Search results with tag "California department of social services"
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES …
www.cdss.ca.govstate of california - health and human services agency california department of social services emergency disaster plan for residential care facilities for the elderly name of facility fax number name(s) of staff title assignment administrator of facility facility address (number, street, city, state, zip code) telephone number ( ) ( )
GROUP HOMES - California Department of Social Services
www.cdss.ca.govManual of Policies and Procedures COMMUNITY CARE LICENSING DIVISION GROUP HOMES Division 6 Chapter 5 STATE OF CALIFORNIA Arnold Schwarzenegger, Governor HEALTH AND HUMAN SERVICES AGENCY S. Kimberly Belshé, Secretary DEPARTMENT OF SOCIAL SERVICES Tameron Mitchell, Chief Deputy Director Distributed Under the Library …
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES …
www.cdss.ca.govSTATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES . FAMILY CHILD CARE CONSUMER AWARENESS INFORMATION . Family Child Care (FCC) is provided by the home of a licensed provider for up to eight children with one adult or up to 14 children with one adult and one assistant. FCC …
STATE OF CALIFORNIA–HEALTH AND HUMAN SERVICES …
www.cdss.ca.govstate of california–health and human services agency california department of social services student financial aid statement welfare-to-work supportive services
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES …
cdss.ca.govSTATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES . EMERGENCY DISASTER PLAN FOR . INSTRUCTIONS: CHILD CARE CENTERS Post a copy in a prominent location in facility, near telephone. Licensee is responsible for updating information as required. Return a copy to the …
PROVIDER NUMBER IN-HOME SUPPORTIVE SERVICES …
www.cdss.ca.govIN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM PROVIDER WORKWEEK & TRAVEL TIME AGREEMENT (To be completed by a provider who provides authorized services to multiple recipients) PROVIDER NUMBER _____ STATE OF CALIFORNIA − HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES SOC 2255 …
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM …
www.cdss.ca.govSTATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY. CALIFORNIA DEPARTMENT OF SOCIAL SERVICES. IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM RECIPIENT DESIGNATION OF PROVIDER. INSTRUCTIONS: • Use black or blue ink. Print information clearly. • You (or your authorized representative) must complete PART A …
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES …
www.cdss.ca.govstate of california - health and human services agency california department of social services “safely surrendered baby” medical questionnaire
PARENT CONSENT FOR ADMINISTRATION OF …
www.cdss.ca.govstate of california - health and human services agency california department of social services. parent consent for administration of medications and medication chart note: regulation section 101221 requires the following information be on file. child care center name: child’s name. medication name. date of birth. dosage. beginning date ...
SOC817: Checklist of Health and Safety Standards for ...
www.cdss.ca.govCaregiver Name: _____ STATE OF CALIFORNIA --HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES . Checklist of Health and Safety Standards for Approval of Family Caregiver Home Pursuant to Division 31MPP Section 31, -445, in order to be approved, all Relative & Non-Relative Extended
PARENTAL CONSENT TO ADOPTION Original: Court Record …
www.cdss.ca.govstate of california — health and human services agency california department of social services parental consent to adoption (in or out-of-california)
RELEASE OF CLIENT/RESIDENT MEDICAL INFORMATION
www.cdss.ca.govstate of california — health and human services agency california department of social services community care licensing release of client/resident
APPLICANT’S AUTHORIZATION FOR RELEASE OF …
www.cdss.ca.govstate of california - health and human services agency california department of social services . applicant’s authorization for release of information
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM AND …
www.cdss.ca.govState of California – Health and Human Services Agency California Department of Social Services SOC 2298 (1/19) Page 2 of 2 Instructions for filling out the Live-In Self-Certification Form 1. All requested information must be entered in English on the form in the designated area. 2. You must sign the form on the designated line. 3.
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM …
www.cdss.ca.govstate of california - health and human services agencies . california department of social services . in-home supportive services (ihss) program individualized back-up plan and risk assessment . section 1 – recipient’s information . recipient’s name: case number: individualized back-up plan . section 2 – support contacts
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM PROVIDER …
www.cdss.ca.govstate of california - health and human services agency california department of social services. in-home supportive services (ihss) program provider or recipient
COMMUNITY CARE LICENSING EVALUATION OF DIRECTOR …
www.cdss.ca.govdirector copy state of california - health and human services agency california department of social services community care licensing evaluation of director qualifications
CALFRESH SUPPLEMENTAL FORM FOR SPECIAL MEDICAL …
www.cdss.ca.govSTATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES CF 31 (4/15) Recommended Form PAGE 2 OF 2 The supplemental form for special medical deductions is for any CalFresh household member who is elderly or disabled.
Initial Application for Calfresh , Cash Aid , and/or Medi ...
www.cdss.ca.govSTATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES . INITIAL APPLICATION FOR CALFRESH , CASH AID , AND/OR MEDI-CAL/HEALTH CARE PROGRAMS . If you have a disability or need help with this application, let the County Welfare Department (County) know and someone will help you.
REQUEST FOR VERIFICATION CASE NAME: CASE NUMBER
cdss.ca.govCALIFORNIA DEPARTMENT OF SOCIAL SERVICES ... If you need the county to help get the proof, fill out the “Authorization for Release of Information” form and return it ... SIGNATURE OF APPLICANT/RECIPIENT DATE IF THIS IS FOR INFORMATION OF A MINOR, ENTER RELATIONSHIP TO MINOR
RESIDENTIAL FACILITIES, RESIDENTIAL INSTRUCTIONS: CARE ...
www.cdss.ca.govstate of california - health and human services agency . california department of social services . emergency disaster plan for adult day programs, adult residential facilities, residential care facilities for the chronically ill and social rehabilitation facilities . instructions: post a copy in a prominent location in facility, near telephone.
ADMISSION AGREEMENT GUIDE FOR RESIDENTIAL …
www.cdss.ca.govstate of california - health and human services agency california department of social services community care licensing. admission agreement guide for residential facilities note: this is a guide only and is not to be used as an admission agreement.
PREPLACEMENT APPRAISAL INFORMATION
www.cdss.ca.govstate of california - health and human services agency california department of social services community care licensing preplacement appraisal information
EMERGENCY PLAN FOR FOSTER FAMILY HOMES
www.cdss.ca.govcrisis center: state of california - health and human services agency california department of social services community care licensing emergency plan for foster family homes
Range of Motion - California Department of Social Services
www.cdss.ca.govMotion Range of Motion, or ROM is the range through which a joint can be moved. Before your injury you usually moved your joints many times during the day. After a spinal cord injury you may move less. Without movement your joints can become tight. Your movement may be limited because of this tightness. An increase in resistance to stretching can
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES …
www.cdss.ca.govagency, after the telephone report is made; keep one copy for the reporter’s file. The receiving agency shall place the original copy in the case file and send a copy to the cross-reporting agency, if applicable. DO NOT SEND A COPY TO THE CALIFORNIA DEPARTMENT OF SOCIAL SERVICES ADULT PROGRAMS OPERATIONS BUREAU.
FACILITY SKETCH (Floor Plan)
www.cdss.ca.govFACILITY NAME: ADDRESS: LIC 999 (3/99) STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING . FACILITY SKETCH (Yard) The yard sketch should show all buildings in the yard including the home (with no detail), garage and storage building.
AR 2 - Reporting Changes for CalWORKs and CalFresh
www.cdss.ca.govSTATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES . REPORTING CHANGES FOR CalWORKs AND CALFRESH . CASE NAME: CASE NUMBER: WORKER NUMBER: Because you get CalWORKs, you must report within 10 days when your TOTAL income reaches a certain level. You must …
CHILD CARE FACILITY ROSTER (RETAIN FOR 3 YEARS) CHILD …
www.cdss.ca.govstate of california—health and human services agency california department of social services. child care facility roster (retain for 3 years)
LIC 503 Health Screening Report - Facility Personnel
www.cdss.ca.govDevelopmentally Disabled Physically Handicapped Children Elderly Mentally Disordered Drug/Alcohol Addiction Other(specify)_____ STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
InHome Supportive Services (IHSS) Program Provider ...
cdss.ca.govCALIFORNIA DEPARTMENT OF SOCIAL SERVICES. INHOME SUPPORTIVE SERVICES (IHSS) PROGRAM PROVIDER ENROLLMENT AGREEMENT. PROVIDER NUMBER PROVIDER NAME (FIRST, MIDDLE, LAST) 1. I attended the required provider enrollment orientation for IHSS providers and I understand and agree to the following:
IMPORTANT INFORMATION FOR PARENTS
www.cdss.ca.govThe California Department of Social Services works to protect the safety of children in child care by licensing child care centers and family child care homes. Our highest priority is to be sure that children ... fingerprints so that a background check can be done to see if they have any history of crime. If we
INSTRUCTIONS: PERSONNEL REPORT - California …
www.cdss.ca.govCALIFORNIA DEPARTMENT OF SOCIAL SERVICES. PERSONNEL REPORT INSTRUCTIONS: This form is intended for keeping a current roster of all the facility personnel, other adults and licensees residing in the facility, including backup persons, volunteers and licensee if administrator/director. Show license/certificate number if applicable for
Food Stampin' Dex - California Department of Social Services
www.cdss.ca.gov200-0B Federal Food Stamp Program renamed the “Supplementa lNutrition Assistance Program” or SNAP effective October 1, 2008. (ACL 08-37) 200-0C Food Stamp Program renamed the “CalFresh Program” (ACL 10-55) 200-1 Complaint procedure; reference to 22-100 (63-106.1) 200-2 CalFresh eligibility must be determined according to federal law
C4Yourself - California Department of Social Services
www.cdss.ca.govis a secure self-service, public-facing, web-based portal that streamlines the way data is collected by using a conversational interview approach. Information entered by applicants is transferred to the C-IV System automatically. Currently, C4Yourself accepts applications for the counties listed below. If you are assisting a
CHILD CARE CENTER - CDSS Public Site
www.cdss.ca.govCHILD CARE CENTER GENERAL LICENSING REQUIREMENTS This Users' Manual is issued as an operational tool. This Manual contains a) Regulations adopted by the California Department of Social Services (CDSS) for the governance
CW 61B (6/01) - California Department of Social Services
www.cdss.ca.govPlease indicate the extent, if any, that this person’s current mental condition would interfere with his/her ability to work or participate in
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES …
www.cdss.ca.govSTATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY . CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION . APPLICANT INFORMATION . This form must be completed by all applicants for a facility license, (i.e., all individuals, each partner in a partnership, or chief executive officer or authorized …
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES …
www.cdss.ca.govCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION. CRIMINAL RECORD EXEMPTION TRANSFER REQUEST. STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY. Activecriminal record exemptionsmay be transferred from one state licensed facility/organizationto another by a license applicantor …
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COUNTY …
www.cdss.ca.govROOMER . CW 8 (11/14) RECOMMENDED FORM . Page 2 of 6 . CA CF . 16 Is he/she working now or expecting to be working in the future? YES . NO . If “YES”, complete below. Attach paystubs or other proof of earnings. If job . hasn’t started what is the anticipated start date?
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