Auburn Otda March 2007

Eliot Spitzer Governor

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

David A. Hansell Commissioner

March 26, 2007

Mr. Roger Newman Deputy Commissioner NYC DHS/Family Services 33 Beaver Street, 16th Floor New York, New York 10004 Dear Mr. Newman: A complete inspection was conducted at the Auburn Family Residence on February 5, 6, 15 and 16, 2007. Although the majority of the items were in compliance with Part 900 of Title 18 NYCRR, several findings indicate noncompliance 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.

"providing temporary assistance for permanent change"

COMMENTS: Please note that we have cited several issues as a matter of concern for priority correction; they are as follows: Violation 10:

Lack of Part 900 child-care for 85 unserviced resident children between 3 months – 5 years.

Violation 17:

Residents' complaints of cold rooms and 16 rooms were taken off-line due to drafty windows (item noted for FMD's attention).

Violation 19:

Frequent elevator breakdowns requiring the FDNY to respond to extricate residents (item noted for FMD's attention).

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 Yania Gonzalez, 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: 03/26/07 REPORT OF INSPECTION Facility Name: Street Address: City:

Auburn Family Residence 39 Auburn Place Brooklyn, New York 11205

COUNTY:

Kings

INSPECTION SCOPE

INSPECTOR NAMES

PROGRAM:

Shirley Haines

ENVIRONMENT:

Carol Whaley

INSPECTION DATES February 5, 6, 7 & 8, 2007 February 15 & 16, 2007

"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.

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REPORT OF INSPECTION REPORT DATE: 03/26/07 FACILITY NAME: Auburn 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 & 04/07/06) 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 or Facility Response: (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 certification cards on file. Although security officers’ license and training profile was maintained, copies of FJC current security officers’ State certification was not on file for review. (Previously cited 04/07/06) CORRECTIVE ACTION: Facility administrative staff must ensure that all FJC Security officers have current State certification and copies of current State certification cards are to be available for review. 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.)

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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. Eight of the twenty-five family case records reviewed lacked copies of medical screen health forms. See Attachment C for names. (Previously cited 02/14/05 & 04/07/06) CORRECTIVE ACTION:

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 4 900.6(h)(3) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to obtain copies of children’s inoculation history. Seven of the twenty-five family case records reviewed lacked copies of the children’s inoculation history. See Attachment C for names. CORRECTIVE ACTION:

Social Services staff must request and obtain copies of children’s inoculation history and file in family case record. 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); 900.11(a) & 900.14(a) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to conduct a comprehensive assessment within 10 days of the family’s admission date. Five of the twenty-five families’ case records reviewed lacked a complete intake assessment and/or missing the following: education or job/employment histories of all adult family members, summary of assessed needs, reasons for family homelessness, ACS verification or results of ACS inquiry. See Attachment C for names. (Previously cited 04/07/06) "providing temporary assistance for permanent change"

CORRECTIVE ACTION: Social Services staff must meet with all family members within two days of their admission date to conduct, at a minimum, a preliminary needs intake review, or a comprehensive assessment. In all cases, a comprehensive assessment (including other adult family members) must be completed within 10 days of the family’s admission date and the Family Case Record Admission/ Assessment form is to be filled out in its entirety. See OTDA approved forms, Pages 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)(i) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to develop with the families a mutually agreed upon service plan within ten days of the family’s admission. Four of the twenty-five families’ case records reviewed lacked an initial service plan agreement. See Attachment C for names. CORRECTIVE ACTION:

Social Services staff must meet with families within ten days of the families’ admission date to develop a mutually agreed upon services plan designed to help the family to achieve permanent housing. 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)(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. Six of the twenty-five family case records reviewed lacked signatures of all resident adults, omitted the other adult assessed needs on ILP’s or the ILP was the same even when changes occurred with the family. See Attachment C for names. (Previously cited 02/14/05 & 04/07/06)

"providing temporary assistance for permanent change"

CORRECTIVE ACTION:

Social Services staff must meet with all families, at a minimum, biweekly to review and revise the Service and Bi-Weekly/Independent Living Plan. All family members’ needs must be addressed on the plan and signed by the adult members of the family. See OTDA approved forms, page C7. 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)(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. Four of the twenty-five family case records reviewed lacked complete housing intake plans and or and housing notes. See Attachment C for names. (Previously cited 02/14/05 & 04/07/06) CORRECTIVE ACTION: 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 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 9 900.10(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 such as employment, job training or education programs. At the time of inspection, there were 227 adult residents residing in the facility, of which 155 were eligible to participate in self-help initiatives. Only 36 of the 155 eligible adults or twenty-three percent (23%) were actively participating in self-help initiatives. (Previously cited 12/20/02, 01/09/04, 02/14/05 & 04/07/06)

"providing temporary assistance for permanent change"

CORRECTIVE ACTION: Social Services staff must assist all eligible adult residents to participate in self-help initiatives that will enhance the families’ ability to obtain and retain permanent housing. Adult residents with special needs, which exempt them from participation in self-sufficiency activities, must have these needs thoroughly documented in the family’s case record. (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 10 900.10(c)(5)(i)&(ii) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to provide structured child-care services for resident children between the ages of 3 months through 5 years. On the day of the inspection, there were 98 resident children between 3 months – 5 years. Of the 98, 13 attended child-care off-site, and the remaining 85 were without child-care. CORRECTIVE ACTION: The administrative staff must ensure that child-care is provided to accommodate all families who are engaged in welfare-to-work initiatives such as: employment, job training, attending an educational program, looking for housing or for short-term emergency care. DHS must assign and designate appropriate rooms for child-care as well as hiring appropriate staff.

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(a) 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. (Previously cited 01/09/04, 02/14/05 & 04/07/06) CORRECTIVE ACTION: The facility’s administrative staff must institute a procedure assigning each family a Sign In/Out form by room numbers which is to include the names of the adults and family composition on each form. All adult family members must sign as they enter and exit the facility. Each entry is to be initialed or signed by facility staff or security officers after they verify residents’ entering or exiting the facility. The Sign In/Out forms are to be reviewed "providing temporary assistance for permanent change"

daily; and families’ presence, absence, approved passes or curfew violation is to be indicated on the daily census form. See next finding #12 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 12 900.11(a)(1) & 900.14(a) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to maintain a daily census (Previously cited 01/09/04, 02/14/05 & 04/07/06)

of

all

its

residents.

CORRECTIVE ACTION: The facility’s administrative staff must maintain an accurate daily census of all its residents which indicates 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 #11 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.)

VIOL REGULATION NUMBER 13 900.11(a)(2) & 900.15(c)(4)(iv) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to maintain an accurate school-age school-age children’s daily departure for school.

master

roster

of

CORRECTIVE ACTION: The facility’s staff designee must ensure that procedures are in place to monitor and document all children of school age daily departure for school. See OTDA approved School age Master forms, pages P43 – P45.

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

VIOL 14

REGULATION NUMBER 900.11(a)(3) "providing temporary assistance for permanent change"

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 & 04/07/06) 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 15 900.5(a)(2) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to ensure that the stairwell “A” fire hose was protected against vandalism. The fire hoses on the 1st and 4th floors were unraveled. CORRECTIVE ACTION: The facility must install fire department approved fire hose enclosures for all fire hoses.

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

VIOL REGULATION NUMBER 16 900.5(a)(3); 900.12(b)(6) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility must ensure that all resident showers are adequately operating. Showers on the 3rd floor provided only cold water.

"providing temporary assistance for permanent change"

CORRECTIVE ACTION: The facility must ensure that adequate hot water for bathing is provided at all times.

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

VIOL REGULATION NUMBER 17 900.5(a)(4); 900.12(a) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: At the time of inspection, 16 rooms were off-line due to the lack of heat due in part to drafty non-storm windows. (Previously cited 01/09/04, 02/14/05, 04/07/06) CORRECTIVE ACTION: Although the facility provided plastic window covering to residents, the attempted insulation of the windows was not sufficient enough to stop cold air drafts. According to staff, plans to replace the windows have been approved, please state the date the replacement windows will commence.

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

VIOL REGULATION NUMBER 18 900.5(a)(1) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility plans to have major exterior brick work done to the facility in the spring of 2007. CORRECTIVE ACTION: The facility must submit a beginning date for exterior brick work and project a completion date.

the

commencement

of

the

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

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VIOL REGULATION NUMBER 19 900.5(a)(6) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to ensure that the elevator was in a good state of repair at all times. Based on records, the New York City Fire Department responds weekly to person(s) stuck in the elevator. The elevator is put back in service without inspection and safety certification from the elevator maintenance company. CORRECTIVE ACTION: The facility must ensure that the elevator is repaired and certified prior to placing it back in service. Please submit a copy of the most recent elevator inspection and certification with this report.

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)(6) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING:

The facility failed to ensure the following maintenance repairs were done: a. The following missing store room doors were being replaced: Storeroom door 273 and door 632. b. c. d.

Smoke door (near 360) not closing all the way. Kitchen door to corridor was off-line. The 4th floor stair “A” door was off-line and had a 3 inch dent at the top of the door.

CORRECTIVE ACTION: The facility must repair all doors as stated above in items a, b, c and d.

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

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VIOL REGULATION NUMBER 21 900.11(a)(8) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to ensure that a staff member on each shift was qualified in Standard First Aid. CORRECTIVE ACTION: The facility must ensure that at least one staff member on each tour, 24 hours per day 7 days per week have a minimum of eight hours of basic first aid training or be a nurse.

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

VIOL REGULATION NUMBER 22 900.12(b)(4) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to provide the resident tub rooms with the following: a. A tub curtain and/or rod to afford the clients privacy. b. An enclosed private dressing area at or near the tubs and showers. CORRECTIVE ACTION: a & b. Private dressing space must be provided at all the communal tubs and shower stalls.

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

VIOL REGULATION NUMBER 23 900.12(e)(8) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to ensure that all resident sleeping areas have shades or other appropriate window covering to ensure privacy. Approximately 90% of the resident bedrooms were without such provisions. (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, 04/07/06) CORRECTIVE ACTION: The facility must apartment windows.

provide

privacy

shades

or

a

window

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covering

for

all

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

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ATTACHMENT A Inspector’s Recommendations and/or Comments Employed Families Employed families ineligible for HSP or other housing subsidies must also develop a service plan/independent living plan, which describes in detail the following procedures: • • • •

A plan to search for housing, including the completion of a weekly housing search sheet which advise the specialist of the family’s housing search progress and other housing issues as necessary; Agreement to an amount of funds to be saved for broker’s fees, first month’s rent, security deposit and other necessary expenses; Agreement to a time frame for saving the necessary fees and deposits; and, Providing proof to the specialist on a weekly basis of such savings.

Families who are non-compliant must be referred to the appropriate supervisor for the sanctioning process to begin.

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)

Complaints of roaches: Rooms 723, 720, 714, 646-4, 642-3, 635, 552, 529, 450-6, 455-1, 356.

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

2)

Excessive belongings were stored in the room and/or garbage, food, clothes was strewn about the floor: Rooms 275, 524, 703 and 825. The families in these units may require intervention for ADL skills by social services personnel.

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

3)

a- The following rooms had windows that failed to close flush to the frame Room 715. b- Room 646-3 window was open and not fitted with a screen or guard rail.

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

4)

Rodent problem: Rooms (rodent entry holes): 827, 624-3, 635, 646-1, 466-4, 352, 358 and 370-1.

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

5)

Unit radiator cover was detached from the radiator: Room 361-4.

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

6)

Toilet (stall) door missing: Bathrooms 279 and 370-1.

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

"providing temporary assistance for permanent change"

7)

Dresser drawer is missing and/or broken: Rooms 280-2, 256, 3-367, 450-4, 626-5, 624-4, 624-3, 703, 745, 742 and 8-222.

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

8)

a- Bathroom 4-462A wall pipe access door was missing (next to tub); the pipe chase is accessible to children. b- The tub in 4-462A could not be used; the overflow drain was covered with tape. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.)

9)

a- The bathroom ceiling exhibited a black mold like growth: 3rd floor handicap bathroom. b- The lower bathroom (opposite 626) window pane was not frosted to provide privacy.

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

10)

a- Padlocks or sliding bolts were attached to the storeroom and utility room corridor side doors. These locks are not the safety locks which would allow an individual locked inside the room to exit when the outside lock is engaged. b- The utility doors and storeroom doors were not labeled or differentiated from other corridor doors.

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

11)

Stairwell “B” door hangs and trash bags were used to maintain the door in the open position; also, the same condition existed at the 5th floor door “A” and stair “A” 1st floor.

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

12)

Floor tiles were missing: Rooms 825 and 614.

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

"providing temporary assistance for permanent change"

13)

There were holes in the 3rd floor security locker room ceiling, plus ceiling tiles were missing.

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

14)

Emergency entry/exit into Room 526 was blocked by a dresser near the door.

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

15)

There was a foul odor in room 454.

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

CORRECTIVE ACTION: Clean, repair, replace and/or restore the above items/make the appropriate intervention and referrals.

"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 3

Auburn Family Residence February 5 – 8, 2007 Shirley Haines

REGULATION NUMBERS 900.6(h)(1)

DESCRIPTION Missing preliminary health forms.

4

900.6(h)(3)

Missing copies of children’s inoculation history.

5

900.10(c)(1)(i); 900.11(a)(6) & 900.14(a)

Incomplete intake assessments on families.

6

900.10(c)(1)(i)

Initial service plan (SP/ILP) not developed within ten days of admission.

7

900.10(c)(1)(ii)

Review of SP/ILP’s not consistently done or only adult signed the plan.

8

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

Housing Intake plans not completed within ten days or missing housing notes.

"providing temporary assistance for permanent change"

RESIDENT NAME/ EMPLOYEE NAME*