summary: Unannounced - 27 findings

raw_content:
Licensed Child Caring Agency Unannounced Site Visit Report
Licensee: Morrison Family Services
Executive Director: Drew Henrie-McWilliams
Dates of Unannounced: November 17, 2021 Downtown Shelter and Residential Program
November 18, 2021 Paso and Sage Program
Licensing Coordinator: Holly Ivey
Other Regulatory or Accrediting Agencies: DHS Treatment Services, The Oregon Youth Authority, and The Federal Government
Purpose: Per OAR 413-215-0101 (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
Findings
Further Action
Needed
Physical Plant 413-215-0511(2)(a) &(c) Yes☐ No Physical Plant 413-215-0511(2)(a) &(c) Buildings are smoke free, clean and in good
Buildings are smoke free, clean and in repair. The following was identified in need of repair:
good repair (REPEAT FINDING 2019) Downtown Shelter:
 Some ceiling tiles were discolored in spots.
The following was identified in need of repair:  Damage to a closet door punctured (about a two-inch diameter.)
Downtown Shelter:  Peeled paint around some of the bedroom door frames.
 Some ceiling tiles were discolored in  Black substance on a bathroom fan vent.
spots.
 Damage to a closet door punctured On November 17, 2021, Holly Ivey, Licensing Coordinator, conducted an unannounced site
(about a two-inch diameter.) inspection at the Downtown Shelter and verified all the issues noted above have been
 Peeled paint around some of the addressed.
bedroom door frames.
 Black substance on a bathroom fan
vent.
Room and Space Requirements Bedrooms Yes☐ No Room and Space Requirements Bedrooms 413-215-0516(3) (c) Outside room with
413-215-0516(3) (c) Outside room with window allowing egress from building.
window allowing egress from building
At the time of the Licensing Renewal an exception request was approved by Licensing.
Morrison is in compliance regarding this past finding.
1
(rev. 200115)
Medication 413-215-0551(10) Written Yes☐ No Medication 413-215-0551(10) Written record of the administration of medication
record of the administration of medication includes: (f) method of administration (i) medication taken outside facility.
includes: (f) method of administration (i)
medication taken outside facility On November 18, 2021, Holly Ivey, Licensing Coordinator, observed the medication
records being utilized by Sage Staff to be in compliance with the above stated rule
 (SAGE)The above required requirement.
information was not found on the
medication records.
Ongoing Training 413-215-0556(2)(c) Yes☐ No☐ Ongoing Training 413-215-0556(2)(c) Discipline and Behavior Management
Discipline and Behavior Management
At the time of the unannounced inspection, the agency still had time to complete the yearly
 (SAGE and Paso) The above required trainings for 2021, a determination for this finding was not made. On December 13, 2021,
information was not consistently Holly Ivey, Licensing Coordinator, requested confirmation from the agency to be submitted
found in the training records. by the end of December 2021, of Sage and Paso Staff, to verify compliance.
Ongoing Training 413-215-0556(4) Yes☐ No☐ Ongoing Training 413-215-0556(4) Designated staff authorized to apply reasonable
Designated staff authorized to apply and prudent parent standard are trained in application of the standard
reasonable and prudent parent standard
are trained in application of the standard At the time of the unannounced inspection, the agency still had time to complete the yearly
trainings for 2021, a determination for this finding was not made. On December 13, 2021,
 (SAGE and Paso) The above required Holly Ivey, Licensing Coordinator, requested confirmation from the agency to be submitted
information was not consistently by the end of December 2021, of Sage and Paso Staff, to verify compliance.
found in the training records.
Ongoing Training 413-215-0061(5) Yes☐ No☐ Ongoing Training 413-215-0061(5) Mandatory reporting (annually) that includes:
Mandatory reporting (annually) that (a) legal definition of child abuse ORS 419B.005, Oregon Laws 2016, chapter 106,
includes: section 36
(a) legal definition of child abuse ORS (b) legal responsibility to immediately report
419B.005, Oregon Laws 2016, chapter 106, (c) legal responsibility to report is personal to the employee
section 36
(b) legal responsibility to immediately At the time of the unannounced inspection, the agency still had time to complete the yearly
report trainings for 2021, a determination for this finding was not made. On December 13, 2021,
(c) legal responsibility to report is personal Holly Ivey, Licensing Coordinator, requested confirmation from the agency to be submitted
to the employee by the end of December 2021, of Paso Staff, to verify compliance.
Paso had one employee file that was missing
documentation of the above required training
in 2020.
Consents 413-215-0576 (1) (e) Allow Yes☐ No Consents 413-215-0576 (1) (e) Allow access as defined in 413-215-0091 & 0101(g)
access as defined in 413-215-0091 & Apply the reasonable and prudent parent standard.
0101(g) Apply the reasonable and prudent
parent standard.
2
I:\LICENSING\CCLU Forms & Templates\Site Visit Checklists (rev. 200115)
 (SAGE) The above required On November 18, 2021, Holly Ivey, Licensing Coordinator, observed the consents being
information was not found on the utilized by the Sage Program to be in compliance with the above stated rule requirement.
consents.
Information about Children in Care 413- Yes No☐ Information about Children in Care 413-215-0581(1) Summary sheet contains the
215-0581(1) Summary sheet contains following: (a) religious preference (b) Name and location of current and previous
the following: (a) religious preference school (e) The name, address, and telephone number of: (C) Other persons
(b) Name and location of current and significant to child. (D) Other professionals to be involved in service planning (if
previous school (e) The name, address, applicable) (REPEAT FINDING-Downtown Shelter, Residential, Paso and Sage)
and telephone number of: (C) Other
persons significant to child. (D) Other At the unannounced inspection the programs were observed to not have summary sheets
professionals to be involved in service at the Downtown Shelter and Residential Program, Sage, and Paso with the information
planning (if applicable) required by the rule above. The agency must have a stand-alone summary sheet with the
required information stated above.
 SAGE: The above required
information (a,b,e,C,D). was not
consistently found in the files
reviewed. Religious preference was
always left blank on the form in the
files reviewed.
 Paso: Missing religious preference
and previous address.
 Downtown Shelter and Residential
Programs: Missing religious
preference.
Service Planning 413-215-0581(2) (e) Yes No☐ Service Planning 413-215-0581(2) (e) (A)&(B) Service plan within 60 days (parent,
(A)&(B) Service plan within 60 days guardian and child actively involved). Describes how child’s issues will be
(parent, guardian and child actively addressed, anticipated outcomes and reviewed by child and guardian/parent.
involved). Describes how child’s issues (REPEAT FINDING -PASO)
will be addressed, anticipated outcomes
and reviewed by child and On November 18, 2021, Holly Ivey, Licensing Coordinator, observed the service plans
guardian/parent. completed by the Paso Program, were not found in compliance with the above stated rule
requirement. The following was identified:
 (PASO) The above required  There was no signature line at the end of the service plans to verify the child and
information was not found in the files the guardian had reviewed the document. Verification of the child and guardian
reviewed. The service plans did not participation must be found on the service plans.
list issues to be addressed or
anticipated outcomes. They only
listed mandatory services to be
provided.
3
I:\LICENSING\CCLU Forms & Templates\Site Visit Checklists (rev. 200115)
Service Planning 413-215-0581(2)(e)(C) Yes☐ No Service Planning 413-215-0581(2)(e)(C) &(D) Service plan is reviewed quarterly and
&(D) Service plan is reviewed quarterly revised when information indicates other services should be provided.
and revised when information indicates
other services should be provided. On November 18, 2021, Holly Ivey, Licensing Coordinator, observed the service plans
being utilized by the Sage Program to be in compliance with the above stated rule
 (SAGE) The above required requirement.
information was not found in the files
reviewed. Service plans were
reviewed and revised by the program
every 6 months.
Case Management 413-215-0581(3) (a) Yes☐ No Case Management 413-215-0581(3) (a) Services are documented, progress toward
Services are documented, progress toward achieving goals is tracked
achieving goals is tracked
On November 18, 2021, Holly Ivey, Licensing Coordinator, observed the services being
 Services: (SAGE) The above documented by the Sage Program to be in compliance with the above stated rule
required information was not requirement.
consistently found in the files
reviewed. The service goals were
adequate, however the plans lacked
detail regarding the progress towards
achievement of goals
.
Case Management 413-215-0581(3) (b)-(d) Yes☐ No Case Management 413-215-0581(3) (b)-(d) discharge planning and instructions
discharge planning and instructions
On November 18, 2021, Holly Ivey, Licensing Coordinator, observed the Discharge
 Discharge Planning: (SAGE) Summaries by the Sage Program to be in compliance with the above stated rule
Minimal discharge information was requirement.
found on the discharge summaries.
Supplemental Information Provided by Yes☐ No Supplemental Information Provided by CCA required policies and procedures
CCA required policies and procedures
The agency revised some policies as part of the Plan of Correction and submitted them to
Licensing.
New Findings from Site Visit Comments
Physical Plant 413-215-0511(2)(a) &(c) Physical Plant 413-215-0511(2)(a) &(c) Buildings are smoke free, clean and in good repair
Buildings are smoke free, clean and in  Downtown Shelter: (Room 509) Closet door was missing and needs to be replaced.
good repair  Sage: Brownish substance was around a threshold of a shower.
4
I:\LICENSING\CCLU Forms & Templates\Site Visit Checklists (rev. 200115)
Interview Summary
Staff and youth from each program were interviewed (6 total youth) at the unannounced site inspection. All the youth stated things were going
well at the programs. The following statements were stated by the youth when asked what they appreciated most about the program: “I feel
connected to my therapist,” “school,” “Everyone treats me really good, everyone treats me really well.” “I like playing soccer.” In the interviews
all the youth confirmed they receive enough food to eat, and snacks are being provided. The youth stated there were no restrictions on their
approved contact list for them to make phone calls. It was confirmed by all the youth that they felt safe while residing in the programs. Many of
the youth stated they had someone at the program they could talk to if they felt uncomfortable or needed anything.
Observations
Staff and youth were observed at the programs that were inspected. The youth that were observed at the programs appeared to be at ease and
comfortable in their environments. The facilities were observed to be clean and in good repair with minimal repair needs (see repair needs
above in the report).
Corrective Actions and Timeframes:
Please submit the following to verify compliance.
Within 45 days of receipt of this report Morrison Family Services, 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 Holly.r.ivey@dhsoha.state.or.us or sent by regular mail to the following address:
Department of Human Services
Children’s Care Licensing Program
Attn: Holly Ivey, Licensing Coordinator
201 High St. SE Suite 500
Salem, OR 97301
12.17.2021
Licensing Coordinator’s Signature: ________________________ Date: ___________________
Manager Review: ______________________________________ Date: _1_2_-_1_7_-_2_0_2_1_ _______
5
I:\LICENSING\CCLU Forms & Templates\Site Visit Checklists (rev. 200115)

program_name: Downtown ORR Shelter/LTGH

program_type: (RC) Residential Care Programs

report_type: Unannounced

licensing_coordinator: Holly Ivey

purpose:
Per OAR 413-215-0101 (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
Findings
Further Action
Needed
Physical Plant 413-215-0511(2)(a) &(c) Yes[ ] No Physical Plant 413-215-0511(2)(a) &(c) Buildings are smoke free, clean and in good
Buildings are smoke free, clean and in repair. The following was identified in need of repair:
good repair (REPEAT FINDING 2019) Downtown Shelter:
- Some ceiling tiles were discolored in spots.
The following was identified in need of repair: - Damage to a closet door punctured (about a two-inch diameter.)
Downtown Shelter: - Peeled paint around some of the bedroom door frames.
- Some ceiling tiles were discolored in - Black substance on a bathroom fan vent.
spots.
- Damage to a closet door punctured On November 17, 2021, Holly Ivey, Licensing Coordinator, conducted an unannounced site
(about a two-inch diameter.) inspection at the Downtown Shelter and verified all the issues noted above have been
- Peeled paint around some of the addressed.
bedroom door frames.
- Black substance on a bathroom fan
vent.
Room and Space Requirements Bedrooms Yes[ ] No Room and Space Requirements Bedrooms 413-215-0516(3) (c) Outside room with
413-215-0516(3) (c) Outside room with window allowing egress from building.
window allowing egress from building
At the time of the Licensing Renewal an exception request was approved by Licensing.
Morrison is in compliance regarding this past finding.
1

Medication 413-215-0551(10) Written Yes[ ] No Medication 413-215-0551(10) Written record of the administration of medication
record of the administration of medication includes: (f) method of administration (i) medication taken outside facility.
includes: (f) method of administration (i)
medication taken outside facility On November 18, 2021, Holly Ivey, Licensing Coordinator, observed the medication
records being utilized by Sage Staff to be in compliance with the above stated rule
- (SAGE)The above required requirement.
information was not found on the
medication records.
Ongoing Training 413-215-0556(2)(c) Yes[ ] No[ ] Ongoing Training 413-215-0556(2)(c) Discipline and Behavior Management
Discipline and Behavior Management
At the time of the unannounced inspection, the agency still had time to complete the yearly
- (SAGE and Paso) The above required trainings for 2021, a determination for this finding was not made. On December 13, 2021,
information was not consistently Holly Ivey, Licensing Coordinator, requested confirmation from the agency to be submitted
found in the training records. by the end of December 2021, of Sage and Paso Staff, to verify compliance.
Ongoing Training 413-215-0556(4) Yes[ ] No[ ] Ongoing Training 413-215-0556(4) Designated staff authorized to apply reasonable
Designated staff authorized to apply and prudent parent standard are trained in application of the standard
reasonable and prudent parent standard
are trained in application of the standard At the time of the unannounced inspection, the agency still had time to complete the yearly
trainings for 2021, a determination for this finding was not made. On December 13, 2021,
- (SAGE and Paso) The above required Holly Ivey, Licensing Coordinator, requested confirmation from the agency to be submitted
information was not consistently by the end of December 2021, of Sage and Paso Staff, to verify compliance.
found in the training records.
Ongoing Training 413-215-0061(5) Yes[ ] No[ ] Ongoing Training 413-215-0061(5) Mandatory reporting (annually) that includes:
Mandatory reporting (annually) that (a) legal definition of child abuse ORS 419B.005, Oregon Laws 2016, chapter 106,
includes: section 36
(a) legal definition of child abuse ORS (b) legal responsibility to immediately report
419B.005, Oregon Laws 2016, chapter 106, (c) legal responsibility to report is personal to the employee
section 36
(b) legal responsibility to immediately At the time of the unannounced inspection, the agency still had time to complete the yearly
report trainings for 2021, a determination for this finding was not made. On December 13, 2021,
(c) legal responsibility to report is personal Holly Ivey, Licensing Coordinator, requested confirmation from the agency to be submitted
to the employee by the end of December 2021, of Paso Staff, to verify compliance.
Paso had one employee file that was missing
documentation of the above required training
in 2020.
Consents 413-215-0576 (1) (e) Allow Yes[ ] No Consents 413-215-0576 (1) (e) Allow access as defined in 413-215-0091 & 0101(g)
access as defined in 413-215-0091 & Apply the reasonable and prudent parent standard.
0101(g) Apply the reasonable and prudent
parent standard.
2

- (SAGE) The above required On November 18, 2021, Holly Ivey, Licensing Coordinator, observed the consents being
information was not found on the utilized by the Sage Program to be in compliance with the above stated rule requirement.
consents.
Information about Children in Care 413- Yes No[ ] Information about Children in Care 413-215-0581(1) Summary sheet contains the
215-0581(1) Summary sheet contains following: (a) religious preference (b) Name and location of current and previous
the following: (a) religious preference school (e) The name, address, and telephone number of: (C) Other persons
(b) Name and location of current and significant to child. (D) Other professionals to be involved in service planning (if
previous school (e) The name, address, applicable) (REPEAT FINDING-Downtown Shelter, Residential, Paso and Sage)
and telephone number of: (C) Other
persons significant to child. (D) Other At the unannounced inspection the programs were observed to not have summary sheets
professionals to be involved in service at the Downtown Shelter and Residential Program, Sage, and Paso with the information
planning (if applicable) required by the rule above. The agency must have a stand-alone summary sheet with the
required information stated above.
- SAGE: The above required
information (a,b,e,C,D). was not
consistently found in the files
reviewed. Religious preference was
always left blank on the form in the
files reviewed.
- Paso: Missing religious preference
and previous address.
- Downtown Shelter and Residential
Programs: Missing religious
preference.
Service Planning 413-215-0581(2) (e) Yes No[ ] Service Planning 413-215-0581(2) (e) (A)&(B) Service plan within 60 days (parent,
(A)&(B) Service plan within 60 days guardian and child actively involved). Describes how child's issues will be
(parent, guardian and child actively addressed, anticipated outcomes and reviewed by child and guardian/parent.
involved). Describes how child's issues (REPEAT FINDING -PASO)
will be addressed, anticipated outcomes
and reviewed by child and On November 18, 2021, Holly Ivey, Licensing Coordinator, observed the service plans
guardian/parent. completed by the Paso Program, were not found in compliance with the above stated rule
requirement. The following was identified:
- (PASO) The above required - There was no signature line at the end of the service plans to verify the child and
information was not found in the files the guardian had reviewed the document. Verification of the child and guardian
reviewed. The service plans did not participation must be found on the service plans.
list issues to be addressed or
anticipated outcomes. They only
listed mandatory services to be
provided.
3

Service Planning 413-215-0581(2)(e)(C) Yes[ ] No Service Planning 413-215-0581(2)(e)(C) &(D) Service plan is reviewed quarterly and
&(D) Service plan is reviewed quarterly revised when information indicates other services should be provided.
and revised when information indicates
other services should be provided. On November 18, 2021, Holly Ivey, Licensing Coordinator, observed the service plans
being utilized by the Sage Program to be in compliance with the above stated rule
- (SAGE) The above required requirement.
information was not found in the files
reviewed. Service plans were
reviewed and revised by the program
every 6 months.
Case Management 413-215-0581(3) (a) Yes[ ] No Case Management 413-215-0581(3) (a) Services are documented, progress toward
Services are documented, progress toward achieving goals is tracked
achieving goals is tracked
On November 18, 2021, Holly Ivey, Licensing Coordinator, observed the services being
- Services: (SAGE) The above documented by the Sage Program to be in compliance with the above stated rule
required information was not requirement.
consistently found in the files
reviewed. The service goals were
adequate, however the plans lacked
detail regarding the progress towards
achievement of goals
.
Case Management 413-215-0581(3) (b)-(d) Yes[ ] No Case Management 413-215-0581(3) (b)-(d) discharge planning and instructions
discharge planning and instructions
On November 18, 2021, Holly Ivey, Licensing Coordinator, observed the Discharge
- Discharge Planning: (SAGE) Summaries by the Sage Program to be in compliance with the above stated rule
Minimal discharge information was requirement.
found on the discharge summaries.
Supplemental Information Provided by Yes[ ] No Supplemental Information Provided by CCA required policies and procedures
CCA required policies and procedures
The agency revised some policies as part of the Plan of Correction and submitted them to
Licensing.
New Findings from Site Visit Comments
Physical Plant 413-215-0511(2)(a) &(c) Physical Plant 413-215-0511(2)(a) &(c) Buildings are smoke free, clean and in good repair
Buildings are smoke free, clean and in - Downtown Shelter: (Room 509) Closet door was missing and needs to be replaced.
good repair - Sage: Brownish substance was around a threshold of a shower.
4

Interview Summary
Staff and youth from each program were interviewed (6 total youth) at the unannounced site inspection. All the youth stated things were going
well at the programs. The following statements were stated by the youth when asked what they appreciated most about the program: "I feel
connected to my therapist," "school," "Everyone treats me really good, everyone treats me really well." "I like playing soccer." In the interviews
all the youth confirmed they receive enough food to eat, and snacks are being provided. The youth stated there were no restrictions on their
approved contact list for them to make phone calls. It was confirmed by all the youth that they felt safe while residing in the programs. Many of
the youth stated they had someone at the program they could talk to if they felt uncomfortable or needed anything.
Observations
Staff and youth were observed at the programs that were inspected. The youth that were observed at the programs appeared to be at ease and
comfortable in their environments. The facilities were observed to be clean and in good repair with minimal repair needs (see repair needs
above in the report).

excerpt:
413-215-0511(2)(a) &(c) Buildings are smoke free, clean and in good repair
Buildings are smoke free, clean and in - Downtown Shelter: (Room 509) Closet door was missing and needs to be replaced.
good repair - Sage: Brownish substance was around a threshold of a shower.
4
Physical Plant


state: OR

facility_name: Downtown ORR Shelter/LTGH

summary: Unannounced - 7 findings

raw_content:
Licensed Child Caring Agency Unannounced Site Visit Report
Licensee: Morrison Child & Family Services
Executive Director: Drew Henrie-McWilliams
Dates of Unannounced: September 8, 2022, Downtown Shelter and Residential Program
September 15, 2022, Paso and Sage Program
Licensing Coordinator: Holly Ivey, and Jorge Pelinski
Other Regulatory or Accrediting Agencies: DHS Treatment Services, The Oregon Youth Authority, and The Federal Government
Purpose: Per OAR 413-215-0101 (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
Findings
Further Action
Needed
Information about Children in Care 413- Yes No☐ Information about Children in Care 413-215-0581(1) Summary sheet contains the
215-0581(1) Summary sheet contains following: (a) religious preference (b) Name and location of current and previous
the following: (a) religious preference school (e) The name, address, and telephone number of: (C) Other persons
(b) Name and location of current and significant to child. (D) Other professionals to be involved in service planning (if
previous school (e) The name, address, applicable) (REPEAT FINDING-Downtown Shelter, Residential, Paso and Sage)
and telephone number of: (C) Other Downtown Shelter Program:
persons significant to child. (D) Other On September 8, 2022, DHS Licensing Coordinators, Holly Ivey, and Jorge
professionals to be involved in service Pelinski, observed the Summary Sheets were not consistently found.
planning (if applicable) (REPEAT (REPEAT FINDING April 5, 2021)
FINDING-Downtown Shelter,
Residential, Paso and Sage) LTGH Program:
On September 8, 2022, DHS Licensing Coordinators, Holly Ivey, and Jorge
 At the unannounced inspection the Pelinski, observed the Summary Sheets were consistently found, however were
programs were observed to not have missing religious preference. (REPEAT FINDING April 5, 2021)
summary sheets at the Downtown
Shelter and Residential Program, Sage:
Sage, and Paso with the information On September 15, 2022, DHS Licensing Coordinators, Holly Ivey, and Jorge
required by the rule above. The Pelinski, observed the Summary Sheets to be in compliance with all the
agency must have a stand-alone required information.
1
(rev. 200115)
summary sheet with the required
information stated above.
PASO:
On September 15, 2022, DHS Licensing Coordinators, Holly Ivey, and Jorge
Pelinski, conducted an unannounced walk-through inspection. Summary
Sheets were not observed as the program had no youth and will be closing
November 15, 2022.
Service Planning 413-215-0581(2) (e) Yes☐ No Service Planning 413-215-0581(2) (e) (A)&(B) Service plan within 60 days (parent,
(A)&(B) Service plan within 60 days guardian and child actively involved). Describes how child’s issues will be
(parent, guardian and child actively addressed, anticipated outcomes and reviewed by child and guardian/parent.
involved). Describes how child’s issues (REPEAT FINDING -PASO)
will be addressed, anticipated outcomes PASO:
and reviewed by child and On September 15, 2022, DHS Licensing Coordinators, Holly Ivey, and Jorge
guardian/parent. (REPEAT FINDING - Pelinski, conducted an unannounced walk-through inspection. Service Plans
PASO) were not observed as the program had no youth and will be closing November
15, 2022.
 On November 18, 2021, Holly
Ivey, Licensing Coordinator,
observed the service plans
completed by the Paso Program,
were not found in compliance with
the above stated rule requirement.
The following was identified:
There was no signature line at the
end of the service plans to verify
the child and the guardian had
reviewed the document.
Verification of the child and
guardian participation must be
found on the service plans.
Physical Plant 413-215-0511(2)(a) &(c) Yes No☐ Physical Plant 413-215-0511(2)(a) &(c) Buildings are smoke free, clean and in good
Buildings are smoke free, clean and in repair
good repair Downtown Shelter:
 Downtown Shelter: (Room 509) (Room 509) On September 15, 2022, DHS Licensing Coordinators, Holly Ivey, and
Closet door was missing and needs to Jorge Pelinski, observed the closet door missing and needs to be replaced.
be replaced. (REPEAT FINDING 2021)
 Sage: Brownish substance was Sage:
around a threshold of a shower.
(rev. 07/21/2022)
On September 15, 2022, DHS Licensing Coordinators, Holly Ivey, and Jorge
Pelinski, observed the showers to be clean and in good repair. The showers were
found to be in compliance.
New Findings from Site Visit Comments
Physical Plant 413-215-0511(2)(a) &(c) Physical Plant 413-215-0511(2)(a) &(c) Buildings are smoke free, clean and in good repair
Buildings are smoke free, clean and in Downtown Shelter:
good repair Bathrooms:
The 4th and 5th level were observed to have rust on some of the stall walls.
Caulking on the back of a toilet needs repair (boys bathroom recreation space)
2nd floor recreation bathroom toilet paper holder was broken.
Rust was found on the backs on some of the toilets underneath the flushing element.
A hole was found in wall of a bathroom stall that needed caulking and paint.
Girls’ bathroom knobs for the shampoo and conditioner were missing.
5th floor recreation Room:
A small area of flooring was observed to be missing in the 5th floor recreation room.
Sage:
Bathroom:
A hygiene box had been removed from a wall in a bathroom, the area needs to be repainted. The
Assistant Program Director, Allison Jacoby-Fries, stated the wall would be painted.
Interview Summary
Staff and youth from each program were interviewed (7 youth total) at the unannounced site inspections. The following information was
obtained from the youth interviews:
 All the youth stated things were going well at the programs.
 When asked what the youth appreciated most about the program the youth stated: “The staff, the support, the outings, school and
recreational activities, singing, painting, hiking, sailing, video games and playing sports. “
 All the youth confirmed they receive enough food to eat, snacks are provided multiple times a day, with unlimited access to fruit.
 All the youth stated there were no restrictions on their approved contact list, that includes families, and other support systems.
 All the youth stated they are provided sufficient hygiene products by the program.
 All the youth stated they had someone at the program they could talk to if they felt uncomfortable or needed anything.
 It was confirmed by all the youth that they felt safe while residing in the programs, except for two youth at the Sage Program. The Sage
Youth stated: “They felt safe most of the time, every once in a while, I get paranoid with a specific kid, I always have to look over my
shoulder because the people here are crazy.” When asked if staff were aware of the youth’s safety concerns, she stated: “I have not
told staff because that’s who the person is, and they don’t change, if they don’t want to.” Other comments regarding safety included:
“When clients make threats to harm others, I don’t feel safe, and staff don’t do anything, but I don’t see behind the scenes.” “Youth have
(rev. 07/21/2022)
threatened to kill me.” “I don’t want to sleep in this space.” “When peers don’t like other peers, it gets intense and sometimes acted on.”
“When I feel unsafe, I want to be away from the person that makes me feel unsafe.” When asked what would help, the youth stated:
“Letting me be in a separate space.” The youth confirmed that her roommate was not making the verbal threats. She stated she talks to
her therapist about her concerns.
DHS Licensing Coordinators, Holly Ivey, and Jorge Pelinski conducted a debrief meeting with Allison Jacoby-Fries, Assistant Program Director,
after the youth interviews at Sage in response to the youth concerns about safety. Ms. Jacoby-Fries, stated when there are safety concerns or
threats directed towards youth the two youth would be completely separated until a reparative meeting could occur. It is recommended that
Morrison Leadership follow up with Sage Staff regarding the concerns raised by the youth, to help the youth address their safety concerns.
Observations
Staff and youth were observed at the programs during the inspection. The youth that were at the programs, appeared to be at ease and
comfortable in the environments. All areas of the programs (inside and outside) where youth had access were observed, to be well kept, clean
and in good repair with minimal repair needs (see repair needs above in the report). The agency vehicles that the youth ride in were observed
and met the requirements per Licensing Rules. The programs have commercial cleaning companies that assist with the cleanliness of the
facilities. The kitchens were observed to have food in all of the programs. Medication was observed to be in locked medication carts behind
locked rooms which was inaccessible to the youth.
Corrective Actions and Timeframes:
Please submit the following to verify compliance.
Within 45 days of receipt of this report Morrison Family Services, 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 Holly Ivey, and Jorge Pelinski, to the following addresses: Holly.r.ivey@dhsoha. state.or.us and
Jorge.l.pelinski@dhsoha.state.or.us
Licensing Coordinator’s Signature: ________________________ Date: _9_-_2_1_-2_0__2_2_ _________
Licensing Coordinator’s Signature: ________________________ Date: _9_-_2_2_-2_0__2_2_ _________
Manager Review: ______________________________________ Date: _9_-_1_9_-2__0_2_2_ ________
(rev. 07/21/2022)

agency_name: Morrison Child and Family Services (MCFS)

program_name: SAGE

view_code: RC

licensee: Morrison Child & Family Services

licensing_coordinator: Holly Ivey, and Jorge Pelinski

purpose:
Per OAR 413-215-0101 (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
Findings
Further Action
Needed
Information about Children in Care 413- Yes No[ ] Information about Children in Care 413-215-0581(1) Summary sheet contains the
215-0581(1) Summary sheet contains following: (a) religious preference (b) Name and location of current and previous
the following: (a) religious preference school (e) The name, address, and telephone number of: (C) Other persons
(b) Name and location of current and significant to child. (D) Other professionals to be involved in service planning (if
previous school (e) The name, address, applicable) (REPEAT FINDING-Downtown Shelter, Residential, Paso and Sage)
and telephone number of: (C) Other Downtown Shelter Program:
persons significant to child. (D) Other On September 8, 2022, DHS

interview_summary:
Staff and youth from each program were interviewed (7 youth total) at the unannounced site inspections. The following information was
obtained from the youth interviews:
- All the youth stated things were going well at the programs.
- When asked what the youth appreciated most about the program the youth stated: "The staff, the support, the outings, school and
recreational activities, singing, painting, hiking, sailing, video games and playing sports. "
- All the youth confirmed they receive enough food to eat, snacks are provided multiple times a day, with unlimited access to fruit.
- All the youth stated there were no restrictions on their approved contact list, that includes families, and other support systems.
- All the youth stated they are provided sufficient hygiene products by the program.
- All the youth stated they had someone at the program they could talk to if they felt uncomfortable or needed anything.
- It was confirmed by all the youth that they felt safe while residing in the programs, except for two youth at the Sage Program. The Sage
Youth stated: "They felt safe most of the time, every once in a while, I get paranoid with a specific kid, I always have to look over my
shoulder because the people here are crazy." When asked if staff were aware of the youth's safety concerns, she stated: "I have not
told staff because that's who the person is, and they don't change, if they don't want to." Other comments regarding safety included:
"When clients make threats to harm others, I don't feel safe, and staff don't do anything, but I don't see behind the scenes." "Youth have

threatened to kill me." "I don't want to sleep in this space." "When peers don't like other peers, it gets intense and sometimes acted on."
"When I feel unsafe, I want to be away from the person that makes me feel unsafe." When asked what would help, the youth stated:
"Letting me be in a separate space." The youth confirmed that her roommate was not making the verbal threats. She stated she talks to
her therapist about her concerns.
DHS Licensing Coordinators, Holly Ivey, and Jorge Pelinski conducted a debrief meeting with Allison Jacoby-Fries, Assistant Program Director,
after the youth interviews at Sage in response to the youth concerns about safety. Ms. Jacoby-Fries, stated when there are safety concerns or
threats directed towards youth the two youth would be completely separated until a reparative meeting could occur. It is recommended that
Morrison Leadership follow up with Sage Staff regarding the concerns raised by the youth, to help the youth address their safety concerns.

previous_findings:
Repeat Comments
Findings
Further Action
Needed
Information about Children in Care 413- Yes No[ ] Information about Children in Care 413-215-0581(1) Summary sheet contains the
215-0581(1) Summary sheet contains following: (a) religious preference (b) Name and location of current and previous
the following: (a) religious preference school (e) The name, address, and telephone number of: (C) Other persons
(b) Name and location of current and significant to child. (D) Other professionals to be involved in service planning (if
previous school (e) The name, address, applicable) (REPEAT FINDING-Downtown Shelter, Residential, Paso and Sage)
and telephone number of: (C) Other Downtown Shelter Program:
persons significant to child. (D) Other On September 8, 2022, DHS Licensing Coordinators, Holly Ivey, and Jorge
professionals to be involved in service Pelinski, observed the Summary Sheets were not consistently found.
planning (if applicable) (REPEAT (REPEAT FINDING April 5, 2021)
FINDING-Downtown Shelter,
Residential, Paso and Sage) LTGH Program:
On September 8, 2022, DHS Licensing Coordinators, Holly Ivey, and Jorge
- At the unannounced inspection the Pelinski, observed the Summary Sheets were consistently found, however were
programs were observed to not have missing religious preference. (REPEAT FINDING April 5, 2021)
summary sheets at the Downtown
Shelter and Residential Program, Sage:
Sage, and Paso with the information On September 15, 2022, DHS Licensing Coordinators, Holly Ivey, and Jorge
required by the rule above. The Pelinski, observed the Summary Sheets to be in compliance with all the
agency must have a stand-alone required information.
1

summary sheet with the required
information stated above.
PASO:
On September 15, 2022, DHS Licensing Coordinators, Holly Ivey, and Jorge
Pelinski, conducted an unannounced walk-through inspection. Summary
Sheets were not observed as the program had no youth and will be closing
November 15, 2022.
Service Planning 413-215-0581(2) (e) Yes[ ] No Service Planning 413-215-0581(2) (e) (A)&(B) Service plan within 60 days (parent,
(A)&(B) Service plan within 60 days guardian and child actively involved). Describes how child's issues will be
(parent, guardian and child actively addressed, anticipated outcomes and reviewed by child and guardian/parent.
involved). Describes how child's issues (REPEAT FINDING -PASO)
will be addressed, anticipated outcomes PASO:
and reviewed by child and On September 15, 2022, DHS Licensing Coordinators, Holly Ivey, and Jorge
guardian/parent. (REPEAT FINDING - Pelinski, conducted an unannounced walk-through inspection. Service Plans
PASO) were not observed as the program had no youth and will be closing November
15, 2022.
- On November 18, 2021, Holly
Ivey, Licensing Coordinator,
observed the service plans
completed by the Paso Program,
were not found in compliance with
the above stated rule requirement.
The following was identified:
There was no signature line at the
end of the service plans to verify
the child and the guardian had
reviewed the document.
Verification of the child and
guardian participation must be
found on the service plans.
Physical Plant 413-215-0511(2)(a) &(c) Yes No[ ] Physical Plant 413-215-0511(2)(a) &(c) Buildings are smoke free, clean and in good
Buildings are smoke free, clean and in repair
good repair Downtown Shelter:
- Downtown Shelter: (Room 509) (Room 509) On September 15, 2022, DHS Licensing Coordinators, Holly Ivey, and
Closet door was missing and needs to Jorge Pelinski, observed the closet door missing and needs to be replaced.
be replaced. (REPEAT FINDING 2021)
- Sage: Brownish substance was Sage:
around a threshold of a shower.

On September 15, 2022, DHS Licensing Coordinators, Holly Ivey, and Jorge
Pelinski, observed the showers to be clean and in good repair. The showers were
found to be in compliance.
New Findings from Site Visit Comments
Physical Plant 413-215-0511(2)(a) &(c) Physical Plant 413-215-0511(2)(a) &(c) Buildings are smoke free, clean and in good repair
Buildings are smoke free, clean and in Downtown Shelter:
good repair Bathrooms:
The 4th and 5th level were observed to have rust on some of the stall walls.
Caulking on the back of a toilet needs repair (boys bathroom recreation space)
2nd floor recreation bathroom toilet paper holder was broken.
Rust was found on the backs on some of the toilets underneath the flushing element.
A hole was found in wall of a bathroom stall that needed caulking and paint.
Girls' bathroom knobs for the shampoo and conditioner were missing.
5th floor recreation Room:
A small area of flooring was observed to be missing in the 5th floor recreation room.
Sage:
Bathroom:
A hygiene box had been removed from a wall in a bathroom, the area needs to be repainted. The
Assistant Program Director, Allison Jacoby-Fries, stated the wall would be painted.

excerpt:
413-215-0511(2)(a) &(c) Buildings are smoke free, clean and in good repair
Buildings are smoke free, clean and in Downtown Shelter:
good repair Bathrooms:
The 4th and 5th level were observed to have rust on some of the stall walls.
Caulking on the back of a toilet needs repair (boys bathroom recreation space)
2nd floor recreation bathroom toilet paper holder was broken.
Rust was found on the backs on some of the toilets underneath the flushing element.
A hole was found in wall of a bathroom stall that needed caulking and paint.
Girls' bathroom knobs for the shampoo and conditioner were missing.
5th floor recreation Room:
A small area of flooring was observed to be missing in the 5th floor recreation room.
Sage:
Bathroom:
A hygiene box had been removed from a wall in a bathroom, the area needs to be repainted. The
Assistant Program Director, Allison Jacoby-Fries, stated the wall would be painted.
Physical Plant