VIII.I AFH Licensing Support
8/1/04
Overview
There are three types of adult foster homes; relative, limited and commercial. All homes must renew their licenses annually through their local SPD/AAA office. Types of actions are: licensing of new homes, renewal of existing homes, changes in capacity (number of residents), addition or change of resident managers, and closures of homes.
New Home (Non-Relative)
An initial contact from a prospective provider is responded to according to the policies of each Branch. It may be that a contact form is completed with the applicant and given to the licensor who schedules an information meeting. It may be that the prospective applicant must attend a group orientation before receiving an application.
Requirements for a new AFH are:
Basic Training Course and Exam |
Required |
AFH Initial Application ( SDS 448 ) |
Required |
AFH Supplemental Application ( SDS 448B ) |
If Necessary |
Fee ($20 per bed) |
Required |
AFH Financial Information ( SDS 448A ) |
Required |
Criminal Record Release ( DHS 301) |
Required |
Criminal Release Mitigation ( SDS 303B ) |
If Necessary |
Physician/Nurse Practitioner Statement (SDS 903) |
Required |
Floor Plan of Home |
Required |
Fire Escape Floor Plan |
Required |
On-Site Inspection (by Licensor) |
Required |
Once the home is established and can receive residents the licensor visits the home to make an inspection and have the contract signed.
When the required paperwork and payment is received by support staff, criminal history checks are done on everyone in the home who is 16 years of age and older, and payment is receipted (see II.G.6 ), a provider number is supplied by the Provider Enrollment Unit. The provider number is part of the contract/licensing number. For example: 3111-500353-0204-N. The 3111 is the branch #, 500353 the provider #, and 0204 is the year and month of expiration. N means non-relative (commercial), R means relative.
Documents are filed in a 6 part folder (see IV.A.2). Some units use a label on the file with the basic information, i.e. provider name, address, phone number, provider number and expiration dates. Other units have a computer program where that information is stored and a hard copy of that information is put into the file folder. Place a PRV7 screen in the file.
A public disclosure file is created and the home is added to the provider section of Oregon ACCESS. If the branch maintains an AFH list for clients and community partners, is should also be added to this list.
Once the contract/license is completed it is given to the Manager/Supervisor for signature. The provider receives a copy, the branch copy is placed in the file and a copy of the branch copy is filed in the public disclosure file.
New Home (Relative)
Requirements for a new relative AFH are:
AFH initial Application ( SDS 448B ) |
Required |
Criminal Record Release ( DHS 301) |
Required |
Criminal Release Mitigation ( SDS 303B ) |
If Necessary |
Physicians/Nurse Practitioner Statement (SDS 903) |
Required |
On-Site Inspection |
Required |
Other Information |
As Requested |
A referral is made from the case manager to the AFH licensor. The licensing process is basically the same as a non-relative home except that a bed fee is not required and under the " conditions," the name of the relative followed by "only" must appear on the license. In a relative home the only persons who need a criminal history check are the paid providers.
New Home (Limited)
The limited license is processed the same as a relative home with the exception that the provider is a long time friend rather than a relative. A bed fee is required.
Change In Capacity
The provider will submit an SDS 448C License Renewal/Capacity Change Application with a $20 per bed fee for each new bed. A floor plan of the home showing where the new beds are located is required. Receipt check. A home visit may be necessary. Complete a new license that reflects the new capacity, have this signed by the appropriate staff, and mail to the provider, copy to file and public file. Notify the Provider Enrollment Unit of the changes.
Change In Resident Manager
Required forms are SDS 448B Supplemental Application, DHS 301 Criminal History Clearance Release Authorization and SDS 303B (if needed), SDS 903 Physician/Nurse Practitioner's Statement, and EQC Certification of Completion and a $10.00 fee. Once the application has been approved by the licensor, type a new license indicating the name of the new resident manager, mail to provider, put copy in file and in public file.
AFH Closure
Send e-mail or fax to the Provider Enrollment Unit stating the name, provider number and effective date of closure. When completed print a PRV1 screen showing BT (business terminated) or copy of the e-mail for the file. Maintain a file of the e-mails. Close in ACCESS and any AFH maintenance on-line format. The public file and the complaint files are pulled and filed in closed AFH files.