CMS-07-021/023 - Los Angeles County Department of Children and ...

EXHIBIT A-VIII
SPECIAL INCIDENT REPORTING GUIDE FOR FOSTER FAMILY AGENCIES (FFA)
The Los Angeles County Departments of Children and Family Services (DCFS) and
Probation have developed this reporting guide. It does not supersede the requirements
outlined in California Code of Regulations, Title 22, Sections 80061, 83061, and 88061;
and the Los Angeles County Foster Family Agency Agreement; Section 10.0.
The FFA shall maintain copies of all reports as required in Sections 1 through 10 of this
guide in the Placed Child's file. The FFA shall also summarize the information in the
quarterly reports to the DCFS placement worker.
Children's files shall be retained for at least five years following the term of this
Agreement or three years from the date of the submission of the final expenditure report
in accordance with the Agreement, Section 11.4.
Many of these special incident-reporting decisions require good judgment and sound
discretion. If in doubt whether to report, call the appropriate agency for clarification.
Whoever is reporting should be prepared for follow-up questions and have some
expertise in the reporting procedure.
The Contractor shall report special incidents to DCFS, Probation, and Community Care
Licensing immediately or the next work day via the I-Track web-based system at
. The Contractor shall still report by telephone and/or by
sending a written report per the Table below to: (1) parents, guardians, or conservators;
(2) law enforcement; (3) the DCFS Child Abuse Hotline; (4) the local fire department;
and (5) the local health officer. If the I-Track web-based system is off-line, use fax as a
substitute per the Table below. Resubmit the report on I-Track as soon as it comes
back on-line.
TABLE OF CONTENTS
TYPE OF INCIDENT PAGE #
1. BEHAVIOR INCIDENTS………………………………………………………..………… 2
2. OTHER SIGNIFICANT INCIDENTS……………………………………………..……… 2
3. ILLNESS…………………………………………………………………………….……... 2
4. INJURY OR ACCIDENT…………………………………………………………..……… 2
5. SERIOUS INJURY, ILLNESS OR ACCIDENT…………………………………..…….. 3
6. DEATH………………………………………………………………………………..…….. 3
7. UNAUTHORIZED ABSENCE……………………………………………………..……... 3
8. CHILD ABUSE……………………………………………………………………..……… 4
9. SIGNIFICANT CHANGES IN FOSTER FAMILY AGENCIES .……………………….. 4
10. SIGNIFICANT INCIDENTS WHICH INVOLVE THE COMMUNITY OR PHYSICAL
PLANT AND MAY HAVE SERIOUS IMPACT ON THE RESIDENTS, E.G
EPIDEMICS, POISONING, CATASTROPHES, FLOODS, EXPLOSIONS,
EARTHQUAKE DAMAGE, ANY FIRES, OR ANY OTHER POTENTIALLY
DANGEROUS ENVIRONMENT ……………………………………………………....… 5