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: PSI Family Services, Inc. DHR DHR/CFSA/DJS Licensing Agency: Contracting Agency(s): Dr. Sheila Pandit Name of Chief Administrator: Email: TFC Mid-Licensure License Type: Type of Inspection: Name and Address of CPA Office License DHR Census by Placing License#/ Date of site Capacity Contract Agency Exp. date Inspection Limit PSI Family Services, Inc Unlimited 58 22 #00302 07/07/2016 8301 Professional Place East, Suite 205 07/09/2017 Hyattsville, Maryland 20785 Inspection Summary Number of Records Reviewed: Youth 10 Staff 6 Foster Parent 6 Adoptive Parent NA 0 0 3 Number of Interviews: Youth Staff Foster Parent CPA Office Inspection: Approved Number of ILP Apartments Inspected: NA Number of Foster Homes Inspected: 3 X Current COMAR Violation: Yes No If Yes, list Cited Violation(s) below: Violation(s) Findings 07.02.21.07 Missing referral information in 1 record reviewed. 07.05.02.17 A(3) Missing immunization record in 3 out of 9 records reviewed. 07.05.02.17 A(2) Missing vision in 4 out of 9 records reviewed. 07.05.02.18 D(8) No educational history or record in 1 out of 9 records reviewed. 07.05.01.08 A(2)(a-c) Agency reporting responsibility. 07.02.21.07 A (2)(d) Missing psychiatric evaluation in 1 out of 9 records reviewed. X 07/15/2016 Corrective Action Plan: Yes No If yes, date of CAP: Any Violations During Mid or Re-Licensure Periods: Yes X No If Yes See Report (s) Date(s): Complaint Outcome: NA Current Status of License: Continued Licensing Sherlema Ferguson 07/15/2016 Coordinator: Date: Email: Richard Berger 07/15/2016 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: PSI Family Services, Inc. Licensing Agency: DHR Contracting Agency(s): DHR/CFSA/DJS Name of Chief Administrator: Dr. Sheila Pandit Email: License Type: TFC Type of Inspection: Mid-Licensure Name and Address of CPA Office License Capacity DHR Contract Limit Census by Placing Agency License#/ Exp. date Date of site Inspection PSI Family Services, Inc 8301 Professional Place East, Suite 205 Hyattsville, Maryland 20785 Unlimited 58 22 #00302 07/09/2017 07/07/2016 Inspection Summary Number of Records Reviewed: Youth 10 Staff 6 Foster Parent 6 Adoptive Parent NA Number of Interviews: Youth 0 Staff 0 Foster Parent 3 CPA Office Inspection: Approved Number of ILP Apartments Inspected: NA Number of Foster Homes Inspected: 3 Current COMAR Violation: Yes X No If Yes, list Cited Violation(s) below: Violation(s) Findings 07.02.21.07 Missing referral information in 1 record reviewed. 07.05.02.17 A(3) Missing immunization record in 3 out of 9 records reviewed. 07.05.02.17 A(2) Missing vision in 4 out of 9 records reviewed. 07.05.02.18 D(8) No educational history or record in 1 out of 9 records reviewed. 07.05.01.08 A(2)(a-c) Agency reporting responsibility. 07.02.21.07 A (2)(d) Missing psychiatric evaluation in 1 out of 9 records reviewed. Corrective Action Plan: Yes X No If yes, date of CAP: 07/15/2016 Any Violations During Mid or Re-Licensure Periods: Yes X No If Yes See Report (s) Date(s): Complaint Outcome: NA Current Status of License: Continued Licensing Coordinator: Sherlema Ferguson Date: 07/15/2016 Email: Program Manager: Richard Berger Date 07/15/2016 Email: