VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Alliance Human Services, Inc.
341 Main Street
Suite 301
Danville, VA 24541
(434) 836-3550

Current Inspector: Dawn Espelage (540) 759-8852

Inspection Date: March 25, 2020

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

Comments:

This is a non-mandated monitoring inspection conducted in response to an agency self-report. Due to the outbreak of COVID-19, the inspection was conducted in the form of a desk review by two inspectors on various dates between 03/25/2020 and 03/31/2020. Standards were reviewed involving children?s services and provider homes. One provider home record and one child record were reviewed. One staff was interviewed regarding treatment and services provided to the youth and placement of youth in the provider home. Four violations were cited as a result of the inspection. Alliance Human Services reports a total of 51 provider homes and 45 children in placement. An exit interview was conducted by phone with the Executive Director, Vice President, Program Director, and Director of Compliance and Risk Management on April 2, 2020 at 9:00 AM to discuss the results of the inspection. An acknowledgement form was not signed as the inspection was conducted off-site.

Violations:

Standard #:	22VAC40-131-40-B
Description:	Violation: Based on a review of the record for a provider home (PH) and interview with personnel (S), the agency failed to comply with its own policies and procedures regarding the number of annual training hours required for provider homes. Evidence: 1) 22VAC40-131-210.D requires each provider to receive additional training annually. 2) The ?Quarterly Health, Safety and Compliance Evaluation? form is used by the licensee to monitor the performance of the provider home. 3) The section titled ?Foster Parent Performance and Ability: Training: Training Hours Reviewed" on the evaluation dated 11/18/2019 documented "hours completed this year: 2" and "hours needed to be in compliance: 18" for P1 from PH1. 3) The licensee provided at least 20 hours of training to providers during 2019. 4) During the exit interview S1 stated that P1?s profession was a barrier to attending training so P1 had received training during home visits with the worker that were not documented on the form. 5) S1 provided the 2019 training record for P1 from PH1 in an email dated 04/06/2020, which documented 1 hour and 45 minutes of training for P1. 6) In the 04/06/2020 email, S1 stated, ?I have attached the training hours and we realize that? (P1 from PH1) ?did not meet the required number of hours for the year. We have some different measures in place to ensure that both providers have the required number of hours for the year?.
Plan of Correction:	A training will be conducted to explain to all staff the requirement for each provider to obtain 20 hours of training annually. On a quarterly basis, the trainings will be reviewed and the foster parents will receive guidance on the trainings and hours that are required.
Standard #:	22VAC40-131-230-A
Description:	Violation: Based on a review of the record for a provider home (PH) and interview with personnel (S), the agency did not visit the home every 90 days as required by 22VAC40-131-230-A. Evidence: 1) The record for PH1 contained documentation of the agency visit to monitor the performance of the provider home on 05/14/2019. The next documented monitoring was dated 08/15/2019, which was 93 days later. 2) The record for PH1 contained documentation of the agency visit to monitor the performance of the provider home on 8/15/2019. The next documented monitoring visit was dated 11/18/2019, which was 95 days later. 3) The record for PH1 contained documentation of the agency visit to monitor the performance of the provider home, a second visit in November, on 11/20/2019. The next documented monitoring was dated 02/26/2020, which was 98 days later. 4) After the violation was discussed during the exit interview, S1 did not provide evidence of any additional monitoring visits to PH1.
Plan of Correction:	A training will occur with all staff to explain the necessity to complete the quarterly monitoring visits no later than every 90 days. This will be reviewed with the staff during supervisions.
Standard #:	22VAC40-131-290-F
Description:	Violation: Based on a review of the record for a foster child (FC) and interview with personnel (S), the licensee failed to arrange for the child to receive routine medical and psychiatric treatment and maintain documentation regarding arrangements for the child?s receipt of care in the file, as required by 22VAC40-131-290.F. Evidence: 1) FC1 did not receive a medication (M) typically prescribed for allergies from 11/7/2019 to 12/6/2019. a. The October ?monthly summary? dated 11/17/2019 and October ?medication administration log? for FC1 states that FC1 was prescribed M1 on 10/25/2020. b. A review of the October, November, and December 2019 ?medication administration logs? documented that FC1 received M1 from 10/25/2020 ? 11/16/2020. c. According to the medication log, FC1 did not receive M1 from 11/17/2019 ? 12/06/2019. d. During the exit interview, the licensee was asked if the agency could provide documentation regarding the non-administration of M1 for FC1 for the period of 11/17 ? 12/06/2019. No additional documentation was provided. 2) The ?medication administration log? completed by PH1 stated that FC1 began taking a medication (M) typically prescribed for psychiatric reasons on 10/16/2019. The record notated that this medication, M2, was prescribed during an inpatient hospitalization in October of 2019. a. The ?medication administration log? documented that FC1 received M2 daily during the month of November, 2019. c. According to the ?medication administration log?, FC1 did not receive M2 after December 1, 2019. d. The record for FC1 did not contain information documenting the prescription or discontinuation of M2 for FC1. e. During the exit interview, S1 was asked if the agency had documentation regarding the prescription or discontinuation of M2 for FC1. Further documentation was not provided.
Plan of Correction:	The Executive Director and Program Director will conduct a training with all staff to explain the requirement to review all medications the client is taking or prescribed on a daily basis. On a monthly basis, the medical records from the medical provider will be requested to ensure that the correct medications are being given.
Standard #:	22VAC40-131-460-E
Description:	Violation: Based on a review of the record for a foster child (FC) and interview with personnel (S), the licensee failed to provide or arrange for the child to receive recommended or identified clinical services including psychiatric and psychological services as required by 22VAC40-131-460.E. Evidence: 1) The record did not contain evidence of outpatient therapy being provided for FC1 in January and February of 2020. a. A ?face-to?face contact note? dated 10/23/2019 in the record of FC1 stated that the child would receive outpatient therapy weekly. b. A 12/18/2020 ?medical/dental/therapist report? completed by the outpatient therapist recommended weekly outpatient therapy. d. An (1) Individualized service plan dated 02/24/2020 and a (2) March 2020 monthly report stated that FC1 had not seen her therapist since December 2019. e. During the exit interview, S1 was asked if the agency had documentation related to the provision of counseling during the months of January 2020 and February 2020. f. Additional information provided by the licensee contained one contact with the therapist regarding scheduling an appointment during the months of January and February of 2020. The contact was an e-mail to the therapist dated 02/27/2020 regarding the status of counseling. 2) The record for FC1 did not contain evidence of follow-through with recommended clinical services (CS). a. FC1?s record contained a ?Family Assessment and Planning Team (FAPT) referral form? dated 03/19/2019 and ?medical/dental/therapist appointment report? from FC1?s therapist dated 06/24/2019 which recommended a clinical service (CS1) for FC1. -- The record did not contain documentation prior to March 2020 that CS1 was pursued or obtained as recommended in June 2019. -- The March 2020 ?monthly summary? for FC1 dated 04/06/2020 reported that the foster parent (P2 from PH1) began the CS1 process with a phone interview on March 11, 2020, which was almost nine months after the recommendation was initially made to the licensee by the child?s therapist. b. The record for FC1 contained a ?medical/dental/therapist appointment report? from FC1?s therapist dated 09/04/2019 which recommended an assessment (CS2) for FC1. The record did not contain documentation that the CS2 was obtained. c. The record for FC1 contained a ?medical/dental/therapist appointment report? from FC1?s therapist dated 12/12/2019 which recommended a clinical service (CS3) for FC1. The record did not contain documentation that the agency pursued CS3 as recommended. e. The record for FC1 contained two ?medical/dental/therapist appointment reports? from FC1?s therapist dated 12/18/2019 and 12/27/2019 which recommended a clinical service (CS4) for FC1. The record did not contain documentation that the agency pursued CS4 as recommended. f. During the exit interview, S1 was asked if the agency had further documentation verifying that the recommended assessments and services (CS1, CS2, CS3, and CS4) were pursued for FC1. The FAPT referral dated 03/019/2019 was provided, as referenced in 2)a. Additional documentation was not provided.
Plan of Correction:	The Executive Director and Program Director will conduct a training with all staff to explain the importance and necessity of following up on all recommendations by the client's provider. During supervisions, the staff will report to the Program Director or Executive Director all medications the client is taking and there will be verification done to ensure that all prescribed medications are being given.