facility_name: The Next Door, Klahre House Residential

summary: 6-month - 15 findings

raw_content:
Licensed Child Caring Agency 6-Month Review Site Visit Report
Residential Care
Licensee: The Next Door, Klahre House Residential Board Chairperson: Ann Harris
Executive Director: Janet Hamada Date of site visit: 11-1-23
Program Director: Melanie Kelly Licensing Coordinator: Irvin Minten, M.S.W.
Other Regulatory or Accrediting Agencies: Oregon Youth Authority (OYA)
Program Compliance: As a part of this 6-month review, as noted OAR, Licensing Umbrella Rules, and Licensing Residential Care
Agency Rules were reviewed.
Program Description(s): The Next Door, Inc. provides services to children and families in the community, including foster care, day
treatment and residential care. The program provides a highly structured, therapeutic environment that emphasizes individual
treatment planning, experiential growth, academic progress and behavior change. The residential care program serves OYA youth. All
youth enrolled in the residential program attend The Next Door’s Day Treatment Program.
Program type and services: The program provides residential care services for youth in OYA custody. Any needed sex offender,
mental health, and drug and alcohol treatment services, as well as Independent Living Program (ILP) and mentoring services, are
provided on-site by staff employed through The Next Door. Educational services are provided on-site by staff employed through the
local school district.
Capacity and Age Range: The program serves males, ages 13-18. The program’s capacity is 5 youth.
Funding sources: OYA
Contracts and sources for referrals: Referrals come from OYA.
Average length of stay: The average length of stay in the program is between 9-18 months.
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Average daily population served: Since opening in May 2023, the program’s average daily population has been about 4 youth. The
program currently has 5 youth.
Number of children served annually: The program estimates it will serve 5 to 7 youth annually.
Use of seclusion or restraint: The program does not utilize seclusion or restraint.
Interviews, Observations: During the 6-month review, 1 program line staff and 2 youth currently enrolled at the program were
randomly selected and individually interviewed. A walkthrough of the facility and the facility’s outdoor area was also completed. During
the review, there was also a great deal of discussion with Asia VanHorn, Program Supervisor, and Dan Foster, Program Manager. The
program’s medication cabinet was also observed.
During individual interviews with the 2 youth, both reported they felt safe in the program, both during the day and at night. Both youth
also reported the program’s staff were sufficiently trained to assist them in meeting their goals and in caring for them. Both youth also
stated they got enough to eat and that they thought the food in the program was good. Both youth also indicated they could make
private calls to persons on their approved contact list, as they could use the program’s land-line phone in one of the program’s main
living areas, without other youth or staff present, and staff would watch them on silent video to ensure they did not make other calls.
Both youth also reported they would not change anything about the program and both stated they liked this program over others they
have been enrolled as this program allowed them the opportunity to go on community outings.
During an individual telephonic interview with 1 program staff, it was reported the program was a good place to work and that they felt
well trained, valued, and appreciated. It was also reported they received sufficient training to effectively do their work and that if an
issue arose, their program’s supervisor was very available to assist and answer questions. This staff also reported that the program’s
management supported continued learning and that if he wanted to learn more about an issue, the program’s management would do all
they could to see that they received training in the area. This staff also stated that since the program had only been in operation for
less than 6 months, the program continued to implement new routine and process, as unique circumstances arose. This staff also
seemed well versed on the program’s behavior management and suicide prevention protocols. This staff also reported that the
program did a great job of meeting each youth’s education and treatment needs and that the program provided good care to each of the
youth.
During walkthrough of the program, it was observed that the house was in a well-maintained middle-class neighborhood and that the
house was a well-constructed and designed, with main living and outdoor areas which were well maintained, welcoming, and in good
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repair. The bathrooms and kitchen also had very nice appliances and fixtures and most of the showers were nicely tiled. The areas
where youth congregated were also nicely painted and included comfortable and nice furniture.
Program Strengths: The program’s supervisor reports they are maintaining best practices in several areas, including having a 30-
minute overlap of staffing at shift change, which allows incoming and outgoing staff opportunity to discuss how each youth is doing. In
addition, the program’s supervisor reports she has frequent discussions with program staff on protocols, what is working well, and areas
in need of improvement. The program’s supervisor and the 1-line staff interviewed also report that program staff provide a high level of
care to the youth, that they want to make a difference in the lives of the youth, and that staff truly care about each of the youth and that
they want the youth to be successful and make needed changes. The program’s manager also reports they are creating a consistent
routine in the program, that the leadership in the program has been “phenomenal,” that the program’s supervisor is readily “available” to
staff, and that the staff in the program feel supported and are well trained.
Program Challenges: Although the program is currently fully staffed, in the first 6 months of operation, the program’s management
reports staffing has been an issue, as interview pools have not been strong and 2 staff quit shortly after hire after they realized the job
was not a good fit. In addition, the program’s management states they have had a couple youth in the program who have been
prematurely discharged due to the youth’s verbal and physical aggression toward staff and other youth.
Changes that have occurred since the program opened: NA
Lawsuits: NA
Grievances and complaints: NA
Corrective Actions and Timeframes: Please submit the following to verify compliance.
Within 45 days of receipt of this report The Next Door, Klahre House Residential must submit a letter of verification indicating the
agency is in compliance with the specific rules cited above and describing how compliance will be maintained going forward. Along
with the letter of verification, the agency must submit any and all specific documentation requested in the body of this report. The letter
of verification and any additional requested documents can be emailed directly to Irvin Minten at Irvin.minten@odhsoha.oregon.gov .
Recommendations: NA
Exceptions: NA
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Changes in License: NA
Summary of Review
Program and Services
Yes No N/A Corrective Actions/Comments
419-400-0020 (2)
Program and services are in scope of X
license
Governance of the Agency
Yes No N/A Corrective Actions/Comments
419-400-0040
(1)(a) Minimum of 5 board members o During this review, the governance of the program was not
X reviewed, as this was closely reviewed prior to the program’s
opening.
(2)(f) Formally evaluate the exec.
X
Director’s performance annually
(2)(g) Approves annual budget X
(2)(h) Obtain and review an annual
independent financial review or audit X
of financial records.
(2)(k) Written quality improvement
X
program
(2)(l) Meeting minutes X
Executive Director or Program
Director Yes No N/A Corrective Actions/Comments
419-400-0040
(3)(a) knowledge of requirements for
providing care and treatment X
appropriate to programs
(3)(g) Approval from BCU o This was reviewed at the time of the program’s opening but
X
was not reviewed again at the time of this review.
Discipline, Behavior Management,
and Suicide Prevention Yes No N/A Corrective Actions/Comments
419-400-0150
(3) Agency uses appropriate and
X
positive methods of behavior
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management and nationally
recognized non-violent crisis
intervention
(3)(b)(C) Agency does not use
chemical and mechanical restraint
X
(excluding medically necessary
devices/prescriptions)
(3)(c) Agency uses appropriate time-
out rooms (adequate space, heat,
light and ventilation and is not X o The program does not utilize time out.
capable of locking) and documents
use in child’s record when applicable
(3)(e) Agency uses seclusion
X o The program does not utilize seclusion or restraint.
appropriately/consistent with policy
(4) Agency has adequate plan in
place to respond to suicidal X
behavior/warning signs
Contractors (if applicable)
Yes No N/A Corrective Actions/Comments
419-400-0120(6)
(a) Agency ensures the contractor
meets the requirements of this rule X o The program does not utilize contractors.
and Chapter 413 division 215
(b)(B) Contract includes the following:
(i) Services provided
(ii) Contractor fees
(iii) Disclosure of information from
contractor to agency
(iv) Lines of authority X
(v) Adherence to rules, including
background check
(vi) Any liability of the agency for acts
of the contractor, rights of indemnity
and limitations on liability
Restraints and Involuntary
Seclusion Yes No N/A Corrective Actions/Comments
419-400-0180
(13)(d) Each child caring agency that
X
submits a report under this section
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shall make its quarterly report
available to the public upon request
at the Child Caring Agency’s main
office and on the child caring
agency’s website if applicable.
Supplemental Information
Yes No N/A Corrective Actions/Comments
Provided by CCA
Documents as indicated on the form
o These areas were reviewed at the time of the program’s
titled “Renewal Licensing Required X
opening but were not reviewed at the time of this review.
Documents”
Documents as indicated on form
titled “Required Financial Documents X
and Information”
All required policies and procedures
X
as identified in the “Umbrella Rules”
All required policies and procedures
as identified in “Agency Type Specific X
Rules”
Physical Plant
Yes No N/A Corrective Actions/Comments
419-400-0090(3)(a) Foster Rights
X o The program does not serve youth in ODHS custody.
Posted (if children in ODHS custody)
419-400-0100(1) Sufficient safe
space, equipment, and office X
equipment
419-400-0230(12) License is posted
X
in common area at each facility
419-470-0020(2)(a) &(c) Buildings • Although the program was found to be in good repair, well-kept
are smoke free, clean and in good and clean, there was some mold in one of the youth’s showers
X
repair where the youth’s shampoo was kept. The program must
ensure there is not any mold in the youth’s showers.
419-470-0020 (2)(d) Rooms are free
of harmful drafts, odors, and X
excessive noise
419-470-0020 (2)(e) Rooms are o 3 of the youth in the program have individual bedrooms and 2
adequate in size and arrangement of the youth share a bedroom. Each of the youth in individual
X
bedrooms have sex offense histories while the 2 youth who
share a bedroom do not have such histories.
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419-470-0020 (2)(f) System provides
a continuous supply of hot and cold
X
water to taps located throughout the
facility
419-470-0020 (2)(h) Building is well
ventilated and room temperature is X
within a normal comfort range
419-470-0030 (1) All parts of the
X
facility ensure the safety of children
Room and Space Requirements
Yes No N/A Corrective Actions/Comments
419-470-0030
(2) There is a separate living room or X
lounge area – 15 SF minimum per
child
(5) There is a separate dining room X
with capacity for ½ of children in care
and 15 SF per child in care
(7) Laundry is separate from living, X
kitchen, and dining areas
(8) Separate storage areas are X
provided for food, kitchen supplies,
utensils, clean linens, soiled linens
and clothing, cleaning supplies and
equip, poisons, chemicals, outdoor
recreational and maintenance
equipment. (Hazardous materials are
properly labeled, in original container
and locked)
(9) Outdoor activity area is protected X o The program’s front and back yards are well maintained.
from vehicles and other hazards and
of a size and availability appropriate
to the age and needs of children in
care
(11) Time-out rooms: Rooms used for X
time out or quiet time must have
adequate space, heat, light and
ventilation and must not be capable
of locking.
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Room and Space Requirements
Bedrooms Yes No N/A Corrective Actions/Comments
419-470-0030(3)
(a) Adequate furnishings and
X
personal items
(b) Separate from rooms used for
dining, living, laundry, kitchen, and X
storage
(c) Meet Oregon Fire Code
X
Requirements
(d) Be an outside room, with a
window that operates as designed. If
the window is modified from its
original design, the fire marshal must X
approve the modification and indicate
this room still meets applicable
Oregon Fire Code.
(d) Ceiling at least 90 inches X
(e) Minimum 60 SF per occupant X
(f) No more than 25 if dorm style X
(g) Permanently wired fixtures X
(h) Window covering X
Room and Space Requirements
Bathrooms Yes No N/A Corrective Actions/Comments
419-470-0030(4)
(a)(A)&(B) 1:8 ratio for toilets and
X
sinks
(a)(D) Hot and cold running water,
soap, and approved hand drying X
options
(a)(E) 1:10 ratio for shower or
X
bathtub
(a)(E) Individual privacy X
(a)(F) Window covering X
(a)(G) Permanently wired fixtures X
(a)(H) Adequate ventilation X
(b)&(c) Wooden racks on floors are
X
prohibited and impervious shower
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mats are disinfected & dried daily be
in good condition and free of mold
Room and Space Requirements
Kitchen Yes No N/A Corrective Actions/Comments
419-470-0030(6)
(a) Used exclusively for storage, food
preparation, dishwashing, and o The kitchen is a very nice area with nice appliances. It also
X
activities related to eating and food contains a large pantry.
preparation activities
(b) Walls, floors are easily cleanable X
(c) Equipment and utensils are easily
cleanable, durable, nontoxic, and X
kept clean
(e) Equipment is easy to clean
X
beneath, between and behind
Furnishings and Personal Items
Yes No N/A Corrective Actions/Comments
419-470-0040
(1) There is a bed with frame, X
(1)(b) clean mattress in good condition,
X
with a minimum thickness of five inches
(1)(c) a pillow in good condition X
(1)(d) a private dresser, closet, or similar
storage area for personal belongings that X
is readily accessible
(2) Linens are in good repair. There
is a waterproof mattress cover or
X
mattress. Linens are appropriate and
towels and washcloths are provided
(3) Bedding is changed weekly or
X
when soiled
(4)&(5) Personal hygiene supplies
X
and appropriate clothing are provided
Food Services
Yes No N/A Corrective Actions/Comments
419-470-0070
(1)(a) Meals are arranged daily,
consistent with normal mealtimes that X
occur during the hours of operation
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and provide snacks between
mealtimes
(1)(b) Menus are prepared in
advance in accordance with USDA
guidelines, provide a variety of foods X
and are adjusted for seasonal
changes including snacks
(1)(b) Menus are kept for at least 6
X
months
(1)(c) Drinking water is freely
X
available
(2)(a) Food is stored, prepared &
X
served in a sanitary manner
(2)(c) & (d) Food products are
obtained from commercial suppliers
(exception of fruits & vegetables),
X
unpasteurized juice is prohibited, and
only Grade A pasteurized and
fortified milk in appropriate container.
Residential Care Safety
Yes No N/A Corrective Actions/Comments
419-470-0080
(2) Written emergency plan that o The program’s emergency plan was reviewed prior to the
includes X program’s opening. It was not reviewed during this 6-month
review.
(a) Identifying the types of
emergencies most likely to happen
X
where the residential care agency is
located
(b) Identifying a place to meet for
X
each type of emergency identified
(c) Identifying an alternate shelter if
X
necessary
(d) Ensuring access to necessary
X
medications or medical equipment
(e) How to help each child in care
X
recover after a disaster
(3) Telephone numbers for local
X
police, fire department, poison
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control, after hours medical advice
and other appropriate emergency
numbers must be posted near all
telephones.
(4) Operative flashlights sufficient in
X
number are readily available to staff
(5)(a) Evacuation drill occurs monthly • Since the program opened, the program has not been having
under varying conditions, is retained monthly evacuation drills as, to date, the program has
2 years and contains: documented only 2 drills, in September and October 2023. In
(A) identify of person conducting drill addition, the program’s fire drill log does not contain all
(B) date & time required fields AND staff are sometimes not completing the
(C) notification method X required fields on the form. These fields include: (A) Identity of
(D) staff participating person conducting drill; (D) Staff participating; and (C)
(E) # of children & staff evacuated Problems encountered. The program must ensure that
(F) special conditions simulated monthly evacuation drills are occurring, that their evacuation
(G) problems encountered drill log contains all required fields, and that the evacuation
(H) time to complete drill log is being fully completed by staff.
Umbrella Safety
Yes No N/A Corrective Actions/Comments
419-400-0200
(5)(b) Vehicle has insurance policy, is X o The program’s vehicles were not observed during the 6-month
smoke free, safe operating condition, review, as the program’s transport vehicles were not present.
and has first aid kit and fire
extinguisher 2-A:10-BC
(1)(b)(A) Each vehicle used to X
transport a child in care must be:
properly registered,
covered by an insurance policy in full
force and effect, maintained in safe
operating condition, and smoke-free.
(3) If a child-caring agency has a X o The program does not have a swimming pool.
swimming pool on the premises that
is accessible to children in care or if a
child-caring agency plans to have
children in care engage in swimming,
the child-caring agency must have
and adhere to policies and
procedures that address, at a
minimum, providing disclosures and
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obtaining consents, assessing
swimming ability of children in care,
and ensuring the safety of pool
access.
(4)(a) The program protects children X
from potentially harmful items and
materials.
(4)(b) Direct supervision of children X
who do not have the ability to adjust
and control water temperature
(4)(c) Light fixtures have protective X
covers unless designed to be used
without one
Medication
Yes No N/A Corrective Actions/Comments
419-470-0100
(3)&(7)(e) Medications have a
prescription and are stored in the o The program’s medication cabinet and 2 children’s MARs were
X
original container with prescription reviewed during this review.
label
(4)&(5) Herbal supplements and
remedies, medical treatments,
special diets, physical therapy,
physical aides or limitations have a
written order signed by a physician or
X
qualified medical professional. A
written order, signed by a physician
or qualified medical professional, is
also required before a restriction on
diet or physical activity is imposed.
(7)(c) Medications are inaccessible to • The children’s medications are currently kept in a locked metal
children and stored behind at least storage cabinet and the metal storage cabinet is in one of the
two locking mechanisms. This does X main living areas of the house. The program must ensure that
not apply to Naloxone. medications are stored behind at least two locking
mechanisms.
(8) Medications are disposed in
o The program will be taking medications to their local pharmacy
accordance with state and federal X
for disposal.
law
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(9) Written record of the disposal of
medications is maintained and
includes:
(a) description and amount
X
(b) name
(c) reason
(d) method
(e) staff & witness signature
(10) Written record of the
administration of medication includes:
(a) name
(b) description • The program’s MAR contains all required fields. However, all
(c) dates and times required fields are not being completed. These fields include:
(d) missed doses X (b) description of the medication; and (h) possible adverse
(e) medication disposed reactions. The program must ensure that staff are fully
(f) method of administration completing each child’s MAR.
(g) ID of person administering
(h) possible adverse reactions
(i) medication taken outside facility
Extracurricular, Enrichment,
Cultural & Social Activities Yes No N/A Corrective Actions/Comments
419-470-0110
(2) Children have ongoing X
opportunities to participate in at least
one age-appropriate or
developmentally appropriate activity
Minimum Staffing Requirements
Yes No N/A Corrective Actions/Comments
419-470-0130
(1)&(2) Supervision is adequate for X
the type of program, location, age
and type of children, ability of
supervisor to respond, electronic
back-up systems.
Minimum ratios are maintained:
Under 30 months of age: 1:4
30 months to ˃ 6 years or non-
ambulatory: 1:6
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Ages 6 and older: 1:7
Overnight (staff awake)
1:10
(4)(a) When one staff is on duty, X
there is additional staff immediately
available with max response time of
30 minutes
(5) There is at least one on-site X
employee authorized to apply the
reasonable and prudent parent
standard
Sleeping Arrangements
Yes No N/A Corrective Actions/Comments
419-470-0140
(1) Children are in separate X
bedrooms than adults, unless parent
and child, or there is written approval
from guardian/parent and licensing
coordinator
(2) There is adequate supervision of X
children when sleeping
(3) When assigning bedrooms a X
residential care agency must
consider all of the following:
(a) Chronological age
(b) Developmental age
(c) Gender identity
(d) Personal history, including
medical, mental health, behavioral
health, and past adverse experiences
including any physical or sexual
abuse
Personnel Files
Yes No N/A Corrective Actions/Comments
419-400-0120
Staff Name/Position X o Personnel files were not reviewed during this 6-month review.
(3)(g) Date of Hire X
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(3)(a) record of education, training,
X
and previous employment
(1)(b) & (3)(b) reference checks
X
completed and documented
(1)(a) & (3)(c) Background check
X
completed and documented
(3)(d) Annual performance
X
evaluations
(3)(f) Record of personnel actions X
(3)(g) Termination date, reason for
X
termination
(3)(h) Current job description (1)(c)
Employee meets minimum
X
qualifications stated in current job
description
New Employee Orientation –
Umbrella Requirements (30 days) Yes No N/A Corrective Actions/Comments
419-400-0120(4)
o Employee training records were not reviewed during this 6-
month review. However, the program’s form to track required
(a) Agency policies and procedures X trainings was discussed and there was a great deal of
discussion about how program staff are trained and supported
in their learning.
(b) Ethical and professional
X
guidelines
(c) Suicide prevention and
X
intervention
(d) Attributes of population served X
(e) & (5)(a) to (c) Mandatory
reporting that includes:
(a) legal definition of child abuse in
ORS 418.257 and 419B.005
X
(b) legal responsibility to immediately
report
(c) legal responsibility to report is
personal to the employee
(f) Privacy laws X
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(g) Emergency procedures X
New Employee Orientation
Residential (Prior to working alone
Yes No N/A Corrective Actions/Comments
and within 30 days)
419-470-0120(1)
(a) Discipline and behavior
management including de-
escalation, crisis prevention, positive
X
behavior management, and
disciplinary techniques that are non-
punitive in nature
(b) CPR and First Aid sufficient to
X
retain a current certification
(c) Universal precautions and
X
hygiene
(d) Application of the reasonable and
X
prudent parent standard
(e) Training on the agency’s policy
on suicide prevention and suicide X
risk assessment tool
Crisis Intervention Training
Standards and Certification Yes No N/A Corrective Actions/Comments
419-400-0160(4) (as applicable)
(a)Complete a minimum of 12 hours
of initial training in person from a
certified instructor, including but not
limited to a minimum of six hours of
training focused on positive behavior X
support, nonviolent crisis intervention
and other methods of nonphysical
intervention to support children in
care during a crisis
(d) Receive a certificate that states:
(A) The dates during which the X
certification is current
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(B) The type of restraint which the
individual is certified to perform if
applicable
(C) The type of training the individual
is certified to conduct if applicable
(D) Any special endorsements
earned by the individual
(E) The level of training
(F) The name of the certified
instructor who conducted the training
and administered the assessment of
proficiency.
(e) A certification issued:
(A) Must be personal to the individual
certified by the training provider X
(B) May be valid for no more than
two years with recertification
Ongoing Training Yes No N/A Corrective Actions/Comments
419-470-0070(2)(b) Employees who
handle food served to children have X
a valid food handler’s card
419-400-0200 (1) Employees
transporting children have: current
driver’s license, insurance, trained in
X
emergency procedures and behavior
management, and training for 15+
passenger vans if applicable)
419-470-0120 (2)(a) Environmental
X
emergencies
419-470-0120 (2)(b) Universal
X
Precautions
419-470-0120 (2)(c) Discipline and
X
Behavior Management
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419-470-0120 (2)(d) Agency’s policy
on suicide prevention and risk X
assessment tool
419-470-0120 (3) Staff providing
direct care must maintain current X
CPR/First Aid certification
419-470-0120 (4) Designated staff
authorized to apply reasonable and
X
prudent parent standard are trained
in application of the standard
419-400-0120(5) Mandatory
reporting (annually) that includes:
(a) legal definition of child abuse in
ORS 418.257 and 419B.005
X
(b) legal responsibility to immediately
report
(c) legal responsibility to report is
personal to the employee
419-400-0160(4)(b) Receive
continuing education (as applicable
on crisis intervention training) from a X
certified instructor on an annual
basis
Comments:
Children’s Records Yes No N/A Corrective Actions/Comments
Health Services
419-470-0090
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(2) Medical history obtained within 30
days (significant findings, current
immunizations, history of surgical
procedures-health issues-injuries, X
allergies, dental, vision, hearing,
behavioral health, and physician
orders)
(4)(a) to (f) Medical exams (3 in first
year of life, 2,4,6,9,14) X
(g) Have a physical examination
within the first 60 days after
admission of a child in care.
Documentation of a physical X
examination having occurred within
the calendar year will meet this
requirement.
Consents
Yes No N/A Corrective Actions/Comments
419-470-0160(1)
(a) Provide routine and emergency
X
medical care
(b) Use the discipline and behavior
X
management system
(c) Use restraint or seclusion (if
applicable). Must specify the reasons
X
for the intervention and how staff are
trained and supervised
(d) Restrict contact with persons
X
outside of the agency
• The program does not have a consent stating that the program
(e) Allow access as defined in 419- will allow access as defined in 419-400-0230 and 0240. The
X
400-0230 & 0240 program must have a consent stating that the program will
allow access as defined in 419-400-0230 and 0240.
(f) Impose a dress code X
• The program does not have a consent that it will apply the
(g) Apply the reasonable and prudent reasonable and prudent parent standard. The program must
X
parent standard have a consent that it will apply the reasonable and prudent
parent standard.
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Disclosures
419-470-0160(2)
Yes No N/A Corrective Actions/Comments
Parent/guardian has acknowledged in
writing:
• The program does not have a disclosure regarding personal or
(a) Information regarding personal or
room searches and protocols for confiscation of contraband.
room searches and protocols for X
The program must have a disclosure regarding personal or
confiscation of contraband
room searches and protocols for confiscation of contraband.
(b) Statement of Rights of Children
X
and Parents/Guardians
(c) Any policies and procedures upon
X
request
Authorizations
Yes No N/A Corrective Actions/Comments
419-470-0160(3)
(a) Disclose or exchange information
X
with others
(b) Child specific visitors X
• Although the program is documenting approved visitation
resources for each youth in the program, the program does
(c) Visitation resources are pre- not have an authorization that all visitation resources must be
X
approved pre-approved. The program must ensure that they have an
authorization that all visitation resources must be pre-
approved.
• The program does not have a pre-approved authorization to
(d) Activity specific authorizations are
allow children to participate in potentially hazardous activities,
pre-approved to allow children to
including but not limited to hiking or using motorized yard
participate in potentially hazardous
X equipment such as lawnmowers. The program must have a
activities, including but not limited to
pre-approved authorization to allow children to participate in
using motorized yard equipment,
potentially hazardous activities including but not limited to
swimming, and horseback riding.
hiking or using a motorized lawn mower.
Information about Children in Care
419-400-0190(1)
Yes No N/A Corrective Actions/Comments
Summary sheet contains the
following:
• The program’s summary sheet does not include an area to list
(a)The name, gender, date of birth,
the previous address for the child. Also, although the
religious preference, and previous X
program’s summary sheet includes an area to document a
address
child’s religious preference, the program’s staff are not
P age 20 | 24
Form Rev. 08/03/2023
providing documentation in the allowed area. The program’s
summary sheet must include an area to indicate the child’s
previous address and the program’s staff must complete all
required fields on the program’s summary sheet, including the
child’s religious preference, if applicable.
(b) Name and location of previous
X
and current school
(c) Date of admission X
(d) Legal custody X
(e) The name, address, and
telephone number of:
(A) The child in care's parents.
(B) The child in care's legal
• The program’s summary sheet does not include an area to list
guardian, if different than the
(c) Other professionals to be involved in service planning (if
parents, and a copy of the
X applicable). The program’s summary sheet must include an
document that provides for his or
area to list other professionals to be involved in service
her authority over the child in care.
planning (if applicable).
(C) Other persons significant to
child
(D) Other professionals to be involved
in service planning (if applicable)
Service Planning
Yes No N/A Corrective Actions/Comments
419-470-0170(2)
o The program’s intake, assessment, and service plans were
(b) Intake document is completed the reviewed. All documents were completed within required
date child accepted into care X timelines, and they also contained required information. The
(emergency placement 48 hours) program also documented efforts to engage the child and the
child’s parents/guardians in the creation of the plan.
(d) Assessment is completed within
30 days and contains relevant
historical info., current behavioral
X
observations, identified need for
services, and how agency will provide
services
(e) (A)&(B) Service plan within 60
days (parent, guardian and child
X
actively involved). Describes how
child’s issues will be addressed,
P age 21 | 24
Form Rev. 08/03/2023
anticipated outcomes, and reviewed
by child and guardian/parent.
(e)(C)&(D) Service plan is reviewed
quarterly and revised when
X
information indicates other services
should be provided
Case Management
Yes No N/A Corrective Actions/Comments
419-470-0170(3)
(a) Services are documented,
progress toward achieving goals is X
tracked
(c) Discharge summary must include:
(A)Current medications
(B)Name of the physician or qualified
medical professional who prescribed
• The program’s discharge summaries do not include all
each medication
required information. The program’s discharge summaries do
(C)Any outstanding medical or other
not include (A) Current medications of child; (B) Name of the
appointments
X physician or qualified medical professional who prescribed
(D)Summary of the child’s
each medication; (C) Any outstanding medical or other
participation in the program and
appointments; and (E) Results of evaluations. The program’s
progress achieved
discharge summaries must include all required information.
(E)Results of evaluations
(F)Recommendations regarding
services
(G)Discharge destination
(e) Follow up services X
(f) Incident Reports X
Records Relating to Restraint &
Yes No N/A Corrective Actions/Comments
Involuntary Seclusion
419-400-0180 (12) Records X
419-400-0180(13)(e) Each child
• The program is not providing notice regarding how to access
caring agency shall provide notice
the quarterly restraint reports to the parents or guardians of
regarding how to access the quarterly
children in the program. The program must ensure they are
reports to the parents or guardians of X
providing notice regarding how to access the quarterly
children in care in the program. The
restraint report to the parents or guardians of children in the
child caring agency shall provide the
program. The program shall provide the notice upon the child
notice upon the child in care’s
P age 22 | 24
Form Rev. 08/03/2023
admission and at least two times in care’s admission and at least two times each year
each year thereafter. thereafter.
419-400-0190(1) Information o All the children in the program are committed to OYA. As a
provided to children in care relating to X result, the OYA caseworker provides the children with
Restraint & Involuntary Seclusion information regarding 419-400-0190(1).
Financial Records
Yes No N/A Corrective Actions/Comments
419-470-0170(4)
• The program is not maintaining an updated financial record for
each youth in the program. The program’s financial record
form also does not include all required fields, or the financial
Records contain date, amount, record form is not being fully completed. The program must
X
source, purpose, signatures ensure that each youth in the program has an updated
financial record and that the program’s financial record form
contains all required fields and that all required fields are
being fully completed by program staff.
Personal Possessions Records
Yes No N/A Corrective Actions/Comments
419-470-0170 (5)
• The program is not maintaining an updated written inventory
Individual written inventory of all
of each child’s personal possessions. The program must
personal possessions is maintained X
ensure they are maintaining an updated personal possessions
and updated as needed
inventory for each child in the program.
Records and Documentation
Yes No N/A Corrective Actions/Comments
419-400-0140
(1) Stored safely X
(2) Permanent, legible, dated, and
X
signed
(3)&(4) Uniform in organization,
readily identifiable and accessible,
current, and complete, containing all X
required info. No eraser tape or white
out.
(7) Permanent registry for each child
includes:
Name
Gender X
Birth date
Names, addresses of parents or
guardians
P age 23 | 24
Form Rev. 08/03/2023
Dates of admission
Placement upon discharge
Comments:
Licensing Coordinator’s Signature: ________________________ Date: ____1_1_/_1_4_/2_0_2_3_______
Manager Review: ______________________________________ Date: _1_1_-1_3_-_2_0_2_3_________
P age 24 | 24
Form Rev. 08/03/2023

agency_name: The Next Door (TND)

licensee: The Next Door, Klahre House Residential

executive_director: Janet Hamada

program_director: Melanie Kelly

board_chairperson: Ann Harris

licensing_coordinator: Irvin Minten, M.S.W.

other_regulatory_agencies: Oregon Youth Authority (OYA)

program_description:
The Next Door, Inc. provides services to children and families in the community, including foster care, day
treatment and residential care. The program provides a highly structured, therapeutic environment that emphasizes individual
treatment planning, experiential growth, academic progress and behavior change. The residential care program serves OYA youth. All
youth enrolled in the residential program attend The Next Door's Day Treatment Program.

capacity_age_range: The program serves males, ages 13-18. The program's capacity is 5 youth.

funding_sources: OYA

contracts_and_referrals: Referrals come from OYA.

average_length_of_stay: The

average_daily_population_served: Since opening in May 2023, the program's average daily population has been about 4 youth. The program currently has 5 youth.

interviews_observations:
During the 6-month review, 1 program line staff and 2 youth currently enrolled at the program were
randomly selected and individually interviewed. A walkthrough of the facility and the facility's outdoor area was also completed. During
the review, there was also a great deal of discussion with Asia VanHorn, Program Supervisor, and Dan Foster, Program Manager. The
program's medication cabinet was also observed.
During individual interviews with the 2 youth, both reported they felt safe in the program, both during the day and at night. Both youth
also reported the program's staff were sufficiently trained to assist them in meeting their goals and in caring for them. Both youth also
stated they got enough to eat and that they thought the food in the program was good. Both youth also indicated they could make
private calls to persons on their approved contact list, as they could use the program's land-line phone in one of the program's main
living areas, without other youth or staff present, and staff would watch them on silent video to ensure they did not make other calls.
Both youth also reported they would not change anything about the program and both stated they liked this program over others they
have been enrolled as this program allowed them the opportunity to go on community outings.
During an individual telephonic interview with 1 program staff, it was reported the program was a good place to work and that they felt
well trained, valued, and appreciated. It was also reported they received sufficient training to effectively do their work and that if an
issue arose, their program's supervisor was very available to assist and answer questions. This staff also reported that the program's
management supported continued learning and that if he wanted to learn more about an issue, the program's management would do all
they could to see that they received training in the area. This staff also stated that since the program had only been in operation for
less than 6 months, the program continued to implement new routine and process, as unique circumstances arose. This staff also
seemed well versed on the program's behavior management and suicide prevention protocols. This staff also reported that the
program did a great job of meeting each youth's education and treatment needs and that the program provided good care to each of the
youth.
During walkthrough of the program, it was observed that the house was in a well-maintained middle-class neighborhood and that the
house was a well-constructed and designed, with main living and outdoor areas which were well maintained, welcoming, and in good
P age 2 | 24

repair. The bathrooms and kitchen also had very nice appliances and fixtures and most of the showers were nicely tiled. The areas
where youth congregated were also nicely painted and included comfortable and nice furniture.

program_strengths:
The program's supervisor reports they are maintaining best practices in several areas, including having a 30-
minute overlap of staffing at shift change, which allows incoming and outgoing staff opportunity to discuss how each youth is doing. In
addition, the program's supervisor reports she has frequent discussions with program staff on protocols, what is working well, and areas
in need of improvement. The program's supervisor and the 1-line staff interviewed also report that program staff provide a high level of
care to the youth, that they want to make a difference in the lives of the youth, and that staff truly care about each of the youth and that
they want the youth to be successful and make needed changes. The program's manager also reports they are creating a consistent
routine in the program, that the leadership in the program has been "phenomenal," that the program's supervisor is readily "available" to
staff, and that the staff in the program feel supported and are well trained.

program_challenges:
Although the program is currently fully staffed, in the first 6 months of operation, the program's management
reports staffing has been an issue, as interview pools have not been strong and 2 staff quit shortly after hire after they realized the job
was not a good fit. In addition, the program's management states they have had a couple youth in the program who have been
prematurely discharged due to the youth's verbal and physical aggression toward staff and other youth.
Changes that have occurred since the program opened: NA

lawsuits:
NA
Grievances and complaints: NA

exceptions:
NA
P age 3 | 24

observations:
, identified need for
services, and how agency will provide
services
(e) (A)&(B) Service plan within 60
days (parent, guardian and child
X
actively involved). Describes how
child's issues will be addressed,
P age 21 | 24

anticipated outcomes, and reviewed
by child and guardian/parent.
(e)(C)&(D) Service plan is reviewed
quarterly and revised when
X
information indicates other services
should be provided
Case Management
Yes No N/A Corrective Actions/Comments
419-470-0170(3)
(a) Services are documented,
progress toward achieving goals is X
tracked
(c) Discharge summary must include:
(A)Current medications
(B)Name of the physician or qualified
medical professional who prescribed
- The program's discharge summaries do not include all
each medication
required information. The program's discharge summaries do
(C)Any outstanding medical or other
not include (A) Current medications of child; (B) Name of the
appointments
X physician or qualified medical professional who prescribed
(D)Summary of the child's
each medication; (C) Any outstanding medical or other
participation in the program and
appointments; and (E) Results of evaluations. The program's
progress achieved
discharge summaries must include all required information.
(E)Results of evaluations
(F)Recommendations regarding
services
(G)Discharge destination
(e) Follow up services X
(f) Incident Reports X
Records Relating to Restraint &
Yes No N/A Corrective Actions/Comments
Involuntary Seclusion
419-400-0180 (12) Records X
419-400-0180(13)(e) Each child
- The program is not providing notice regarding how to access
caring agency shall provide notice
the quarterly restraint reports to the parents or guardians of
regarding how to access the quarterly
children in the program. The program must ensure they are
reports to the parents or guardians of X
providing notice regarding how to access the quarterly
children in care in the program. The
restraint report to the parents or guardians of children in the
child caring agency shall provide the
program. The program shall provide the notice upon the child
notice upon the child in care's
P age 22 | 24

admission and at least two times in care's admission and at least two times each year
each year thereafter. thereafter.
419-400-0190(1) Information o All the children in the program are committed to OYA. As a
provided to children in care relating to X result, the OYA caseworker provides the children with
Restraint & Involuntary Seclusion information regarding 419-400-0190(1).
Financial Records
Yes No N/A Corrective Actions/Comments
419-470-0170(4)
- The program is not maintaining an updated financial record for
each youth in the program. The program's financial record
form also does not include all required fields, or the financial
Records contain date, amount, record form is not being fully completed. The program must
X
source, purpose, signatures ensure that each youth in the program has an updated
financial record and that the program's financial record form
contains all required fields and that all required fields are
being fully completed by program staff.
Personal Possessions Records
Yes No N/A Corrective Actions/Comments
419-470-0170 (5)
- The program is not maintaining an updated written inventory
Individual written inventory of all
of each child's personal possessions. The program must
personal possessions is maintained X
ensure they are maintaining an updated personal possessions
and updated as needed
inventory for each child in the program.
Records and Documentation
Yes No N/A Corrective Actions/Comments
419-400-0140
(1) Stored safely X
(2) Permanent, legible, dated, and
X
signed
(3)&(4) Uniform in organization,
readily identifiable and accessible,
current, and complete, containing all X
required info. No eraser tape or white
out.
(7) Permanent registry for each child
includes:
Name
Gender X
Birth date
Names, addresses of parents or
guardians
P age 23 | 24

Dates of admission
Placement upon discharge
Comments

excerpt:
&(c) Buildings
are smoke free, clean and in good
repair • Although the program was found to be in good repair, well-kept
and clean, there was some mold in one of the youth’s showers
where the youth’s shampoo was kept. The program must
ensure there is not any mold in the youth’s showers.

excerpt:
(5)(a) Evacuation drill occurs monthly
under varying conditions, is retained
2 years and contains:
(A) identify of person conducting drill
(B) date & time
(C) notification method
(D) staff participating
(E) # of children & staff evacuated
(F) special conditions simulated
(G) problems encountered
(H) time to complete • Since the program opened, the program has not been having
monthly evacuation drills as, to date, the program has
documented only 2 drills, in September and October 2023. In
addition, the program’s fire drill log does not contain all
required fields AND staff are sometimes not completing the
required fields on the form. These fields include: (A) Identity of
person conducting drill; (D) Staff participating; and (C)
Problems encountered. The program must ensure that
monthly evacuation drills are occurring, that their evacuation
drill log contains all required fields, and that the evacuation
drill log is being fully completed by staff.

excerpt:
(7)(c) Medications are inaccessible to
children and stored behind at least
two locking mechanisms. This does
not apply to Naloxone. • The children’s medications are currently kept in a locked metal
storage cabinet and the metal storage cabinet is in one of the
main living areas of the house. The program must ensure that
medications are stored behind at least two locking
mechanisms.

excerpt:
(10) Written record of the
administration of medication includes:
(a) name
(b) description
(c) dates and times
(d) missed doses
(e) medication disposed
(f) method of administration
(g) ID of person administering
(h) possible adverse reactions
(i) medication taken outside facility • The program’s MAR contains all required fields. However, all
required fields are not being completed. These fields include:
(b) description of the medication; and (h) possible adverse
reactions. The program must ensure that staff are fully
completing each child’s MAR.

excerpt:
(e) Allow access as defined in 419-
400-0230 & 0240 • The program does not have a consent stating that the program
will allow access as defined in 419-400-0230 and 0240. The
program must have a consent stating that the program will
allow access as defined in 419-400-0230 and 0240.

excerpt:
(g) Apply the reasonable and prudent
parent standard • The program does not have a consent that it will apply the
reasonable and prudent parent standard. The program must
have a consent that it will apply the reasonable and prudent
parent standard.

excerpt:
(a) Information regarding personal or
room searches and protocols for
confiscation of contraband • The program does not have a disclosure regarding personal or
room searches and protocols for confiscation of contraband.
The program must have a disclosure regarding personal or
room searches and protocols for confiscation of contraband.

excerpt:
(c) Visitation resources are pre-
approved • Although the program is documenting approved visitation
resources for each youth in the program, the program does
not have an authorization that all visitation resources must be
pre-approved. The program must ensure that they have an
authorization that all visitation resources must be pre-
approved.

excerpt:
(d) Activity specific authorizations are
pre-approved to allow children to
participate in potentially hazardous
activities, including but not limited to
using motorized yard equipment,
swimming, and horseback riding. • The program does not have a pre-approved authorization to
allow children to participate in potentially hazardous activities,
including but not limited to hiking or using motorized yard
equipment such as lawnmowers. The program must have a
pre-approved authorization to allow children to participate in
potentially hazardous activities including but not limited to
hiking or using a motorized lawn mower.

excerpt:
(a)The name, gender, date of birth,
religious preference, and previous
address • The program’s summary sheet does not include an area to list
the previous address for the child. Also, although the
program’s summary sheet includes an area to document a
child’s religious preference, the program’s staff are not providing documentation in the allowed area. The program’s
summary sheet must include an area to indicate the child’s
previous address and the program’s staff must complete all
required fields on the program’s summary sheet, including the
child’s religious preference, if applicable.

excerpt:
(e) The name, address, and
telephone number of:
(A) The child in care's parents.
(B) The child in care's legal
guardian, if different than the
parents, and a copy of the
document that provides for his or
her authority over the child in care.
(C) Other persons significant to
child
(D) Other professionals to be involved
in service planning (if applicable) • The program’s summary sheet does not include an area to list
(c) Other professionals to be involved in service planning (if
applicable). The program’s summary sheet must include an
area to list other professionals to be involved in service
planning (if applicable).

excerpt:
(c) Discharge summary must include:
(A)Current medications
(B)Name of the physician or qualified
medical professional who prescribed
each medication
(C)Any outstanding medical or other
appointments
(D)Summary of the child’s
participation in the program and
progress achieved
(E)Results of evaluations
(F)Recommendations regarding
services
(G)Discharge destination • The program’s discharge summaries do not include all
required information. The program’s discharge summaries do
not include (A) Current medications of child; (B) Name of the
physician or qualified medical professional who prescribed
each medication; (C) Any outstanding medical or other
appointments; and (E) Results of evaluations. The program’s
discharge summaries must include all required information.

excerpt:
Each child
caring agency shall provide notice
regarding how to access the quarterly
reports to the parents or guardians of
children in care in the program. The
child caring agency shall provide the
notice upon the child in care’s • The program is not providing notice regarding how to access
the quarterly restraint reports to the parents or guardians of
children in the program. The program must ensure they are
providing notice regarding how to access the quarterly
restraint report to the parents or guardians of children in the
program. The program shall provide the notice upon the child

excerpt:
Records contain date, amount,
source, purpose, signatures • The program is not maintaining an updated financial record for
each youth in the program. The program’s financial record
form also does not include all required fields, or the financial
record form is not being fully completed. The program must
ensure that each youth in the program has an updated
financial record and that the program’s financial record form
contains all required fields and that all required fields are
being fully completed by program staff.

excerpt:
Individual written inventory of all
personal possessions is maintained
and updated as needed • The program is not maintaining an updated written inventory
of each child’s personal possessions. The program must
ensure they are maintaining an updated personal possessions
inventory for each child in the program.


state: OR

summary: Unannounced - 12 findings

raw_content:
Licensed Child Caring Agency Unannounced Site Visit Report
Residential Program
Licensee: The Next Door, Inc – Klahre House Residential
Treatment Program
Executive Director: Janet Hamada
Program Director(s): Melanie Kelly
Date of Unannounced: 10-1-24
Licensing Coordinator: Irvin Minten, M.S.W.
Other Regulatory or Accrediting Agencies: Oregon Department of Human Services (ODHS) Treatment Services and Oregon
Youth Authority (OYA)
Purpose: Per OAR 419-400-0240 (1)(b) Children’s Care Licensing is required to perform at least one unannounced site visit a
year where children in care reside.
Previous Findings Repeat Comments
License Renewal Site Visit Findings
11/01/23 Further
Action
Needed
Physical Plant. 419-470- Yes☐ No✓ During walkthrough of the program, the program was found to be
0020(2)(a) &(c). Buildings are very clean and in good repair. Youth enrolled in the program
smoke free, clean and in good assist in cleaning the program on a twice a week basis.
repair.
• Although the program
was found to be in good
repair, well-kept and
Form Rev. 11/14/2023 P age 1 | 15
clean, there was some
mold in one of the
youth’s showers where
the youth’s shampoo
was kept. The program
must ensure there is not
any mold in the youth’s
showers.
Residential Care Safety Yes☐ No✓ The program’s monthly fire drill log was observed, and the log
419-470-0080(5)(a). An contained all required fields. In addition, the program was found
evacuation drill occurs to be having monthly fire drills and the fire drill log was being fully
monthly under varying completed.
conditions, is retained 2 years
and contains:
(A) identify of person
conducting drill
(B) date & time
(C) notification method
(D) staff participating
(E) # of children & staff
evacuated
(F) special conditions
simulated
(G) problems encountered
(H) time to complete
• Since the program
opened, the program has
not been having monthly
evacuation drills as, to
date, the program has
documented only 2 drills,
Form Rev. 11/14/2023 P age 2 |
15
in September and
October 2023. In
addition, the program’s
fire drill log does not
contain all required
fields AND staff are
sometimes not
completing the required
fields on the form.
These fields include: (A)
Identity of person
conducting drill; (D) Staff
participating; and (C)
Problems encountered.
The program must
ensure that monthly
evacuation drills are
occurring, that their
evacuation drill log
contains all required
fields, and that the
evacuation drill log is
being fully completed by
staff.
Medication 419-470-0100(7)(c). Yes No✓ The program’s medications are kept in a locked metal storage
Medications are inaccessible cabinet in one of the main living areas of the house. In addition,
to children and stored behind the medications are now also kept in a locked storage compartment
at least two locking within the locked metal storage cabinet; thus, they are now stored
mechanisms. This does not behind two locking mechanisms.
apply to Naloxone.
Form Rev. 11/14/2023 P age 3 |
15
• The children’s
medications are
currently kept in a locked
metal storage cabinet
and the metal storage
cabinet is in one of the
main living areas of the
house. The program
must ensure that
medications are stored
behind at least two
locking mechanisms.
Medication. 419-470-0100(10). Yes☐ No✓ During the unannounced site review, a child’s MAR was randomly
Written record of the selected and observed. All required fields of the child’s MAR were
administration of medication completed including a description of the medication and the
includes: possible adverse reactions to the medication, as noted on the
(a) name prescription bottle, that the child may experience.
(b) description
(c) dates and times
(d) missed doses
(e) medication disposed
(f) method of administration
(g) ID of person administering
(h) possible adverse reactions
(i) medication taken outside
facility.
• The program’s MAR
contains all required
fields. However, all
required fields are not
being completed. These
Form Rev. 11/14/2023 P age 4 |
15
fields include: (b)
description of the
medication; and (h)
possible adverse
reactions. The program
must ensure that staff
are fully completing each
child’s MAR.
Consents. 419-470-0160(1)(e). Yes☐ No✓ The program now has a consent stating that the program will allow
Allow access as defined in access as defined in 419-400-0230 and 0240. This consent is
419-400-0230 & 0240. reviewed and signed by the youth’s parent or guardian at the
• The program does not youth’s intake meeting into the program.
have a consent stating
that the program will
allow access as defined
in 419-400-0230 and
0240. The program must .
have a consent stating
that the program will
allow access as defined
in 419-400-0230 and
0240.
Consents. 419-470-0160(1)(g). Yes☐ No✓ The program now has a consent that the program will apply the
Apply the reasonable and reasonable and prudent parent standard. This consent is reviewed
prudent parent standard. and signed by the youth’s parent or guardian at the intake meeting
• The program does not of a youth into the program.
have a consent that it
will apply the reasonable
and prudent parent
standard. The program
must have a consent that
Form Rev. 11/14/2023 P age 5 |
15
it will apply the
reasonable and prudent
parent standard.
Disclosures. 419-470- Yes☐ No✓ The program now has a disclosure regarding personal and room
0160(2)(a). searches and protocols for confiscation of contraband. This
Parent/guardian has disclosure is reviewed and signed by the youth’s parent or
acknowledged in writing: guardian at the intake meeting of a youth into the program.
Information regarding
personal or room searches
and protocols for confiscation
of contraband.
• The program does not
have a disclosure
regarding personal or
room searches and
protocols for
confiscation of
contraband. The
program must have a
disclosure regarding
personal or room
searches and protocols
for confiscation of
contraband.
Authorizations. 419-470- Yes☐ No✓ The program now has an authorization that all visitation resources
0160(3)(c). Visitation must be pre-approved. This authorization is reviewed and signed
resources are pre-approved. by the youth’s parent or guardian at the intake meeting of a youth
• Although the program is into the program.
documenting approved
visitation resources for
each youth in the
Form Rev. 11/14/2023 P age 6 |
15
program, the program
does not have an
authorization that all
visitation resources
must be pre-approved.
The program must
ensure that they have an
authorization that all
visitation resources
must be pre-approved.
Authorizations. 419-470- Yes☐ No✓ The program now has an activity specific authorization that
0160(3)(d). Activity specific ensures that all potentially hazardous activities in which children
authorizations are pre- in care may participate in while enrolled in the program are pre-
approved to allow children to approved. This authorization is reviewed and signed by the
participate in potentially youth’s parent or guardian at the intake meeting of a youth into
hazardous activities, including the program.
but not limited to using
motorized yard equipment,
swimming, and horseback
riding.
• The program does not
have a pre-approved
authorization to allow
children to participate in
potentially hazardous
activities, including but
not limited to hiking or
using motorized yard
equipment such as
lawnmowers. The
program must have a
Form Rev. 11/14/2023 P age 7 |
15
pre-approved
authorization to allow
children to participate in
potentially hazardous
activities including but
not limited to hiking or
using a motorized lawn
mower.
Information about Children in Yes☐ No✓ The program’s summary sheet now contains the name, gender,
Care. 419-400-0190(1)(a). date of birth, religious preference, and previous address of the
Summary sheet contains the child. This summary sheet is contained in the child file of each
following: (a)The name, child enrolled in the program.
gender, date of birth, religious
preference, and previous
address.
• The program’s summary
sheet does not include
an area to list the
previous address for the
child. Also, although the
program’s summary
sheet includes an area to
document a child’s
religious preference, the
program’s staff are not
providing documentation
in the allowed area. The
program’s summary
sheet must include an
area to indicate the
child’s previous address
Form Rev. 11/14/2023 P age 8 |
15
and the program’s staff
must complete all
required fields on the
program’s summary
sheet, including the
child’s religious
preference, if applicable.
Information about Children in Yes☐ No✓ The program’s summary sheet on each child now includes an area
Care. 419-400-0190(1)(e). to list other professionals to be involved in service planning, if
Summary sheet contains the applicable. The program must also ensure that staff are
following: (e) The name, completing all required fields on the child’s summary sheet.
address, and telephone
number of:
(A) The child in care's
parents.
(B) The child in care's legal
guardian, if different than
the parents, and a copy of
the document that provides
for his or her authority over
the child in care.
(C) Other persons
significant to child
(D) Other professionals to
be involved in service
planning (if applicable).
• The program’s summary
sheet does not include
an area to list (c) Other
professionals to be
involved in service
Form Rev. 11/14/2023 P age 9 |
15
planning (if applicable).
The program’s summary
sheet must include an
area to list other
professionals to be
involved in service
planning (if applicable).
Case Management. 419-470- Yes☐ No✓ The program’s discharge summaries now include all required
0170(3)(c)(A-G). Discharge fields.
summary must include:
(A)Current medications
(B)Name of the physician or
qualified medical professional
who prescribed each
medication
(C)Any outstanding medical or
other appointments
(D)Summary of the child’s
participation in the program
and progress achieved
(E)Results of evaluations
(F)Recommendations
regarding services
(G)Discharge destination.
• The program’s discharge
summaries do not
include all required
information. The
program’s discharge
summaries do not
include (A) Current
Form Rev. 11/14/2023 P age 10 |
15
medications of child; (B)
Name of the physician or
qualified medical
professional who
prescribed each
medication; (C) Any
outstanding medical or
other appointments; and
(E) Results of
evaluations. The
program’s discharge
summaries must include
all required information.
Records Relating to Restraint Yes☐ No✓ The program is now providing notice regarding how to access the
& Involuntary Seclusion. 419- quarterly reports to the parents or guardians of children in care.
400-0180(13)(e). Each child This notice is being provided at the time of a child in care’s intake
caring agency shall provide meeting into the program and is also being provided on the
notice regarding how to children in care’s Initial and On-Going Treatment Plans.
access the quarterly reports to
the parents or guardians of
children in care in the
program. The child caring
agency shall provide the
notice upon the child in care’s
admission and at least two
times each year thereafter.
• The program is not
providing notice
regarding how to access
the quarterly restraint
reports to the parents or
Form Rev. 11/14/2023 P age 11 |
15
guardians of children in
the program. The
program must ensure
they are providing notice
regarding how to access
the quarterly restraint
report to the parents or
guardians of children in
the program. The
program shall provide
the notice upon the
child.
Financial Records. 419-470- Yes☐ No✓ The program is now maintaining an updated financial record for
0170(4). Financial records each child in care in the program. The program’s financial record
contain date, amount, source, form also includes all required fields.
purpose, signatures.
• The program is not
maintaining an updated
financial record for each
youth in the program.
The program’s financial
record form also does
not include all required
fields, or the financial
record form is not being
fully completed. The
program must ensure
that each youth in the
program has an updated
financial record and that
the program’s financial
Form Rev. 11/14/2023 P age 12 |
15
record form contains all
required fields and that
all required fields are
being fully completed by
program staff.
Personal Possessions Yes☐ No✓ The program is now maintaining an individual written inventory
Records. 419-470-0170 (5). for each child in care of all personal possessions and this inventory
Individual written inventory of is being updated, as needed.
all personal possessions is
maintained and updated as
needed.
• The program is not
maintaining an updated
written inventory of each
child’s personal
possessions. The
program must ensure
they are maintaining an
updated personal
possessions inventory
for each child in the
program.
New Findings from Site Visit Comments
There were not any new findings
from the site visit.
Form Rev. 11/14/2023 P age 13 |
15
Interview Summary
During the unannounced site review, a good deal of discussion took place with Poe Foster, Program Manager and with Asia
Van Horn, supervisor of the Klahre House Residential Program. Shortly after the site visit, I was also able to have a
telephone conversation with Melanie Kelly, Program Director. In addition, two youth enrolled in the Klahre House
Residential Program and one staff of the program were randomly selected and individually interviewed. The staff person
was interviewed via the telephone.
One of the youth enrolled in the residential program stated the program was “nice,” that the program was a “homelike
setting,” that the food was “pretty good,’ and that they went on lots of outings in the community. The other youth stated he
“liked living in the program,” that he had his own room, that the food was OK, and that he was learning a great deal in the
program, especially in his gardening and culinary classes. He also stated he liked the program more than other programs he
had previously been enrolled since he had his own room. Both youth stated that staff were helpful and nice. When asked if
they would change anything about the program, one of the youth could not think of anything they would change and the
other wished the program would provide him with “more free time” and he wished the program would allow him to call and
talk with old friends. This youth also stated he wished his Probation Officer didn’t take so long to approve visits with his
family members outside of the program. Both youth also stated they felt safe in the program both during the day and at
night while in their bedrooms, and both youth reported they were able to make private calls when they wanted to persons on
their approved contact list. Both youth also denied ever being treated badly or observing anotheryouth in the program being
treated badly in any way by program staff.
During telephonic interview with the one line staff, we discussed his duties as a Youth Care Specialist. He stated he enjoys
working for the agency and feels supported in his role. He also stated he always has someone to call, if he were to have a
question and stated the culture of the program is welcoming to everyone, is positive, and is supportive. He also stated he
receives enough information about each child to effectively address their treatment issues and keep them safe and was able
to talk about systems the program had in place to effectively keep staff updated about youth’s behaviors and critical
information about new admits into the program. He also stated he felt he received sufficient training and was able to
effectively relay the program’s suicide prevention and search policies and stated he had his annual suicide prevention
training coming up in the next week. Finally, he stated his supervisor had discussions with him about suicide prevention,
medication administration, and search, as appropriate and when issues came up.
Form Rev. 11/14/2023 P age 14 |
15
Observations
During walkthrough of the program, it was observed that the house was in a well-maintained middle-class neighborhood and
that the house was well-constructed and designed, with main living and outdoor areas which were well maintained,
welcoming, and in good repair. The bathrooms and kitchen also had very nice appliances and fixtures, and most of the
showers were nicely tiled. The areas where youth congregated were also nicely painted and included comfortable and nice
furniture. The residence was also very clean. The main living area of the program had a vaulted ceiling, with the kitchen
directly attached. The kitchen also had a nice pantry.
Corrective Actions and Timeframes:
Please submit the following to verify compliance.
Within 45 days of receipt of this report The Next Door must submit a letter of verification indicating the agency is in
compliance with the specific rules cited above and describing how compliance will be maintained going forward. Along with
the letter of verification, the agency must submit any and all specific documentation requested in the body of this report. The
letter of verification and any additional requested documents can be emailed directly to Irvin Minten at
Irvin.minten@odhsoha.oregon.gov.
Licensing Coordinator’s Signature: ________________________ Date: ___________________
10-17-2024
Manager Review: ______________________________________ Date: ___1_0_-_1_6_-2_0_2_4_______
Form Rev. 11/14/2023 P age 15 |
15

program_type: (RC) Residential Care Programs

report_type: Unannounced

view_code: RC

facility_type: Residential Program

licensee: The Next Door, Inc - Klahre House Residential Treatment Program

purpose:
Per OAR 419-400-0240 (1)(b) Children's Care Licensing is required to perform at least one unannounced site visit a
year where children in care reside.
Previous Findings Repeat Comments
License Renewal Site Visit Findings
11/01/23 Further
Action
Needed
Physical Plant. 419-470- Yes[ ] No✓ During walkthrough of the program, the program was found to be
0020(2)(a) &(c). Buildings are very clean and in good repair. Youth enrolled in the program
smoke free, clean and in good assist in cleaning the program on a twice a week basis.
repair.
- Although the program
was found to be in good
repair, well-kept and

clean, there was some
mold in one of the
youth's showers where
the youth's shampoo
was kept. The program
must ensure there is not
any mold in the youth's
showers.
Residential Care Safety Yes[ ] No✓ The program's monthly fire drill log was observed, and the log
419-470-0080(5)(a). An contained all required fields. In addition, the program was found
evacuation drill occurs to be having monthly fire drills and the fire drill log was being fully
monthly under varying completed.
conditions, is retained 2 years
and contains:
(A) identify of person
conducting drill
(B) date & time
(C) notification method
(D) staff participating
(E) # of children & staff
evacuated
(F) special conditions
simulated
(G) problems encountered
(H) time to complete
- Since the program
opened, the program has
not been having monthly
evacuation drills as, to
date, the program has
documented only 2 drills,

15
in September and
October 2023. In
addition, the program's
fire drill log does not
contain all required
fields AND staff are
sometimes not
completing the required
fields on the form.
These fields include: (A)
Identity of person
conducting drill; (D) Staff
participating; and (C)
Problems encountered.
The program must
ensure that monthly
evacuation drills are
occurring, that their
evacuation drill log
contains all required
fields, and that the
evacuation drill log is
being fully completed by
staff.
Medication 419-470-0100(7)(c). Yes No✓ The program's medications are kept in a locked metal storage
Medications are inaccessible cabinet in one of the main living areas of the house. In addition,
to children and stored behind the medications are now also kept in a locked storage compartment
at least two locking within the locked metal storage cabinet; thus, they are now stored
mechanisms. This does not behind two locking mechanisms.
apply to Naloxone.

15
- The children's
medications are
currently kept in a locked
metal storage cabinet
and the metal storage
cabinet is in one of the
main living areas of the
house. The program
must ensure that
medications are stored
behind at least two
locking mechanisms.
Medication. 419-470-0100(10). Yes[ ] No✓ During the unannounced site review, a child's MAR was randomly
Written record of the selected and observed. All required fields of the child's MAR were
administration of medication completed including a description of the medication and the
includes: possible adverse reactions to the medication, as noted on the
(a) name prescription bottle, that the child may experience.
(b) description
(c) dates and times
(d) missed doses
(e) medication disposed
(f) method of administration
(g) ID of person administering
(h) possible adverse reactions
(i) medication taken outside
facility.
- The program's MAR
contains all required
fields. However, all
required fields are not
being completed. These

15
fields include: (b)
description of the
medication; and (h)
possible adverse
reactions. The program
must ensure that staff
are fully completing each
child's MAR.
Consents. 419-470-0160(1)(e). Yes[ ] No✓ The program now has a consent stating that the program will allow
Allow access as defined in access as defined in 419-400-0230 and 0240. This consent is
419-400-0230 & 0240. reviewed and signed by the youth's parent or guardian at the
- The program does not youth's intake meeting into the program.
have a consent stating
that the program will
allow access as defined
in 419-400-0230 and
0240. The program must .
have a consent stating
that the program will
allow access as defined
in 419-400-0230 and
0240.
Consents. 419-470-0160(1)(g). Yes[ ] No✓ The program now has a consent that the program will apply the
Apply the reasonable and reasonable and prudent parent standard. This consent is reviewed
prudent parent standard. and signed by the youth's parent or guardian at the intake meeting
- The program does not of a youth into the program.
have a consent that it
will apply the reasonable
and prudent parent
standard. The program
must have a consent that

15
it will apply the
reasonable and prudent
parent standard.
Disclosures. 419-470- Yes[ ] No✓ The program now has a disclosure regarding personal and room
0160(2)(a). searches and protocols for confiscation of contraband. This
Parent/guardian has disclosure is reviewed and signed by the youth's parent or
acknowledged in writing: guardian at the intake meeting of a youth into the program.
Information regarding
personal or room searches
and protocols for confiscation
of contraband.
- The program does not
have a disclosure
regarding personal or
room searches and
protocols for
confiscation of
contraband. The
program must have a
disclosure regarding
personal or room
searches and protocols
for confiscation of
contraband.
Authorizations. 419-470- Yes[ ] No✓ The program now has an authorization that all visitation resources
0160(3)(c). Visitation must be pre-approved. This authorization is reviewed and signed
resources are pre-approved. by the youth's parent or guardian at the intake meeting of a youth
- Although the program is into the program.
documenting approved
visitation resources for
each youth in the

15
program, the program
does not have an
authorization that all
visitation resources
must be pre-approved.
The program must
ensure that they have an
authorization that all
visitation resources
must be pre-approved.
Authorizations. 419-470- Yes[ ] No✓ The program now has an activity specific authorization that
0160(3)(d). Activity specific ensures that all potentially hazardous activities in which children
authorizations are pre- in care may participate in while enrolled in the program are pre-
approved to allow children to approved. This authorization is reviewed and signed by the
participate in potentially youth's parent or guardian at the intake meeting of a youth into
hazardous activities, including the program.
but not limited to using
motorized yard equipment,
swimming, and horseback
riding.
- The program does not
have a pre-approved
authorization to allow
children to participate in
potentially hazardous
activities, including but
not limited to hiking or
using motorized yard
equipment such as
lawnmowers. The
program must have a

15
pre-approved
authorization to allow
children to participate in
potentially hazardous
activities including but
not limited to hiking or
using a motorized lawn
mower.
Information about Children in Yes[ ] No✓ The program's summary sheet now contains the name, gender,
Care. 419-400-0190(1)(a). date of birth, religious preference, and previous address of the
Summary sheet contains the child. This summary sheet is contained in the child file of each
following: (a)The name, child enrolled in the program.
gender, date of birth, religious
preference, and previous
address.
- The program's summary
sheet does not include
an area to list the
previous address for the
child. Also, although the
program's summary
sheet includes an area to
document a child's
religious preference, the
program's staff are not
providing documentation
in the allowed area. The
program's summary
sheet must include an
area to indicate the
child's previous address

15
and the program's staff
must complete all
required fields on the
program's summary
sheet, including the
child's religious
preference, if applicable.
Information about Children in Yes[ ] No✓ The program's summary sheet on each child now includes an area
Care. 419-400-0190(1)(e). to list other professionals to be involved in service planning, if
Summary sheet contains the applicable. The program must also ensure that staff are
following: (e) The name, completing all required fields on the child's summary sheet.
address, and telephone
number of:
(A) The child in care's
parents.
(B) The child in care's legal
guardian, if different than
the parents, and a copy of
the document that provides
for his or her authority over
the child in care.
(C) Other persons
significant to child
(D) Other professionals to
be involved in service
planning (if applicable).
- The program's summary
sheet does not include
an area to list (c) Other
professionals to be
involved in service

15
planning (if applicable).
The program's summary
sheet must include an
area to list other
professionals to be
involved in service
planning (if applicable).
Case Management. 419-470- Yes[ ] No✓ The program's discharge summaries now include all required
0170(3)(c)(A-G). Discharge fields.
summary must include:
(A)Current medications
(B)Name of the physician or
qualified medical professional
who prescribed each
medication
(C)Any outstanding medical or
other appointments
(D)Summary of the child's
participation in the program
and progress achieved
(E)Results of evaluations
(F)Recommendations
regarding services
(G)Discharge destination.
- The program's discharge
summaries do not
include all required
information. The
program's discharge
summaries do not
include (A) Current

15
medications of child; (B)
Name of the physician or
qualified medical
professional who
prescribed each
medication; (C) Any
outstanding medical or
other appointments; and
(E) Results of
evaluations. The
program's discharge
summaries must include
all required information.
Records Relating to Restraint Yes[ ] No✓ The program is now providing notice regarding how to access the
& Involuntary Seclusion. 419- quarterly reports to the parents or guardians of children in care.
400-0180(13)(e). Each child This notice is being provided at the time of a child in care's intake
caring agency shall provide meeting into the program and is also being provided on the
notice regarding how to children in care's Initial and On-Going Treatment Plans.
access the quarterly reports to
the parents or guardians of
children in care in the
program. The child caring
agency shall provide the
notice upon the child in care's
admission and at least two
times each year thereafter.
- The program is not
providing notice
regarding how to access
the quarterly restraint
reports to the parents or

15
guardians of children in
the program. The
program must ensure
they are providing notice
regarding how to access
the quarterly restraint
report to the parents or
guardians of children in
the program. The
program shall provide
the notice upon the
child.
Financial Records. 419-470- Yes[ ] No✓ The program is now maintaining an updated financial record for
0170(4). Financial records each child in care in the program. The program's financial record
contain date, amount, source, form also includes all required fields.

interview_summary:
During the unannounced site review, a good deal of discussion took place with Poe Foster, Program Manager and with Asia
Van Horn, supervisor of the Klahre House Residential Program. Shortly after the site visit, I was also able to have a
telephone conversation with Melanie Kelly, Program Director. In addition, two youth enrolled in the Klahre House
Residential Program and one staff of the program were randomly selected and individually interviewed. The staff person
was interviewed via the telephone.
One of the youth enrolled in the residential program stated the program was "nice," that the program was a "homelike
setting," that the food was "pretty good,' and that they went on lots of outings in the community. The other youth stated he
"liked living in the program," that he had his own room, that the food was OK, and that he was learning a great deal in the
program, especially in his gardening and culinary classes. He also stated he liked the program more than other programs he
had previously been enrolled since he had his own room. Both youth stated that staff were helpful and nice. When asked if
they would change anything about the program, one of the youth could not think of anything they would change and the
other wished the program would provide him with "more free time" and he wished the program would allow him to call and
talk with old friends. This youth also stated he wished his Probation Officer didn't take so long to approve visits with his
family members outside of the program. Both youth also stated they felt safe in the program both during the day and at
night while in their bedrooms, and both youth reported they were able to make private calls when they wanted to persons on
their approved contact list. Both youth also denied ever being treated badly or observing anotheryouth in the program being
treated badly in any way by program staff.
During telephonic interview with the one line staff, we discussed his duties as a Youth Care Specialist. He stated he enjoys
working for the agency and feels supported in his role. He also stated he always has someone to call, if he were to have a
question and stated the culture of the program is welcoming to everyone, is positive, and is supportive. He also stated he
receives enough information about each child to effectively address their treatment issues and keep them safe and was able
to talk about systems the program had in place to effectively keep staff updated about youth's behaviors and critical
information about new admits into the program. He also stated he felt he received sufficient training and was able to
effectively relay the program's suicide prevention and search policies and stated he had his annual suicide prevention
training coming up in the next week. Finally, he stated his supervisor had discussions with him about suicide prevention,
medication administration, and search, as appropriate and when issues came up.

15

previous_findings:
Repeat Comments
License Renewal Site Visit Findings
11/01/23 Further
Action
Needed
Physical Plant. 419-470- Yes[ ] No✓ During walkthrough of the program, the program was found to be
0020(2)(a) &(c). Buildings are very clean and in good repair. Youth enrolled in the program
smoke free, clean and in good assist in cleaning the program on a twice a week basis.
repair.
- Although the program
was found to be in good
repair, well-kept and

clean, there was some
mold in one of the
youth's showers where
the youth's shampoo
was kept. The program
must ensure there is not
any mold in the youth's
showers.
Residential Care Safety Yes[ ] No✓ The program's monthly fire drill log was observed, and the log
419-470-0080(5)(a). An contained all required fields. In addition, the program was found
evacuation drill occurs to be having monthly fire drills and the fire drill log was being fully
monthly under varying completed.
conditions, is retained 2 years
and contains:
(A) identify of person
conducting drill
(B) date & time
(C) notification method
(D) staff participating
(E) # of children & staff
evacuated
(F) special conditions
simulated
(G) problems encountered
(H) time to complete
- Since the program
opened, the program has
not been having monthly
evacuation drills as, to
date, the program has
documented only 2 drills,

15
in September and
October 2023. In
addition, the program's
fire drill log does not
contain all required
fields AND staff are
sometimes not
completing the required
fields on the form.
These fields include: (A)
Identity of person
conducting drill; (D) Staff
participating; and (C)
Problems encountered.
The program must
ensure that monthly
evacuation drills are
occurring, that their
evacuation drill log
contains all required
fields, and that the
evacuation drill log is
being fully completed by
staff.
Medication 419-470-0100(7)(c). Yes No✓ The program's medications are kept in a locked metal storage
Medications are inaccessible cabinet in one of the main living areas of the house. In addition,
to children and stored behind the medications are now also kept in a locked storage compartment
at least two locking within the locked metal storage cabinet; thus, they are now stored
mechanisms. This does not behind two locking mechanisms.
apply to Naloxone.

15
- The children's
medications are
currently kept in a locked
metal storage cabinet
and the metal storage
cabinet is in one of the
main living areas of the
house. The program
must ensure that
medications are stored
behind at least two
locking mechanisms.
Medication. 419-470-0100(10). Yes[ ] No✓ During the unannounced site review, a child's MAR was randomly
Written record of the selected and observed. All required fields of the child's MAR were
administration of medication completed including a description of the medication and the
includes: possible adverse reactions to the medication, as noted on the
(a) name prescription bottle, that the child may experience.
(b) description
(c) dates and times
(d) missed doses
(e) medication disposed
(f) method of administration
(g) ID of person administering
(h) possible adverse reactions
(i) medication taken outside
facility.
- The program's MAR
contains all required
fields. However, all
required fields are not
being completed. These

15
fields include: (b)
description of the
medication; and (h)
possible adverse
reactions. The program
must ensure that staff
are fully completing each
child's MAR.
Consents. 419-470-0160(1)(e). Yes[ ] No✓ The program now has a consent stating that the program will allow
Allow access as defined in access as defined in 419-400-0230 and 0240. This consent is
419-400-0230 & 0240. reviewed and signed by the youth's parent or guardian at the
- The program does not youth's intake meeting into the program.
have a consent stating
that the program will
allow access as defined
in 419-400-0230 and
0240. The program must .
have a consent stating
that the program will
allow access as defined
in 419-400-0230 and
0240.
Consents. 419-470-0160(1)(g). Yes[ ] No✓ The program now has a consent that the program will apply the
Apply the reasonable and reasonable and prudent parent standard. This consent is reviewed
prudent parent standard. and signed by the youth's parent or guardian at the intake meeting
- The program does not of a youth into the program.
have a consent that it
will apply the reasonable
and prudent parent
standard. The program
must have a consent that

15
it will apply the
reasonable and prudent
parent standard.
Disclosures. 419-470- Yes[ ] No✓ The program now has a disclosure regarding personal and room
0160(2)(a). searches and protocols for confiscation of contraband. This
Parent/guardian has disclosure is reviewed and signed by the youth's parent or
acknowledged in writing: guardian at the intake meeting of a youth into the program.
Information regarding
personal or room searches
and protocols for confiscation
of contraband.
- The program does not
have a disclosure
regarding personal or
room searches and
protocols for
confiscation of
contraband. The
program must have a
disclosure regarding
personal or room
searches and protocols
for confiscation of
contraband.
Authorizations. 419-470- Yes[ ] No✓ The program now has an authorization that all visitation resources
0160(3)(c). Visitation must be pre-approved. This authorization is reviewed and signed
resources are pre-approved. by the youth's parent or guardian at the intake meeting of a youth
- Although the program is into the program.
documenting approved
visitation resources for
each youth in the

15
program, the program
does not have an
authorization that all
visitation resources
must be pre-approved.
The program must
ensure that they have an
authorization that all
visitation resources
must be pre-approved.
Authorizations. 419-470- Yes[ ] No✓ The program now has an activity specific authorization that
0160(3)(d). Activity specific ensures that all potentially hazardous activities in which children
authorizations are pre- in care may participate in while enrolled in the program are pre-
approved to allow children to approved. This authorization is reviewed and signed by the
participate in potentially youth's parent or guardian at the intake meeting of a youth into
hazardous activities, including the program.
but not limited to using
motorized yard equipment,
swimming, and horseback
riding.
- The program does not
have a pre-approved
authorization to allow
children to participate in
potentially hazardous
activities, including but
not limited to hiking or
using motorized yard
equipment such as
lawnmowers. The
program must have a

15
pre-approved
authorization to allow
children to participate in
potentially hazardous
activities including but
not limited to hiking or
using a motorized lawn
mower.
Information about Children in Yes[ ] No✓ The program's summary sheet now contains the name, gender,
Care. 419-400-0190(1)(a). date of birth, religious preference, and previous address of the
Summary sheet contains the child. This summary sheet is contained in the child file of each
following: (a)The name, child enrolled in the program.
gender, date of birth, religious
preference, and previous
address.
- The program's summary
sheet does not include
an area to list the
previous address for the
child. Also, although the
program's summary
sheet includes an area to
document a child's
religious preference, the
program's staff are not
providing documentation
in the allowed area. The
program's summary
sheet must include an
area to indicate the
child's previous address

15
and the program's staff
must complete all
required fields on the
program's summary
sheet, including the
child's religious
preference, if applicable.
Information about Children in Yes[ ] No✓ The program's summary sheet on each child now includes an area
Care. 419-400-0190(1)(e). to list other professionals to be involved in service planning, if
Summary sheet contains the applicable. The program must also ensure that staff are
following: (e) The name, completing all required fields on the child's summary sheet.
address, and telephone
number of:
(A) The child in care's
parents.
(B) The child in care's legal
guardian, if different than
the parents, and a copy of
the document that provides
for his or her authority over
the child in care.
(C) Other persons
significant to child
(D) Other professionals to
be involved in service
planning (if applicable).
- The program's summary
sheet does not include
an area to list (c) Other
professionals to be
involved in service

15
planning (if applicable).
The program's summary
sheet must include an
area to list other
professionals to be
involved in service
planning (if applicable).
Case Management. 419-470- Yes[ ] No✓ The program's discharge summaries now include all required
0170(3)(c)(A-G). Discharge fields.
summary must include:
(A)Current medications
(B)Name of the physician or
qualified medical professional
who prescribed each
medication
(C)Any outstanding medical or
other appointments
(D)Summary of the child's
participation in the program
and progress achieved
(E)Results of evaluations
(F)Recommendations
regarding services
(G)Discharge destination.
- The program's discharge
summaries do not
include all required
information. The
program's discharge
summaries do not
include (A) Current

15
medications of child; (B)
Name of the physician or
qualified medical
professional who
prescribed each
medication; (C) Any
outstanding medical or
other appointments; and
(E) Results of
evaluations. The
program's discharge
summaries must include
all required information.
Records Relating to Restraint Yes[ ] No✓ The program is now providing notice regarding how to access the
& Involuntary Seclusion. 419- quarterly reports to the parents or guardians of children in care.
400-0180(13)(e). Each child This notice is being provided at the time of a child in care's intake
caring agency shall provide meeting into the program and is also being provided on the
notice regarding how to children in care's Initial and On-Going Treatment Plans.
access the quarterly reports to
the parents or guardians of
children in care in the
program. The child caring
agency shall provide the
notice upon the child in care's
admission and at least two
times each year thereafter.
- The program is not
providing notice
regarding how to access
the quarterly restraint
reports to the parents or

15
guardians of children in
the program. The
program must ensure
they are providing notice
regarding how to access
the quarterly restraint
report to the parents or
guardians of children in
the program. The
program shall provide
the notice upon the
child.
Financial Records. 419-470- Yes[ ] No✓ The program is now maintaining an updated financial record for
0170(4). Financial records each child in care in the program. The program's financial record
contain date, amount, source, form also includes all required fields.
purpose, signatures.
- The program is not
maintaining an updated
financial record for each
youth in the program.
The program's financial
record form also does
not include all required
fields, or the financial
record form is not being
fully completed. The
program must ensure
that each youth in the
program has an updated
financial record and that
the program's financial

15
record form contains all
required fields and that
all required fields are
being fully completed by
program staff.
Personal Possessions Yes[ ] No✓ The program is now maintaining an individual written inventory
Records. 419-470-0170 (5). for each child in care of all personal possessions and this inventory
Individual written inventory of is being updated, as needed.
all personal possessions is
maintained and updated as
needed.
- The program is not
maintaining an updated
written inventory of each
child's personal
possessions. The
program must ensure
they are maintaining an
updated personal
possessions inventory
for each child in the
program.
New Findings from Site Visit Comments
There were not any new findings
from the site visit.

15

excerpt:
419-470-0170 (5). for each child in care of all personal possessions and this inventory
Individual written inventory of is being updated, as needed.
all personal possessions is
maintained and updated as
needed.
- The program is not
maintaining an updated
written inventory of each
child's personal
possessions. The
program must ensure
they are maintaining an
updated personal
possessions inventory
for each child in the
program.
New Findings from Site Visit Comments
There were not any new findings
from the site visit.
15
There were not any new findings
from the site visit.
15