Maryland Department of Human Resources Office of Licensing and Monitoring 311 W. Saratoga Street Baltimore, Maryland 21201 Office: 410.767.7871 Fax: 410.333.8408 Child Placement Agency Report Provider Organization: Martin Pollak TFC, Inc DHR DHR Licensing Agency: Contracting Agency(s): Name of Chief Administrator: Richard Norman Email: License Type: Treatment Foster Care Type of Inspection: Re-licensure Name and Address of CPA Office License DHR Census by Placing License#/ Date of site Capacity Contract Agency Exp. date Inspection Limit Martin Pollak, Inc. Un 80 51 00046 6-22-16 3701 Eastern Avenue Limited 6/26/18 Baltimore, MD 21224 Inspection Summary Number of Records Reviewed: Youth 21 Staff 15 Foster Parent 22 Adoptive Parent 0 3 4 0 Number of Interviews: Youth Staff Foster Parent CPA Office Inspection: Approved Number of ILP Apartments Inspected: NA Number of Foster Homes Inspected: 0 Current COMAR Violation: Yes No X If Yes, list Cited Violation(s) below: Violation(s) Findings Corrective Action Plan: Yes No X If yes, date of CAP: Any Violations During Mid or Re-Licensure Periods: Yes No X If Yes See Report (s) Date(s): NA Complaint Outcome: Re-licensed Current Status of License: Licensing Gary C. Lee 7/12/2016 Coordinator: Date: Email: Richard Berger 7/12/2016 Program Manager: Date: Email:
Maryland Department of Human Resources Office of Licensing and Monitoring 311 W. Saratoga Street Baltimore, Maryland 21201 Office: 410.767.7871 Fax: 410.333.8408 Child Placement Agency Report Provider Organization: Martin Pollak TFC, Inc Licensing Agency: DHR Contracting Agency(s): DHR Name of Chief Administrator: Richard Norman Email: License Type: Treatment Foster Care Type of Inspection: Re-licensure Name and Address of CPA Office License Capacity DHR Contract Limit Census by Placing Agency License#/ Exp. date Date of site Inspection Martin Pollak, Inc. 3701 Eastern Avenue Baltimore, MD 21224 Un Limited 80 51 00046 6/26/18 6-22-16 Inspection Summary Number of Records Reviewed: Youth 21 Staff 15 Foster Parent 22 Adoptive Parent 0 Number of Interviews: Youth 3 Staff 4 Foster Parent 0 CPA Office Inspection: Approved Number of ILP Apartments Inspected: NA Number of Foster Homes Inspected: 0 Current COMAR Violation: Yes No X If Yes, list Cited Violation(s) below: Violation(s) Findings Corrective Action Plan: Yes No X If yes, date of CAP: Any Violations During Mid or Re-Licensure Periods: Yes No X If Yes See Report (s) Date(s): Complaint Outcome: NA Current Status of License: Re-licensed Licensing Coordinator: Gary C. Lee Date: 7/12/2016 Email: Program Manager: Richard Berger Date: 7/12/2016 Email: