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DCFS Assessment and Safety of Child Placements Report
DCFS Assessment and Safety of Child Placements Report
STATE OF NEVADA
Performance Audit
Department of Health and Human Services
Division of Child and Family Services
Assessment and Safety of Child Placements
2022
Legislative Auditor
Carson City, Nevada
Audit Assessment and Safety of
Child Placements
Highlights
Highlights of performance audit report on the Division of Child and Family Services
Division of Child and Family Services issued on
May 4, 2022. Summary
Legislative Auditor report # LA22-14. While overall we found the Division generally complied with requirements associated with child
placements, some improvements can be made. Health, safety, and regulatory standards were not
Background always followed for some providers that care for children in state custody. Additionally, there
The Division of Child and Family Services’ was no evidence that some required background checks and provider assessments were
(Division) mission is to provide support and completed, and some inspections and subsequent corrective action of foster homes were not
services to assist Nevada’s children and families adequately documented. We also found unlicensed homes are not subjected to the same
in reaching their full human potential. The standards of licensed foster homes, but additional measures can help ensure the welfare of
Division provides or oversees a continuum of children placed in these homes. Improved oversight of child placement providers will assist the
services to support children, parents, and Division in ensuring the safety and welfare of children in state custody.
caregivers. The continuum of services includes Foster care payments were accurately and appropriately administered by the Division. We
comprehensive case management, emergency reviewed a representative sample of foster care and specialized payments and found payments
shelter care, foster and relative care, group home were made to verified youth placements at licensed facilities. Additionally, specialized
care, respite care, residential treatment care, and payments were supported by corresponding documentation in the Division’s records. Accurate
independent living services. and justified foster care payments support the financial health of the Division, the State, and
When the Division identifies a child that is in foster care providers.
need of protection due to abandonment or an
unsafe home environment, the Division can
Key Findings
remove the child from the home and place the Child placement providers did not always comply with health, safety, and regulatory standards.
child in licensed foster or unlicensed homes. Of 30 homes inspected, 10 or 33% of homes had health and/or safety deficiencies, and 79% of
foster placements had at least 1 foster care regulatory violation. (page 7)
The Division is responsible for overseeing the
home environment and care provided to children Four foster providers assessed did not comply with medication management requirements
in state custody. The Division also provides established in regulation. Foster care providers are required to maintain records detailing
supplemental payments to support additional provided medication and the date and time administered. Homes evaluated included children on
needs regarding the care of children in licensed antipsychotic and anti-seizure medications. (page 10)
foster homes. Child welfare services are funded After conducting reviews of Division files for 11 unlicensed placements selected for inspection,
primarily by state and federal funds. we found the Division did not have evidence required background checks and home assessments
were completed for some providers. There was no evidence of home inspection documentation
Purpose of Audit for 27% and no evidence of background checks for 45% of unlicensed placement providers
The purpose of the audit was to determine if reviewed. In addition, some emergency placements lacked required Division safety assessments,
Division processes ensure foster care and other including Emergency Placement Checklists (29%) and Confirming Safe Environment
homes for children in state custody are adequate assessments (57%). (page 11)
to ensure the safety and welfare of children. We
also evaluated controls over certain payments We also found that the Division did not always complete home inspection documentation and
supporting children and youth to ensure ensure that all residents of foster homes received required health assessments. Fifty-eight
payments were accurate and appropriate. This percent (14 of 24) of foster home inspection documentation was incomplete, including 2 missing
audit included a review of the Division’s inspection checklists, 7 checklists with inspection criteria not completed, and 10 inspection
activities for the 18-month period beginning checklists with missing or incomplete corrective action plans. Of the 24 foster homes, 5 homes
July 1, 2020, through December 31, 2021. We (21%) did not have a tuberculosis test completed timely for all the adults in the home, and 1
also reviewed child and placement monitoring foster home resident did not have any tuberculosis test on file. (page 12)
activities back to calendar year 2017. The Division has not established a written agreement with unlicensed providers who oversee
children in state custody, and home inspection procedures for unlicensed providers are brief or
Audit Recommendations poorly defined. Additionally, the Division does not provide documentation regarding expected
This audit report contains 10 recommendations home health and safety standards to unlicensed providers. The Division, children in state
to improve Division oversight of in-home custody, and providers are at increased exposure to preventable risk due to inadequate oversight
providers who care for children in state custody. of unlicensed placements. (page 14)
The Division accepted the 10 recommendations. Foster care payments were accurately and appropriately administered by the Division. We
Recommendation Status randomly selected 50 fiscal year 2021 foster care payments of 4,068 total claims and found
payments were accurately calculated, payment records in Unified Nevada Information
The Division’s 60-day plan for corrective action
Technology for Youth (UNITY) agreed to the state accounting system, and special payments
is due on August 1, 2022. In addition, the 6-
were supported by medical documentation. (page 18)
month report on the status of audit
recommendations is due on February 1, 2023.
For more information about this or other Legislative Auditor Audit Division
reports go to: http://www.leg.state.nv.us/audit (775) 684-6815. Legislative Counsel Bureau
STATE OF NEVADA
LEGISLATIVE COUNSEL BUREAU
CARSON CITY OFFICE LAS VEGAS OFFICE
LEGISLATIVE BUILDING GRANT SAWYER STATE OFFICE BUILDING
401 S. CARSON STREET 555 E. WASHINGTON AVENUE, SUITE 4400
CARSON CITY, NEVADA 89701 LAS VEGAS, NEVADA 89101
(775) 684-6800 (702) 486-2800
Legislative Commission
Legislative Building
Carson City, Nevada
This report contains the findings, conclusions, and recommendations from our
performance audit of the Department of Health and Human Services, Division of Child
and Family Services, Assessment and Safety of Child Placements. This audit was
conducted pursuant to the ongoing program of the Legislative Auditor as authorized by
the Legislative Commission. The purpose of legislative audits is to improve state
government by providing the Legislature, state officials, and Nevada citizens with
independent and reliable information about the operations of state agencies, programs,
activities, and functions.
Respectfully submitted,
Introduction .................................................................................................... 1
Background .............................................................................................. 1
Appendices
A. Audit Methodology.............................................................................. 19
Introduction
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Assessment and Safety of Child Placements
Expenditures
Personnel $10,583,434
Program Costs 9,381,946
Operating & Travel 1,414,423
State Cost Allocations 164,313
Information Services 110,547
Purchasing Assessment 2,938
Total Expenditures $21,657,601
Difference $ 1,743,788
Less: Reversion to General Fund (1,621,830)
Less: Budget Reduction to General Fund (121,958)
Balance Forward to 2022 $ -
Source: State accounting system.
(1)
Other revenue includes adjustments and reimbursements.
As of June 30, 2021, the Division had 798 filled positions of 1,065
legislatively authorized positions. The Division’s vacancy rate was
25%. The Division has rural child welfare offices in Carson City,
Elko, Ely, Fallon, Fernley, Pahrump, Tonopah, Winnemucca, and
Yerington.
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Assessment and Safety of Child Placements
Scope and The scope of our audit included a review of the Division’s activities
Objectives for the 18-month period beginning July 1, 2020, through
December 31, 2021. We also reviewed child and placement
monitoring activities back to calendar year 2017. Our audit
objectives were to:
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Health and Safety We found the majority of placements were sufficiently sanitary and
Deficiencies of safe; however, child placement providers did not always comply
Child Placements with health, safety, and regulatory standards. We inspected 30
licensed and unlicensed placements in all Division regions,
including 24 licensed foster care and 6 unlicensed placements. Of
those inspected, 10 or 33% of placements had health and/or
safety deficiencies, and 19 or 79% of foster placements had at
least 1 foster care regulatory violation. An example of a regulatory
violation included providers not maintaining proper medical and
other child records. In placements in which health and safety
standards were not maintained, children were potentially exposed
to conditions that put their health and safety at risk.
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Assessment and Safety of Child Placements
Hazardous Exterior
Chemical Hazard (2) Conditions (2)
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Assessment and Safety of Child Placements
No Child Clothing
Inventory (18)
No Evidence The Division did not have evidence that health and safety
Certain Health assessments were completed for some providers housing children
and Safety in state custody. Additionally, some foster provider home
Assessments inspection documentation was not completed according to policy.
Completed Important health and safety assessments were not completed
timely, leaving children at a higher risk with providers lacking
sufficient preliminary and continuing assessment.
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2 7 10
4 of 10 5 of 10 6 of 10
Inspections with CAPs Lacked CAPs Lacked
Noncompliance Assigned Documented
Lacked CAPs Timeframe for Follow-Up
Correction
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Recommendations
1. Communicate to licensed and unlicensed providers
applicable health, safety, and regulatory deficiencies
identified in this audit report. Periodically inform licensed
and unlicensed providers of common deficiencies identified
in Division home inspections.
2. Generate a list that is routinely updated of all unlicensed
providers that care for children in state custody and their
contact information.
3. Enhance supervisory oversight to ensure staff routinely
verify medication administration records are completed in
accordance with Division policy and regulations.
4. Improve the medication administration template for ease of
use and understandability.
5. Ensure supervisory oversight is performed and documented
for unlicensed placements to ensure Emergency Placement
Checklists, Confirming Safe Environment assessments,
background checks, and home inspections are being
completed timely.
6. Ensure documented supervisory review routinely takes place
of a sample of foster home inspection paperwork to verify
completeness and confirm corrective action plans are issued
and resolved.
7. Comply with policy requiring tuberculosis testing be
completed timely and documented.
8. Establish a written agreement with unlicensed placement
providers regarding rights and responsibilities for care of
children in state custody. Ensure the agreement
acknowledges the Division or its authorized representatives
may perform home inspections.
9. Create and implement an inspection checklist for unlicensed
placements that is completed on a regular basis.
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Appendix A
Audit Methodology
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We used nonstatistical audit sampling for our audit work, which for
these analyses was the most appropriate and cost-effective
method for concluding on our audit objectives. Based on our
professional judgement, review of authoritative sampling guidance,
and careful consideration of underlying statistical concepts, we
believe that nonstatistical sampling provided sufficient, appropriate
audit evidence to support the conclusions in our report. We did not
project the exceptions to the population, because tests were not
intended to be projected.
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Assessment and Safety of Child Placements
Our audit work was conducted from April 2021 to January 2022.
We conducted this performance audit in accordance with generally
accepted government auditing standards. Those standards require
that we plan and perform the audit to obtain sufficient, appropriate
evidence to provide a reasonable basis for our findings and
conclusions based on our audit objectives. We believe that the
evidence obtained provides a reasonable basis for our findings and
conclusions based on our audit objectives.
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Appendix B
Response from the Division of Child and Family Services
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