Form Soc 818 - Relative Or Non-Relative Extended Family Member Caregiver Assessment
Download a blank fillable Form Soc 818 - Relative Or Non-Relative Extended Family Member Caregiver Assessment in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Soc 818 - Relative Or Non-Relative Extended Family Member Caregiver Assessment with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6Child’s Name:
Case Number:
Child’s Name:
Case Number:
Caregiver Name: __________________________________________________________________________________
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
Relative or Non-Relative Extended Family Member
Caregiver Assessment
All statements below must be answered “Yes” to approve the caregiver. When there is a “No”
answer, the worker should assess whether the provision of reasonable assistance or additional
services to the caregiver would enable the caregiver to properly respond to the child’s needs,
health and safety. If the worker later reassesses the caregiver and determines that conditions
supporting the No answer have changed sufficiently to answer Yes, caregiver approval may be
given at that time.
Responses to the following statements have been assessed by the undersigned.
1. The caregiver has been provided a summary of State home approval regulations and is
capable, having sufficient physical and mental health, to meet these requirements for the care
and supervision appropriate to the specific needs of the child to be served. [§89318]
[
] Yes [
] No
Comments:
2. The caregiver is aware of the child’s immediate emotional, behavioral, physical, medical, and
educational needs and is able to meet the health, safety, and well-being needs of the child.
[§89378/WIC 361.2]
[
] Yes [
] No
Comments:
3. The caregiver understands State child abuse and neglect laws and shall report by telephone,
e-mail, or fax any circumstances indicating the child has been abused or neglected within 24
hours after the event occurs to the approval agency. [§89361]
[
] Yes [
] No
Comments:
4. The caregiver understands the child shall be entitled to participate in age and
developmentally appropriate extracurricular, enrichment, and social activities. [§89379(a)]
[
] Yes [
] No
Comments:
SOC 818 (12/10)
Relative or Non-Relative Extended Family Member
Caregiver Assessment
Page 1 of 6
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Soc 818nmd - Relative Or Nonrelative Extended Family Member Caregiver Assessment - Nonminor Dependent
Legal
Form Na 1261a - Notice Of Action - Form And Instructions- For Approved Relatives, Non-relative Extended Family Members, Foster Family Homes, Non-related Legal Guardians Or Non-minor Dependents Residing In A Supervised Independent Living Setting
Legal
Form 2504-ad - Excise Or Employment Tax-offer Of Agreement Of Assessment And Collection Of Additional Tax And Offer Of Acceptance Of Overassessment
Legal
Form 2504-ad - Excise Or Employment Tax-offer Of Agreement To Assessment And Collection Of Additional Tax And Offer Of Acceptance Of Overassessment
Legal
Related Categories
Parent category: Legal