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

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EXHIBIT A-II How do I set up an Your ILSP worker will help you with this. You can set up an emancipation account? emancipation account by opening, or having an adult open an account in your name with a bank or savings and loan institution that is insured. This account should be separate from any account you keep for basic spending money. The money that you deposit in this account must be from work or other sources that are part of your written independent living transitional plan. The money in this account must be used for purposes related to the goal of emancipation or when you leave foster care. If you need to withdraw money from this account while you are still in foster care, your social worker must agree in writing that the reason you need to withdraw the money is related to the goal of emancipation and place the written approval of the withdrawal in your case file. Legal Rights of Teens In Out of Home Care Page 21
RELIGION Can my foster parents or No. You do not have to attend religious services that you group home make me go to a do not wish to. 80 church, temple, or mosque? EXHIBIT A-II Can my foster parents or No. You have a right to attend religious services of your group home keep me from choice. Your foster parents or group home must help you to going to my church, temple, arrange transportation to and from your place of worship or mosque? provided it is within a reasonable distance. The only other way you can be prevented from attending religious services is if there is a very strong reason for not allowing you to go. Foster parents, for example, can refuse to take you to services if you seriously misbehaved on a prior occasion. They cannot, however, refuse to take you to services simply because they don’t want to. Your social worker is supposed to help match you to foster care providers who will understand your religious needs. 81 Legal Rights of Teens In Out of Home Care Page 22
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DEPARTMENT OF CHILDREN AND FAMILY S
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REQUEST FOR STATEMENT OF QUALIFICAT
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1.0 INTRODUCTION 1.1 Preamble For o
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COUNTY agencies and their partners
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1.3 DCFS Mission Statement DCFS wil
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2.0 GENERAL INFORMATION 2.0 Scope o
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2.4.1.2 Prospective Contractor must
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old for 30 days or less; (3) provid
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Contractor protest. In all cases, t
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2.19 Conflict of Interest No County
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submit evidence at that hearing. Af
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solicitation may result in the pros
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County’s contracting process by c
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2.33 Contractor’s Charitable Cont
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3.0 Instructions to Prospective Con
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The request for a Solicitation Requ
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3.7.1 Language The SOQ and all docu
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coverage should the prospective Con
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3.8.6 Please refer to Section 3.0 I
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4.0 SOQ REVIEW/SELECTION/QUALIFICAT
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The Department will execute Board o
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19 20 21 22 List of Required Forms
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CONTRACTOR’S ORGANIZATION QUESTIO
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CONTRACTOR’S ORGANIZATION QUESTIO
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VENDOR’S EEO CERTIFICATION REQUIR
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REQUIRED FORMS - FORM 5 FAMILIARITY
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PROSPECTIVE CONTRACTOR LIST OF TERM
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REQUIRED FORMS - FORM 9 COUNTY OF L
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REQUIRED FORMS - FORM 11 OFFER TO P
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CERTIFICATION OF FISCAL COMPLIANCE
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LIST OF COMMITMENTS Legal Name of A
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REQUIRED FORMS - FORM 17 CONTRACTOR
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CERTIFIED FOSTER PARENT CONFIDENTIA
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CONTRACTOR’S EMPLOYEE ACKNOWLEDGE
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Type of program: Foster Family Agen
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CONTRACTOR’S NAME: CONTRACT NO. N
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REQUEST FOR STATEMENT OF QUALIFICAT
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TRANSMITTAL FORM TO REQUEST A RFSQ
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APPENDIX E LISTING OF CONTRACTORS D
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SAMPLE CONTRACT COUNTY OF LOS ANGEL
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LIST OF EXHIBITS SAMPLE CONTRACT Ex
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SAMPLE CONTRACT Exhibit A-IX Requir
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as a single process. SAMPLE CONTRAC
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SAMPLE CONTRACT 2.27 “Foster Care
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SAMPLE CONTRACT written in accordan
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SAMPLE CONTRACT Such insurance shal
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SAMPLE CONTRACT 6.0 INSURANCE COVER
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SAMPLE CONTRACT partial, and supple
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SAMPLE CONTRACT 7.15 Provided that
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10.0 COUNTY’S RESPONSIBILITY SAMP
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SAMPLE CONTRACT 10.13 The CSWs shal
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SAMPLE CONTRACT and/or Certified Fo
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SAMPLE CONTRACT Investigation/Monit
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SAMPLE CONTRACT will also invite CO
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SAMPLE CONTRACT 18.4 The CONTRACTOR
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SAMPLE CONTRACT management review,
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SAMPLE CONTRACT 20.2 CONTRACTOR and
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SAMPLE CONTRACT 22.2 CONTRACTOR her
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SAMPLE CONTRACT notice by the CONTR
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SAMPLE CONTRACT COUNTY’s prior wr
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SAMPLE CONTRACT FOSTER FAMILY AGENC
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SAMPLE CONTRACT to the Contract, wh
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SAMPLE CONTRACT governing or impact
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8.0 GRIEVANCES SAMPLE CONTRACT term
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SAMPLE CONTRACT 11.1.2 For purposes
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SAMPLE CONTRACT CONTRACTOR will int
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SAMPLE CONTRACT conduct a hearing w
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SAMPLE CONTRACT CONTRACTOR warrants
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SAMPLE CONTRACT solely of CONTRACTO
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1015, attached hereto as Exhibit L.
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SAMPLE CONTRACT 30.1.3 CONTRACTOR m
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SAMPLE CONTRACT not limited to, the
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SAMPLE CONTRACT amounts COUNTY clai
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COUNTY OF LOS ANGELES DEPARMENTS OF
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PART A: INTRODUCTION 1.0 PREAMBLE E
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EXHIBIT A COUNTY agencies and thei
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EXHIBIT A (Health and Safety Code),
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PART B: TARGET DEMOGRAPHICS 1.0 TAR
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1.0 SAFETY EXHIBIT A PERFORMANCE OU
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1.1.7 Required Services by CONTRACT
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EXHIBIT A The CONTRACTOR shall Moni
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PROGRAM TARGET GROUP: Placed Childr
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EXHIBIT A the fullest extent possib
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EXHIBIT A Monitor for Compliance th
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3.0 WELL-BEING EXHIBIT A PERFORMANC
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EXHIBIT A participation in treatmen
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EXHIBIT A individuals to the extent
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EXHIBIT A 88068.2, 88068.3, and 880
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EXHIBIT A objectives appropriate to
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EXHIBIT A The CONTRACTOR shall prov
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3.7.4 Monetary Consequences EXHIBIT
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EXHIBIT A Days. After 14 Days, the
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EXHIBIT A The CONTRACTOR shall have
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EXHIBIT A for the Placed Child to r
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EXHIBIT A specified in the Needs an
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EXHIBIT A The CONTRACTOR shall Moni
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FOSTER YOUTH BILL OF RIGHTS EXHIBIT
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EXHIBIT A-I 19. Residents have the
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EXHIBIT A-I Reprise 25. Residents s
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INTENTIONALLY LEFT BLANK EXHIBIT A-
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EXHIBIT A-IVa STATE OF CALIFORNIA
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FOSTER CHILD’S NEEDS AND CASE PLA
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AGENCY - GROUP HOME AGREEMENT Child
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EXHIBIT A-VIII SPECIAL INCIDENT REP
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5. SERIOUS INJURY, ILLNESS OR ACCID
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EXHIBIT A-VIII 10. SIGNIFICANT INCI
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SCREENING REQUIREMENT PERIODICITY S
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Anticonvulsant medications, when pr
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Dr. faxes pages 1 & 2 of PMAF to th
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EXHIBIT A-X 2. Contact the physicia
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EXHIBIT A-X 1. Instruct the caregiv
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APPROVAL LEVELS Section Level Appro
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(CSW completes top section) Los Ang
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D. Please attach a list of the foll
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TO THE HEADS OF EXECUTIVE DEPARTMEN
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implementation of individual provis
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E. Negotiation and Approval of Indi
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. The restraints or requirements im
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objectives of the organization are
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distribution base. The result of th
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special cost studies (such as an en
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other activity. The bases must be e
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g. The results of each negotiation
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49. Training costs 50. Transportati
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e. Costs identified in subparagraph
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compensation for employees on feder
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(3) Excise taxes on accumulated fun
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with certainty as to time, intensit
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appeals, antitrust suits, or the pr
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(1) Donated or volunteer services m
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(1) Capital expenditures for genera
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(2) "Idle facilities" means complet
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enovations, alterations, equipment,
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. For non-profit organizations subj
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already required or maintained. Als
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see paragraphs 37., Professional se
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41. Recruiting costs. a. Subject to
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continued to own the property. This
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48. Termination costs applicable to
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(3) Fees charges by the educational
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e. Foreign travel. Direct charges f
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Southern Research Institute, Birmin
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A-C Handbook Page 1 AUDITOR-CONTROL
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A-C Handbook Page 3 2.2 Cash Receip
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A-C Handbook Page 5 If a Payroll Re
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A-C Handbook Page 7 Outside Meals -
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A-C Handbook Page 9 CONTRACTOR shal
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A-C Handbook Page 11 2.3 Petty Cash
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A-C Handbook Page 13 Salaried emplo
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A-C Handbook Page 15 Indirect Cost
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A-C Handbook Page 17 2.3 Acceptable
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A-C Handbook Page 19 D. UNALLOWABLE
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EXHIBIT C-II AUDITOR-CONTROLLER/DEP
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• California Code of Regulations,
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If CONTRACTOR and A-C/DCFS hold a p
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XIV. Final Report to the Board of S
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EXHIBIT D Cont. I understand that I
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EXHIBIT D-I Cont. I understand that
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24. Equipment Leases 25. Depreciati
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Report all costs related to telepho
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EXHIBIT E D. Total Un-Expended AFDC
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EXHIBIT F (D) If the State Departme
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EXHIBIT F (C) Individuals who are e
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EXHIBIT F subdivision (g). The Stat
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EXHIBIT F processing. (B) Upon requ
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EXHIBIT F self-addressed envelope f
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EXHIBIT F shall disclose that clien
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EXHIBIT F state, would have been pu
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statement, fingerprints and photogr
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Name, Address and Telephone Number
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EXHIBIT G If a CSW or SCSW has any
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EXHIBIT G 10) minute orders and cou
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0500-501.20 (Rev 12/02) EXHIBIT G 4
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EXHIBIT G See Procedural Guide 0200
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EXHIBIT G that the research will no
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EXHIBIT G detrimental to the safety
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EXHIBIT G Procedural Guide 0500-504
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EXHIBIT H of changes to the plan. (
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EXHIBIT I (e) The child's caretaker
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EXHIBIT I CSW in Concurrent Plannin
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Procedures A. WHEN: A CHILD IS DETA
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B. WHEN: A CHILD IS IN OUT-OF-HOME
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Dependency Investigator CSW Respons
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EXHIBIT I For offices who have impl
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EXHIBIT I FB1 Addendum, Family Back
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CHILD WELFARE SERVICES PROGRAM 31-4
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Department of the Treasury Internal
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DCFS FOSTER FAMILY AGENCY CONTRACT
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EXHIBIT N medication authorizations
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EXHIBIT N 5. The DCFS Division Chie
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EXHIBIT O 1. The lesser number is a
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EXHIBIT O COUNTY OF LOS ANGELES CON
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CONTRACTOR’S CERTIFICATION OF COM
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F I F I F I F I EXHIBIT R F O R Y O
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8. Does the child receive the sport
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EXHIBIT R 33. Is the child given th
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Every baby deserves a chance for a
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Es mejor que las mujeres busquen ay
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• Llámenos para recibir informac
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A. WHEN: A FAD INDICATES A POTENTIA
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EXHIBIT T O/P Collection EW 4. INVA
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EXHIBIT T NOTE: Overpayment recover
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Reconciliation EW 3. Receive the Ba
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Overpayment Recovery Unit ES WHO HO
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CHARITABLE CONTRIBUTIONS CERTIFICAT
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SERVICE DELIVERY SITES Foster Famil
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TABLE OF CONTENTS INTRODUCTION/SUMM
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PURPOSE/PHILOSOPHY STATEMENT These
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TEAMING PROCESS Family-Centered Tea
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COURT ORDERS Oftentimes, the judici
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First 24 Hours Child removed from p
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FAMILY VISITATION PLAN Prior to the
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• Whether or not the parent is a
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• Maintain objectivity, and remai
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Judicial Officers Judicial Officers
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Unless the FVP specifically states
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the visitation objectives. In addit
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Sexual Abuse Permanency Transportat
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SUBCOMMITTEE MEMBERS The Drafting S
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EXHIBIT Y of information, including
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EXHIBIT Y accounting of Disclosures
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DISCHARGE SUMMARY FOR DCFS: FOSTER
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INTENTIONALLY LEFT BLANK EXHIBIT BB
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10.0 COMPLIANCE WITH CIVIL RIGHTS L
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Exhibit T Overpayments Exhibit U Gr
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WHEREAS, CONTRACTOR warrants that i
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2.0 DEFINITIONS Exhibit T Overpayme
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2.16 “Do Not Refer Status” or
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2.31 “Pool Rate” - means the ra
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notify COUNTY of such change. COUNT
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equivalent providing the CONTRACTOR
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a bed open for a Placed Child, CONT
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7.14 CONTRACTOR may appeal the fina
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9.2 If CONTRACTOR’s staff qualify
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10.11 COUNTY Workers shall provide
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13.0 FEES 12.1 CONTRACTOR shall mai
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Exhibit N, DCFS/Probation Group Hom
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16.0 FINANCIAL REPORTING 16.1 CONTR
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closing summary of CONTRACTOR's rec
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including but not limited to, the U
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19.6 Nothing herein precludes COUNT
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entirety; or (2) reduced in accorda
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accounted for and that unspent fund
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omissions, resulting from its perfo
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County of Los Angeles - Department
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4.0 BUDGET REDUCTIONS In the event
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6.2.3 The assurance that all employ
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CONTRACTOR hereby assures that it w
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12.3 CONTRACTOR shall comply with a
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modify, deny or adopt the proposed
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minimum waiting time for clearance.
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County of Los Angeles Department of
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eject children for placement consis
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30.0 DISCLOSURE OF INFORMATION 30.1
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33.7 CONTRACTOR shall obtain the fo
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35.0 TERMINATION FOR CONVENIENCE 35
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CONTRACTOR receives, has access to,
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COUNTY OF LOS ANGELES DEPARTMENT OF
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COUNTY OF LOS ANGELES DEPARTMENTS O
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• Safety and Survival; • Emotio
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Service Access Service providers wi
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The CONTRACTOR shall request approv
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Plan/Quarterly Reports in cooperati
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6.4 The CONTRACTOR’S Treatment Te
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PART C: SERVICE TASKS TO ACHIEVE PE
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1.0: SAFETY PERFORMANCE OUTCOME GOA
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Placed Children; and (2) abide by a
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(b) The CONTRACTOR shall use seclus
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PERFORMANCE OUTCOME SUMMARY 2.0 PER
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2.0: REUNIFICATION/PERMANENCY PERFO
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2.2 Visitation Plan: modification i
Page 565 and 566: (a) For infants from birth to 6 mon
Page 567 and 568: PERFORMANCE OUTCOME SUMMARY 3.0 WEL
Page 569 and 570: 3.0 WELL-BEING PERFORMANCE OUTCOME
Page 571 and 572: (b) Two children’s rights recentl
Page 573 and 574: their responsibilities to pupils in
Page 575 and 576: 3.2.8 Educational Assessments by th
Page 577 and 578: information such as immunizations g
Page 579 and 580: The CONTRACTOR shall have an emerge
Page 581 and 582: assistance with homework; (5) daily
Page 583 and 584: 3.11.5 Clothing Fit, Appropriatenes
Page 585 and 586: placed with a minor parent if the C
Page 587 and 588: PART D - PERFORMANCE REQUIREMENT SU
Page 589 and 590: FOSTER YOUTH BILL OF RIGHTS EXHIBIT
Page 591 and 592: 19. Residents have the right to con
Page 593 and 594: not prohibited by the resident's ne
Page 595 and 596: TABLE OF CONTENTS ii EXHIBIT A-II I
Page 597 and 598: OUT-OF-HOME CARE EXHIBIT A-II What
Page 599 and 600: EXHIBIT A-II What is a juvenile cou
Page 601 and 602: EXHIBIT A-II care still exist, if y
Page 603 and 604: EXHIBIT A-II Can I have an attorney
Page 605 and 606: TYPES OF PLACEMENTS EXHIBIT A-II Wh
Page 607 and 608: GUARDIANSHIP EXHIBIT A-II What is t
Page 609 and 610: INDEPENDENT LIVING EXHIBIT A-II Wha
Page 611 and 612: CONFIDENTIALITY AND YOUR RECORDS EX
Page 613 and 614: WHEN RECORDS ARE DESTROYED Juvenile
Page 615: MONEY EXHIBIT A-II Do I have a righ
Page 619 and 620: EXHIBIT A-II What if I can't get a
Page 621 and 622: EMANCIPATION EXHIBIT A-II What does
Page 623 and 624: EXHIBIT A-II What are the disadvant
Page 625 and 626: KNOW YOUR RIGHTS EXHIBIT A-II With
Page 627 and 628: DEFINITION INDEX The number refers
Page 629 and 630: ENDNOTES 1. The following abbreviat
Page 631 and 632: 35. WIC 317(c) 36. WIC 317(d),(e) E
Page 633 and 634: 84. VC 12814.6 85. VC 17701 86. FC
Page 635 and 636: PROBATION CASE PLAN FORM (PROB 1385
Page 637 and 638: EXHIBIT A-V 1. Describe Circumstanc
Page 639 and 640: EXHIBIT A-V Probation Officer’s R
Page 641 and 642: EXHIBIT A-V _______________________
Page 643 and 644: SIGNATURES: EXHIBIT A-V MINOR: THIS
Page 645: FOSTER CHILD’S NEEDS AND CASE PLA
Page 663 and 664: cc: to group home, child’s(ren’
Page 665 and 666: SPECIAL INCIDENT REPORTING GUIDE FO
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4 EXHIBIT A-VIII 5. SERIOUS INJURY,
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6 EXHIBIT A-VIII 10. SIGNIFICANT IN
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SCREENING REQUIREMENT PERIODICITY S
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Anticonvulsant medications, when pr
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Dr. faxes pages 1 & 2 of PMAF to th
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EXHIBIT A-X 2. Contact the physicia
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EXHIBIT A-X 1. Instruct the caregiv
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APPROVAL LEVELS Section Level Appro
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Group Home Organization: FORMAT FOR
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Exhibit A-XIIIa COUNTY OF LOS ANGEL
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Exhibit A-XIIIb COUNTY OF LOS ANGEL
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GROUP HOME PROGRAM STATEMENT EXHIBI
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TO THE HEADS OF EXECUTIVE DEPARTMEN
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implementation of individual provis
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E. Negotiation and Approval of Indi
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. The restraints or requirements im
Page 699 and 700:
objectives of the organization are
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distribution base. The result of th
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special cost studies (such as an en
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other activity. The bases must be e
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g. The results of each negotiation
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49. Training costs 50. Transportati
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e. Costs identified in subparagraph
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compensation for employees on feder
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(3) Excise taxes on accumulated fun
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with certainty as to time, intensit
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appeals, antitrust suits, or the pr
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(1) Donated or volunteer services m
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(1) Capital expenditures for genera
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(2) "Idle facilities" means complet
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enovations, alterations, equipment,
Page 729 and 730:
. For non-profit organizations subj
Page 731 and 732:
already required or maintained. Als
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see paragraphs 37., Professional se
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41. Recruiting costs. a. Subject to
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continued to own the property. This
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48. Termination costs applicable to
Page 741 and 742:
(3) Fees charges by the educational
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e. Foreign travel. Direct charges f
Page 745 and 746:
Southern Research Institute, Birmin
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A-C Handbook Page 1 AUDITOR-CONTROL
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A-C Handbook Page 3 2.2 Cash Receip
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A-C Handbook Page 5 If a Payroll Re
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A-C Handbook Page 7 Outside Meals -
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A-C Handbook Page 9 CONTRACTOR shal
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A-C Handbook Page 11 2.3 Petty Cash
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A-C Handbook Page 13 Salaried emplo
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A-C Handbook Page 15 Indirect Cost
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A-C Handbook Page 17 2.3 Acceptable
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A-C Handbook Page 19 D. UNALLOWABLE
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EXHIBIT C-II AUDITOR-CONTROLLER/DEP
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EXHIBIT C-II circumstances, the ent
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EXHIBIT C-II At the pre-exit meetin
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EXHIBIT C-II will be provided with
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CONTRACTOR EMPLOYEE ACKNOWLEDGEMENT
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Group Home Semi-Annual Expenditure
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EXHIBIT F (D) If the State Departme
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EXHIBIT F (C) Individuals who are e
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EXHIBIT F subdivision (g). The Stat
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EXHIBIT F processing. (B) Upon requ
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EXHIBIT F self-addressed envelope f
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EXHIBIT F shall disclose that clien
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EXHIBIT F state, would have been pu
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statement, fingerprints and photogr
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Name, Address and Telephone Number
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EXHIBIT G If a CSW or SCSW has any
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EXHIBIT G 10) minute orders and cou
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0500-501.20 (Rev 12/02) EXHIBIT G 4
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EXHIBIT G See Procedural Guide 0200
Page 805 and 806:
EXHIBIT G that the research will no
Page 807 and 808:
EXHIBIT G detrimental to the safety
Page 809 and 810:
EXHIBIT G Procedural Guide 0500-504
Page 811 and 812:
EXHIBIT H of changes to the plan. (
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EXHIBIT I (e) The child's caretaker
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EXHIBIT I CSW in Concurrent Plannin
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Procedures A. WHEN: A CHILD IS DETA
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B. WHEN: A CHILD IS IN OUT-OF-HOME
Page 821 and 822:
Dependency Investigator CSW Respons
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EXHIBIT I For offices who have impl
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EXHIBIT I FB1 Addendum, Family Back
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Department of the Treasury Internal
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DCFS GROUP HOME CONTRACT INVESTIGAT
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EXHIBIT N c) insufficient or poor f
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EXHIBIT N 5. The Division Chief or
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EXHIBIT O 1. The lesser number is a
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EXHIBIT O COUNTY OF LOS ANGELES CON
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CONTRACTOR’S CERTIFICATION OF COM
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F I F I F I F I EXHIBIT R F O R Y O
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8. Does the child receive the sport
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EXHIBIT R 33. Is the child given th
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It is best that women seek help to
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Safely Surrendered Baby Hotline (87
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Cada recién nacido merece una opor
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DATE OF ISSUE: APPLICABLE TO: LEGAL
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TA/EW b) INVALID OVERPAYMENT EXHIBI
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WHO HOW following conditions exist:
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EXHIBIT T Deposit EW 3. Reconcile t
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O/P Collection EW b) Enter the stat
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c) FAD Exception Distribution d) Ov
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s mobility and independent function
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1180.3. (a) This section shall appl
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(A) Obesity. (B) Pregnancy. (C) Agi
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PROBATION QUARTERLY REPORT FORMAT E
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Name of School: Address of School:
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Date Type Los Angeles County Probat
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Are there any SIRS to report? Yes N
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TARGET POPULATIONS WITH CORRESPONDI
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EXHIBIT Y THE TARGET POPULATION FOR
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CONTRACT NO. COUNTY PROGRAM DIRECTO
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EXHIBIT CC LOS ANGELES COUNTY SUPER
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INTRODUCTION/SUMMARY In June, 2005,
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elatives) should reflect the unique
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Additionally, every effort should b
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DEPENDENCY CASE STAGES Stage 1: Pre
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The Pre-Disposition Family Visitati
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PRELIMINARY CONSIDERATIONS/FACTORS
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• Provide a drug/weapon/violence
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• Give parents suggestions for wh
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Visitation Objectives (reason for e
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issues specific to teen parents. Th
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Circumstance Team Response in FVP
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BIBLIOGRAPHY Casey Family Programs.
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Reporting Runaways A Guide for Care
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CONTRACTOR’S OBLIGATIONS UNDER HI
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213-974-2166 EXHIBIT EE The initial
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5.0 MISCELLANEOUS EXHIBIT EE agents
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CONTRACTOR’S NAME: CONTRACT NO. C
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BACKGROUND AND RESOURCES: CALIFORNI
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It is best that women seek help to
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Safely Surrendered Baby Hotline (87
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Cada recién nacido merece una opor
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2.203.010 Findings. Chapter 2.203,
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APPENDIX M following: 1. Has ten or
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