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317:40-5-40. Home profile process

Revised 9-1-21

(a) Applicability.  This Section establishes procedures for the Developmental Disabilities Services (DDS) home profile process.  A home profile is required for:

(1) Agency companion services (ACS);

(2) Specialized foster care (SFC) services;

(3) Respite services delivered in the provider's home;

(4) Approving services in a home shared by a non-relative provider and a member; and

(5) Any other situation that requires a home profile.

(b) Pre-screening.  Designated DDS staff provides the applicant with program orientation and completes pre-screening activities to include, but are not limited to:

(1) Facts description, and guiding principles of the Home and Community-Based Services (HCBS) program;

(2) An explanation of:

(A) The home profile process;

(B) Basic provider qualifications;

(C) Health, safety, and environmental issues; and

(D) Training required per Oklahoma Administrative Code (OAC) 340:100-3-38;

(3) Gathering relevant information about the family, including household members, addresses, and contact information, and motivation to provide services; and

(4) An explanation of a background investigation conducted on the applicant and any adult or child living in the applicant's home.

(A) Background investigations are conducted at the time of application and include, but are not limited to:

(i) An Oklahoma State Bureau of Investigation (OSBI) name and criminal records history search, including the Oklahoma Department of Public Safety (DPS), Sex Offender Registry, Mary Rippy Violent Offender Registries, and Nurse Aide and Non-technical Services Worker Registry;

(ii) Federal Bureau of Investigation (FBI) national criminal history search, based on the fingerprints of the applicant and any adult members of the household; except when an exception is necessary as outlined below.

(I) When fingerprints are low quality (as determined by OSBI, FBI, or both) and make it impossible for the national crime information databases to provide results, a name-based search (state, national, or both) may be authorized.

(II) When the DDS State Office residential staff request an exception from an individual, who has a severe physical condition precluding the individual from being fingerprinted, a name-based search (state, national, or both) may be authorized. 

(iii) Search of any involvement as a party in a court action;

(iv) Search of all OKDHS records, including Child Welfare Services records, Community Services Worker Registry, and Restricted Registry;

(v) A search of all applicable out-of-state child abuse and neglect registries for any applicant or adult household member who has not lived in Oklahoma continuously for the past five (5) years.  A home is not approved without the results of the out-of-state child abuse and neglect registry checks, when a registry is maintained in the applicable state, for all adult household members living in the home.  When a child abuse and neglect registry is not maintained in the applicable state, a request for information is made to the applicable state; and

(vi) Search of Juvenile Justice Information System (JOLTS) records for any child older than thirteen (13) years of age in the applicant's household.

(B) An application is denied when the applicant or any person residing in the applicant's home:

(i) Has a criminal conviction of or pled guilty or no contest to:

(I) Physical assault, battery, or a drug-related offense in the five-year period preceding the application date;

(II) Child abuse or neglect;

(III) Domestic abuse;

(IV) A crime against a child, including, but not limited to, child pornography;

(V) A crime involving violence, including, but not limited to, rape, sexual assault, or homicide, including manslaughter, excluding physical assault and battery; or

(ii) Does not meet OAC 340:100-3-39 requirements;

(c) Home profile process.  When the applicant meets the requirements of the prescreening, the initial home profile process described in (1) through (8) of this subsection is initiated.

(1) The applicant provides required information for the completion of the home profile.

(2) When an incomplete form or other information is returned to DDS, designated DDS staff sends a letter to the provider or provider agency identifying information needed to complete the required forms.  The home profile is not completed until all required information is provided to DDS.

(3) Designated DDS staff completes the home profile when all required forms are completed and provided to DDS.

(4) For each reference provided by the applicant, designated DDS staff documents the results of each completed reference check.

(5) Designated DDS staff, through interviews, visits, and phone calls, gathers information required to complete the home profile.

(6) DDS staff review policies and areas of responsibilities with the applicant and acknowledgment is made in writing by the applicant and designated DDS staff.

(7) The DDS area residential services programs manager sends to the applicant:

(A) A provider approval letter confirming the applicant is approved to serve as a provider; or

(B) A denial letter stating the application and home profile are denied.

(8) DDS staff records the dates of completion of each part of the home profile process.

(d) Home standards.  In order to qualify and remain in compliance, the applicant's or provider's home must meet the provisions in (1) through (11) of this subsection.

(1) General conditions.

(A) The home, buildings, and furnishings must be comfortable, clean, and in good repair and the grounds must be maintained.  There must be no accumulation of garbage, debris, or rubbish or offensive odors.

(B) The home must:

(i) Be accessible to school, employment, church, day programming, recreational activities, health facilities, and other community resources as needed;

(ii) Have adequate heating, cooling and plumbing; and

(iii) Provide space for the member's personal possessions and privacy;

(iv) Allow adequate space for the recreational and social needs of the occupants.  

(C) Provisions for the member's safety must be present, as needed, including:

(i) Guards and rails on stairways;

(ii) Wheelchair ramps;

(iii) Widened doorways;

(iv) Grab bars;

(v) Adequate lighting;

(vi) Anti-scald devices; and

(vii) Heat and air conditioning equipment guarded and installed in accordance with manufacturer requirements.  Home modifications and equipment may be provided through HCBS Waivers operated by DDS.

(D) Providers must not permit members to access or use swimming or other pools, hot tubs, saunas, ponds, or spas on the premises without supervision.  Swimming pools, hot tubs, saunas, ponds, or spas must be equipped with sufficient safety barriers or devices designed to prevent accidental injury or unsupervised access.

(E) The household must be covered by homeowner's or renter's insurance including personal liability insurance.

(2) Sanitation.

(A) Sanitary facilities must be adequate and safe, including toilet and bathing facilities, water supply, and garbage and sewer disposal.

(B) When a septic tank or other non-municipal sewage disposal system is used, it must be in good working order.

(C) Garbage and refuse must be stored in readily cleanable containers, pending weekly removal.

(D) Sanitation for household pets and other domestic animals must be adequate to prevent health hazards.

(i) Proof of rabies or other vaccinations as required by a licensed veterinarian for household pets must be maintained on the premises.

(ii) Pets not confined in enclosures must be under control and not present a danger to members or guests.

(E) There must be adequate control of insects and rodents, including screens used for ventilation in good repair on doors and windows.

(F) Universal precautions for infection control must be followed in care to the member.  Hands and other skin surfaces must be washed immediately and thoroughly when contaminated with blood or other body fluids.

(G) Laundry equipment, if in the home, must be located in a safe, well-ventilated, and clean area, with the dryer vented to the outside.

(3) Bathrooms.  A bathroom must:

(A) Provide for individual privacy and have a finished interior;

(B) Be clean and free of objectionable odors; and

(C) Have a bathtub or shower, flush toilet, and sink in good repair, and hot and cold water in sufficient supply to meet the member's hygiene needs.

(i) A sink must be located near each toilet.

(ii) A toilet and sink must be provided on each floor where rooms of members who are non-ambulatory or with limited mobility are located.

(iii) There must be at least one (1) toilet, one (1) sink, and one (1) bathtub or shower for every six (6) household occupants, including the provider and family.

(4) Bedrooms.  A bedroom must:

(A) Have been constructed as such when the home was built or remodeled under permit;

(B) Be provided for each member.

(i)Exception to allow members to share a bedroom may be made by DDS area residential program manager, when DDS determines sharing a bedroom is in the best interest of the member.

(ii) A member must not share a bedroom with more than one (1) other person;

(iii) Minor members must not share bedrooms with adults.

(C) Have a minimum of eighty (80) square feet of usable floor space for each member or one-hundred and twenty (120) square feet for two (2) members and two (2) means of egress.  The provider, family members, or other occupants of the home must not sleep in areas designated as common use living areas, nor share bedrooms with members;

(D) Be finished with walls or partitions of standard construction that go from floor to ceiling;

(E) Be adequately ventilated, heated, cooled, and lighted;

(F) Include an individual bed for each member consisting of a frame, box spring, and mattress at least thirty-six (36) inches wide, unless a specialized bed is required to meet identified needs. Cots, rollaways, couches, futons, and folding beds must not be used for members.

(i) Each bed must have clean bedding in good condition consisting of a mattress pad, bedspread, two (2) sheets, pillow, pillowcase, and blankets adequate for the weather.

(ii) Sheets and pillowcases must be laundered at least weekly or more often if necessary.

(iii) Waterproof mattress covers must be used for members who are incontinent;

(G) Have sufficient space for each member's clothing and personal effects, including hygiene and grooming supplies.

(i) Members must be allowed to keep and use reasonable amounts of personal belongings and have private, secure storage space.

(ii) The provider assists the member in furnishing and decorating the member's bedroom.

(iii) Window coverings must be in good condition and allow privacy for members;

(H) Be on ground level for members with impaired mobility or who are non-ambulatory; and

(I) Be in close enough proximity to the provider to alert the provider to nighttime needs or emergencies, or be equipped with an alert system.

(5) Food.

(A) Adequate storage must be available to maintain food at the proper temperature, including a properly working refrigerator.  Food storage must be such that food is protected from dirt and contamination and maintained at proper temperatures to prevent spoilage.

(B) Utensils, dishes, glassware, and food supplies must not be stored in bedrooms, bathrooms, or living areas.

(C) Utensils, dishes, and glassware must be washed and stored to prevent contamination.

(D) Food storage and preparation areas and equipment must be clean, free of offensive odors, and in good repair.

(6) Phone.

(A) A working phone must be provided in the home that is available and accessible for the member's use for incoming and outgoing calls.

(B) Phone numbers to the home and providers must be kept current and provided to DDS and, when applicable, the provider agency.

(7) Safety.

(A) Buildings must meet all applicable state building, mechanical, and housing codes.

(B) Heating, in accordance with manufacturer's specifications, and electrical equipment, including wood stoves, must be installed in accordance with all applicable fire and life safety codes.  Such equipment must be used and maintained properly and in good repair.

(i) Protective glass screens or metal mesh curtains attached at top and bottom are required on fireplaces.

(ii) Unvented portable oil, gas, or kerosene heaters are prohibited.

(C) Extension cord wiring must not be used in place of permanent wiring.

(D) Hardware for all exit and interior doors must have an obvious method of operation that cannot be locked against egress.

(8) Emergencies.

(A) Working smoke detectors must be provided in each bedroom, adjacent hallways, and in two (2) story homes at the top of each stairway.  Alarms must be equipped with a device that warns of low battery condition, when battery operated.

(B) At least one (1) working fire extinguisher must be in a readily accessible location.

(C) A working flashlight must be available for emergency lighting on each floor of the home.

(D) The provider:

(i) Mainstays a working carbon monoxide detector in the home;

(ii) Mainstays a written evacuation plan for the home and conducts training for evacuation with the member;

(iii) Conducts fire drills quarterly and severe weather drills twice per year;

(iv) Makes fire and severe weather drill documentation available for review by DDS;

(v) Has a written back-up plan for temporary housing in the event of an emergency; and

(vi) Is responsible to re-establish a residence, if the home becomes uninhabitable.

(E) A first aid kit must be available in the home.

(F) The address of the home must be clearly visible from the street.

(9) Special hazards.

(A) Firearms and other dangerous weapons must be stored in a locked permanent enclosure.  Ammunition must be stored in a separate locked location.  Providers are prohibited from assisting members to obtain, possess, or use dangerous or deadly weapons, per OAC 340:100-5-22.1.

(B) Flammable and combustible liquids and hazardous materials must be safely and properly stored in original, properly labeled containers.

(C) Cleaning supplies, medical sharps containers, poisons, and insecticides must be properly stored in original, properly labeled containers in a safe area away from food, food preparation areas, dining areas, and medications.

(D) Illegal substances are not permitted on the premises.

(10) Vehicles.

(A) All vehicles used to transport members must meet local and state requirements for accessibility and safe transit, licensing, inspection, insurance, and capacity.

(B) Drivers of vehicles must have valid and appropriate driver licenses.

(11) Medication.  Medication for the member is stored, per OAC 340:100-5-32.

(e) Evaluating the applicant and home.   • 1  The initial home profile evaluation includes, but is not limited to:

(1) Evaluating the applicant's:

(A) Interest and motivation;

(B) Life skills;

(C) Children;

(D) Methods of behavior support and discipline;

(E) Marital status, background, and household composition;

(F) Income and money management; and

(G) Teamwork and supervision, back-up plan, and use of relief; and

(2) Assessment and recommendation.  DDS staff:

(A) Evaluates the ability of the applicant to provide services;

(B) Assesses the overall compatibility of the applicant and the service recipient, ensuring the lifestyles and personalities of each are compatible for the shared living arrangement. The applicant must:

(i) Express a long term commitment to the service   member unless the applicant will only be providing respite services;

(ii) Demonstrate the skills to meet the individual needs of the member;

(iii) Express an understanding of the commitment required as a provider of services;

(iv) Express an understanding of the impact the arrangement will have on personal and family life;

(v) Demonstrate the ability to establish and maintain positive relationships, especially during stressful situations; and

(vi) Demonstrates the ability to work collaboratively and cooperatively with others in a team process;

(C) Approves only applicants who can fulfill the expectations of the role of service provider;

(D) When the applicant does not meet standards, per OAC 317:40-5-40, ensures the final recommendation includes:

(i) A basis for the denial decision; and

(ii) An effective date for determining the applicant does not meet standards.  Reasons for denying a request to be a provider may include, but are not limited to:

(I) A lack of stable, adequate income to meet the applicant's own or total family needs or poor management of the available income;

(II) A physical facility that is inadequate to accommodate the addition of a member to the home or presents health or safety concerns;

(III) The age, health, or any other condition of the applicant that impedes the applicant's ability to provide appropriate care for a member;

(IV) Relationships in the applicant's household that are unstable and unsatisfactory;

(V) The mental health of the applicant or other family or household member that impedes the applicant's ability to provide appropriate care for a member;

(VI) References who are guarded or have reservations in recommending the applicant;

(VII) The applicant failed to complete the application, required training, or verifications in a timely manner as requested or provided incomplete, inconsistent, or untruthful information;

(VIII) The home is determined unsuitable for the member requiring placement;

(IX) Confirmed abuse, neglect, or exploitation of any person;

(X) Breach of confidentiality;

(XI) Involvement of the applicant or provider involvement in criminal activity or criminal activity in the home;

(XII) Failures to complete training, per OAC 340:100-3-38;

(XIII) Failures of the home to meet standards per subsection (d) of this Section; and

(XIV) Failures to follow applicable OKDHS or Oklahoma Health Care Authority (OHCA) rules;

(E) Notifies the applicant in writing of the final approval or denial of the home profile;

(F) When an application is canceled or withdrawn prior to completion of the home profile, completes a final written assessment that includes the:

(i) Reason the application was canceled or withdrawn;

(ii) DDS staff's impression of the applicant based on information obtained; and

(iii) Effective date of cancellation or withdrawal. Written notice is sent to the applicant to confirm cancellation or withdrawal of the application, and a copy is included in local and State Office records.

(f) Frequency of evaluation. Home profile evaluations are completed for initial approval or denial of an applicant. After an initial approval, a home profile review is conducted annually and as needed for compliance and continued approval. DDS area residential services staff conduct at least biannual home visits to specialized foster care providers. The annual home profile review is a comprehensive review of the living arrangement, the provider's continued ability to meet standards, the needs of the member and the home to ensure ongoing compliance with home standards. A home profile review is conducted when a provider notifies DDS of his or her intent to move to a new residence. DDS staff assesses the home to ensure the new home meets home standards and is suitable to meet the member's needs. The annual home profile review;

(1) Includes information specifically related to the provider's home and is documented, as an annual review;

(2) Includes a medical examination report completed a minimum of every three (3) years following the initial approval, unless medical circumstances warrant more frequent completion;

(3) Includes information from the DDS case manager, the provider of agency companion or SFC services, the Child Welfare specialist, Adult Protective Services, and Office of Client Advocacy staff, and the provider agency program coordinator when applicable.

(4) Includes information from the service member indicating satisfaction with service and a desire to continue the arrangement;

(5) Includes areas of service where improvement is needed;

(6) Includes areas of service where progress was noted or were of significant benefit to the member;

(7) Ensures background investigation, per OAC 317:40-5-40(b), is repeated every year, except for the OSBI and FBI national criminal history search;

(8) Ensures the FBI national criminal history search, per OAC 317:40-5-40(b)(4)(A)(ii), is repeated every five (5) years;

(9) Ensures written notification to providers and agencies, when applicable, of the continued approval of the provider.

(10) Includes written notification to providers and agencies, when the provider or agency fails to comply with the home standards, per OAC 317:40-5-40 including deadlines for correction of the identified standards.

(g) Reasons a home profile review may be denied include, but are not limited to:

(1) Lack of stable, adequate income to meet the provider's own or total family needs or poor management of available income;

(2) A physical facility that is inadequate to accommodate the addition of a member to the home or presents health or safety concerns;

(3) The age, health, or any other condition of the provider that impedes the provider's ability to provide appropriate care for a member;

(4) Relationships in the provider's household that are unstable and unsatisfactory;

(5) The mental health of the provider or other family or household member impedes the provider's ability to provide appropriate care for a member;

(6) The provider fails to complete required training, or verifications in a timely manner as requested or provides incomplete, inconsistent, or untruthful information;

(7) The home is determined unsuitable for the member;

(8) Failure of the provider to complete tasks related to problem resolution, as agreed, per OAC 340:100-3-27;

(9) Failure of the provider to complete a plan of action, as agreed, per OAC 317:40-5-63;

(10) Confirmed abuse, neglect, or exploitation of any person;

(11) Breach of confidentiality;

(12) Involvement of the applicant or provider involvement in the criminal activity or criminal activity in the home;

(13) Failure to provide for the care and well-being of the service member;

(14) Failure or continued failure to implement the individual Plan, per OAC 340:100-5-50 through 100-5-58;

(15) Failure to complete and maintain training, per OAC 340:100-3-38;

(16) Failure to report changes in the household;

(17) Failure to meet standards of the home per subsection (d) of this Section;

(18) Failure or continued failure to follow applicable OKDHS or OHCA rules;

(19) Decline of the provider's health to the point he or she can no longer meet the needs of the service member;

(20) Employment by the provider without prior approval of the DDS area programs manager for residential services; or

(21) Domestic disputes that cause emotional distress to the member.

(h) Termination of placement. When an existing placement is terminated for any reason:

(1) The Team meets to develop an orderly transition plan; and

(2) DDS staff ensures the property of the member and state is removed promptly and appropriately by the member or his or her designee.



Revised 2-9-15

1. Evaluating the applicant and home.

(1) Interest and motivation.  Explore the applicant's interest and motivation for providing services by asking the questions in (A) through (H) of this paragraph.

(A) How did the applicant learn about the applicable Home and Community-Based Services (HCBS) program?

(B) Is there an existing relationship between the applicant and a specific member for placement?  If so, explain the relationship.

(C) Why does the applicant wish to expand the applicant's family?

(D) Has the applicant ever had a home profile completed?  If so, when, where, and what were the results?

(E) Is assuming the care of a member, in part, an attempt to work through a loss or to repeat or replace a major relationship?

(F) What expectations does the applicant have for the member?

(G) Is the extended family supportive of the decision to participate in the applicable HCBS program?

(H) Has the applicant had experience with an individual with developmental disabilities?  If not, the applicant is made aware of the physical and emotional requirements of a person for whom the applicant may provide care.

(2) Applicant and any other adult in the home.  Knowledge of past experience and influences is vital in understanding the applicant's and other adult's current functioning.  Significant areas of study include:

(A) life skills and general attitudes of the applicant;

(B) childhood relationships with parents, siblings, relatives, or other meaningful persons, asking what each adult's childhood was like;

(C) experiences, such as death, illness, divorce, or poverty that had an impact on each person's attitudes, feelings, and expectations;

(D) whether the applicant ever knew anyone who was sexually or physically abused.  When so, the applicant's experience is explored in depth and information is included in Oklahoma Department of Human Services (OKDHS) Form 06AC047E, Home Profile Notes;

(E) concepts of appropriate behavior support and discipline and the manner in which behavior supports must be administered, especially as applied to persons with developmental disabilities;

(F) the meaning of education and training to the applicant;

(G) the general physical and emotional health of household members.

(i) Adult family members must complete DHS Form 06AC011E, Family Health History.

(ii) When a household member has a physical disability, does the disability affect the ability to function as a provider of services providing adequate care and supervision?  When yes, in what manner?

(iii) Do any household members experience a medical or emotional condition?  Is any household member under professional care for any condition that requires the use of prescribed drugs or narcotics?  If any household member uses prescribed drugs or narcotics, explore the extent of the use;

(H) the emotional abilities of family members to provide services.

(i) If any household member previously received psychiatric or psychological counseling, the circumstances and results must be explored in depth.

(ii) A release of information is obtained allowing contact with the person who provided the counseling;

(I) the applicant's physical description;

(J) an employment record regarding work stability and satisfaction derived from employment;

(K) social relationships with members of the community, including hobbies, skills, talents, and special interests;

(L) religious influences, affiliations, and activities.

(i) Does the applicant have any specific religious beliefs that may affect a member in areas, such as dress code, holiday observances, medical care, daily living, or social activities?

(ii) Will the applicant ensure the member is able to attend the member's choice of place of worship as often as desired and practice his or her faith as desired;

(M) the reaction to stressful situations;

(N) the current relationships within the family, including marital and parent-child relationships;

(O) the relationship with children, adults and minors, living outside of the home.  Adult children must be interviewed by DDS staff in writing, by phone, or in person;

(P) special training, ability, or experience in working with or caring for a person with physical disabilities, mental retardation, behavior problems, emotional disturbances, or other special needs;

(Q) guidelines for background investigations during annual reviews:

(i) yearly Oklahoma State Bureau of Investigation (OSBI) background checks are not necessary as RapBack serves the purpose for a yearly Oklahoma criminal background check for active, specialized foster parents and/or companion homes.

(ii) The Federal Bureau of Investigation does not have a program similar to OSBI RapBack and continued fingerprinting for national criminal history records checks is necessary for active, specialized foster parents and/or companion homes every five years.

(S) explanations of any arrests or convictions, including status of parole or probation, from information obtained from the required background investigation per OAC 317:40-5-40(b); and

(T) explanations of any allegations of abuse, neglect, or exploitation of child, adult, or animal.

(i) If there are no findings on the required searches, the absence of findings is stated as such on DHS Form 06ACO47E, Home Profile Notes.

(ii) A copy of background investigation searches and findings is included in local and State Office records.

(3) Children in the home.  Provide a description of children in the home regarding:

(A) age and physical appearance;

(B) personality, interests, and skills;

(C) strengths and problems in parent-child relationships, school adjustment, behavior, and health;

(D) ability to get along with other persons, especially persons with developmental disabilities;

(E) physical or developmental disabilities and health, including current immunizations;

(F) attitude toward having a relationship with a person who has developmental disabilities; and

(G) depending on age, attitude toward persons receiving services.

(4) Behavior support and discipline.  Applicants are advised on discipline and behavior management, per OAC 340:110-5-62, and individual planning and protective intervention, per OAC 340:100-5-50 through 340:100-5-57.

(A) DDS staff discusses with the applicant how he or she disciplines his or her natural children.

(i) When there is a divergence between DHS policy and the methods used to discipline natural children, DDS staff explores how the applicant will deal with any problems that may result from this difference.

(ii) DDS staff discusses with the applicant how the applicant was disciplined as a child and any effects it has on the applicant's attitude toward discipline.

(iii) From information obtained through training and discussion with the applicant, DDS staff documents the applicant's understanding and acceptance of applicable Oklahoma Health Care Authority (OHCA) or DHS policy on DHS Form 06AC047E, Home Profile Notes.  This information is considered in the final recommendation.

(iv) DDS staff determines whether there is agreement among all adults in the household on methods of discipline.

(v) Any applicant who does not agree to abide by applicable OHCA or DHS policy is not approved to provide services.

(B) Members may require behavior supports.  An Individual Plan (IP) is developed by the Personal Support Team (Team) that includes the service provider.

(C) Prohibited procedures, per OAC 340:100-5-58, must be upheld in the home.

(5) Marital status and background, household composition, and children.  DDS staff documents aspects of the applicant's marital status.

(A) Current marriage, when applicable.  DDS staff describes the applicant's marriage regarding:

(i) the length of the present marriage;

(ii) the stability of the marriage;

(iii) the methods used to resolve marital problems; and

(iv) whether the decision to become a provider is a joint decision.

(B) Previous marriage, when applicable.  DDS staff discusses with the provider, his or her previous marriage regarding the:

(i) number and lengths of the previous marriages;

(ii) reason the marriages ended; and

(iii) children involved, visitation, and child support arrangements, if applicable.

(C) Single or never married.  When the applicant is not married, DDS staff discusses the:

(i) best and most difficult aspects of being single;

(ii) applicant's source of support; and

(iii) significant adult relationships in the applicant's life.

(6) Income and money management.  Verification of income and expenses is required.

(A) DHS Form 06AC009E, Financial Assessment, must be completed.

(B) Any financial problem areas are discussed and included in DHS Form 06AC047E.

(C) The applicant, and family when applicable, shows financial stability by being able to pay their bills and to live within their financial means.

(7) Teamwork and supervision, back-up plan, and use of relief.  DHS Form 06AC047E includes a brief description of the:

(A) fundamental responsibility of DHS to meet the member's physical, emotional, and medical needs;

(B) responsibility of the provider for the member's daily care ensuring all areas of need are met;

(C) primary responsibility of Child Welfare Services staff and the DDS case manager as liaisons in all planning with the member, natural family, provider, Team, provider agency, and court, as applicable;

(D) situations necessitating placement;

(E) varying lengths of time for which members require services;

(F) characteristics of members requiring services;

(G) differences between service provision and adoption;

(H) importance of teamwork in:

(i) working toward member reunification with his or her biological family, if appropriate; or

(ii) when reunification is not possible, developing an alternative permanent plan for the member; and

(I) OHCA and DHS policies and procedures regarding:

(i) room and board payments;

(ii) clothing provisions;

(iii) medical care;

(iv) behavior support;

(v) confidentiality;

(vi) education; and

(vii) religious training.

2.   Consultation.  Consultation may be obtained from the DDS area residential programs manager, area manager, or State Office residential programs manager in the assessment and recommendation process.

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