Form Lic 281 - Application Instructions For A Facility License Page 21
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22B15.
NEIGHBORHOOD COMPLAINT POLICY
Facilities shall establish procedures for immediate response to incidents and complaints. The
procedures must include a time when the owner, licensee or designee will be available to meet with
neighborhood residents. Applicable to non-resident owner community care facilities providing
residential care for six or fewer persons ONLY.
B16.
FIRST AID CARD
Staff responsible for providing direct care and supervision shall receive training in first aid from
persons qualified by agencies including but not limited to the American Red Cross.
Copies of first aid cards for applicant/administrators must be submitted.
COPIES OF FIRST AID CARDS WILL BE VERIFIED.
B17.
ORIENTATION CERTIFICATE
Proof of attendance MUST be submitted with application.
B18.
GROUP HOME PROGRAM STATEMENT
•
For complete instructions refer to Group Home Program Statement - General Instructions
(LIC 9106).
•
Applicants should be aware that written statements of support from host counties social services
or probation departments are required before AFDC-FC rates may be funded.
•
Applicants may substitute the Group Home Program Statement for all SECTION B documents
except Section B5, Personnel Policies and Section B16, Neighborhood Complaint Policy. Attach
Section B5 and Section B16 to the back of the program statement.
•
Applicants must submit two sets of Group Home Application documents unless program is not
requesting a Foster Care Rate Setting.:
- One set will be sent to Rate Setting
- One set will be kept by the Licensing Agency
•
The licensing agency will not accept photocopied signatures on required documents.
•
Applicants should make a third set of Group Home Application documents for their own files.
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