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: Kennedy Krieger Institute Licensing Agency: DHR Contracting Agency(s): DHR, DDA Elizabeth Thompson Name of Chief Administrator: Email: TFC Quarterly 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 Kennedy Krieger Institute Unlimited SED 50 DHR 56 #00357/ 12/16/2013 2901 Biddle Street Medical 9/16/2014 Baltimore, MD 21213 50 Inspection Summary Number of Records Reviewed: Youth 3 Staff 3 Foster Parent 6 Adoptive Parent N/A Number of Interviews: Youth 0 Staff 0 Foster Parent 0 Approved CPA Office Inspection: Number of ILP Apartments Inspected: N/A Number of Foster Homes Inspected: 0 COMAR Violation: Yes X No If Yes, list Cited Violation(s) below: Violation(s) Findings 07.02.21.10 D (3) 2/3 client records didn’t document foster parent progress notes health history 07.05.02.18 D (6) 2/3 client records didn’t document 1/3 client record immunizations 07.05.02.17 A (3) didn’t document 07.05.02.17 A (1) 2/3 client records physical exam didn’t document 07.05.02.17 A (2) 3/3 client records dental, hearing or vision exams. didn’t document 07.05.01.09 D & 07.05.01.17 D (2) 3/3 personnel records references didn’t document 4/6 foster parent records failed to document timely recertification 07.05.02.16 G (4) 1/6 foster parent record failed to document CJIS clearance on 18 year old 07.05.02.11 E (7) (a) X 12/16/2013 Corrective Action Plan: Yes No If yes, date of CAP: Complaint Outcome: N/A Current Status of License: Continued Licensing Coordinator: Lisa Beeman Date: 12/20/2013 Email: Program Manager: Richard Berger Date 12/20/2013 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: Kennedy Krieger Institute Licensing Agency: DHR Contracting Agency(s): DHR, DDA Name of Chief Administrator: Elizabeth Thompson Email: License Type: TFC Type of Inspection: Quarterly Name and Address of CPA Office License Capacity DHR Contract Limit Census by Placing Agency License#/ Exp. date Date of site Inspection Kennedy Krieger Institute 2901 Biddle Street Baltimore, MD 21213 Unlimited SED 50 Medical 50 DHR 56 #00357/ 9/16/2014 12/16/2013 Inspection Summary Number of Records Reviewed: Youth 3 Staff 3 Foster Parent 6 Adoptive Parent N/A Number of Interviews: Youth 0 Staff 0 Foster Parent 0 CPA Office Inspection: Approved Number of ILP Apartments Inspected: N/A Number of Foster Homes Inspected: 0 COMAR Violation: Yes X No If Yes, list Cited Violation(s) below: Violation(s) Findings 07.02.21.10 D (3) 2/3 client records didn’t document foster parent progress notes 07.05.02.18 D (6) 2/3 client records didn’t document health history 07.05.02.17 A (3) 1/3 client record didn’t document immunizations 07.05.02.17 A (1) 2/3 client records didn’t document physical exam 07.05.02.17 A (2) 3/3 client records didn’t document dental, hearing or vision exams. 07.05.01.09 D & 07.05.01.17 D (2) 3/3 personnel records didn’t document references 07.05.02.16 G (4) 4/6 foster parent records failed to document timely recertification 07.05.02.11 E (7) (a) 1/6 foster parent record failed to document CJIS clearance on 18 year old Corrective Action Plan: Yes X No If yes, date of CAP: 12/16/2013 Complaint Outcome: N/A Current Status of License: Continued Licensing Coordinator: Lisa Beeman Date: 12/20/2013 Email: Program Manager: Richard Berger Date 12/20/2013 Email: