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I Central School District • of Special Education

Preschool Individualized Education Program 2009-2010 Confidential Student Information

Student Name: Winona R Piscitelli Native Language: English Address* State: NY Home #: (631) Parent/Guardian} Relation: Foster Mother None

Birth Date: 07/06/2005 (4:4) Interpreter: No

Alt ID#: 320755 Gender: Female County: Suffolk Work #: (631 Mobile #: (631i

Zip: 11967
Native Lang.: English Interpreter; No

.ASSI^CATfl^^-^ilfl^ Committee: Committee on Preschool Special Education Reason: Initial Eligibility Determination Meeting Disability: Preschool Student with a Disability Recommended Placement: Just Kids Middle Island Home School: Charles E. Walters Elementary School Projected Start: 01/19/2010 End By: 06/25/2010 Extended School Year: Ineligible Special transportation: In deterininntg and zfoi^^ft'rig a ; considered tffilf Specified: Special S&ting,:Ykhide and/or Etjt&pmekt N^s Date: 11/20/2009 Decision: Classified Preschool Grade: Preschool Projected Next Review: 06/01/2010 Projected Reevaluation: 11/03/2012 tysffcffatidnneeds, the following should be ,' Type of Transportation, Other

'
Special Transportation: No

"

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' ' ' "

!

Special Education Programs: Integrated Co-Teaching Provider: i Start 02/01/2010 gnd 06/25/2010 Ratio 18-2+1 Freq 5 Period Weekly Duradon Location 5 hrs Within the building

Speech/Language Theraj Provider:

Start 02/01/2010

End 06/25/2010

Ratio 1-1

E 3

Period. Weekly

Duration Location 30 rains Within the building

Pr&graw MotflOcations/AccommodatidrtS/^ ggrvice/SupDort
None Required

»ILY SERVICES PROGRESS NOTES Case Name: Location: Palmiotti.Winona M Case ID: 24158873

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******* *****WARNING*

CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

LOSS Office/Field Office Type(s): Family/Primary Discharge Resource Visitation Family Participant(s): Palmiotti.Winona M; Piscitelli,Winona; Focus: Palmiotti.Winona M; Piscitelli,Winona; Progress Note Narrative: Csw picked Winona up from daycare for visit with mother at the Mac office. She was eating lunch so the daycare worker wrapped her food to go. When we arrived at the office mom was in with the case worker. Mom saw Winona and came out. The caseworker was talking to her but mom ignored her. The caseworker told mom that if she curses during the visit, it will be ended. Mom was very agitated and turned her back to the caseworker. Mom then asked the guard to go outside with her so she can talk to him. Csw told mom that this time was for her daughter. Mom became angry and responded that the visit doesn't start yet. Csw arrived ten minutes early. Csw told her the we need to go in the room so she can visit with Winona. As soon as we were in the room mom asked that the supervisor be called. Csw advised her that she may do that after the visit as this time is for her daughter. Csw put Winona's lunch on the table. Mom took out a bagel. Winona said she didn't want her lunch so mom told her to throw it out. It was spaghetti, milk and an apple. Csw told mom that the apple and milk are good for her. Mom responded that she doesn't eat apples nor drink milk. Winona had a few bites of the bagel and cream cheese with a spoon. Winona said something that sounded like daddy. Mom kept saying what. about 6-7 times. While doing this mom just stared at Winona with cold eyes. Winona appeared to become uncomfortable. Csw finally told mom she needs to stop attacking Winona as she is saying daddy. Winona then said at daddy's. Mom just stared at her until Winona looked down; mom then stared at csw. Mom asked for crayons for Winona. Csw was able to find some. Winona sat at the table and drew pictures. Winona said she drew daddy. Mom said, "who, I don't know who you're talking about". She said this several times. Winona was becoming frustrated and csw told mom that she needs to stop as she knows who daddy is. Mother just stared at csw. Winona then played with some of the toys and sat on the rocking chair. Winona pointed to the tattoo on her hand and said fairy. Mom asked her who put it on her hand. Winona said mama Lisa. Mom became angry and said, "you mean Lisa". Winona just looked down. Winona hugged mom when it was time to leave. Csw has observed that the only time mom hugs Winona is when Winona initiates it. Csw returned her to daycare. 'End Of Note* Event Date: 12/10/2009 Entry Date: 12/11/2009 Dist.Agy: A47 Author: Towns,Lori Method: Phone Type(s): Casework Contact Family Participant(s): Piscitelli.Paul; Focus: Palmiotti.Winona M; Piscitelli.Paul; Piscitelli.Winona;

Note Status: Entered By:

Final Towns,Lori

Progress Note Narrative: PC from BF- he states his Atty advised him not to attend the SPR tommorow due to BM's vindictive nature Atty advised he not be in the same room as her CW states this is fine the meeting is really for BM to understand what she needs to do to reunify. Agency isn't asking him to do anything and are in support of child being placed in his custody BF is concerned about his daughters safety due to BM knowing where he lives and that child stays with him on wekends- CW states if he has any problems call the police first then call (number provided) CW will mail him a copy of OP and current court order ************ End Of Note"** Event Date: 12/14/2009 Entry Date: 12/21/2009 Dist.Agy: Author: Towns, Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Service Provider Focus: Palmiotti.Winona M;

A47

Note Status: Entered By:

Final Towns, Lori

Progress Note Narrative: Return V/M from Neil Burton from Acess- he reports that BM never finished their assesment- she came only for the basic informational session and never returned- They closed her case out
C|^.J

Event Date: Entry Date: Author: Method: Location:

12/16/2009 12/17/2009 Dist.Agy: Clark, Josephin Face To Face LOSS Office/Field Office

A47

Note Status: Entered By:

Final Clark, Josephin

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r^wf/LY SERVICES PROGRESS NOTES Case Name: Palmiotti.Winona M Case ID: 24158873

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*****WARNING*****

CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

Type(s): Family/Primary Discharge Resource Visitation Family Participant(s): Palmiotti.Winona M; Piscitelli.Winona; Focus: Palmiotti.Winona M; Piscitelli.Winona; Progress Note Narrative: Csw picked Winona up from daycare for visit with mom at the Mac office. Csw was ten minutes late due to a several car accident that closed the road, Mom was in the lobby when we arrived. Mom greeted her with a hello. Winona gave mom two pictures that she made in school. Mom just took them without saying anything. Mom brought her a chicken nugget lunchable. Winona didn't want the chicken. Mom gave her cheese crackers and the candy that was in the lunchable. Mother is aware that Winona eats lunch right before csw picks her up. Winona then needed to go to the bathroom. Mom then gave her a toy from home to play with. Winona took a book to look at. Mom sat at the table. Winona mentioned the pictures she drew. Mom asked her what she drew. Mom talks to her in a stern voice and never praised or told Winona that she did a nice job on the pictures. Winona wanted to draw but there weren't crayons around. Csw told mom she's welcomed to bring activities for Winona. Winona saw Barbie dolls, mom played with her with the dolls and doll house. Mom said that Winona has about 300 Barbie dolls at home. Csw responded that was a lot. Mom asked what was wrong with that in which csw said, nothing, that's just a lot of dolls. Mom said that she never says no to Winona and that she gets everything she asks for. Csw said that may not necessarily the best thing to do as you don't always get everything in reality. Mom just shrugged her shoulders. When it was time to leave mom procrastinated and it took a while for Winona to get her coat on. As we were leaving thru the door, mom started to call Winona. Csw held Winona hand and put arm around her and went to the car. Csw returned her to daycare,
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Event Date: 12/16/2009 Entry Date: 12/21/2009 Dist.Agy: A47 Author: Towns, Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Relative Focus: Palmiotti.Winona M; Piscitelli.Winona;

Note Status: Entered By:

Final Towns, Lori

Progress Note Narrative: V/M from Carol Marzocco requesting a return call before BM's visit today with child CW leaves a return message for Carol
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Event Date: 12/17/2009 Entry Date: 12/17/2009 Dist.Agy: A47 Author: Towns, Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Relative Focus: Palmiotti.Winona M; Piscitelli.Winona;

Note Status: Entered By:

Final Towns, Lori

Progress Note Narrative: PC from Carol Marzocco- she asks how the visit went yesterday between BM and child- CW states CW hasn't heard yet since it is first thing in the morning- Carol goes on to say that BM called her after the visit and said that CW or person supervising the visit pulled Winnona's arm during the visit- CW asks Carol to hold to speak to CSW who supervised to visit CW is informmed by CSW Clark that the visit had ended and BM had said her good bye's to child and BM called child back and CSW told child to keep walking and put her arm around child and proceeded to the car CW informs CArol of the above and states the visits are in a time frame and can't go over due to scheduling- No Pysical force of any kind was used on the child CW also informs Carol that all visits are supervised and this visit in particular requires extra supervision by security close by due to the BM's behavior and use of foul language- all parties are bond to tell the truth and would not lie about what went on during the visits CW goes on to say that BM has said that CW has cursed at BM and this is untrue which can be backed up by Security CW explains to Carol that all agency employees are hear to help this family and want the best for this child. This CW has offered numerous times to help BM get into therapy, etc in order to reunify with her child and BM continues to be non compliant BM needs to make an initiative to reunify Carol states that BM's atty called her yesterday and asked if they had their home study yet- CW again explains to Carol that the agency is not going to request a curtosy home study by her county at this time since this isn't the agency's plan for the child and this would not be fair to her county It is agency's plan to place the child in her father's custody He has rights over them If his petition is denied by the Judge then agency will seek to start their home study CW also reminds Carol that BF has visitation rights and he has a right to say he doesn't want his child placed out of county- He has liberal visitation

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/V..W/LY SERVICES PROGRESS NOTES Case Name: Palmiotti.Winona M Case ID: 24158873

*****WARNING***** CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

and has her for the weekend and Carol would have to bring child hear at least 3 times per week to accomodate this visitation schedule as well as the BM's visit carol states this wouldn't be a problem CW reminds Carol that as she has been told over and over the agency is not requesting a courtesy home study at this time CW tells Carol that maybe next week they can come during BM's visit to see child- CW will let her know since normal CSW is off and the visit may have to be rescheduled for a different day or time so CW will get back to her as soon as it is scheduled *End Of Note*' Event Date: 12/17/2009 Entry Date: 12/28/2009 Dist.Agy: A47 Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Relative Focus: Palmiotti.Winona M; Piscitelli.Paul; Piscitelli.Winona;

Note Status: Entered By:

Final Towns,Lori

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:

' • ' - " • - - - - - • - - ' - - -'. : -".--"-'•--"-

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Progress Note Narrative: PC from Barbara Grant- she said that BM called CPS on CPS- she said that CSW pshyically dragged the child- CW states this has allready beeb address the am- CSW did nothing of the sort to the child- Barbara didn't think so but just found it humerous that BM would say such a thing Barbara reports that BM calls her 15 times per hour- this is tourtoure for her- she can't wait until this is all over

Event Date: 12/22/2009 Entry Date: 12/22/2009 Dist.Agy: Author: Towns,Lori Method: ' Phone Type(s): Collateral Contact Other Participant(s): Service Provider Focus: Palmiotti.Winona M;

A47

Note Status: Entered By:

Final Towns,Lori

Progress Note Narrative: PC to Neil Burton from Access- CW asks if he can clarify what is written in the inital assesment done on BM since the handwritting is hard to readNeil states that BM did admit to drinking alcohol every day 20 years ago and had a relapse in August 2009 and Sept 16, 2009. BM also admitted to abusing crack-cocaine and canabis 20 years ago DR. Nadkarni diagnoses BM on Axix 1- alcohol abuse 30500 BM reports she has been mentally, Psyical, and emotionally abused and now she has trouble trusting people especially CPS End Of Note Event Date: 12/23/2009 Entry Date: 12/31/2009 Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Relative Focus: Palmiotti.Winona M;

Dist.Agy:

A47

Note Status: Entered By:

Final Towns,Lori

Progress Note Narrative: PC from Barbara Grant MA, she reports that she feels BM is starting to realize what is going to happen with her daughter- Barbara can see BM is breaking down emotionally- Barbara asks if she can call BM on Christmas day so she can speak to child on the phone briefly for Christmas (Barbara reports BF and child will be at her home celebrating)- CW doesn't fell this is a good idea since BM will probably just get more angry that BFa nd Barbara get to see the child and she doesn't Barbara feels it will help BM's mental state- CW agrees to a brief call on speaker phone supervised and if anything is said call is to be ended
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Event Date: 12/23/2009 Entry Date: 1/4/2010 Dist.Agy: Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Foster/Adoptive Parent

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Note Status: Entered By:

Final Towns,Lori

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r*~,iLY SERVICES PROGRESS NOTES Case Name:
Focus:

. 24158873

*****WARNING*****

CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

Palmiotti.Winona M

Case ID:

Piscitelli.Winona;

Progress Note Narrative: PC to FM • • - home visit set up for next week • 9

Event Date: Entry Date: Author: Method: Location:

12/23/2009 1/4/2010 Dist.Agy: Towns, Lori Face To Face LOSS Office/Field Office Type(s): Casework Contact Family Participant(s): Palmiotti.Winona M; Focus: Palmiotti.Winona M; Progress Note Narrative: CW met with BM at the office-

A47

Note Status: Entered By:

Final Towns, Lori

BM asks CW to make an appointment for her for the mental health evaluation- CW asks BM where she would like to have evaluation completedBM states wherever just make me the appointment- CW states CW will make the appt at Pederson Krag since they will usually give an appointment sooner if DSS requests so- BM signs a release for CW to make the appointment and for the results of the mental health eval BM states she will be self pay due to no insurance and believes Pederson Krag will do the eval for free BM provides CW will letters from Good Samaritain parenting class that she has completed- BM signs a release so CW can speak to the providor BM states that EAC parenting class teaches you to hit your children and that playing games with kids in the way to go- BM reports she attnded 2 classes there but stopped since she didn't believe in what they were teaching her BM states she found out her mother was in Creedmore Psychiatric Hsp with a diagnosis of Scitzophrenic CW asks BM about her evaluation at Accesso- since it states she is diagnosed with Alcohol abuse- BM states she drank once when child was removed from her and only drinks coffee and smokes cigarettes CW states that the evaluation notes she drank everyday 20 years ago and used marijuana and cocaine- BM denies any cocaine use ever but admits to drinking and useing marijuana 20 ago *End Of Note* Event Date: Entry Date: Author: Method: Location: 12/23/2009 1/5/2010 Dist.Agy: A47 Clark.Josephin Face To Face LOSS Office/Field Office Type(s): Family/Primary Discharge Resource Visitation Family Participant(s): Palmiotti.Winona M; Piscitelli.Winona; Focus: Palmiotti.Winona M; Piscitelli.Winona;

Note Status: Entered By:

Final Clark,Josephin

Progress Note Narrative: Csw picked Winona up from day care for visit with mother at the Mac office. Mom arrived shortly after us. Mom barely greeted Winona. She had a bag of gifts with her. Once in the room she gave them to Winona one at a time. She gave her a cabbage patch doll, a dog, Barbie doll, Another doll, a teddy bear and a toothbrush. Winona gave mom a star made of pip cleaners with her picture in the middle. Mother took it but didn't acknowledge it, didn't say how nice or thank you. Winona had her head down. Csw told her what a nice job she did and how nice it was. Winona smiled at this. They spent the rest of the visit playing with play -doh. Mom said good bye to Winona and gave her a hug. Csw returned her to day care, *End Of Note* Event Date: 12/28/2009 Entry Date: 1/4/2010 Dist.Agy: Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Mental Health Focus: Palmiotti.Winona M; Progress Note Narrative:

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A ^IILY SERVICES PROGRESS NOTES Case Name: Palmiotti.Winona M Case ID: 24158873

'*****WARNING***** CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

PC to Pederson Krag Admissions- CW asks to make an appt for BM for Mental Health Eval- release form faxed over CW is informmed that the SW assigned will be Jenette and she will call BM tommorow to do an application over the phone and make her appt to come in for evaluation- CW is not able to just make the appt for BM CW also faxed over current court order and petition
(***************************************C.».J Q* MQA-*************

Event Date: 12/28/2009 Entry Date: 1/4/2010 Dist.Agy: Author: Towns,Lori Method: Phone Type(s): Casework Contact Family Participant(s): Palmiotti.Winona M; Focus: Palmiotti.Winona M;

A47

Note Status: Entered By:

Final Towns,Lori

Progress Note Narrative: PC to BM- CW left a message stating that Pederson Krag will be contacting her tommorow to conduct an application via phone and set up appt for Mental Health eval

Event Date: 12/29/2009 Entry Date: 12/29/2009 Dist.Agy: A47 Author: Towns, Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Relative Focus: Palmiotti.Winona M; Piscitelli.Paul; Piscitelli.Winona;

Note Status: Entered By:

Final Towns, Lori

Progress Note Narrative: PC from Maternal Aunt Barbara Grant- she reports that she has to apologise to CW since Barbara asked permission for BM to speak to child on the phone on Christmas day since Barbara felt that BM was deteriorating and a phone call on Christmas would be nice for her- CW did approve a brief supervised call via speaker phoneHowever Barbara reports she did call BF's phone where child was for Christmas and then called BM on three way call so she could say Merry Christmas to her daughter- Instead all BM did was curse at BF, the call was ended very quickly however the child did hear this foul language from herBM Barbara reports she feels horrible for this- CW states this will not happen again Barbara states BM is now involved with some group in New Jersey for people who have been abused by CPS- BM has stayed with some lady from this group she just met for the past few days Barbara feels BM is mentally ill and wishes she can get help

Event Date: 12/29/2009 Entry Date: 12/29/2009 Dist.Agy: A47 Author: Towns, Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Relative Focus: Palmiotti.Winona M; Piscitelli.Winona;

Note Status: Entered By:

Final Towns, Lori

Progress Note Narrative: PC from Carol Marzocco maternal step grandmother- she is requesting a visit with child- CW offers them to attend BM's visit tommorow as long as BM is ok with this- Carol states tommorow is not good for them-CW offers them a visit on next opening 1/15/10 at 9:30 am- MGM reports this is too early for them since they are traveling to get there- CW asks what time they can get to office- MGM responds 10:30 or 1 1am the earliest CW states then 10:30 will be the start time to accomodate their request, visit must still end at 12:00 due to CSW schedule- CW reminds MGM that if they were able to arrive to office earlier then the visit could be longer *End Of Note* Event Date: Entry Date: Author: Method: 12/29/2009 1/11/2010 Towns,Lori Face To Face

Dist.Agy:

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-rt/IILY SERVICES PROGRESS NOTES Case Name: Palmiotti.Winona M Case ID: 24158873

"""WARNING***** CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

Location: Foster Home Type(s): Casework Contact Other Participant(s): Foster/Adoptive Parent Family Participant(s): Piscitelli,Winona; Focus: Piscitelli,Winona; Progress Note Narrative: CW met with Winona and FIVMBMBat the Foster HomeAlso present was Foster Grandmother Winona has the start of a cold- her nose is running slightly- FM reports that she was at BF's from X-mas eve until yesterday and BF said she had a slight fever BF said he gave her children's motrin- today she has no fever FM reports that Child will be going back to BF's on Thursday for new years CW has noticed and FM reports that Child's speech has gotten clearer CW discusses with FM child startingtfHIBfe- we both agree that we will hold off her start date to see if child is placed in BF's custody so not to make child have so many changes Winona shows CW some toys she got for Christmas- FM states she got so much stuff between her BM, BF and them Next home visit set for 1/13 at 5:30

Event Date: Entry Date: Author: Method: Location:

12/30/2009 Event Time: 1:30:00 PM 12/30/2009 Dist.Agy: A47 Other Face To Face LOSS Office/Field Office Type(s): Family/Primary Discharge Resource Visitation Family Participant(s): Palmiotti.Winona M; Piscitelli.Winona; Focus: Palmiotti.Winona M; Piscitelli,Winona;

Note Status: Entered By:

Final Caputo,Victoria

Progress Note Narrative: This Community Service Worker picked Winona up at her FH for her 2 hour supervised visit at the DSS building with BM. Winona appeared neat, dressed appropriately and friendly. CSW noticed Winona sneezed, had a cough which sounded very congested and a runny nose which was thick with mucus. This was brought to the caregivers attention when Winona was returned home. We proceeded to the DSS building. Winona fell asleep during the transport. Once we arrived at the DSS building, we were greeted by BM. BM and Winona exchanged hugs and we proceeded to the visitation area. Once in the visitation room, BM helped Winona off with her jacket and commented on what Winona was wearing, (thermal type shirt, tee shirt over thermal, and a light hooded sweat shirt under her jacket). CSW commented, "Winona's dressed in layers, that's good." BM angrily responded, "no, it's not." BM offered Winona the crayons, coloring book, snacks, juice and bracelet craft that she brought for her. Before starting bracelet craft, BM asked for CSW's approval stating, "the other woman is a witch." Time was spent playing with doll house, making a bracelet together, coloring together and eating snacks. BM complained that the FH doesn't allow or give Winona the juice pouches or cheese and peanut butter crackers that she enjoys. While playing with doll house, Winona asked to get Barbie dolls out of the cabinet. BM explained to CSW that Winona has 300 Barbie dolls. CSW commented that was a lot of dolls. BM sounded annoyed and asked CSW what was wrong with that. CSW said nothing is wrong it's a lot of dolls.. Winona asked to use the bathroom. While waiting to use the bathroom, CSW asked to wipe Winona's nose just as a woman was leaving the bathroom stall. BM snapped at CSW stating CSW was confusing Winona. BM commanded Winona to use the bathroom which she used independently. CSW apologized to BM explaining that Winona's nose was running. BM explained Winona gets confused easily. BM helped Winona wash her hands and we proceeded back to the visitation room. Winona appeared comfortable with BM initiating hugs and kissing a boo boo BM had on her finger. BM appeared patient and affectionate with Winona exchanging hugs and kisses. CSW asked BM several times to wipe Winona's nose. Winona mentioned having a belly ache. BM asked if Winona has seen a doctor. CSW was not sure but assured BM she would bring to FM and Caseworkers attention. During the visit CSW redirect BM several times from making angry/ negative comments in front of Winona regarding CPS and Winona' foster home. BM informed CSW that everything she bought for Winona disappears. BM said she never saw the shoes she bought Winona worn at all, hasn't seen the stuffed toy she put on Winon's coat/ zipper, or the Elmo book bag. BM accused the FH of taking away and throwing away Winona's toys. BM commented to Winona not to let anyone take/throw away her bracelet which BM put on Winona's ankle. BM said she didn't want it to disappear like everything else. BM commented about CPS stating she saw CPS workers on the Internet, smoking and doing drugs. Commenting to CSW that Steve Levy is handing out pink slips and asked CSW did she know he's laying of you CPS workers, CPS is piss poor and kidnaps children, fabricate lies, CSW informed BM that she would listen to her complaints privately but during the visit in front of Winona, was not the time or place as it is supposed to be a positive time for her and Winona. BM commented that Winona should know the truth and stated that people don't want to listen or hear. CSW reminded BM she would be more then happy to listen and hear but not during the visit. After further negative comments CSW informed BM that she would have to end the visit if she did not stop the angry, negative and inappropriate comments. BM eventually

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ttntlLY SERVICES

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*****WARNING*****

PROGRESS NOTES
Case Name: Palmiotti.Winona M Case ID: 24158873

CONFIDENTIAL INFORMATION
AUTHORIZED PERSONNEL ONLY

stopped and invited CSW to color picture with her and Winona. Visit was ending BM helped Winona on with her coat and informed CSW if Winona runs to her after the visit not to stop her explaining Winona will kiss BM and leave quietly with CSW. When leaving Winona and BM exchanged hugs and kisses. CSW did not have any problems. Winona left with CSW quietly as BM repeated goodbye. Winona was transported back to her FH without incident.

Event Date: 12/31/2009 Entry Date: 1/12/2010 Dist.Agy: Author: Towns, Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Foster/Adoptive Parent Focus: Piscitelli, Winona;

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Note Status: Entered By:

Final Towns, Lori

Progress Note Narrative: ___ CW left a Voice mail for FMriMMBtetating that she must take child to the DR for her cold since BM was complaining about it yesterday during her visit and CW doesn't want BM to make another CPS report FM Carbone left CW a return message stating that she doesn't have Child today she is aliready with BF for the holiday- she gave BF her Medicaid card so if she needs to see a Dr BF can take her
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Event Date: 1/4/2010 Entry Date: 1/4/2010 Dist.Agy: Author: Towns, Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Foster/Adoptive Parent Focus: Piscitelli.Winona;

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Note Status: Final Entered By: Towns, Lori

Progress Note Narrative: CW left a v/m for FMttttHPStating that Winona will have a visit with MGP's on Thursday from 2-3:30
****************** End

Of Note

Event Date: 1/4/2010 Entry Date: 1/4/2010 Dist.Agy: Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Mental Health Focus: Palmiotti.Winona M;

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Note Status: Entered By:

Final Towns,Lori

Progress Note Narrative: PC to Ped Krag Admissions to follow up if BM has had her phone application yet and if mental health eval is scheduled yet- CW is informmed that as of now there is no appointment made and she will note the file for someone to follow up with CW as to the status of this

Event Date: 1/4/2010 Entry Date: 1/4/2010 Dist.Agy: A47 Author: Towns,Lori Method: Phone Type(s): Casework Contact Family Participant(s): Palmiotti.Winona M; Focus: Palmiotti.Winona M; Piscitelli.Winona;

Note Status: Entered By:

Final Towns,Lori

Progress Note Narrative: PC from BM- she requests CW do her a favor- She asks that CW get a child's medical records for her- CW states CW can't just get any child's medical records- BM states yes you can because the child is in Foster care- CW states still CW isn't permitted access to the medical records of all foster children- BM states yes you can you have to get them CW asks BM who's records she wants- BM reports Timothy CW reports that CW has no access to Timothy's medical records she would have to contact the DSS who has custody of him Suffolk DSS isn't privy to this info

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W/LV SERVICES

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*****WARNING*****

PROGRESS NOTES
Case Name: Palmiotti.Winona M Case ID: 24158873

CONFIDENTIAL INFORMATION
AUTHORIZED PERSONNEL ONLY

BM states yes you can get them since Suffolk is using this against me you can get the records you have to get the records- BM continues to rant insisting that CW get these medical records- CW interrups BM and tells BM she needs to stop putting so much energy into this other stuff and put her energy into reunifying with Winnona CW advises BM to contact her atty about this because this CW can't help her with this BM stops for a minute and asks how is Winona anyway? CW states she is fine BM states you are lying why are you lying? CW states the child is doing fine, CW goes on to say that child will be having a visit with her parents on Thursday BM states why Thursday? CW states this is the first available opening for a visit BM asks why not Wednesday? CW states her parents were offered to come to her visit last week as long as she agreed to it however they said no, then CW offered them the next available opening which was on 1/15/10. They took this however called to say this was not good- CW had a cancellation on 1/7/10 and this is the scheduled visit BM asks if CW has a court order for this? CW replies that we do not need a court order, Grandparents have rights to visit their grandkids BM asks are you aware that these people have never met Winona? CW tells BM that CW is aware that this is BM's plan for her child to be placed with her parents- Does BM want child to just be placed with them without ever meeting them? BM states this isn't her plan for her child CW states this is what she said at court BM repeats this is not her plan for Child CW asks BM what the status of her mental health evaluation is at Pederson Krag? BM states she knows nothing about it- CW states she was supposed to get a call last week from PK and CW just called PK and they said atthis time there is no appt made CW states CW left BM A message last week stating PK would be calling her to set up appt and for phone application BM asks what number CW was calling her on? CW replies the 516 number BM states the 516 number has been cancelled for a while CW reminds BM that as part of her court order she must provide a valid address and phone number to be reached BM states she has given a number this is her number- (CW doesn't have caller ID ) BM states she lives in Ohio not NY CW tells BM to call PK to set up her appt- the number is provided to BM again CW tells BM CW has to hang up now
****************************^ Q* I^Q* ~********************^*********^

Event Date: 1/4/2010 Entry Date: 1/14/2010 Author: Towns, Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Relative Focus: Palmiotti.Winona M;

Dist.Agy:

A47

Note Status: Entered By:

Final Towns, Lori

Progress Note Narrative: PC from Barbara Grant she reports BM is posting things on Steve Levy's website, and is joining anti CPS groups BM told Barbara that CPS would have a problem with Barbara because her 3 year old child still wears a pull up- Barbara states "I can't deal with her anymore" Barbara states she googled Schizophrenia and feels this is what BM has
Of Mot «***

Event Date: 1/6/2010 Entry Date: 1/14/2010 Dist.Agy: Author: Towns.Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Foster/Adoptive Parent Focus: Piscitelli, Winona;

A47

Note Status: Entered By:

Final Towns.Lori

Progress Note Narrative: V/M from FM &ff& she reports she is going on vacation in Feb and will need a respite for child if child is still in her care

Event Date: Entry Date:

1/6/2010 1/14/2010

Dist.Agy:

A47

Note Status:

Final

Date Printed:

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-.

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F^ilLY SERVICES PROGRESS NOTES Case Name: Author:
Method: Location:

-~

"""WARNING*****

CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY 24158873 Clark.Josephin

Palmiotti.Winona M Clark.Josephin

Case ID: Entered By:

Face To Face LOSS Office/Field Office Type(s): Family/Primary Discharge Resource Visitation Family Participant(s): Palmiotti.Winona M; Piscitelli.Winona; Focus: Palmiotti.Winona M; Piscitelli.Winona; Progress Note Narrative: Csw picked Winona up at daycare for visit with mom at the Mac office. Mom arrived shortly after we did. In the room mom asked her for a hug. She gave Winona candy and a drink box. Mom asked her if she wanted to color and took out crayons and a coloring book. They sat at the table coloring. Winona had to go to the bathroom. While in there Winona gave mom several hugs. Back in the room mom read her a book. They also played with the toys. Winona had a toy microphone. Mom took it to use it. Winona became upset and tried to take it back. Mom held on to it for a while before giving it back. Winona had to go to the bathroom again. Back at the room mom gave her some more candy and another drink. Mom gave her a kiss during the visit and then again when it was time to leave. Winona gave mom a big hug and then left with csw. Csw returned her to daycare. *End Of NOte******************************** Event Date: 1/7/2010 Entry Date: 1/14/2010 Dist.Agy: Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Legal/Attorney Focus: Piscitelli.Winona;

A47

Note Status: Entered By:

Final Towns.Lori

Progress Note Narrative: V/M from Cathy Fusco, LG SW requesting an update on child *End Of Note* Event Date: Entry Date: Author: Method: Location: 1/7/2010 1/14/2010 Dist.Agy: A47 Clark.Josephin Face To Face LDSS Office/Field Office Type(s): Family/Primary Discharge Resource Visitation Other Participant(s): Relative Family Participant(s): Piscitelli.Winona; Focus: Piscitelli.Winona;

Note Status: Entered By:

Final Clark.Josephin

Progress Note Narrative: Csw picked Winona up from daycare for visit with grandfather and step-grandmother. The caseworker came down when csw arrived. She met with the grandparents and introduced Winona to them. She was a little shy at first but warmed up to them. They brought Christmas gifts for her. The gave her a coloring book, crayons and dolls. Winona played by herself. The grandmother did go over to her and played along. The grandfather sat on the couch. The grandmother sat Winona next to her and read her a book. The grandmother said to the grandfather that maybe Winona would like to color. He sat next to her and they colored. They both gave her a hug and kiss when it was time to leave. Csw returned Winona to daycare.

Event Date: 1/8/2010 Entry Date: 1/8/2010 Dist.Agy: Author: Towns.Lori Method: Phone Type(s): Casework Contact Family Participant(s): Palmiotti.Winona M; Focus: Palmiotti.Winona M;
tr

A47

Note Status: Final Entered By: Towns.Lori

Progress Note Narrative: PC from BM- she reports that Pederson Krag has nothing on her- CW states that they do have her file and release and background informationCW spoke to them this week CW asks if BM is calling the correct center- BM states yes the one on Route 111 BM states "no they have nothing until Feb- They have nothing" "They have no release, nothing" CW states she should then take the appointment they are offering her for Feb- BM states no they wouldn't make they appointment

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\rnlLYSERVICES PROGRESS NOTES Case Name: Palmiotti.Winona M Case ID: 24158873

^-

"""WARNING*****

CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

BM states "you have to call" CW states no Winona CW has allready called and sent over the information now it is up to you this is the proceedure BM insists "no you have to call you have to call" CW tells BM this is what agency is recommending she do to reunify with her daughter she must take the initiative and do what is asked of her- CW states the possibility of BM getting an appointment for a mental health evalutaion before her court date in less than 2 weeks is probably not going to happen- CW has been working with BM to get this eval done since CW was assigned this case CW reminds BM that her child has been in foster care for months she should have called earlier BM replies"my child is in foster care because you are getting me confused with someone else" CW tells BM to speak to her atty about this

Event Date: 1/8/2010 Entry Date: 1/14/2010 Dist.Agy: Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Legal/Attorney Focus: Piscitelli,Winona;

A47

Note Status: Final Entered By: Towns,Lori

Progress Note Narrative: Return P/C to LG SW Cathy- She is calling for an update on child and wether or not they should begin to investigate the MGP's the Marzocco'sCW explains that MGP's were here yesterday for a visit with child however agency is not looking into them at this time as resources since child has a BF who is a wonderful resource- child and BF love each other, have weekend visits and they go well BM's visits with Child do not go as well as agency would like CW suggests SW go to see child and BF interact CW also informs SW that MGF, Phillip Marzocco has CPS history placing his 5 children including BM in foster care- BM was in FC from when she was age 5 to around 11-This is a concern for agency
*****************!

End Of Note*

Event Date: 1/8/2010 Entry Date: 1/14/2010 Dist.Agy: Author: Towns,Lori Method: Phone Type(s): Casework Contact Family Participant(s): Piscitelli,Paul; Focus: Piscitelli,Paul;

A47

Note Status: Final Entered By: Towns,Lori

Progress Note Narrative: PC to BF - CW asks about the indicated CPS case from 10/17/2005- BF reports that BM claimed that he slammed the door on BM and BF states he never followed up with CW from Naussau- however BM did admit to CPS CW that BM was lying about him slamming the door on BM

Event Date: 1/8/2010 Entry Date: 1/14/2010 Dist.Agy: Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Mental Health Focus: Palmiotti.Winona M;

A47

Note Status: Entered By:

Final Towns,Lori

Progress Note Narrative: PC from Theresa Sharon from FEGS 691-7080 X 350- she requests a return PC for more information about this BM CW left a return VM on 1 /11 /10
************«*******»»**********»*«»»***«***»«*«»****************»**«*£n(J

Event Date: 1/11/2010 Entry Date: 1/11/2010 Author: Towns,Lori Method: Phone Type(s): Collateral Contact

Dist.Agy:

A47

Note Status: Entered By:

Final Towns,Lori

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F-f*dllLY SERVICES

^~

*****WARNING*****

PROGRESS NOTES Case Name: Palmiotti.Winona M Case ID: 24158873

CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

Other Participant(s): Relative Focus: Palmiotti.Winona M; Piscitelli.Paul; Piscitelli.Winona; Progress Note Narrative: PC from Maternal Aunt, Barbara Grant she reports that she saw child and BF this weekend and child is thriving- Barbara states the FM is doing a great job with her she sees such a difference in her since she last saw her in Sept- Barbara also states that the relationship between child and BF is so great and loving like a typical father daughter relationship should be Barbara reports BM tried to be child's best friend not her mother and this wasn't good Barbara reports BF brought child to her child's birthday party at Build a Bear and BF put a special talking message to child in her bear Barbara reports that BM told her that BF no longer has unsupervised visits with child since CW went to BF's house on Christmas Day and saw BF having an alcoholic drink so his unsupervised visits were taken away- Barbara knows this is untrue since she was with BF and child yesterday during the unsupervised visit Barabara also states BM said she saw CW Lisa Scafide in a drug deal in a parking lot last week and that she has video tape of this CW walking in DSS parking lot to CWs car pulling and pushing a child- CW states this is all false and if she thinks she is video taping us then she should be advised that we also have video in our parking lot so we can be taping her taping us! End Of Note Event Date: 1/12/2010 Entry Date: 1/14/2010 Dist.Agy: Author: Towns, Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Mental Health Focus: Palmiotti.Winona M;

A47

Note Status: Entered By:

Final Towns, Lori

Progress Note Narrative: PC to Theresa from PEGS regarding BM- Theresa reports that BM contacted FEGS for mental health services however she reported to PEGS that she resides in OHIO and for some reason CPS is requesting BM to come to NY for services- Theresa thought this sounded a bit strange so wanted to confirm this with CW- CW informs Theresa that BM does own a home in OHIO however resides at 1355 Locust Ave in Bohemia and does need a mental health evaluation as reccommended by agency- Theresa reports that since BM insisted that she resides in OHIO they are unable to provide her with services in NY

Event Date: 1/12/2010 Entry Date: 1/14/2010 Dist.Agy: A47 Author: Towns, Lori Method: Phone Type(s): Casework Contact Family Participant(s): Piscitelli.Paul; Focus: Palmiotti.Winona M; Piscitelli.Paul; Piscitelli.Winona;

Note Status: Final Entered By: Towns, Lori

Progress Note Narrative: PC to BF to inform him that unfortunately we have to cancel his visit with Child for this weekend since BM has filed another petition in court and states since paternity has not yet been established (allthough we have DNA trial has not been had to adjudicate BF) our ACA advised that visits be stopped at this time- CW appoligizes for this CW advises that BF contact his ATTY to see if anything can be done about this but this CW must stick to what ACA tells CW BF is very upset about this PC to FM Carbone to inform her there will be no visit this weekend with BF- FM reports this is unfortunate because the child counts down the days on the calender until she will see her BF- she really loves him

•DRAFT* Event Date: 1/13/2010 Entry Date: 1/25/2010 Dist.Agy: Author: Towns,Lori Method: Face To Face Location: Foster Home Type(s): Casework Contact Other Participant(s): Foster/Adoptive Parent Family Participant(s): Piscitelli.Winona; Focus: Piscitelli.Winona; A47 Note Status: Draft Entered By: Towns,Lori

Date Printed:

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rm/IILY SERVICES

*****WARNING***"

PROGRESS NOTES
Case Name: Palmiotti.Winona M Case ID: 24158873

CONFIDENTIAL INFORMATION
AUTHORIZED PERSONNEL ONLY

Progress Note Narrative: CW met with Winona and FMMBMfcat the Foster Home-

Winona is watching Dora on TV when CW arrives- this is her favorite show so she was very attentive to this CW asks Winona how her visit with BM went today- Winona didn't answer CW FM attempted to get her attention stating Winona CW is asking you a question- Winona just looked at us FM then asked Child how her visit with Mommy today was- Winona didn't answer CW asks again - no response- this is dropped CW then asks Winona how she likes going to BF's house- Winona immediately turns to CW with a huge smile on her face and brings CW a Build bEAR BUNNY SHE HAD GOTTEN FROM bf- wINONA SHOWS cw THAT the bunny talks- it is the BF's voice saying " Winona I love you" Winona tells CWthis is very special Winona brings CW the clothes for the bunny and we play together with it Winona also shows CW a necklace she is wearing from BF Winona is doing well in foster home- she is thriving- her speech has improved greatley CW explains to FM that at upcoming court date BF may get custody and CW will make arrangement to come pick child up that night and return to BF FM states she knows this is the best placement for child, she just hopes BF allows her to remain in contact with child
**********************************************************************C|« J

*DRAFT* Event Date: Entry Date: Author: Method: Location: 1/13/2010 1/25/2010 Dist.Agy: A47 Clark,Josephin Face To Face LOSS Office/Field Office Type(s): Family/Primary Discharge Resource Visitation Family Participant(s): Palmiotti.Winona M; Piscitelli,Winona; Focus: Palmiotti.Winona M; Piscitelli,Winona; Note Status: Entered By: Draft Clark,Josephin

Progress Note Narrative: Csw picked Nonna up from daycare for visit with mother at the Mac office. Mom was in the lobby when we arrived. Before saying hello to Nonna, mom noticed a necklace that Nonna was wearing. She asked Nonna who gave that to her. Nonna answered, with her head down, daddy. Mom just looked at her. Once in the room mom took out a rice pudding for Nonna which was eaten right away. Nonna then went for the second one. As mom was getting it for her csw explained to mom that she just had lunch and should wait before giving her a second one. Nonna also had a drink. Nonna then wanted the cheese doodles and another snack mom had. Csw explained again that she eats lunch right before being picked up and that one snack is more then enough for the visit. Mom read Nonna a book. They then played with the toys in the room. When playing mom tend to talk at her instead of with her. During the visit mom said that she has concern with Nonna wearing the necklace. Csw observed that necklace was long enough and Nonna didn't play with it. Nonna went to the bathroom twice during the visit. Csw returned her to daycare. End Of Mote ********************************************************************* Event Date: 1/14/2010 1/14/2010 Dist.Agy: Entry Date: Towns, Lori Author: Phone Method: Type(s): Collateral Contact Other Participant(s): Mental Health Focus: Palmiotti.Winona M;

A47

Note Status: Entered By:

Final Towns,Lori

Progress Note Narrative: PC from Joanna Halsey, Director of Pederson Krag- she reports she has CWs referral for services for BM however they have not yet heard from BM- Joanna reports they received this CWs referral on 12/28/09 they called BM on 12/30 and 12/31/09 and left messages both days and BM has not yet returned their call- They need her to call them in order to complete a 3 page phone intake and then provide her with an appointment for mental health evaluation- CW asks Joanna if BM does call them in the next few days are they willing to assist BM or are they closing her file? Joanna states that if BM calls them they will work with BM and will be able to get her in for an appointment one day next week but BM must call them first CW thanks Joanna for her time and assistance Joanna states that BM can call Joanna directly at 920-8344 and she will assist her immidiately *End Of Note* **************************************************

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FAMILY SERVICES PROGRESS NOTES Case Name: Palmiotti.Winona M Case ID: 24158873

~

*****WARNING*****

CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

Event Date: 1/14/2010 Entry Date: 1/14/2010 ' Dist.Agy: Author: Towns.Lori Method: Phone Type(s): Casework Contact Family Participant(s): Palmiotti.Winona M; Focus: Palmiotti.Winona M;

A47

Note Status: Entered By:

Final Towns.Lori

Progress Note Narrative: PC to BM - CW leaves BM a voice mail stating that CW just spoke to Joanna at Pederson Krag and they are able to assist her with a mental health eval however BM must call PK to do phone intake first then they can get her in for mental health eval as soon as next week before her court date-CW states she can call Joanna directly at 920-8344
CpJ

**************************************************************

Event Date: 1/14/2010 Entry Date: 1/14/2010 Author: Towns.Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Relative Focus: Piscitelli.Winona;

Dist.Agy:

A47

Note Status: Entered By:

Final Towns.Lori

Progress Note Narrative: PC from MGM, Carol Marzocco- she requests a visit with child next week- CWexplians that as CWhas allready told her there is no availability for next week and we have court on Thursday so if custody doesn't change hands on Thursday then they should call CW and CW will try to set up a visit for them for the following week- CW states Cw is aware that agency has an opening on Monday 1/25 from 9:30-1 1 :30 so they can have this slot if child is still in our care MGM states this is early for them - CW states this is what is avail as of now but she can call CW next week again to see if anything else comes up MGM reports they will be here for court next week

•DRAFT* Event Date: 1/15/2010 Entry Date: 1/25/2010 Dist.Agy: A47 Author: Towns.Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Relative Focus: Palmiotti.Winona M; Piscitelli.Winona; Note Status: Entered By: Draft Towns.Lori

Progress Note Narrative: PC from MGM, Carol Marzocco- she reports she got a call from BM yesterday and she said the criminal background check CW did on them came back with bad stuff- CW states this is false the criminal came back fine MGM states "what the hell is she talking about then" CW did inform MGM that CW did not run CPS background checks yet but CW is aware that MGF has CPS history from years ago and it will be up to CWs administration whether or not we will persue them as a resource for child with this info MGM states she wants to be honest with CW and reports that they had their other granddaughter in their home for 2 weeks and when returned to her BF she was red in her private area so her BF called in a CPS report against PGF alleging sexual abuse- this was unfounded. MGM states that her daughter and her spouse have a history of DV and this was BF's way of getting to the family MGM goes on to say that the Judge in their county said that he wasn't going to hold MGF CPS history against him from 35 years ago so this agency cant- CW states this is untrue

'DRAFT* Event Date: 1/15/2010 Entry Date: 1/25/2010 Dist.Agy: A47 Author: Towns.Lori Method: Face To Face Location: Parent's Home Type(s): Casework Contact Family Participant(s): Piscitelli.Paul; Focus: Palmiotti.Winona M; Piscitelli.Paul; Piscitelli.Winona; Note Status: Draft Entered By: Towns.Lori

Date Printed:

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\MILY SERVICES PROGRESS NOTES Case Name: Palmiotti.Winona M Case ID: 24158873

'""WARNING***** CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

End Of Note* 'DRAFT* Event Date: 1/22/2010 Entry Date: 1/29/2010 Dist.Agy. A47 Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Relative Focus: Palmiotti.Winona M; Piscitelli.Paul; Piscitelli.Winona; Note Status: Entered By: Draft Towns,Lori

Progress Note Narrative: PC from MGM Carol Marzocco- she states "what a disaster yesterday" "BM screwed everything up" Carol reports that BM didn't want BF's sister in the court room so then the court officer said MGP's didn't want her there and then the Judge said no one was allowed in the court room for the trial MGM states they had filed for custody of Winona in December and the Judge Dismissed their petition stating that he would not hear a custody petition before he hears a visitation petition so they must file for visitation CW asks did they then file for visitation? MGM states they will file for visitation now- they will have their atty file for them

•DRAFT* Event Date: 1/22/2010 Entry Date: 1/29/2010 Dist.Agy: Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Foster/Adoptive Parent Focus: Piscitelli.Winona; A47 Note Status: Draft Entered By: Towns,Lori

Progress Note Narrative: PC from FM ( • f SHE asks what happened with SD ? FM states she doesn't want child moved out of current setting she is doing so well • • t however she needs speech- this can be dome in daycare
r*********************************************************p~fJ Qr I^Q* g*********************************************************************

•DRAFT* Event Date: 1/22/2010 Entry Date: 1/29/2010 Dist.Agy: Author: Towns, Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Legal/Attorney Focus: Piscitelli.Paul; Piscitelli.Winona; A47 Note Status: Draft Entered By: Towns, Lori

Progress Note Narrative: CW left a message for LG Pilo stating agency wants to relaese child to BF on trial discharge- CW requests return call regarding her position on this CW speaks to LG SW Cathy Fusco- CW discusses agency's plan- Cathy reports he will get in touch with LG on Monday and call CW back
*********************************************************************

'DRAFT* Event Date: 1/22/2010 Entry Date: 1/29/2010 Dist.Agy: A47 Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Relative Focus: Palmiotti.Winona M; Piscitelli.Winona; Note Status: Draft Entered By: Towns.Lori

Progress Note Narrative: V/M from Carol Marzocco- she requests a retun call- this is very important
**********************************************************************Cnrf Qf MQAp*********************************************************************

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\MILY SERVICES PROGRESS NOTES Case Name: Palmiotti.Winona M Case ID: 24158873

'""WARNING***** CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

End Of Note* 'DRAFT* Event Date: 1/22/2010 Entry Date: 1/29/2010 Dist.Agy. A47 Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Relative Focus: Palmiotti.Winona M; Piscitelli.Paul; Piscitelli.Winona; Note Status: Entered By: Draft Towns,Lori

Progress Note Narrative: PC from MGM Carol Marzocco- she states "what a disaster yesterday" "BM screwed everything up" Carol reports that BM didn't want BF's sister in the court room so then the court officer said MGP's didn't want her there and then the Judge said no one was allowed in the court room for the trial MGM states they had filed for custody of Winona in December and the Judge Dismissed their petition stating that he would not hear a custody petition before he hears a visitation petition so they must file for visitation CW asks did they then file for visitation? MGM states they will file for visitation now- they will have their atty file for them

•DRAFT* Event Date: 1/22/2010 Entry Date: 1/29/2010 Dist.Agy: Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Foster/Adoptive Parent Focus: Piscitelli.Winona; A47 Note Status: Draft Entered By: Towns,Lori

Progress Note Narrative: PC from FM ( • f SHE asks what happened with SD ? FM states she doesn't want child moved out of current setting she is doing so well • • t however she needs speech- this can be dome in daycare
r*********************************************************p~fJ Qr I^Q* g*********************************************************************

•DRAFT* Event Date: 1/22/2010 Entry Date: 1/29/2010 Dist.Agy: Author: Towns, Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Legal/Attorney Focus: Piscitelli.Paul; Piscitelli.Winona; A47 Note Status: Draft Entered By: Towns, Lori

Progress Note Narrative: CW left a message for LG Pilo stating agency wants to relaese child to BF on trial discharge- CW requests return call regarding her position on this CW speaks to LG SW Cathy Fusco- CW discusses agency's plan- Cathy reports he will get in touch with LG on Monday and call CW back
*********************************************************************

'DRAFT* Event Date: 1/22/2010 Entry Date: 1/29/2010 Dist.Agy: A47 Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Relative Focus: Palmiotti.Winona M; Piscitelli.Winona; Note Status: Draft Entered By: Towns.Lori

Progress Note Narrative: V/M from Carol Marzocco- she requests a retun call- this is very important
**********************************************************************Cnrf Qf MQAp*********************************************************************

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t-#MILY SERVICES PROGRESS NOTES Case Name: Palmiotti,Winona M Case ID: 24158873

*****WARNING***** CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

•DRAFT* Event Date: 1/25/2010 Entry Date: 1/25/2010 Dist.Agy: A47 Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Relative Focus: Palmiotti.Winona M; Piscitelli.Winona; Note Status: Draft Entered By: Towns,Lori

Progress Note Narrative: 8:30am- MGM Carol Marzocco calls and presses the emergency button and speaks to CW Morris asking to speak to CW Towns- MGM is informmed CW Towns is currently on the phone and will call Carol Back 9:13am- MGM Carol Marzocco leaves a message on CW's voicemail requesting a return call and states this is very importatant 9:52am- MGM calls CW again and CW is on the phone- MGM presses again the emergency button and speaks to unit clerk and again is told CW is on the phone- MGM leaves a message with clerk for CW to call MGM back this is very important 10:52am- MGM calls again and CW answers- MGM asks if she can have visits with Winona or does she have to file petition for visitation- CW states CW has allready spoke to MGM about this and she must file the petition- MGM states she will have her atty file petiton for her MGM then asks how she can get a copy of the Neglect allegations against BM- CW states this is confidential info- MGM asks again how she can get a copy of this- CW states she can ask BM for this info but CW is not able to provide it to her MGM asks if this is OHIO'S case- CW states no this is Suffolk County's Neglect Petition End Of Note.A******************************************************************** •DRAFT* Event Date: 1/25/2010 Entry Date: 1/25/2010 Dist.Agy: Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): School Staff Focus: Piscitelli.Winona; Progress Note Narrative: CW left a V/M for I "" services in A47 Note Status: Entered By: Draft Towns,Lori

ktt from Just Kids*

>CW states it is not necessary to hold spot for Winona at this time child will start

*******************************************************!

End Of Note************* •DRAFT*

Event Date: 1/25/2010 Entry Date: 1/29/2010 Dist.Agy: Author: Towns,Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Foster/Adoptive Parent Focus: Piscitelli.Winona;

A47

Note Status: Entered By:

Draft Towns,Lori

Progress Note Narrative: PC from FMVH^A- She reports she will be on vaca from 2/15 until 2/20- CW states it is ok for child to stay with BFthis week FM reports that Winona's services are set to start 2/1/10- CW agrees to a push in speech and special ed teacher as to not change child's environment at this time ********************************************************************** End Of Note' •DRAFT* Event Date: 1/26/2010 Dist.Agy: Entry Date: 2/1/2010 Author: Towns,Lori Method: Phone Type(s): Casework Contact Family Participant(s): Piscitelli.Paul; Focus: Piscitelli.Paul; Piscitelli.Winona; A47 Note Status: Entered By: Draft Towns,Lori

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-AMILY SERVICES PROGRESS NOTES Case Name: Palmiotti.Winona M Case ID: 24158873

*****WARNING***** CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

Progress Note Narrative: PC to BF - CW explains to BF to go to SD and register child to see when they can start her with Preschool special ed services and agency will try to place child with him on trial basis when the services begin*End Of Note *DRAFT* Event Date: Entry Date: Author: Method: Location: 1/27/2010 2/1/2010 Dist.Agy: A47 Clark,Josephin Face To Face LOSS Office/Field Office Type(s): Family/Primary Discharge Resource Visitation Family Participant(s): Palmiotti.Winona M; Piscitelli.Winona; Focus: Palmiotti.Winona M; Piscitelli.Winona; Note Status: Draft Entered By: Clark,Josephin

Progress Note Narrative: Csw picked Nonna up at day care for visit with mom at the Mac office. Mom arrived shortly after us. Nonna greeted mom with a hug, mom picked her up. Mom brought cheetos and a drink for Nonna. They worked on a bracelet together. Mom also read a book to her. Nonna lost interest in it and played with toys while mom read. During the visit Nonna had to go to the bathroom twice. Nonna gave mom two hugs during the visit. Mom returned the hugs but never initiated it. Csw returned Nonna to day care. *End Of Note'*************************************************** . •DRAFT* Event Date: 1/29/2010 Entry Date: 2/3/2010 Author: Towns.Lori Method: Phone Type(s): Collateral Contact Other Participant(s): Relative Focus: Palmiotti.Winona M; Dist.Agy: A47 Note Status: Entered By: Draft Towns.Lori

Progress Note Narrative: V/M from materal aunt Barbara grant- she reports that BM posted stuff on facebook about this CW Barbara thanks CW for all CWs hard work for this child End Of Note* 'DRAFT* Event Date: 2/1/2010 Entry Date: 2/3/2010 Dist.Agy: Author: Towns.Lori Method: Phone Type(s): Casework Contact Family Participants): Piscitelli.Paul; Focus: Piscitelli.Paul; Piscitelli.Winona; A47 Note Status: Draft Entered By: Towns.Lori

Progress Note Narrative: PC to BF- he reports he took Winona to dentist on saT ALL WAS GOOD- AND he has a dr appt scheduled for her with her former pediatrician for Thur am for a TB test^required for starting school in his district B reports child is registered with his school district but meeds the physical to start but they said she can start immidiately they will use her former evaluations and IEP BF will pick up child on Wed night this week so he can take her for Dr appt *pp..j •DRAFT* Event Date: Entry Date: Author: Method: Location: 2/3/2010 Dist.Agy: 2/8/2010 Clark, Josephin Face To Face LDSS Office/Field A47 Note Status: Entered By: Draft Clark,Josephin

Date Printed:

2/11/2010 8:52:37 AM

Page:

60

FAMILY SERVICES PROGRESS NOTES
Case Name: Palmiotti.Winona M Case ID: 24158873

*****WARNING***** CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

Office Type(s): Family/Primary Discharge Resource Visitation Family Participant(s): Palmiotti.Winona M; Piscitelli.Winona; Focus: Palmiotti.Winona M; Piscitelli.Winona; Progress Note Narrative: Csw picked Nonna up from daycare for visit with mom at the Mac office. Nonna didn't start her lunch so it was brought with us. Mom hadn't arrived when we arrived so csw sat Nonna at a table so she could eat her hamburger. When mom arrived Nonna didn't greet or acknowledge mom until mom asked for a kiss. Nonna gave her one but seemed reluctant. Csw let mom know that Nonna just finished eating so she should wait a little before giving her a snack. Mom demanded what she ate, csw advised. Mom gave her a drink. Mom took out a puzzle she brought with her for them to do. Nonna had to go to the bathroom twice during the visit. During one of the bathroom visit mom saw a bruise on Nonna's knee. Mom kept asking Nonna how she got it. Nonna didn't know how but mom still continued to ask until csw stepped in. Csw told mom that she can't keep going at Nonna and that if she has a question to speak to the caseworker. At the end of the visit Nonna said bye to mom and was ready to go. Mom tried to detain her with constant byes and asking for hugs. Nonna gave her one hug but then wanted to leave. Csw returned her to daycare.
*********#***!

End Of Note**

Date Printed:

2/11/2010 8:52:37 AM

Page:

61

FAMILY A' _

SMENT AND SERVICE PLAN

-~*****WARNING***** COrti-IDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

Case Name:

Palmiotti.Winona M

Case ID:

24158873

Stage Name: Palmiotti.Winona M Case Initiation Date: 09/16/2009 LOSS With Case Management: SUFFOLK

Stage ID: 26414000 Report Date: 10/15/2009 LDSS/Agy with Case Planning:

FAMILY SERVICE PLAN - SIGNATURE PAGE

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End of the Report

OFFICE OF CHILDREN AND FAMILY SERVICES FORM

Page:14

FAMILY A(

WENT AND SERVICE PLAN

-"""WARNING***** CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

Case Name:

Palmiotti.Winona M

Case 10:

24158873

Stage Name: Palmiotti.Winona M Case Initiation Date: 09/16/2009 LOSS With Case Management: SU FFOLK

Stage ID: 26414000 Report Date: 12/10/2009 LDSS/Agy with Case Planning:

FAMILY SERVICE PLAN - SIGNATURE PAGE Name Signature Role Date

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End of the Report

OFFICE OF CHILDREN AND FAMILY SERVICES FORM

Page:15

Case Transfer Summary
Worker: 102 Dates in Unit: since 9-9-09 Reason for Transfer: Judical Intervention Open for Services Case Name: Winona Palmiotti Case Address: 915 Sunrise Hwy W Babylon (Sunrise motor inn) Family Composition: see below Names Winona Palmiotti Relationship Mother
DOB
4-7-73

Location if different Mom is transcient last known location 1355 Locust Ave Bohemia

Winona Piscitelli

daughter

7-6-05

Significant Health Issues: Child Winona is 4 yrs and weight wise is off the growth chart Since entering foster care she has lost 51bs and has received 4 immunizations and blood work. She had not been to a pediatrican since 2006. There are apparent delays in her speech and a full evaluation has been requested through Just Kids. Mother Winona does not have a mental health diagnosis however she is mandated to get a psych eval. Her behavior is very very concerning. She is extremely hostile. I have been cautioned by her relatives that she is very vindictive person. Reasons for DSS Involvement: Mother has an extensive history of'evading' CPS dating back to 1989. In 2004 a neglect petition was filed in Sullivan County on behalf of her then 16 year old autistic and mildly retarded son Timothy on the grounds of abandonment. Child came into care as mother's whereabouts could not be ascertained. That child is unable to function independently in society and remains institutionalized in upstate NY> Mother is to have no contact with him. In 2005 she had another child a dau- Winona. Nassau Cty was going to petition against Ms Palmiotti and learned that

there was an existing case in Sullivan County -Ms Palmiotti and child "disappeared" In April of this year Richland Cty Ohio rec'd a report on mother and child after child was brought into hospital with burns on hands and arms. She fell into a fire pit. Ohio was concerned with what they observed and offered Ms Palmiotti services. She agreed. Ohio requested an order to produce when they were unable to gain access to child. They then went into court to mandate services. Mom fleed again back to NY. A report was rec'd in NY when mother was seen at DSS center punching child. Mother and child were placed in shelter in Deer Park. Shelter had concerns and mother was offered preventive services by team 71. She fleed and went back to Ohio. Ohio sought to remove child and mother fleed again back to NY. She was staying at the Sunrise Motel. Child was removed on 916-09 and placed into protective custody. Current Presenting Problems: Mother is still not addressing her mental health issues and is extremely difficult to work with... Current petition does not have information about previous child. We were instructed we need the court documents from upstate. Once I receive documentation from Sullivan County I will be submitting an amended lit sheet Services Being Provided: Case work counseling Other Involved Individuals or Agencies: Court Orders: Type/Date of Court Order/Conditions of Orders: 9-18-09 order placing child Winona in foster care and op no unsupervised contact Pending Petitions and Status: Neglect Petition pending Next Court Date: 11 -13-09 Voluntary Transfers of Custody for Foster Care: Date of Voluntary: Conditions of Voluntary: Next Court Date: Immediate Actions Needed Upon Transfer: authorization for evaluation was signed and faxed to Just Kids on 10-15-09 evaluation will be taking place first week in November. Follow up with Just Kids and foster mom. Visitation/Transportation arrangements, if applicable: Visitation was just increased to two hours without our input- visitation has not been going good csw's notes are not in yet once in may want to meat to discuss Prescribed medications, il^pplicahte (specify child(ren) and medication(s)):

Memoranduni
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From: Evelyn Mack SSE-I
IV-E Unit / Management Systems / MacArthur BuUding X: 4-9495
Date:

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For:
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APPLICATION DATE

RECERTIFICATION DATE

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NEW YORK STATE
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LDSS-292'i Statewide (Rev. 1/0

8TM351f t i ' iiLit u ' ! u ^ >\r („ ^ { 'w \) - I un-lei stand thai Temporary Assistance (TA) and Food Stamp Benefits (FS) recipients are categorically income eligible for the Home Energy Assistance Programs (HEAP). If I arn not included in the annual automatic HEAP payment process for certain TA and FS recipients, ! intend to apply for a HEAP benefit within the next 12 months. !f I decide not to apply for HEAP within the next 12 months, I will let my worker know. I understand that FS recipients are eligible for a telephone allowance if they pay for a home phone, cell phone, phone calling card or coin-operated pay phone, if I do not have to pay for phone calls, I will let my worker know. ASSIGNMENT OF SUPPORT R3GHT8 - i assign to the State and social services district any rights I have to support from persons having legal responsibility for my support and any rights I have to support on behalf of any family member. ] RELEASE OF EDUCATIONAL RECORDS - i give permission to the State Department j of Health and local department of social servfoe^to: o Obtain any information regarding the ^yc^agnal records of myself and/or my minor j child(ren), herein named, including information necessary for claiming MA i reimbursement for health-related educational services. o Provide the appropriate federal government agency access to this information for the sole purpose of audit. RELEASE OF INFORMATION FOR THE EARLY INTERVENTION PROGRAM - If my child is evaluated for or participates in the New York State Early Intervention Program, I give permission to the local Department of Social Services and New York State to share rny child's Medical Assistance eligibility information with my county or municipal Early intervention Program for the purpose of billing Medical Assistance. RELEASE OF MEDICAL INFORMATION - I consent to the release of any medical information about me and any members of rny family for whom I can give consent: by my Primary Care Provider, any other health care provider or the New York State Department of Health (SDOH) to rny health plan and any health care providers involved in caring for me or rny family, as reasonably necessary for my health plan or my providers to carry out treatment, payment, or health care operations; by my health plan and any health care providers to SDOH and other authorized federal, state, and local agencies for purposes of administration of the Medicaid, Child Health Plus and Family Health Plus programs; and, by my health plan to other persons or organizations, as reasonably necessary for my health plan to carry out treatment, payment, or health care operations. I also agree that the information released may include HIV, mental health or alcohol and substance abuse information about me and members of my family, to the extent permitted by law. If more than one adult in the family is joining a Family Health Plus or Medicaid health plan, the signature of each adult applying is necessary for consent to release information.

• Foi vul" ,-in'J, ,,<( i iuj ' , iijjjicny -.ssisiance ana/or food stamp benefits The Office o'r Tcrrir>or?n' r.nrl I'ji&abidfv Assistance may or may not release your name and address to your telephone service provider. Your telephone service provider may or may not use this information to enroll you in their Lifeline Service for a discounted telephone rats. If you do not want this infosTnation rgiieased, cheek this box D . You may contact your telephone service provider directly for enrollment in the discounted rate Lifeline Service. Medicaid-only applicants/recipients must contact their telephone service provider directly for enrollment in the discounted rate Lifeline Service. FOR RiEilWJRSESlEMT OF PUBLIC ASSISTANCE BENEFITS PAYSSEWT - i authorize the Commissioner of the Sor~', Security Administration (SSA) to send to the local social services district the amount \ to me at the time of my first payment of (1) retroactive Supplemental Security Income' (SSI) benefits that i may receive upon an application for SSi or (2) retroactive SSI benefits I may receive if I am terminated or suspended from receiving SSI benefits and am later reinstated. I understand that the local social services district may take from my SSI payment the amount of Public Assistance (except assistance paid wholly or partly with federal funds) that was paid to me during the period beginning with rny first day of eligibility for SSI or the first day to which SSI benefits were reinstated after a period of suspension or termination and ending with the month that SSi payments actually began (or the following month if the local social services district cannot stop delivery of rny last public assistance payment during the month that SSi payments began). After taking this money from rny SSi cheek(s), the local social services district will pay me the balance; if there is any, no later than 10 working days from the date it receives rny SSi payment. I also understand that if the district takes more money than I believe was paid to me as Public Assistance, i will be given an opportunity for a hearing. I understand that: » the SSA may treat the date that I subtr 'this; signed authorization to the lo' social services district as the date I tirsRJ&come eligible for SSI if I submit .^. application for initial SSi benefits within the next 60 clays. © this authorization will apply to any SSI application or appeal which is presently pending before the SSA with respect to me and to any SSI application I make or appeal i request with respect to the period ending one year after I sign this agreement. This authorization will terminate one (1) year after it is received by the local social services district and will not have any effect upon future SSI applications, appeals or reviews if rny case is completely decided, if the SSA makes an initial payment of SSI either on my application or after a period of suspension or termination or if the State and I mutually agree to terminate the authorization. _

i! have read and understand the notices above.! understand and agree to the assignments, authorizations and consents above. I sjiueatuyid/or affirm under the penalties of perjury that the information i have given or will give to the local social services district is correct.
APPLICANT/REPRESENTATIVE SIGNATURE DATE SIGNED

PAG

LDSS-292'i Statewide (Rev. 1/0

8TM351f t i ' iiLit u ' ! u ^ >\r („ ^ { 'w \) - I un-lei stand thai Temporary Assistance (TA) and Food Stamp Benefits (FS) recipients are categorically income eligible for the Home Energy Assistance Programs (HEAP). If I arn not included in the annual automatic HEAP payment process for certain TA and FS recipients, ! intend to apply for a HEAP benefit within the next 12 months. !f I decide not to apply for HEAP within the next 12 months, I will let my worker know. I understand that FS recipients are eligible for a telephone allowance if they pay for a home phone, cell phone, phone calling card or coin-operated pay phone, if I do not have to pay for phone calls, I will let my worker know. ASSIGNMENT OF SUPPORT R3GHT8 - i assign to the State and social services district any rights I have to support from persons having legal responsibility for my support and any rights I have to support on behalf of any family member. ] RELEASE OF EDUCATIONAL RECORDS - i give permission to the State Department j of Health and local department of social servfoe^to: o Obtain any information regarding the ^yc^agnal records of myself and/or my minor j child(ren), herein named, including information necessary for claiming MA i reimbursement for health-related educational services. o Provide the appropriate federal government agency access to this information for the sole purpose of audit. RELEASE OF INFORMATION FOR THE EARLY INTERVENTION PROGRAM - If my child is evaluated for or participates in the New York State Early Intervention Program, I give permission to the local Department of Social Services and New York State to share rny child's Medical Assistance eligibility information with my county or municipal Early intervention Program for the purpose of billing Medical Assistance. RELEASE OF MEDICAL INFORMATION - I consent to the release of any medical information about me and any members of rny family for whom I can give consent: by my Primary Care Provider, any other health care provider or the New York State Department of Health (SDOH) to rny health plan and any health care providers involved in caring for me or rny family, as reasonably necessary for my health plan or my providers to carry out treatment, payment, or health care operations; by my health plan and any health care providers to SDOH and other authorized federal, state, and local agencies for purposes of administration of the Medicaid, Child Health Plus and Family Health Plus programs; and, by my health plan to other persons or organizations, as reasonably necessary for my health plan to carry out treatment, payment, or health care operations. I also agree that the information released may include HIV, mental health or alcohol and substance abuse information about me and members of my family, to the extent permitted by law. If more than one adult in the family is joining a Family Health Plus or Medicaid health plan, the signature of each adult applying is necessary for consent to release information.

• Foi vul" ,-in'J, ,,<( i iuj ' , iijjjicny -.ssisiance ana/or food stamp benefits The Office o'r Tcrrir>or?n' r.nrl I'ji&abidfv Assistance may or may not release your name and address to your telephone service provider. Your telephone service provider may or may not use this information to enroll you in their Lifeline Service for a discounted telephone rats. If you do not want this infosTnation rgiieased, cheek this box D . You may contact your telephone service provider directly for enrollment in the discounted rate Lifeline Service. Medicaid-only applicants/recipients must contact their telephone service provider directly for enrollment in the discounted rate Lifeline Service. FOR RiEilWJRSESlEMT OF PUBLIC ASSISTANCE BENEFITS PAYSSEWT - i authorize the Commissioner of the Sor~', Security Administration (SSA) to send to the local social services district the amount \ to me at the time of my first payment of (1) retroactive Supplemental Security Income' (SSI) benefits that i may receive upon an application for SSi or (2) retroactive SSI benefits I may receive if I am terminated or suspended from receiving SSI benefits and am later reinstated. I understand that the local social services district may take from my SSI payment the amount of Public Assistance (except assistance paid wholly or partly with federal funds) that was paid to me during the period beginning with rny first day of eligibility for SSI or the first day to which SSI benefits were reinstated after a period of suspension or termination and ending with the month that SSi payments actually began (or the following month if the local social services district cannot stop delivery of rny last public assistance payment during the month that SSi payments began). After taking this money from rny SSi cheek(s), the local social services district will pay me the balance; if there is any, no later than 10 working days from the date it receives rny SSi payment. I also understand that if the district takes more money than I believe was paid to me as Public Assistance, i will be given an opportunity for a hearing. I understand that: » the SSA may treat the date that I subtr 'this; signed authorization to the lo' social services district as the date I tirsRJ&come eligible for SSI if I submit .^. application for initial SSi benefits within the next 60 clays. © this authorization will apply to any SSI application or appeal which is presently pending before the SSA with respect to me and to any SSI application I make or appeal i request with respect to the period ending one year after I sign this agreement. This authorization will terminate one (1) year after it is received by the local social services district and will not have any effect upon future SSI applications, appeals or reviews if rny case is completely decided, if the SSA makes an initial payment of SSI either on my application or after a period of suspension or termination or if the State and I mutually agree to terminate the authorization. _

i! have read and understand the notices above.! understand and agree to the assignments, authorizations and consents above. I sjiueatuyid/or affirm under the penalties of perjury that the information i have given or will give to the local social services district is correct.
APPLICANT/REPRESENTATIVE SIGNATURE DATE SIGNED

LDSS-4809 (2/2008)

Initial Foster Child Eligibility Checklist, Page 1 of 4 NEW YORK STATE OFFICE OF CHILDREN AND FAMILY SERVICES

INITIAL FOSTER CHILD ELIGIBILITY CHECKLIST
Instructions: Complete a separate form for each child in foster care.

SECTION I. CASE INFORMATION Note: Citizenship or qualified immigration status required for eligibility.
Name Child's Name (Last./irst, Middle Initial) CIN (optional) Unit/Worker Number Case Number

1 /(* / or-

DOB

Date of Placement 1 lib I &

900^9
r-, \-S

r\

A,

FA/SN Clearance Date J0 1 1/ $9 FA/SN Recipient Q Yes .fefcNo wMS Screen Print D FA/SN ABEL Budget

SSI Clearance Date /O I fa 1 SSI Recipient D Yes C N o

SECTION II. TITLE IV-E ELIGIBILITY

Date Court Petition Filed: *j_ I (2.1

Date of Removal from the Home: i_ / /^ / 0 °i

FOSTER CHILD MUST MEET ALL REQUIREMENTS BELOW FOR TITLE IV-E ELIGIBILITY: 1. CITIZENSHIP. Is the child a citizen of the U.S. or a qualified immigrant as defined under the federal PRWORA? NO (Child ineligible for any funding) °-|f NO...go to Section IV, Eligibility Summary. 2. LEGAL AUTHORITY AND BEST INTERESTS, (a) Was the child removed from the home of a parent/other specified relative as the result of a court order under FCA Articles 3 (JD), 7 (PINS), or 10 (abuse/neglect), or SSL 358-a, or SSL 384-b (deceased parents), and does the placement order transfer care and custody or custody and guardianship to the Commissioner, and (b) does the initial removal order explicitly state that the court made a case specific finding that continuation in the home would be contrary to the welfare of the child or removal was in the best interests of the child, or (c) was a Voluntary Placement Agreement signed by the child's parent(s) or legal guardian(s) pursuant to SSL 384-a, that gives care and custody to the Commissioner? Note: Both YES answers a) and b) must be checked for a court ordered placement. Basis of Legal Custody: Q FCA Article 3 D FCA Article 7 l^,FCA Article 10 D SSL 358-a D SSL 384-a D SSL 384-b ; Placement order gives care and custody, or custody and guardianship to the Commissioner. y lf_ol &/
Date ot Order

AND
OR

-

Initial removal order contains a contrary to the welfare or best interest determination.

Date of Order

'•<L
/

c. D YES Voluntary Placement Agreement signed by parent or legal guardian and Local District Representative
D NO (Child ineligible for Title IV-E) «-|f NO...go to Section III, TANF-EAF.
3.

/

Date ol Agreement

REASONABLE EFFORTS. For placements made by a court order, is there a case specific determination by the court and stated in an order issued within 60 days from the date the child was removed from the home, that the agency made reasonable efforts to prevent removal, including a finding, where appropriate, that no efforts were reasonable, or that reasonable efforts were not required due to statutorily specified circumstances? Note: The court must demonstrate what documentation was used to make its determination.
YES 7//$/ 0 /(Date of Order)

D NO (Child ineligible for Title IV-E.

»-|f NO...go to Section III, TANF EAF.

D NA (Placement by voluntary agreement) 4. AGE. Was the child under the age of 18 on the date of the court order or on the date the Voluntary Placement Agreement was signed? D NO (Child ineligible for Title IV-E and TANF-EAF) »-|f NO.. .go to Section IV, Eligibility Summary.

LDSS-4809 (2/2008)

Initial Foster Child Eligibility Checklist, Page 2 of 4

5.

LIVING WITH A SPECIFIED RELATIVE. Was the child living in the home of a parent/specified relative who had legal custody in the month, or in any of the six months before the month (the defined period), that the court petition was filed or the Voluntary Placement Agreement was signed? Name of relative VJ',y^ov>.a_ \ O-Vrwicr^d* and relationship

D Time condition met, but the specified relative and the relative foster parent are the same person or the physical removal and the legal removal are not from the same person. (Child ineligible for Title IV-E) »• If time condition met, but...go to Section III, TANF-EAF Eligibility. D NO (Child ineligible for Title IV-E and TANF-EAF) •• If NO...go to Section IV, Eligibility Summary. 6. PARENTAL DEPRIVATION. Was the child deprived of parental support and care for one or more of the following reasons? ^Absence of parent from home; (2) incapacity of parent; (3) unemployed/underemployed parent; (4) death of parent. YES Circle all reasons that apply. 7. $1 NO (Child ineligible for Title IV-E) «-|f NO...go to Section III, TANF-EAF.

ADC FINANCIAL ELIGIBILITY. Would the child have been financially eligible for AFDC in accordance with program rules in effect on 7/16/96, based on the family's income and resources in the month that the Voluntary Placement Agreement was signed or the court petition was filed leading to the removal of the child? f^^M^f tS/dfaviS*J D YES Financial eligibility documented ^jZj NO (Child ineligible for Title IV-E) D NO Income unknown

If NO...go to Section III, TANF-EAF. «-|f answers to 1-7 are YES...go to Section III, TANF-EAF Eligibility.

A.

EMERGENCY SITUATION. This emergency situation is due to the following circumstance(s): $ FCA Article 10 court ordered removal/placement. D FCA Article 7 court ordered placement D FCA Article 3 court ordered placement D SSL 358-a court order D SSL 384 placement made by Voluntary Surrender Agreement D SSL 384-a placement made by Voluntary Placement Agreement D SSL 384-b placement based on death of parent D FCA 651(b) placement of unaccompanied refugee minor

B. TANF-EAF REQUIREMENTS. Foster child must meet all requirements below for TANF-EAF eligibility: 1. CITIZENSHIP. Is the child a citizen of the U.S. or a qualified immigrant as defined under the federal PRWORA? 0 YES 2. D NO (Child ineligible for any funding) «-|f NO...go to Section IV, Eligibility Summary.

LIVING WITH A SPECIFIED RELATIVE. Was the child living in the home of a parent/specified relative at any time within six months before foster care placement? EJYES D NO (Child ineligible for TANF-EAF) «-|f NO...go to Section IV, Eligibility Summary.

3.

NO PREVIOUS EAF AUTHORIZATION. Was there no EAF authorization written in the past 12 months, except one written in the past 30 days, or one written for the same emergency where the authorization has not been closed? G3rES D NO (Child ineligible for TANF-EAF) «-|f NO...go to Section IV, Eligibility Summary.

4.

INSUFFICIENT RESOURCES. Is the child without sufficient income/resources immediately accessible to meet his/her needs? EfYES D NO (Child ineligible for TANF-EAF) 'If NO...go to Section IV, Eligibility Summary.

5.

NEED FOR SERVICES DUE TO REASONS OTHER THAN REFUSAL OF EMPLOYMENT/TRAINING. Did the child's need for services arise for reasons other than the parent/specified relative's refusal without good cause to accept employment or training? 0 YES D NO (Child ineligible for TANF-EAF) ""If NO...go to Section IV, Eligibility Summary.

LDSS-4809 (2/2008)

Initial Foster Child Eligibility Checklist, Page 3 of 4

6.

NEED FOR SERVICES D LIE TO REASONS OTHER THAN MISMANAG EMENTOFPAGRANT. Did the

child's need for services a rise for reasons other than the parent/specified •elative's mismanagement of a public assistance grant? sligible for TANF-EAF) «-|f NO.. .go to Section IV, Eligibility Summary. 'Nrf] YES D NO (Child in In accordance with 18 NYCRR 372.4( d), costs for services that are necessary to a ddress needs arising from the cited emergency are authorized under the EAF program. This authorization will cpntinue until the emergency ends.
Wnrkpr'c ^innaturp ' \-^t—^^ "*"

j A*~£-^~V' •

Date

VV ° C /

Date Supervisor's Signature / / * ] [/ y/Ls C Jwfc'UC SECTION /. ELIGIjSll/rY SUMMARY & SIGNATURES/SUPERVISOR'S REVIEW

THE CHILD IS: / ELIGIBLE FOR TITLE IV-E ONLY: [TEncode child 02 (eligibility code) and 08 (direct service code) on WMS. • ELIGIBLE FOR TANF-EAF ONLY: JZl Encode child 04 (eligibility code) and 08 (direct service code) on WMS. ELIGIBLE FOR TITLE IV-E AND TANF-EAF (DUAL ELIGIBILITY): D Encode child 02 (eligibility code) and 08 and 08E (direct service codes) and add "E" suffix to POS lines as needed on WMS. INELIGIBLE FOR TITLE IV-E AND TANF-EAF; D Encode child 06, 07, 08 or 14 (eligibility code) and 08 (direct service code) on WMS. INELIGIBLE FOR ANY FUNDING (Costs for this case are not reimbursable for any Federal or State funding as child is not a U.S. citizen or qualified immigrant): D Encode child 14 (eligibility code) and 08 (direct service code) and add "N" suffix to direct service and POS lines as needed on WMS. Worker's Signature Supervisor's Signature ^, ^ Date
Date

/

/

/

~^i^^4j^<^-^^^~^t

/Ol £}l 0 *%

*• Proceed to review the case for Title XX Below 200% of Poverty eligibility (except for cases that have been determined eligible for Title IV-E and TANF-EAF; and cases that are INELIGIBLE FOR ANY FUNDING). SECTION V. DOCUMENTATION OF ELIGIBILITY Indicate the documentation used for each item of eligibility. Indicate where that documentation is located in the case record or that it is attached to this form.

Item
1. Citizenship ' (Title IV-E/TANF-EAF) Legal Authority (Title IV-E) a. Care and Custody/Guardianship and Custody b. Voluntary Placement Agreement Best Interests/Contrary to Welfare Reasonable Efforts to Prevent Removal Finding Within 60 Days of Removal (Title IV-E) Age (Title IV-E/TANF-EAF)

Documentation

Location in Case Record

Attached^

6/c,
^

2.

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*J2/
b.D

3.

// //

D D

4

5.

A/i
O/^
0/<4/

D

6.

Living with a Specified Relative (Title IV-E/TANF-EAF) Parental Deprivation (Title IV-E)

/tf0f*&

D D

7.

LDSS-4809 (2/2008) 8. ADC Financial Eligibility (Title IV-E) a. FA or SN Budget/Other Income b. ADC Scratchpad Budget (7/96) 9. Emergency Situation (TANF-EAF)

Initial Foster Child Eligibility Checklist, Page 4 of 4

At* 7

£&&/&€£
a.D

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C/9

n
D

10. No Previous EAF Funding (TANF-EAF) 1 1 . Insufficient Resources (TANF-EAF) 12. Need for Services for Reasons Other Than Refusal of EmploymenVTraining (TANF-EAF) 1 3. Need for Services for Reasons Other Than Mismanagement of Public Assistance Grant (TANF-EAF)

vys* 5

n

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n
D

CASE NAME : Palmio. .Winona M CASE# =24158873

APPROVAL FORM
STAGE NAME: STAGE: Palmiotti,Winona M Investigation DATE SUBMITTED: SUBMITTED BY: 10/9/2009 Lisa Scafide

EVENT DESCRIPTION:

Safety Assessment

APPROVED BY:

NAME: TITLE: DATE APPROVED/REJECTED: STATUS:

Robert Leto Supervisor 10/9/2009 Approve

EVENT DESCRIPTION:

Investigation Actions

APPROVED BY:

NAME: TITLE: DATE APPROVED/REJECTED: STATUS:

Robert Leto Supervisor 10/9/2009 Approve

EVENT DESCRIPTION:

Investigation Conclusion

APPROVED BY:

NAME: TITLE: DATE APPROVED/REJECTED: STATUS:

Robert Leto Supervisor 10/9/2009 Approve

EVENT DESCRIPTION:

Child Protective Record Summary

APPROVED BY:

NAME:

Robert Leto

CASE NAME : Palmio. .Winona M CASE# =24158873

APPROVAL FORM
STAGE NAME: STAGE: Palmiotti,Winona M Investigation DATE SUBMITTED: SUBMITTED BY: 10/9/2009 Lisa Scafide

EVENT DESCRIPTION:

Safety Assessment

APPROVED BY:

NAME: TITLE: DATE APPROVED/REJECTED: STATUS:

Robert Leto Supervisor 10/9/2009 Approve

EVENT DESCRIPTION:

Investigation Actions

APPROVED BY:

NAME: TITLE: DATE APPROVED/REJECTED: STATUS:

Robert Leto Supervisor 10/9/2009 Approve

EVENT DESCRIPTION:

Investigation Conclusion

APPROVED BY:

NAME: TITLE: DATE APPROVED/REJECTED: STATUS:

Robert Leto Supervisor 10/9/2009 Approve

EVENT DESCRIPTION:

Child Protective Record Summary

APPROVED BY:

NAME:

Robert Leto

CASE NAME : Palmiu..,-, \Vmona M CASE# : 24158873 TITLE: DATE APPROVED/REJECTED: STATUS: Supervisor 10/9/2009 Approve

! C&**-

tfe CPS I rwestigalion Conclusion Paliw^Ptfinona M
^^^^^^^*

S:28384647/C: 24158873
- -

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Edit.,,.Options Forms Reports Help

Case Name: PaImiotti,Winona M Investigation Dates ived J09/09/Z009 ': • '.-••'^a Occurred:]// Determination: INDICATED Timei:j04:41 PM —=—=^
Tjim

Risk Rating: Very High Elevated Risk Exists Investigation Begun: J09/09/2009 ~|
•SSfciSE,, -—J

Investigation Completed: jl^0/00/2009 -|j _J
Duplicate Stage SD:

Closure Reason: jCase open-CPS required) F* High Risk Comments * oni.F<ii*s,,

Fatality-No Surviving Children Narrative...

r ••- -•;
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Case Name:
Case ID: Intake Stage ID: Investigation Stage ID:

R

>tti,Winona M

24u*873 26384552 26384647

• ""* WARNING***** CONFv .liNTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

CPS INVESTIGATION SUMMARY
The information in this section reflects the most current and up-to-date findings regarding this report. The Narrative data reflects the findings associated with the Investigation. Intake Received: Incident Occurred: Investigation Begun: Investigation Completed: Investigation Approved: Determination: Closure Reason: Family Assessment Response: Supervisor: Primary Worker: Secondary Worker: 9/9/2009 9/9/2009 10/8/2009 Indicated Case open-CPS required

Robert Leto Lisa Scafide County/Jurisdiction County/Jurisdiction SUFFOLK NASSAU

Garrett Wakefield

ALLEGATION INFORMATION
MA / AB Child Piscitelli.Winona Piscitelli.Winona Piscitelli,Winona Alleqation(s) Inadequate Food, Clothing, Shelter Inadequate Guardianship Lack of Medical Care Subject Of Report Palmiotti.Winona Palmiotti.Winona Palmiotti.Winona Decision Substantiated Substantiated Substantiated

ALLEGATION DETAIL MA/AB Child Piscitelli.Winona Piscitelli,Winona Piscitelli.Winona Setting Of Abuse/Maltreatment

INJURY DETAIL
MA / AB Child Type Side Area Cause

PRINCIPAL INFORMATION Name: Added to Case: Palmiotti.Winona 9/9/2009

Printed: 10/8/2009

Office of Children and Family Services

Page: 1 of 6

Case Name: Case ID: Intake Stage ID: Investigation Stage ID: Relationship: Role: Person ID: DOB:

F >tti,Winona M 24,.o8-73 26384552 26384647

•"WARNING***** CONK .uNTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

Sex:
Language: Race: Ethnicity: DOD:

Mother Confirmed Subject 28610736 4/7/1973 Female English White Non-Hispanic or Latino 915 SUNRISE HWY APT 116 WEST BABYLON, NY 11704-6116 SUFFOLK (516)238-0371 Ext. Piscitelli.Winona 9/9/2009 Child

Approx:

N

Reason:
Address:

Phone: Name:

Added to Case:
Relationship: Role: Person ID: DOB: Sex: Language: Race: Ethnicity: DOD:

Confirmed Maltreated
28610740 7/6/2005 Female English White Non-Hispanic or Latino POBOX 1800 HAUPPAUGE, NY 11788-8600 SUFFOLK Approx: N

Reason:
Address:

Phone: Name: Added to Case:
Relationship: Role:

(631)503-7765 Ext. Piscitelli,Paul 9/9/2009 Biological Father No Role 28610737 5/27/1972 Male English White Non-Hispanic or Latino 318 ELLISON AVE WESTBURY.NY 11590-1835 NASSAU

Person ID:
DOB: Sex: Language:

Approx:

N

Race:
Ethnicity: DOD: Reason:

Address:

Phone:

(516)333-2672 Ext.

Printed: 10/8/2009

Office of Chilrirpn anrt Familw

Case Name: Case 10: Intake Stage ID: Investigation Stage ID:

Pf tti,Winona M 24ua873 26384552 26384647

* 'WARNING***** CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

INVESTIGATION CONCLUSION NARRATIVE
The Investigation Narrative must address each allegation for each identified child and subject in the report. Please note that an allegation involving multiple children or subjects may be addressed in the same statement. (See Help for Examples.) Using the standard of "Some Credible Evidence", please explain how the evidence complies with each of the respective Elements of the legal definition of Abuse and Maltreatment, as applicable. Evidence must also comply with jurisdictional requirements, including who can be considered a subject of a report. For Substantiated Abuse Allegations Go To Section A. For Substantiated Maltreatment Allegations Go To Section B. For Unsubstantiated Allegations Go To Section C.

Section A

LEGAL DEFINITION - ABUSE

* Subject inflicts or allows to be inflicted physical injury to the child by other than accidental means which causes or creates a substantial risk of death, or serious or protracted disfigurement, or protracted impairment of physical or emotional health or protracted loss or impairment of the function of any bodily organ; OR •fr Subject creates or allows to be created a substantial risk of physical injury to the child by other than accidental means which would be likely to cause death or serious or protracted disfigurement, or protracted impairment of physical or emotional health or protracted loss or impairment of the function of any bodily organ; OR * Subject commits or allows to be committed a sex offense against the child as defined in Penal Law, Article 130; allows, permits or encourages the child to engage in any act described in Penal Law, Sections 230.25, 230.30.or 230.32; commits any of the acts described in Penal Law, Section 255.25; or allows the child to engage in acts or conduct described in Penal Law, Article 263 (Age and corroboration requirements of Penal Law, Article 263 do not apply).
For each substantiated allegation of abuse, please describe how the evidence gathered supports the finding of abuse:

Section B

LEGAL DEFINITION - MALTREATMENT

The elements of maltreatment are:

Printed: 10/8/2009

Office of Children and Family Services

Page: 3 of 6

Case Name:

Palmiotti, w mona M

Case ID:

24158873

Intake Stage ID: Investigation Stage ID:

26384552 26384647

***** WARNING***** CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

A. 1. The physical, mental, emotional condition of the child has been impaired or placed in imminent danger of impairment; AND 2. Subject failed to exercise a minimum degree of care > in supplying adequate food, clothing, shelter, education, medical, dental, optimetrical or surgical care, though financially able to do so or offered financial or other reasonable means

to do so; OR
^ in providing proper supervision or guardianship; OR > unreasonably inflicting or allowing to be inflicted harm or a substantial risk of harm, including: • infliction of excessive corporal punishment; or • misuse of drugs; or • misuse of alcohol to the extent that the subject loses self-control of his or her actions; or • other acts of a similarly serious nature; AND 3. There is a causal connection between 1 and 2— the failure to exercise a minimum degree of care caused the impairment or imminent danger of impairment; OR B. The subject of this report demonstrated an intent to forego his or her parental rights and obligations as manifested by the subject's failure to visit or communicate with the child although able to do so;

,

OR

C. The subject of the report inflicted serious physical injury upon a child by other than accidental means.

For each substantiated allegation of maltreatment, please describe how the evidence gathered supports the finding of maltreatment: Ms Winona Palmiotti aka Grant aka Marzocco; has a long extensive documented history of fleeing from one county to another whenever services or intervention was presented to her. This behavior dates back to when her first child Timothy was born in 1989. There are numerous indicated cases in Broome, Sullivan, Chenago, Nassau and Suffolk County. In 2004 abandonment charges were filed against Ms Palmiotti on behalf of Timothy. A warrant was issued for her however she was not found. At the time Timothy was found in upstate NY. His grandmother was sick in bed in a hotel room, he was running through the parking lot naked banging on doors and windows. He was 16. Timothy was deemed mildly retarded and severely autistic. History shows he rec'd a formal education only through the 2nd grade. Timothy was placed in a facility and his grandmother was placed in a hospital. Ms Palmiotti resurfaced in Nassau County in August 2005. She had just given birth to her second child Winona Rose. According to history Nassau's notes indicate they had wanted to pursue judicial invention against Ms Palmiotti on behalf of infant and add her to the Broome County court case that was still pending on behalf of Timothy. However, Ms Palmiotti and infant's whereabouts became unknown and no further action was able to be taken. Timothy aged out before Ms Palmiotti's rights could be terminated. Due to the severity of Timothy's disability he is unable to function independently in society. He is remains in an upstate adult facility. He is now 20 years old. Ms Palmiotti is not permitted to have contact with him. In April of this year 3 y/o Winona Piscitelli was brought into a hospital in Akron Ohio after falling into a fire pit and sustaining burns to her hands and arms. As a result of Richland County Child Protective Services having many concerns Mother Winona Palmiotti was offered preventive services. Ms Palmiotti agreed and then made herself and

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Office of Children and Family Services

Page: 4 of 6

Case Name: Case ID: Intake Stage ID: Investigation Stage ID:

Palmiotti, wmonaM 24158873 26384552 26384647

***** WARNING***** CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

child unavailable. The agencies concerns pertained to the conditions found in the child's home, the child drinking from a bottle and wearing a diaper, the child' s apparent developmental delays, (limited verbal skills unable to speak in 2 syllable words or in coherent sentences) Ms Palmiotti's financial difficulties and inability to pay her gas electric and water along with concerns that Ms Palmiotti herself appeared somewhat limited or psychologically impaired; Richland county sought Judicial Intervention to mandate services. All notes are contained in physical case record. Richland County then learned that Ms Palmiotti had gone to NY. Simultaneously, a report was rec'd in Suffolk county re: Winona Palmiotti and her daughter. When contact was made with Ms Palmiotti in Deer Park, LI and services were offered she again left Suffolk county and returned to Richland County. Richland county was notified and met with Ms Palmiotti. Ms Palmiotti learned that Richland County was planning to ask for custody of child Winona and fleed with child again returning to NY. This report was then rec'd stating Ms Palmiotti and her daughter were with bio father Paul Piscitelli in Nassau County. Mother, alleged father and child Winona were all seen and interviewed at Nassau County at DSS. Mother advised she and child would be staying at a motel located in West Babylon. She advised Mr Piscitelli paid for the room . This cw met with Ms Palmiotti who advised she left Ohio because she could not find a pediatrican and could not secure services for her daughter. She advised the economics conditions in Ohio were bad and the town was devastated by the loss of a major employer GM. She stated she was applying for public assistance and emer housing here in NY. Cw pointed out she had a home and a business in OHIO. She stated she had no work due to the economy and was prepared to just "leave" the house.

There is credible evidence to support that Ms Winona Palmiotti has neglected her child Winona Piscitelli. The last time child Winona rec'd any immunizations was in 2006. Child Winona is unable to verbally communicate in an effective manner. Her vocabulary is limited and she is extremely difficult to understand. In court, Ms Palmiotti claimed that she only learned of this after the child was hospitalized for her burns. Ms Palmiotti claims she tried to get a pediatrican to see her daughter but could not find one in her area that accepted her insurance. She also stated she did not have her daughter vaccinated due to concern that being vaccinated prior to 4 yrs old would cause the child to be autistic. Mother was advised back in April to get her dau evaluated for early intervention services. Mother did not. On 9-16-09 after gathering information from Richland County and reviewing history an administrative decision was made to take the child into protective custody. There was concern that if mother was served to go to court she would again flee with child. On 9-18-09 a hearing was conducted and Judge Quinn decided it was in the child's best interest that she remain in the care and custody of the commissioner of the Dept of Social Services. An Order of protection was put in place providing mother only have supervised visitation with child. Mr Paul Piscitelli maintains he is the biological father and a paternity test was ordered and conducted on 9-30-09. Results have not yet been received. Mr Pisicitelli has stated he wants custody of the child. Agency is not opposed at this time of approving Mr Piscitelli as a resource for Winona should it deemed he is her biological father. Immediately after child was taken into care Mrs Palmiotti stated she wanted to go back to Ohio. She claimed her rights were being violated she is a resident of Ohio not of NY. She filed a petition and was denied a hearing. The weekend after Winona entered foster care, Ms Palmiotti entered into a domestic violence shelter. Another report was then rec'd by the SCR alleging sex abuse against Mr Piscitelli on behalf of Winona Piscitelli. Ms Palmiotti was advised that little Winona was unable to be interviewed due to her inability to verbally communicate. Ms Palmiotti consented to the child having a SANE exam. Exam was performed on child 9-23-09. The results of the exam as well as the findings of that investigation are unknown by this caseworker as it is being handled by SCW Angela Brigiotti on the Abuse team. To date, Child Winona has been seen by the county's public health nurse and a private medical doctor. She has rec'd 4 vaccinations. She is currently in foster care and attending daycare. She is reportedly doing very well socially with no behavioral outbursts or acts of aggression toward adults or children. Since entering care Winona has lost

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Office of Children and Family Services

Page: 5 of 6

Case Name: Palmiotti, vv mona M Case ID: 24158873 Intake Stage 10: 26384552 Investigation Stage ID: 26384647

***** \V.,RNING***** CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY

approximately 5 pounds. She is still "off " the growth chart for her age and height. At last doctor visit of 10-5 she weighted 52 Vz pounds. Her speech has improved slightly. There is a lot of concern pertaining to Ms Palmiotti's psychological state of being. She fails to understand how her actions/inability to act/ unwillingness to act places her daughter at risk of imminent harm and danger. Ms Palmiotti has failed to provide a stable suitable environment for child Winona. She has failed to address her medical needs by not securing a pediatrican to address child's developmental delays, weight and behavioral outbursts. The interaction between mother and child is not loving and nurturing. Mother does not show any affection nor does she verbalize any sentiment to child. Several relatives have come forward expressing their concern about Ms Palmiotti's inability to properly care for her child Winona. When asked why they have not intervened they stated that Ms Palmiotti can be very vindictive and they did not want to bring that upon themselves or their families. This case is indicated against Ms Palmiotti and will remain open for services.

Section C

UNSUBSTANTIATED ALLEGATIONS

For each unsubstantiated allegation, please describe how the evidence gathered does not suppor a inaing of or each child abuse or maltreatment as defined in the elements above. Please be sure to address each allegati and subject:

Printed: 10/8/2009

Office of Children and Family Services

Page: 6 of 6

DSS-2999 <Rev. e/aa)
TO:

SCHOOL DISTRICT NOTIFICATION OF FOSTER CHILD PLACED IN A FOSTER FAMILY, AGENCY BOARDING, OR GROUP HOME
DATE OF BIRTH OR APPARENT AGE DATE CHILD ENTERED FOSTER CARE

ADDRESS OF CHILD WHEN CHILD ENTERED FOSTER CARE (Include name(s) of parent(s) or legal guardian(s))

9-1 (,-09

(School District Child is Attending) FROM: (County Department of Social Services) Pursuant to Section 445.1 of the Social Services Regulations, I am notifying you of the foster care placement of the below named child. For additional information regarding this notification, please contact:
CONTACT PERSON TELEPHONE NO. NAME OF SCHOOL DISTRICT CHILD RESIDED IN WHEN CHILD ENTERED FOSTER CARE (DISTRICT OF ORIGIN)

j/0.

I

NAME OF SCHOOL DISTRICT LAST ATTENDED (if different from above)

ADDRESS OF SCHOOL DISTRICT OF ORIGIN

ADDRESS OF SCHOOL DISTRICT LAST ATTENDED

NAME OF^SPCIAL SERVICES COMMISSIONER CHARGED WITH CARE OF CHILD

CHILD'S FULL NAME

ADDRESS OF SOCIAL §|RVICE» COMMISSIONER

=OSTER FATHER'S NAME

18TOD
NAME OF AUTHORIZED AjSENCY ACTINGJFOR COMMISSIONER

-OSTER MOTHER'S NAI

\DDRESS OF FOSTER PARENT(S) OR NAME AND ADDRESS OF AGENCY BOARDING, OR GROUP HOME

tcc-k/e
ADDRESS OF AUTHORIZED AGENCY

Vko
repare within 10 days of foster child's admission to school. /bite - To agency Canary - To school district child now attending. ink - To school district child resided in when child entered foster care.
SIGNATURE OF COMPLETING OFFICIAL

ML*

01/28/2010 15:38 FAX &318549347

*

SC CPB #***************#**** *** TX REPORT *** *********************

\

@I001

TRANSMISSION OK TX/RX NO CONNECTION TEL SUBADDRESS CONNECTION ID ST. TIME USAGE T PCS. SENT RESULT 1179 93452165

01/28 15:38 00'27 2 OK

COUNTY OF SUFFOLK
STEVE LEVY
SUFFOLK COUNTY EXECUTIVE DEPARTMENT OP SOCIAL SERVICES Gregory Biass
COMMISSIONER

FAX TRANSMITTAL COVER SHEET

Number of pages, including this cover sheet: Far Number sent toV
D

**B'

Tlme:

CONFIDENTIALITY NOTICE
The documents which accompany this telefax transmission sheet contain information which is confidential and/or legally privileged, and which is intended ON LY for the use of the person or entity named above. If you have received this transmission in error you are hereby notified that anv disclosure

01/27/2010

11:24

631-345-2165

PAGE

02/03

tntral School District Committee on Preschool Special Education Office of Special Education

IEP Amendment Agreement and Consent Form RE: Winona Piscitelli I. I£P Amendment Proposal The proposed change(s) to your child's IEP is(are) specified below [indicate Hie current IEP status and the proposed change(s)]:

Authorized School Official: Print Name II. Agreement and Consent I have received the Notice of Agreement to Amend an IEP without a formal Committee Meeting and reviewed the proposed change(s). I understand that if I consent, the amended IEP shall be put into effect once reviewed and supported by the Board of Education and that all staff involved in implementing the amended IEP shall be notified of the changes and, as required have access to the new IEP. I also understand that I will be provided with a revised copy of the IEP with the amendments incorporated. In granting consent, I acknowledge that I have been advised of my right to consult with the appropriate personnel or related service providers concerning the proposed changes and my right to request and attend a formal Committee meeting to recommend such changes and have agreed to waive a meeting to expedite the changes proposed. I am also advised that nothing hi this agreement shall limit or otherwise ...affect my right to request a meeting with the Committee in the future. / onsent to waive my right for a Committee on Preschool Special Education meeting and consent to the sed changes D I do not consent to waive my right for a Committee on Preschool Special Education meeting and request that a meeting be scheduled.
Parent/Guardian: Print Name Signature

Signature

/Da

\lz?
Da

Authority: 34 CFR §300.324(a) (4)

ai/27/2ala

U!»

SM^M.B,

^ ^

faggpHtCentra! School District Committee on Preschool Special Education
Office of Special Education

Request for Agreement to Amend an IEP without a Formal Committee Meeting January 26,2010 To the Parent/Legal Guardian of Winona Pisatelli Re: Winona Piscitelli Dear Parent/Legal Guardian of Winona Pisatelli: In accordance with the Individuals with Disabilities Education Act (IDEA), the parent of a child with a disability and the district may agree that it is not necessary to convene a Committee on Preschool Special Education meeting for the purpose of amending the child's Individual Education Program (IEP). Specifically, the regulations permit amendments to a child's IEP only after the annual IEP review meeting for a school year. Enclosed please find an IEP Amendment Agreement and Consent Form which indicates the proposed changes to your child's IEP and indicates your consent to not convene a Committee on Preschool Special Education meeting for the purpose of making these changes. Please note that you have the right to consult with the appropriate personnel or related servj.ce providers concerning the proposed changes prior to making your decision. If you agree and consent, your child's IEP will be modified in the manner explained on the form by this written agreement without the necessity of a Committee on Preschool Special Education meeting. The amended IEP will be forwarded to the Board of Education for their review. Once the Board of Education has met to review the amended IEP, you will receive a letter notifying you of the Board's decision. All staff involved in implementing the amended IEP shall be notified of the changes and, as required, have access to the new IEP. You will also be provided with a revised copy of the IEP with the amendments incorporated. If you wish to waive your right to a Committee on Preschool Special Education meeting and agree to the amendment proposed, please sign and date the enclosed IEP Amendment Agreement and Consent Form and return it to our office immediately. If we do not receive your written consent and there continues to be a need to amend the IEP, the district will schedule a meeting with the Committee on Preschool Special Education. Please note that you do not have to grant consent and that you have the right to have the proposed amendments considered by Committee on Preschool Special Education at a formal meeting. Be advised that nothing in this agreement shall limit or otherwise affect your right to request a formal meeting with the Committee in the future. If you have any questions regarding this notice or the request for consent, please do not hesitate to contact our office. Previously you have received a Procedural Safeguards Notice that explains your rights regarding the special education, process, but if you need an additional copy, please contact our office. Sincerely., Brenda Giglio-McCabe Brenda Giglio-McCabe Chairperson CPSE End: 1. IEP Amendment Agreement and Consent Form

01/27/2010

11:24

631-345-21E5

PAGE

01/03

SPECIAL EDUCATION DEPT.
DATE: Send to: / TIME:

Attention;

From: Education Office Office Location: Phone Number: Number of Pages, Induing Coven
a REPLY ASAP a PLEASE COMMENT FOR

URGENT

~

Confidential Notice

The Information contained in this facsimile is privileged and confidential, intended only for the Individual or entity above. If you are not the intended redolent you are hereby notified that any dissemination, distribution or copy of this fax is strictly prohibited. If you have received this transition In error, or if any parts are missing or illegible, please notify us at (631) 345-2173.

ax cover
I Special Education Department

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