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 Treatment Foster care DHR DHR Licensing Agency: Contracting Agency(s): Richard Norman Name of Chief Administrator: Email: Treatment Foster Care 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 Martin Pollak Un 80 65 3/25/14 00046/ 3701 Eastern Avenue limited June 25, Baltimore, MD 21224 2014 Inspection Summary Number of Records Reviewed: Youth 3 Staff 0 Foster Parent 3 Adoptive Parent N/A 0 0 0 Number of Interviews: Youth Staff Foster Parent CPA Office Inspection: Approved Number of ILP Apartments Inspected: N/A Number of Foster Homes Inspected: 0 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: N/A Complaint Outcome: Continued Current Status of License: Licensing Gary C. Lee 4/27/2014 Coordinator: Date: Email: Richard Berger 4/27/2014 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 Treatment Foster care Licensing Agency: DHR Contracting Agency(s): DHR Name of Chief Administrator: Richard Norman Email: License Type: Treatment Foster Care 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 Martin Pollak 3701 Eastern Avenue Baltimore, MD 21224 Un limited 80 65 00046/ June 25, 2014 3/25/14 Inspection Summary Number of Records Reviewed: Youth 3 Staff 0 Foster Parent 3 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 No X If Yes, list Cited Violation(s) below: Violation(s) Findings Corrective Action Plan: Yes No X If yes, date of CAP: Complaint Outcome: N/A Current Status of License: Continued Licensing Coordinator: Gary C. Lee Date: 4/27/2014 Email: Program Manager: Richard Berger Date: 4/27/2014 Email: