(a) All
applications must be accompanied by the following documents, which shall be
reviewed by the Department for completeness and compliance with 606 CMR 3.00:
1. a statement of purpose as required by 606
CMR 3.04(1);
2. a statement of the
ownership of the program, including the names and addresses of all owners, or,
in the case of corporations, the officers as required by 606 CMR
3.04(2)(a)2;
3. a projected one
year operating budget, and documentation of sufficient funds for at least three
months. For an operating agency, a current financial report, appropriate fiscal
portions of contracts if any, and a statement of the current rate of payment as
set by the Commonwealth, if applicable;
4. a description of the intended staffing of
the facility or program on a 24 hour per day, seven day per week basis
including availability of emergency on-call staff;
5. organizational table, as required by 606
CMR 3.04(2)(c);
6. written policy
and procedure for internal investigation of child abuse and neglect as required
by 606 CMR 3.04(3)(e);
7. written
procedures regarding complaints and grievances, as required by 606 CMR
3.04(3)(j);
8. personnel policies,
as required by 606 CMR 3.04(6)(a);
9. job descriptions, as required by 606 CMR
3.04(6)(c);
10. salary ranges, as
required by 606 CMR 3.04(6)(d);
11.
plan for using volunteers, as required by 606 CMR 3.04(6)(g);
12. a plan for staff orientation and training
as required by 606 CMR 3.04(7);
13.
written plan for referral services, as required by 606 CMR
3.05(1)(j);
14. written agreement
with the placement agency, purchaser of services and parent or guardian, as
required by 606 CMR 3.05(2)(d);
15.
evidence of ability to comply with 606 CMR 3.05(4)(a), including a copy of the
advanced degree person's resume;
16. plan for family work, as required by 606
CMR 3.06(2);
17. plan for social,
psychological and psychiatric services, as required by 606 CMR
3.06(3);
18. a plan for meeting the
emergency medical needs of children and evidence of access to emergency mental
health services for children, as required by 606 CMR 3.06(4)(a) and
3.06(3)(a);
19. plan for health
services, as required by 606 CMR 3.06(4);
20. evidence of access to schools for the
provision of any necessary educational services;
21. plan for administration of medication, as
required by 606 CMR 3.06(4)(k);
22.
plan for educational services, as required by 606 CMR 3.06(5);
23. plan for vocational services, as required
by 606 CMR 3.06(6);
24. plan for
recreational services, as required by 606 CMR 3.06(7);
25. plan for follow-up services, as required
by 606 CMR 3.06(12);
26. plan for
nutritional services, as required by 606 CMR 3.07(6);
27. description of rules for behavior
support, as required by 606 CMR 3.07(7);
28. allowance policy, as required by 606 CMR
3.07(8)(b);
29. visiting, mail and
telephone policies, as required by 606 CMR 3.07(9) including procedures
required by 606 CMR 3.07(9)(f)1. and 2.;
30. runaway procedures, as required by 606
CMR 3.07(10);
31. written policy
describing search procedures, as required by 606 CMR 3.07(11);
32. plan for transportation, as required by
606 CMR 3.07(12), including documentation of insurance coverage, as required by
606 CMR 3.07(12)(g);
33. a current
Certificate of Inspection or Use and Occupancy Permit issued by the Department
of Public Safety or the local building inspector, as required by 606 CMR
3.08(1)(a);
34. a written report
from the appropriate health inspector documenting that the facility or program
is in compliance with
105 CMR 410.000:
Minimum Standards of Fitness for Human Habitation (State Sanitary Code,
Chapter II) as required by 606 CMR 3.08(1)(b);
35. documentation that the facility or
program has had a fire inspection from the local fire department, as required
by 606 CMR 3.08(1)(c);
36. a
written plan detailing procedures for meeting potential emergencies as required
by 606 CMR 3.08(2)(a);
37. written
documentation of lead-free paint inspection if applicable, on the approved form
as required by 606 CMR 3.08(4)(b);
38. written plan for monitoring student
safety around swimming areas, if applicable, as required by 606 CMR
3.08(5)(g);
39. evidence of
compliance with St. 1983, c. 233, Revenue Enforcement and Protection Program
(REAP) on a form provided by the Department with the initial
application;
40. the applicant's
completed CORI affidavit.
(b) In addition, applications for licensure
of temporary shelter home programs must include the following:
1. written statement identifying
qualifications of shelter home parents as required by 606 CMR
3.09(2);
2. written physical
requirements for shelter homes as required by 606 CMR 3.09(3);
3. written plan for orientation of shelter
home parents as required by 606 CMR 3.09(4);
4. written procedures for completion of
shelter home assessments and approval of shelter homes as required by 606 CMR
3.09(5);
5. written plan for
ongoing training of shelter home parents as required by 606 CMR
3.09(8);
6. general shelter home
parent agreement and agreement upon placement of an individual child as
required by 606 CMR 3.09(9)(a) and (b).
