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September 17, 2001
TO: Child Placing Agencies and Juvenile Courts That Certify Foster Homes for Licensure
Report Format for Special EvaluationsSUBJECT:
MCL §722.113(4) of the Child Care Organizations Act of 1973 states: ?Inspection reports completed by state agencies, local authorities, and child placing agencies, shall be furnished to the department and shall become a part of its evaluation for licensing of organizations covered by this act?? The Bureau, in an attempt to assure consistency and a level of quality in reports, has moved to standardized formats for all reports. As a part of this move to standardized reporting formats, the expectation is that child placing agencies will begin using the same format for special evaluation reports as is used for investigations of other types of facilities licensed by the Bureau.
The required format, attached to this letter, is consistent with the requirements of Child Placing Agency Rule 400.12316 (5).
R 400.12316 Special evaluation.
(5) Upon completion of the evaluation, an agency shall prepare a written report that includes all of the following information:
(a) The date the information was received.
(b) Identification of the information source, unless anonymous or confidential, as specified in Act No. 238 of the Public Acts of 1975, as amended, being §722.621 et seq. of the Michigan Compiled Laws, and known as the child protection law.
(c) The allegations.
(d) Dates and places of contacts, names of persons interviewed, and names of the interviewers. If children are interviewed, their last names shall not be included in the report.
(e) Findings of fact, based upon the evaluation.
(f) Conclusions regarding licensing rules compliance or noncompliance based on the findings of fact.
(g) Any change in the agency's decision regarding the number, sex, age, race, ethnic background, and specific characteristics of children who may be placed that is based upon the documentation contained in the summary and conclusions of the report.
(h) Recommendations regarding licensing action and any required corrective action.
If there are any questions about Child Placing Agency Letter #2001-07, please call your Child Welfare Licensing Consultant or the Child Foster Home Licensing Unit at (517) 335-6108.
Sincerely,
Carole Hakala Engle, Director
Bureau of Regulatory Services
Attachment
CHILD PLACING AGENCY NAME
SPECIAL EVALUATION REPORT
I. IDENTIFYING INFORMATION
License Number:
Investigation Number:
Complaint Receipt Date:
Information Source:
Investigation Initiation Date:
Licensee Name:
Address:
Telephone Number:
Original License Date:
License Status:
Effective Date:
Expiration Date:
Licensed Capacity:
II. SUMMARY OF ALLEGATIONS
III. POTENTIAL RULE OR STATUTE VIOLATIONS (Identify all rules or sections of the Act, by rule name and number or section of the Act, that are alleged to be in violation.)
IV. METHODOLOGY (List dates and places of contacts, names of persons interviewed, and names of interviewers. If children are interviewed, their last names shall not be included in the report.)
V. DESCRIPTION OF FINDINGS (Identify the facts uncovered during the investigation related to the alleged violations.)
VI. ADDITIONAL FINDINGS in section III.) (Identify any facts uncovered during the investigation which constitute a violation of a rule or section of the act not cited
VII. CONCLUSIONS (A separate conclusion regarding each rule or section of the Act that is alleged to be in violation must be stated. List the specific rule or section of the Act and indicate ?Compliance? or ?Violation?. If any of the cited violations are repeated violations, indicate that this is a repeat violation.)
VIII. CHANGES IN LICENSE TERMS RECOMMENDED (Any change in the agency?s decision regarding the number, sex, age, race, ethnic background, and any specific characteristics of children who may be placed that is based on the documentation contained in findings and conclusions sections of the report.)
IX. RECOMMENDATION (The following choices are to be used for the recommendation on the status of the license.)
I recommend that the status of the foster home license remains unchanged.
OR
Upon receipt of a signed, acceptable corrective action plan, I recommend issuance of a (1st, 2nd, 3rd) provisional license.
OR
I recommend revocation of the foster home license.
OR
I recommend refusal to renew the foster home license.
Name of Certification Worker Date
Telephone Number
Supervisor Date
Telephone Number