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Audit finds health, safety and regulatory problems among state’s child placement providers

Tabitha Mueller
Tabitha Mueller
Health CareState Government
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State auditors have tasked the Division of Child and Family Services with developing a plan to correct health, safety and regulatory problems plaguing child placement providers that came to light during a recent audit.

The corrective action plan, which was presented to state lawmakers on Wednesday and is due in about three months, will come amid a staffing shortage and increasing stress on Nevada’s foster care system. Specifically, the performance audit of the division — conducted from July 1, 2020, through Dec. 31, 2021 — found that:

  • Of 30 homes inspected, 33 percent had health or safety deficiencies.
  • About 79 percent of foster placements had at least one regulatory violation.
  • The division, children in state custody and providers are all at increased exposure to risk because of inadequate oversight of unlicensed placements, or homes that do not have a licensed foster parent, such as a close relative.

Reviews of unlicensed placements also indicated insufficient or missing documentation and situations that could potentially harm children or care providers. Auditors noted that unlicensed homes are not subject to the same standards as licensed foster care homes.

“We found the majority of placements were sufficiently sanitary and safe. However, child placement providers do not always comply with health, safety, and regulatory standards,” Deputy Legislative Auditor Scott Jones told the Legislature’s Audit Subcommittee on Wednesday. “The division could reduce the risk of harm to children or providers in an unlicensed placement if proper agreements and standards are established.”

Foster care providers must maintain records detailing oversight of medications, and the division is required to complete home inspections and ensure that residents of foster homes receive health assessments. Out of 24 foster homes included in the audit, about 58 percent of home inspection documentation was incomplete or missing. Five homes did not have a tuberculosis test completed for all adults, and four had not tracked or properly filled out medication records.

The report noted that the division has not established a written agreement with unlicensed providers overseeing children in state custody, and home inspection procedures for unlicensed providers are “brief or poorly defined.”

In one instance, Jones said auditors identified an unlicensed placement with “unsanitary and bleak living conditions” that prompted the transfer of children to a different home.

To address the problems, auditors made 10 recommendations to improve oversight of home providers who care for children in state custody. Among them:

  • Communicate the health, safety and regulatory deficiencies identified in the report to providers
  • Ensure staff verify medication administration records are completed per regulations and improve the medication administration template for ease of use
  • Establish a written agreement with unlicensed providers regarding rights and responsibilities for the care of children in state custody
  • Create and implement an inspection checklist for unlicensed placements that is completed on a regular basis
  • Develop and provide documented health and safety standards to unlicensed providers upon the child’s placement.

The division accepted all of the recommendations and must submit a 60-day plan for corrective action on Aug. 1. Afterward, a six-month report on the status of audit recommendations is due on Feb. 1. 

Despite a staff vacancy rate hovering between 33 and 36 percent, Administrator Cindy Pitlock said the division is getting creative about attracting employees, committed to making the necessary changes and increasing the workforce to meet staffing needs.

“We are certainly working … with our HR department, with other divisions within our own department to utilize our resources as best we can to take care of the most acute situations and triage in that manner,” Pitlock said. “Hopefully, someday, there will be light at the end of our tunnel, and that light will be more people to help perform services for the state.”

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