A Child 4

COUNTY OF SUFFOLK
STEVE LEVY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF SOCIAL SERVICES GREGORY J. BLASS COMMISSIONER
To: Sullivan County Government Center Attn: Family Court Clerk of the Court I would like to formally request all family court orders on record pertaining to Timothy Grant DOB 1-30-89. Our agency currently has a neglect petition pending in Suffolk County Family Court. Our petition is against Timothy's biological mother, Winona Palmiotti on behalf of her youngest child. During the course of our investigation we learned of Sullivan County's court proceedings regarding Timothy. Unfortunately, I do not have a docket number. I hope the follow can assist you in finding the case. Court involvement spanned from 2004 through 2007. I believe Sullivan County filed their initial petition in 2004. There should also be TPR petition from 2005 Order terminating rights in 2006/07 and an Order of Protection from possibly July 2006. I believe the Judge's name was Meddaugh. Any documentation you can provide would be greatly appreciated. Please fax the last order and petition to 631-854-3358 attn: Team 63/102 All information can be mailed to: Suffolk County Department of Social Services Child Protective Services PO Box 18100 Hauppauge,NY 11788-8900 Attn: T63/102
Thank you for your prompt attention to this matter. Sincerely Lisa Scaf Suffolk County Child Protective Services Senior Caseworker Investigations
BOX 18100
HAUPPAUGE, N.Y. 11788-8900
(631) 854-9935
FCSA DATA BASE INFORMATION SHEET
CASE NAME:
, Q-\
INITIAL:-
UPDATE:
CLESNITIAUS
PRIMARY TEAMS C?^>
SECONDARY,
ANCILLARY
WORKER'S NAME / NUMBER :

%
AL AUTHORITY FOR SERVICE CASE: CID
VOLUNTARY CPS
COURT ORDERED CPS
PREVENTIVE
OT1 (SPECIFY ORIGIN OF REQUEST)
ICPC (SPECIFY ORIGIN OF REQUEST)
COMPLETE BELOW SECTION FOR CHILDREN NOT IN PARENTAL CUSTODY (N-DOC. FOSTER CARE. JD. PINS)
CHILD'S NAME.
i_iJ
D.O.B. CUSTODIAN/RESOURCE
ADDRESS
REMOVAL RETURN TYPE (N-DOC, FC, JD, PINS) DATE HOME
KxjÛxi MY f r9 (07
COMMENTS:
IAJAS^-^^-
MENTAL HEALTH CLINICS (cont)

Opti-Care Mental Health Centers Smithtown Center 99 Hollywood Drive, Smithtown, NY, 11787 Riverhead Center 877 E. Main Street, Riverhead, NY, 11901 Pederson Krag Mental Health Centers: Smithtown 11 Route 111, Smithtown, NY, 11787 Huntington 55 Horizon Drive, Huntington, NY, 11743 Patchogue Geriatric Center 3 Grove Avenue, Patchogue, NY, 11772 Peconic Center - Riverhead 540 E. Main Street, Suite 2, Riverhead, NY, 11901 Riverhead Mental Health Center Jail Unit - Suffolk County Correctional Facility 100 Center Drive, Riverhead, NY, 11901 Riverhead Mental Health Center 300Center Drive County Center, Riverhead, NY, 11901 Skills Unlimited MHC - Oakdale 405 Locust Avenue, Oakdale, NY, 11769 Western Suffolk Center Pilgrim Psychiatric Center, Bldg. 56 998 Crooked Hill Rd., W. Brentwood, NY, 11717 Yaphank Center 31 Industrial Blvd., Medford, NY, 11763 920-8300 920-8000 475-7138 369-1277 852-1852 366-5800
284-5500
852-1440
567-3320 761-2082
924-4411
15
PARENTING REFERRAL LIST

ALTERNATIVES COUNSELING CENTER.................----------________369-120Q ANTOINETTE L. MICHAEL'S HOPE COUNCELING CENTER ....... 859-0250 22 RAILROAD AVE., SAYV1LLE, NY 11782 CATHOUC CHARITIES. .............. ....................................,......665-3434 269 W. MAIN STR. BAYSHORE, NY 11706
COMMON SENSEEARENTING^.. .... ...., -I ......---------------------.,.......673-7836* f . lS ^/ .-,.,,. ..".;-*^.-.:. ' , . -: : ..-:.'. t ..-.-' '';-.. . - * , . ; " - , .: :"'" ";
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KARENKAPLAN ,
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'Parenting Your YounigCmad^ using S;T.E.Pf ISUP TOWNSHIP........ ......... ' : . . _ . . . ^ PARENT RESOURCE CENTER ^665-1900 ADULTS & CHILDREN W/LEARNiNG&r DEVELOPMENTAL.DISABILITY s; ^ REFERRAL LINE..------------i.;... ............. ....... .. ..... ......... ....................... ...... ...;. 265-3311, PARENTING SKIia^VORKSHOPa. ';L.,^^.^^. ^1^1......^^ ' ' PEDERSON KRAG,...
PEDERSON KRAG SMITHTOWN
..................................
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SUNRISE COUNSELING BAYSHORE
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..... 666-1615 $45 -$55 PERSESSION
SUMY PSYCHOLOGICAL CENTEER..............._ ...... .... ...... ............^.632-7830 TOWN OF BABYLON.~...v^..~.-....,. .....~............ ...... ,________________......,...
SMTTHTOWN TOWN HALL-WEEKDAY PedersonKrag Center North
Free child cairf or >e fiifst 5
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: Sylvia Cabrera Smith 66543229 evening*?(Cifl*51297i^
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Excepts most insurances kichKfing HMO me^caid Pablo Guevara

289-5353
Patchogue^ 360^730
\âcdte-. , Spanish shafting paretiti^ ""
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COMMUNITY RESOURCES Parenting Madonna Heights, Dix Hills Sagamore Psychiatric Center Family Service League Family Service League/Home Base Early Head Start Pederson-Krag Resource Center Passages Jim.Lackner Sunshine Prevention (Selden) Point of Woods (Stony Brook) Hope House Ministries (Pt. Jeff) South Brookhaven Health Cntr. Parent.
643-8800 673-7836 85*$zn i (Ronkonkoma) 758-5200 Ext. 112 (perinatal, newboms) 265-3311 Smithtown 360-7517 878-2080 Moriches 345-5645 Home 476-3099 632-7874 928-2377 852-1028 -665-3434
Others Planned Parenthood
Huntington 427-7154 Westlslip 893-0150 Bay Shore 665-1173 Centereach 558-6676 Commack 462-5222 East Islip 859-1110
YMCA
Women's Counseling Service Mothers of Super Twins (multiples)
LIPA-REAPP (Residential energy affordability partnership program) For lowering electric bills, new refrigerators, lightbulbs, roofing Repairs, insulation, windows. Contact Lynette Curly 1-800 263-6786.
CLINICAL CARE ASSOCIATES &
Qj ELS
TURNING POINT COUNSELING
Topics specifically dealt with i iis group format include: .' Styles of parenting y -Active communication o Responsibility . Handling Anger Power of Encouragement ) espect . Think-Feel-Dp Cycle
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191 North .Ocean Avenue *,,' Ratchogue, NY 11772

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Phone: 631-475-8641 Fax: 631-475-8642
August 18, 2008
Parenting, Programs on Long;...Island.

Suffolk County 1. EA C Lone Island Parenting Institute (631- 73 7-1454/Ronkonkoma) weekly parenting education workshops on various topics, in addition to the 6 or 7-week "Common Sense Parenting" workshops, the 6Vweek parent-child "Bright Beginnings" < woricshtipsyanrftheS^ stf 2. Brookh&venMenwrial Hospital ExMCtwtParenfc
3. Cornell Cooperative Extension of Suffolk County (63 1-727-7850/Riverhead) otters parenthig education workshops on a variety of topicsyineludingr nutrition; diê^^ child developmenti managing children'sianger, parenting ^^ '-^
'~
Parent Resource Center i631->224-"9
offers parenting awatieriesV ;'" workshops on suchtopies as:i)arentingtens, discipline, and-sibling rivalry. 7 Peder$Q&-i Common Sense Parenting for parmts of iîldren ages 5-18v as \ in-home parenting for parmts with childfeh who are severely icmotioaaJly distttfbed.^! ''. 8. Planned Parenthood ffudscm-Peconic (63 J-240-1152/Smittitown) Offers parent .' 9: Reach for the Stairs Tutorins Family Coaching Service f631*642-7876/Coratn) 'VI. offers individualized parenting education information on such topics as: pptQf ' training, discipKne, i^tmes andisdiedMes, pareht-child^bntract development, family IQ.Roeers Memorial Library Children and Family Services (631-283-0774/South ''
August 18, 2008
11. SaKamaxeChildren's-Ps^nrtite Center ffiWaverrv Ave. Clinic (631-3701676/Patchoeue) offers Common Sense Parenting for parents of children 5-18 years of age. 12. Smithtown Parent Resource Center / Smithlown Youth Bureau (6M-360- ' 7595/Smithtown) offers 2-hour workshops on various parenting topics such as: discipline, child development, encouragement/praise, and parenting adolescents. Additionally, trainers will go off-site to offer workshops. 13. SNAP Lone Island fPatchoeue) - offers parent education workshops specifically for parents of teens as well as for teen parents. 14. Si Charles Hospital Family Education Proeram (63,1'434^700/Poet Jefferson) offers workshops to expectant parents on such topics; as preparing for children, and;; pre-;and.post-nataTexercise* Additional groups araoffered^for new rooms 15. Hauppauee Puttie Library Children and Family Services (63>l-9<79~ 1600/HaiwDaUee): offers Parent-Child workshops for parents>of r-3Vear olds? - These .-. 5 week;sessions include a differott topicachweek;w^l^ ;' : conunuiJity*e0*eseHtid^ to kpeak.to partts-whf ttatrve
" ' " ôffetÂyork^ps ror parents' -,' *
M.':'y: Hm0*^KeJmirttteH7/EaslHarttt
parent edueati0frwd^&
Nassau County
/ft-,
ftâ^ , patenting adolescents;: ThInstiteteistiBErently ''' offering "Raising a Thinking Chil^" for parents of 4-year ts{d Children as'wdl as ; ongoing parent support groups for single parents and are offered at various times.
19. W#Cettri0rifttmtt^
classes on aH parenting topics based children's ages* in additionio "mtpray and me" classes and parent care workshops^ All workshops are offered at-various imeaK: . offers Parent-Chfid workshops forparents of l-3yearolds. These 5 week sessions include a different topic each week', as well as a, social worker or community- = * . representati ve40 speak? 1 parents 'wWletfieirchfldren^piayv
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August 18. 2008
2 1. HunMHs&e Consultants Mfavo^ Program (516-7415141} offers parent education workshops on such topics as child development, positive discipline, and parent self-awareness. 22. The National Assoc. of Mother's Centers (516-399-MOMS)* with locations throughout Nassau and Suffolk, offers support groups as well as parent education workshops on various topics. 23 . North Shore LI Jewish Health System Center for Parent Education (516-465-2500/various Nassau County locations) offers workshops on such topics asi car. seal safety, Lamaze, infant CPU, breastfeeding, Bafiycarev and baby safety. ' ; 24. The Parent Resource Center n
25;
^ '
offers small group workshops on such topics as: developmental' milestones, parenting practice, behavior"'problems:. Additibhally; trainers will go off-site to offer ; workshops^" " ^ " ' " . ' ' ' ' : " . . . ' . ' "':' , ' - ' ' ' .' '
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TEMI17
Date
To L
/l/Y/7?
Oranization *J~ Fax# fry-m?

From Organization ACCESS. TOWN OF ISLIP
Fax# f 63 n 224-1206 Subject

Pages: (including cover sheefl 7
Comments Cfi , * e.
A.
PROHIBITION ON RE-PISCLOSURE OF CONFIDENTIAL INFORMATION CONCERNING SUBSTANCE ABUSE PATIENT NOTICE TO ACCOMPANY DISCLOSURE MADE WITH CLIENTS CONSENT
This information has been disclosed to you from records protected by Federal confidentiality rules (42 CER part 2 and HIPPA). The federal rules prohibit you from making further disclosure of this information unless further disclosure is expressly permitted by the written consent of tbe person to whom it pertains or as otherwise permitted by 42 CFRpart 2 and/or HIPPA. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient. Any unauthorized further disclosure in violation of these laws may result in a fine of jail sentence or both
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DETERMINATION OF NEED FOR PHYSICAL EXAMINATION Part 822 PROGRAM

NAME OF CLIENT ADMISSION DATE
ID NUMBER
NOTE: THIS FORM wr BE USED AS AN ADDENDUM TO THE MEDICAL ASSESSMENT.* MAY
A, SUMMARY DETERMINATION
) .The client's medical assessment provides insufficient information about the health status of the individual, or indicates that further medical review is required. Therefore, a physical examination ' wffl be performed which must take place within 2 1 days of the client's admission and must in&Jude laboratory tests and other diagnostic procedures determined necessary by the examining physician as prescribed in Section 8 below physical examination is not needed as documented in Section C below.
J3. PJ^SICAtEXAMJDNATION ARRANGEMENTS

(. ) On-s'ite by a physician, registered physician's assistant, or nurse practitioner who is on staff or un der contract wfeh the provider. ' '
i-' *
( _ ) At the site of any OASAS licensed program by a physician, registered physician's assistant or aarse practitioner who is on staff or under contract with the provider. ( ) Referral to an outside physician with whom the provider has entered into a qualified service agreement (per 42 CFR part 2).' Referral to the client's primary care physician, with appropriate consents to release confidential information which allows for the sharing of information between die provider and the physician;
* * * * * i f i
C, EXPLAKAHON OF DETERMINATION NOT TO CONDUCT A PHYSICAL EXAM BASIS FOR DECISION (DOCUMENT CLEARLY): '
./V^/^/KD
SfCNATUÊ
CREOENTJAL
*The Medical Assessmwt must fae made via a 6ce-to-fece contact with proftssfonaJ medical stsfTof the program fLe. nurse practitfoner, registered nurse. Wcensed practical nitrsc, or other health care professions! licensed end certified by the State
Department of Education to examine, evaluate, diagnose and treat the physical and psychiatric conditions' of tha client
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TOWN OF (SLIP
DEPARTMENT OF HUMAN SERVICES ACCESS/ACCESO Division of Drug and Alcohol Counseling and Education Services
401 MAIN STREET ISLtP, NEW YORK 11751 (631) 224-5330 452SUFFOLKAVENUE-BRENTWOODINEWYORK11717 (631)436-6065
PSYCHIATRIC PROGRESS NOTE

DATE
CLIENT NAME KW^ r^^^^f
CLIENT #
SESSION TYPE W/JJ tJL I ^JLJrSESSION LENGTH
I T
/rJLJ
DOCTORS SIGNATURE
PAGE
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ACCESS
PART 822 GOTMttCAL DEPENDENCE!OUlPAilCE initial Detenninatioii / Level of Care Determination / Admission Decision
WiV
\o<\"\ V PatieirtName
M/n^tt
,. . . .;.....::;. ^^.^-,.-.
" ' 3aaent>#
Yea _,
No*
Initial Determination This individual appears to be is need of chemical dependence services. individual appears to be free of serious communicable disease that can be transmitted through ordinary contact . tois individual appeats to be not in need of acote hospital care, acute psychiatric care or other intensrve services which cannot be provided in ooajmictioii with, otttpatient care. .
:
r , .,' .' , Yes ' .No*

No*
*If no, make appropriate referral on reverse side of fMs form, _^_ '_ LOCAJPTk Criteria Non-Crtsi> Level of Care Petermination ladicatedLevel of Care: . ,continue []ao,got6#15
._
I. Dependence condition or abuse condition
2. Utablei6 participate in or compfyrith treatment [ . outside 24ôur structured treatment setting '. [ 3. Imminent health ristfrom continued alcohol or [] yesdrug use . . 5. Complications or contorbidities requiring medico! management/monitoring dtufy 6. Established opiate dependence condition 7. Chooses to participate in Methadone Treatment
;
['] yes, continue []no -3^. ' -
Jn.patieatKdiabifila.tion.
-. . .
[jyes > . . ' [ ] no. &
^"aêritRehabiEtation ; ' , lateiisiveR^dentMReliabiUtation .
[] ye^^daue" ' ' "' . ' yô>E oto ^ []yes -^ ..SsiSal to M^badoneTreatrienlv continue []no, coatiaue . [Jisresjgcj^fllftO ' ' ' ' ' ' . " -\-
8. Substantial deficits tn functional stalls 9. Physical health care needs 10, Inadequate social support system 11. Substantial risk of relapse 12. Jbtoderate to severe dependence condition 13. Inadequate LMng Environment \4. Requires 24~hour a day 'residential services end ongoing clinical and peer support 15. Significant other
[].no,goto#ii ;
[Jyes ^ [JjsJ5onrirme \M& * [ ) iao, continue
[]no
iiÂ / K^ f ^ fe.?^p
.:, ,; .... ......
OntpatientiReiiabiSation (goto#^l) tensive6t%atieat ' (gotoWT) , ' ,
Ihteasive Qu^jatieat . (go to #13) Outpatient noii-iiitettsivo. (go to
[ ] yes, continue
t] no, end.
[jyes Sttppoxtiveiivittg ...."-, -A--.-- Ouîalient non-iatensive^ .' []no,ejad
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a of Care: f\/-P&4^ A/ &TM L~t^\ ' if~^ Are flisre patieait fefitors fcat aigae against to level of caie? [ix*^ [] Yes Cspeoify1 betew)
/I
'
C<S?
CIfnj[cB% Rjecocomended Level of Care (if dififereaQ: ^ Additional Factws Relevant to Placement
.__
AdMssionPedsion /^. - ... I have reviewed the 'saieenfag informal^ in^^
N ' ,.-
, ' :'
' ' ' : ^ ' ''"''
.,
/Âiive determined that thisperson can be a&nittetf to îsser^^^^,e

lift individual has been detctminfidto be able to achieve orfflaintain, , . abstinence and racovcty goals Tntia ths ^jpHcatioa of onqjktient services.
''
chemical abfase'ar depeodence.

'
. ,*?/...
(For prtrvtltt certified to provide CD OutyatUnt ReJiabH&i&Ht Services, please diteckwkick admission criteria ccppfy. f lease tie reminded (Hat Criteria id AND EITHER Crtierb #2 OR. Criteria %3 MUST apply.) '
tflTfoiadivSdTiBliias.aa inadequate ?ooiaIsTrppQrtsyBtepi..
AND . . .'_
.- '.
"_" " ;" ; ' . ' " ""''"

.-_,_ Yisa .
Yes
#2. Either tie fedrvidual has substantial deficits in.foncdonalakflls, OR . #3 The individaal has health caie needs requiring!ialteniioa or monitoring by
If fhis petson is not ad^nttad, it is &a the following reasonfs) fadude referral to More appropriate care, tfapplicable): .
OF AUTHORIZED REKtESENTATIVlI OKEOP(SIBLE QHI)
.A ;./v^
._
PASE
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TOWN OF ISL1P
DEPARTMENT OF HUMAN SERVICES AQCESS/ACCESO Drvteion of Drug and Alcohpl Counseling and Education Services
'' ' '
401 MAN STREET-1SLB NEW YORK T1751-(631) 224^5330 ... 452 SUFFOLK AVENUE 8RENIWOCQ NEW YORK 11717 631; 436-4065 Elizabeth Lorenz,
Psychiatric Evaluation
Client #: Gender:
^
"Client Name Rate of Birth: Namfc of the client's Primary Counselor: ^ son for Referral:
Date:
Historyjof Psychiatric Illness: J
&
Pa*t Medical/surgical History: t Psychiatric Histtry: x" Yes No If yes, condition being treated:_
Where: (JW tP~A, -S^. Reason: Presently under care ofa Psychiatrist Family History:
z
Yes
If yes, condition being treated:
Histo'ry 6f past medications (including.adyerse reactions to specific medications) r Current Medications or orders for all medications: y]^( Psychiatrist's name, address and telephone ftfifqkesure a release of information is signed):-^
.'
..
Review of systems:
Psychiatric Evaluation: Orientation: Level of Awareness; Affect: Posture; Speech:
/M/
SI n .
Fcrson Drowsy _ Relaxed / Rapid ^Slow Monotone _Soft Normal Rate and rhythm JLabile Depressed Euphoric .^x^CTflTrn '__ . ^ Hallucinations Jilusions .^.Âppropriate Derealizatioii JDepressed Slouched Shared _Stuporous .Nonnal ^Posturing _Pressxa:eil
^coherent
1OUS
Mood: Perceptions:
Irritable
__Depersonalizatiori.
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Client Name: Motor Activity; Thought Process:
Client #
Thought Contents:
Judgement:.' Immediate Recall; Recent Memory: Remote M>ino*y Diagnosis:
Âppropriate-' ^Restless Tremors' '. , ^ Retardation Loose Association. Tangential ^ Retardation ,/Întact Blockings Paranoid Ideation Âppropriate Delusions Phobias : .Obsessions '__ __Ideas of Reference/fofiuence 'Fair - Fair bfêAsvJ rvUu->t Is^'OO ' . ' ' . ' ' . *
s Good s Good . . f Good .. ,
Fair Eair '
'
JPoor Poor'
Poor Poor
Axis I:
Axis' II: Wo
Pr
i/û v^
X1 f
Axis.ni fa AxisIV ' l^îA' ff/U, "AxisV . ipervision: r^-Yes XpmJTifltinn; Yes
C r.^j/
e-Cv-^v/K-*rvi^W'- )
. '
No ^-No
Clinical Assessment: -(To include symptoms of alcohol/drug abuse or dependences level of motivation, denial pertinej nedical, p^cMatric, fanaily, parenting, relationship jega!3 and vocation needs. Describe areas of vanerabiMes, 'clients strengfliSj preferences,and abilities): /^Lt \~~
eatment Recommendations (To include level of cateêc^jSilendedlpased ontEent'j
ait's medical and/or psychiatric history, the'clieijt's ability to maintain abstinence, risk of relapse HTV
ing/educational requirements and strength of sobe^ support ^ystem:
Cr
itional Referrals:
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.ASSESSME
Client Name
v J .* '.
V \
v\*
Date /y/y/x,..Client#
Does dieateuiTeotiy s&flfer&Ma aiy of flte fbZZowing:

(SwnrtiJe udditfanalinfonnatfcm, trbere apipropriate (<i,g. date of diagnosis, freqneacy cf probtem*,
Shortstess of Breath ' ^
Heart Disease
s/Accidents
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Female: Age of fast period Date of last period Date of last ob^gya exam
Menses: ^ negater. inegnlar feuM .dig# caareoffy begtegaaot? '
^-
Has oKerrt been tested for HBV/IB ? OTHER;
Signature of Medical Diiecton
COUNTY OF SUFFOLK
December 7, 2009 Access 401 Main Street Islip, NY 11751
......
__.._
RE: Winona Palmiotti To Whom It May Concern: The above named person is currently receiving services from Suffolk County Department of Social Services. It is important that we have a copy of her mental health evaluation and your recommendations for our file. It is believed that Ms. Palmiotti registered for an intake with your office on October 5, 2009. She was provided a follow up appointment on October 15, 2009 at 5:30 (Please see attached letter from your agency). Please forward a copy of her mental health evaluation to my attention at Suffolk County Department of Social Services, PO Box 18100, Hauppauge, NY 1 1788-8900 Attn. MacArthur Bid. Team 17-108. This information can also be faxed to my attention at 631-854-9347. 1 have enclosed a signed release of information. Please feel free to contact me at 631-854-9397 with any questions.
Sincerely,
Lori Towns, Caseworker Child Placement Bureau, Team 17
BOX 18100
(631) 854-9935
COUNTY OF SUFFOLK
STEVE LEVY SUFFOLK COUNTY EXECUTIVE

DEPARTMENT OF SOCIAL SERVICES
JANET DEMARZO
COMMISSIONER
PERMISSION FOR RELEASE OF INFORMATION

I hereby authorize
at
and
Suffolk County Dept. of Social Services at 3455 Veterans Highway, NY 11779 to communicate and release information to each other regarding:
I understand that the information to be released is confidential and protected from disclosure. I understand that I have the right to cancel this Permission for Release of Information at anytime before it is released. I also understand that this Permission for Release of Information will expire when acted upon, or six months, whichever comes first.
Signed:_ Relationship:^ Address:
Date
BOX 181OO
HAUPPAUGE, N.Y. II788-89OO
(631)85-
SUFFOLK COUNTY DEPT. OF SOCIAL SERVICES P.O. BOX 18100 HAUPPAUGE, NEW YORK 11788-8900
7DDT IbflD DDDD B5^7
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FIRST NOTICE HKbl N U U b t ySECOND NOTICE \\\.W RETURNED-XOC^
000209470? CCT23 2003 FvlAILEDFROM ZIP CODE 1 1 788 ^^fv.fg\i\\ ^^f^"?',A\N,a i&2, Vf ^JiVl.r-'"-'"
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Winona M Palmiotti 1355 Locust Ave Bohemia, NY 11716-2182 Dear Winona Palmiotti
NIXIE RETURN TO SENDER UHCL. AIMED UWASL.E TO
OO 11/27/OSi
SENDER: COMPLETE THIS SECTION Complete Items 1,2, and 3. Also complete item 4 If Restricted Delivery is desired. Print your name and address on the reverse so that we can return the card to you. Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to:
COMPLETE THIS SECTION ON DELIVERY A. Signature
X
B. Received by (Printed Name)
ID Agent D Addressee C. Date of Delivery
D. Is delivery address different from item 1 ? D Yes If YES, enter delivery address below: Q No
UJl tWtl
atb
3. Service Type B*6ertifled Mail D Registered D Insured Mail
D Express Mail D Return Receipt for Merchandise D C.O.D. DYes
4. Restricted Delivery? (Extra Fee) 2. Article Numoer (Transfer from service label) PS Form 3811, February 2004
7DD1 IbflD DDDD BSH7 HSfll

Domestic Return Receipt
102595-02-M-1540
JOUNTY OF SUFFOLK
DEPARTMENT OF SOCIAL SERVICES Winona Palmiotti 1355 LOCUST AVE BOHEMIA, NY 11716-2182 Dear Winona Palmiotti,
Date:
12/03/2009
Gregory J. Blus Commissioner
You are invited to participate in a Service Plan Review, which is a conference to review the plan for the safety, permanency, and well being of the following children. Children Piscitelli.Winona The Service Plan Review is scheduled on: Date Time Location Address December 11,2009 11:15 AM SUFFOLK COUNTY DSS Room 101 Floor 1 Date of Birth July 06,2005 . Age 4 .
3455 VETERANS MEMORIAL RONKONKOMA NY 11779-7629 The purpose of the meeting is to bring together the child, family, and service providers to discuss the child(ren)'s and family's strengths and needs, to review their progress, and to plan for the future. It is necessary that you participate in this meeting to develop and review the plan, as important decisions will be made at this meeting. We need your participation in making these decisions. We invite you to bring with you anyone who can help with such planning, for example, family members, friends, a member of the clergy, or any other representative of your choice. If you are the parent or guardian of a child in foster care, or if you are a child in foster care, it is important that you know the following. Under State and federal law, if a child remains in foster care for 15 of the most recent 22 months, there is an obligation on this agency to file a petition to terminate parental rights, unless there is a legally acceptable reason for not doing so. This is a significant topic for discussion at each Service Plan Review meeting. If you have any questions or problems regarding the scheduled conference, please contact your assigned worker or the contact person listed below. Sincerely,
Case Planner: Case Manager: Towns,Lori Contact Person: Timothy Ferguson
Phone: Phone: 631-854-9397 Phone: 631-854-3475
Ext: Ext:
BOX1S100
HAUPPAUGE, N.Y. U788 - 8900
(631)854-9935
COUNTY OF SUFFOLK
STEVE LEW SUFFOLK COUNTY EXECUTIVE
DEPARTMENT OF SOCIAL SERVICES Paul Piscitelli 318 ELLISON AVE WESTBURY, NY 11590-1835 Dear Paul Piscitelli,
Date:
12/03/2009
Gregory J. Blast
Commissioner You are invited to participate in a Service Plan Review, which is a conference to review the plan for the safety, permanency, and well being of the following children. Children Piscitelli.Winona The Service Plan Review is scheduled on: Date Time Location Address December 11, 2009 11:15 AM SUFFOLK COUNTY DSS Room 101 Floor 1 Date of Birth July 06,2005 Age 4
Ext: Ext:
BOX 18100
HAUPPAUGE, N.Y.I 1788-8900
(631)854-9935
JOUNTY OF SUFFOLK
Date:
12/03/2009
Gregory J. Bhus Commissioner Dear Lisa Carbone, You are invited to participate in a Service Plan Review, which is a conference to review the plan for the safety, permanency, and well being of the following children. Children Piscitelli.Winona The Service Plan Review is scheduled on: Date Time Location Address December 11, 2009 11:15 AM SUFFOLK COUNTY DSS Room 101 Floor 1 Date of Birth July 06,2005 Age 4 .
Ext: Ext:
BOX 18100
HAUPPAUGE.N.Y. 11788-8900
(631)854-9935
JOUNTY OF SUFFOLK

MichelePilo 320 CARLETON AVE STE 3800 CENTRAL ISLIP, NY 11722-4510 Dear Michele Pilo,
Date:
12/03/2009
Gregory J. Blasi Commissioner
You are invited to participate in a Service Plan Review, which is a conference to review the plan for the safety, permanency, and well being of the following children. Children Piscitelli,Winona The Service Plan Review is scheduled on: Date Time Location Address December 11,2009 11:15 AM SUFFOLK COUNTY DSS Room 101 Floor 1 Date of Birth July 06,2005 Age 4
Ext: Ext:
BOX 18100
(631)154-9935
REQUEST FOR PRIOR APPROVAL OF SPECIAL NEEDS
TO: FR:
Linda Swartz, AD Child Placement Bureau Lori Towns, Caseworker Sally O'Donnell, Supervisor
DATE: 11/27/09 RE: Foster ChildWinona Piscitelli Case # S00900898 Next Recert Date Total Amount Requested $ 37.50 DOB 7/6/05 Child's CIN #DW78162E
Estimates Attached
REASON FOR REQUEST: Foster mother purchased a car seat booster for child. AMOUNT FORTHCOMING FROM OTHER SOURCES: $ DEADLINE FOR DEPOSIT OR PAYMENT: AMOUNT APPROVED $ J? 7 Date: /'/*"7 Supervisor's Signature^Jjjjî & ' IDENTIFY SOURCE
FOR APPROVAL OF PROPOSED EXPENDITURE $ 100 - $200 ASSISTANT DIRECTOR'S REVIEW
AMOUNT APPROVED $ Ass't Dir. Signature
Date:
FOR APPROVAL OF PROPOSED EXPENDITURE OVER $200 DIRECTOR'S REVIEW
AMOUNT APPROVED $ Director's Signature
Date:
NOTE Forward two copies for approval. One copy will be returned for the record. CSA-824 (10/00) Request for Prior Approval of Special Need
11/23/2009
09:51
531 -SSS^-i
SCDOHDSCSN
PAGE
02/02
COUNTY OF SUFFOLK
STEVE LEVY
SUFFOLK COUNTY EXECUTIVE
DEPARTMENT OF HEALTH SERVICES
LJNDA MERMELSTEIN, M , MPH

Acting Commissioner
November 23, 2009
Dear Ms, Towns,
IjjtaMHFfor Children with Special Needs. Lisa currently works Monday-Friday from 8:30 a.m. to 4:30 p.m. Please feel free to contact me if you need any further information.
Sincerely,
Sheila Ventrice
Assistant Coordinator of Special Instruction (631)853-2334
DIVISION OF SERVICES FOR CHILDREN WITH SPECIAL NEEDS 50 Laser Court, Hauppauge, NY 11788(631)853-3130 Fax (631) 853-2300
CSLGS
TRANSPORTATION SERVICES REQUISITION/RECORD Case Name: Winona Palmiotti Case Number: S00900898 Court Ordered: Yes IE1 No Q Requisition Date: 11/17/09 Child/Children and DOB: Winona Piscitelli [~l Deliver items Q Drop off records
Type of Activity: 1^1 Supervised Visit with transportation Q Supervised Visit without transportation n Transportation Only
Visit or Activity to Commence on: Thursday Nov 19 Frequency of Visit: E>3l time dweekly Obi-weekly dmonthly Length of Visit: open hours Time of visit: (check) [3am dafternoon CHevening QSaturday (IF VISIT MUST BE A SPECIFIC TIME OR DAY, PLEASE INDICATE): Foster Parent or Custodian: Address: Home Phone:
NOV 1 7 2009 Child Placement Bureau Suffolk County Social Services

TEAMS
Person(s) Authorized to have visit and relationship to children: Father- Paul Piscitellii Home Phone: 516-414-8076 Cell: 516-348-4524 PICK UP location(s) (list all):Daycre4 Visitation Site/Address: Drop off child at BF's home- 318 Ellison Ave, Westbury, NY 11590 RETURN location(s): No return BF will drive child back to FH
Please check all that apply: Order of Protection (Attach copy) Letter from custodian giving permission for DSS to transport (Attach copy) Îndividuals not permitted at visit: MEDICAL INFORMATION (check all that apply, please note individual with condition/allergy): HHAllergy (list allergy) [HAsthma CUSeizure disorder QOther CUSpecial equipment EUNone
Comments: Non respondent father has court ordered unsupervised visits with child. He resides in Westbury. He is requesting a visit with child on Thursday 11/19. Transportation for child is requested one way anytime in the morning Caseworker: Lori Towns Assigned to: Team# 17 Start Date: Extension: 4-9397 Time:
Transportation Unit cannot handle request at this time: ~Transporfatiert^pV)rdinator
d.
aims
Wiaona's Healthy Nutrition Plan My most important concern with Winona is her eating habits. She is a size 7-8 when she should be a 4-5. Winona is a good eater, but is used to fatty fast foods, salt and sugar added drinks and foods. I'm not a nutritionist but I know the difference from eating healthy and Winona has not been provided with healthy choices. I'm very worried about her health, and proper development. I believe a well balanced diet is essential for Winona, with combined physical activity throughout the day. I will also consult her pediatrician as to what's recommended for Winona's diet and adjust it accordingly. She should have 3 meals a day, breakfast, lunch and dinner, with plenty of grains, vegetables, and fruits, low calorie, low fat, low salt, meals, and about 2 healthy snacks in between. Her sleep time is very important for a continued nutritional plan, with daily physical activities, and she should have about 10-12 hours of sleep at night, and maybe a daily nap of about 1 hour, working with her sleeping habits at first as they get adjusted. Winona's nutritional plan will be challenging, but will be enforced by allowing experimentation with a variety of healthy foods, and to not punish her for not eating well, but to encourage her with a healthy plan for myself, reward her, by telling her "good job" for eating. Even if she ate very little, I would save her food for later, as she's hungry or add those missed nutrients to her diet the following day accordingly. Also adding fun to her food such as a low fat dressing to veggies or a few Fruit Loops, or fresh fruit such as strawberries or a banana to her Cheerios, and also give her a few choices as to what she wants to eat and let Winona decide. This will encourage her to eat more and also will help build her self esteem as she feels she's in control. I believe with some experimenting and some fun, she can be on a well balanced nutritional diet she needs. Milk-Great source of Calcium, Vitamin D, Protein. Avoid fats from milk, serving low fat milk or skim milk, Soy Milk, Calcium Forfeited Orange Juice, or low fat Yogurt w/o added sugar. Make Yogurt fun with fresh fruit such as Strawberries. About 3 - 8oz servings of milk a day. Cereal - Whole Grain, or Multi Grain cereals such as Cheerios, have many Vitamins and Minerals, with no sugar. Cereals can be combined with fruit, such as strawberries or bananas, or add a few pieces of sweeten cereals such as fruit loops to give it a little more flavor, and fun. Served with reduced fat, or low fat milk, and a small portion will make a great meal, as she finishes her meal and praised with a good job for doing so, she will be encouraged to finish her future meals, and building her self esteem at the same time. Vegetables - High in fiber, Vitamin A, C, Potassium and others. Try all different varieties of vegetables, Cooked Carrots, Corn, Peas, Backed Potato, Broccoli, String Beans, Mashed Potato's, Celery, Lettuce and Tomatoes. Combine vegetables with egg omelets, wraps, or some light dressing. Not to over cook vegetables as they will be crunchy and fun to eat. Serve in small portions so she can finish, and will be rewarded with a "good job", which will also help build her self esteem.
Fruits - Fresh Fruits are essential in Winona's diet as they contain many vitamins and minerals naturally. Apples, Oranges, Peaches, Strawberries, Bananas, and other fruits can be served in many ways to make them fun to eat. Fruits can be served in a meal or as a healthy snack. I would give her a few choices of fruits, such as Strawberry or Banana, but not too many choices otherwise she would be confused and overwhelmed. 1 -2 cups a day of fresh fruit Juice - Winona likes Juice Drinks, such as Capri Sun. I noticed her drink as much as 3 servings at one time. Juice Drinks are not a good source of a healthy diet, as they contain sugar that can promote cavities, and they don't contain many nutrients, and will fill Winona, and she will not be hungry at meal time. A great alternative is 100% pasteurized Fruit Juice, Milk or Water, but fresh fruit as a snack is better. If she drinks Juice, It should be 100% fruit juice, or watered down Juice, with low or no sugar. I think its better served at no more man 602 a day, and served in a sports bottle, which will limit her intake, rather than a glass or a sippy cup, so hunger will set in later at meal time. I will experiment with Winona as to what she likes to drink and provide healthy choices for her. Eggs - Eggs do have cholesterol, but no saturated fat. Many minerals and vitamins are in eggs, such as Protein, Iron, and more, so eggs make a good meal every so often. An egg is sufficient 2-3 times a week. Eggs can also be combined with vegetables, as an omlet, French Toast, and can be served a number a ways to make it fun to eat. I will experiment with her to see how Winona likes eggs. Oatmeal - Oatmeal is full of whole grains, and can be served numerous way so Winona will like it. Oatmeal can be a healthy meal, or served as a snack. A small portion will encourage her to finish it, as she's praised for a good job. Peanut Butter - Peanut Butter can be high in fat, but is full of vitamins and minerals. Vitamin A, E, B6, Iron, and Protein. A low fat, vitamin forfeited, peanut butter is a good alternative. Peanut Butter combined with a small portion of fruit spreads with low sugar content, combined with Whole Grain bread, cut hi shapes will make it fun to eat and enjoy. Pasta - Pasta is a good source of grains. Low hi calorie, fat, cholesterol free and sodium free. Pasta can be served hi many ways and shapes to make it fun to eat. It can also be combined with vegetables for more needed nutrients. A low salt cheese sauce or tomato sauce can be served with pasta. I will experiment as to what Winona likes best. Pasta does contain carbohydrates, but this should give Winona the energy through out the day, combined with physical activity. Multi-grain pasta is a great alternative as it is less hi carbohydrates and offers more needed nutrients.
Fish - Tuna Fish is a great food full of Omega-3 fatty acids. Great source for brain development and overall normal growth development. Fish does contain mercury, but low mercury Albacore Tuna served in small portions and in infrequent intervals combined with low fat mayonnaise, some vegetables, such as celery and Whole Wheat bread should be sufficient for Winona's diet Again, sandwiches can be made in different shapes to make it fun to eat I will have to experiment with Winona and see how she likes it Meats -1 would need to experiment with her as to what meats she likes. All she knows now is hamburger. I don't know, but I think that she was eating too much fast food for the past 3 years. I will try a few healthy meats with her in different healthy varieties such as chicken, beef and turkey. Low salt cold cuts or cooked meats, maybe combine meats, such as lean ground beef with Pasta. These are just a few of many ways, how I believe Winona should be eating. I will always experiment with her as to what healthy food she likes and dislikes, and will give her choices as required. Although there will be times that a few food she eats will be unhealthy, I will always encourage healthy choices all the time. Winona is very active and with attention to her proper diet, working with her, and giving her much attention, choices and praise, combined with involvement with physical activities, making it fun and at the same time, encouraging her, she should be on the road to a healthier little girl. I Miss You -1 Love You So Much Always and Forever. My Little Sweet P (Princess) -Daddy
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AMERICAN GREETINGS
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AMERICAN GREETINGS CLEVELAND. OHIO 4414 OAQC. LLC MADE IN U.S.A.
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Case Name: Winona Palmiotti Case Number: S00900898 Court Ordered: Yes 3 No Q
TRANSPORTATION SERVICES REQUISITION/RECORD Requisition Date: 10/29/09 Child/Children and DOB: Winona Piscitelli Q Deliver items E] Drop off records
Type of Activity: ^ Supervised Visit with transportation Q Supervised Visit without transportation d Transportation Only
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Visitor Activity to Commence on: Week of Nov 9 Frequency of Visit: (S31 tiSiei [Zlweekly [Ubi-weekly Omonthly Length of Visit: 2 hows--'' Time of visit: (check) Qam Qafternoon Oevening dSaturday (IF VISIT MUST BE A SPECIFIC rr*v "n " *v m v * ^ 1vir" Foster Parent or Custodian:
Address:
Home Phone:
Cell:
Person(s) Authorized to have visit and relationship to children: Mother Winona Palmiotti Home Phone: 516-238-0371 Cell: PICK UP location(s) (list all)^ Visitation Site/Address: dss RETURN location(s): daycare Please check all that apply: QOrder of Protection (Attach copy) OLetter from custodian giving permission for DSS to transport (Attach copy) Qlndividuals not permitted at visit:
TEAMS CHiW PlaCSment Bureau Suffolk County SOCfaf SeiVfceS
OCT 2 9 2009
MEDICAL INFORMATION (check all that apply, please note individual with condition/allergy): QAllergy (list allergy) DAsthma QSeizure disorder DOther equipment C]None Comments: One time make up visit for agency closure on Wed 11/11/09. Mother is seveFlyjnentaHy ill. CSW must watch Caseworker: Lori Towns Assigned to: Team# 17 Extension: 4-9397 Time: ^\\ Date
Start Date: _
Transportation Unit cannot handle request at this time^\ (TUPC! ^ l>_\ pQijinPy Transportation Coordinator
TOWN OF (SLIP
DEi 7tTMENT OF HUMAN SERVICES ACCESS/ACCESO Division of Drug and Alcohol Counseling and Education Services
.
401 MAIN STREET ISLIP, NEW YORK 11751 -(631) 224-5330 452 SUFFOLK AVENUE BRENTWOOD, NEW YORK WM > (631) 436-6065
Phil Nolan, Supervisor

Elizabeth Lorenz, Commissioner
Date:
I/O \ i^VSt^v ^^[ oVh ( C\~H has come to the ACCESS office today to register for an intake appointment. Initial information has been taken and a referral-in has been written up. The client will be notified and assigned their intake appointment as soon as possible. A release of information has been signed by this client and will be kept on file. If you have any questions about the status of this case, do not hesitate to call the ACCESS office at 224-5330. Sincerely,
I "
rJ
('
"^
i /
Counselor
CASE TRAM? "R
)STER CARE PLACEMENT QUALITY A.
JR
E COVER SHEET
TO:
FROM:
, Supervisor .Team
JLLu CA^W_H DATE:
fO - ^ - O| Co^3> \ to 5^
17
Unit/worker:
, Supervisor Q_, , Team Case number: Date sent to M&U
Case name:: Qx\ W
PLEASE ATTACH FORMS IN ORDER LISTED FOR SUPERVISOR
WMS) SERVICES (SOO) CASE OPENING (FOR MSU) (1 OR 2)
'DSS-2921 Application for Services 'CSA-906 CSA/WMS Transmittal - Note name of foster parent SS-3373 UCR/CCRS Assessment Plan Grid - NOTE: MSU staff will access through Connections LOSS 461 1 (revision date 8/04) Family Checklist for Eligibility & Authorization for EAF
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WMS SERVICES AUTHORIZATION (CASE OPENCHILD IN CASE) (FOR MSUj *CSA-906A CSA/WMS Transmittal - Note name of foster parent NOTE: Worker must state on 906 whT progress note the info, is documented on. Note: MSU STAFF ARE RESPONSIBLE FOR ADDING INDIVIDUALS TO CONX. To add a child to an open case (newborn, etc.) add: D *DSS-3502 Services Worksheet D 'DSS-3316 CCRS Supplemental Information (Must Indicate Ethnicity) D 'DSS-3373 UCR/CCRS Assessment Plan Grid
. MEDICAID ELIGIBILITY TO IV E UNIT (3, 4, 5, 6 or 7)
Date sent to IV-E
*DSS-2921 Application for Medicaid for each child with Third Party Health Insurance information and verification of birth (certificate or copy of letter requesting it) LOSS 4809 (revision date 8/04) *Verification of child's Social Security number .
*4. CSA-67Q *FACE SHEET: All fields must be completed - NOTE: FAMILY INCOME MUST BE INCLUDED
ALL PARENTS must appear on Face Sheet (copy to IVE, orig. to case record) *5. CHILD SUPPORT (See Desk Guide) DO NOT REFER IF CHILD LEFT FOSTER CARE W *CSA-954 Notice of Determinajtiofl of Responsibility for Child Support If referred to CSEB: B" CSA-956 Referral of Parents to CSEB (EACH PARENT MUST BE REFERRED) D DSS-2860 Child Support Enforce/Ref. (if on PA) (EACH PARENT) OR EfDSS-2521 App. For Child Support Svcs (if non-PA) (EACH PARENT) 6. D D Q D D "LEGAL AUTHORITY - VOLUNTARY - in Legal Activity Record *CSA-397 Voluntary Transfer Agreement (copy) *DSS-3416 Religious Designation of Child "CSA-396 Affidavit of Paternity *CSA*983 Consent for Child's Medical/Dental Care (NOTE - In Case Record) 'Consent for Out of County & Out of State Travel (NOTE - In Case Record)
7> * LEGAL AUTHORITY - COURT PLACEMENTS - in Legal Activity Record S 'Article 10 Remand/Transfer of Custody D 'Article 1 0 Adjudication/Transfer of Custody D *JD PINS/DFY Adjudication/Transfer of Custody
8.
D* APPROVED ( . . s SIGNATURE) FOSTER CARE PLACEMENT REVIEW AD'
XL i..(/-YviJrCt cl
9. ]$l*DSS-2999, School District Notification for School Age Child Placed into Foster Home
Child enrolled date
_ _=___=__ _
10. FOR ALL CHILDREN ENTERING INSTITUTIONAL OR DIAGNOSTIC PLACEMENT D'Juition Reimbursement Information Sheet NOTE; MUST BE INCLUDED WITH OPENING PACKAGE 1 1 . [^Transfer Summary (in CONX CPRS) ~" B^Birtfi certificate or Q request ^Paternity Statement (in legal record). ZL#Bchool records or D request H'ffMedical records or H"request 32#SSN verification or D SS5 ^#Neglect/Abuse Petition (in Legal Activit' jS^Court Order (in Legal Activity Recor lvy D OtherSupervisor's Signature (sending) _ Supervisor's Signature (receiving)_^ _ Date
-, _ . _ . .
Date
/.
. ,
Asterisk (*) indicates material necessary to process Medicaid or Services case. If absent or incomplete case will be returned for correction. Pound sign (#) indicates material necessary to be Included on all transferred cases. "Instructions for use - For initial case opening use sections 1 & 11 - For transferring between two teams checK all that apply - For Foster Care placements use entire sheet
Rev. OWG an
COUNTY OF SUFFOLK
October 21,2009 Re: Case ID 24158873 Intake Stage ID 26384552 Date of Intake 9/9/2009
Winona M Palmiotti 1355 Locust Ave Bohemia, NY 11716-2182 Dear Winona Palmiotti
On 10/21/2009, you were notified that you were the subject or other person named in a report of suspected child abuse or maltreatment received by the New York State Child Abuse and Maltreatment Register (State Central Register). At that time, you were informed of the investigation process conducted by the SUFFOLK County Child Protective Service and your rights in regard to this matter. We must now inform you that this report has been "indicated" and that you are the subject of the report. This means that some credible evidence has been found to support the determination that you maltreated or abused the child(ren) named in the report. In addition to this letter, I, the undersigned caseworker, am willing to discuss in more depth the reasons for this determination and your feelings concerning this matter. Services may also be offered to assist you and your family. Since this report has been determined to be indicated, it will remain in the New York State Child Abuse and Maltreatment Register. As you were previously informed in your notification letter, you are entitled to request a copy of all information regarding the report contained in the State Central Register. However, the Commissioner of the New York State Office of Children and Family Services and social services district official must withhold information identifying the person who made the report unless that person has consented in writing to the release of such information. In addition, the Commissioner and social services district official may withhold information identifying a person who cooperated in the investigation of the report if the Commissioner reasonably determines that the release of the information would be detrimental to that person's safety or interest. As a subject of a report, that is a person determined to be responsible for causing or allowing to be inflicted injury, abuse or maltreatment to the child(ren) named in the report, you have the right to request the Commissioner of the New York State Office of Children and Family Services to amend (change) the record of the report if you believe that the information in the report is inaccurate. Such a request could include a request that the report be amended from being "indicated" to being "unfounded". This request must be made by you within 90 days of receiving this
BOX 18100
(631)854-9935
notice. Do not wait to receive copies of the information contained in the State Central Register if you wish to request an amendment. As a result of your request, a complete review of the record and the factors upon which an "indicated" determination was made will take place. Upon completion of this review, you will be notified by the New York State Office of Children and Family Services, in writing, of the decision made in response to your request. If the Office does not amend the record in accordance with your request or if the Commissioner does not act upon your request for an amendment of the report within 90 days of receiving this request, you will be notified of the date when a fair hearing on your request will be held. If you fail to request that the report be amended within 90 days, or, if upon your request, the report is not amended to be "unfounded", the information will remain in the Register until your youngest child's 28th birthday. An indicated report in the Register may be disclosed to an inquiring licensing or provider agency, pursuant to Section 424-a of the Social Services Law, if the substance of the report is found to be both supported by a fair preponderance of the evidence and relevant and reasonably related to employment or licensure in the child caring area for which you have applied. Such an indicated report may affect your ability to work or be licensed in the child care field or adopt a child or become a foster parent. The Office has developed guidelines regarding whether indicated instances of child abuse and maltreatment are relevant and reasonably related to such employment or licensure. You have the right to request these "Guidelines of Relevant and Reasonably Related" at any time. You will automatically receive them if you request amendment of the report. If you have not yet requested a copy of the information contained within the State Central Register and desire such information, and/or if you wish to request amendment of the information regarding the report contained in the State Central Register, you may do so by sending a written request to: New York State Office of Children and Family Services Child Abuse and Maltreatment Register P.O. Box 4480 Albany, New York 12204-0480 This written request should include your full name, the full name(s) of the child(ren) named in the report, your address, the address of the children, the Case ID, and the Intake Stage ID number given in the upper right-hand comer of this letter.
Lisa Scafide Caseworker (631)854-9139 Telephone Number Ext.
Robert Leto Caseworker Supervisor
COUNTY OF SUFFOLK
October 21,2009 Re: Case ID 24158873 Intake Stage ID 26384552 Date of Intake 9/9/2009 Paul Piscitelli 318 Ellison Ave Westbury.NY 11590-1835 Dear Paul Piscitelli
On 10/21/2009, you were notified that you were the subject or other person named in a report of suspected child abuse or maltreatment received by the New York State Child Abuse and Maltreatment Register (State Central Register). At that time, you were informed of the investigation process conducted by the SUFFOLK County Child Protective Service and your rights in regard to this matter. We must now inform you that this report has been "indicated." This means that some credible evidence has been found to support the determination that the child(ren) named in the report has/have been maltreated or abused. However, you have been found not to be responsible for causing injury, abuse or maltreatment to the child(ren) or for allowing such injury, abuse or maltreatment to be inflicted on such child(ren). In addition to this letter, I, the undersigned caseworker, am willing to discuss in more depth the reasons for this determination and your feelings concerning this matter. Services may also be offered to assist you and your family. Since this report has been determined to be indicated, it will remain in the New York State Child Abuse and Maltreatment Register. As you were previously informed in your notification letter, you are entitled to request a copy of all information regarding the report contained in the State Central Register. However, the Commissioner of the New York State Office of Children and Family Services and social services district official must withhold information identifying the person who made the report unless that person has consented in writing to the release of such information. In addition, the Commissioner and social services district official may withhold information identifying a person who cooperated in the investigation of the report if the Commissioner reasonably determines that the release of the information would be detrimental to that person's safety or interest. If you have not yet requested a copy of the information regarding the report contained within the State Central Register and you desire such information, you should send a written request to:
BOX 18100
(631)854-9935
New York State Office of Children and Family Services Child Abuse and Maltreatment Register P.O. Box 4480 Albany, New York 12204-0480 This written request should include your full name, the full name(s) of the child(ren) named in the report, your address, the address of the children, the Case ID, and the Intake Stage ID number given in the upper right-hand corner of this letter.
Lisa Scafide Caseworker (631)854-9139 Telephone Number Ext.
Robert Leto Caseworker Supervisor
COUNTY OF SUFFOLK
STEVE LEVY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF SOCIAL SERVICES October 21,2009 GREGORY J. BLASS COMMISSIONER
Re: Case ID: 24158873 Call ID: 26384552 Report Date: 9/9/2009
Dea:
This letter is in response to your request, pursuant to Section 422(4) of the Social Services Law, to the findings of the investigation concerning your report of suspected child abuse or maltreatment. You made such a report in your professional or official capacity as a person required to report child abuse or maltreatment. Office of Children and Family Services records show that the report has been deemed 'indicated', as child protective services has found some credible evidence of abuse and /or maltreatment. Should you have any questions or concerns regarding this, please do not hesitate to contact me at the address listed above. Thank you for your cooperation. Very truly yours,
Robert Leto Supervisor
Lisa Scafide Senior Caseworker
BOX 18100
(631)854-9935
Institute.for Parenting
CONSENT FOR RELEASE OF INFORMATION Date: Counselor: Extend of nature of information to be disclosed: \O\V* Mlfheill t(H W
Adclphi University
Purpose or need for the disclosure:
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From: (Name, address and phone number of person or organization disclosing information):
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To: (Name, address and phone number of person or organization to which disclosure is to be made):
I understand that 1 have the right to revoke this consent at any time except to the extent that action has been taken thereon. 1 also understand that my consent will expire when acted upon, or six (6) months from this date, whichever occurs first I understand that such disclosure is bound by Title 42 of the Code of Federal Regulations governing the confidentiality of patifint records, when applicable. Title 42 prohibits you from making any future disclosure of this information without my specific written consent, or as otherwise permitted by such regulations. A general authorization for the release of medical or other information is NOT Sufficient for this purpose.
Print Name of Witness
Adelphi University
I nstitute.for Parenting
FAX COVER SHEET
FROM: COMPANY: FAX NUMBER: DATE:
Michel k
853!
TOTAL NO. OF PAGES IMCLUUlNti COVER: SENDRU FAX KlIlM'RRn-
SENDER PHONE NUMBP.Ri
516-237-8512
RE;
O N E S O U T H A V l i N U E P.O. B O X 7 0 1 G A R D E N C I T Y , N Y 11S3'0
CONNECTIONS CHILD PROTECTIVE RECORD SUMMARY CASE ID: STAGE CD: 24158873 INV STAGE ID: INV STAGE NAME: 26384647 Palmiotti.Winona M
"'"WARNING*****
CONFIDENTIAL INFORMATION AUTHORIZED PERSONNEL ONLY
CASE NAME: Palmiotti.Winona M
INT REPORT DATE: 9/9/2009
HOUSEHOLD COMPOSITION
ID NAME 1 Palmiotti.Winona PERSON ID 28610736 REUINT Mother D.O.B. 4/7/1973 SEX F ROLE Confirmed Subject 2 Piscitelli.Paul 28610737 ETH, RACE NH White LANG English SSN 067-70-3251 REL
Bio. Father
Child
5/27/1972
No Role
NH
White
English
Piscitelli.Winona
28610740
7/6/2005
Confirmed Maltreated
NH
White
English
110-94-0570
ID 1 2
ADDRESS 1355 LOCUST AVE 318 ELLISON AVE
CITY BOHEMIA WESTBURY HAUPPAUGE NY NY NY
ZIP
11716-2182 11590-1835 11788-8600
CNTY
CD
PHONE (516)238-0371 (516)333-2672 (631)503-7765
047 028 047
PO BOX 1800
Date Printed:
10/9/2009 12:06:48 PM
Page:
10/16/09
FRI 17:51 FAX 631854335"
CPS MACARTHUR PARK ft:}:****.}:#* ***:## *** TX REPORT ***

ae*********** *********
ilOOl
TRANSMISSION OK TX/RX NO CONNECTION TEL CONNECTION ID ST. TIME USAGE T PCS. SENT RESULT
1390
918457940199
10/16 17:50 00'43 2 OK
COUNTY OF SUFFOLK
Gregory J. Blass
Commissioner
Fax
To:. 31
O UT T
From: Lisa Scat te 631-854-9139 Pages: Date:
IO-IL-0?
D Please Reply D Please Recycle
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Comments:
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COUNTY OF SUFFOLK
Gregory J. Blass Commissioner
From: Lisa Scafide 631-854-9139 Pages: Phone: U C- ~Vd- 3OCO Re; p,o^ jLjg3X"T -cft~ CjQJU/"^" CTUrgent D For Review Date: ***** D Please Reply D Please Recycle
O Please Comment
Comments:
Thank youjptûr prompt attention to this matter
A Since/ely
'
Lisa Scafide Team 63/102 Confidentiality Notice: The documents, which accompany this telefax transmission sheet, contain information which is confidential and/or legally privileged, and which is intended only for the use of the person or entity named above. If you have received this transmission in error you are hereby notified that any disclosure, copying distribution, or the taking of any action in reliance of the contents of this information is strictly prohibited and that the documents must be returned to this office immediately. If you have received this transmission in error, or if any parts of it are missing or illegible, please notify us at 631-854-9139
BOX 18100
(631)854-9935

A Child 4

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COUNTY OF SUFFOLK

HAUPPAUGE, N.Y. 11788-8900

FCSA DATA BASE INFORMATION SHEET

PRIMARY TEAMS C?^>

WORKER'S NAME / NUMBER :

AL AUTHORITY FOR SERVICE CASE: CID

COURT ORDERED CPS

OT1 (SPECIFY ORIGIN OF REQUEST)

ICPC (SPECIFY ORIGIN OF REQUEST)

REMOVAL RETURN TYPE (N-DOC, FC, JD, PINS) DATE HOME

MENTAL HEALTH CLINICS (cont)

PARENTING REFERRAL LIST

^- ^^ ^T>?mR^^JV"-j*- >i-^"--/ -:- ; ^

V : " ";:*i ^-' : ;

GOOD SAMARTFA^.:. .;:...i'^.^. ... .^..:.-^...^ . : . . .^.^ 1.... ^.......376*4159

PEDERSON KRAG SMITHTOWN

SUNRISE COUNSELING BAYSHORE

..... 666-1615 $45 -$55 PERSESSION

SMTTHTOWN TOWN HALL-WEEKDAY PedersonKrag Center North

Free child cairf or >e fiifst 5

' ': ' '"' ' "'

. Family Service Leagne^1 , ;*<"

: Sylvia Cabrera Smith 66543229 evening*?(Cifl*51297i^

Excepts most insurances kichKfing HMO me^caid Pablo Guevara

" ' '"

Others Planned Parenthood

Women's Counseling Service Mothers of Super Twins (multiples)

CLINICAL CARE ASSOCIATES &

TURNING POINT COUNSELING

191 North .Ocean Avenue *,,' Ratchogue, NY 11772

Phone: 631-475-8641 Fax: 631-475-8642

August 18, 2008

Parenting, Programs on Long;...Island.

Parent Resource Center i631->224-"9

August 18, 2008

August 18. 2008

Oranization *J~ Fax# fry-m?

Fax# f 63 n 224-1206 Subject

PAGE ACCESS 12/09/2009 00:11 16312241206

DETERMINATION OF NEED FOR PHYSICAL EXAMINATION Part 822 PROGRAM

NOTE: THIS FORM wr BE USED AS AN ADDENDUM TO THE MEDICAL ASSESSMENT.* MAY

J3. PJ^SICAtEXAMJDNATION ARRANGEMENTS

PSYCHIATRIC PROGRESS NOTE

CLIENT NAME KW^ r^^^^f

SESSION TYPE W/JJ tJL I ^JLJrSESSION LENGTH

r , .,' .' , Yes ' .No*

I. Dependence condition or abuse condition

['] yes, continue []no -3^. ' -

[jyes > . . ' [ ] no. &

^"a^eritRehabiEtation ; ' , lateiisiveR^dentMReliabiUtation .

Ihteasive Qu^jatieat . (go to #13) Outpatient noii-iiitettsivo. (go to

PAGE 12/09/2009 00:11 16312241206 "ACCESS

AdMssionPedsion /^. - ... I have reviewed the 'saieenfag informal^ in^^

/^Aiive determined that thisperson can be a&nittetf to ^isser^^^^,e

chemical abfase'ar depeodence.

tflTfoiadivSdTiBliias.aa inadequate ?ooiaIsTrppQrtsyBtepi..

"_" " ;" ; ' . ' " ""''"

OF AUTHORIZED REKtESENTATIVlI OKEOP(SIBLE QHI)

Historyjof Psychiatric Illness: J

Client Name: Motor Activity; Thought Process:

s Good s Good . . f Good .. ,

Fair Eair '

eatment Recommendations (To include level of cate^ec^jSilendedlpased ontEent'j

: Sylvia Cabrera Smith 66543229 evening?(Cifl51297i^