la audit-wings of refuge foster family agency contract review (may 2011)

8/3/2019 LA Audit-Wings of Refuge Foster Family Agency Contract Review (May 2011)

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C O U N T Y O F L O S A N G E L E SDEPARTM ENT OF AUDITOR-CONTRO LLER

KENNETH HAHN HALL OF ADMINISTRATION500 WEST TEMPLE STREET, ROOM 525LOS ANGELES, CALIFORNIA 90012-3873

PHONE: (213) 974-8301 FAX: (213) 626-5427

WENDY L. WATANABEAUDITOR-CONTROLLER

May 12,2011

TO: Supervisor Michael. Antonovich, MayorSupervisor Gloria MolinaSupervisor Mark Ridley-Thoma sSupervisor Zev YaroslavskySupervisor Don Knabe

ASST. AUDITOR-CONTROLLERS

ROBERT A. DAVIS

JOHN NAlMOJUDl E. THOMAS

FROM: Wendy. WatanabeAuditor-Controller

SUBJECT: WINGS OF REFUGE FOSTER FAMILY EVIEW- A DEPARTMENT OF CHILDREN AND FAMILY SERVICESPROVIDER

We have completed a contract compliance reviewf Wings of Refuge FoAgency (Wings of Refuger Agency), a Departmentf Children and Fam ily Service

(DCFS) provider. The purpose of our review Refuge was providing the services outlinedn their Program Statement contract. We completedur review inune 2009 and conducted a follow-upMarch 201 0.

DCFS contracts withings of Refuge, a private non-profit organ ization to recruit, trainnd certify foster parents for supervisiCFSplaces in foster care. Once the Agency places a chheplacement until the childs discharged from the program. Wingf Refuge oversees2certified foster homesn which 162 DCFS children were pt the time of oureview. Wingsf Refuge is located in the Secondnd Fifth Districts. DCFS

of Refuge approximately3.6 million during Fiscalear 2009-1 0.

Results of Review

The foster children indicatedhat they enjoyed living with their hefoster parents indicated thathe services they received fromhe Agency generallytheir expectations.he Agency also ensured thattaff possesse d the education and work experience, conducted hiring clearances,nd provided ongo

Help Conser\/c Paper --Print Do~rDleSided"To Enrich Lives Through Effective and Caring Service"



Board of Supervisors

May 12,2011

training for staff workingn the County contract. However, Wingf Refuge did

always ensure that foster homes compliedith other County contract and Ca

Department of Social Services' (CDSS) Title2 regulations. For example:

One (13%) of the eight foster homeseviewed in 2009 did not adequately

potentially dangerous itemse.g., cleaning solutions). This issueas also noted in

our Wings of Refuge contract review report issued onugust 4, 2008.

During our follow-up reviewn 2010, the three homese revisited from our

review adequately secured potentially dangerous

Wings of Refuge's attached response indicates the requirements to fosterarents during home inspections.

Two (25%) of the eight foster homeseviewed in 2009 did not have a writte

disaster plan in the home.n addition, one home did not have a readily ava

of emergency contacts.

During our follow-up reviewn 2010, the three homese revisited had a disaster

plan and emergency numbers readily available.

Wings of Refuge's attached response indicates thatcompliance during monthly home inspections.

One (13%) of the eight foster homeseviewed in 2009 did not have a smok

detector in the hallway leading to the children's bedroom.

During our follow-up reviewn 2010, the three homese revisited had operable

smoke detectorsn the hallways leadingo the children's bedrooms.

Wings of Refuge's attached response indicates thatsmoke detectors are operable duringome inspections.

One (13%) ofhe eight foster homeseviewed in 2009 had a safety or the

safety bars on the children's bedroomindows that was obstructed by t

making it difficult to escape in casef an emergency. In addition,he children who

slept in the bedroom did not know howo release the safety device.

also noted in our report issued onugust 4, 2008.

During our follow-up reviewn 201 0, the foster family had moveo a new home

did not have safetyars on the windows.

Wings of Refuge's attached response indicates hey will complete inspections to ensure safety devices are not ob



Board of SupervisorsMay 12, 201 1

Five (63% ) of theight foster home s reviewedn 2009 were not assessedof Refuge to ensurehe foster parents could care for morehan two children. At time of our review, three ofhe hom es had three childrennd two homes had four

children. This issueas also noted in our report issued on Augus t, 2008.

During our follow-up reviewn 2010, we confirmed the foster home s appropriately assessed.

Wings of Refuge's attachedesponse indicates that they will

assessments as required.

One (13%) of theight foster hom es reviewed in 2009 had two children sharbedroom s with adultouths. Subseq uent to our review, we confirmedyouths now shareroom and theoster ch ildren share a room.

During our follow-up review in 2010,e confirmed thathe home had childrensharing rooms with otherge appropriate children.

Wings of Refuge's attached response indicatesnd ensure

compliance duringtaff placement meetings.

Five (22% ) of the3 case files reviewedn 2009 didot have docum entationchildren's DCFS social workers were provided with monchildren's progress. This issue was alsooted in our report issued 2008.

During our follow-up review in 201 0,he ten additional children's chad docum entation that the children'sCFS social worker was pmonthly phonepdates.

Wings of Refuge's attached response indicates

document and provide monthlypdates to DCFS social workers.

Five (22%) ofhe 23 case files reviewedn 2009 did not have docum entchildren wereisited wee kly byings of Refuge's social workers three months of placement as required. This

issued on August 4,200 8.

During our follow-up review in 201 0,he ten additional children's chad docum entation that they were visited weekly.


document that they visit the childrens required.



Board of SupervisorsMay 12,2011

Two (9%) of the 23 case files reviewedn 2009 didot have Special InReports (SIR) although the files had documentationAgency to prepare the reports. This issue waslso noted in our report issued

August 4,2008.

During our follow-up review in010, one (10%) ofhe ten additional childrenasefiles reviewed requiredhe Agency to prepare SIR and the Agency appropriatelyprepared the SIR.

Wings of Refuge's attached response indicates thworkers.

One (4%) of the 23 Needs and Services Plans (NSPs) reviewedn 2009 washreemonths past due and five (21%) NSPs reviewed diot have goals thatere

measurable and specifico the child. These issuesere also noted inur reportissued on August,2008.

During our follow-up review in 2010, two (20%)f the 10 additional NSPs did not have goals that were measurable and o the child.n addition, two(20%) of the 10 NSPs were both prepared two monthsate.

Wings of Refuge's attached response indicateshat they will ensureSPs areprepared properlynd timely.

Four (40%) ofhe ten children reviewedn 2009 that were taking psychotropic

medications didot have required documentation of moheprescribing physiciann their case files. However, bothhe foster parents hechildren indicated that theyere taking their medication andere seen monthly the prescribing physician. This issueas also noted in our report issuedn August4, 2008.

During our follow-up review in 2010, all nine aeretaking psychotropic medication,e confirmed they were seen monthly prescribing physician.


documentation ofhe physician evaluationsnd monitor to ensure compli

Eight (35%) of the 23 children reviewedn 2009 received initial dental examin

late byn average of8 days. In addition, two (9%) children examinations latey an average of 16 days. This issueas also noted in our reportissued on August,2008.



Boa rd of SupervisorsMay 12,2011

During our follow-up review in 2010,wo (20%) of the 10 additional chilreviewed received an initial medical exam inationn average of9 days andone (10%)child was over four months late for their initt the

time of our review.

Wings of Refuge's attached response indicates thathey will ensure childrenmedical and dental exams within the required timeframes.

Tw o social workers carriedn average of 18 cases eachnd one supervisor1 0 cases and supervised six social workers, which is more he maximumcaseload allowed. This issueas also noted in our report issuedn August 4, 2008.

During our follow-up reviewn 2010, three social workers still f17 cases each.

Wings of Refuge's attached response indicates thhey are hiring additionalworkers and supen/isors and will monitor compliance during

Deta ils of our review, along with recomm endations

Review of Report

W e discussed our report with W ings of Refugen D ecember 1, 2010. In their attachedresponse (Attachment I), Wingsf Refuge mana gemen t indicateshe actions thAgency has takeno implemen t the recomm endations. W e also notified DCF S he

results of our review.n their response (AttachmentI), DCFS indicates they monitor the Agency for comp liance with our recomm endations.

W e thank Wings of Refuge management for their nd assistance durinreview. Please calle if you have any questionsr your staff may contactonChadwick at213) 253-0301.

Attachments

c: William T Fujioka, Chief Execu tive OfficerJackie Contreras, Ph. D, Interim Director,CFSJam es Sm ith, Chair, Board of Directors, W ingsf RefugeRenee Moncito, President and CEO, Wings ofJean Chen, Comm unity Care LicensingPublic Information OfficeAudit Committee



FOSTER FAMILY AGENCY PROGRAMWINGS OF REFUGE FOSTER FAMILY AGEN

FISCAL YEAR009-10

BACKGROUND

The Department of Children and Family Services

Family Agency (Wings of Refuger Agency) a negotiated monthly

placement, established byhe California Department of Social

Care Ratesureau. Based on the child's age, Wings of Refuge receives

$1,430 and1,679 per month, per child.CFS paid Wingsf Refuge approximatel

$3.6 million during Fiscal Year (FY) 2009-10.

PURPOSEIMETHODOLOGY

The purpose of our review was to determine whas providing

the services outlinedn their Program Statementnd the County contract.e reviewedcertified foster parent files, children's case files, nd interviewed

Agency's staff. Welso visited a number of certified foster

children and the foster parents. We completed our revieune 2009nd conducted

a follow-up review in March 2010.

BILLED SERVICES

Objective

Determine whether Wingsf Refuge provided program servicesn accordance with

County contractnd CDSS Title 22 regulations.

Verification

We visitedight of the 62 Los Angeles County certified foster hat Wings of

Refuge billedCFS in February and March 2009nd interviewed eight foster parents

and 19 foster children placedn the eight homes. In addition, weeviewed case files

eight foster parentsnd 23 children ande reviewed the Agency's monitoring activity.

During March01 0, we revisited three homes and reviewed ase files.

Results

Wings of Refuge needso ensure that foster homes aren compliance with th

contract andDSS Title 22 regulationsnd that foster parent and child

Needs and Services Plans (NSPs), and Terminatioave all the required

information. In addition, the Agency needso ensure that children's init

dental examinations and NSPs are completed tind that childrenre visited by the

Agency socialorker as required. Specifically,e noted the following:

A U D I T O R - C O N T R O L L E R

C O U N T Y O F L O S A N G E L E S



Wings o f Refuge Foster Family Agency Pane 2

Foster Home Visitation

o One (13%) ofhe eight foster homeseviewed in 2009 did not adequatelypotentially dangerous itemse.g., clean ing solutions). This issueas also noted inour W ings of Refuge contract review report issuedn August, 2008.

During our follow-up reviewn 2010, the three home se revisited from our originalreview adequately secured potentially dangerous

o One (13%) ofhe eight foster home s reviewed in 2009 hatub and shower. Subsequento our review, thegency provided docum entationthe tub and showe r were refurbished.

During our follow-up reviewn 2010, the three homese revisited had bathat were clean andell maintained.

0

One (13%) of the eight foster homes reviewedn 2009 had several vacuumobstructing the hallway leading tohe children's bedroom and bathn addition,the home's patioas filled with tools and equipment, makt difficult to pass fromthe living area out to the patio. This issueas also noted in our reportssued onAugust 4, 2008. Subse quent tour review, the Agency reportedparents clearedhe hallway and patio.

During our follow-up reviewn 201 0, the three homese revisited had passagewaysand backyards thatere clear and free of obstruction.

Two (25%) ofhe eight foster home seviewed in 2009 didot have a writte

disaster plann the home . In addition, one home did not have a readily avaof emergen cy contacts as required.

During our follow-up reviewn 2010, the three home s we revplan and emergen cy numbe rs readily available.

One (13%) of theight foster home seviewed in 2009 didot have a smokdetector in the hallway leading tohe children's bedroom.

During our follow-up review in 2010, the three ad operablesmoke detectorsn the hallways leading tohe children's bedroom s.

* One (13%) ofhe eight foster homes reviewed in009 had a safety releaseor thesafety bars on the children's bedroomindows that was obstructed bymaking it difficulto escape in case of anmergency. In addition, thehildren whoslept in the bedroom did not know how to releasehe safety device. This also noted inur report issuedn August 4, 2008.


C O U N T Y O F L O S A N G EL E S



Wings of Refuge Fosteramily Agency Page 3

During our follow-up review in 201, the foster family had movedo a newome that

did not have safety bars on the windows.

Foster Parent Certification

o Five (63%) ofhe eight foster homeseviewed in 2009 wereot assessed by Wingsof Refuge to ensure the foster parents could careor more thanwo children. At the

time of our review, three of the homesad three childrennd two homes had

children. This issue waslso noted in our report issued onugust 4, 2008.

During our follow-up reviewn 2010, we confirmed that the foster

appropriately assessed.

One (13%) of the eight foster homeseviewed in 2009 had two children sharin

bedrooms with adult youths. Subsequent to our review,e confirmed thathe adult

youths now share a room andhe foster children share aoom.

During our follow-up reviewn 2010, we confirmed the home had children sharin

rooms with otherge appropriate children.

One (13%) ofhe eight foster parent certification fileseviewed in 2009 did n

contain documentation thathe foster parent completed the 5 hours of

annual continuing education training.

During our follow-up reviewn 2010, the five additional foster par

completed the required annual continuing education t

Children's Case Files and Needs and Services Plans

0 Five (22%) of the 23 case files reviewedn 2009 did not have documenta

children's DCFS social workersere provided with monthly un the

children's progress. This issueas also noted in our reportssued on August 4,

2008.

During our follow-up review in 2010, theen additional children'sase files reviewed

had documentation thathe children's DCFS social worker was provided

monthly phone updates.

Five (22%) of the3 case files reviewed in 2009 did not children were visited weeklyy Wings of Refuge's socialorkers during the

three months of placements required. This issueas also noted in our report

issued onugust 4, 2008.

During our follow-up review in010, the ten additional children's ca

had documentation that they wereisited weekly.





Wing s of Refuge Fosteramily Agencv Page 4

Two (9%) of the 23 caseiles reviewed in 2009 did not have Special Reports (SIR) although theiles had docum entation of behaviorheAgency to prepare the reports. This issue wasn our report issuenAugust 4,20 08.

During our follow-up reviewn 2010, one (10%) ofhe ten additional children'sfiles reviewed required the Agency to prepare aIR and the Agency apprepared the S IR.

One (4%)f the 23 NSPs reviewed in 2009 was three mfive (21%) NSPs reviewed did notave goals that were measu rablend spec ific the child. These issuesere also noted in our report issued onugust 4, 2008.

During our follow-up reviewn 2010, two (20%) of the 10 additional did not have goals thatere measurable and specific to the child.n addition, (20%) of the 10 NSP s wereoth prepared two months late.

Medical Services

Four (40%) of the ten children reviewedn 2009 thatere taking psychotropimedications did not have required docum entationheprescribing physiciann their case files. Howe ver, both thnd thechildren indicated that they were taking their nd were seen monthlyy

the prescribing physician. This issue waslso noted in our report issued on August4, 2008.

During our follow-up reviewn 2010 , all nine additional children re

taking psychotropic medication,e confirmed they were seen heprescribing physician.

Eight (35%) of the 23 children reviewedn 2009 received initial dentalate by an average of8 days. In addition, two (9%) children received examinations latey an average of 16ays. This issueas also noted in our reportissued onugust 4, 2008.

During our follow-up reviewn 2010, two (20%) ofhe 10 additional chilreviewed received an initial medical exam inationn average of 59 days andone (10%) child was over four months late for tt the

time of our review.

Termination Reports

Eight (32%) ofhe 25 Termination Reports reviewedn 2009 did not includeclosing summaryf the Agency's placement recordss required. This isalso notedn our report issuedn August 4, 2008.





Wings of Refuge Foster Family Agency Pane 5

During our follow-up reviewn 2010, the 13 additional Termination R

had an appropriate closingummary.

Recommendations

Wings of Refuge management ensure:

1. Staff adequately monitor fosteromes to ensure they comply with theCounty contractnd CDSS Title 22 regulations.

2. Foster parentsdequately secure cleaning solutions and other items

that could pose a potential safetyazard to children.

3. Foster homes are safe and well-maintained in accordance with the

County contractnd CDSS Title 22 regulations.

4. Foster parentsave written emergency plans and emergency numbersposted.

5 . Foster homes have operable smoke detectors in the hallways leadingto the children's bedrooms.

6 . Window safety devices are not obstructed by beds or other itemsnd

children know how to operate the devices.

7. Foster home assessments are completed foromes when more than

two children are placed.

8. Foster homes obtain exceptionrom Community Care Licensing

before foster childrenhare a bedroom with anyone over the age of 18.

9. Foster parents complete the required annual continuing education

training.

10. DCFS social workers are updated monthly regardinghe children's

progress.

11. Children are visited bygency social workers weekly during the first

three months oflacement and twice a month afterhe first threemonths of placement.

12. Special Incidentseports are prepared when required.

13. NSPs are prepared within the required timeframes, contain goals

are specific, measurable, and time-limited, and are approved by the

DCFS social worker.




Wings of Refuge Foster Family Agency Page 6

14. Children taking psychotropic medications are seen monthly by the

prescribing physician.

15. Children's initia l medical and dental examinations are conducted

within the timeframes specified in the County contract.

16. Termination Reports include a closing summary of the Agency's

records related to the child 's placement.

CLIENT VERIFICATION

Obiective

Determine whetherhe program participants receivedhe services that W ings billed to DCF S.

Verification

We interviewed9 children placed in eight Wings of Refuge certifiedomes andeight foster parentso confirm the services the Agency billed

Results

The foster children indicated that they enjoyed ith their foster paren tsnd thefoster parents indicated thathe services they received from the their expectations.

Recommendation

None.

STAFFINGICASELOAD LEVELS

Obiective

Verify that Wings of Refuge social workers' caseot exceed 15 placementsand thathe supervising social w orkeroes not supervise morehan six social workersas required by the County contract and CDS S Title2 regulations.

Verification

We interviewed Wingsf Refuge's administratornd reviewed caseload statistics andpayroll recordsor the Agency 's social workers and supervising





Wings of Refuge Foster Family Agencv Page 7

Wings of Refuge isot always complying with the maximumaseload requirements.Specifically, twogency social workers carriedn average of8 cases each durinhemonths reviewed in009. In addition, one supervisor carried 10 cases and supervised

six social workers duringne of the months reviewed. This issue waslso noted in ourreport issuedn August 4,2008.

During our follow-up reviewn 2010, three social workers still cf 17cases.

Recommendations

Wings of Refuge management:

17. En sure that social workers and supervisorso not have more cases

than allowed by CDS S Title 22 regulations.

18. Hire additional social workers and supervisorsf the numberf casesand staff exceeds the maximum number allowed.

STAFFING QUALIFICATIONS

Objective

Determine whether Wingsf Refuge's staff possess the educationork experiencequalifications required by their Countyontract and CDSS Title 22 regulations. In

addition, determine whetherhe Agency conducted hiring clearancesstaff and provided ongoing training totaff.

Verification

We interviewed Wingsf Refuge's administratornd reviewed each staffs personnelfile for documentationo confirm their educationnd work experience qualificathiring clearancesnd ongoing training.

Results

Wings of Refuge's administrator, supervisingocial worker, andocial workerspossessed the required educationnd work experience. In addition, the Agencyconducted hiring clearancesrior to hiring their staff and provided staff workingn the County contract.

Recommendation

None.




Wings of Refuge Foster Family A ~ e n c y Page 8

PRIOR YEAROLLOW-UP

Objective

Determine the status of the recommendations reported inmonitoring review.

Verification

We verified whetherhe outstanding recommendations from Y 2006-07 monitorreview weremplemented. The report was issuedn August 4, 2008.

Results

The August, 2008 monitoring reportad 24 recommendations. The Agency fuimplemented 10 recommendations and partially implementeHowever, the Agency has not implemented2 recommendations fromhe August 4,2008 monitoringeport.

Recommendation

19. Wing s of Refuge man agem ent implement the ourecomm endations from theugust 4, 2008 monitoringeport.





Attachment I

Page 1 of 5

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Attachment I

Page 4 of 5

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Attachment IPage 5 of 5



Attachment IIPage 1 of 2

County of Lo8AngekrDEPARTMENTOF CHILDREN AND FAMILY SERVICES

932()?Or W a PIrc S e l8,El&ah, C a l k c - ~ ~t731

I&?i%mMVm

TO:

E l i ~ a b sA C mbnOutd HomeCere ManagementD i v MFoslw Family AgenCsyIGraup MMne Perfwmirnca Managemen!

DCFS RESPONSE TO THE AUDITOR COIJfftOtLrm'S COHTRACT REVIEW OFWIiNGS OF REFUGE FOSfER FAMILY AGE#CY

The Audw~rConttdlet's (A-C) C~RtfacZR w h v of Wlngs of h h g a fos;ber FamilyAxJ-y was cenducted during May and 3w# 2090. On !3eoembev 14. 2010, ttre A-Csnfonned the Out of Home Cam Managpmmt Oivtaipn [OHCMD) that Phey a b~ M J u c t e d fellow-up ravkw m March 2010 and pmuided their December 14,2010 lnafdraft rep& of the cantract mmpllance iwiw induding Weir folbw-up review resuPts.The DCFS monitor r e \ rMh e rwort onEleo~mW16, 2010.

The k C ' s oompliana slnd folW-up reviews found rm egregious f i i n g s whit* rcxe toIhe level af a r e f e d to the C M d Pro@- Hdine. The A-C's May and June 20DBwmpliano8 review mted abut mmn0een tindinge. The FFKs Corrective Actian Pian(CAP) dated Namber 30,2010 indicates that the ir -fling c h a w usl ptiw to beA-C's compliance review irnpaaed its results. The FFA hss made rwtable i m p r m m ~ derne the mrnpfiam r e m w and tha A X ' & follwv-up review mf3eets the FfA'simpiementalionof the A-C's r~dmnwndiltronsn m ~ s t he areas of c o n m s , except

in thee areas. Ths A-C's l a i l ~ w v pwiww noted that twin of the ten reviewed Needsand Service P t m (NSPsS were two m o & k late and haaf goals thal m r e raot childspacifs and maasurable; two 9f the ten revirrwled chiklren r e # M lab inhl medicalexemirzetlana and om child m i w e d a M6 iniM dental examin~~tion;nd Hltee P~cibll

wiwke~s arried an a al stwmtmn cases, exceeding the maximum numberabmcl far tM socW wkericase ratio. The FFA's CAP dated NarcsmBes 20. 2010indkalr?d that they are hiring addi%mals9cM uuorkere and supewisars and providingc b w suppervision. The A-C apprswsdW Wings of RefugeFFA's CAP.

On De0bmk.r 18,2010, the DCFSmonrtor foltoW up a97 Vtg three rarnaming fmdings.The FFA's administrator informed th% m ~ t u rhat Itmy have provided extfinsive stafftralntcrg cin NSPs, mot they are fully ~ilking ar Accountabifity Report as an n€emal



Attachment II

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la audit-wings of refuge foster family agency contract review (may 2011)

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