Fillable Form Rfa 9099c - Compliant Investigation Report

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA STATE DEPARTMENT OF SOCIAL SERVICES

INSTRUCTIONS

COMPLAINT INVESTIGATION REPORT-CONTINUED – If the complaint allegation is substantiated, the

Resource Family is in nonconformance with Written Directives or any applicable laws and a Corrective

Action Plan will be issued. The RFA 9099C is used to document deficiencies related to substantiated

allegations only. Any additional deficiencies observed that are not part of the complaint allegation(s) under

investigation are documented separately on the RFA 809 and RFA 809C.

DEFICIENCIES – A nonconformance with Written Directives or any applicable laws. Resource Families

must be notified in writing of all Written Directives or any applicable law deficiencies. Deficiencies related

to a complaint investigation are only issued for a complaint finding of substantiated and documented on

the RFA 9099C.

CORRECTIVE ACTION PLAN – The Corrective Action Plan (CAP) is a plan developed by the County which

describes how the Resource Family is not meeting the requirements of one or more of the Written Directives

or any applicable law, and the steps the Resource Family and the County will take to ensure that the

Resource Family meets the requirements of the Written Directives or any applicable law. The County shall

request and consider feedback from the Resource Family when developing the CAP. It is incumbent that the

County establishes the time limit for the CAP. In order to set the time limit, the County must take into

consideration the seriousness of the deficiency, the number of children or nonminor dependents in care

involved, and the availability of resources and support. The more specific the plan, the less chance exists

for any misunderstanding in setting time limits and reviewing corrections. The Resource Family who

encounters problems beyond his/her control in completing the corrections within the specified timeframe

may request and be granted an extension of the correction due date by the County. The CAP for

deficiencies related to substantiated allegations will be documented on the RFA 9099C.

CORRECTION NOTIFICATION – The Resource Family is responsible for completing all corrections and

promptly notifying the County of corrections. Resource Families are advised to keep a copy of any letters

sent to the County concerning corrections, or if corrections are telephoned to the County, the date, person

contacted, and information given.

APPEAL RIGHTS – The Resource Family has a right, without prejudice, to discuss any disagreement in this

report with the County concerning the proper application of the Written Directives or any applicable laws.

When visiting a Resource Family during the course of an investigation, the County shall ensure that the

Resource Family is aware of their rights and responsibilities during the investigation process, including

appeal rights for any actions which may result.

APPEAL REVIEW – The County has a duty to review the facts presented without prejudice. Upon review of

the facts and in accordance with Written Directives or applicable law, the County may amend any portion of

the action taken or may dismiss the violation.

RFA 9099C (9/17)

INSTRUCTIONS

Form Rfa 9099c - Compliant Investigation Report - Continued Page 2