Form 2978f FOSTER FAMILY HOME – SAMPLING GUIDE Texas Department of Family and Protective Services January 2006
Foster Home Name: Facility # Date:
Address: Verified Age Range: Verified Capacity: Announced Unannounced
CPA: CPA Facility #: Verification Date: Time Begin: End:
Foster Family and Children in Care Reviewer Findings:
Reviewer Guidelines: List the names and ages of all persons living in the home. Record the names and ages of all household members. To determine compliance with these standards, you may review the contact list, interview foster parent(s), interview foster children, and evaluate CPA records, including background checks submitted.
Observation: You should also observe the children’s living quarters during the tour of the home. Be alert to the number of beds/sleeping locations in the home. Take photographs, as needed, in accordance with section 4800 in the Licensing Policy and Procedure Handbook.
Interview questions: Who lives here? Do you have any overnight visits/visitors? Who do you use for respite care? What procedures do you follow? Has the CPA ever asked you to care for children 18 years old or older? What is the CPA policy regarding releasing foster children to other persons? Who do you have contact with in the CPA?
Paperwork: AF1100, AF1200 View contact list. AF1300
Behavior Intervention and Behavior Management Reviewer Findings:
Reviewer Guidelines: To determine compliance with these standards, interview foster parent(s), interview foster children, and evaluate CPA records including serious incident reports.
Observations: Be alert to the presence of prohibited medications. Emergency medications should only be given when a child is a danger to himself or others. Are high chairs and car seats being used appropriately?
Interview questions: Children: What happens to you when you act out (get into trouble)? What happens to (insert name of another child in the home) when they act out? Did anyone explain to you what would happen to you if you tried to hurt yourself or someone else? Have you ever been restrained or held? Tell me what happened? Adults: How do you discipline the children? What is your most difficult discipline issue and how do you handle it? Did you receive specific instructions regarding when you can use personal restraints? What were your instructions regarding personal restraints? What happens after you restrain a child? Tell me how you participated in (insert the foster child’s name) service planning re: behavior intervention?
Paperwork: AF1310, AF2110 View serious incident reports. AF2310, AF2311 View restraint documentation. AF2321, AF2322, AF2323 View medication log and/or physician’s orders. AF2331, AF2332, AF2333 AF2334, AF2335 AF2341, AF2342, AF2343 AF2530, AF4200
Foster Home Name: Facility # Date:
Training Reviewer Findings: Reviewer Guidelines: To determine compliance with these standards, interview foster parent(s), and evaluate CPA records.
Interview questions: What type of training did you receive prior to children being placed in your home? Tell me about the training you have had this year. How do you get your training? How many hours of training have you had this year? When was the last time you had training? What was the training topic? When was the last time you had CPR/First aid training? Who provided the training? Have you had training on assessing causes of behavior, strategies to avoid harmful behaviors, maintaining positive behaviors, or intervention strategies? When was the last time you received this training? Did the training prepare you to deal with the behaviors of children?
Paperwork: AF1400 View CPR/first aid training certificate or certification card(s), if available in AF1411 the home. AF1413 View training certificates or log, if available in the home. AF2110
Children’s Rights Reviewer Findings: Reviewer Guidelines: To determine compliance with these standards, interview foster parent(s), interview foster children, and tour the children’s living quarters. Take pictures, if necessary, to record observations.
Observations: Observe the storage for children’s personal belongings, including dressers, closets, and bathroom area. Observe clothing, shoes, and personal-care items. Be alert to appropriate size, style, condition, season, and accessibility. Is clothing and storage comparable to that of the biological children? If possible, observe children’s grooming, particularly hair, teeth, nails, and overall hygiene. Is grooming appropriate for the child’s special needs, including ethnic and racial needs? Are the necessary additional supplies available for infants, including diapers, toys, equipment? Does each child have his own bed and mattress? Are linens clean and changed at least once a week? Do not be distracted by a child’s unkempt room, laundry pending or in progress, or other aesthetics.
Interview questions: Children: Show me your room. Do you have to share your room with others (Who do you share your room with)? Where do you keep your (clothes, shoes, school work, personal grooming items, personal possessions)? Where do you sleep? Does anyone sleep with you (do you have to share your bed with anyone)? What do you do if you want to be alone (have privacy)? What do you do if you (want to) (need to) buy something? If you get money, what do you do with it? Where do you go to school? Who is your teacher? What is your favorite subject? Where (When) do you do your homework? Who helps you with your homework? What do you get to do for fun? What do you like the best about being here? What do you like the least about being here? Have you been in other foster homes? Adults: Describe a routine day in your home. Where do you obtain clothing, shoes, personal items for the children? Follow-up on statements from the children, as needed, re: school work, fun activities, money, grooming supplies, and training.
Paperwork: AF2210, AF2220 View the contact list for each child. AF3200, AF3300
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Foster Home Name: Facility # Date:
Nutrition Reviewer Findings: Reviewer Guidelines: To determine compliance with these standards, interview foster parent(s), interview foster children, and tour the food storage and preparation areas. Take pictures, if necessary, to record observations.
Observations: Observe the food storage areas including pantry and refrigerator. Is an adequate supply of food on hand for the number of persons living in the home? Do the refrigeration appliances appear to be cooling adequately? Is other food stored appropriately, including sealed or covered and clearly labeled? Is the food storage and preparation area relatively clean and free of insects or signs of rodents? Do not be distracted by dirty dishes left from a recent meal, unless they are attracting insects/rodents. Does it appear a variety of foods including fruits and vegetables are served daily? Is milk available for those children who drink it? Is water readily available to children?
Interview questions: Children: Show me where you eat your meals. Who eats with you? What did you have for (breakfast) (lunch) (supper) today (yesterday)? What do you do if you get hungry (thirsty) between meals? Who does the cooking (do you help with the cooking, shopping, dishes, clean-up)? Adults: Ask questions, as appropriate, re: food preparation, planning, routine meals and snacks served. Follow-up on statements from the children re: meals. Follow-up on observations re: food preparation and storage.
Paperwork: AF2400 If a menu(s) is maintained and available, view this. AF3200
Medications and Medical Records Reviewer Findings: Reviewer Guidelines: To determine compliance with these standards, the reviewer will interview foster parent(s), review medication logs, observe medication storage, and observe children’s medical records in the home. If medication is administered during the sampling visit, the reviewer will observe this.
Observations: Observe storage of refrigerated and/or non-refrigerated medication. Check expiration dates. Is medication kept inaccessible to children? Is refrigerated medication kept in a separate container to prevent contamination of other foods if it should leak? Is all medication in its original container and clearly labeled? Are there indications children in care may have primary medical needs?
Interview Questions: Children: When you are sick, who takes care of you? If you have to take medicine, who gives it to you? Do you go to the dentist (doctor)? Who takes you to the dentist (doctor)? Adult: Are any of the children currently taking medications? Show me where you keep refrigerated medication. Where do you keep non-refrigerated medication? How do you keep track of medication? Can you show me the log? What do you do with medication when a child is no longer in care? What are your procedures for maintaining children’s medical and dental records? Can you show me the records? How often do you report the child’s visits to the doctor (dentist) to the CPA? Do you care for children that have primary medical needs?
Paperwork: AF2510 View medication logs. AF2520 View children’s medical records.
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Foster Home Name: Facility # Date:
Home Environment Reviewer Findings:
Reviewer Guidelines: To determine compliance with these standards, you must walk through the home and outdoor areas to determine if health and safety hazards are present.
Observations: Consider all ages of children in care and the type of care provided when determining safety and health hazards. Observe the home, including laundry and/or garage areas for hazards, including accessible flammable or poisonous substances. Ask to see where cleaning supplies are stored. Ask to see where firearms are stored. Are firearms, explosive materials, and projectiles inaccessible to children? Observe outdoor play and accessible storage areas. Be alert to accessible power tools, flammable or poisonous substances, play structures in poor repair, trampolines, standing water, evidence of rodents, pet feces, stray animals, dangerous pets, and unsupervised access to swimming pools or other bodies of water. Observe furniture, windows, doors, walls, flooring, kitchens and bathrooms to ensure they do not present hazards to children. Be alert to exposed wiring, garbage/trash not managed properly, inappropriate or unsafe ventilation and heating, peeling paint, weak flooring or trip hazards, insects and rodents, and other hazards. Are bathroom, laundry, and kitchen fixtures in good working order? Be alert to wet carpeting, rotten wood, standing water, blocked drains. Is the home environment generally clean and well maintained? Based on the number of people living in the home, does the home appear overcrowded?
Interview Questions: Children: Are there any areas of the house or yard where you are not allowed to go by yourself? Do you or other family members have any pets? Where are they kept? Who is responsible for caring for them? Adult: When was the last time you had a fire inspection (health inspection)? Who did the inspection? Do you keep any firearms, weapons, or explosive materials in or outside of the home? How do you ensure children in your care do not have unsupervised access to bodies of water (poisonous substances) (firearms) (flammable materials)? What are your plans in the event of an emergency?
Paperwork: AF3100 View pet vaccination records, if filed at the home. AF3200 View a copy of the fire/health inspection reports, if filed at the home. AF3300, AF4200 Be alert to issues in a child’s treatment plan that places other children or family members at risk.
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Foster Home Name: Facility # Date:
Reports and Communication Reviewer Findings:
Reviewer Guidelines: List the names of all children and their affiliation with the foster home, such as To determine compliance with these standards, you must interview the foster parent and view records in foster child, biological child, adoptive child, day care child, respite care child, the home. List the names of all children present and living in the home and their affiliation. child not in care (i.e. neighbor visiting), or other related child (i.e. grandchild):
Observations: Be alert to breakdowns in or lack of communication between the CPA and foster home. Be sensitive to the concerns a foster parent may have when asked to share information about their current CPA. Be alert to conflict of care issues (i.e. appropriate level of supervision, appropriate placement for children with therapeutic, habilitative, or primary medical needs, needs of all children taken into consideration).
Interview Questions: What types of serious incidents have you been instructed to report? What happens if (when) you make a report? Do you know how and who to contact after business hours regarding disaster or emergency situations? Do you know what to do if there is a weather emergency (fire) (flood) (electrical or water failure)? How does the CPA contact you about a potential placement and how long do you have to prepare? What information is shared with you before a child is placed in your home? Was information in the intake study is shared with you? How was it shared with you? When was it shared with you? What information was shared with the child before being placed in your home? Do you feel that you have the necessary skills to meet the needs of children placed in your care? What role do you play in the development of a child’s service plan (treatment team meetings)? What kinds of things do you generally talk about? How are children involved in the development of their service plan (treatment team meetings)? If you have questions about the service plan, what do you do? How often does a representative from the CPA come to your home? What time of day do they come to your home? What do they do when they come to your home? How much time do they spend with you (your children) (foster children) (other foster parent/adult)? Did someone from the CPA visit your home before children were placed in your care? Who did the CPA interview during the verification process? Were you asked to sign an agreement with the CPA before children were placed in your care? How responsive do you feel the CPA is to your needs? Have you been a foster parent for any other CPA?
Paperwork: AF4100, AF4200 View serious incident reports. 3300, 3400, 3500, 3600 View the foster home verification. View daily logs, if maintained.
How to use this foster home sampling guide:
Licensing staff are required to use this foster home sampling guide to monitor All foster homes. This sampling guide provides a list of topics that must be covered during the
inspection, and provides suggested interview questions.
Licensing staff should follow up on areas of concerns with additional questions that may not be included here. Refrain from reading the questions to the interviewee. The guide is written with the assumption that Licensing staff are familiar with the applicable minimum standards prior to the inspection. It will be the Licensing staff’s responsibility to identify all standards related to concerns identified during the inspection. Complete the Foster Home Sampling Report; enter each identified concern into the foster home file in CLASS; prepare the sampling letter for the CPA. For detailed instructions see sections 4322 and 4323 of the Licensing Policy & Procedure Handbook. Save all sampling guides for future reference.
Remember to notify the CPA within 24 hours of any immediate hazards found during the inspection. Immediate hazards include hazards that require the CPA follow up immediately to ensure a plan is in place and followed for the protection of children, including but not limited to unsupervised access to bodies of water, firearms, or
medication, no water or electricity, structural damage to the home that makes it uninhabitable, unsafe equipment, and construction hazards.
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