Checklist of Health and Safety Standards

for Approval of Family Caregiver Home

Pursuant to Division 31 MPP 31-445.3, in order to be approved ,all Foster Care Homes must meet the following standards,set forth in Title 22, Division 6, Chapter 9.5, Article 3.

STANDARDS PERMITTING ALTERNATIVE PLANS

The f The following statements must be answered YES, unless not applicable or an

exception is granted, to approve the home for placement.	Yes	No	N/A	*Alternative
1. Adequate bedroom space is provided: [§89387(a)]
No more than 2 children share a bedroom.
No sharing a bedroom by children of opposite sex unless each child is under 5 years of age.

Each child has individual bed with clean linens, pillow, blankets, mattress in good repair.

Each bedroom has sufficient portable or permanent closet and drawer space for each child.

The child does not share a bedroom with an adult unless the child is an infant.

There are no more than 2 infants and no more than 2 adults sharing the same bedroom.

Infant has age-appropriate, safe/sturdy bassinet or crib.
No room commonly used for other purposes or as a public or general passageway to another room is used as a bedroom,

(i) Easy passage is allowed between beds and room entrance.
2. The home has telephone service (may be waived if telephone access is available). [§89373]

STANDARDS NOT PERMITTING ALTERNATIVE PLANS

The following statements must be answered YES, unless not applicable or a corrective action plan has been agreed upon. # indicates a standard for which “not applicable” is an unacceptable response.	Yes	No	N/A	»CAP
3. The home appears to be clean, safe, sanitary and in good repair. [§89387(b)]

#

4. Indoor and outdoor halls, stairs, ramps, and porches are free of obstructions and hazards [89387(c)]

#

5. Home contains at least 1 toilet, sink, tub or shower maintained in safe, clean operating condition. [§89387(i)]

#

6. Bunk beds of more than two tiers must not be used. [§89387(j)]
Upper tier has bed rails. [§89387(j)]
Children under five years of age or those who are unable to climb into or out of the upper tier unassisted shall not be permitted to use the upper tier. [§89387(j)]

7. Home is maintained at comfortable temperature at all times. [§89387(k)]

#

8. Child’s safety is ensured in homes with fireplaces, open forced heaters and woodstoves. [§89387(l)]

9. Lamps and necessary light is provided in all rooms and other areas to ensure comfort and safety of persons in the home. [§89387(m)]

#

10. Home has indoor sprinkling system or functioning smoke detector installed in the hallway(s) of each sleeping area audible in each bedroom or sleeping room. [§89387(p)]

#
11. Hot water from faucets is delivered at a safe temperature. [§89387(n]
#
12. Medicines, disinfectants, cleaning solutions, poisons, firearms and other dangerous items are stored where inaccessible to children. [§89387.2]

#

13. Storage areas of firearms and other dangerous weapons are locked or in lieu of locked storage the applicant is utilizing trigger locks or has removed and locked the firing pin/s separately from the firearm/s. Ammunition is stored and locked separately from firearms. [§89387.2]

14. Solid waste is stored, located and disposed of in a manner that will not permit the transmission of communicable disease or of odors, create a nuisance, or provide a breeding place or food source for insects or rodents . [§89387(o)]

#

15. Each sleeping room has at least one operable window or door that ensures safe, direct, emergency exit to the outside. If security window bars are used, the window is considered operable only if equipped with safety release devices. [§89387(q)]

16. Yard or outdoor activity space is provided free from hazards to life and health. [§89387.1)]

#

* Alternative: Documented Alternative Plan must be attached.

» Correctable Deficiencies: Corrective Action Plan must be attached.

I certify that the above-named caregiver’s home substantially meets the standards for approval as described in this form.

Signature (County CWS Worker)	Date

DEFICIENCIES AND PLANS OF CORRECTION

When a violation of health and safety standards is observed, the county worker has the

responsibility to determine the length of time by which a correction must be made and to

provide the relative with reasonable assistance in meeting that standard. The basic

factors to be considered in making this assessment are the potential consequences to a

child placed in the home and the immediacy of the need to correct.

The types of deficiencies are as follows:

1. Immediate Impact. Deficiencies that, if not corrected, would have a direct and

immediate risk to the health, safety or personal rights of the foster child. If

placement is imminent, correction MUST BE MADE prior to placement of the

child.

2. Potential Impact: Deficiencies that without correction could become a risk to

the health, safety or personal rights of the child.

Examples of Immediate Impact Deficiencies:

For initial approval:

Health Related: unlocked medications, inappropriate storage of medications.

2. Food Service: food contaminated with mold, fungus or bacteria; bloated or

ruptured canned foods; infestation of insects or vermin; unsanitary conditions in

food preparation areas that present immediate health hazard; storing of food next

to or with toxic substances.

3. Building and Grounds: no fence or approved cover for bodies of water; broken

stair or stair railings; poisons, toxic substances, firearms in areas accessible to

children; unlit stairwells used by children.

4. Fixtures, Furniture, Equipment and Supplies: toilet not in working condition,

garbage accessible to children, unsafe fireplace or heaters that are in use,unsafe

water temperature, condition of bedding or towels is unsanitary, furniture is

broken and could cause injury if used.

5. Criminal record Clearance and Child Abuse Index Check: failure to obtain a

CLETS clearance and submit a fingerprint or Criminal Record Clearance and

Child Abuse Index Check for those individuals whom have frequent and routine

contact with the child(ren) in care

For re-assessment, all of the above, and:

1. Personal Rights: abuse, neglect, inappropriate use of restraints, the use of

corporal punishment, and similar violations having a direct negative impact on

either the physical or emotional well-being of children in care.

2. Health Related Services: storing mislabeled, unlabeled, outdated or

discontinued medications; failure to ensure that needed medical care is provided

to those in care.

3. Food Service: failure to maintain enough food to meet the needs of the children

for the next 24 hours.

4. Care and Supervision: child requires a level of care that cannot be met by the

caregiver without the provision of additional supports or services.

5. Supplies: failure to maintain enough basic hygiene items to meet the needs of

the child(ren).

Examples of Potential Impact Deficiencies:

For initial approval:

Food Service: failure to clean dishes and utensils.

2. Buildings and Grounds: conditions that may have a negative impact on children

in care if not corrected, such as multiple conditions that indicate an overall

deterioration of the home; widespread neglect of maintenance; unsanitary living

and food preparation areas.

3. Furniture, Fixtures, Equipment and Supplies: furnishings should be considered

as deficient only when they are clearly damaged to the extent they are not

functional, (e.g., a tear in the seat of a chair vs. exposed springs); no operable

sink or shower; inadequate linens.

For re-assessment, all of the above, and:

1. Reporting Requirements: Failure to notify the Department regarding incidents of

abuse, neglect, death, injury, etc. as required by §89361.

Record Keeping: Failure to maintain children’s records as required by §89370.

Plan of Correction

When a child welfare worker has determined that a deficiency exists, the proposed

caregiver and the worker will discuss each deficiency and develop a plan for correcting

each deficiency. If the deficiency is not corrected during the visit, then the plan of

correction must be in writing, with a copy provided to the caregiver, and shall include at

least the following information:

1. Citation of the regulation section that is violated.

2. Description of the nature of the deficiency.

3. The actions to be taken by the applicant and the assistance to be provided by

the County.

4. The date by which each deficiency shall be corrected.

5. The phone number of the county office responsible for approval of the home.

WHEN THERE ARE CHILDREN IN THE HOME, THE WORKER MUST REQUIRE

IMMEDIATE CORRECTION OF A DEFICIENCY IF THE DEFICIENCY WOULD POSE

AN IMMEDIATE THREAT TO THE HEALTH AND SAFETY OF CHILDREN. UNDER

THESE SAME CIRCUMSTANCES, IF THERE ARE NO CHILDREN IN CARE, AND

PLACEMENT IN IMMINENT, CORRECTION SHOULD BE WITHIN 24 HOURS OR

LESS, AND BEFORE PLACEMENT IS MADE. OTHERWISE, THE DATE FOR

CORRECTING A DEFICIENCY SHALL NOT BE MORE THAN 30 CALENDAR DAYS

FOLLOWING THE DATE OF THE VISIT, UNLESS THE WORKER DETERMINES

THAT THE DEFICIENCY CANNOT BE CORRECTED IN 30 CALENDAR DAYS. IN

THIS CASE, THE WORKER MUST DETERMINE AN APPROPRIATE COMPLETION

DATE. TITLE IV-E IS NOT AVAILABLE UNTIL THE MONTH IN WHICH THE

CORRECTIONS ARE COMPLETED AND THE HOME FULLY MEETS THE

STANDARDS.

THE CORRECTIVE ACTION PLAN SHALL SPECIFY CORRECTIVE ACTIONS

WHICH MUST BE TAKEN WITHIN 30 DAYS AND THE DATE ON WHICH THE

CORRECTIONS WILL BE COMPLETED.

In determining the date for correcting a deficiency, the worker should consider the

following:

1. Whether there are children in care.

2. The potential hazard presented by the deficiency.

3. The availability of equipment or personnel necessary to correct the

deficiency.

4. The estimated time necessary for delivery and installation of any necessary

equipment.

If a written plan of correction is used, the worker is responsible for ensuring corrections

have been completed within the required timeframes.

SOC 817 Revised 10-02	Page 2 of 6

STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

SOC 817 Revised 10-02 Page 1of 1

DCS 309A (9/01)

Checklist of Health and Safety Standards for Approval of Caregiver Home

Glenn D. Gibbons

2002-11-06

Dolores Escandon

Form

HSS