Form Lic 281 - Application Instructions For A Facility License Page 11
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22Section B
Forms by Type of Facility
Forms required to be completed by the applicant for licensure by type of facility are listed below:
Group
Small
Foster Family Agency
Adult Residential
Home
Family
Adoption Agency
Social Rehabilitation Facility
SUPPORTIVE DOCUMENTS
Home
Transitional Housing
Community
Adult Day Programs
Placement Program
Treatment
RCFE
Facility
RCF-CI
B1.
Partnership
Agreement/Articles of
Required
Required
Required
Incorporation/Articles of
Organization
B2.
Verification of
Administrator
Required
Required
Required
Qualifications and
Certification
B3.
Verification of Social
Worker Qualifications
Required
Required
B4.
Job Description - each
Required
Required
Required
position
Required
Required
Required
B5.
Personnel Policies
B6.
In service Training
Required
Required
Required
for Staff
B7.
Facility Program
Description
Required
Required
Required
Required
B8.
Rules of
Discipline/Personal
Required
Required
Required
Required
Rights
Required
Required
Required
Required
B9.
Admission Policies
B10. Sample Menu
Required
Required
Required
B11. Control of Property
Required
Required
Required
Required
B12. Bacteriological Analysis
of Private Water Supply
(When Water for Human
Required
Required
Required
Required
Consumption is from a
Private Source)
B13. Insurance Information
RCFE Only
B14. Theft & Loss Policy
RCFE Only
B15. Neighborhood Complaint
Policy – Applicable to
non-resident owner
community care facilities
Required
Required
providing residential care
for six or fewer persons
ONLY.
B16. First Aid Card
Required
Required
Required
Required
B17. Orientation Certification
Required
Required
Required
Required
B18. Group Home and Foster
Family Agency Program
Required
Foster Family Agency
Statement for rate
ONLY
setting purposes
10
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal