- iififim - NEW YORK STATE OFFICE OF TEMPORARY AND ASSISTANCE Andrew M. Cuomo 40 NORTH PEARL STREET Kristin M. Proud Governor ALBANY, NEW YORK 12243-0001 Commissioner October 1, 2013 Ms. Julia Moten Deputy Commissioner NYC DHS/Family Services 33 Beaver Street, 16"' Floor New York, New York 10004 Re: Auburn Family Residence Infant Death Complaint investigation by OTDA Dear Ms. Moten: At 4:58 PM on August 27, via email, OTDA received a com laint from the Coalition for the Homeless stating that a 3 month old female infant, had died that. morning at the Auburn Family Residence. The child was found in the family's unit and the' . complaint alleged that heat related conditions were responsible for her death. IS complaint was forwarded to OTDA Shelter inspector Shirley Haines on August 28-who was coincidentally already on-site conducting the facility's annual-inspection. During her review, Ms. Haines found that_case record indicated that she had been admitted to Auburn by HERO on May 2, 2013. At the time of her admission was 7 months pregnant and was also accompanied by her one year old son,-- The case record further indicated that on June 16, --child was discharged from the hospital after her premature birth on May 26. The medical discharge summary found in the case file stated that the child had "a history of respiratory distress and _"feeding problems". Subsequent to the death of her the night of August 27 with a family member whereupon her one year old child was taken into custody by ACS allegedly based on reports from an unknown source that had left her childrenunattended in her unit over the night of August 26. On August 28, Environmental Inspector Tom Dudley conducted a site visit to investigate the heat related aspect of the Coalition's complaint. The results of that investigation are included in the attached report. On Se tember 3, Mr. Dudley returned to the facility to further investigate the whereabouts olion the night her child died. He reviewed the sign--in and sign-out "pr0w'ding temporary assistance for change" 0 TDA-L 'i 2 log and could not adequately determine i_had actually left the facility on August 26 as alleged because there was no record 0 er signing out of the facility on that night. As a result of OTDA's investigation and extensive review of facility records and procedures, we have identified the following critical findings as a result of this complaint. RESPONSE TO THIS COMPLAINT INSPECTION VISIT IS DUE 10 DAYS WITHIN RECEIPT OF THIS REPORT FACILITY: DATE OF RESPONSE: Auburn Family Residence RESPONSE SUBMITTED BY: TITLE: TELEPHONE: E-MAIL ADDRESS: ADMISSIONS and REFERALS 900.6(f) (1) (3) A district may not refer to a family shelter any family containing a member who has a physical condition that makes placement inappropriate or may cause danger to others; is likely to substantially interfere with the health, safety of care; is in need of a level of medical, or other assistance that cannot be rendered safety and effectively by the facility, or cannot be reasonably provided by the facility. FINDING Instead of placing this mother of a one year old who wa ven months pregnant in a shelter that specializes in serving mothers and their i_nfants as placed at Auburn Family Residence which is highly unsuitable for families with infants. The large congregate setting with without cooking or toilet facilities in the units does not lend itself to the proper care of newborn infants and children under the age of 2 years. CORRECTIVE ACTION DHS must inform their HERO placement unit that placing pregnant mothers and children, especially infants and toddlers under 2 years of age, in Auburn is an inappropriate placement due to the lack of amenities for this young and vulnerable population. Henceforth, this population should be prudently placed by HERO in appropriate settings with programs that will assist infants and toddlers to thrive. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) FINDING Once the mother's hospital discharge form was reviewed by the facility, and it was noted that the infant was born prematurely and had a history of respiratory distress and difficulty with feeding, the facility should have made a referral to a shelter which had the means and a program to provide a suitable environment for a mother with a newborn with medical issues. CORRECTIVE ACTION Henceforth, the facility must take into consideration medical conditions of its residents and make appropriate referrals to facilities that can meet the needs of the family. a.s'sI'sI'mIce for Jermanem' cI'mnge" -3- DHS Response: (DHS must be specific and state .the time period when the deficiency will be corrected.) - SAFE AND COMFORTABLE ENVIRONMENT 900.12(a) 8: 900.6(f) (1) (3) - The facility must be maintained in a good state of repair and sanitation and in conformance with applicable State and local laws, regulations and ordinances in order to assure a safe, comfortable environment for residents. Extreme heat can be a detriment to the health of residents. FINDING - During the NYC mid--July heat wave from July 14 to July 20, 2013, the temperature ranged from 90 to 97 degrees. The unit in which the newborn child was living was inappropriate for a child with respiratory distress since the unit's temperatures would have ranged from at least 95 to 102 degrees given the 5 degree unit differential in unit CORRECTIVE ACTION The facility must be aware of the medical conditions of the residents and make appropriate referrals to other facilities that can meet the needs of the family especially given extreme conditions beyond the facility's control. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) ASSESSMENT SERVICES AND ONGOING PROGRESS NOTES 900.10(c) -- The facility or social services district must document the resident services or independent living plan and all direct services and service referrals to other entities provided while the resident family is in the facility. FINDING The facility failed to maintain adequate and progress notes. There was no documentation of any pre--nata| or post-natal case management notes regarding the mother and newborn. Progress notes were inadequate and not timely and did not address the needs of all family members including the one year old child. CORRECTIVE ACTION Social Services staff must document direct and indirect family services via progress notes throughout the family's stay at the facility. Progress notes are to include an initial background history of the family, interaction observed between household members during intake, and include any changes made to the household such as birth of newborn and medical conditions and follow up, admission/discharge of a family member, obtaining or losing employment, incidents or other relevant information pertaining to the family. Progress notes are to be documented as often as needed. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) RESIDENT SERVICES temporary Jermanem' change" OTDAJ 1 -4- -- The services or independent living plan must be reviewed with the family_bi-- weekly and such plan must be revised as necessary to obtain permanent housing. FINDING The facility failed to review/revise the bi-weekly. was not specific to the family nor did it include changes that occurred with the family. CORRECTIVE ACTION Social Services staff must meet with families bi-weekly to review and revise The plan must be a mutually agreed upon plan that is dated and signed by all adult family members and include specific items related to the family. For example, attend prenatal and post natal appointments; complete an SSI application, etc. A signed copy of each revised must be provided to the family. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) SUPERVISION 900.11(a) (1) Supervision includes recording a daily census of residents, including a record of daily admissions and discharges and maintenance of a daily sign-in and sign-out sheet. FINDING In observing the facility's procedure for residents entering and leaving the shelter, OTDA staff observed residents coming and going without signing in or out. In addition, when OTDA inspectors checked the sign-in sheet for August 26, the day in whicwvas allegedl absent from the facility, it was discovered that the sign-in sheet had on een used once by since her admission on May 2. The only record of a departure or return for was for June 6, 2013. Furthermore, the issue of residents not signing in or out of the facility had been previously cited in a prior inspection dated May _17, 2012. CORRECTIVE ACTION The facility administrator or designee must maintain the Resident Sign-In and Out Roster daily. All families must have an assigned Sign In/Out form and each resident must sign in and out as they enter and leave the facility. or designee must initial each entry as residents and their children enter and leave the facility. Residents who enter or exit without their children must be questioned as to the whereabouts of their children and counseled accordingly. Residents who refuse to sign in and out are to receive a warning notice and be referred to their caseworker for appropriate counseling which must also be included in their progress notes. Please note that facility staff must also verify/check residents' rooms when residents do not sign in or out for more than a day. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) Please note again that the above items must be addressed within 10 days of receipt of this report. Please insert corrective action in the boxes provided and submit your "pr'0w'rh'ng rr.s'sr'smncef0r remument nrrmu 1 -5- response to: otda.sm.css.bss@otda.ny.gov. Should you have questions regarding the information contained in this letter, please contact Tracey Miller at (212) 961-8234. Sincerely, Jim Dolan, Director Bureau of Shelter Services cc: Ronald Abad, DHS-CO Elaine Deschamps-Garcia, DHS-CO Moses Ajasin, DHS-CO Derrick Aiken, Director, e-mail "prowling rempormy permrment 1 NEW YORK STATE OF TEMPORARY AND DISABILITY ASSISTANCE Andrew M. cudmo 40 NORTH PEARL STREET Kristin M. Proud Governor ALBANY, NEW YORK 12243-0001 Commissioner October 28, 2013 Ms. Julia Moten Deputy Commissioner NYC DHS/Family Services 33 Beaver Street, 16"' Floor New York, New York 10004 Re: Auburn Family Residence Infant Death Complaint investigation by OTDA Dear Ms. Moten: At. 4:58 PM on August 27, via email, OTDA received a com Iaint from the Coalition for the Homeless stating that a 3 month old female infamfl had died that morning at the Auburn Family Residence. The child was found in the family's unit and the complaint alleged that heat related conditions were responsible for her death. This complaint was forwarded to OTDA Shelter inspector Shirley Haines on August 28 who was coincidentally already on-site conducting the facility's annual inspection. During her review, Ms. Haines found that --_ca_se record indicated that she had been admitted to Auburn by HERO on May 2, 2013. At the time of her admission, was 7 months pregnant and was also accompanied by her one year old son, The case recordfurther indicated that on June 16--chi|d was discharged from the hospital after her premature birth on May 26. The medical discharge summary found in the case file stated that the child had "a history of respiratory distress and "feeding problems". Subsequent to the death of her the night of August 27 with a family member whereupon her one year old child was taken into custody by ACS allegedly based on reports from an unknown source that--had left her children unattended in her unit over the night of August 26. On August 28, Environmental Inspector Tom Dudley conducted a site visit to investigate the heat related aspect of the Coalition's complaint. The results of that investigation are included in the attached report. On September 3, Mr. Dudley returned to the facility to further investigate the whereabouts of 'on the night her child died. "provr'rIt'ng temporary rr.s'sr'si'mrce for OTDA-L 1 He reviewed the sign--in and sign-out log and could not adequately determine if -- had actually left the facility on August 26 as alleged because there-was no record of her signing out of the facility on that night. As a result of OTDA's investigation andextensive review of facility records and procedures, we have identified the following critical findings as a result of this complaint. RESPONSE TO THIS COMPLAINT INSPECTION VISIT IS DUE 10 DAYS WITHIN RECEIPT OF THIS REPORT FACILITY: - DATE OF RESPONSE: Auburn Family Residence RESPONSE SUBMITTED BY: TITLE: Ron Abad Assistant Commisioner TELEPHONE: E-MAIL ADDRESS: 212-361-0940 Rabad@dhs.nyc.gov ADMISSIONS and REFERALS 900.6(f) (1) (3) -- A district may not refer to a family shelter any family containing a member who has a physical condition that makes placement inappropriate or-may cause danger to others; is likely to substantially interfere with the health, safety of care; is-in need of a level of medical, or other assistance that cannot be rendered safety and effectively by the facility, or cannot be reasonably provided by the facility. FINDING Instead of placing this mother of a one year old who was also seven months pregnant in a shelter that specializes in serving mothers and their infants,_was placed at Auburn Family Residence which is highly unsuitable for families with -infants. The large congregate setting with without cooking or toilet facilities in the units does not lend itself to the proper care of newborn infants and children under the age of 2 years. CORRECTIVE ACTION DHS "must inform their HERO placement unit that placing pregnant mothers and children, especially infants and toddlers under 2 years of age, in Auburn is an inappropriate placement due to the lack of amenities for this young and vulnerable population. Henceforth, this population should be prudently placed by HERO in appropriate settings with programs that will assist infants and toddlers to thrive. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) DHS makes every effort to ensure the safety and well--being of all its shelter clients. Additionally, DHS understands the needs of both parents and children, and takes appropriate measures to mitigate any hardships families may face while residing at Auburn. While DHS shares OTDA's concern on this issue and will attempt to avoid placing such clients at Auburn, depending on capacity, DHS must have_ flexibility with the placement of clients in facilities that have available units, especially units for large families. As noted in its response to violation 1B, DHS has effective procedures in place to ensure clients' medical issues are appropriately addressed and that all clients are aware they can request reasonable accommodations (which may include transfers andlor medically-necessary devices) "providing temporary rr.s'.s'israucef0r permrmem' change" 1 FINDING #1 B: Once the mother's hospital discharge form was reviewed by the facility, and it was noted that the infant was born prematurely and had a history of respiratory distress and difficulty with feeding, the facility should have made a referral to a shelter which had the means and a program to provide a suitable environment for a mother with a newborn with medical issues. CORRECTIVE ACTION #1 B: - Henceforth, the facility must take into consideration medical conditions of its residents and make appropriate referrals to facilities that can meet the needs of the family. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) DHS makes every effort to ensure the safety and well-being of all its shelter clients. Additionally, DHS understands the needs of both parents and children, and takes appropriate measures to mitigate any hardships families may face while residing at Auburn. DHS has effective procedures in place to ensure clients' medical issues are appropriately addressed and that all clients are aware they can request reasonable accommodations (which may include transfers and/or medically-necessary devices). Specifically, Facility staff apprises all clients of their right to request reasonable accommodations for transfers, for medical devices, or for, e.g.,air conditioners. Once a client submits proper medical documentation to staff in support of his/her request for a reasonable accommodation, such documentation is forwarded to Program staff and Medical Director for evaluation. In such cases, DHS makes timely determinations to ensure that a client's needs are fully addressed. SAFE AND COMFORTABLE ENVIRONMENT 900.12(a) 8. 900.6(f) (1) (3) - The facility must be maintained in a good state of repair and sanitation and in. conformance with applicable State and local laws, regulations and ordinances in order to assure a safe, comfortable environment for residents. Extreme heat can be a detriment to the health of residents. FINDING During the NYC mid--Ju|y heat wave from July 14 to July 20, 2013, the temperature ranged from 90 to 97 degrees. The unit in which the newborn child was living was inappropriate for a child with respiratory distress since the unit's temperatures would have ranged from at least 95 to 102 degrees given the 5 degree unit differential in un_ CORRECTIVE ACTION The facility must be aware of the medical conditions of the residents and make appropriate referrals to other facilities that can meet the needs of the family especially given extreme _conditions beyond the facility's control. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) Each unit at Auburn is equipped with a wa|l--mounted fan, and families can request an additional fan if needed. In addition, the facility has a cooling room set up in the cafeteria -- which is equipped with constant air conditioning - that is available 24 hours during summer months. Due to the building's "provirlmg rempomry permanent nrnA-r 1 electrical grid, individual air conditioning units in client rooms are not permitted at'Auburn. Households with family members who have medical conditions that can be acerbated by extreme temperatures are routinely assessed for transfer based on the medical documentation that is provided. This is an on-going practice. ASSESSMENT SERVICES AND ONGOING PROGRESS NOTES 900.10(c) - The facility or social services district must document the resident services or independent living plan and all direct services and service referrals to other entities provided while the resident family is in the facility. FINDING The-facility failed to maintain adequate and progress notes. There was no documentation of any pre-natal or post-natal case management notes regarding the mother and newborn. Progress notes were inadequate and not timely and did not address the needs of all family members including the one year old child. CORRECTIVE ACTION Social Services staff must document direct and indirect family services via progress notes throughout the family's stay at the facility. Progress notes are to include an initial background history of the family, interaction observed between household members during intake, and include any changes made to the household such as birth of newborn and medical conditions and follow up, admission/discharge of a family member, obtaining or losing employment, incidents or other relevant information pertaining to the family. Progress notes are to be documented bi-weekly or as often as needed. DHS Response: must be specific and state the time period when the deficiency will be corrected.) Effective 9/4/13, Social Service staff were instructed to construct a comprehensive initial intake progress note entry for all families referred to the Facility that will include the family's history, including housing and employment assessment, as well an any special needs. The initial progress note entry will be the foundation for on--going case note documentation to address family needs, referrals for services compliance and non-compliance. All incident Reports as well as any infractions of the Shelter Rules and Regulations will be followed up with a progress note entry. RESIDENT SERVICES -- The services or independent living plan must be reviewed with the family bi- weekly and such plan must be revised as necessary to obtain permanent housing. FINDING The facility failed to review/revise the SPIILP bi-weekly. SPIILP was not specific to the family nor did it include changes that occurred with the family. CORRECTIVE ACTION "pr0w'rlr'ug remporriry a.s'sr'smricef0r iermrinem' cilirrnge" 1 Social Services staff must meet with families bi-weekly to review and revise The plan must be a mutually agreed upon plan that is dated and signed by all adult family members and include specific items related to the family. For example, attend prenatal and post natal appointments; complete an SSI application, etc. A signed copy of each revised must be provided to the family. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) On 9/9/13, Social Services were instructed that they must conduct weekly or bi-weekly lLP's with all adults in each family for every family residing at the Facility. The ILP plan will include tasks for each family that including medical appointments. Each family member will be given a copy of the revised ILP. SUPERVISION 900.11(a) (1) -- Supervision includes recording a daily census of residents, including a record of daily admissions and discharges and maintenance of a daily sign-in and sign-out sheet. FINDING - . In observing the facility's procedure for residents entering and leaving the shelter, OTDA staff observed residents coming and going without signing in or out. In addition when OTDA inspectors checked the sign-in sheet for August 26, the day in which'/as allegedl absent from the facility, it was discovered that the sign-in sheet had only been used once by since her admission on May 2. The only record of a departure or return for mas for June 6, 2013. Furthermore, the issue of residents not signing been previously cited in a prior inspection dated May 17, 2012. . CORRECTIVE ACTION The facility administrator or designee must maintain the Resident Sign-In and Out Roster daily. All families must have an assigned Sign In/Out form and each resident must sign in and out as they enter and leave the facility. The ASW or designee must initial each entry as residents and their children enter and leave the facility. Residents who enter or exit without their children must be questioned as to the whereabouts of their children and counseled accordingly. Residents who refuse to sign in and out are to receive a warning notice and be referred to their caseworker for appropriate counseling which must also be included in their progress notes. Please note that facility staff must also residents' rooms when residents do not sign in or out for more than a day. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) On 9/9/13, the Auburn Family Residence Operation staff were instructed to re--enforce Sign-in/Sign-Out Policy with each family leaving or entering the facility. If a client refuses to sign-in and sign-out, the Director, Deputy Director and/or Director of Social Service will conference the family along with the Sup 1's to address the non-compliance and expectations. The case conference will then be documented in the progress notes. A written warning will also be issued to the family for failure to abide by the facility rules. "provr'rling rempormy rermrmem' change" OTDAJ1 Please note again that the above items must be addressed within -10 days of receipt of this renort. Please insert corrective action in the boxes provided and submit your response to: otda.sm.css.bss@otda.ny.gov. Should you have questions regarding the information contained in this letter, please contact Tracey Miller at (212) 961-8234. Sincerely, Jim Dolan, Director Bureau of Shelter Services cc: Ronald Abad, DHS-CO Elaine Deschamps-Garcia, DHS-CO Moses Ajasin, DHS-CO Derrick Aiken, Director, e-mail daiken@dhs.nvc.qov JRD/bjh "proi-idmg fer.-zpormy rimsrancefor ermrmem' OTDA-I 1 NEW YORK STATE OF TEMPORARY AND ASSISTANCE Andrew Cuomo proud Governor ALBANY, NEW YORK 12243-0001 Commissioner November 15, 2013 Ms. Julia Moten Deputy Commissioner NYC DHS!Fami|y Services 33 Beaver Street, 16"' Floor New York, New York 10004 Dear Ms. Moten: A complete inspection was conducted at the Auburn Family Residence on August 28, 27 28, 2013 and September 3, 4, 8. 5, 2013. Attached is the report of that inspection. Please note that several findings indicate non-compliance with Part 900 of Title 18 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 for 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 is 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 Attached to this report is the Confidential Resident and Staff Findings (ATTACHMENT A) noted during our inspection. The faci|ity's response to these attachments must be included in the facility's overall response to this report. Also attached to this report is the Tier II Fire Safety Inventory Checklist for Annual Inspection (ATTACHMENT B). Please note that the following findings require priority correction: Finding #1 re: completion of an operational plan for certification; Finding #3 re: lack of child care services; Finding #7 re: fire safety installations; Finding #8 re: fire panel and emergency lights connection to a backup generator; Findin #9 re: lack of a surveillance system; Finding #11 re: vent chutes with dust and debris, black mold in bathrooms, poor air quality; Finding #12 re: exterior water infiltration; Finding #26 re: lack of monitoring residents' entry and exits; Finding #29 re: overall physical plant deficiencies. "pr0vr'dr'ng temporary -L 1 The 'above items are health and safety issues andlor issues of long-standing duration and present barriers to renewing the facility's operating certificate. With regard to Fire Safety Protection, the current system is inadequate. There is insufficient supervised smoke detection coveraqe throuqhout the building which is not monitored bv shelter -staff because the fire panel is located in the adiacent hospital in a locked basement room. Additionally, a second fire safety system installed in 1998 that has the potential to provide adequate protection remains dormant because it has not been approved by the FDNY for activation. - Please note that Part 900 of Title 18 allows withholding reimbursement of state funds in cases where resident health and safety are at risk. Should you have questions regarding the information contained in the attached inspection report, please contact Tracey Miller at: or call (212) 961-8234. For additional information regarding homeless shelter issues, Regulations and forms, please visit Sincerely, Jim Dolan, Director Bureau of Shelter Services Enclosure cc: Yianna Pavlakos, DHS-CO James Russo, DHS-CO Julia Moten, DHS-CO Elaine Deschamps-Garcia, DHS-CO Ronald Abad, DHS-CO, Joslyn Carter, DHS-CO Todd Hamilton, DHS-C0 Thomas Vanacore, DHS-CO Roxanne Edwards, DHS-CO -- JD/bjh "pr'0w'dr'ng i'ern1mrm;p assisi'rmce. for rerma.-rem OTDA-L 1 OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE REPORT OF INSPECTION Facility Name: Auburn Family Residence Street Address: 39 Auburn Place City: Brooklyn, New York 11205 County: . I Kings INSPECTION SCOPE INSPECTOR NAMES INSPECTION DATES PROGRAM: Shirley Haines . August 26 28, 2013 ENVIRONMENT: Thomas Dudley I September 3, 8. 5, 2013 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 Onc_e NYS OTDA completes a facility inspection, 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. PART A -- DHS's Response to the Inspection Report. This section requires that facility violations be reviewed and completed by the district as follows: DHS STAFF: Please complete all identifying information including name, title, telephone number and email address of the DHS employee responding to this inspection report. It is important to manually data enter the date so that it does not change each time the report is opened. 1) DHS's response to the findings must be typed in bold in DHS's Response Box located below OTDA's Corrective Action. - - 2) The district must collaborate with the facility prior to submitting a response to ensure compliance. 3) The district must be specific and state the time period when the deficiency will be corrected. PART -- FaciIity's Response to the Inspection Report. This section requires that the facility respond to violations in the inspection report as follows: FACILITY STAFF: Please complete all identifying information including name, title, telephone number and email address of the facility employee responding to this inspection report. It is important to manually data enter the date so that it does not change each time the report is opened. 1) The facility's response to the findings must be typed in bold in the Facility's Response Box located below OTDA's Corrective Action. The facility must be specific and state the time period when the deficiency will be corrected. 2) The faciIity's response to the "Confidential Resident and Staff Findings" (Attachment A) must be addressed according to the specific individual and finding as noted on the attachment. 3) A Tier II Fire Safety Inventory Checklist for Annual Inspection (Attachment B) is also included listing the facility's fire safety installations and recommendations or needs if any. The faciIity's response to the inspection report must be e--mailed or a hard copy forwarded to DHS's Director of Quality Assurance and Support. Note: All facility responses to the inspection report must be forwarded to DHS for their approval before they are forwarded to OTDA. Once DHS has reviewed and approved the facility's response, a copy of the complete report must be sent hard copy to: Benita Hayes, Bureau of Shelter Services, Office of Temporary and Disability Assistance, 40 North Pearl Street, 10*" Floor, Albany, New York 12243 or electronically to: otda.sm.css.bss@otda.ny.qov. OTDA will review all facility responses for compliance and, if necessary, request DHS and the facility to submit additional information. PART A -- DHS RESPONSE TO THE INSPECTION REPORT ONLY REPORT DATE: 11/15/13 I FACILITY NAME: Auburn Family Residence I DISTRICT: DATE OF RESPONSE: Department of Homeless Services RESPONSE SUBMITTED BY: TITLE: TELEPHONE: E-MAIL ADDRESS: REPORT OF INSPECTION VIOL REGULATION NUMBER 1 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: PRIORITY CORRECTION FINDING: New York City Department of Homeless Services' 01/30/12 response to the Operational Plan Amendment letter was inadequate and a operational plan amendment letter was subsequently issued on 05/11/12 to which there has been no response. Consequently, the Operational Plan is still not approved and an Operating Certificate has not been issued for this facility. The facilitv's operational plan expired in December 2005 DHS must review the responses submitted and make adjustments as noted below in items A and A) HAI no longer provides part-time recreation activities for the school age children. The facility is to provide a viable After-School Recreation program on-site. The facility lacks a supervised electronic surveillance system. (Previously cited 11I28I11, 04I02I12 addendum and 10I22I12) CORRECTIVE ACTION: Although the facility responded to the issues from the Operational Plan Amendment in the 01/07/13 response to the 10/22/12 inspection report, the response to the Amendment letter to the Operational Plan remains outstanding. This must be a separate response. A) The response to the Amendment to the Operational Plan must reiterate that the facility has hired two additional recreation workers and employs a total of 3 workers to satisfy the recreation staff positions required at this time. DHS Response: (DHS must be specific andstate the time period when the deficiency will be corrected.) - B) The lack of surveillance system remains an outstanding issue at the facility. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 2 SPECIFIC ITEMS OF COMPLIANCE AND CORRECTIVE ACTION REQUIRED FINDING: Because of the large congregate setting and the lack of cooking and toilet facilities within the units, Auburn Family Residence is unsuitable for families with infants and toddlers under 2 years ofage. CORRECTIVE ACTION: DHS must inform HERO that placing families with children under 2 years of age in Auburn Family Residence is inappropriate due to the lack of amenities for this vulnerable population. HERO should instead be placing these families in settings where their health and well-being are assured. Specifically. HERO should be directed to refer only families with children over 2 vears of age to Auburn. In addition, as families with young children exit the facility for permanent housing, they should be replaced only with families with children ages 2 and above so that the population served will be corrected through attrition. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 3 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: PRIORITY CORRECTION FINDING: The facility failed to provide structured childcare services for resident children between the ages of 6 months and 4 years. On the days of the inspection, there were seventy seven (77) resident children between 6 months and 4 years with only twelve (12) of the children attending childcare off-site. The -remaining 65 children were without childcare services. (Previously cited 03126107, 10124108, 10105109, 10104110, 11128111,' 04102112 addendum 10122112) CORRECTIVE ACTION: DHS must ensure that childcare is provided to accommodate all families who are engaged in welfare-to--work initiatives including, but not limited to, employment, job training, educational programs andlor housing search. According to the October 22,2012 report, DHS indicated they would encourage families to utilize City-licensed child care services. However, with only twelve (12) children attending a childcare program off-site at the time of the inspection, it does not appear they have done so. The DHS facility administrator is to designate appropriate rooms for childcare and ensure that childcare is be provided on-site for resident children as follows: 0 Hire at a minimum 4 appropriate childcare staff. - Provide childcare during the hours from -- Provide appropriate furnishings, manipulative toys, crayons, wheel toys, etc. for the childcare program. - DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 4 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The Screen I medical forms reviewed lacked the date the exam was conducted. They also lacked the signature of medically qualified personnel nor did they have electronic signature in ten of the sixteen family case records reviewed. (Previously cited 10122112) See Attachment A for names. CORRECTIVE ACTION: DHS must ensure that facility staff obtains a copy of all family members' preliminary health screen forms at the point of admission or within 24-hours of admission. The facility must ensure that all preliminary health screen forms are signed and dated by medically qualified personnel or have the appropriate electronic signature.' DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 5 8: 900.14(a) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: The CARES fails to maintain a master roster of all families residing in the facility either alphabetically or by room number. The roster should include the room number, the family's name, family composition and names and dates of birth for all adults and children. (Previously cited 1OI22I12) CORRECTIVE -ACTION: DHS responded that "The CARES Facility Roster-Individual Level" is a sortable report that lists family name, room number, family composition etc. However, the facility was unable to generate a master roster as requested during the inspection. DHS must train staff in the process of generating _a master roster for the facility and submit the master roster indicating the data required with the response to this report. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 6 900.14(a) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The CARES Incident Report form lacks adequate space for documenting the resolution of the incident. In addition, facility staff is unable to add additional follow-up comments to the resolution section when needed. (Previously cited 10l22I12) CORRECTIVE ACTION: DHS must ensure that additional comments and resolutions can be added to CARES reports. All incident reports must include the resolution of the incident. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 7 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: PRIORITY CORRECTION Note: Although DHS submitted a response with last year's report of inspection asserting that this item was being addressed, the identified deficiency and unsafe condition remains outstanding. FINDING: According to NYS Fire Code 502.1, "The principal attended or unattended location where the status of detection, alarm communications and control systems is displayed, and from which the systems can be manually is not being adhered to at this facility. There is no way to visually document that the she|ter's fire panel is active and on-line since it is located in a locked basement room in the adjacent hospital. Additionally, there is no documentation available to show when the fire panel was inspected attesting to the system's fitness. In addition, the facility has fire safety installations in place that fail to provide adequate fire safetv protection for this TIER ll facility: Supervised smoke detectors (only one o_n each floor at the elevator bank) in the corridors and basement are more 30' apart and monitored by the Cumberland Hospita|'s paneh Of the battery operated smoke/carbon monoxide detectors in the units, over 75% were inoperable; - Pull stations on each floor connected to an unmonitored annunciator panel in the adjacent hospital; a An inaccessible and unmonitored annunciator panel is located in a remote and locked part of the basement of the adjacent Cumberland Hospital; The first floor annunciator relay panel with zone read-outs or a sounding device from the main annunciator panel is located in the locked hospital basement. Please note that a new fire safety system was installed in 1998. However, FDNY approval has not been granted and the system remains dormant. This system includes: a Supervised smoke detectors in the units, corridors and basement; A new_first floor annunciator panel which also monitors water flow; - Pull stations (a set), strobes and an IFA (Previously cited 10I04I10, 11I28I11, and CORRECTIVE ACTION: DHS must activate this dormant Fire Panel and all of itssafety related components for the safety of all residents and staff. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 8 (7) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: PRIORITY CORRECTION Note: Although DHS submitted a response to last year's 10/22/12 report of inspection asserting that this item was being addressed," the identified deficiency and unsafe condition remains unresolved. FINDING: The facility failed to operate in accordance with all applicable State and local laws, Regulations and codes relating to the building and construction of physical plant, fire prevention and fire protection and the overall health and safety of its occupants by not ensuring that the emergency generated power for the fire panel remains intact at all times. The wiring for the fire panel has not been connected to the necessary source of power. At the time of inspection, although the wiring for the emergency generator was in place, the site's fire panel and emergency lighting had not been connected to the generator as an emergency! backup source of power. (Previously cited 10l22l12) CORRECTIVE ACTION: DHS must have the back-up emergency generator connected to the site's fire panel and emergency systems immediately. At a minimum, a self-certification is required by the system's installer and should include all of the emergency health and safety components. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 9 PRIORITY CORRECTION SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: Note: In a recent incident (08/26/13) involving ACS and an infant child and concerning the whereabouts of said child's mother, an electronic surveillance system would have documented the alleged exit of a mother from the facility without her children. FINDING: The facility failed to ensure that adequate and agpropriate electronic surveillance equipment was installed in order to lessen the risk of resident injury, prevention of theft and unauthorized persons from entering the facility. In addition, on the residential floors spanning up to 7000 square feet, there is only one security officer. (Previously cited 11115101, 12120102, 01109104, 02114105, 04107106, 03126107, 10124108, 10105109, 10104110, 11128111, 04102112 addendum, 05117112 complaint 10122112) CORRECTIVE ACTION: . DHS must ensure that the facility install an electronic surveillance system that will cover the entrance door, perimeter of the building, lobby and other problem areas. The surveillance system must have recording capabilities and allow for playback while the system continues to record. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 10 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: The Temporary of for this family shelter expired in 1998 and still designates this site as a medical facility. FINDING: The facility failed to produce a valid Certificate of Occupancy reflective of this building's use as a shelter. (Previously cited 11/281118. 10122112) CORRECTIVE ACTION: DHS must obtain an appropriate of for this facility. DHS Response: (DHS and the Facility must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 11 PRIORITY CORRECTION SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility must be maintained in a good state of repair and sanitation and in conformance with applicable State and local laws, regulations and ordinances in order to assure a safe, comfortable environment for residents, including all lavatories, must be kept clean, sanitary, and free of insects. A) More than 85% of theibathrooms were found with exhaust chutes that were extremely saturated with dust and debris. (Previously cited 10122112) B) In addition, black I mold was found in several communal bathrooms, as well as personnel unit bathrooms. This condition may be directly related to the poor ventilation andexhaust at the site. (Previously cited 10122112) 0) Upon inspecting unit-on 09/04/13, a three year old child was found coughing and vomiting to the extent that the director was forced to notify EMS 1:55pm. This asthmatic child's condition appeared exacerbated by the poor air quality throughout the building. CORRECTIVE ACTION: A) DHS must have the exhaust chutes professionally cleaned so that the bathrooms receive fresh air and the exhausted air is properly dispensed. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) B) In addition, DHS must have the mold infestation throughout the facility remediated immediately. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) C) Young children who exhibit chronic breathing problems should not be retained or referred to this shelter given the poor air quality at this site. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 12_ - SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED FINDING: In unit 747 there were signs of infiltrating water appearing to have originated from the facade. The western walls of this unit appeared to have taken on water for an extended period of time. CORRECTIVE ACTION: DHS must have the walls in this unit skimmed and painted. Also inspect and repair the weakened section of the facade related to this unit. DHS Response: (DHS must be specific and state the time period when the deficiency will be corrected.) PART -- RESPONSE TO THE INSPECTION REPORT REPORT DATE: 11115113 I SPON Auburn Family Residence RESPONSE SUBMITTED BY: TITLE: TELEPHONE: E--MAIL ADDRESS: REPORT OF INSPECTION VIOL REGULATION NUMBER 13 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: - The facility failed to ensure that all security guards (monitors) have current registration with New York State Department of State as required by the Security Guard Act of the Laws of New York, 1992. Twenty-five (25) security guards' registration cards were expired or were missing. See Attachment A for names. CORRECTIVE ACTION: The facility must ensure that only those who have been issued a security guard registration card by the Department of State are employed to perform services involving the protection of individuals or property from harm or theft or the deterrence, observation, detection, reporting or response to unlawful or unauthorized activities. Documentation of safety guards' (officers or house monitor, etc.) registration must be maintained on premises at all times for OTDA review and inspection. Please visit the Department of State website for more information: Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 14 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to obtain copies of all families' preliminary health examination forms within 24 hours of admission and/or ensure that all forms were signed by medically qualified personnel or had an electronic signature in six of the seventeen family case records reviewed. See Attachment A for names. (Previously cited 10104110, 11I28I11 10122112) CORRECTIVE ACTION: Facility staff must obtain a copy of all family members' preliminary health screen form at the point of admission or within 24-hours of the family's admission date into the facility. Facility must ensure that all preliminary health screen forms must be signed and dated by medically qualified personnel or have an electronic signature. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) -VIOL REGULATION NUMBER 15 A SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: - The facility failed to obtain inoculation history of children in seven of the seventeen family case records reviewed. See Attachment A for names. (Previously cited 10/04/10, 11128111 8. 10I22I12) CORRECTIVE ACTION: Social Services staff must obtain copies of children's inoculation history and file them in the family's case record. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 1 6 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to provide residents the right to present grievances on one's own behalf, or on behalf of other residents. Complaints reviewed did not indicate that the resident received a response to their complaint. (Previously cited 10l22I12) CORRECTIVE ACTION: The administrator or designee must address and answer all complaints in writing. The resident must receive a copy of the complaint and the response, the original must be filed in the family case record and a copy must be maintained in a binder that is available for review during OTDA inspection. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 17 8: 900.9 I SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: According to facility staff, DHS is requiring the use of resident employment, housing and savings contracts. Said contracts, specifically those with mandated timelines, have not been approved" by OTDA as required by 18 Part 900 regulations. CORRECTIVE ACTION: must ensure that the facility immediately refrains from using resident employment, housing and savings contracts and pull said forms from each family's- file. Any contract agreements between social service staff and residents should be indicated as such in the approved Bi- Weekly ILP contract. The residents rules and rights are as stipulated in the approved "Code of Conduct". Note: Caseworkers may meet more than bi-weekly with residents if needed. Facility Response: (DHS must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 13 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: . The facility failed to complete the Intake Admission1Assessment form or the Shelter Assessment1Applicant Information Document in nine of the seventeen family case records reviewed. The following information was missing: - Date that the intakelassessment was conducted 0 Missing education -and work history of adult family members 0 Summary of assessed needs a Signatures of adult family members (Previously cited 04107106, 03126107, 10124108, 10105109, 10104110, 11128111 10122112) CORRECTIVE ACTION: The social service staff must meet with all families within two days of their admission date to conduct, at a minimum, a preliminary needs intake or a comprehensive assessment. In all cases, a comprehensive assessment must be completed within 10 days of the family's admission. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 19 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to review and revise the SPIILP bi-weekly with the families in five of the seventeen family case records reviewed. did not indicate specific needs for all adult family members or listed incorrect family member. See Attachment A for names. (Previously cited 1012211 2) CORRECTIVE ACTION: Social Services staff must meet with all adult family members bi-weekly to review and revise the SPIILP. Specific needs are to be addressed for each family member. All must be signed and dated by all adult family members bi-weekly and the family must be given a copy of the signed SPIILP bi-weekly. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 20 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: - The facility failed to document all resident services via progress notes in ten of the seventeen family case records reviewed. In addition, the initial progress notes summary was missing and the progress notes were inadequate. For example, the following information was missing: another adult joined the family, residents' employment, whereabouts of children while resident is working, or follow up to written complaints. See Attachment A for names. (Previously cited 10122112) CORRECTIVE ACTION: Social Services' staff must document resident services via progress notes while the family resides in the facility. Progress notesare to include any changes to the household such as the birth of newborn, admission or discharge of a family member, obtaining or losing employment, location of children when resident is working and any other relevant information pertaining to the family. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 21 900.14(a) SPECIFIC ITEMS OF NON COMPLIANCE ANDICORRECTIVE ACTION REQUIRED: FINDING: The facility failed to complete the family's housing intake plan in thirteen of the seventeen family case records reviewed. See Attachment A for names. (Previously cited 10104110, 11128111 10122112) CORRECTIVE ACTION: Social Services staff must meet with families within ten days of the family's admission date to _complete the housing intake plan. The housing plan must be signed and dated by all adult family members and the case workerlhousing specialist. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 22 900.14(a) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to document housing assistance provided to_families via housing progress notes in eight of the seventeen family case records reviewed. See Attachment A for names. (Previously cited 10122112) CORRECTIVE ACTION: Social Services staff must document initial housing assistance provided to families and thereafter document assistance at least once a month or as often as needed. Notes are to include families' attempts to obtain permanent housing and any barriers or obstacles that may prevent them from obtaining permanent housing in a timely way. Housing notes are to make sense from one entry to the next indicating the fluidity and the chronological occurrences. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 23 900.10c(3) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: PRIORITY CORRECTION. FINDING: With the recent hiring of 2 new recreation workers, the facility now has three recreation workers. However, the schedule of activities received reflects the hours from -- Sunday through Saturday. Recreationalleducational activities for the school age children are not provided when school age children are dismissed for half day sessions, during winter and spring recess, holidays and summer vacation. CORRECTIVE ACTION: DHS and the facility must provide full-day recreationa|1educational programs -when public schools are dismissed half day, for holidays, during winter1spring recesses and summer vacations. Recreational services must be provided from 8AM to 7PM which will allow residents to continue' employment while residing at the facility. The recreational staff can stagger their hours to ensure full-day service. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 24 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to assist or refer all eligible adult residents to engage in self-help initiatives. At the time of the inspection, there were 250 adult residents residing in the facility, of which 206 were eligible to participate in self-help initiatives. Only 48 of the 206 eligible adults or twenty- three percent were participating in self--help initiatives. (Previously cited 10105109, 10104110, 11128111 8: 10122112) CORRECTIVE ACTION: Social Services staff must assist all eligible adult residents to participate in self-sufficiency initiatives that will enhance the families' ability to obtain and retain permanent housing. Adult residents with special needs, which exempt them from participation in se|f--sufficiency activities, must have these needs thoroughly documented in the family's case record. Self-sufficiency activities should be included in the Independent Living Plan and participation followed closely by the case manager. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 25 900.14(a) . SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to maintain an accurate record of families' daily attendance on the census form. The form was missing the following information: fami|y's admission date, names of all families, curfew violations, residents who were on a pass and billing days for the month. In additio_n, the facility's "Curfew Violations" list which is generated daily did not always agree with the census. (Previously cited 1012211 2) CORRECTIVE ACTION: The facility must maintain the census form as required in 18 900.16(f) which includes the documentation of the presence and absence of all families residing in the facility on a daily basis. The census documents must clearly distinguish all family absences (Passes or AWOL) curfew violations, discharges and total billing days per family per month in which reimbursements are claimed. The symbols representing present and absent etc. must be indicated on the form, for example, present, A absent without approval, approved pass, and curfew violation. New families are to be added at the end of the form along with their admission date. The family's admission date must be indicated on the form and the total billing days must be tallied for each month. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 26 8: 900.14(a) SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to maintain documents for all residents signing in and out daily. Additionally, some of the Residents' Sign In/Out forms were missing. The procedure of signing in and out was at issue during the infant death incident when there were reports that a mother left the shelter without her children. These reports were unable to be substantiated because of the inaccurate records. During the September 3-5, 2013 inspection. staff at the front desk were observed allowing families to enter and leave the facilitv without signing in or out. (Previously cited 05117112 complaint 08123113 complaint) CORRECTIVE ACTION: The facility must maintain documents of all residents signing in and out daily on the Sign In/Out form as required by 18 900.16(f) which requires documentation of the presence and absence of all families residing in the facility on a daily basis. The form must also document the whereabouts of all children to ensure that children are not left unattended in resident units. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 27 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to maintain an accurate master roster of all school age chi|dren's daily departure for school. The school age departure roster was incomplete, family names, admission dates, school enrollment dates, chi|d's grade and name of school. It could not be determined if all school-age children were enrolled in school or enrolled in school in a timely way.'Previously cited 03126107, 10124108, 10105109, 10104110, 11128111 10122112) CORRECTIVE ACTION: - The facility is to maintain the School-Age Departure form and include the following: family name, child's name, assigned room number, family admission date, children's school enrollment date, school name and child's grade. An assigned facility worker is to supervise and "monitor school age children's daily departure. Although the Department of Education representative provides assistance, the facility is responsible for maintaining and providing this information during the inspection process. See OTDA approved Daily School Departure1Attendance form at our website: Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 28 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: FINDING: The facility failed to attach resolutions to incident report forms consistently. (Previously cited 11128111 8: 10122112) CORRECTIVE ACTION: The facility's administrator or designee must ensure that when an incident occurs, an incident report form is completed along with a resolution statement included or attached to the form. All incidents, along with resolutions and a brief summary log of incidents are to be available for review during OTDA inspection. Note: AWOL's, curfew violations and residents refusing to sign in and out are to be filed separately and must n_cr>>t be included with the incidents. Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) VIOL REGULATION NUMBER 29 SPECIFIC ITEMS OF NON COMPLIANCE AND CORRECTIVE ACTION REQUIRED: PRIORITY CORRECTION . The facility failed to ensure that the building is maintained in a good state of repair and sanitation and in conformance with the applicable State and local laws, regulations, and ordinances as follows. (a)Hardware1Fascia Repaired Items not completed within 30--days of this report must be Yes No Date explained in the Facility Response Section below. Unit: 710, 647, 449, 380, 36_0, Damaged window Damaged floor hallway window screens Unit: 713, 731, 742, 647, 624, 452, 367, 370, 258, 283 Damaged ceiling . Unit: 529, 468, 443, 380 Damaged front--door Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) Electrical Repaired items not completed within 30-days of this report must be Yes No Date explained in the Facility Response Section below. Unit: 546, 381 Damaged Refrigerator Unit: 461-2, 461-3, Damaged Carbon Monoxide Detectors Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) Vermin Repaired Items not completed within 30-days of this report must be Yes No Date explained in the Facility Response Section below. 712, 647, 450, 370 Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) Furniture Repaired Items not completed within 30-days of this report must be Yes No Date explained in the_Facility Response Section below. Unit: 828,635, Damaged dresser Unit: 646, 647, 624, 529, 472, 466,461, 461-3, 449, 450, 376, Damaged mattress/bed frame Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) Apartment conditions Special Note: During this environmental inspection, a family of two was moved out of_unit 754 due to insufficient space for two standard beds. The configuration created an egress issue for the residents. This unit can only fit a single bed and a crib. Repaired Items not completed within 30-days of this report must be Yes No Date explained in the Facility Response Section below. Unit: 752, 751, developing bathroom mold Facility Response: (The facility must be specific and state the time period when the deficiency will be corrected.) ATTACHMENT A 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: Auburn Family Residence OF INSPECTION: August 26 - 28, 2013 NAME: Shirley Haines FINDING REGULATION DESCRIPTION RESIDENT EMPLOYEE NAME NUMBER NUMBERS 4 14 - Preliminary health forms were missing. 8 Upon inspecting a family unit, a three year old child was found coughing and vomiting to the extent the director was forced to notify EMS 1:55pm. This asthmatic child's condition appeared exacerbated by the poor air quality throughout the building. 13 900.5(3) Security registration cards expired or missing. FINDING NUMBER 8 REGULATION NUMBERS DESCRIPTION RESIDENT EMPLOYEE 15 Copy of children's inoculation history missing. 18 900.14(a) Incomplete Intake assessments, missing education and or work history, summary of assessed needs, signature or date. 19 Service plan Independent Living plan not reviewed or revised bi--weekly. 20 Inadequate progress notes - missing initial progress notes, data on other family member joining the family, same progress notes without changes, why a resident is using two last names, lacked employment of residents or when started a newjob, children's whereabouts while resident working, etc. 21 900.14(a) Completed Housing Intake plan was missing. 22 900.14(a) Missing housing notes or the housing notes were the same as the progress notes. ATTACHMENT TIER II Fire Safety Inventory Check List for Annual Inspection Facility Name: Auburn Family Residence Street Address: 39 Auburn Place City: Brooklyn, New York 11205 County: Kings INSPECTION SCOPE I INSPECTOR NAMES INSPECTION DATES ENVIRONMENT Thomas Dudley September 3-5, 2013 EQUIPMENTIPROCEDURES Yes No COMMENTS But not CONNECTONS: ANNUNCIATOR PANEL monitored SMOKES by shelter HOWEVER THE IS NOT MONITORED staff BY STAFF AND IS LOCATED IN A LOCKED ROOM IN THE BASEMENT OF THE ADJACENT HOSPITAL OUTSIDE MONITORING STATION CO. NAME: STAFF ON HAND DO NOT HAVE ANY INFORMATION RE: AN OUTSIDE MONITORING STAT. FIRE DRILLS CARBON MONOXIDE DETECTORS IN APTS. x! UNSUPERVISED II BATTERY OPERATED El HARDWIRED SMOKE DETECTORS IN APTS. UNSUPERVISED Tl BATTERY OPERATED :1 HARDWIRED SUPERVISED SMOKE DETECTION SYSTEM Inadequate El UNITS CORRIDORS :1 (MONITORED AT PANEL) -smoke STAIRWELLS ca THE PANEL FOR THE SUPERVISED SMOKE heads are SMOKE DETECTORS ARE INADEOUATE DETECTION SYSTEM IS INACCESSIBLE TO located FOR THE SPACE OF THE CORRIDORS AND STAFF. IT IS LOCATED IN A LOCKED ROOM only at THE SMOKES ARE CONNECTED TO THE IN THE ADJACENT HOSPITAL. I elevator UNMONITORED LOCKED PANEL ROOM IN banks on THE HOSPITAL BASEMENT each floor SPRINKLER SYSTEM El UNITS cu CORRIDORS STAIRWELLS BASEMENTS FLOOR ONE ROOM HAS ONE SPKR A FORMER LAB ROOM EMERGENCY LIGHTING LANDINGS CORRIDORS xl STAIRWELLS BASEMENTS INTERIOR FIRE ALARM Box INTERNAL El CENTRAL RELAY UNABLE TO VERIFY IF THERE IS A LEAST AN IFA SINCE THE PANEL IS BEHIND A LOCKED BASEMENT DOOR EVACUATION PLANS POSTED El ELEVATORS El STAIRWELLS THROUGHOUT UNITS FIRE EXTINGUISHERS UNITS CORRIDORS BASEMENTS STROBES VOICE COMMUNICATION SYSTEMS I I: FIRE PANEL IIJINTERCOM BULLHORN SUFFICIENT MAINTENANCE PERSONNEL A HOUSEKEEPING ON-SIGHT OVERALL MAINTENANCE OF FACILITY OK NEEDS: xl PLUMBING ELECTRICAL xl FASCIA HARDWARE xl GROUNDS UNIT INSPECTIONS NEEDED I No MAINTENANCE DIRECT CARE FACILITY MAINTENANCE CONTRACTS HANDS--ON MEP SPECIALIST OR NEEDED HANDYMAN IS RECOMMENED FOR THIS A SITE DUE TO THE AGEHOF THE BUILDING I OveraI1'Inspections Comments: THIS FIRE SAFETY INSTALLATIONS ARE INSUFFICIENT AND DO NOT-PROVIDE ADEQUATE PROTECTION FOR THE SITE. SEE FINDINGS. In: . Ar whz' innit' Neiuzfe of _TQ0tes: -- in Exlafisisa: am: of sagmf Sec. i' I. . . *2-Ea 'r ?3 3 fjfifii . %flMVClitmf DEE-E3 CC>rnp1aE:1t eaniered in to mg book Inczidam Rapert Staff c3tifiad:m_mHH( (ms {)Soc- 'wag - . fl?igg I . of 3 . fig: $333333 I I I .59 '7 . wk"er. .6-. is - Ck' W2 e,u-W: ea em as Jsgefl; 5 . Date i? D-HS {fin . . Complaint ezlisred in to log' bpcak JDEIR }S0c. A: I I 6 zg__LVM.m "3 13:15 I Rep01'ted. mg . Sate S03. t, Nature of Came Mu II "mfigviaghf fin 095% 'gs Clieznir Signamrel DHS Superviisoz' on Coinlplaini entered in to Iog gook pages:H'_ Incident R?pert )S0c. Wrkz' )othe1'_ Mb At what time: Timi-3 Repefied i Cfiezzt MW Daze oflairtla: Sac. 54 fi_ Namrfi Of Ci $5 1 (uh:-Hm I 'f wfimxafif-I I 3&1 :5 . I 'neg rm . I 233% '79. . c?wi 6&5 5 M: fmflar 'J6/Pdf <> 9 all 3- . [3 .3'/94 A . . End': . vim . . Migw Qim 'fix fl 3' QLEENT COMWAENT amz; REPORT REPORTEB "roxgxfilf Haw SOC. SEC. D: cuem NAME: D.O.B- 3&3/3 NATURE OF COMPLAENT: COMPLAENT: '9 /Eg?zgfikg ?n i "fin? etgawamfi fl?ga?kfia gf?gm 5 Q33 "Ema m_3ififififixzi ms bmk, gm Efifim 3% {Egg an 'mm LMEE. . Jr; mg E5 ma Fmgwua DHS POLICESUPERVESOR om DESK: INCIDENT agmm" WE fii im a SW1 ENTERED mm) LOG BOOK 33 f' L. WAS ms STAFF THE WHO: mm CM NOTATEGNS: WHfiuT TIME: NATU RE .19"fima - Egg 53 Ciifif?f EUR I I 0f 'figs. _m_m ?35 65.53 Rfidfl afi .a}t 'zfirxxa. 5/ 11$. fi?m W?_if "La_Qr:_i if Hi We mama gm>> gage Egg:-; Qavia 1 ?samo if zfi sf 1 . ll u;m~2 mm . e.r%%nL aw fiwfii fizz'? rim" 07?' e/yin fiefj ?"iE3z:g f: 07"" ffa//we (Jog an Client Signature DES Sllpervisor on . . Entered in to 'gag book MN E1mide11iReporEUR . S?affNOtifiEURG:1_ _wm_ W. I - i 'mi 3338; QLIENT COMPEAENT FORM i 7 .1 TEME REPORTED: REPORTED CLIENT NAME Hm 53.0.rxmuag or 54/; 71}: {ma 5355!? 93"? ?fisfe: FM 5554' X78 53.3 fi7>>L-E. 5% ?33} 5.1" 74% cgiftfl EMF: 5/?a 59$ 2% "ma? MA ?3 Mfimiri xx; 5192;; lg gs Q35, .53' Eqfijf /752;/6. 5' as." 58! <30 aw mi; 9&7? bfl?e .3993 MI an ici $33 /as' era [m 3 W3 ., JZ3 Mei' 4" a be 2% @613 Sm: :5 712178 5197Q {ms POUCE supsavzsoaozxz aasx: COMPLAINT ENTERED INTO LOG aoox .75' WHAT TWTE: INCEDENTREPORT WAS DHS STAFF YES, THE WHO: M15: LLANEOUS moTm":oNs: a fi?wr Cfiri. $3s~-trek CLIENTS - CUENT COMHAENT mm DATE: jg" "mv:E REPORTED: REPORTED TO: Pa . CLEENT 3.53.3. QMEP 7 NATURE OF COMPLAINT: COMPLAINT: 1 3? 5 .. fififim? 3? figazaifii. 7 iswx $9 155am: Emma V: 5 5 H3 WW. 6'f'tEURi<< Ma A Mr mag; (ms I I DHS POEJCE SUPERWSOR ON DESK: COMPLAENT ENTERED INTO LOG BQGK WHAT TIME: zwcsagm agpoar it: WAS DHS STAFF IF YES, THE Wm: Mi LANEOUS NS: a 4 fax" Ju?xm raw CLEENTS SIGNATURE: 1 CUENT FORM fl TIME REPORTED: 35903759 I CUENT NAME: 9.0.3. sac. sec. NATURE OF Cowman: /3 COMPLAINT: 533/64, fig A j9~n X'@z f?/gM?4 73 7 mas POLICE sufimvzsoa ON DESK: ENTERED mo LOG BOOK megs): WHAT TIME: REPORT WAS ans STAFF Names? YES, THE ws-so: NOTATEONS: 4 I 305. if Date of biaiilivff '-mfj, /755%, ye>> (gag; . cf gr?'7557'V'Lra?h' :28 '7?7C3;7j 55. 5? 3 flu?fy fl" 3 . /"fig Client I, . . If EH8 Supez'v2s03:'oI1 Duty; Em C0mpIais:11'. in to log book I D?ia-: Inc:idez1tRepo::ii Staff 'N<3tifiEUR:d:_ At what tililfiz Wafkl (jczihisn: /77 - Date gm, geg_/sag is (LI 'ca 3053 I I . 5+ 5% Ozrmefila 6 a an cum?) we -- v} %'1rE\ ea"? CH. .,fl0\ U;-if) V-1 :1 Omaax) (be;LJw rs as 3% 'find 'm JL Ciieslat Signa?ure Supfilfvisfii' on {Em Carrlpiaint ezltered in to leg book )Soc. Wrki' At what iimerm . ifiotestwfi 4w mg. . xgf?awgg" cf DE-ES DutyNaz21r2::_ Dam mi' 39;; 4' Naiu.are oi' I I zi<.1rLA? L, /7 fi,_Q~ .. {ice 46% - I fl rwfj" 5* :5 La fiw?e .H ggfl'13 11k. 7 3? Clfirani Calnpiaint ezzierad. if; K) log back pageszm Report 9" a ff what "timer Jazzy:/m VF we;