WHAT EVIDENCE DO WE NEED TO DEMONSTRATE IMPLEMENTATION?

Documents to be submitted include:

Operational Items

1. Copy of the operating license
2. Copy of the certificate of occupancy
3. Copy of the Children/Youth Rights and evidence if distribution
4. Copies of behavior support and management policies and evidence of receipt by staff
5. Grievance process for children/youth and families of those served and evidence of distribute

Program & Quality Improvement Items

6. Program goals, with accompanying action plan and steps to attain goals (including timelines and responsible persons). This process should include:

• Development and implementation of a program improvement team, consisting of representation from:
• Staff,
• Site Director
• Host Agency
• Children/Youth
• Parents
• Use of program assessments:
• Questionnaires:
  • Staff Questionnaires
  • Family Questionnaires
  • Children/Youth Questionnaires
  • Host Questionnaire
• Program observations:
  • Staff Observation(s)
  • Parent Observation(s)
  • Site Director Observation
  • Community Stakeholder Observation(s)
• Development and implementation of an action plan with;
  • At least five (5) program improvement goals,
  • Action steps necessary to accomplish each goal,
  • Responsible persons assigned to each action step, and
  • Identified timeline for accomplishment of the action steps and goals.

Human Resources Items

7. Copies of staff CPR and First Aid Certifications
8. Organization chart with supervision lines identified
9. Staff coverage schedule for previous quarter
10. Resumes of the Program Administrator and Site Director
11. Job descriptions of Program Administrator and Site Director, as well as a sample of a staff job description
12. Performance evaluation forms for the Program Administrator and Site Director, as well as a sample of a staff performance evaluation.
13. List of training topics for initial staff orientation training, and an overview of ongoing training requirements.
14. Employee grievance procedures and evidence of distribution
15. Table of contents for Employee/Staff Manual

Safety Information

16. Record of fire drills for past year
17. Emergency response/preparedness plan
18. Copies of parental complaints or accidents involving injury to children for previous year, redacting surnames and other identifying information of children and youth.

Activity, Health and Nutrition Information

19. Activity schedules for the previous quarter with corresponding lesson plans
20. Menus for the previous quarter
21. Written policy indicating how children who become ill are handled to ensure other children are not impacted

Financial Information

22. Copy of the program's budget for the current year
23. Financial management and planning procedures
24. Copy of most recent 990 and audit & management letter, as applicable. If none, then submit most recent annual financial statement.

Policies, with evidence of distribution and agreement by staff and entity providing oversight

25. Conflict of interest policy
26. Discrimination policy
27. Employee supervision policy/procedures
28. Harassment policy
29. Nepotism policy
30. Medication management/administration policies and procedures
31. Policies/procedures requiring background checks for employees
32. Policy requiring TB and physical exams for employees
33. An example of a staff development plan and a copy of the current annual training calendar for employees.

Additional Information

34. Provide 2-3 examples of how your program has attempted to eliminate challenges you may have faced regarding staff turnover
35. Provide 3-4 examples of your approach to ensuring positive and healthy relationships are promoted and developed between:
    • staff;
    • children;
    • staff and families; and
    • staff and children.