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COUNTY OF LOS ANGELES DEPARTMENT OF AUDITOR-CONTROLLER

KENNETH HAHN HALL OF 500 WEST TEMPLE STREET, LOS ANGELES, CALIFORNIA PHONE: (213) 974-8301 FAX: (213) 626-5427
WENDY L. WATANABE
AUDITOR-CONTROLLER

ADMINISTRATION ROOM 525 90012-3873


ASST. AUDITOR-CONTROLLERS

ROBERT A. DAVIS JOHN NAlMO JUDl E. THOMAS

May 12,2011

TO:

Supervisor Michael D. Antonovich, Mayor Supervisor Gloria Molina Supervisor Mark Ridley-Thomas Supervisor Zev Yaroslavsky Supervisor Don Knabe

FROM: SUBJECT:

L. Watanabe Wendy Auditor-Controller


WINGS OF REFUGE FOSTER - A DEPARTMENTOF CHILDREN AND FAMILY PROVIDER FAMILY REVIEW SERVICES

AGEN

We have completed a contract ofcompliance Wings of Refuge review Foster Agency (Wings or Agency), of Refuge a Department and Family of Children Services (DCFS) provider. The purpose of our review was Refuge was providing the services in their Program outlined Statement and contract. We our review Junein completed 2009 and conducted a follow-up March 2010.

DCFS contracts Wings of Refuge, with a private non-profit com organization to and certify recruit, train foster parents for DCFS supervising places in foster care. Once the Agency places the a child, placement until discharged child is the from the of Refuge program. oversees 62 Wings certified foster in which homes 162 DCFS children the time were of at our placed review. of Refuge is located in the Wings Second Fifth and Districts. DCFS paid of Refuge approximately $3.6 million during Year 2009-1 Fiscal 0.
Results of Review

The foster childrenthat they indicated enjoyed living with their the foster foster parents the services indicated that they received the Agency from generally The Agency also staff possessed ensured that the require their expectations. education and work experience, conducted and hiring provided clearances, ongoing
Help Conser\/c Paper -- Print Do~rDle -Sided "To Enrich Lives Through Effective and Caring

Service"

Board of May 12,2011 Page 2 training always Department

Supervisors

for staff the working on County contract. However, of Refuge did Wings not ensure that foster with other County contract homes complied and California of Social Services' 22 regulations. (CDSS) For Title example:

homes reviewed in 2009 did not adequately One (13%) of the eight foster This issue also noted was in potentially dangerous cleaning solutions). (e.g., items our Wings of Refuge contract review August report issued on 4, 2008. During our follow-up review adequately in review 2010, the secured three revisited we homes potentially from our dangerous indicates

orig

Wings of Refuge's attached response the requirements parents during home inspections. to foster Two (25%) disaster of emergency of plan

tha

the eight reviewed in 2009 did not have foster homes a in addition, one home did not have In the home. a readily contacts.

written available

During our follow-up in review the three 2010, plan and emergency numbers Wings of Refuge's compliance

homes we revisited had a disaster readily available. indicates inspections. that a smoke bedroom.

attached response during monthly home foster leading

the

One (13%) of the eight detector in the hallway During our follow-up smoke detectors in the Wings of Refuge's smoke detectors

reviewed in 2009 did not have homes to the children's

in review the three 2010, homes we revisited had operable hallways to theleading children's bedrooms. attached response arehome inspections. operable indicates during that

the

One (13%) eight of the foster homes reviewed in 2009 had a safety for the safety bars on the children's windows that was obstructed bedroom by making it difficult to escape an emergency. In addition, children who of in case the slept in the bedroom did not release to know how the safety device. also noted in our report August 4, 2008. issued on During our follow-up in 201 review 0, did not have safetyon the windows. bars Wings of Refuge's inspections to attached ensure the foster

release the

Th

family new had home to a moved that

response they will safety devices

indicates complete are not

that safety obstructe

Board of May 12, 201 1 Page 3

Supervisors

Five (63%) of the eight foster homes in 2009 reviewed were not assessed of Refuge to theensure foster parents could than two children. care for more At time of our review, homesthree three of the had childrentwo homes had four and children. This alsoissue in our report issued on was noted August2008. 4, During our follow-up appropriately inreview we confirmed the foster 2010, assessed.
that they

the

homes
will

were

Wings of Refuge's response indicates attached assessments as required.

comple

One (13%) of the eight foster homes reviewed in 2009 had two children sharing bedrooms youths. Subsequent to our with adult review, we confirmed youths now room a share and foster children share a room. the During our follow-up sharing rooms
Wings compliance of

review we confirmed in 2010, the home had children that age appropriate children. with other
attached meetings. response and ensure indicates

Refuge's staff placement during

Five (22%) of the case 23 files children's DCFS social workers children's progress. 2008. During our follow-up had documentation monthly updates. phone
Wings document of

in 2009 reviewed not have did documentation were provided with This noted in issue our report was also issued

monthly on

reviewthe ten in additional0, 201 children's that DCFS social the children's worker was
response workers.

case provided

Refuge's attached and provide to DCFS social updates monthly

indicates

Five (22%) 23 case files the of children visited weekly were three months of issued on August 4,2008. During our follow-up had documentation
Wings document of

reviewed in 2009 did Wings of by Refuge's placement as reviewthe ten in additional0, 201 that they were

not

have social required.

documentation workers d This issu case

children's visited weekly.

Refuge's attached that they as required. the visit

response children

indicates

Board of Supervisors May 12,2011 Page 4 Two (9%) of the 23 case in 2009 files not have did reviewed Special Incidents Reports (SIR) although the files had documentation Agency to prepare the reports. This also noted in our report issue was issued on August 4,2008. During our files reviewed prepared the SIR.
Wings of Refuge's workers.

follow-up 2010, one review the ten of additional (10%) in case children's the Agency to required prepare SIR and the Agency appropriately a
attached response indicates that

One (4%) of the 23 Needs and Services Plans (NSPs) in 2009 three reviewed was months past due and five (21%) NSPs have goals not reviewed were that did measurable andthe specific to child. These were alsoissues noted our in report issued on 4,2008. August During our follow-up did not have goals (20%) of the 10 NSPs were reviewof the 10 additional in 2010, two NSPs (20%) that were to the measurable addition, twoand child. In both prepared late. two months
response that they willindicates are NSPs ensure

review speci

Wings of Refuge's attached prepared and timely. properly

Four (40%) ten children the of reviewed that were taking in 2009 psychotropic medications not have did required documentation the of monthly prescribing inphysician case their files. the foster However, parents both the and children indicated were taking that they their medication were seen monthly and by the prescribing physician. also notedThis was in our issue issuedAugust report on 4, 2008. During taking prescribing our follow-up review in 2010, psychotropic we confirmed they were seen medication, physician. all were nine monthly

addition by t

Wings of Refuge's attached response documentation the physicianof evaluations and monitor to

indicates tha ensure compliance.

Eight (35%) of the 23 children reviewed received initial in 2009 dental examinations late an average 48 days. In addition, by of two (9%) children receive examinations by an average of 16 days. late This was also noted in our report issue issued on 4,2008. August

Board of Supervisors May 12,2011 Page 5 During our follow-up reviewed received one (10%)child was over time of our review. two (20%) of the 10 2010, review in additional children initial medical an average 59 days and examination of months late for theirthe initial at
children that

an four

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

Two social workers an average of 18 carried cases and eachone supervisor 10 cases and supervised six social workers, which the maximum is more caseload allowed. This also noted in our was issue report issuedAugust 4, 2008. on During our 17 cases each. follow-up in 2010, review three social workers of still

tha

carr

Wings of Refuge's workers and supen/isors and

attached response they are hiring indicatesadditional that will monitor compliance during

we

Details of

our

review,

along

with

recommendations

for

Review of Report

We discussed our report with December 1, 2010.ofIn their attached on Wings Refuge response (Attachment of Refuge I), Wings management the actionsindicates the Agency has implement the recommendations. We also notified to taken DCFS the of results of our review. In their response II), DCFS indicates (Attachment they wi monitor the Agency for compliance with our recommendations. We thank review. Chadwick Wings of Refuge Please if you call me have any (213) 253-0301. at management assistance for and questions your staff or may

their duringcoope Don contact

Attachments c: William T Fujioka, Chief Executive Officer Jackie Contreras, Ph. DCFS Interim D, Director, James Smith, Chair, Board of Refuge of Directors, Wings Renee Moncito, President and CEO, Wings Jean Chen, Community Care Licensing Public Information Office Audit Committee

of

Refu

FOSTER WINGS OF REFUGE FISCAL

FAMILY AGENCY FOSTER FAMILY YEAR 2009-10

PROGRAM AGENCY

BACKGROUND

The Department of Children and Family Services (D Family Agency (Wings Agency)of or a negotiated Refuge monthly rate, placement, established the California by Department of Social Service Care Rates Bureau. Based on the child's age, Wings of Refuge receives betwe $1,430 $1,679 per month, and per DCFS paid child. Wings of Refuge approximately $3.6 million during Fiscal Year (FY) 2009-10.

PURPOSEIMETHODOLOGY

The purpose of our review was to determine was providing whether the services in their outlined Program andStatement the County We reviewed contract. certified foster parent files, children's and interviewed case files, thepe Agency's staff. visitedWe also a number of certified foster homes children and the foster parents. We completed 2009conducted review June and our a follow-up review in March 2010.

BILLED SERVICES Objective


Determine County whether of Refuge Wings provided contract and CDSS Title 22 regulations. program in accordance services with

th

Verification

We visited of the 62 Los Angeles eight County certified that Wingsfoster of hom Refuge DCFS in February billed and and interviewed eight foster March 2009 parents and 19 foster children eight homes. In addition, reviewed case in the placed we files for eight foster andparentschildren we reviewed the Agency's monitoring activity. 23 and During 2010, we revisited March three homes and files. case reviewed additi

Results
Wings contract Needs information. dental Agency

of Refuge ensure needs that to foster in compliance homes are with the C CDSS Title and 22 regulations and that foster parent and children's and Services Plans (NSPs), have all and required the Termination In addition, the Agency to ensure needs that children's initial examinations and NSPs that arechildrenvisited by the and are completed timely worker as required. social Specifically, the following: we noted

AUDITOR-CONTROLLER COUNTY OF LOS ANGELES

Wings of Refuge Foster Family Agency

Pane 2

Foster
o

Home

Visitation

One (13%) eightof the foster homes reviewed in 2009 did not adequately (e.g., issue also noted in was potentially dangerous cleaning solutions). This items our Wings of Refuge contract on review 2008. report August 4, issued During review our follow-up in 2010, the three review adequately secured homes we revisited from our original potentially dangerous in 2009 had documentation had

One (13%) the of eight foster homes tub and shower. to our review, Subsequent the tub and shower were refurbished.

reviewed Agency provided the homes we revisited

During our follow-up2010, the three in review that were cleanmaintained. well and
0

bathrooms

One (13%) of the eight foster homes in 2009 had reviewed several vacuum c obstructing the hallway the children'sleading bedroom to In addition, bathroom. and the home's was filled patio with tools and equipment, pass it difficult to from making the living area out to the patio. was also noted in our This issue report issued on August 4, 2008. Subsequent review, our to the Agency reported parents the hallway and cleared patio. During our follow-up 0, the three in 201 review and backyards were clear that and free homes we revisited had passageways of obstruction. not did have a a readily written available

Two (25%) the of eight foster homes reviewed in 2009 disaster in the home. In addition, one home did not have plan of emergency contacts as required. During plan our and follow-up2010, in emergency review three the numbers

homes readily not have did to

we revisited available. a smoke

One (13%) eight foster of the homes reviewed in 2009 detector in the hallwaychildren'sleading the bedroom. During smoke our follow-up detectors hallways in the

review in 2010, had operablethree the theleading children's to bedrooms.

ho

* One

(13%) eightof the foster homes 2009 had reviewed a safety for the in release safety bars on the children's that was bedroom windows obstructed by making it todifficult in case escape of an emergency. In addition, childrenthe who slept in the bedroom did not know how the to release device. safety This also noted report our in issued on August 4, 2008.

the

issu

AUDITOR-CONTROLLER COUNTY O F LOS ANGELES

Wings of

Refuge

Family Agency Foster follow-up bars

Page 3

During our did not have safety Foster


o

0, the foster in family 201 to a new review had home that moved on the windows.

Parent

Certification

Five (63%) eight of the foster reviewed in 2009 homes were not assessed by Wings of Refuge to ensure the foster more parents children. At the care for two than could time of our review, three had three of the children homes two homes and had four children. This also noted in our issue was report August 4, 2008. issued on During our appropriately follow-up 2010, we review in confirmed assessed. that the foster

ho

One (13%) of the eight fosterreviewed in 2009 had two children homes sharing bedrooms with adult youths. Subsequent towe our confirmed review,the adult that youths now share a room the and foster children room. share a During rooms One contain annual our follow-up2010, we confirmed the home had children in review with age appropriate other children. (13%) eight the of foster parent documentation foster the parent that continuing education sharing

reviewed in 2009 certification did files not completed 15 hours the of required training. foster education Plans parents training.

During our follow-up completed the required Children's Case Files


0

in review the five 2010, additional annual continuing and Needs and Services

Five (22%) of the 23 incase 2009 files did children's DCFS social workers provided were children's progress. This issue also noted in our was 2008.

not reviewed have documentation with monthly the on updates report issued on August 4,

During our follow-up ten additional review in 2010, case files children's the reviewed had documentation the children's DCFS social worker was that provided monthly phone updates. Five (22%) 23 case the files of reviewed children were visited weekly by Wings of three months of required. as placement issued August 4, 2008. on in 2009 did Refuge's workers during social This also noted in our was issue children's not the report

with

have first

During our follow-up 2010, the ten reviewadditional in had documentation visited weekly.they that were

case

A UDITOR-CONTROLLER COUNTY OF LOS ANGELES

Wings of

Refuge

Family Agencv Foster

Page 4

Two (9%) of the files reviewed in 2009 did not 23 case have Special Incid Reports (SIR) files had although documentation the of behavior the Agency to prepare the reports. in our This report issue on issued was al August 4,2008. During our follow-up in 2010, one (10%) the ten additional review of files reviewed required the Agency to SIR and prepare the a prepared the SIR. reviewed One (4%) 23 NSPs of the five (21%) NSPs reviewed have goals the child. These were also noted in our issues

children's Agency appropriat months to

in 2009 was three that did were andmeasurable not specific report issued August 4, 2008. on the 10 additional to theaddition, In child. late.

During our follow-up in 2010, two (20%) review of did not have goals were measurable and specific that (20%) of the 10 NSPs both prepared two months were Medical Services

NS two

Four (40%) of the ten in children 2009 were taking that reviewed psychotropic medications did not have required documentation the prescribing inphysician case their files. However, and the both the fo children indicated that they were were taking and seen monthly their medica by the prescribing physician. also noted in ourissue issued on August This report was 4, 2008. During taking prescribing our follow-up2010, all nine in review additional psychotropic we confirmed medication, they physician.

children reviewed were the seen mo

Eight (35%) of the 23 in 2009 children received reviewed initial dental late by an average In addition, two (9%) 48 days. of children received examinations by an average days. of 16 issue also noted in our report late This was issued August 4, 2008. on During reviewed one (10%) time of our Termination Eight closing also follow-up 2010, two (20%) in review received an initial child was over four review. Reports (32%) 25 Termination the of Reports 2009 did in reviewed not include summaryAgency's placement of the as records required. This issue noted in our report issuedAugust 4, 2008. on our

initi

the of additional 10 children medical an average of 59 days examination and months late at the for their

AUDITOR-CONTROLLER COUNTY OF LOS ANGELES

Wings of Refuge Foster Family Agency


During our follow-up had an appropriate in 2010, the 13 additional review summary. closing Termination

Pane 5
Reports

Recommendations Wings of Refuge management ensure:


1.

Staff adequately monitor homes to ensure they comply with the foster County contract and CDSS Title 22 regulations. Foster parents adequately secure cleaning solutions and other that could pose a potential hazard to children. safety Foster homes are safe and well-maintained in accordance with the County contract and CDSS Title 22 regulations. Foster posted. parents have written emergency plans and emergency numbers items

2. 3.

4. 5.

Foster homes have operable smoke detectors in the hallways leading to the children's bedrooms. Window safety devices are not obstructed by beds or other children know how to operate the devices. Foster home assessments are completed two children are placed. items and

6.

7.
8.

homes when more than for

Foster homes obtain exception Community Care Licensing from before foster share a bedroom with anyone over the age of 18. children Foster parents complete the required annual continuing education training. monthly the children's regarding

9.

10. DCFS social workers are updated progress.

11. Children are visited Agency social workers weekly during the first by three months placement and twice a month of the first three after months of placement. 12. Special

Incidents are prepared when required. Reports

13. NSPs are prepared within the required timeframes, contain goals are specific, measurable, and time-limited, and are approved by the DCFS social worker.
AUDITOR-CONTROLLER

tha

Wings of Refuge Foster Family Agency

Page 6

14. Children taking psychotropic medications are seen monthly by the prescribing physician. 15. Children's initial 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 billed to DCFS.


Verification

the program whether

participants the services received that

Wings

of

We eight
Results

interviewedchildren placed in eight 19 foster to confirm parents the

Wings services

of Refuge homes and certified the Agency billed

to

The foster their

foster children indicated with that their they foster parents the services indicated that they received expectations.
Recommendation None. STAFFINGICASELOAD LEVELS

enjoyed and the parents from the

living Age

Obiective

Verify that Wings and that supervising the as required by the County
Verification

of Refuge social exceed 15 placements caseloads not workers' social not worker does supervise than six more social workers contract and CDSS Title 22 regulations.

We interviewed of Refuge's Wings payroll records Agency's for the

administrator and reviewed caseload statistics and social workers and supervising

AUDITOR-CONTROLLER COUNTY OF LOS ANGELES

Wings of Refuge Foster Family Agencv

Page 7

Wings of Refuge not always is complying with caseload requirements. the maximum Specifically, Agency social two workers an average 18 cases each carried of the during months reviewed In addition, one supervisor carried 10 cases and supervised 2009. in six social workers one of the months reviewed. This during issue also noted in our was report issued on August 4,2008. During cases. our follow-up in 2010, review three social workers of 17 still carried

Recommendations Wings of Refuge management:

17. Ensure that social workers and supervisors not have more cases do than allowed by CDSS Title 22 regulations.
18. Hire additional social workers and staff exceeds the maximum

and

if the supervisors of cases number number allowed.

STAFFING Objective

QUALIFICATIONS

Determine whether of Refuge's Wings staff possess workthe experience education qualifications required by their County and CDSS Title 22 regulations. In contract addition, determine the Agencywhether conducted hiring clearances staff and provided ongoing staff. training to
Verification

We interviewed of Refuge's Wings administrator and reviewed each staffs personnel file for documentation to confirm their and work experience education qualifications, hiring clearances and ongoing training.
Results

Wings of Refuge's administrator, social worker, supervising and workers social possessed the required education and work experience. In addition, the Agency conducted hiring prior to hiring clearances their staff and provided staff working County on the contract.
Recommendation None.
AUDITOR-CONTROLLER

ong

Wings of Refuge Foster Family A ~ e n c y PRIOR Objective Determine the status of the monitoring review. Verification We verified whether the outstanding review implemented. The were report Results The August2008 monitoring 4, implemented 10 recommendations However, the Agency has not 2008 monitoring report. Recommendation recommendations 2006-07 FY wasAugust 4, 2008. on issued recommendations FOLLOW-UP YEAR

Page 8

reported

in

the

monitoringthe from

had report 24 recommendations. The Agency fully and partially implemented implemented 12 recommendations the August 4, from

19. Wings of Refuge management implement recommendations from August 4, 2008 the monitoring report.

the

outstandin

AUDITOR-CONTROLLER COUNTY OF LOS ANGELES

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Attachment I Page 5 of 5

Attachment II Page 1 of 2

County of Lo8 Angekr DEPARTMENT OF CHILDREN AND FAMILY SERVICES


932()?O W a PIrc Tr

S e 2l8,El &ah, C a l k c - ~9t731 ~


I&?i%M m . V m

TO:

Eli~abs

Out d Home Cere ManagementD i v M Foslw Family AgenCsyIGraup MMne Perfwmirnca Managemen! DCFS RESPONSE TO THE AUDITOR COIJfftOtLrm'S COHTRACT REVIEW OF WIiNGS OF REFUGE FOSfER FAMILY AGE#CY

A C mbn

The Audw~rConttdlet's (A-C) C~RtfacZR w h v of Wlngs of h h g a fos;ber Family AxJ-y was cenducted during May and 3w# 2090. On !3eoembev 14. 2010, ttre A-C snfonned the Out of Home Cam Managpmmt Oivtaipn [OHCMD) that Phey a b ~MJucted fellow-up ravkw m March 2010 and pmuided their December 14,2010 flnaf a draft rep& of the cantract mmpllance iwiw induding Weir folbw-up review resuPts. The DCFS monitor r e \ r Mh e rwort on Ee ~ W 2010. l o m 16,

The k C ' s oompliana slnd folW-up reviews found rm egregious f i i n g s whit* rcxe to Ihe level af a r e f e d to the C M d Pro@Hdine. The A-C's May and June 20DB wmpliano8 review mted abut m n e n tindinge. The FFKs Corrective Actian Pian m0e (CAP) dated N a m b e r 30,2010 indicates that their -fling c h a w jusl ptiw to be A-C's compliance review irnpaaed its results. The FFA hss made rwtable i m p r m m ~ d erne the mrnpfiam remw and tha A X ' & follwv-up review mf3eets the FfA's impiementalionof the A-C's r~dmnwndiltrons m ~ sd the areas of c o n m s , except rn t ww i wn in thee areas. Ths A-C's l a i l ~ w v p w noted that ti of the ten reviewed Needs and Service P t m (NSPsS were two mo&k late and haaf goals thal m r e raot child spacifs and maasurable; two 9f the ten revirrwled chiklren r e # M lab i n h l medical exemirzetlana and om child m i w e d a M6 iniM dental examin~~tion; Hltee P~cibll and wiwke~scarried an a al stwmtmn cases, exceeding the maximum number abmcl far tM socW wkericase ratio. The FFA's CAP dated NarcsmBes 20. 2010 indkalr?d that they are hiring addi%mals9cM uuorkere and supewisars and providing c b w suppervision. The A-C apprswsd W Wings of Refuge FFA's CAP.
On De0bmk.r 18, 2010, the DCFS monrtor foltoW up a97 Vtg three rarnaming fmdings. The FFA's administrator informed th% m ~ t u that Itmy have provided extfinsive staff r tralntcrg cin NSPs, mot they are fully ~ i l k i n g mar Accountabifity Report as an inemal

Attachment II Page 2 of 2

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