CHILD CARE FACILITY AMENDED FACTS ID: 123780 This is to certify that HILLCREST BEHAVIORAL HEALTH (Licensee) is hereby granted this LICENSE to conduct and maintain HIGDON HILL GROUP HOME (Name of Child Care Facility) as a CHILD CARE INSTITUTION for it! (Type of Child Care Facility) (Number of children) ages 11-19 YEARS OLD (Age range of children) located at 6869 FIFTH AVENUE SOUTH (Street Address) BIRMINGHAM (City) State of Alabama in JEFFERSON (County) This LICENSE shall be in force for a period of two years from the day of w, to the 30TH day of MARCH, M, subject, however, to be revoked on the failure of the above-named Child Care Facility to comply with the provisions of Title 38, Chapter 7, Code of Alabama 1975, or the standards and regulations prescribed by the Department of Human Resources of the State of Alabama in accordance with the provisions of said law. IN WITNESS WHEREOF, I have hereunto set my hand this 16TH day of MAY, 2017. BY A Commissi State of Alabama epartment of Human Resources NOTE: This LICENSE must be posted in a conSpicuous place on the premises DHR-CCSD-1969 Revised 10/2010 an?mm CHILD CARE FACILITY FACTS ID: 128360 This is to certify that HILLCREST BEHAVIORAL HEALTH (Licensee) is hereby granted this LICENSE to conduct and maintain RISE, PHASE II formerly known as Bessemer Group Home (Name of Child Care Facility) as a CHILD CARE INSTITUTION for (Type of Child Care Facility) (Number of children) ages 18-21 YEARS OLD Girls (Age range of children) located at 1631 2ND AVENUE NORTH BESSEMER (Street Address) (City) State of Alabama JEFFERSON (County) This LICENSE shall be in force for a period of two years from the 318T day of MARCH, 2011, to the 30TH day of MARCH, m, subject, however, to be revoked on the failure of the above-named Child Care Facility to comply with the provisions of Title 38, Chapter 7, Code of Alabama 1975, or the standards and regulations prescribed by the Department of Human Resources of the State of Alabama in accordance with the provisions of said law. IN WITNESS WHEREOF, I have hereunto set my hand this 18TH day of APRIL, 2 l7. - BY Commissione'r I State of Alabama Department of Human Resources NOTE: This LICENSE must be posted in a conspicuous place on the premises DHR-CCSD-1969 Revised 10/2010 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES NAME: Higdon Hill Group Home RISE Phase II (Formerly Bessemer Group Home) PROVIDER FACILITY TYPE SERVICES PROVIDED 123780 (Higdon Hill) Child Care Institution Intensive 128360 (RISE Phase II) Child Care Institution Intensive Shanna Wester, Program Specialist I LW APPROVED BY: giving/22+? yimential Licensing SITE LOCATION (S): 6869 Ave. Birmingham, 1631 2"d Ave. North, Bessemer, AL 35020 SATELLITE OFFICES: DATE OF March 2, 2017 PURPOSE OF VISIT: License Renewal LICENSE CAPACITY: Higdon Hill 20 RISE Phase II 12 CURRENT OCCUPANCY: Higdon Hill 19 (9 Boys/10 Girls) RISE Phase II - 3 DATE OF EXPIRATION: March 30, 2017 MET WITH: Steve McCabe, Executive Director; Stephen Murphy, Director of Risk Management and Regulatory Compliance; Roshelle Marbury, Program Director; LaShunda Banks, Program Director Children?s Files: Each child had a well-organized record. Admission applications, educational, and medical information were on ?le. Treatment plans were thorough and reviews were completed timely. Personnel Files: Applications, job descriptions, and educational information were on file. Orientation, new hire and ongoing training was provided for staff and completed within required time frames. Criminal clearances were on ?le for each employee. Revised February 2014 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES CLIENT RECORDS COUNTY OF ADMISSION FOR PLACEMENT REVIEWED ORIGIN i CLIENT RECORDS 1. Application on File. (CPA, page 34; CCF, page 19) 2. Face Sheet, including parent?s names. (CPA, page 32; CCF, page 19-20) 3. Pre-placement Visit. (CPA, page 32; CCF, page 25; TFC, pages 47- 49) 4 a. Current ISP. (TFC, pages 48-50; CPA, page 26; CCF, page 21) 4b. ISP Participants listing CCF only (CCF, page 23) 5a. Initial Treatment/Care Plan as required. (T C, pages 50, 52-54; CPA, page 26, CCF, page 21) 5b. Initial Treatment/ Care Plan is written by a licensed social service staff as required. (CCF, page 21) gm; 5c. The initial treatment plan was conducted in a timely manner as required. 6. Comprehensive Treatment Plan (TFC, pages 51, 54-56). EDD K4 K4 7a. Treatment Plan Reviews (TFC, pages 51, 55-56; CPA, page 26; CCF, page 23) Revised February 2014 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES 7b. Treatment Plan Reviews are written by a licensed social service staff as required. (CCF, page 23) K4 El 7c. Treatment plan reviews were conducted in a timely manner as required. IE El 7d. The review consist of written summary of the child?s adjustment and progress in all important areas of his/her life during the period since the last care/treatment plan. IXI 8. Long Term Goal listed on the treatment plans. (TFC, pages 49- 50, CCF, page 30; CCF, page 22) Cl 9. and Needs listed on the treatment plans. (TFC, pages 49-50; CPA, page 26; CCF, page 22). 10. Progress notes; daily, weekly, summaries. (TFC, page 46; CPA, page 30; CCF, pages 24) El 11. Court order (TFC, page 46; CPA, 32; CCF, page 20) El 12. Social History (TFC, page 46; CPA, 32; CCF, page 20) El 13. Assessment Previous and Current (CPA, 32; CCF, page 20) 14. Report(s) (CPA, 32; CCF, page 20) IE I: 15. Placement History. (TFC, page 45; CPA, 32; CCF, page 20) IXI I: El 16. Educational History/School Information. (TFC, page 46; CPA, 32; CCF, pagg 20) IE El 17. Special Education/IEP. (TFC, page 46 CPA, 32; CCF, pages 20, 32) [3 El 18. Current (TFC, page 46; CPA, 32; CCF, page 20) El 19. Current Immunizations. (TFC, page 46; CPA, 32; CCF, page 20) 20. Current Dental Examination. (TFC, page 46; CPA, 32; CCF, page 20, 27) 21. EPSDT Referral with Approval for Services. (TFC, page 46) IZI El 22. Birth Certi?cate (TFC, page 46; CCF, page 19) >14 23. Social Security 3224. Financial Arrangements (CPA, 31; CCF, page 22) 25a. Placement Agreement Forms are on file. (TF C, page 46; CPA, 30; CCF, page 21) El 25b. Placement agreements are signed by the proper authority. (TFC, page 46; CPA, 25; CCF, age 21) Revised February 2014 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES El 26. Authorizations for Routine and Emergency Medical Care and Out of State Travel. (TFC, page 46; CPA, 30; CCF, page 21) 27. Correspondence to/from Agencies. (TFC, page 46; CPA, 32; CCF, page 21) 28. Incident Logs. (TFC, page 46; CCF, pages 52-53) 29. Discharge/Aftercare Plan, if applicable. (TFC, pages 48, 52; CPA, pages 27; CCF, pages 32, 9a) 30. The child care facility shall ensure that each child receives an allowance, spending money, or has the opportunity to earn money. (CCF31. Children have access to religious worship services of their choice. (CCF, A-Principles of Child Care Facilities, page 2, paragraph page 3, paragraph page 5, G) El IX 32. SHELTER: Admissions- A child of any age shall be permitted admission to shelter care as permitted by the facility license. The admission age range of children is 13-17 years old. (Web copy, CCF, pages 41-42) 33. SHELTER: Admissions: The local Department of Human Resources shall be contacted about all children admitted to shelter care (unless the child is admitted by the Department of Human Resources) so that files can be cleared to determine whether the child is known to the Department or is in need of services. The contact shall occur either immediately during of?ce hours, or at 8:00 am. the next morning, weekends and holidays included. It shall be permissible for those shelter care facilities that have social services, or other social service agencies serving families and children, to provide social services to runaways. (Web copy, CCF, pages 41-42) 34. SHELTER: Admissions: Placement in a shelter is meant to be short term. Children admitted through agencies other than DHR shall have an assessment conducted at admission to give guidance regarding the possible length of stay and to identify the short-term plans while the child is in shelter. The shelter stay shall not exceed 30 days without the mutual agreement of the agency or person with planning responsibility and the parents, legal custodian, or agency having custody as documented in the child?s Care/Treatment Plan and/or ISP. (Web copy, CCF, pages 41-42) 35a SHELTER: Admissions: The child?s record shall include: Child?s Record Sheet for Shelter Care Facility an alternate for providing the same information is acceptable). (Web copy, CCF, pages 41-42) 35b. Copy of legal authorization for placement. (Web copy, CCF, pages 41-42) Revised February 2014 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES Cl 36. SHELTER: Staff Requirements: The shelter care facility shall have a ratio of no more than ten (10) children for a two child care staff, and no more than eight (8) children under direct supervision of one child care worker. Children of the staff shall be included in determining the staff/child ratio. Exception: During the hours of 10 PM to 7AM, the ratio of child care workers to children shall not be less than one child care worker on duty for each 10 children. (Web copy, CCF, page 43) DEFICIENCIES (CLIENT RECORDS) CLIENTS DEFICIENCY 5b. Initial treatment/care plan was not written by a licensed social service staff as required. (CCF, page 21) Provider implemented changes immediately to prevent this de?ciency from occurring again. COMMENTS The agency must comply with Minimum Standards for Residential Child Care Facilities. HOMES REVIEWED FOSTER HOMES REVIEWED COUNTY Yes No IX 1. Application on file. (CPA, page 32) El 2. The original a roval certification is on ?le. (CPA, pages 5, 33) PP IX 3. Approved before child placed. (CPA, pages 5, 32) 4. Documentation of Character and Suitability, to include all adult household members. (CPA page 32-33-TFC page. 35) a. Result of ABI report b. Result of FBI report c. Result of Central Registry Clearance Documentation (14 years and older) d. At least three personal references on ?le (original approval). El El . e. One non-relative reference at annuals El El El IX 5. Foster Parents ?shall be able to read and write?. (CPA, page 32; FFH, page 9) Revised February 2014 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES El K4 6. Home study completed by Licensed Social Worker and disposition of application. (CPA, pages 29,32,39) Cl 7a. Renewals are conducted by Licensed Social Workers. (CPA, page 27) 7b. Foster parent submitted the completed Application to Foster and/or Adopt (DHR-FCS-704), or the licensed child placing agency?s prescribed application form, thirty (30) days prior to the expiration date on the current annual approval. (FFH pages 30-31, D. l) 7c. If a foster parent makes application for renewal 30 days prior to the expiration of the current application, the approval shall continue in effect until notice of action is taken by the approving agency. (FFH pages 30-31, D. l) 8. Documentation of number of biological child (ren) in home. (CPA, page 32; FFH pages 45) 9a. Current Physician?s statement of health on all family members must be on file. (CPA, pages 32, 39-40) K4 9b. Adoptive parents must provide medical treatment to children as recommended by a legally licensed physician. (CPA, page 34) 10. Smoke Alarms/Fire Extinguishers/Emergency plan. (CPA, page 32) 11. Financial Reports on file. (CPA, pages 29, 32) EIZ 12. ADOPTION: Record of placement and subsequent supervision. (CPA, page 33) 13. List of children placed in the home, including dates of placement and removal on file. (CPA, page 33) l4. ADOPTION: Record of contacts prior to placement. (CPA, page 33) 15. ADOPTION: Legal Documents: Marriage, Divorce, Citizenship, etc. (CPA, page 33) 16. ADOPTION: Home Study Disposition of Application. (CPA, page 33) 17. Current Driver?s License. (CPA, page 32; FFH page 9; TFC, page 37) 18. Documentation on matching of children in file. (CPA, page 28; TFC, page 49) Revised February 2014 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES IXI 19. Documentation of home/apartment insurance with liability coverage. (TFC, page 45) 20. Documentation of Automobile insurance. (FFH page 4; TFC, pages 36, 44) 21. Correspondence of ?le. CPA, page 33) XEIZ 22. Applicants must be at least nineteen years of age. (CPA, page 29) 23. Applicants, who are married, must have been married at least one year. (CPA, page 29) 24. Applications shall be accepted from persons of any religious faith. (CPA, page 29) 25. Applications may be accepted when either the prospective father or mother is a citizen of the United States. (CPA, page 34) El Cl El DEI El E?l? 26. ADOPTION: The agency shall establish administrative policies, practices and procedures related to adoptions. These shall be clearly defined and explained. (CPA, page 29) 27. ADOPTION: A licensed child-placing agency shall not conduct or approve an adoptive home study on any of its employees or of?cials, which includes board members, volunteers, or relatives of the aforementioned or anyone else who has direct affiliation with the agency. Arrangements must be made with another licensed child-placing agency or licensed social worker to conduct and approve the study, make a placement, provide post-placement supervision and for re-approval. (CPA, page 30) 28. ADOPTION: The child-placing agency shall ensure that the child has full protection of the law through completion of legal adoption in accordance with Title 26, Chapter 10, Sections 10 A and 10 C, Code of Alabama 1975 (see c0py of the Alabama Adoption Law in the Addendum) or appropriate adoption laws where the child lives. (CPA, page 30) 29. ADOPTON: In working with any out-of-state agency or individual in the placement of any child, the child placing agency shall comply with provisions of the Interstate Compact on the Placement of Children law concerning the bringing into the state of any child, or the Interstate Compact on the Placement of Children law of the state into which the child is to be sent. In order to ensure such compliance, all requests and correspondence shall be channeled through the State Department of Human Resources, Family Services. (See Appendix, Page A-4, Alabama Interstate Compact on the Placement of Children Guidelines) (CPA, page 30) Revised February 2014 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES 30. ADOPTION: Child-placing agencies must comply with standards regarding adoption reapplication. (CPA- pages 33-34) El El 31. The agency shall provide adequate and comfortable facilities for a reception room; offices for interviewing, placement of children, conferences, and clerical staff; a room (or rooms), appr0priately furnished and which offers privacy, to serve as a meeting place for adults and children for visits, becoming acquainted, and/or in preparation for adoption or for foster family placement and a secure repository for storage of records and microfilms. The agency shall not store agency records in a room in a personal home or have the operation of the agency in a room in a personal home. (CPA, page 34) IE 32. ADOPTION: The agency shall develop a resource file of approved adoptive applicants to assure that an adequate choice of families can be considered for each child. (CPA, page 29) 33. Foster parents are GPS trained. (FFH, pages 5-6) 34. TFC parents received GPS plus ten hours of pre-services. (FFH, pages 5-6; TFC pages, 38- 40) 35. Foster parents received 15 hours annually in-service training. (FFH, 5- 6) IXIEEIX 36. TFC parents received 24 hours annually in-service training. (TFC, pages 38-42; TFC pages, 38- 40) BEECH: DECIDE 37. The caseworker shall visit with the TFC foster home to meet with at least one TFC foster parent no less than bi-weekly. (TFC, pages 24 and 78; CPA, pages 33, 4f) I: K4 38. Caseworker or other program staff shall provide at least weekly contact in person with the TFC foster parent. (TFC, pages 24 and 78; CPA, pages 33, 4f) El El 39. There was documentation in ?le to support semi-annual visits. (TFC, page 78; CPA, pages 33, 4f) 40. There was a signed copy of the Agency and Foster Parent Agreement Form in the foster home file. (TFC, pages 95-100; CPA, page 27; FFH, page A-2) HOMES Foster Home Deficiency COMMENTS Revised February 2014 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES PERSONNEL RECORDS STAFF POSITION TYPE OF RECORD REVIEW LaShanda Banks Program Coordinator Complete Derrick Houston Mental Health Technician Complete Jimmy Lewis Youth Care Worker Complete Tisa Booker Mental Health Technician Complete Tawanna Davidson Youth Care Worker Complete Lesa Beavers Youth Care Worker Complete Yvonne Fitzpatrick Youth Care Worker Complete Bridgette Martin Social Worker/Therapist Complete Johnney Jones Mental Health Technician Complete Kristie Jenkins Mental Health Technician Complete Gabrielle Popwell Mental Health Technician Complete Kamala Horn Transitional Coordinator Complete following files were reviewed for ABI, FBI, and CAIN Clearances Donald Bush Mental Health Worker Criminal History Check only Roshelle Sharpe Youth Care Worker Criminal History Check only Stefanie McFarland Mental Health Technician Criminal History Check only Selena Hyatt Mental Health Technician Criminal History Check only Deidre Rivers Mental Health Technician Criminal History Check only Bernard Warren Mental Health Technician Criminal History Check only La Charo Williams Mental Health Technician Criminal History Check only Andrea Rowe Mental Health Technician Criminal History Check only Note: Criminal History Check only consists of checking documentation of ABI, FBI, and the Child Abuse/Neglect Central Registry Clearance. Yes No Revised February 2014 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES IXI El El 1. Application on file. (CCF, page 9, CPA, page 9) El 2. The facility has a personnel ?le on each employee. (CCF, pages 9, 11, CPA, pages 9) 3. Job descriptions on ?le. (CCF, page 9, CPA, page 9) 4. Documentation of Character and Suitability (CCF, pages 9 -14, CPA, pages 10-11, 15-18) a. Result of ABI report b. Result of FBI report c. Result of Central Registry Clearance Documentation d. At least three personal references on file. 5. Documentation of Education (CCF, page 9, CPA, page 11) 6. Documentation of License of Social Service Staff (CCF, page 17, CPA, page 12) DECIDE 7a. Staff Development Training (CCF, pages 18-19, CPA, pages 13) Documentation of Orientation Training K4 7b. Orientation Training was conducted in a timely manner. 8a. Staff Development Training (CCF, pages 18-19, CPA, pages 14) Documentation of New Hire Training EE 8b. New Hire Training was conducted in a timely manner. 9a. Staff Development Training (CCF, pages 18-19, CPA, pages 14) Documentation of Continuing Education Training 9b. Continuing Education Training was conducted in a timely manner. DECIDED EE 10. Salary on ?le. (CCF, page 9, CPA, page 9) 10 Revised February 2014 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES El 11. Current report of medical examination on file. (CCF, pages 9 - ll; CPA 9-10) El El 12. Annual Evaluation on ?le. (CCF, page 9, CPA, page 10) IZIZ El 13. Staff who provides transportation shall have a valid driver?s license and a copy of the license shall be on file with the facility. (CCF, page 33) DEFICIENCIES COMMENT (PERSONNEL RECORDS) There were no deficiencies in this area. PHYSICAL FACILITY Yes 2 0 a? 1. Is the license posted in a conspicuous place on the premises? (CCF, page 47; CPA page 43) 2a. Does the facility have a current fire inspection? (CCF, page 34) (1). Is it available? If yes, the date of the inspection: 5/12/161Higdon Hill); 3/17/16 (RISE Phase II) (2). Was it conducted in a timely manner? IZIZ E?g 2b. Does the facility have an evacuation plan available? (CCF, page 37) (1). If so, is it posted? 2c. Does the facility have a current health inspection? (CCF, page 34) (1). Is it available? If yes, the date of the inspection: 11/28/16 i don Hill - 2/27/17' SE Phase II IZIZE (2).Was it conducted in a timely manner? 3. The following areas are clean and adequately supplied: 11 Revised February 2014 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES K4 El a. Kitchen and dining area (1.) Provide, maintain, equip and keep in safe and sanitary condition premises established or used for child care as required by any law, regulation or ordinance applicable to such facility. page 47, C. l-g) El El (2.) The first responsibility of every child care facility as defined in the Child Care Act is to provide developmental experiences for within a setting which also affords adequate food, clothing, shelter, safety and education.? page l-A, Principles of Child Care Facilities) (3.) All building shall be equip with furnishings that are suf?cient to sustain the basic function of the building, adequate in condition, attractiveness, and durability, and appropriate to the age and size of the children who will be using the building. page 34, C3) IXI Cl b. Sleeping quarters/ Maximum Privacy mfg?, (1.) Provide, maintain, equip and keep in safe and sanitary condition premises established or used for child care as required by any law, regulation or ordinance applicable to such facility.? page 47, C, l-g) El El (2.) The first responsibility of every child care facility as de?ned in the Child Care Act is to provide developmental experiences for within a setting which also affords adequate food, clothing, shelter, safety and education.? page l-A, Principles of Child Care Facilities) IE El El (3.) All building shall be equip with furnishings that are suf?cient to sustain the basic function of the building, adequate in condition, attractiveness, and durability, and appropriate to the age and size of the children who will be using the building. page 34, C3) IX (4.) Adequate ventilation shall be provided in all areas of the facility. page 36 E-l) (5.) Adequate heating and cooling shall be provided in the living and sleeping areas of all building.? page 36, (3) Ventilation, Heating, Cooling, Lighting and Telephones) IXI CI El (6.) Bedrooms should be comfortable and attractive, assuring the maximum amount of privacy. page 36, 2f) 12 Revised February 2014 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES El (7) Bedroom has a window. page 36, 2e) IZIZ Ell] El (8) There shall be no more than one child per bed. page 36, D2b) El - c. Bathrooms (CCF, page 36, page 34, 3c; CCF, page 47, (1.) Provide, maintain, equip and keep in safe and sanitary condition premises established or used for child care as required by any law, regulation or ordinance applicable to such facility.? page 47, C, l-g) El El (2.) The first responsibility of every child care facility as defined in the Child Care Act is to provide developmental experiences for within a setting which also affords adequate food, clothing, shelter, safety and education.? page l-A, Principles of Child Care Facilities) K4 El (3.) All building shall be equip with furnishings that are suf?cient to sustain the basic function of the building, adequate in condition, attractiveness, and durability, and appropriate to the age and size of the children who will be using the building. page 34, C3) XI (4.) Adequate ventilation shall be provided in all areas of the facility. page 36 E-l) El d. Living quarters (CCF, pages 34 (3C), 36-37; CCF, page 47, (1- g) (1.) ?Provide, maintain, equip and keep in safe and sanitary condition premises established or used for child care as required by any law, regulation or ordinance applicable to such facility.? page 47, 13g) K4 El (2.) The ?rst responsibility of every child care facility as defined in the Child Care Act is to provide developmental experiences for within a setting which also affords adequate food, clothing, shelter, safety and education.? page l-A, Principles of Child Care Facilities) K4 El (3.) Adequate ventilation shall be provided in all areas of the facility. page 36 E-l) 13 Revised February 2014 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES CID (4.) Adequate heating and cooling shall be provided in the living and sleeping areas of all building.? page 36, (3) Ventilation, Heating, Cooling, Lighting and Telephones) 4. The child care facility shall have sufficient number of qualified paid staff to provide for each child?s physical and emotional needs at all times and perform required tasks. page 26 A-la) 5. Menus shall be written in advance and shall be kept on file for one year and available for review. (CCF, page 27) 6. All medicine, drugs, and hazardous chemicals shall be kept in locked cabinets, inaccessible to the children. (CCF, page 37) 7. The grounds are free from anything that constitutes a danger or hazard, such as abandoned automobiles, household appliances and uncovered wells and cisterns; stacked lumber with exposed nails; explosives; and dangerous or unvaccinated animals. (CCF, 37) K4 8. A telephone shall be provided in every living unit, cottage and administrative building. (CCF, page 36) 9. On site swimming pools shall be completely enclosed by a barrier on all our sides of at least four feet in height. (CCF, pages 34-35) 10. Documentation of successful completion of a basic water safety course on file. (CCF, page 35) >14 11. The child care facility shall provide time for each child to be alone if appropriate, and places to go where the child will not be disturbed. He/she shall also be provided an opportunity to exercise some free choices of activity. page 32, 11d) IE 12. The child care facility shall provide facilities and staff to make recreation and other activities available within the child care facility. page 32, 11b) 13. Provision shall be made for adequate playtime, both for organized and free play, indoor and out, for all children under care. page 32, 11c) 14. Attractive, well- kept grounds with suf?cient outside play space shall be provided. page 34, 1) 15. The facility shall develop a fire evacuation plan and a plan that will be implemented in the threat of a natural disaster (such as a tornado warning). (CCF, 37) 14 Revised February 2014 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES IX El 16. Routine drills to practice the plans will be conducted. Each child shall be advised of the plan upon entering care. (CCF, 37) COMMENT Physical Facility Comment: Sleeping quarters RISE Phase II The occupancy allowed by minimum standards is 10 beds per unit. This facility was set up to accommodate twelve beds in unit one and two beds in unit two. This was corrected on the spot. In unit one, there are ten beds, and unit two has two beds which give the facility a maximum of 12 beds. ADMINISTRATIVE REVIEW Yes No 1. Current renewal application (740 741) completed and on ?le. (CPA, page 35; CCF, pages 44-45) Cl 2. Documentation of Character and Suitability (ABI, FBI, CANS reports) of the Executive Director of ?le. (CPA, pages 10-11; CCF, pages 9 -l4) 3. Documentation of Education Requirements on ?le for the Executive Director. (CPA, pages 11; CCF, pages 15-16) A . Current Annual Audit on ?le. (CPA, page 7; CCF pages 14-15 5" Provider submits population reports to SDHR Licensing Unit as required by Minimum Standards. (CCF, pages 15, 52) HE CID EU 6a. Provider has policies and procedures regarding reports to the departments to include, enrollment, changes, incidents, and child abuse/neglect reports. (CCF pages 52-53) 6b. Provider report and submit incident reports as required by Minimum Standards. (CPA, page 15 CCF, pages 52-53) K4 7. Case records are locked when unattended. (CPA, page 32; CCF, page 22) 8. The provider shall maintain con?dential case records on all cases. (CPA pages 31-32) (CCF, page 22) DEED DEED K4 9. A completed Alabama Department of Human Resources Declaration if Citizenship or Alien Status for Licensing Program for this licensing/renewal period. (Alabama Act 2011-535 (I-IB56), The Beason-Hammon Taxpayer and Citizen Protection Act. Revised February 2014 15 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES K4 El 10. The provider shall have a manual of operating policies and procedures regarding its services. (CPA page 8; CCF, pages13-15) XI El El 11. A child-placing agency which provides a full range of services, including, but not limited to, adoption, foster family homes, counseling services, or financial aid, shall maintain an of?ce with a resident executive and staff within the state of Alabama. (CPA page 8) K4 Cl 12. Each social work supervisor and each social worker shall be provided with a copy of the manual of operating policies and procedures and a copy of said manual shall be provided to the Department. (CPA page 8) El 13. Written personnel practices and policies developed by the board (or, in the absence of a board, by the executive) shall be on ?le in the child-placing agency and with the Department. A copy of personnel practices and policies shall be made available to each employee. (CPA page 8) (CCF page 7) El El 14. Policies regulating salaries, fringe benefits, working hours, sick leave, vacations, holidays, retirement and terminations. (CPA page 9) (CCF page 7) K4 Cl 15. A licensed child-placing agency shall not conduct or approve a foster home study on any of its employees, which includes board members, volunteers, or relatives of the aforementioned or anyone else who has direct affiliation with the agency. (CPA page 27) K4 El 16. A licensed child-placing agency shall not conduct or approve an adoptive home study on any of its employees, which includes board members, volunteers, or relatives of the aforementioned or anyone else who has direct affiliation with the agency. Arrangements must be made with another licensed child-placing agency or licensed social worker to conduct and approve the study, make a placement, provide post-placement supervision and for reapproval. (CPA page 40) IE 17. A licensed child-placing agency notify in writing the local County Department of Human Resources in which the foster family home is located that said home has been approved. The County Department shall also be noti?ed when the home is no longer approved. (CPA page 27) 16 Revised February 2014 DEPARTMENT OF HUMAN RESOURCES DIVISION OF RESOURCE MANAGEMENT SITE VISIT REPORT FOR RESIDENTIAL CHILD CARE FACILITIES AND CHILD PLACING AGENCIES >11 El 18. Provide written protocol on the matching of children and foster families and documentation to support placement of children. Placement shall be made only after careful consideration is given as to how well the prospective foster family will meet the child?s needs and preferences. (CPA page 28) COMMENT (ADMINISTRATIVE REVIEW) There were no deficiencies in this area. CONCLUSION Please review the deficiency areas of this report and submit your responses to the deficiencies no later than thirty days of the receipt of this report. Your response should include a proposed corrective action plan including timeframes to address the deficiencies in the report. 17 Revised February 2014