Current through Register No. 40, October 3, 2024
(a) All applicants
for licensure shall complete and submit an application form to the department,
which includes:
(1) Whether the application is
for a new, renewed, or revised license;
(2) Whether the program will operate a group
home, child care institution, independent living home, homeless youth shelter,
or specialized care program;
(3)
Whether the applicant, owner, or business organization intends to provide
short-term placements;
(4) The
name, physical address, mailing address, and telephone number of the
program;
(5) The name, telephone
number, and mailing address of the applicant, owner, or business
organization;
(6) An e-mail address
for the program and the applicant, owner, or business organization, if
available;
(7) Federal tax
identification number if one has been assigned;
(8) A list of all buildings in which
residents will be cared for which identifies:
a. The building identifier;
b. The building's purpose or
function;
c. The type(s) of
residential child care services that the applicant, owner or business
organization intends to offer in the building as specified in He-C
4001.02(a)(2) above; and
d. The
proposed number of residents and age range to be cared for in each residential
building;
(9) The total
requested resident capacity of the program;
(10) How the program is owned and organized,
whether private, partnership, or other organization type, including name of
business organization, business identification number, and the names,
title/position, and telephone numbers of the officers of the business or board
members, if applicable;
(11)
Whether the program will be operating as for-profit or non-profit;
(12) The name, birth name(s), and date of
birth of the program director;
(13)
The qualifications of the program director, including education and
experience;
(14) For persons who
have contact with residents in the residential child care program, more than 5
hours per week, excluding residents who are admitted to the program, and
including any applicant, owner, officer of the business organization, program
director, executive director, board member, household member, program staff,
intern, volunteer or any other individual in the state of New Hampshire or the
United States, information and details disclosed by the individual on their
application for employment, or otherwise known by the program, regarding the
following:
a. Criminal convictions in a state
other than New Hampshire;
b.
Current criminal investigations in any state;
c. Current investigations of child abuse or
neglect in any state;
d. Previous
findings of child abuse or neglect in a state other than New
Hampshire;
e. Current investigation
of juvenile delinquency for juvenile household members; and
f. Previous adjudications of juvenile
delinquency for juvenile household members;
(15) The information required by (14) above
shall include:
a. The name and position or
affiliation of the individual;
b.
Whether this information is a charge, allegation, conviction, finding, or
current investigation;
c. The name
and city of the court of DCFY office in which the case was handled, as
applicable; and
d. The date of any
conviction or finding;
(16) A statement dated and signed by the
program director and the applicant, or an individual legally authorized to sign
for the applicant attesting to the following:
"I HAVE READ AND AM IN COMPLIANCE WITH ALL APPLICABLE RULES
IN He-C 4001";
"I UNDERSTAND THAT THE DEPARTMENT MAY INVESTIGATE ANY
CRIMINAL CONVICTION RECORD, FINDING OF CHILD ABUSE OR NEGLECT, OR INVESTIGATION
OF OR FINAL DETERMINATION REGARDING ANY JUVENILE DELINQUENCY AND WILL MAKE A
DETERMINATION REGARDING WHETHER THE INDIVIDUAL POSES A CURRENT RISK TO THE
HEALTH, SAFETY OR WELL BEING OF CHILDREN";
"I UNDERSTAND THAT THE DEPARTMENT MAY DELAY ITS DECISION TO
APPROVE OR DENY THIS APPLICATION PENDING THE OUTCOME OF ANY INVESTIGATION, WHEN
THE APPLICANT, OWNER, OR PROGRAM DIRECTOR, ARE NAMED AS THE PERPETRATOR IN ANY
CURRENT INVESTIGATION OF ANY CRIME, OR IN AN ALLEGATION OF ABUSE OR
NEGLECT";
"I UNDERSTAND THAT PROVIDING FALSE INFORMATION ON THIS
APPLICATION OR ANY OF THE ATTACHMENTS, OR FAILING TO DISCLOSE ANY INFORMATION
REQUIRED ON THE APPLICATION, OR REQUIRED TO BE SUBMITTED WITH THIS APPLICATION,
SHALL BE CONSIDERED GROUNDS FOR LICENSE DENIAL OR REVOCATION";
"I HAVE READ THE NH RESIDENTIAL CHILD CARE PROGRAM
LICENSING RULES, AND UNDERSTAND THAT FAILURE TO MAINTAIN MY PROGRAM IN
COMPLIANCE WITH THE APPLICABLE RULES, MAY JEOPARDIZE MY LICENSE/PERMIT";
"I AUTHORIZE ANY POLICE DEPARTMENT, COURT SYSTEM OR HUMAN
SERVICE AGENCY IN THIS OR ANY OTHER STATE TO RELEASE COPIES OF ANY CRIMINAL
RECORDS OR CHILD ABUSE OR NEGLECT RECORDS TO THE DEPARTMENT"; and
"ALL INFORMATION PROVIDED AS PART OF THIS APPLICATION AND
IN THE REQUIRED ATTACHMENTS IS TRUE AND COMPLETE TO THE BEST OF MY
KNOWLEDGE";
(17) The
position of the individual who signed pursuant to (16) above, such as
applicant, board president, board secretary, executive director, or program
director;
(18) For each building, a
floor plan diagram of indoor residential childcare space which shall specify:
a. Room dimensions;
b. Location of exits;
c. How each room will be used;
d. The location of bathrooms and bathroom
fixtures, including toilets, sinks, bathtubs, and showers;
e. The location of other hand-washing sinks;
and
f. The length, width, and
ceiling height of each bedroom;
(19) For each building, a diagram of outdoor
play and recreation space which shall specify:
a. The overall dimensions of the outdoor play
space including the length and width of the space;
b. The locations of exits, gates, and
stationary outdoor play or recreation equipment, including the location of and
type of fencing, if any, including gates;
c. The location of the outdoor play space in
relation to the indoor space; and
d. The location and description of any
outdoor water and street hazards including the presence of and location of any
pools, ponds, streams, rivers, streets, roads, or other hazards that are in
close proximity;
(20)
For renewal or revisions applications, diagrams as specified in (18) and (19)
above if changes have been made in the residential child care space since the
last application submitted to the department; and
(21) For renewal or revision applications, a
check mark in the box on the form, indicating when no changes have been made to
residential child care space since the last application submitted to the
department.
(b)
Residential child care programs that have multiple buildings on the same or
adjoining property may apply for a single license for those multiple buildings
provided that:
(1) In accordance with
residential child care space requirements specified in
He-C
4001.16, each residence has adequate square footage,
common living space, and complete bathroom units for the number of residents
who will reside in each building;
(2) An individual who meets at least the
minimum qualifications of a direct care staff is designated in charge in each
building; and
(3) All program staff
and residents are aware of the identity of the direct care staff who is
designated in charge in each building.
(d) With the application,
the applicant shall submit to the department a completed "NH State Fire Code
compliance report" documenting that, within the 12 months of the date the
department receives the application, the premises have been inspected by the
local fire department or the state fire marshal's office, for compliance with
the applicable parts and sections of the State Fire Code, under
RSA 153:1,
VI-a, and Saf-FMO 300, including but not
limited to NFPA 1 and NFPA 101, and as amended by the state board of fire
control and ratified by the general court pursuant to
RSA 153:5,
and approved to operate as a residential child care program.
(e) The "NH State Fire Code compliance
report" required under (d) above shall include the following:
(1) Completed by either program personnel or
the fire inspector:
a. The name, address,
telephone number, and license number of the residential child care
program;
b. The name of the
applicant;
c. The type of
residential child care to be provided; and
d. The number and age range of residents for
whom the applicant intends to provide care; and
(2) Completed by the fire inspector:
a. The date the premises were inspected by
the fire inspector;
b. For each
building which will be used by residents:
1.
An indication regarding whether the fire inspector approves or does not approve
the premises to operate as a residential child care program;
2. Any areas of non-compliance with the State
Fire Code, under
RSA 153:1,
VI-a, Saf-C 6000, and Saf-FMO 300, including
but not limited to NFPA 1 and NFPA 101, and as amended by the state board of
fire control and ratified by the general court pursuant to
RSA 153:5;
and
3. Any conditions or
restrictions placed by the fire inspector, including but not limited to, any
limits relative to the number and age range of residents to be cared for in the
program or any rooms, levels, or other areas of the premises not approved for
use by residents;
c. An
indication whether or not the fire inspector approves, does not approve, or
grants a conditional approval for the residential agency type(s) to
operate.
d. If a conditional
approval is granted, it shall include:
1. The
details regarding what action must be taken; and
2. The date the conditional approval will
expire;
e. The printed
name, address, telephone number, and title of the fire inspector;
f. The dated signature of the fire inspector;
and
g. The city or town in which
the fire inspector has authority.
(g) The
zoning documentation required in (f) above shall include the following:
(1) The name and address of the
program;
(2) The name of the
applicant;
(3) Any zoning
requirements or restrictions imposed by the town or city regarding the
existence of the program, including any limits regarding ages or number of
residents to be cared for in the program, and any buildings on the property
that do not have zoning approval; and
(4) The signature of an individual authorized
to sign on behalf of zoning, and date signed.
(j) The documentation of education and
experience required under (i) above shall include the following:
(1) Copies of transcripts, certificates,
diplomas, or degrees as applicable; and
(2) A resume or other documentation of
previous experience.
