Form Lic 281e - Application And Supporting Documentation Checklist - Short-Term Residential Therapeutic Program Page 7
Download a blank fillable Form Lic 281e - Application And Supporting Documentation Checklist - Short-Term Residential Therapeutic Program 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 Lic 281e - Application And Supporting Documentation Checklist - Short-Term Residential Therapeutic Program 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
6
7
8CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
COMMUNITY CARE LICENSING DIVISION
19. BOARD OF DIRECTORS STATEMENT (LIC 9165, PUB 326)
•
Licensees are required to provide a copy of the Community Care Licensing’s publication 326, Facts You Need to
Know, Short-Term Residential Therapeutic Program Board of Directors, to each member of their board of directors.
•
Provide a copy of the signed Board of Directors Statement (LIC 9165) from each member of your board of directors
to the licensing agency.
20. CONTROL OF PROPERTY
It is necessary for the licensing agency to determine that the applicant/licensee has control over the facility property.
Once licensed, the licensee must be able to ensure that the facility and grounds are maintained and are in compliance
with regulations (i.e. repairs made to physical plant, swimming pools fenced, etc.).
•
Provide the name(s) and address(es) of the property owner(s) of the facility.
•
A copy of the lease agreement or rental agreement must be provided. (There are no requirements related to length
of the lease or rental agreement).
—
If the agreement precludes the use of the property as a facility, prevents the applicant/licensee from achieving
compliance with regulations, or the operation of a facility is contrary to the terms of the agreement, the license
must be denied/withdrawn as the licensee would not have adequate control over the property (i.e. the
agreement states that Susie and Mary are to be the persons residing in the house and anyone else needs to
be approved or the agreement states that the property cannot be used for business purposes and the
applicant wishes to operate a STRTP for more than six persons).
•
Proof of ownership must be provided if the applicant is the owner of the property.
—
The licensing agency can verify this by a Property Tax bill, Deed or other related document. The documents
provided must contain the facility street address within the document or its attachments.
•
The Lease agreement must be consistent with the LIC 401.
21. BACTERIAL ANALYSIS OF WATER (if applicable)
•
As a condition of initial licensure, the applicant shall provide evidence of an on-site inspection of the source of the
water and a bacteriological analysis which establishes the safety of the water, conducted by the local health
department, the State Department of Public Health or a licensed commercial laboratory.
•
Subsequent to initial licensure, the licensee shall provide evidence of a bacteriological analysis of the private water
supply as frequently as is necessary to ensure the safety of the clients.
22. APPLICATION OR DOCUMENTATION OF ACCREDITATION
An STRTP shall obtain national accreditation from an entity identified by the department.
The three approved accreditation agencies are:
•
The Commission on Accreditation of Rehabilitation Facilities (CARF):
•
The Council on Accreditation (COA):
•
The Joint Commission (JC):
For an STRTP that has been licensed before January 1, 2017 the following will apply:
•
Shall have until December 31, 2018 to obtain accreditation.
•
Shall submit documentation of accreditation or application for accreditation or a copy of its application for
accreditation to the licensing agency as part of an updated program statement.
•
Shall provide documentation to the department reporting its accreditation status as of January 1, 2017, January 1,
2018 and July 1, 2018.
LIC 281E (1/17) (PUBLIC - OPTIONAL)
PAGE 7 OF 8
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Fcr 16 - Group Home/short Term Residential Therapeutic Program (strtp) Shelter Costs Declaration And Survey
Legal
Form Dr-1c - Application For Collective Registration For Short-term Rental Of Living Or Sleeping Accommodations - Department Of Revenue, State Of Florida
Financial
Form Dr-1c - Application For Collective Registration For Short-term Rental Of Living Or Sleeping Accommodations - 2012
Financial
Form Dr-1c - Application For Collective Registration For Short-term Rental Of Living Or Sleeping Accommodations
Financial
Related Categories
Parent category: Legal