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

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EXHIBIT A-VIII
D. A physical injury inflicted upon a child by another person by other than accidental
means. This includes unlawful corporal punishment and willful cruelty or infliction
of unjustifiable physical pain or punishment on a child by any person.
E. Neglect, including medical neglect.
F. Infliction of mental/emotional suffering.
HOW TO WHOM WHEN
Fax only if I- Phone law enforcement Immediately
Track is down County Placement Worker (For DCFS, use Immediately
except law Child Abuse Hotline after hours)
enforcement, Phone parent/guardian Immediately, if deemed
parent/guardian,
appropriate by County
and, if after
Placement Worker, Child Abuse
hours, the
Hotline, or Law Enforcement
Hotline.
Community Care Licensing Immediately or the next workday
OHCMDM/Probation Monitors Immediately or the next workday
Written
Copy in clinical file (DMH children only) Immediately
Send copy to law enforcement Within 36 hours
NOTE: Use of State Form SS8572, “Suspected Child Abuse,” is mandatory.
Additional information may be provided on the “Special Incident Report (SIR)” form
with a copy of SS8572 attached.
9. SIGNIFICANT CHANGES IN GROUP HOMES
A. Any change in licensee’s mailing address.
B. Any change in the plan of operation which affects service to children.
C. Any change of the Chief Executive Officer of a corporation or association.
D. A change in administration.
HOW TO WHOM WHEN
Written report by
mail/fax.
County Placement Worker Immediately upon anticipation of
change; immediately upon
occurrence or the next workday
OHCMDM/Probation Monitors Immediately upon anticipation of
change; immediately upon
occurrence or the next workday
E. Staffing disruption, e.g. strikes or staff shortages.
HOW TO WHOM WHEN
Written report by Community Care Licensing Immediately or the next workday
mail/fax except Call County Placement Worker (DMH Immediately or the next workday
for DMH Worker. children only)
OHCMDM/Probation Monitors Immediately or the next workday