First Home Care’s Portsmouth branch was investigated by the Department of Social Services (DSS) during an unannounced monitoring inspection after a self-reported incident of an injured child was made to the agency. DSS found 5 violations of key health and safety standards after a child was injured while in a foster home supervised by a substitute caretaker that was not approved by the program. DSS revealed that one foster child’s documentation stated that he/she needed “significant medical and behavior needs” and “intensive supervision to prevent harmful consequences to self and others.” However, on 6/30/2014, it was reported that the child had suffered injuries that required hospitalization and surgery. It was later uncovered that the foster family’s sister was the substitute caretaker at the time of the incident. However, the case manager stated during an interview, “I have never heard of FH1s sister until the incident” and the previous case manager was not aware of any substitute caretakers for the foster child. DSS could not find any documentation of approved substitute caretaker arrangements or the foster family’s planned absence. DSS also found that the child’s case was not properly staffed and that “no staffing [was] conducted” prior to placement in the foster home. Lastly, First Home Care had “failed to maintain a narrative account of the preparation of the family for each child placed in the home.” In the plan of correction, the program removed the foster child from the particular foster home and completed staff training on policies and procedures.