk in).

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

4)

Dresser drawer missing/broken: Rooms 649, 646-5, 614, 620 and 624-6.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

5)

a- Cracked bathroom window: Room 743. b- The 1sq/ft lead lined glass (in the 1st fl “B” stairwell door) was cracked.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

6)

Smoke detector not connected: Room 523.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

"providing temporary assistance for permanent change"

7)

Ceiling tiles stained/broken and or in disrepair: Hallway corridor near room 275, room 261, 257 and 742.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

8)

No shower curtain: 8th floor ladies room and the 6th floor men’s shower room.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

9)

The door lock would not engage: Room 275.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

10)

Roach complaint: Room 540E.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

11)

a- Toilet stall lock is missing in the 6th floor women’s bathroom. b- The 7th floor men’s tub was “under repair”.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

12)

a- The Exit sign over stairwell door “D7” was not illuminated. b- Stairwell door “^A” was kept in the open position.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

13)

abcd-

No refrigerator in room 633. Refrigerator freezer does not freeze food: Room 838. Refrigerator shuts off automatically: Room 733. Freezer constantly becomes ice encrusted: Room 757.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

"providing temporary assistance for permanent change"

14)

No cold water from faucet: Room 822.

Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

CORRECTIVE ACTION: Repair/replace restore as needed.

"providing temporary assistance for permanent change"

ATTACHMENT C CONFIDENTIAL RESIDENT AND STAFF FINDINGS This attachment is for the purpose of identifying specific residents so that the findings noted on report may be corrected. It should be kept confidential. FAMILY SHELTER NAME: DATE(S) OF INSPECTION: INSPECTOR(S) NAME: FINDING NUMBERS 2

Auburn Adult Family Residence January 26, 27, 30 & 31 2006 Shirley Haines

REGULATION NUMBERS 900.5(a)(7)&(b)

DESCRIPTION Security guard certifications expired or copies not available. Page 1 of 3

"providing temporary assistance for permanent change"

RESIDENT NAME/ EMPLOYEE NAME*

FAMILY SHELTER NAME: DATE OF INSPECTION: INSPECTOR(S) NAME: FINDING NUMBERS 2

Auburn Adult Family Residence January 26, 27, 30 & 31, 2006 Shirley Haines

REGULATION NUMBERS Con’t

3

900.6(h)(1)

5

900.10(c)(1)(ii) & 900.14(a)

6

900.10(c)(1)(ii)

DESCRIPTION Security guard certifications expired or missing. Missing preliminary health forms. Incomplete or missing intake/ assessment or date indicating when intake/assessment was conducted. SP/ILP not reviewed or revised bi-weekly, missing other adult needs on SP/ILP or only signed by one family member. Page 2 of 3

"providing temporary assistance for permanent change"

RESIDENT NAME/ EMPLOYEE NAME*

FAMILY SHELTER NAME: DATE(S) OF INSPECTION: INSPECTOR(S) NAME: FINDING NUMBERS 7

Auburn Adult Family Residence January 26, 27, 30 & 31 2006 Shirley Haines

REGULATION NUMBERS 900.10(c)(1)(i)&(ii)

DESCRIPTION Lacked required number of housing search on SP/ILP.

8

900.10(c)(1)(iii); 900.10(c)(4) & 900.15(c)(4)(v)

Lacked referrals to programs or referrals not made timely.

9

900.10(c)(2)(ii)(a) & 900.14(a)

Lacked date on housing intake plan, missing housing notes or up to date housing notes. Page 3 of 3

"providing temporary assistance for permanent change"

RESIDENT NAME/ EMPLOYEE NAME*