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CITY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION
OR\G\NAL
Subject: Findings of Fact for denial of
Conditional Use Permit No. 01-09 (Extension
of Time No. 03-06) - A request for a one year
Extension of Time from September 18, 2003,
to September 18, 2004, to renovate an
existing building to establish a 72-bed group
home. The project site is located at 216 West
6th Street in the CR-2, Commercial Regional,
land use district.
From: James Funk, Director
Dept: Development Services
Date: December 18, 2003
MCC Date: January 5,2004
Synopsis of Previous Council Action:
December 15, 2003, the Mayor and Common Council closed the public hearing and denied
Conditional Use Permit No. 01-09 (Extension of Time No. 03-06).
Recommended Motion:
That the Mayor and Common Council adopt the Findings of Fact supporting denial of Conditional
Use Permit No. 01-09 (Extension ofTime No. 03-06).
YmAiv c, ~ rJt::-
James F
Contact Person:
ATon Liang
Phone: 384-5057
Supporting data attached: Staff Report
Ward: 1
FUNDING REQUIREMENTS: Amount: N/A
Source: (Acct. No.)
Finance:
Council Notes:
Agenda Item No. J '5
01105 }04-
f2.6V t SeD
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CITY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION
STAFF REPORT
SUBJECT: Conditional Use Permit No. 01-09 (Extension ofTime No. 03-06) - A request for
a one year Extension of Time from September 18,2003, to September 18, 2004, to
renovate an existing building to establish a 72-bed group home.
BACKGROUND
At their meeting of December 15,2003, after receiving input and comments from the applicant
and applicant's representatives, the Mayor and Common Council denied Conditional Use Permit
No. 01-09 (Extension of Time No. 03-06) per the recommendation of the Planning Commission
and continued for two weeks for Development Services to bring proposed Findings of Fact to the
Council. Section 19.36.050 of the Development Code states that all of the Findings of Fact must
be made in order to approve a Conditional Use Permit. Findings 2 and 5 cannot be made.
FINDINGS OF FACT IN SUPPORT OF DENIAL
2) Is the proposed use internally consistent with the General Plan?
No, the proposed project is not internally consistent with the General Plan objective and
policy as follows:
General Plan Objective 1.6 states: "Control the development ofland uses which may
adversely impact the character of the City and quality oflife of its residents'.
General Plan Policy 1.7.2 states: "Require that all development in each land use
classification adheres to the requirements and standards of the zone in which it is
located".
Since the project description was altered, the proposal would not promote land use
compatibility. As a result, the proposed proj ect is not internally consistent with the
General Plan. The proposed project would negatively impact the character of existing
residential neighborhoods in this area. Specifically, the proposed project would result in
significant intrusion into the immediate adj acent residential neighborhoods to the north
and east.
Based on changes to the project, as represented by the applicant, the Mayor and Common
Council denied the Extension of Time because the project was considerably different
from what was approved through the Conditional Use Permit. The applicant and their
representative stated that the clients would be from both San Bernardino and Riverside
Counties, instead of San Bernardino County alone. In addition, the applicants'
representative stated that the facility would house both boys and girls instead of boys
only as per the original application. The representative also stated that the security
arrangements have changed in that the facility would not be a lock-down facility.
5) Are the location, size, design, and operating characteristics of the proposed use
compatible with the existing and future land uses within the general area in which the
proposed use is to be located and will it create significant noise, traffic or other
conditions or situations that may be objectionable or detrimental to other permitted uses
in the vicinity or adverse to the public interest, health, safety, convenience, or welfare of
the City?
The proposed project could be detrimental to the public interest, health, safety,
convenience, or welfare of the City in that the original project description was modified.
The modified project was never reviewed or analyzed as to its feasibility relating to
staffing, security, financing and other related issues. The proposed project is no longer
the same project that was approved in September 2001. The proposed project could
allow uses that would operate in a manner that would not be consistent with the existing
and future land uses within the general area. The proposed project could create conditions
that would be detrimental or objectionable to other permitted uses in the vicinity and
adverse to the welfare of the City. In addition, circumstances have changed on-site and in
the surrounding area. The condition of the buildings has severely deteriorated in the past
few years. And, the area itself has experienced a growing drug problem that could be
problematic to the clients of the facility and/or to residents in the surrounding area.
FINANCIAL IMPACT
N/A
RECOMMENDATION
That the Mayor and Common Council adopt the Findings of Fact supporting denial of Conditional
Use Permit No. 01-09 (Extension of Time No. 03-06).
,'"
CITY OF SAN nERNARDINO-REQUEST FOR COUNCIL ACTION
From:
Dept:
James G. Funk, Director
Development Services
Subject: Appeal of Planning Commission denial of
Conditional Use Permit No. 01-09 (Extension of
Time) to renovate an existing building to establish a
72-bed group home. The project site is located at
216 West 6th Street in the CR-2, Commercial
Regional land use district.
Date:
November 25, 2003
MCC Date: December 15, 2003
Synopsis of Previous Council Action:
None
Recommended Motion:
That the hearing be closed and that the Mayor and Common Council:
1) Uphold the appeal and approve Conditional Use Permit No. 01-09 (Extension of Time No. 03-06) based
on the Findings of Fact contained in the Planning Commission Staff Report, subject to the Conditions of
Approval (Attachment C) as amended, and Standard Requirements (Attachment D), or
2) Deny the appeal and uphold the Planning Commission's denial of Conditional Use Permit No. 01-09
(Extension of Time No. 03-06), and continue to the next meeting to allow Development Services to bring
revised Findings of Fact to the Council.
V~J~~~~rJr-
Contact person: Aron Liang
Phone: 384-5057
Supporting data attached: Staff Report
Ward(s): 1
FUNDING REQUIREMENTS: Amount: N/A
Source: (Ace!. No.)
(Acct. Description)
Finance:
Council Notes:
J~J JSj/J3
Agenda Item No.
3/
,
CITY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION
STAFF REPORT
SUBJECT:
APPEAL OF PLANNING COMMISSION DENIAL OF CONDITIONAL
USE PERMIT No. 01-09 (Extension of Time No. 03-06)
Owner/Appellant:
Christine Edgcombe
Family Service Agency
1669 North "E" Street
San Bernardino, CA 92405
(909) 886-6737
BACKGROUND
The applicant is appealing the Planning Commission denial of Conditional Use Permit No. 01-09
(Extension of Time No. 03-06), from September 18, 2003 to September 18, 2004, to renovate an
existing building to establish a 72-bed group home. The project site is located at 216 West 6th
Street in the CR-2, Commercial Regional land use district (Exhibit A).
Please refer to the Planning Commission Staff Report (Exhibit B) for additional discussion.
At its meeting on October 21,2003, the Planning Commission voted 3 to 4 to approve the
extension of time. Commissioners Coute, Enciso and Morris voted in favor of the motion and
Commissioners Lockett, Lynch, Sauerbrun and Thrasher voted against the proposal. The motion
did not pass and no other motions were made.
The Planning Commission was concerned mainly because Family Services Agency may not be
the entity that will operate this facility. The facility could be sold to a separate entity that may
not have adequate resources to operate a level 12 group home.
On November 11,2003, the applicant filed an appeal to the Mayor and Common Council. The
applicant is asking that the Mayor and Common Council overturn the decision of the Planning
Commission and approve Conditional Use Permit No. 01-09 (Extension of Time No. 03-06)
from September 18,2003, to September 18,2004. Please see Exhibit C for specific grounds for
the appeal.
Conditional Use Permit No. 01-09 (Extension of Time No. 03-06) does not propose any changes
to the project; therefore it is still consistent with the original Findings of Fact and previously
approved Conditions of Approval and Standard Requirements.
AP No. 03-16
December 15, 2003
Page 2
Staffs recommendation for approval of the Conditional Use Permit and Extension of Time was
based on the proposed project, not the entity (Family Services Agency) that applied for the
permit. If the Mayor and Common Council wish to approve the Extension of Time, staff
recommends inclusion ofthe following Conditions of Approval:
1) Only Children from San Bernardino County shall be referred to this facility.
2) This facility shall require state licensing prior to occupancy, and a valid state-license shall be
maintained throughout the life of the project.
3) This facility shall comply with the Sate of California and San Bernardino County insurance
program requirements throughout the life ofthe project.
4) Only staff, clients and the families of clients, probation officers and court personnel will be
allowed to enter the facility.
5) The ratio of staff to client shall remain the same all year round including holidays and
weekends at 1:4 from 6:30am to !0:00pm and 1:12 from !0:00pm to 6:30am.
FINANCIAL IMPACT
None. The applicant submitted the appeal fee.
RECOMMENDATION
That the Mayor and Common Council close the hearing and:
1) Uphold the appeal and approve Conditional Use Permit No. 01-09 (Extension of Time No.
03-06) based on the Findings of Fact contained in the Planning Commission Staff Report,
subject to the Conditions of Approval (Attachment C) as amended, and Standard
Requirements (Attachment D), or
2) Deny the appeal and uphold the Planning Commission's denial of Conditional Use Permit
No. 01-09 (Extension of Time No. 03-06), and continue to the next meeting to allow
Development Services to bring revised Findings of Fact to the Council.
Respectfully Submitted,
James Funk
Director of Development Services
'Jf
AP No. 03-16
December 15, 2003
Page 3
EXHIBITS:
A Location Map
B Planning Commission Staff Report
C Application for Appeal
f
ATTACHMENT A
CITY OF SAN BERNARDINO PROJECT: CUP 01-09
PLANNING DIVISION
LOCATION MAP
LAND USE DISTRICTS HEARING DATE: 9/18/01
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SUMMARY
CITY OF SAN BERNARDINO PLANNING DIVISION
CASE:
AGENDA ITEM:
HEARING DATE:
WARD:
Conditional Use Permit No. 01-09 (Extension of Time No. 03-06)
2
October 21, 2003
I
OWNER/APPLICANT:
Family Service Agency
1669 North F Street
San Bernardino, CA 92405
909.886.6737
REQUEST/LOCATION:
A request for a one year Extension of Time for Conditional Use Permit No. 01-09, from
September 18,2003, to September 18,2004, to renovate an existing building to establish a 72-
bed group home. The proposed site is located at 216 West 6th Street in the CR-2, Commercial
Regional, land use district.
CONSTRAINTS/OVERLAYS:
None
ENVIRONMENTAL FINDINGS:
o Not Applicable
. Exempt, Section 15301, Existing Facility
o No Significant Effects
o Potential Effects, Previous Mitigated Negative Declaration
STAFF RECOMMENDATION:
. Approval
. Conditions
o Denial
o Continuance to:
"
CUP No. 01-09 (EOT No. 03-06)
Hearing Date: 10-21-03
Page 2
REOUEST AND LOCATION
A request for a one year Extension of Time for Conditional Use Permit No. 01-09, from
September 18, 2003, to September 18, 2004, to renovate an existing building to establish a 72-
bed group home. The proposed site is located at 216 West 6th Street in the CG-2, Commercial
General land use district. No changes to the project are proposed as a part of this extension of
time request.
SETTING/SITE CHARACTERISTICS
The proposed project site is 2.44-acres, square shaped, and relatively flat. The site is located on
the northwest corner of 6th Street and Mountain View A venue, in the CR-2, Commercial
Regional land use district. The surrounding uses include commercial and residential to the east
and north, a vacant lot and residential to the south, and the Social Security Administration
building tot he west in the CR-2, Commercial Regional, land use district.
CALIFORNIA ENVIRONMENTAL OUALITY ACT (CEOAl STATUS
The Extension of Time request does not propose any changes to the project. Staff reviewed the
project and concluded that no changes in environmental conditions or circumstances have
occurred since the original approval on September 18, 2001, therefore, the CEQA exemption is
still valid.
BACKGROUND
The Planning Commission originally approved Conditional Use Permit No. 01-09 to establish a
72-bed group home in September 18, 2001. The original time frame to establish the use was two
years, with an expiration date of September 18, 2003. Pursuant to the Planning Commission
Staff Report dated September 18,2001, Attachment B, Condition of Approval No.2, the
applicant is allowed a one-time extension of time.
Please refer to the Planning Commission Staff Report for more details (Attachment B).
This request is the only one-year extension of time permitted for this proposed project and if the
construction does not commence within one year of this extension of time approval, this permit
approval shall become null and void. Any action after that time will require filing of a new
Conditional Use Permit application
CONCLUSION
No changes are proposed as a part of the Extension of Time request; therefore it is still consistent
with the original Findings of Fact and previously approved Conditions of Approval and Standard
Requirements.
CUP No. 01-09 (EaT No. 03-06)
Hearing Date: 10-21-03
Page 3
RECOMMENDATION
Staff recommends the Planning Commission approve the one-year extension of time from
September 18, 2003, to September 18,2004, based on the previously adopted Findings of Fact
and subject to the approved Conditions of Approval and Standard Requirements.
Respectfully Submitted,
J~ u,bu-rJT?
Director of Development Services Department
L2=-
Senior Planner
Attachment A
Attachment B
Attachment C
Location Map
Planning Commission Staff Report Dated September 18,2003
Applicant's Request Letter dated September 15, 2003
\'!'
ATTACHMENT A
CITY OF SAN BERNARDINO PROJECT: CUP 01-09
PLANNING DIVISION (EOT 03-06)
LOCATION MAP
LAND USE DISTRICTS HEARING DATE: 10/21/03
11
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ATTACHMENT B
SUMMARY
CITY OF SAN BERNARDINO PLANNING DIVISION
CASE:
AGENDA ITEM:
HEARING DATE:
WARD:
Conditional Use Permit No. 01-09
3
September 18, 2001
I
OWNER:
APPLICANT:
Jeff Johnson
Family Services Agency
1669 No. 'F' Street
San Bernardino CA 92405
(909) 886-6737
Kathy Oswalt
Gary Miller Architects
350 W. 5th Street, Suite 201
San Bernardino CA 92401
(909) 889-4480
REQUEST/LOCATION:
The applicant requests approval of a Conditional Use Permit under authority of Development Code
Section 19.06.020 Table 06.01(G)(6), to establish a 72 bed, Residential Care Facility (group home) in
an existing building located on the northwest corner of 6th Street and Mountain View Avenue, in the
CR-2, Commercial Regional land use district.
CONSTRAINTS/OVERLAYS:
None
ENVIRONMENTAL FINDINGS:
o Not Applicable
. Exempt, Section 15301, Existing Facility
o No Significant Effects
o Potential Effects, Mitigated Negative Declaration and Mitigation Monitoring and Reporting
Program
STAFF RECOMMENDATION:
. Approval
. Conditions
o Denial
o Continuance to:
Conditional Use Permit No. 01-09
Meeting Date: September 18, 2001
Page 2
PROJECT DESCRIPTION
The applicant requests approval of a Conditional Use Permit under authority of Development Code Section
19.06.020 Table 06-01(G)(6) to establish a 72 bed Residential Care Facility in an existing building. The
building was previously used for the Y.M.C.A. The applicant is proposing to remodel the facility to include
36 bedrooms, 7 classrooms, a kitchen, and 7 offices with an administrative section. The applicant is
proposing to reuse the existing racket ball court, basketball court'multipurpose facility, and the swimming
pool (Attachments A & B).
The proposed residential care facility (group home) will be used to house Level 12 children between the
ages of 10 and 16 years old. The State classification for Level 12 is the "psychological model", children in
need of of a great deal of care and supervision because of their emotional state. Levels 13 and 14 are
reserved for Residential Treatment Centers and are locked for security reasons. The children are referred
from the Department of Behavioral Health, Department of Children Services, and the Probation
Department. The Family Services Ageny has indicated that only children from San Bernardino County will
be referred to this facility (Attachment G). A detailed analysis of the operation of the group home is
provided in Attachment E of this report. An analysis of the levels of group home care facilities is provided
in Attachment F of this report.
SETTING/SITE CHARACTERISTICS
The proposed project site is 2.44-acres, square shaped and relatively flat. The site is located on the
northwest corner of 6th Street and Mountain View Avenue, in the CR-2, Commercial Regional land
use district. The surrounding uses include commercial and residential to the east and north, a vacant
lot and residential to the south, and the Social Security Administration building to the west in the CR-
2, Commercial Regional, land use district.
BACKGROUND
The Development Review Committee reviewed the project on several occasions and requested
additional information. On August 23,2001 the DRC moved the project to the Planning Commission.
FINDINGS AND ANALYSIS
1. Is the proposed use conditionally permitted within, and would not impair the integrity
and character of the subject land use district, and does it comply with all of the
applicable provisions of this Development Code?
Yes, pursuant to Development Code Section 19.06.020 Table 06-01(G)(6), a Residential Care
Facility is an allowed use in the CR-2, Commercial Regional land use district, subject to
approval of a Conditional Use Permit. The proposed project complies with all applicable
provisions of the Development Code and General Plan.
Conditional Use Permit No. 0/-09
Meeting Date: September 18, 200/
Page 3
TABLE A - DeveloDment Code/General Plan Conformance
CATEGORY PROPOSAL DEVELOPMENT GENERAL PLAN
CODE
Permitted Use Residential Care Facility Permitted subject to N/A
Conditional Use Permit
Height 30 feet maximum 100 foot maximum N/A
Setbacks
- Front 36.5 feet o feet N/A
- Side 23.5 feet o feet N/A
- Rear 23.0 feet o feet N/A
- Side Street 35.5 feet o feet N/A
Landscaping 30,740 square feet
- Total 10,005 square feet N/A
29% 15%
Lot Coverage 37.2% 100% N/A
Parking
- Standard 45 spaces. 23 spaces N/A
- Handican 2 spaces I spaces
2. Is the proposed use consistent with the General Plan?
General Plan Policy 1.6.2 states that it is the policy of the City of San Bernardino to:
"Control the location and number of alcohol sales, adult bookstores and businesses, game
arcades and other community-sensitive uses, based on proximity to residences, schools,
religious facilities, and parks in accordance with legislative and legal requirements",
General Plan Policy 1.16.10 states that it is the policy of the City of San Bernardino to:
"Permit a diversity of region-serving uses including local, county, and state
govemmentall Administrative, professional offices, culturallhistorical and entertainment,
convention facilities, hotels/motels, financial establishments, restaurants, supporting
retail and services, educational institutions, public open spaces, and similar uses in
downtown areas designated as Commercial Regional-Downtown (CR-2)".
Yes, the proposed project will promote and implement these General Plan policies and add
education and training. The applicant proposes a Staff to client ratio of 1:4 for security during
the day and a 1:12 ratio at night. The facility will be equipped with a video monitoring system
Conditional Use Permit No. 0/-09
Meeting Date: September /8. 200/
Page 4
inside and outside to monitor all activity. If the situation arises that one or more of the
children becomes a problem in the facility, Family Services calls the referring agency to come
in and discipline the child. The only time that the Police Department is called, is if a child is
missing without leave, or a crime has been committed.
3. Is the approval of the Conditional Use Permit for the proposed use in compliance with
the requirements of the California Environmental Quality Act and Section 19.20.030(6)
of the Development Code?
Yes, the proposed project was found to be exempt from the California Enviromnental Quality
Act per Section 15301 - Existing facility.
4. Are there potentially significant negative impacts upon environmental quality and
natural resources that could not be properly mitigated and monitored?
No, as identified in Finding #3 above the proposed project was found to be exempt from the
California Enviromnental Quality Act per Section 15301 Class 32 - Existing Facility.
5. Are the location, size, design, and operating characteristics of the proposed use
compatible with the existing and future land uses within the general area in which the
proposed use is to be located and will it create significant noise, traffic or other
conditions or situations that may be objectionable or detrimental to other permitted uses
in the vicinity or adverse to the public interest, health, safety, convenience, or welfare
of the City?
Yes, the applicant proposes to remodel and operate the 72-bed facility consistent with the
guidelines established by the State of California. The proposed project complies with
Development Code/General Plan Conformance Standards as defined in Table A. The applicant
has provided 29% landscaping and parking in excess of the requirements of the Development
Code.
The project will not create significant noise, traffic, or other conditions or situations that may
be objectionable or detrimental to other permitted uses in the vicinity or adverse to the public
interest, health, safety, convenience or welfare of the City.
6. Is the subject site physically suitable for the type and density/intensity of use being
proposed?
Yes, the site is physically suitable for the type and density/intensity of the project being
proposed as evidenced by project compliance with all applicable Development Code Standards
as noted above in Table 'A' and as described in Setting and Site Characteristics.
Conditional Use Permit No. 01-09
Meeting Date: September 18, 2001
Page 5
7. Are there adequate provisions for public access, water, sanitation, and public utilities
and services to ensure that the proposed use would not be detrimental to public health
and safety ?
All agencies responsible for reviewing access, and providing water, sanitation and other public
services have all had the opportunity to review the proposal, and none have indicated an
inability to serve the project. The proposal will not be detrimental to the public health and
safety in that all applicable Codes will apply to the construction of this project.
CONCLUSION
The proposal meets all necessary Findings of Fact for approval of Conditional Use Permit No. 01-09.
However, Staff has reservations regarding this project. Although the Family Services Agency has an
excellent reputation in the community, it has never run a facility such as this. Staff is not completely
comfortable that there will not be some adverse impacts associated with this project.
RECOMMENDATION
Staff recommends the Planning Commission:
1. Approve Conditional Use Permit No. 01-09 based upon the Findings of Fact contained in this
Staff Report and subject to the Conditions of Approval (Attachment C) and Standard
Requirements (Attachment D).
Respectfully Submitted,
~~
James Funk
Director of Development Services
T-.. &.A~/_.- ~.;
~ndi
Associate Planner
Attachment A
Attachment B
Attachment C
Attachment D
Attachment E
Attachment F
Attachment G
Location Map
Site Plan, Floor Plan
Conditions of Approval
Standard Requirements
Facility operating standards
Department of Social Services Classifications
Referral Agencies
1-
ATTACHMENT A
CITY OF SAN BERNARDINO PROJECT: CUP 01-09
PLANNING DIVISION
LOCATION MAP
LAND USE DISTRICTS HEARING DATE: 9/18/01
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FAMILY SERVICES AGENCY
PROPOSED CROUP HOME
216 SIXTH SrR€ET
SAN BERNARDINO. CA. 924.')8
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I. NORTHEAST VIEW OF ENTRANCE & CORNER OF BUILDING
2. SOUTHEAST REAR VIEW OF BUILDING & ENTRANCE
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3. EAST VIEW FO BULDING AND PARKING LOT
4. NORTHWEST VIEW OF BUll..DING AND PARKING LOT
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NORTHWEST CORNER OF BUILDING, TAKEN FROM 6
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6. NORTHEAST CORNER OF BULIDING & ENTRANCE
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7. SOUTHWEST VIEW OF VACANT LOTS ACROSS 6 STREET
---- ----" -
8. NORTHWEST VIEW OF SOCIAL SECUITY BUILDING ADJACENT TO
PARKING LOT & ENTRANCE
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SOUTHEAST VIEW OF RESIDENTIAL, CORNER OF 6
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10. SOUTHEAST VIEW OF RESIDENT AL & COMMERCIAL PROPERTY
ADJACENT TO SITE
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10. WEST VIEW OF APP ARTMENT COMPLEX NORTH OF SITE
Conditional Use Permit No. 01-09
Meeting Date: September 18,2001
Page 8
A TT ACHMENT C
CONDITIONS OF APPROVAL
Conditional Use Permit No. 01-09
1. Within two years of development approval, commencement of construction shall have occurred
or the permit/approval shall become null and void. In addition, if after commencement of
construction, work is discontinued for a period of one year, then the permit/approval shall
become null and void. Phasing of project construction/development shall be as follows:
Expiration Date: September IS, 2003
2. The review authority may, upon application being filed 30 days prior to the expiration date and
for good cause, grant a one-time extension not to exceed 12 months. The review authority
shall ensure that the project complies with all current Development Code provisions.
3. In the event this approval is legally challenged, the City will promptly notify the applicant of any
claim, action or proceeding and will cooperate fully in the defense of this matter. Once notified,
the applicant agrees to defend, indemnify and hold harmless the City of San Bernardino (City),
the Economic Development Agency of the City of San Bernardino (EDA), any departments,
agencies, divisions, boards or commission of either the City or EDA as well as predecessors,
successors, assigns, agents, directors, elected officials, officers, employees, representatives and
attorneys of either the City or EDA from any claim, action or proceeding against any of the
foregoing persons or entities. The applicant further agrees to reimburse the City of any costs and
attorneys' fees which the City may be required by a court to pay as a result of such action, but
such participation shall not relieve applicant of his or her obligation under this condition.
The costs, salaries, and expenses of the City Attorney and employees of his office shall be
considered as "attorneys fees" for the purpose of this condition.
As part of the consideration for issuing this permit, this condition shall remain in effect if this
Conditional Use Permit is rescinded or revoked, whether or not at the request of applicant.
4. Construction shall be in substantial conformance with the plan(s) approved by the Director,
Development Review Committee, Planning Commission or Mayor and Common Council.
Minor modification to the plan(s) shall be subject to approval by the Director through a minor
modification permit process. Any modification which exceeds 10% of the following allowable
measurable design/site considerations shall require the refiling of the original application and a
subsequent hearing by the appropriate hearing review authority if applicable:
a. On-site circulation and parking, loading and landscaping;
b. Placement and/or height of walls, fences and structures;
J<
Conditional Use Permit No. 0/-09
Meeting Date: September /8,200/
Page 9
c. Reconfiguration of architectural features, including colors, and/or modification of finished
materials that do not alter or compromise the previously approved theme; and,
d. A reduction in density or intensity of a development project.
5. No vacant, relocated, altered, repaired or hereafter erected structure shall be occupied or no
change of use of land or structure(s) shall be inaugurated, or no new business commenced as
authorized by this permit until a Certificate of Occupancy has been issued by the Department.
A temporary Certificate of Occupancy may be issued by the Department subject to the
conditions imposed on the use, provided that a deposit is filed with the Department of Public
Works prior to the issuance of the Certificate, if necessary. The deposit or security shall
guarantee the faithful performance and completion of all terms, conditions and performance
standards imposed on the intended use by this permit.
6. This permit or approval is subject to all the applicable provisions of the Development Code in
effect at the time of approval. This includes Chapter 19.20 - Property Development Standards,
and includes: dust and dirt control during construction and grading activities; emission control
of fumes, vapors, gases and other forms of air pollution; glare control; exterior lighting design
and control; noise control; odor control; screening; signs, off-street parking and off-street
loading; and, vibration control. Screening and sign regulations compliance are important
considerations to the developer because they will delay the issuance of a Certificate of
Occupancy until they are complied with. Any exterior structural equipment, or utility
transformers, boxes, ducts or meter cabinets shall be architecturally screened by wall or
structural element, blending with the building design and include landscaping when on the
ground.
7. The applicant shall identify the address on the wall of each building with 6-inch high letters or
numbers, and on the roof of the building in one-foot by four foot numerals.
8. No expansion or intensification (ie. change in rate classification level or increase in the number
of beds/kids) may occur without a new Conditional Use Permit approval.
9. All off-site activities with the children shall be supervised at the same 1:4 ratio (Staff to
children) of supervision as is required in the facility.
,
Conditional Use Permit No. 01-09
Meeting Date: September 18, 2001
Page 10
10. This permit or approval is subject to the attached conditions or requirements of the following
City Departments or Divisions:
a. Public Works Division
b. Plan Check Division
c. Fire Department
d. Public Services Department
e. Municipal Water Department
f. Parks Recreation and Community Services
r
AITACHMENI' "D"
I E
DEPARTMENT OF DEVELOPMENT SERVICES/PUBLIC WORKS DIVISION
CASE NO: C.U.P. 01-09
DESCRIPTION: Renovate existing building to 72
Bed Group Home.
APPLICANT: Gary W. Miller
LOCATION: 216 ~ ~ Street
. NOTE TO APPLICANT: Where separate Engineering plans are required. the applicant Is
responsible for submitting the Engineering plans direcUy to the Engineering Division. They
may be submitted prior 10 submittal of Building Plans.
1. Drainage and Flood Control
a} If site drainage is to be outletted into the public street, the drainage shall
be conveyed through a parkway culvert constructed in accordance with
City Standard No. 400. Conveyance of site drainage over the Driveway
approaches will not be permitted.
2. Grading and Landscaping
a) The design of on-site improvements shall also comply with all
requirements of The California Building Code, Title 24, relating to
handicap parking and accessibility, including retrofitting of existing building
access points for handicap accessibility, if applicable.
b} A handicap accessible path of travel shall be provided from the public way
to the building entrance. All pathways shall be concrete paved and shall
provide a minimum clear width of 4 feet. Where parking overhangs the
pathway, the minimum paved width shall be 6 feet.
c} Where the handicap accessible path of travel crosses drive aisles, it shall
be delineated by striping or textured/colored concrete pavement.
d} An easement and covenant shall be executed on behalf of the City to
allow the City to enter and maintain any required landscaping in case of
owner neglect. The Real Property Section for execution by the property
owner and shall ensure that, if the property owner or subsequent owner(s}
Page 1 of 4 Pages
8/31/2001
'0
DEPARTMENT OF DEVELOPMENT SERVICES/PUBLIC WORKS DIVISION
CASE NO: C.U.P. 01-09
DESCRIPTION: Renovate existing building to 72
Bed Group Home.
APPLICANT: Gary W. Miller
LOCATION: 216 W. f1" Street
fail to properly maintain the landscaping, the City will be able to file
appropriate liens against the property in order to accomplish the required
landscape maintenance. A document processing fee in the amount of
$200.00 shall be paid to the Real Property Section to cover processing
costs. The property owner, prior to plan approval, shall execute this
easement and covenant unless otherwise allowed by the City Engineer.
3. Utilities
a) Design and construct all public utilities to serve the site in accordance with
City Code, City Standards and requirements of the serving utility, including
gas, electric, telephone, water, sewer and cable TV (Cable TV optional for
commercial, industrial, or institutional uses).
b) Utility services shall be placed underground and easements provided as
required. Utility services shall be placed underground and easements
provided as required.
c) All existing overhead utilities adjacent to or traversing the site on either
side of the street shall be undergrounded in accordance with Section
19.2.030 of the Development Code.
d) Existing Utilities which interfere with new construction shall be relocated at
the Developer's expense as directed by the City Engineer, except
overhead lines, if required by provisions of the Development Code to be
undergrounded.
Page 2 of 4 Pages
8/31/2001
-.
DEPARTMENT OF DEVELOPMENT SERVICES/PUBLIC WORKS DIVISION
CASE NO: C.U.P. 01-09
DESCRIPTION: Renovate existing building to 72
Bed Group Home.
APPLICANT: Gary ~ Miller
LOCATION: 216 ~ fIh Street
e} As an alternative to undergrounding required by Section 29.20.030 (non-
subdivision) the Development Code, the developer will provide a letter of
agreement for participation in an assessment district, if one is formed, to
fulfill the requirement for undergrounding utilities. Prior to issuance of
building permit developer shall have the letter of agreement recorded with
the deed.
4. Street Improvement
a} Construct Handicap Ramps in accordance with City Standard No. 205 at
all curb returns within and adjacent to the project site. Dedicate sufficient
right-of-way at the corner to accommodate the ramp.
b} Construct Driveway Approaches per City Standard No. 204, Type II,
including Handicap by-pass. Remove existing driveway approaches that
are not part of the approved plan and replace with full height curb & gutter
and sidewalk.
c) Curb return radii at the intersection of Mountain View Avenue and 6'"
Street shall be 25 feet..
5. Reauired Engineering Permits
a} Off-site improvements construction permit.
Page 3 of 4 Pages
8/3112001
p
DEPARTMENT OF DEVELOPMENT SERVICES/PUBLIC WORKS DIVISION
CASE NO: C.U.P. 01-09
DESCRIPTION: Renovate existing building to 72
Bed Group Home.
APPLICANT: Gary W. Miller
LOCATION: 216 ~ ~ Street
6. ADplicable Engineering Fees1
a) Plan check and inspection fees for off-site improvements - 4% and 4%.
respectively, of the estimated construction cosf of the off-site
improvements.
I All Fees are subject to change without notice.
'Estimated Construction Cost for Off-Site Improvements Is based on a list of standard unit prices on file with
the Public Works Division.
Page 4 of 4 Pages
8/31/2001
I"'''"
CITY OF SAN BERNARDINO
Tenant Improvement Standard Requirements
Development Services/Plan Check Division
~
DRC/CUPIDP:CUP NO.OI-09
DATE: 5-17-01
Address:216 W. 6TH STREET
When submitting plans for Building Plan Check, (4) four sets (5 if "expeditious review") offuUy
dimensioned scaled drawings (18"X 24" min) with the following information are required:
I. Site Plans - Show building location (vicinity map) and legal address.
2. Handicapped Accessibility - Show handicapped access route from public sidewalk, parking space
and within tenant space which includes restrooms, drinking fountains and public telephones.
3. Floor Plan - Show overall floor plans of building and indicate adjacent space, side yards, parking
areas, etc.
4. Occupancy - Indicate type of occupancy and the proposed use of the improved area (i.e., retail
sales, woodshop, office, etc.)
5. Type of Construction - Indicate type of construction of the existing building (i.e., woodframe,
concrete tilt-up masonry, etc.)
6. Detallinll- Show all existing and proposed walls, indicating which are the proposed. Also provide a
wall section detail showing stud size and type, plates, method of attachment at floor and ceiling or
roof, suspended ceiling detail, etc.
7. Doors - Show all door locations, fire-rating (if applicable), direction of swing, self-closing
mechanisms, etc.
8. Single Line Diallram - Provide electrical single line diagrams and load calculation if new or
upgraded service is proposed.
9. Liehting and Electrical LlIyout - Provide lighting and electrical layout. Include panel schedule
with load calculations. Energy forms are required for the addition of new lights.
10. Plumbine - Plumbing plans may be required if any new plumbing is being proposed. Consult Plan
Checker.
300 N 'D' Street
909-384-5071 Office
San Bernardino CA 92418
909-384-5080 Fax
r
II. Mechanical - Provide mechanical drawing showing location of existing and proposed registers,
location to HV AC equipment and duct locations and size. Energy forms are required when installing
a new system.
12. Energy Compliance Forms - Provide Title 24 Energy Calculations for proposed Tenant
Improvement spaces involving conditioned space for new additions within a shell building.
Required forms would include calculations for the envelope, lighting and mechanical. Print
completed signed forms on plans.
13. Occupancy Reclassification - Ifthere is any proposed change in use, the applicant shall state the
proposed use (i.e., from office to retail) and indicate square footage of affected areas.
14. Note - Approval from the following agencies may be required prior to permit issuance (Health
Dept., SCQAMD, Water Dept. for sewer capacity, Fire Dept., Water Reclamation Dept.)
Comments: 1) PROVIDE AREA INCREASE CALCULATIONS FOR MIXED OCCUPANCY.
2) PROVIDE OCCUPANT LOAD FOR MIXED OCCUPANCY.
3) A NEW CERTIFICATE OF OCCUPANCY WILL BE REQUIRED FOR THE NEW USE.
4) PROVIDE SEATING DIAGRAM FOR CAFETERIA AREA.
5) JUSTIFY OCCUPANCY CLASSIFICATION FOR R-2.2
300 N 'D' Street
909-384-5071 Office
San Bernardino CA 92418
909-384-5080 Fax
I
CITY OF SAN BERNARDINO FIRE DEPARTMENT
STANDARD REQUIREMENTS Case: WP 0 I.Oq
Date: 6.2.? - 01
Reviewed By: G.oe:Ju
2({o W
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GENERAL REQUIREMENTS:
8 Provide one addlllon8l HI of construction plan. to Building .nd Safety for Fire Department us. .t time of plan chack.
Contact the City of San Bernardino Fire Department at (909) 384-53SS for opecIftc detailed requlramenla.
o The devaloper shaH provide for adequala fire flow. Minimum fire flow requinlmenla .han be based on .quare OOtaga, constnJcIIon featu.... and _re
Infonnation .upplled by the developer and IIll!!l be available lII!m: to placing combustible malarial. on ."e.
WATER PURVEYOR FOR FIRE PROTECTION:
o TIle fire protection walar _ for the .... of ll1iI project Is provided by:
o Ban Bernardfno Municipal Walar Departmen~EngI_ring (909) 384-5391
o East Valley Water DIslrIc:l-EngIneering (909) SSPr8ll86
o other Water purveyor:
Phone:
PUBUC FIRE PROTECTION FACIUTlES:
o Public fire hydnlnta are required along _Is at Intatvela not to e_ 300 feet for com_ and mu_ldential ..... .nd at Intervals not to_
500 feet for..._ ......
o Fire hydrent mlnlnwm flow Ia'" of 1 ,500 gpm at . 20 psi minimum ...ldu.1 pl888Ure .re required for commercial and mulll-...ldential ...... MinImum fire
hydlant flow rel80 of 1,000 gpm .t a 20 psi minimum _ual _ure .re required for _I a.....
o Fire hyd_ type Ind .pecIftc location 8haII be jointly _ by the CIty of Ban BemanIIno FIra Department In corjunction with the water purveyor. FIra
hydrant m.terials Ind InataKatlon .ha" conform to tho standaAla Ind apacIficallona of tho walar purveyor.
o Public fire hydlanta, fire _.,.nd public watar faci_ _ry III meat FIra Department requ_.re tho developer'.IInancIaI_18IbIIty and
shall be Installed by tho walar pulV8yOr or by the developer.t tho walar purveyor'. dl.....tion, Contac:l tho walar purveyor Indlcatad _ for_I
Infonnatlon.
ACCESS:
8 Provide two separete. dedicated route. of Ingressleg.... to the pIqHlrty e_noe. The route. shall be paved. .11 weather.
Provide an lICC08. road 1ll00ch building for fire apparetu.. _ l'OlIdway .hall have an .II-we.ther driving .urface of nolle8s than 20 feel of unob-
structad width,
o Extend roa_y to within 150 feat of .11 poriion. of tha exterior waU of.n .lngle story buildings,
o Extend 1O._y III within 50 feet of the exterior waD of.U multipie-story buHdIngs.
o Provide "NO PARKING" .Igns whenever patkIng of vehicle. would pooalble reduce the claal3l1OO of acce.. roa_ys to las. th.n the required width. SIgns
.re to reed "FIRE LANE-NO PARKI_.C. Sac. 15.1t1".
o De.d-end ._ lhaU not ._ 500 feet In length .nd shall h.ve. minimum 40 fool redlu. turnaround.
o The namas of.ny new._ (public or prlvala) shall be .Ubmlttad to tho Fire Department for .pproval.
SITE:
o A118C0888 roads and ._ .re to be constructad .nd usable prior to comb_ construction,
o Privala fire hydrants shal be Installed to protact aach building located more than 150 feet _ the curb nne. No fire hydranta .hould be within 40 faal at Iny
.- wall. The hydlanla .han be Wet _ type. with one 2'n k1ch and 4 Inch outie~ and .pplOV8d by tho Fire Depar1mant AI888 Idlacenl Ill...
hydl3nls sh.1I be daalgnaJed .s . "NO PARKING" zone by palnllng .n 8 k1ch wide. red .tripe for 15 feat In each direction In front of the hydrant In.uch I
mannar that I iMII not be bIoci<ed by par10ld V8hlclas. lall8ring to be In whila S" by %",
. !WILDINGS:
1Il Add/888 num"'lI .hall be Installed on the bulIdlng at the front or _ applOV8d location In.uch . m.nner as to be v1a1ble _ the frontage _ com-
rnan:IaI and multi famUy acld.... numOlaI. .hal be S Inchea lan, .lngle fomlly .dd.... num.... sh.n be 4 Inchas laU. The color d the numaraIa _ """"
... with the color at the background.
o Identify each gas and _ malar with the number at the unit "serves.
. R Fire Ildingulahara muat be Inslalled prior to the building baing oocupled. The minimum rating for .ny fira Ildingulshar . 2A 10BIC. Minimum dleb1bu1lon at
fira extingulahers must be such thet no Intartor part of the btJRdlng . OV8r 75 feat travaJ dls1anoe _ . fira Ildinguishar.
o Aparlm8n1 housas with 1S or more Unlls. hotel. (motala) with 20 or more unn.. or .partments or hol8ls (motels) thnas .torIes or ITllll'llln helght.ha11 be
. equipped with .utom.tIc fira sprinklera designed to NFPA .tandard..
Ji!. All buildings. OV8r 5,000 squ.ra feet, shall be equipped with .n .utomatlc fire .prinkar.ystem dasigned to NFPA standard.. TIll. lncIudas _ling buldlnga
vacenl over 385 days.
'l2f.- Subm" plana for the fira p_n .ystem to the Flra Department prior to beginning construction of the .ystam. Penn" required.
_'0 Tenant Improvem_ in all.prinklered bulldlng..ra to be applOV8d by the Fire Department prior to start of construction. Penn" required.
I Provide fire .lann (requlrad tIvoughout). Plans mu.t be .pproved by the FIra Department prior to start d Installation. Penn" required.
,Fire Department oonnection to .prinkler .ystem/standplpe system. shall be rqaulred .t Flra Deparlm8nt .pproved location.
FIraCOde P.nnlraqulrad. RE~ IOE.lh'l/fJo-<-. t2.oAeY.' "f" CA.~
Fira Sprinlder mllllltortng required. Plana mu.t be apProve/Mly the Flra Department prior 10 tho stari d conslrucllon. Penn" required.
Note: The applicant mUlt req'j' In wrlllng, .ny changes to FIra Deparlm8nt requlramenll. ('
;)DITIOLoNALINFORMATI.ON:' ('~f'.12.!!)('1;<5 ~;tIl~/_ t;;;" ~D. '- :?'~{' ./2.4. ~)
- _lA/ W=;lL6:.C Ex. I T _I C4nl. ?f=- ~A'iJ:L 1Nl9:J t M 8(..'~1 rJs1
~ 1f}'it~, ':;;-:'-'."'OC Ty"fL. =-.- /if/:>n'LrrI ON ON
_t'Mtn7.nM
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CITY OF SAN BERNARDINO FIRE DEPARTMENT
STANDARD REQUIREMENTS Case: C'... ,p 01-09
Date: ,C;- /7 -,J/
'2 { fvJ W (i't.... ~ Reviewed By: ~~""
\.'Jr"
GENERAL REQUIREMENTS:
~ Provide one additional set of construction plens to Building and Safety for Fire DepaJ1ment use eltime of plan check.
Contact the City of San Bernardino Are DepeJ1ment at (909) 384-5388 for specifIC detailed requirements.
The developer Sh.a11 provkSe for adequate fire flow. Mlni~um fire flow requirements S~II be based on square footage, construction features. and exposure
Inlannallon supplied by the developer and mUlt be available Drior to placing combustible materials on site.
WATER PURVEYOR FOR FIRE PROTECTION:
~e fire protection water service for the erea of Ihis project is provided by:
San Bernardino Municipal Water DepeJ1ment-Engineering (909) 384.5391
East Valley Water Oislrict-Engineering (909) 888-8986
o Other Water purveyor. Phone:
PUBLIC FIRE PROTECTION FACILITIES:
0 Public fire hydrants are required along streets at intervals not to exceed 300 feet for commercial and mufti-residential areas and at Intervals not to exceed
500 feet for residential areas.
0 Fire hydrant minimum flow rates of 1,500 gpm at a 20 psi minimum residual pressure are required tor commercial and muni-residential areas. Minimum fire
0 hydrant flow rales of 1,000 gpm at a 20 psi minimum residual pressure are required for residential areas.
Fire hydrant type and specific location shall be jointly determined by the City of San Bemardino Fire Department in COnjunction v.ilh the water purveyor. Fire
0 hydrant materials and installation shall conform to the standards and specifications of the water purveyor.
Public fire hydrants, fire services, and public water facilities necessary to meel Fire Department requirements are the devetoper's financial responsibility and
shall be installed by the water purveyor or by the developer at the water purveyor's discretion. Contact the water purveyor indicated above for additional
infonnation.
ACCESS:
ft Provide two separate, dedicated routes of ingresslegress to the property entrance. The routes shell be paved, alt weather.
Provide an access road to each building for fire apparatus. Access roadway shall have an all-weather driving surface of not less than 20 feet of unob-
structed width.
0 Extend roadway to within 150 'eel of all ponions of the exterior wall of all single story buildings.
,>H Extend roadway to YtUtUn 50 feet 0' the exterior wall 01 all multlple-slory buildings.
Provide "NO PARKING" signs Yttlenever parking of vehicles would possible reduce the clearance of access roadways to less than the required width. Signs
are to read "ARE LANE_O PARKlNG-M.C. Sec. 15.1S".
0 Dead-end streets shall not exceed 500 feet in length and shall have a minimum 40 foot radius turnaround.
0 The names of any new slreets (publk: or private) shall be submitted to the Fire Department for approval.
-:;&E:
All access roads and streets are to be constructed and usabJe prior to combustible construction.
Y Private tire hydrants shall be installed to protect each building located more than 150 feet from the curb line. No fire hydrants should be wfthin 40 feet of any
exterior wall. The hydrants shall be Wet Slrrel type, Viith one 2~ inch and 4 Inch outlet. and approved by the Fire Department. Areas adjacent to fire
hydrants shall be designated as a "NO PARKING" zone by painting an 8 inch wide. red stripe lor 15 feel in:;;ckl direction in front of the hydrant In ouch e
manner that it will not be bfocked by parked vehicles. Lettering 10 be In white 6~ by ~~. <!:'<JS-:; I ~~
~ILDINGS:
, Address numerals IhaU be installed on the building at the front or other approved location In such a manner as to be visible from the frontage street. Com-
mercial and multi famity address numerals shan be 6 inches tall. single lamily address numerals shall be 4 inches tall. The color 01 the numerals shall con-
0 lrest with the color 01 the background.
Identity each gas .-ad .ectric meter with the number of the unit it serves.
~ Fire extinguishers must be installed prior to the building being occupied. The minimum rating for any fire extingulsher is 2A 10BIC. Minimum dlstribution 01
fire extinguishers must be such that no interior part of the building is over 75 feet travet distance from a fire extinguisher.
0 Apartmenl houses Vt'ith 18 or more units, hotels (motels) with 20 or more units, or apartments or hotels (motels) three stories or more in height shall be
equipped with automatic fire sprinklers designed to NFPA standards.
)g:f All buildings, over 5,000 square leet. shall be equipped with an automatic fire sprinker system designed to NFPA standards. This includes existing buildings
vacant over 365 days.
~ Submit plans for lhe fire protection system to the Fire Department prior to beginning construction of the system. Permit required.
Tenant improvements in all sprinklered buildings are to be approved by the Are Department prior to start of construction. Pennit required.
!ProvidO fire alann (required throughout). Plans must be approved by the Fire DepaJ1ment prior to slart of installation. Permit required.
Fire Department connection to sprinkler system/standpipe system, shall be required at Fire Department approved location.
. Fire Code Pennlt required.
Fire Sprinkler monitoring required. Plans must be approved by the Fire Department prior to the start of construction. Pennit required.
Note: The applicant mUll reque~n writing. any cklenges to Fire Departmenl requirements.
ADDITIONAL INFORMATION: [. .p r ();.LlJ2f?( IS.. K N 0"';1-- fJJ 0/ r-:Af1k'-'1 G y$Tf=: iii . --
'2-) ....J.A..,-rlf;::',. -n./~ (';Cr, (JArto'. , (" l III '-~I p~ r',?N.
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Project Number C"tA, yo 0 \ - 0:1
Project DescriptlonlBuslness Name ~ li"\IUA'.l.l
Project Location/Address \
Reviewed By
[Office Use Only: City Sen/ice
COMMERCIAL
x.. 1. EsbIbIIIh ~ comrnerdlll ?,fuM endclu'e(I) aCCOl dWlg to CIty P\mlic: Worb standard 508 willi a wIcIIh of
(", / % ,. and a Ienglh of l~ . loc8tIon and oriel....., of endclu'e(I), gates, and compactor 1111(1) ....
be __ on SIte ~,1abeIed willi elmellMN. and lIpedlicallonB to meet P\mlic: Worb standard 508.
L 2. Locate refuM encIoIu'e(l) and compactor 1111(1) to be safely ace e 'tole for IIeIVlce vehlclea 8nd wIlhout
obatnIclIon to drive ..... cII1vewaya. loadWlg ZOMS. parking. or hanclcap BCCeA. Endoaure must be at Ieaat 5'
from combualible walla, e_IlMa, or opec*'P [98 CA Fi"e Code 1103.2.2]. MHmum radi of 40' for al drive tuma
along the main ingre8a to and egreu from endclu'ea and compactor paela.
3. III8laI _ compactor unIl(l) willi a minimum capaclly of _ cubic yarela for each unit. RoI-olf box lI1I(a)
ahaI meet PdIIc Worb Standard 510.
...1!:...- 4. RefuM and rec:yclng IIeIVlce to thllllocatlon ahaI be provkled by the CIty of San Bernarclno lOeu olherllile
noted. New acc:cudB reqlb a completed ServIce AppIcallon wilh a fill deposit rell.med to the CIty of San
Bemardlno RefuM & Rec:yclng DIvision prior to illauance of the final Cer1lficate of Occupancy.
1- 5. City front-load coIeclion -w:es wi be estabIshed at the foIowing minimum levels:
CITY OF SAN BERNARDINO
PUBUC SERVICES DEPARTMENT - REFUSE & RECYCUNG DMSION
STANDARD DEVELOPMENT REQUIREMENTS
300 North D Street-4th Floor CA 92418-0001
909-384-5335
~.- -
. No.
s-' ,
Date Completed Application Retumed
/
'---J
REFUSE SERVICE
QTY BIN DAYS /WEEK
1-2CY
I 3CY On?
4CY
ICY
RECYCUNG SERVICE
QTY BIN DAYS/WEEK
1.2CY
/ 3CY ,
4CY
ICY
ORGANICISERVICE
QTY BIN DAYS/WEEK
1-2CY
3CY
4CY
ICY
6. Sealed compactor W1il(.) ahaI be Instaled wilh a recommended minimum 30 cubic yard rol-olf box:
W1il(.) for refuae, W1il(.) for commingled dry recyclables, and W1il(.) for organics.
7. AppIcant wi submit a completed Integrated waste M_gement Survey to the P\mlic: ServiceII DepaI1rnent
RefuM and Rec:ycIng DIvision a minimum of 5 CIty work days for approVlll prior to iIIauance of any CIty permIIa.
contact 909-384-5549. phone or 909-384-5190 fax.
RESIDENTIAL
1. Resiclential refuae end recycling seM;es are to be provkled by the CIty of San Bernardino Refuae & RecydIng
Division. The City wi provide one set of e blue. green, and black 96 or 64-ga1on autometed service carlll to each
single famly unit OR one set to every two-unit multiple famly dweIIng up to six lIIlits. .
2. ResIdentlalllllits wi have a minimum 3 feet by 9 feet concrete pad located out of view of pubic rist4-of-way ,
for atorage of each set of three automated carla. MInImum gate openlnge wi be 3 feet, and the path of lrlIvel
from the storage pad to curb ahaI be conlInuously paved.
3. A minimum 12-foot lIpace along the curb on the slreet must be clear for residential automated ..w:e carla,
including a minimum 2-foot setback of allllruclll"es, fences, and raised Iandacaplng.
4. Day of automated cart service shan be: M T W Th
ADDITIONAL CONDITIONS OR NOTES
/PfIIIc-- & RecycIng (CSRa)](G~RC FIe]
R._3.Ullllll
r
Af'.r 135-()3/-:;'S
SAN .,,,,IlNARDINO MUNICIPAL WATER DEPA..:.1>fENT
STANDARD REQUIREMENTS
Review of PI.....: r'?I"JN/J/-rfoNA-L / J.<"b ?e~h1lr t)/ -~ . Dale Compiled:
.J~ ..Jb#N.s~N / r/J1r)/~Y $'~VA .
OwnerlD'l!(eloper: ~ JlJII/~ ~Tf'tr~' n...c;""....IJ'.."...~CompdedBy:
1Yl:'(.,-" "14/ 14-t!!: II / 4- /.L"O If. ~ol/~.1rfb~t:
Type of Project: P.'~<7 Rkt?iG -rtJ Aa..,Mt'lLJlH'"t? n "'>< NuiOOer of Units:
Location: ;;)/ ~ _ ,_ _-d. ..
WATER DEPARTMENT ENGINEERING:
Contsct: :rFtlYJlE~ ./l,/E: Phone: g'6l/-53f!~ Fax: aK ~~3'Z.
Nole: All Waler Services are Subject to the Rules & RegulatioDl of the Wiler Department.
.lfsize of Main Adjacent the Project: 4~1 in ~d , (;." ~/ IN kH- /J'E:u/
/r.O: I . I
~Approximate Wiler Pressure: '15 -~Ievation of Water Stonee: J;;J/fl? Hydnnt Flow 0 20 poi:
:.f Type, Size, Location, and Distance to Nearest Fire Hydnnt: :<f 1IfI.."( r; ./9<'1'0/
o Pressure Reaulator Required on Cuatomer'. Side on the Meter,
o Off'lite Water Facilities Required.
o Area Nol Served by San Bernardino Municipal Wiler Deportment,
o Comments:
WATER OIJAUTY CONTROL:
Contact: C.",Al ARF/IE77r Phone: ~t/--5/.3'J Fax: ..984-5532-
~'P'P' Backflow Device Required at Service Connection. FeR. Potne.sTIL-- F>4H f'os e:..s
/, ouble Check Backflow Device Required at Service Connection.F()~ I ~R.I G,. TI DII/ J F 1 Ife rp~1f f'dWlT
I Backflow Device 10 be Inspected Before Wiler Service can be Activaled.
o No Backflow Device Required II This Time.
ENVIRONMENTAL CONTROLIINDIJSTRIAL WASTE:
Contact: .71..1 ~A--r.r"A/ Phone: JNI/-SSo 7 Fax: _:}p,,/-52.Str
Note: No Brine Regenerative Water Softeners May be Installed, Unless Holding and Hauling is Provided for the Brine. All Joten:epton
will be a 1200 Gallon Capacily with a Sample Box Included. .
o Industrial Wasle Pemut Required. 5UR(E'f p eR/rUT ,,~j./cnTCc;.A/ ,.,f Elf '
;{:Grease Inlerceptor Required. P ()$S: . 0 Sand/Oil Interceptor Required. 0 No Issues alIbis Time.
o Pre-treatment Required.
SEWER CAPACITY INFORMATION:
Cootact: NJ'eL. /HtJhJ"elli Phone: .?gtj-5CJ$3 Fax: 3Rt/--7;)..J/
Nole: Proof of Payment Must be Submitted to tbe Building & Safety Department Prior to Issuance of the Building Permit.
)(N 0 Sewer Capacity Fee Applicable at This Time.
o Sewer Capacity Fee Must Be Paid to the Water Department for Gallons Per Day, Equivalent Dwelling Units:
o Suhject to Recalculation of Fee Prior to the Issuance of BuiWing Permit.
Breakdown of Estimated Gallons Per Day:
STDREQl'U.FIlM (2"97)
CITY OF SAN BERNARDINO PARKS, RECREATION " COMMUNITY SERVICES DEPARTMBNT
STANDARD REQUIREMENTS
216 W. 6th Street
Ca.e: C.u.n. 01-09
Da te : 9-04-01
Reviewed By: Jim Gondos
GENERAL REQUJ:RBNBN'1'S:
[ I C01IIIUrcial Indu.trial and Multi-Unit
[ I A.....m.nt Di.trict
[ I R..id.ntial
[ I Purpo.e, Guidelin.. and submittal procedure
I I Irrigation and Landscaping Plans.
I I Contact the City of San Bernardino parka,R.cr.ation and (''''''''''Tolty S.rvia.s
D.partment at (909) 384-5217 or 384-5314 for .p.cific d.tsil.d
r.quirem.nt..
SPECIFIC REQUJ:RBNWNTS:
I "I lIaint.nance of landacap. ar.a.
I xl plant.r Ar.as
I I Int.rior Plant.r Ar.as
I I Irrigation Systlllll8
I I S.tback Ar.as
I I Slop. Ar.as
I I Ground Cov.r and B.dding lIat.rial
I I Brosion Control
I I W..d Control
PLANT MATERIALS
I I plant list and climatic conditiona
I I Str..t Tr..s
I I Plant Mat.rial Size Requirements and Ratioa
mSPBC'l'I:ON AND o-J;D.IliK RBQ1T.[RBIIEI!ITS
I I Irrigation System
I I Landacaping
I I Hardacap. Itlllll8
[ I Stre.t tr.. Sp.cifications
I I Arboriat R.port
I I Ramoval or d.atruction of tre.s
I I Scr..ning R.quirement (City, D.v.Code)
Note. The applicant muat request, in writing, any change. to the Parks, Recr.ation and
Community S.rvic.. r.quirements. Additional information
No new landscanine is reauired. Maintenance is reauired as per the Citv Development Code
Section 19.28
lIS:jj
Chairman
Tom Davis
Past Chairman
Anne Benjamin
Vice Chairman
Jesse Valenzuela
Secretary
Suzette Borror
Treasurer
Phyllis Poulos
Directors
Karen Bell
Narciso Cardona
Mark Emoto
Bertie Holley.
Mary Hoskins
V. V. Kniseley. PhD.
David Moore
Brenda Perez
Shelley Silver
Frank Stallworth
Ricardo Terrones
President I CEO
Jeffrey P. Johnson. MA
Vice President
Operations/CFO
Marilyn Campbell
Medical Director
David H. Whitbread. MD
Clinical Director
June Swan. PhD
Vice President
Grants and Projects
lohn Bradshaw. MS
Program Director
Margwen Nichols. MS
Administrative Asst.
Linda Montgomery
.life member
SERVING SAN
BERNARDINO
COUNTY
AN ACCREDITED
FAHIL Y SERVICE
AGENCY
.
UNITED WAY
MEMBER AGENCY
...
. .
M ..
FSA
FAMILY SERVICE AGENCY OF .N BERNARDINO
San Bernardino Offices:
1669 North "E" St., San Bernardino, CA 92405
(909) 886-6737' (909) 881-3871 Fax' (909) 886-4889 Hotline
Alternative Choices:
216 W. 6th St., San Bernardino, CA 92401
(909) 888-4440' (909) 888-0886 Fax ATTACHMENT "E"
lune 14,2001
To: Design Committee Members
From: Family Service Agency of San Bernardino
Subject: YMCA Remodeling Project ( Level 12 Group Home)
Dear Design Committee Member:
Enclosed for your perusal are copies of questions with answers that your
committee asked the Family Service Agency representatives at your
meeting in May.
I have also included for you questions and answers that the state of
California's Department of Licensing included when one is applying to the
state for a license for a Level 12 Group Home application.
Thank you so much for your questions and we look forward in meeting
with you in the very near future.
Sincerely,
~._--_.-
~ ""..---"
,
cc:/ Design Committee
Fontana Office:
9161 N. Sierra, Ste. 202
Fontana, CA 92325
(909) 822-3533 . (909) 822-3050 Fax
Vlctorvllle Office: ,
15402 Sage 51. Ste 101-102
Vlctorvllle, CA 92392
(909) 843-9953
Creatllne Office:
23406 Crest Forest Dr.
Crestllne, CA 92425
(909) 338-4689. . (909) 338.8230 Fax
FAMILY SERVICE ASSESSMENT CENTER
QUESTIONS AND ANSWERS
1. What is a level 12 group home and who is legally responsible Cor it?
All group homes in the state of CaliComia are regulated by state licensing (Community Care
License). Each group home has a Rate Classification Level (RCL). Levels 1 - 3 are in the
"family model," 4 _ 6 are in the "social model" needing more supervision, levels 7 - 9 are in the
"psychological model" having a significant number of emotional problems and needing more
care and supervision, and levels 10 - 12 are in the "psychiatric model," needing a great deal of
care and supervision because of their emotional state. RCLs 13 and 14 are reserved for children
who need intensive care and treatment. These facilities are also referred as Residential
Treatment Centers and are locked for security reasons. Before the Family Service Agency
facility can becoine an assessment center, we need to become a level 12 group home site. This is
in response to the County of San Bernardino's Request for Proposal (RFP) dated November,
2000.
2. Explain how the Assessment Center is going to be secure Cor both the clients and the
community.
The ratio of staff to client will be 1:4. This means that for every four children in the Assessment
Center, there will be a staff person assigned and on duty supervise them from 6:30a.m. until
10:00p.m. From 10:00p.m. until 6:30a.m., the staff ratio will be I: 12. This lower ratio is
because the clients are sleeping during these hours.
During holidays and weekends, the ratio remains the same. All staff of the Assessment Center
will be required to be trained in the management of children with behavior problems. This
training is designed to defuse problems before they become a crisis. This training (PARTS) is
required by the State of California at all level 12 facilities, and the Assessment Center must also
follow the state regulations.
Our Assessment Center will have in place both on the inside of the facility and on the outside,
the most up-to-date modem video camera system to help monitor the security ofthe facility, the
safety of the residents and staff, and the safety ofthe community. The only place that the
cameras will not be placed will be the bedrooms and the bathrooms.
Before entering the Assessment Center, the court will assign each child their own personal
Probation Officer. This means that if any time our Assessment Center has any type of problem
with a client, their probation officer will be notified immediately.
Around the outside of the Assessment Center, a 6ft. decorative iron fence will be installed.
3. How will the clients receive an education while living at the Assessment Center?
Family Service Agency of San Bernardino will work with the city and county schools as we seek
to educate our children assigned to the Assessment Center. FSA will establish it's own Non-
Public School (NPS) because 65% of the children in the center will require special education.
This is not unusual because many of the group homes in the state operate their own school. This
relieves the school district of a number of behavioral problems that occur on a daily basis
because of the emotional state of these children.
4. Is this center open to the general public?
No. Only staff, clients, and the families of clients, probation officers, and court personnel will be
allowed to enter the facility.
s. What does your renovation plan consist of?
a. Family Service Agency of San Bernardino has contracted with a local
architectural and construction management firm to design and construct the
facility to meet the State of California requirements.
b. Fire sprinklers will be installed throughout the facility.
c. The East wing of the facility will be converted into a 120 dormitory with to beds
per room (as stipulated fn state regulations). Classrooms, common areas, offices,
recreation (inside & outside) will all be a part of the renovation process.
d. The kitchen will be renovated into a cafeteria for meals.
e. All pluming and electrical systems will be upgraded to meet city codes.
f. Renovations will all follow the State of California codes for an RCL 12 facility
(as is outlined in Title XXII).
-r.-
6. What type of juveniles will be housed in the Assessment Center?
The majority of the children that will stay at our facility are youth with aggressive behavior and
impulse control dysfunctions. Many of these youth come from dysfunctional home settings with
a lack of supervision and role modeling in their home. This will be an all-male youth assessment
center. H very high percentage of these children suffer from past abuse.
7. Explain your insurance program for the site.
We currently have a four million-dollar liability package, and the State of California will pay for
the children's medical needs. We will also adhere to the County of San Bernardino's
requirement which requires us to have a tem million-dollar vehicle coverage insurance package.
8. Do you have ample parking for your Assessment Center?
We currently have 52 parking spaces on our property. At no time will our staffuse all of
these parking spaces. At anyone time, the staff may use 34 - 39 parking spaces.
9. Why is it important for our county to have it's own Assessment Center?
At this time, the placement of children in this county is done after a limited assessment. This
means that the Probation Department psychologist does an assessment based on some testing (in
some cases) and the child is placed in available facilities. The assessment center will allow for .
the observation of clients over a 90 day period. It also allows for more extensive testing,
therefore allowing therapists, probation officers, and other staff to make a more informed
recommendation for the long-term placement of the child. This is good for the child as he will
be more likely to satisfactorily adjust to appropriate placement and complete treatment. Out-of-
county placement is becoming a practice of the past. Each county in the state is now being
required to house it's own troubled children.
:iROUP HOME PROGRAM STAT lENT
PART III PROGRAM NARRATIVE
(provide the information requested below and place it behind the corresponding tabbed divider (see General Instructions). The section number
corresponding to the Table of Contents is shown for each subject area.)
PROGRAM DESCRIPTION
PURPOSE, METHODS AND GOALS-SECTION 3
[Reference: CCR 80022(b)(1); MPP 11-402.356(a)]
Describe the PURPOSE, METHODS AND GOALS of the program.
Include:
What the program will provide for the children and how it will be accomplished:
The purpose of the Family Service Agency Residential Assessment Center (RAC) is to provide a clean, safe
and comfortable environment for children while they are being assessed for long-term placement. In
addition, these children will participate in group counseling, individual, and family counseling, an
emotional growth program, life skills counseling, anger management sessions, values clarification groups,
and counseling for alcohol and other drugs. FSA 's treatment goals are: to help the adolescent assume
responsibility for their offenses while enhancing their capability to understand the impact of their actions on
the community; to help them to develop empathy for the experience of victims; to assist the child in
achieving a more complete understanding of their own individual issues and to work with them in order to
develop strategies that may be used should they find themselves once again beginning the cycle leading to
inappropriate behavior; to provide new information which will challenge their rigid, stereotype ideas about
sex roles and intimacy and their misinformation about sexuality; and to provide various skill training
elements, which include assertiveness and anger management.
How children will be assessed:
Upon being referred to the Family Service Agency Juvenile Residential AssessmentIPlacement facility,
each child will undergo a through evaluation as follows:
MedicallDental: The facility registered nurse will review the youth's medical records to determine what (if
any) medications have been prescribed and if medications accompany the child. This medical record
review should reveal any acute or chronic medical conditions suffered by the youth as well. A complete
medical interview will be completed by the nurse who will turn the information over to the FSA Medical
Director for review. Unless an acute medical episode is identified, the FSA Medical Director will assign the
case to one of the medical team members who will complete a physical examination within 30 days of the
youth's admission (unless a physical examination was completed within the period of 6 months prior to
placement).
A child for whom vaccinations against Poliomyelitis, Diphtheria, Pertussin, Tetanus, Measles, Rubella, or
Mumps cannot be verified will receive the first dose of the appropriate vaccine within 30 calendar days of
placement. The child's medical treatment plan (a part of the Needs and Service Plan) will be developed and
monitored under the supervision of the Family Service Agency's Medical Director. Any funded medical
. services will be identified and included as a part of this overall plan.
A dental evaluation will be completed within the first 30 days of admission if a period of 6 months has
elapsed since the last visit. This examination will be completed by a dental service.
Educational Testing: During the first 30 days following admission to the Family Service Agency Juvenile
Residential AssessmentIPlacement facility, appropriate cognitive functioning tests will be given to the child
by licensed Psychologist. Th tests will vary based on the age and r rted academic functioning level of
the child, and may include the Thermatic Apperception Test (TAT), the Wechsler, and the WlSC tests.
Familv. Social and Behavioral Functioninl! Assessment: Abram Rosneblatt, Ph.D., from the University of
California at San Francisco and the contract evaluator for children's System of Care (SOC) was asked to
provide his recommendations of what he thought would be a good way to both provide valid outcome data
while giving clinicians useful information for use in their treatment planning and service provision. Dr.
Rosnebaltt, based on his extensive experience with children's Systems Of Care, and in consultation with
Norm Wyman of Santa Cruz County Mental Health and Don Kingdon who at that time worked for Ventura
County Mental Health, recommended that the State adopt a series of seven assessment instruments. Some
of these instruments are intended to be completed by the client, others by a parent or primary caregiver, and
one by the clinician. Of the seven instruments, five are considered to be "core" or required, while the other
two are optional but recommended. The data that will be generated from the Children and Youth
Performance Outcome System will serve several primary purposes, which include:
Assisting clinicians with treatment planning and service provisions:
Effecting quality improvement in local mental health programs;
Providing performance outcome data to the State and Legislature; and
Allowing the comparison between California's public mental health programs and those of other
states
What type of treatment will be provided:
The program provides a structured psychotherapeutic and socially interactive program which includes
group and individual psychotherapy as well as contingency management components, family therapy, close
academic programming and supervision in an on-grounds SED school. In addition, developmental,
vocational education and social skill training components will also receive significant emphases. Specific
treatment modalities will be designed according to the needs of the child, and will include: Cognitive
Restructuring, Experiential, Psychoanalytic, Bowen Therapy, Substance Abuse counseling including AA,
NA, and other appropriate groups. Therapists will conduct group therapy sessions and will provide three
individual therapy sessions to each child on a weekly basis.
How results or outcomes will be measured and how often.
Out-come measures will be an important part of the overall program. First, and perhaps most importantly,
these instruments were selected for their potential utility to clinicians in assisting with treatment planning
and service provision. In addition, an important purpose of the performance outcome is effect quality
improvement in local mental health programs. The FSA JRAC will use five of the out-come tools to
evaluate the effectiveness of the project. The scales to be used are:
Client Living Environments Profile( CLEP)
The client Living Environments Profile (CLEP) is a public domain instrument (it may be freely copied) that
was developed by the Children's Performance Outcome Technical Work Group under the oversight of the
Department of Mental Health. The CLEP is an indicator of the child's living situation and the
restrictiveness of the living situation over the last 12 months. Specifically, the CLEP collects two kinds of
information: 1) current living situation and 2) predominant living situation over the last twelve months. The
CLEP is to be administered for all target population clients within 60 days of first receiving service,
annually and at discharge.
Child Behavior Checklist (CBCL)
The Child Behavior Checklist (CBCL) is designed to determine the child's perception of their level of
appropriate behaviors as well as the perceptions ofteachers (ifavailable), and caregivers. This instrument
has become a standard asses~ nt for the County of San Bernardino' ~ ;partment of Behavioral Health,
and was developed by Dr. T.M. Achenbach, Ph.D. of the University of Vermont. The Minnesota
Multiphasic Personality Inventory- Adolescent (MMPI-A) may also be given to those age appropriate youth
for whom additional traits and extreme mood swings need further assessment. This test was developed by
Dr. J.N. Butcher, Ph.D. from the University of Minnesota.
Client Satisfaction Questionnaire (CSQ-8)
The Client Satisfaction Questionnaire (CSQ-8) was developed, validated and copyrighted by Clifford
Atkinson, Ph.D., a professor at the University of California at San Francisco. Dr. Atkinson is also an
associate of Abram Rosnelatt, Ph.D., who is the contract evaluator for Children's Systems of Care and who
also was the architect of the model we are using for the Children and Youth Performance Outcome System.
The CSQ-8 is to be completed by the parent/primary care giver and was designed to rate the level of
satisfaction with the service provided for their child using a Likert-type (5-point) rating scale. The CSQ-8
is to be administered annually and at discharge.
Family Empowerment Scale (FES)
The Family Empowerment Scale (FES) is a public domain instrument (it may be freely copied) and has
been used in evaluation research conducted by the Regional Research Institute for Human Services at
Portland State University in Oregon. The FES is designed to measure parents' or family care givers'
attitudes, knowledge and behavior related to their power to get effective care for their child and participate
in community and political change in children's mental health systems. The instrument contains 34
straightforward items (e.g., A I am able to get information to help me better understand my child@)thatare
rated on a 5-point scale from not true at all to very true. The FES is recommended, but not required, to be
administered for all target population clients annually and at discharge.
Youth Satisfaction Questionnaire (YSQ)
The Youth Satisfaction Questionnaire (YSQ) is a public domain instrument (it may be freely copied) and
has been used in the evaluation of a community-based case management program that provides
individualized services to seriously emotionally disturbed children. The YSQ is designed to measure both
the child's general satisfaction with service and their satisfaction with specific services they have received.
The instrument contains 5 general questions (e.g., "Did you like the help you were getting?") with answers
rated as "yes", "somewhat" or "no"; and has a section where specific services can be entered into blank
paces to be rated with a grade from A to F to rate the quality of care. The YSQ is designed to be completed
by the child or adolescent client 9 year of age or older. The YSQ is recommended, but not required, to be
administered for all target population clients age 9 or older annually and at discharge.
I r the program is certified by the Department or Alcohol and Drug Programs, attach a copy or the certification.
The Family Service Agency is certified by the state of California as an alcohol and other drug trealrnent
facility (certification enclosed).
PLANNED ACfIVITlESlUSE OF , IMUNlTY RESOURCES-SECTION 4
[Reference: CCR 80022(bXI3), 84065(e). 84079]
Describe tbe program's planned SOCIAL and RECREATIONAL activities.
Include:
The plan for indoor and outdoor activities:
Recreational activities are structured to reinforce the therapeutic goals of each adolescent. The
reinforcement is accomplished by organizing the activities in a manner that will assist adolescents in
developing or enhancing their living skills. Some children will participate in individual therapeutic
recreation programs. These children will have been identified by the treatment team as needing some
specialized "therapeutic recreational activities" to enhance their program. All recreational activities are
geared to teach adolescents team work/play and how to cope with failure and success in sports-like
activities. The basic therapeutic skills involved in all recreation activities are verbal skills, sharing,
cooperation, team tasks and competition. Adolescents will participate in music therapy, educational
television, nature walks, radio programs and other educationally stimulating media productions. Outside
recreation will consist of monitored field trips, movies, picnics, etc. Staff will supervise all activities on
grounds and off grounds.
Tbe plan for individual cbild activities and group interaction activities:
Depending on the treatment plan, some children may be required to participate in specialized individual
recreation activities. Also, children who have special talents and abilities will be encouraged to participate
in specific activities that other children may not be involved.
Whicb cbildren are involved in the activities:
All children will be involved in recreational activities of some kind. These activities will include group and
individual activities as is prescribed by the child's individual treatment plan.
A list of community resources used by the program (for example, YMCA, YWCA, libraries, parks, church groups):
1. Boy Scouts
2. Sports Leagues
3. Summer Activities sponsored by the San Bernardino Recreation Department
4. Community Youth Services including summer ITPA.
5. The San Bernardino Library
6. The San Bernardino County Arts Center
7. Disneyland
8. The Ball Parks (located one block away)
9. Neighborhood Recreational Centers
If tbe facility espacity is 13 or more, identify tbe staff position responsible for panning, supervising and conducting activities:
The Family Service Agency Juvenile Residential Assessment Facility Manager will be responsible for
planning, supervising, and managing the recreational activities. This person will delegate some of these
responsibilities to line staff on an as needed basis.
Describe the program's plaoned educational activities and services.
[Reference: CCR 84079(aX5),81068.2)
Include:
Special education:
FSA will provide on-grounds special and regular educational services for all residents. The Assistant Team
Leader is responsible for supervision and ensuring that adolescents do school homework. Due to various
circumstances, we expect some children to corne into our Assessment Center with different levels of
educational deficits. From our experiences, those who have been out of school for a while tend to resist
going back to school. Sometimes, when they go back, they ditch, or become disruptive and defiant in order
that they may be suspended. Most of these children feel inadequate to measure up to the standards in class
and they do not want to be ridiculed by unsympathetic classmates who have been in school all the time.
Use of public andlor private schools:
The Agency will not utilize any outside school system unless special circumstances dictate the necessity of
such services.
On grounds school:
As was stated earlier, FSA will provide an on-grounds school capable of providing services to special as
well as regular students.
Tutoring, if applicable:
Each child (needing the services) will be provided with tutorial services three times weekly. these services
will be provided by college students who specialize in teaching children with learning disabilities.
Provide a SAMPLE DAILY AcrlVITY SCHEDULE for one week. including weekends and holidays.
The schedule mUlt include social, recreational and educational activities.
FAMILY SERVICE AGENCY GROUP HOME DAILY ACTIVITY CALENDAR:
Monday-Friday
Monday-Thursday
Monday-Thursday
Friday
Friday
6:00 a.m. - 6:30 a.m. Wake up, personal hygiene
6:35 a.m. - 7:35 a.m. Breakfast
7:35 a.m. - 8:00 a.m. AM Chores
8:00 a.m. - 3:00 p.m. On-ground school/or Vocational Training
3:00 p.m. - 3:30 p.m. After school snack
3:30 p.m. - 5:30 p.m. Study time, personal tutoring, or family visits
5:30 p.m. - 6:00 p.m. Special Recreation
6:00 p.m. - 6:45 p.m. Dinner Hour
6:45 p.m. - 7:00 p.m. Prepare for therapy
7:00 p.m. - 9:00 p.m. Therapy: Individual & Group
7:00 p.m. - 9:00 p.m. Other Specific activities with counselor
7:00 p.m. - 9:00 p.m. Recreational Activities
9:00 p.m. - 9: 15 p.m. Snack
9: 15 p.m. - 10:00 p.m. Showers, preparation for bed
10:00 p.m. Lights out
9:00 p.m. - 10:00 p.m. Special activities
F AMll.. Y SERVICE AGENC ; JROUP HOME\ WEEKEND ACTIVI CALENDAR:
Saturday
8:00 a.m. -
8:30 a.m. -
9:15 am.-
11:00 a.m.-
12:00 p.m. -
12:30 p.m. -
2:30 p.m. -
4:00 p.m. -
5:00 p.m. -
5:30 p.m. -
6:30 p.m. -
7:00 p.m. -
9:00 p.m.
9:00 p.m. -
10:00 p.m.
8:00 a.m. -
8:30 a.m. -
9:15 a.m. -
9:30 a.m. -
11 :00 a.m. -
12:30 p.m. -
1:00 p.m. -
1 :20 p.m. -
5:00 p.m. -
5:30 p.m. -
6:30 p.m. -
6:45 p.m. -
9:00 p.m. -
Sunday
8:30 a.m.
9:15 a.m.
11:00 am.
12:00 p.m.
12:30 p.m.
2:30 p.m.
4:00p.m.
5:00 p.m.
5:30 p.m.
6:30 p.m.
6:45 p.m.
9:00 p.m.
10:00 p.m.
8:30 a.m.
9:15 a.m.
9:30 a.m.
10:45 a.m.
12:30 p.m.
1:00 p.m.
1:15 p.m.
5:00 p.m.
5:30 p.m.
6:30 p.m.
6:45 p.m.
9:00 p.m.
10:00 p.m.
Wake up, personal hygiene
Breakfast
Cleaning of rooms and personal needs
Free time (on grounds)
Lunch .
Recreation, family visits, etc.
Return home-on ground activities, snacks,
telephone call, letter writing
Individual counseling or rap group
Free time (on grounds)
Dinner hour
Clean up from dinner
Movie or other planned outing
Return home
Showers, get ready for bed
Lights out
Wake up, personal hygiene
Breakfast
Kitchen duty
Free time (on grounds)
Worship for those who desire to do so
Lunch
Clean up
Family visitation (on grounds)
Recreation activities, snack (on grounds)
Free time (on grounds)
Dinner hour
Clean up, kitchen duty
Rap session
Showers, get ready for bed
SPECIAL SERVICESlPROGRAMS OFFERED-SECTION 5
[Reference: MPP 11-402.356(1)]
Describe any special or programs which wm be offered.
Emotiona] and Socia] Growth Pro~
Human Deve]opment is a biopsychosocia] process which begins at conception. Each human is therefore
impacted by the interaction of biological, psychological and socia] forces (Travers, 1982). Because of the
interactive nature of human development, it is impossible to confine an exhibited problem to one
developmental compartment. Behavior is therefore integrated (an internally connected construct of thought
processes and past experiences) and interactive (responsive to the perceived environment). The reciprocal
interactions between heredity and environment produce their results in a complex, interactive manner. This
is further complicated by the fact that we are also interacting reciprocally with the environment on a minute
by minute basis.
In many cases for our residents, an emotional trauma of the past has stopped (or significantly retarded) their
progress through Eric Erickson's Stages of development. This has had a negative impact on their ability to
understand who they are and to develop relationships with others. Based on the initial (and subsequent)
assessments, Emotional Growth Group sessions will target emotional tasks for recommendation. These
tasks will include empathy building (Rosenthal, R., 1977), the social arts (Feldman and Bernard Rime,
1991), impulse control (Block, J. 1995), and anger management (Tauris, C. 1989). The five major
components of successful emotional (and social) development will be processed with residents:
knowing one's emotions, managing emotions, motivating oneself, recognizing emotions in others, and
handling relationships. We embrace the philosophy that to the degree a person has both cognitive and
emotional inteIIigence, these pictures merge. Still, of the two, emotional inteIIigence add far more of the
qualities that make us more fully human.
If the program provides vocational training, describe:
Tbe skill taught;
Following is a sampling of the ROP courses available to the adolescents:
Aircraft Ground Service
Animal Care and Control
Auto Upholstery
Barbering
Building Remodeling
Catering
Computer Repair
Desktop Publishing
Emergency Medical Technician
Greenhouse Operations
Hotel/Motel Occupations
Instructional Aide
Legal Assistant
Microcomputer Repair
Plumbing Occupations
Recreational Leader
Security Guard
Tow Truck Operator
Welding Occupations
Airframe and Power plant
Auto Body Repair
Banking Occupations
Building Maintenance
Cable TV Installation
Certified Nursing Assistant
Data Entry
Electronics Occupations
Forestry Firefighter
Hospital Occupations
Industrial Drafting
Landscape Occupations
Machine Shop Training
Motorcycle Repair
Printing Occupations
Retail Sales
Silkscreen Occupations
VCR Repair
Word Processing
Goals of the training program:
Pre-vocational PrOlmlm (Long-term placement residents only)
Productive members of our society have developed vocational skills, a sense of responsibility, the ability to
participate in acceptable recreational activities and adequate interpersonal behavior. The treatment team
and the child care staff are instrumental in ensuring that adolescents, who as a result of their age cannot
participate in the vocational programs described below, will still gain many of the skills prerequisite for
successful adult adjustment. Acquisition of these skills will orient the adolescents to the world of work.
The program will include visitations to hospitals, restaurants and factories which have the potential of
providing future job opportunities for the adolescents.
These social and pre-vocational skills will be developed as part of the same treatment program that is
treating the adolescents' underlying emotional problems. For early adolescents, treatment emphasis will be
on social skills development-including communication, interpersonal and self-help skills. In addition,
children will receive an introduction to independent living skills. Development of these skills including
meal preparation will continue throughout the pre-vocational and vocational programs. Children who have
completed the pre-vocational and vocational programs will have developed skills necessary for shopping,
preparing healthy meals and laundering their own clothing.
Vocational Prolmlm CLonl!-term residents onlv)
Adolescents, prior to emancipation, should have developed vocational skills, a sense of responsibility, the
ability to participate in acceptable recreational activities, independent skills and should have developed
adequate interpersonal behavior. The consultants and the child care staff are instrumental in ensuring that
the adolescents gain many of these skills which are requisite for successful adult adjustment. These skills
will be developed at that same time as the adolescents' underlying emotional problems are treated. They
will be enrolled in at least one career education class each semester through the Regional Occupational
Program offered through San Bernardino County.
The Regional Occupational Program (ROP) is a career education system that provides training programs to
help high school students develop the skills they need for full or part-time employment or for higher-level
vocational or technical training programs. ROP provides high quality vocational, technical and
occupational preparation through a variety of specialized courses. ROP enables students to be trained on
the job site and meet industry standards for job performance.
Transitional Prolmlms
Adolescents 17 2 years and older who have not succeeded at a vocational activity and who meet the
eligibility requirements will be referred to the State Department of Vocational Rehabilitation for evaluation
and training. The facility will be responsible for completion of all forms enabling the adolescents to benefit
from the vocational training offered. Programs offered will include Carl Perkins and ITP A Job Search and
Job Training.
All adolescents (in long-term placement) in the Emancipation programs will have ample opportunities to
shop for their food and clothing, plan and help prepare balanced meals and monitor their own grooming and
complete laundry independently. When necessary, they will receive supervised instruction in these skills
and in other aspects of appropriate adult behavior. Thus, by the time they attain the age of majority, they
will become productive members of our society.
Hands-on exporion.. received:
Work and Anprenticeshin Prol!rams
In addition, to ROP courses, llescents will be encouraged to partic. e in the Cooperative Vocational
Education program and in Workability and Job Training Partnership Act programs. Cooperative Vocational
Education (CVE) assists students to develop and refine occupational competencies (attitudes, skills and
knowledge) needed to acquire, adjust and advance an occupation. It accomplishes this by correlating formal
vocational classroom instruction with regularly scheduled, paid on the job training experience. Workability
and JTPA are subsidized employment programs. Long-term placement children will also be provided the
option of participating in a facility coordinated job placement and apprenticeship programs in conjunction
with local merchants and discount stores, fast food and other restaurants and supermarkets, provided the
child is able to successfully complete the first three phases of the program.
All vocational activities including ROP will be in addition to the adolescent's educational program which
may be modified to include placement in a continuation high school if the children is enrolled in the public
schools. Vocational activities will never be allowed to interfere with the mandatory school attendance
requirements and progress toward graduation. Most of the FSA children will be in the 7 to 18 age range,
however, the program will help them to develop a work ethic at this early age.
Materials provided:
Materials for all training will be provided by the respective governrnent program.
Work and Aoorenticeshio Prolp"ams
In addition, to ROP courses, adolescents will be encouraged to participate in the Cooperative Vocational
Education program and in Workability and Job Training Partnership Act programs. Cooperative Vocational
Education (CVE) assists students to develop and refine occupational competencies (attitudes, skills and
knowledge) needed to acquire, adjust and advance an occupation. It accomplishes this by correlating formal
vocational classroom instruction with regularly scheduled, paid on the job training experience. Workability
and JTP A are subsidized employment programs. Long-term placement children will also be provided the
option of participating in a facility coordinated job placement and apprenticeship programs in conjunction
with local merchants and discount stores, fast food and other restaurants and supermarkets, provided the
child is able to successfully complete the first three phases of the program.
All vocational activities including ROP will be in addition to the adolescent's educational program which
may be modified to include placement in a continuation high school if the children is enrolled in the public
schools. Vocational activities will never be allowed to interfere with the mandatory school attendance
requirements and progress toward graduation. Most of the FSA children will be in the 7 to 18 age range,
however, the program will help them to develop a work ethic at this early age.
Number of hours per day/days per week training is provided:
Six hours/per day has been set aside for either academic or vocational training. The hours are from 8:00
AM to 3:00 PM M - F (see schedule).
How training is funded:
All training is funded by the respective governrnent program. Academic education for the SED clients and
the regular school clients will be funded by the Department of Education, San Bernardino County School
System. JTPA, Welfare-to-Work, R.O.P., and CYE. will fund the vocational program.
MEDlCAIJDENfAL-SECTION 6
Describe procedures used to provide routine medical and deotal care, including procedures ror bandliDgand usisting children witb
selr.administered medications. [Refereoce: CCR 80075(a)(IHl))
1. The outside medical and dental providers will be paid by MediCal. All are ClIDP providers.
Routine medical services will be provided by the medical staff at the Assessment Center. This staff
is composed of the medical Director, a psychiatrist, and two registered nurses. Major medical
problems will be sent to San Bernardino's Arrowhead Medical Center in Rialto.
2. All medical supplies are locked in a medicine cabinet and is dispensed by the nurse on duty. All out
dated or
unused medicines are disposed of and logged on medication log sheet which is filed with date of
discard in the adolescent's file. The Head Nurse is responsible for the control of medical supplies.
The on-duty nurse is responsible for monitoring and assisting children with self-administration of
medications.
3. Each resident who enters the facility will receive a complete physical examination within 30 days of
their placement. The results of that examination will be summarized on a standard commercial
physical examination summary form. For outside medical services, if the physician is not ClIDP
affiliated, he/she will be requested to follow ClIDP guidelines and provide equivalency services.
Successive visits to a physician will be logged in the resident's file in the section entitled Health and
Medical Records by the nurse on duty.
Dental services will be handled by dental offices subscribing to Medi-Ca1 services and payments.
Describe procedures used to ideotify and bandle medical, deotaland psychiatric emergencies. (Rerereoce: CCR 80075(01
I. The residents' safety will be assured by the presence of on-duty, trained nurses and child care
personnel at all times. These personnel will be trained in the management of medical and
psychiatric emergencies. In addition to achieving First Aid certification, they will continue to
participate in in-service training for First Aid and the Management of Assaultive Behaviors. These
in-service sessions will be presented alleast annually by experts in First Aid and crisis diffusion
respectively. The crisis in-service trainer will also have expertise in the area of managing assaultive
behaviors.
As part of their training, staff will be provided with a list of behaviors which would be indicative of
a psychiatric emergency. These include suicide signs and psychotic manifestations. They will be
provided with the telephone number of the local PSYCHIATRIC EMERGENCY TEAM (800/472-
4305) for emergency assistance. If a resident manifest behavior which warrants a call to the
Psychiatric Emergency Team, or has a medical crisis that requires emergency assistance, the child
care worker will notifY the administrator, the medical director, the team leader, and the County
Placement Worker and the Consultant by telephone immediately following the crisis.
Identify starr position(s) responsible ror dispensing and destroying medications. (Rererence: CCR 8007S(i)(I), 84075(b))
I. Prescribed medication will be inventoried by the head nune on a daily basis and stored in a locked
medicine storage cabinet in the facility office. Access will be limited to the medical director, the
nurses, and the team leaders. A medication chart will be kept for each resident in hislher file. The
head nurse is responsible for all medical records. The medication chart requires that the following be
listed:
1. lme of medication
2. Prescribed dosage
3. Administration schedule
4. Purpose or illness
5. Precautions or special instructions
6. Prescribing physician
7. Signed initials of staff member responsible for administration.
The head nurse will ensure that the prescriptions are reviewed by the prescribing physician no less than
monthly. Medication no longer required will be disposed of in the safest and most appropriate manner
available by the head nurse. Destroyed medication will be logged and witnessed by the second nurse on
duty. State of CA form #LIC 622 will be utilized for this purpose.
PART III. PROGRAM NARRATIVE (Continued)
TRANSPORTATlON- SECTION 7
Describe arrangements for transporting children to and form scbool, activities provided outside the facility(ies) (iDcludingattendance at
religious service) and medicalldenWappointments. (Reference: CCR 800U(b) (10))
The Family Service Agency Assessment Center has it's own vehicles for transportation of adolescents.
Specify bow the program will ensure tbat vehicles used to transport children are maintained in safe operating condition.(Reference:
CCR 80074)
All are equipped with the necessary safety devices (car seats for adolescents under 45lbs. and seat belts)
required by the law when transporting adolescents. Daily and weekly inspections will be completed by
Child Care Workers assigned to this task. These inspections will be logged in a specific maintenance booi!;.
Specify bow lbe program will ensure lbat vehicle registration and insurance will be maintained.
The vehicles used to transport the adolescents are serviced at regular intervals and safety inspected by the
DMV.
Specify bow the program will ensure tbat only appropriately 6censed program staff and voluateen will transport children.
Staff must provide DMV printouts (annually) of their current California drivers license. Proof of insurance
will also be required by staff. All staff will be required to participate in a safety orientation to discuss the
unique problems and circumstances involved in transporting minors. Staff may not transport children in
their own vehicles at any time.
ADMISSION/ASSESSMENT/ DISCHARGE POLICIES AND PROCEDURES
ADMISSIONllNTAKE-SECfION-8
[Rd"e=c:e: CCR 80022(bX2),84068.1, 84068.2)
1. Describe the procram', admissionfmtake procedures.
Include:
Criteria for evaluating appropriateness of referral, for placemenl;
It should be understood that the Family Service Agency Juvenile Residential Assessment Center is an
ASSESSMENT CENTER We anticipate a contract with the San Bernardino County Juvenile Probation
Department to provide assessment services for a significant number of children who are waiting in Juvenile
Hall for assessment and appropriate placement. Therefore, the likelihood that we will refuse any child for
an initial assessment is small.
Pre-nlacement Assessment/orientation:
1. Evaluation of dynamics involved in child's problem(s).
2. Obtain history and understanding ofproblem(s).
3. Receive explanation of program, home visits, educational and recreational in
treatment process.
4. Assessment of parents' acceptance of their role and responsibility in the problem(s)
and change process.
5. Explore the concerns presented by social workers and consultant.
All children admitted to The Family Service Agency JRAS shall be governed by the following general
admission policies and procedures, with the exception of emergency placements (which we will accept as a
part of the contract):
1. The initial interview with the potential child and guardian, placement agency or authorized
representative shall be conducted by the Intake Coordinator. At this interview, data pertinent
to child's social and health history will be gathered.
2. From the initial interview the intake coordinator will compile a temporary file of child's
personal data, reason for seeking placement, problems and placement sources.
3. After the initial interview, the child is taken back to the referral source (unless it is an
emergency placement) until a decision is reached pertaining to hislher acceptance or non-
acceptance into the facility.
Admission Process:
1. Check to see that all necessary papers in packet have been filled out, especially Consent for
Treatment, and that we have received a Medi-Cal card. Give materials to director.
NEEDS AND SERVICE PLANS/ASSESSMENT -SECfION 9
(Rcfcreoce: CCR 84022(b)(2)]
2. Describe procedures of developing a needs and services plan which addresses each chad's needs and the services required to _t
such needs:
Upon entry into the facility, the facility social worker will develop a NEEDS AND SERVICES PLAN for
all residents with the exception of those placed on an emergency basis. The plan will address the following
areas and/or needs of each child or adolescent.
a. Reason for placement.
b. Education.
c. Training.
d. Personal care and grooming.
e. Ability to manage money with emphasis on the maximum amount of money allowed in the
resident's physical possession.
f. Visitation, including frequency and limitations.
g. Other services necessary for the residents (and family-if appropriate) including type and
facility's ability to provide.
h. Services to be provided by the facility in cooperation with community resources.
I. Planned length of placement and discharge planned.
j. Financial arrangements for provision of services.
In addition, the plan will address the child or adolescent's level of functioning, concerns and needs in the
follow areas:
a. Cognitive
b. Academic and School
c. Emotional
d. Social Interaction
e. Adjustment and Compliance
f. Decision Making
g. Gross and Fine Motor
h. Pre-vocational andlor Vocational
I. Health and Hygiene
J. Family Interaction.
2. Child is takel. his room. The intake worker and th, .am leader is responsible for seeing
that child is escorted to his room with his possessions.
Note: Bedrooms have no locks on doors.
Information required to u.... referrals for placement:
A child who is accepted (and his guardian, representative of the placement agency or authorized
representative) will meet with the Administrator at which time the child and his authorized representative
shall be welcomed into the program. They will be given an orientation regarding the program at that time.
At the conclusion of the orientation the following information will be requested:
Evaluation of child and family to determine family's contribution to child's presenting
problem.
Obtain additional history of the child/family.
Court Records.
Previous testing completed by psychologists or psychiatrists.
Medical and dental records
Discharge report from previous placement.
Special Incident Reports from previous placement.
Treatment plan or Needs & Service plans from previous placement.
Time-frame for responding to referring agencies regardinll acceptance or rejection of referral:
1. The decision to accept or not to accept a child for placement shall be made in a team case
conference to be conducted by the Medical Director. A decision shall be made and notice of
such decision forwarded to the guardian, placement agency or authorized representative
within three (2) business days following the initial interview.
2. If a child is not accepted for placement, based on information obtained in the interview, the
proper person will be notified within 24 hours after the decision is rendered.
Stair position responsible for intake:
The Family Service Agency Juvenile Residential Assessment Intake Worker is responsible for all initial
intake recommendations. This person will be a masters level therapist.
Procedures for accepting entercency placements on a time-limited andlor trail buis:
Because of the nature of the Assessment Center, children will be referred for emergency placement on a
regular basis. The only information that will be needed in these cases will be parent/guardian information,
medical history (if any), offense (if any), and the probation officer who is in charge of the case. Should
court records be available, we will expect to have these also submitted along with the child at placement.
3. [)acribe procedures ror revi... ~ evaluation ror th. -.Is and servic. plan.
In addition to the resident's specific progress in each of the areas listed above, ALL SPECIAL INCIDENTS
recorded since development of the previous plan will be reviewed and used as a means of evaluating the
appropriateness of the NEEDS AND SERVICES PLAN for the resident. Special incidents are initially
recorded by the staff member on duty. The clinical worker on duty is required to review all entries of
inappropriate behavior. The NEEDS AND SERVICES PLAN updates will always reflect the incidents
listed below which have occurred since development or update of the previous plan. Incidents requiring
recording include:
I. Suicide attempts
2. Runaways
3. Serious illnesses
4. Serious accidents
5. Major property destruction
6. Major altercations
7. Serious complaints by residents
8. Major incidences of defiance
9. Actions necessitating physical restraints
10. Unauthorized family visits.
Incidents of all significant behavioral, treatment, school, medical, family and other important
information will be logged by the child care worker on duty. This will insure that the information
will be available to the administrator and facility social worker during each scheduled weekly
review of the residents' progress by the staff social worker and the administrator. The files will be
reviewed for progress in each of the major areas of functioning included on the NEEDS AND
SERVICES PLAN. Special incidents and the residents' general progress will also be reviewed to
determine the continued appropriateness of the treatment goals as well as the continued
appropriateness of the residents' placement. When program or placement changes appear warranted,
but no less frequently than quarterly, the placement agencies will be notified
4. [)acribe procedures ror implementinc and modiryinC th. needs and servic.. plan.
Although modification of the NEEDS AND SERVICES PLAN is required only at semi-annual
intervals, the NEEDS AND SERVICES PLAN will be coordinated with monthly assessments and
reports. If the authorized placement representative is unable to attend the quarterly review, reports
will be submitted to the placement agency indicating progress or lack of progress in the treatment
program. Evaluations of academic achievements,
training programs, medical, and therapy progress will be included. The staff social worker will be
responsible for contacting DCS and for developing and submitting the quarterly reports as well as
for making other routine and special reports to placement agencies.
Progress toward each of the goals and objectives developed which were developed on the previous
quarterly update of the NEEDS AND SERVICES PLAN will be reviewed. Objectives not met will
be evaluated for continued appropriateness. They will either be retained, modified or deleted.
Special incidents and reports from outside agencies will be reviewed as will all logged notations by
facility staff. This information will be utilized to modify current objectives or to develop new ones.
A revised NEEDS AND SERVICES PLAN will be developed and submitted on a quarterly basis to
the placement agency.
s. Describe !be policy reprdinl participatioD of !be child aDd hislber authorized representative in developial. updatiDl and
modifyiDK !be Deeds Df!be service plan.
The facility will adhere to [CCR 84068.2(dXl)] requirements and ensure that the authorized
representative of the resident has been notified by telephone as to the date of the NEEDS AND
SERVICES PLAN development meeting. The facility social worker is the individual responsible for
the notification and for obtaining approval for implementation. The participation of the resident is
encouraged, but may not always be appropriate. That determination will be made by the resident's
authorized representative. No plan will be implemented without the approval of the authorized
representative of the resident. The placement agency will be provided with copies of the quarterly
reports if the authorized placement worker is unable to attend the scheduled reviews.
DlSCHAIlGElREMOV AI.- SECTION 10
[Rcfen:ace: CCR 84068.2, 84068.4J
1. Descn'be proceduftS for planned discbarce or removal
As soon as it is determined that a dismissal is pending, the child's placement worker and the administrator
should be notified. If there is an opportunity to set up a dismissal date and time, it shan be made when the
Agency social worker is on duty and during the week. The treatment team leader win get the necessary
papers ready, e.g., dismissal sign-out sheet, inoculation card, report cards, social security cards, etc., and the
on-duty child care worker will pack and fill out inventory sheet The team leader will notify the child's
placement worker of the pending dismissal date so that the child can sign out and have the transfer papers
made up for the new placement, return home, etc.
It should be noted here that in all cases, the Probation Officer win be the person determining that a suitable
placement has been found.
2. Describe proceduns of r emerceocy discbarce or removal
In the case of emergency discharges, either the P.E.T. Team will have been called to remove the child
because he/she has been determined to be a danger to themselves or others, or the child's behavior is
somehow disrupting the program in the center. In the latter case, the child's probation officer win be called
to remove the child, or Agency personnel will take the child and his/her belongings back to Juvenile Hall.
Notifications of all appropriate persons win proceed as usual in this case.
VISITATION RuLES AND POLICY. SECflON. 11
[Rdcrcoce: CCR 80068(bX6) 840723]
Describe !be policy and ruJes .....rcliag visitation.
1.
1n.1ade:
When and under what .ircumstances children can be visited at tile facility by family memben, friends and alben:
1. After admission, visitation will be scheduled according court or placement officer
recommendations. The probation officer will go over this with parents.
2. All visiting must be cleared with the child's placement officer. Thursday at 4:00 p.m. is the
deadline for making any weekend visiting plans.
3. Visiting will be in designated areas of the center. not in the child's parent's automobile. etc.
4. Permission must always be secured from the child's probation officer to take the child off
grounds for any reason.
When ud under what circumstaDces !be cbild is permitted to have home visits with parcots udlor relatives:
Because of the nature of the assessment center, children will not be allowed to have home visits.
When IlJId UDder what circumstances !be cbild i. permitted to bave ovemipt visits with parents, relatives, fomily memben
IlJId frieDds:
There will be no home visits for residents.
When and under ....t cir....m......- atller types af visits are or are aot penaiUed.
Visits will be permitted ON GROUNDS.
PART Ill. PROGRAM NARRATI\_ ,CouliDued)
HOUSE RULES- SECTION 11
1. Describe the procnm" policy or aUowia& cbiJdrea 10 be UDlUpcrvised ....y from the r.ciIity, iDdudiDc issuin&.......1o
cbildreu.
At no time will any child placed at Family Service Agency Juvenile Residential Assessment Center be
allowed to be away from the center unsupervised.
3. Specify other boone ru....
ludude:
Cun... boun OD ,cbool Di&Jrts, weekeDds aud bolidays:
During the week, lights are to be out at 10:00 PM. On weekends, lights are to be out at 10:30 PM At no
time will residents be out of the facility alone.
SmokiD&:
No smoking will be allowed in or around the Center.
DaIiD& other Cbildreu in p1._t:
Children in placement will not be allowed to date.
CompleliDc Homework:
Homework is to be completed on a nightly basis. Tutorial services are available for every resident needing
help with homework.
CleaDiD& bedrooms aud other .reas:
A part of the chores daily is that each resident must maintain their personal space in a clean and orderly
manner. The point system will be used to provide positive reinforcement.
u.. or eatertsinment equipmeat (the cbiId', aud the facility',):
Personal entertainment items are allowed provided the child has acquired the necessary daily points. No
child is allowed to touch center equipment The staff on duty is responsible for manipulating this
equipment.
Dress code:
No gang related attire will be allowed in the facility or at any time that the child is a resident.
Laundry:
Specific times are available for residents to do their laundry.
General prohibited beblvion:
I. There shall be no drug or alcohol use.
2. There shall be no intentional damaging offacility property.
3. Homework assignment shall be completed as soon as possible.
4. Adolescents shall practice good citizenship, both in the home and in the community.
5. There will be no fighting ...Jowed.
6. There is no smoking allowed inside of the facility, this includes family, friends, visitors.
7. There will be no throwing of any objects inside of the facility.
8. Adolescents shall not enter the office area unless asked to do so by a staff member.
9. Adolescents shall not go into another child's room, unless they are invited.
10. There shall be no stealing.
11. Adolescents must follow staffmembers directions.
12. Adolescents must have and maintain good personal hygiene.
13. There shall be no explicit reading materials or posters.
JENERAL POLlOES AFFECTING ODLDREl . ..ACED
DlSaPLINE POLlOES- SECJ'ION 13
1. Describe the prolram's discipline policy. [lUfereace: CCR 80071(a)(3), (7)- (8), 84071, 84071.1)
Include:
Type(s) of discipline used:
Facility discipline is based on the principle that positive reinforcement of an appropriate or "on_task"
behavior increases the probability that the desired behavior will occur again. Positive reinforcement is
available through praise and distribution of points and any resulting rewards and/or privileges through the
level system. Facility discipline is also based on the principle that non-reinforcement of an inappropriate
behavior decreases the probability of reoccurrence.
All interventions utilized in the facility respect, to the maximum extent possible, the resident's human
dignity and personal privacy and assure the resident of personal freedom, social interaction and individual
choice. All interventions likely to cause physical pain, deprive the resident of his basic needs or likely to
cause emotional pain are prohibited
To insure that disciplinary procedures meet the facility criteria, a behavior management program has been
designed which emphasizes positive reinforcement of appropriate behaviors, while at the same time
extinguishing inappropriate behaviors. For the most part, this system should eliminate the need for other
types of intervention. However, there will be times when a behavior cannot be ignored. At these times,
"TIME-OUTS," loss of points and resulting decrements in their standing on the level system, an immediate
drop in a level, and an initiation of termination proceedings will be utilized as disciplinary procedures.
Conditions under which each tvoe of disciDllne will be used:
THE USE OF "TIME_OUTS" AND POLICY FOR DEALING WITH REFUSAL TO ACCEPT A "TIME-
OUT."
When behavior is inappropriate, it will be pointed out to the resident. The resident will be asked to
terminate that behavior. The resident will be praised if termination occurs. If the behavior is not terminated,
the child care worker will suggest that the resident leave the situation in which the inappropriate behavior is
being manifested. The resident will then be praised for leaving the situation and engaging in a more
appropriate alternate behavior, including remaining in hislher room or other designated area. If the child or
adolescent does not voluntarily leave a situation to prevent an escalation of inappropriate behavior, she will
be assigned a 10-20 minute "time-out" under supervision. Locked rooms or rooms without windows will
never be utilized for "time-out" purposes. If a resident does not agree to accept a "time-out," all attempts
will be made to remove the other residents from the situation. This will eliminate a source of attention and
. positive reinforcement. HOWEVER, EVEN IF THE RESIDENT DOES NOT CEASE HIS
INAPPROPRIATE BEHAVIOR AND AGREE TO A "TIME-OUT," NO ATTEMPT WILL BE MADE TO
PHYSICALLY REMOVE HIM FROM THE SETTING UNLESS HIS BEHAVIOR ENDANGERS THE
RESIDENT, OTHER RESIDENTS OR STAFF.
If, despite use of these procedures, the resident's behavior remains a threat to the resident, other residents or
staff, LIMITED PHYSICAL RESTRAINT MAYBE UTILIZED. However, any type of physical restraint
of a resident is to be used ONLY AS A LAST RESORT and only if there is a clear immediate danger to the
resident themselves, other residents or staff, and all other practical interventions have been attempted by the
child care staff. Physical restraint will be limited to BASKET HOLDS or similar procedures and will be
maintained only until the reSlvcnt is calm. If the resident cannot be c.....led within IS minutes, police (911)
will be called. Immediately following such an incident, special incident reporting procedures will be
initiated.
NO STAFF MEMBER WilL BE AUTHORIZED TO UTILIZE EVEN LIMITED PHYSICAL
RESTRAINT TECHNIQUES UNTIL THEY HAVE COMPLETED A MINIMUM OF 16 HOURS OF
TRAINING IN THE MANAGEMENT OF ASSAUL TIVE BEHAVIORS. The training will enable the staff
to reduce the need for physical restraints and to insure that such restraints are used only to control and
isolate the resident without injury to the resident or staff.
WHEN TOKEN ECONOMY IS NOT APPLICABLE
THE USE OF LOSS OF POINTS AND RESULTING DECREMENTS IN THE LEVEL OF THE
RESIDENTS STATUS ON THE LEVEL SYSTEM Residents receive points for daily chores, for engaging
in behaviors that are required of all residents and for meeting the criteria for 6 personal goals set jointly by
the resident and the facility. A resident is not given points when chores are not satisfactorily completed,
when he does not engage in appropriate behavior and when he does not meet a personal goal. The reduced
point total can result in a reduction of his level.
THE USE OF AN IMMEDIATE DROP IN A LEVEL
A resident's level may be reduced by one or more level(s) as the result ofa major violation of the program's
rules as listed in the previous section. However, a decision to "drop" the resident one or more levels cannot
be made by the child care worker on
1. Upon entering The Family Service Agency Group Home, each child will be informed of his
rights. A personal right form will be signed and placed in adolescent's file. These rights will
be gone over by the Administrator, the child's representative, and the child.
2. The procedure for disciplinary action involves an initial conference between the child and the
team leader to discuss the nature of hislher offense. The child will be informed of the
disciplinary action agreed upon for his offense. The counselor will sign an agreement for the
disciplinary action.
This agreement will be placed in the child's locked file. Because of the nature of our population, we
keep a daily progress file to show daily behavior patterns.
3. The behavior modification point system serves as a disciplinary technique to support therapy,
counseling. recreation, life skills training and education. Rewarding adolescents with merit
points is a contemporary application of operant conditioning to modify behavior. The point
system is used to reinforce positive behavior, to reinforce constructive, self-enhancing
behavior to extinguish undesirable, destructive behavior.
For example, an individual treatment goal might be for a child to gain control over impulsive self-
defeating behavior. The point system would reward the child with bonus points at specific instances
when internal control was demonstrated. Examples of point system are as follows:
a. Desirable Behavior
*Timely positive completion of morning;
*Grooming and tasks;
*Punctual arrival at breakfast;
*Sharing, good group participation;
*Punctual arrival at dinner;
If a staff member has not received training in the use of physical restraints or does not feel
confident of his ability to control the child without injury to the child or himself, or if he has
been unable \~ .;ontact the administrator or facility L. .Jager, he will call the police (911).
Immediately following an incident in which the physical and emotional health andlorsafety
of any child is threatened, the County Probation Officer and Consultants will be contacted by
telephone.
As part of the initial orientation staff will be provided with a list of behaviors which would
be indicative of a psychiatric emergency. Some of these are suicide signs and psychotic
manifestations. They will be provided with the telephone number of the local
PSYCHIATRIC EMERGENCY TEAM, (714)925-7661, for assistance at these times. If a
child manifests behavior which warrants a call to the Psychiatric Emergency Team or has a
medical crisis that requires emergency assistance, the child care worker, immediately
following the crisis, will notify the Administrator, County Placement Worker and Consultant
by telephone.
Types of discipline DOt permitted (corporal pwlisbmeut and viol.tion of penona! ripls);
2. Adolescents shall not be punished before the group. There will be no corporal punishment, infliction of
bodily pain, deprivation of essentials such as meals, monetary allowances, visits from parents, home
visits, or any type of degrading or humiliating punishment used. Corporal punishment will not be used
by facility staff under any circumstances. Psychoactive medication will never be utilized as a
disciplinary measure.
Denial of adequate sleep, food, water, shelter, bedding, physical comfort or access to bathroom facilities
will never be used by the staff for any purpose. Verbal abuse, ridicule or humiliation are prohibited as
disciplinary tools. Locked seclusion, deprivation of one or more senses or simultaneous immobilization
of all four extremities will not be utilized as behavior change techniques and disciplinary purposes.
Provisions for contact with p......1s andlor p1acmaent rep.......tatives (confereftCe).
At any time that a major disciplinary action is necessary, the resident's guardian and placement officer will
be notified immediately.
NOTE: Prone .""";0"""'1 and Iikc ltlCImiques sbaIl DOl be iodudod as part ofa prognD11'. discipline policy nor wrillal into iDdividua1.-1s
and services pllllS. Such techniques arc DOl to be . plllllllOd Slql in modifying bcbavior. Tbcy arc CCI:lSidered to be QD\y last raort emergency
physical _I techniques designed to prevail injUl)" to lbc assau1tive child of olbcrs.
OULDREN'S COMPUANT/GRIE. . ..\ICE PROCEDURES- SECTION 14
3. Describe procedu.... by which chil....... or tbeir authoriled representatives are informed of tbeir riabts and permitted to file
complaints. [Reference: eRR 84071.1) Indude bow cbildrea, tbcir authoriled representatives and ataIf receive copies of !be
written complaintl.,;ev1JlCe procedu.....
Policy of procedure for In-House Complaints; Policy Statement in Compliance with Group Home
Regulation #84072.2
1. The Family Service Agency Group Home desires to be informed of any complaints regarding
facility, staff or operations as a matter of policy. Any child in residence or their authorized
representative should file such complaints through the following procedure:
a. Write down any complaints about a staff person or a facility operation and give the
written complaint to the administrator.
b. The Administrator and the Director will review written complaints and decide upon a
resolution whenever appropriate and possible. The staff and the person filing the
complaint will be included in determining problem resolution.
c. Signed copies of the complaint will be placed in the file of the child on whose behalf
the complaint is made, along with a written report by the Administrator detailing any
resolution activities.
Copies of this procedure are posted in the Home's Community Area and pointed out
to children and their authorized representative during intake interviews and upon
admission to the facility.
HANDLING ODLDREN'S FUNDS, ALLOWANCES, AND SALARIES-SECI10N 15
4. Describe how the procram accounts ror ud haodles children', penolUll funds. (1lef......ce: CCR
SOOZZ(b)(ll),8OO15.8OO16,84016)
The Agency will handle only funds necessary to pay children for allowances on a weekly basis.
5. Describe the procedure ror iIIuiaa aDow....... including the amount.
The adolescents will receive a weekly personal allowance of$5.00. The allowance will be issued by the on
duty staff and logged in on the child's cash resource sheet in this file. There are no off-ground paid jobs.
Children's funds:
Children's personal funds will be maintained in a locked cash drawer, maintained by the on duty staff. All
monies and gifts received by adolescents from family will be logged and cash receipt filled out stating who
gave money and the amount logged. The on duty staff is responsible for disbursing funds to adolescents.
The Family Service Agency Assessment Center will not be responsible for checking nor savings accounts
for adolescents.
CHORES-SECTION 16
6. Describe any cbo.... children are required to perform u part ortlloir npIar routi-..
Adolescents will be assigned the following chores:
Making of his own bed
Keeping room clean
Putting away and folding of clothes
Removing his dishes from the table
Rotating chore assignments shall be:
Watering of the lawn
Emptying of trash cans
Sweeping and mopping of the floors
Collection of newspapers and books
Assist in kitchen clean-up
Vacuuming
NUTRlTIONlSAMPLE MENU-SEl )N 17
[Ref.........: CCR 8oo22(b)(9), 80076(0) (5) &; (6)]
7. Provide. SAMPLE MENU which indudes:
ODe week', worth of pIamled meals, indudinlsaacks from the four buic food Iroups; Portion sizes; and Times meals are served.
Nutrition! Samnle Menu - Section 17
The Family Service Agency Assessment Center
Menu
Also see attach Menu WIt I nortlon SIZeS.
Breakfast 6:35 AM Lunch 12 Noon Dinner 6:00 PM Snack 9:01
Saturday Pancakes/Syrup Hot dogs Fried Chicken Cookies
Sausage (pork or beet) Soup French Fries Milk
Butter Fresh Fruit Green Salad
Milk Beverage Jell-O
Milk
Sunday ToastIEggs Ham Sandwich Roast Beef Fresh Fruit
Hash Brown Potatoes Raw Vegetables Mashed Potatoes
Bacon Chips Steamed Broccoli
JuicelButter Iced Tea Cake Beveral!:e
Monday Dry Cereal Peanut Butter/Jelly Tuna Casserole Raw Vegel
T oast/Butter Sandwich Green Salad Dip
JuicelMilk Fresh Fruit BreadlButter
Jellv, Milk Beveral!:e
Tuesday T oast/Butter Top Ramen Soup Baked Chicken Cheese/Cn
Eggs/Jelly Bologna Sandwich Rice-a-Roni s
Sausage (pork or beet) Fruit Green Beans
Milk Milk Fruit Cocktail
BreadlButter
Bevera2e
Wednesday Rice Cereal Vegetable Soup SpaghettilMeat Sauce Fresh Fruit
Eggs Grilled Cheese Spinach Salad
T oast/Butter Sandwich Garlic Bread
Juice Iced Tea Pudding
Beveral!C
Thursday Link Sausage Burrito Salisbury Steak/Gravy Chips
French Toast Com Chips Rice
SyrupIButter Fruit Steamed Carrots
Milk Beverage Sliced Peaches
Beveral!C
Friday Hot Cereal Sloppy Joes Shepherds Pie Fruit Rolls
Toast/Jam Mixed Fruit Tossed Salad
Bacon Chips RollslButter
Milk/Juice Beveral!:e Pear Halves
cd . h
,
-I Beverage
THE MENU IS SUBJECT TO CHANGE DUE TO A V AlLABILITY OF FOOD SUPPLIES
ALL CHANGES TO THE MENU WILL BE RECORDED, ALL MENUS WILL BE RETAINED FOR 3
YEARS.
8. Describe any provisions a.,aiIable for chUdrea with special dietary needs.
The resident's medical problems and religious requirements are a factor in the preparation and service of
meals. In addition to the regular menu, vegetarian or other specialized meals win be prepared as needed to
meet the special needs of any of the residents. Included as a special need win be the preparation of low
caloric meals when required for medical needs. To insure that food intake will be part of the overall
treatment program, each resident will be weighed monthly and records kept as part of an individual health
plan. Meal planning and preparation will also take into account the personal likes and dislikes of each
resident. Emphasis for all residents win be a healthy balanced diet and as a result the kitchen will be off-
limits to the residents, with the exception of specified times when supervision is available. This will reduce
the intake of multiple snacks between meals. Morning, after school, and bedtime snacks will be provided by
the facility.
The facility imposes no general dietary restrictions resulting from religious or program issues. However,
religious requirements of residents will be a factor in menu planning.
Newly obtained containers of food are always placed behind the containers already stocked by the facility.
This insures that food which has been stored the longest will be consumed first. On a monthly basis, the
"pull" or "use by " dates win be inventoried by the evening child care worker and all containers with
expired dates will be discarded. At least a two day supply of perishables and a seven day supply of non-
perishables is always maintained.
PART 10. PROGRAM NARRATIVE (Coatinued)
CLOTHING AND INODENTALS- SECTION 18
I. Describe bow the prolram eosures tbat children baye adequate c1otbinl:
1. All children who enter The Family Service Agency Assessment Center program will be required to
bring a supply of clothing and/or approved clothing allowance. (See attached list for clothing).
Clothing will be inventoried upon entrance into the Family Service Agency Assessment CenteI by
staff counselors. If the resident does not have adequate clothing, his clothing supply may be
supplemented by Family Service Agency Group Home program (for emergency clothing allowance
only). A clothing checklist will be provided for each child and a copy will be placed in the child's
locked file.
All clothing will be labeled during the initial inventory process and when newly purchased in the
process of replacement. All personal property will also be labeled and inventoried. Clothing and
personal property will be checked against the inventory lists on a monthly basis or under special
circumstances. These circumstances include planned and unplanned terminations. Residents who are
capable will be encouraged to report lost or destroyed and newly purchased articles to the facility
manager in order to assist the facility staff in updating the inventory. The facility will be responsible
for all personal property given to the facility for safekeeping.
2. The monthly clothing allowance is $40.00 per month, and an annual emergency allotment ofSlSO
will be available for each resident. This money is to be used only for special circumstances such as
rapid change in physical size or unavoidable loss. TheIe will be a monthly inventory of clothing to
determine the condition of children's clothes. clothing will be replaced when needed. The wom or
destroyed clothing will be replaced when needed. The wom or destroyed clothing will be
documented and a request will be made for replacement. The Family Service Agency Group
Home's staff will pay close attention to the rapid growth of Adolescents and clothing will be
purchased as appropriate. Residents will be encouraged to assist in selecting replacement clothing
whenever appropriate. The age of the resident will be a factor in determining the extent of
participation in clothing selection. Since residents may be heavily influenced by peers and
promotional clothing ads total freedom of choice is impractical for the residents at this facility as it
is in any family setting. However, by providing adequate structure, e.g., forced choices, replacement
of clothing and enhancement of the resident's wardrobe can be a joint effort between the child care
staff and the resident. In this way, for residents for whom it matters, individual tastes, popular styles,
and "personal statements" can be taken into consideration without ignoring cost, need and utility.
3. The method of selection and purchase of clothing will be I) to provide a written request for needed
clothing; 2) to give the written request to the Program Director; 3) to place a copy of the written
request in the child's locked file; and to have the item of clothing purchased with each child's
monthly clothing allowance.
4. Residents who destroy, lose or give away their clothing will receive special counseling.
s. The Child Care Worker will be responsible for any necessary clothing repair. Clothing in need of
repair will be given to the night staff. Clothing which can be repaired "in-house" by a child care
worker will be returned to the resident within three days. Clothing which requires professional repair
will be delivered to the appropriate repair shop within three days.
6. All clothing and personal property are marked and inventoried upon entering the facility, whether it
is brought in by staff, resident or given to the resident as a gift. An inventory list is made of all
Adolescent's belongings, and upon termination, planned and unplanned, the inventory list is checked
against what leaves \-. _ ..1 the adolescents. If items are missit.__ The Family Service Agency Group
Home will replace them and forward them to the child's Social Worker. In the event of an
unplanned termination, the children's clothing and belongings will be inventoried and kept locked in
a storage space in the administrator's office for 30 days until they are claitned by an authorized
representative.
7. Clean bed linens, towels and wash cloths are issued on a weekly basis. A washer and dryer are
available at the facility for the use of staff and mature residents. Linen will be washed on a weekly
basis by the house keeping staff. All residents are responsible for stripping and remaking their beds.
To insure an adequate reserve of items, two sets of bed and bath linen, (sheets, pillow cases,
blankets, bath towels, face cloths) will be allotted for each resident. The facility linen supply will be
inventoried weekly by the facility manager, and replaced as needed.
2. Dauibe bow the prozram proYides penonal bYCime items (for <sample, .......poo IDd deodorant).
Personal Hygiene Items:
All personal hygiene items are provided to adolescents by The Family Service Agency Group Home. Items
include hair care products and equipment, oral hygiene, physical items, deodorants, powder, body oils and
lotions, skin care products, and gender specific items. These supplies will be inventoried on a weekly basis
and resupplied by the facility as needed to insure that an adequate inventory remains in supply. They will be
replaced immediately from the inventory at no expense to the resident.
SEP-07-2001 e9: 19
909 384 9034
909 384 9034 P.81/14
ATTACIIMENI' Bp"
FAMILY SERVICE AGENCY OF SAN BERNARDINO
166' North "Elf Street
SaD Bernardino, CA 9240!
Telephoae: (909) 1116-6737
'.11:: (909) 881-3171
'aulmUe Trlallllltbll Slalltt
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Fro.: J P. Jola.- M.A. pru./CIO
Dat.: S felllber 2001
N......r ofP lae. COverSh..t: 1.r
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Seader'. Fas Number: ('0') 111-31'71
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HOW TO CALCULATE TRAINING HOURS
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. HOW TO CALCULATE TRAL'lJING HOVRS
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Each Cbild Care: and SuperYilion employee shsll r\lCtl\'e an additiOll.lll weiabtina "E
,10 ~'1It1l &1 avefllt of 40 or more hoUl's of on-SOini ltIin11li per FllIl-tilll.
Equivalnrt position (!-'T!) per year is prll~ided. m'l are 1he number of pOgitloll$.
NOT STAFF.lo your &roup home JltllJrlllll.
2080 h!)\lrs ar~ i:.1ui~ell.IQ 1 PrE pcsitioo This number i. dettrlllined by
multiplyin, S2 WIleks in a yur by 40 hours worked per week.
To CIll!lpu:e the IIwnber of bours of on-saini tr8ining you must provide to Qualify
for the ad.:litiOll81 weillhting of .10 for llU cbild can: and supervision'$I1Ift', do the'
followiq: .
1. Oelrrmi~ the total number or child care and sLlpcrvisioll. bours to bo
providod this IILl1nber iJ or- the sa 2 fomt.line 13, c:olulllll2:
2, De:ermine the Dumber of Ftf,;'s in your Jl1'OCI'Ill' by di\~diIlg the total
number of child car~ ""14 ,uptrvisiOll hOlllS by 2080 (one f'TF.);
3, Multiply tht number IlfFTE's by 40. This is tho numlJcr oitrllnlaa
hours your proJl'&lll11ll.lS1 provide for all child Clll'C and IUpetVislou
slaft'to 11l1lllf>' tor In additional wCi&hlill, of .10.
EXAMPLE
12,410 hours reported on :he SR2.1ine 13. COIULlL'I2
12.470 h;r..rs di"ded by 2080 equal; 6 F'I'Es
6 FTE. ml,lrlplied by .10 equRlJ 2.:0 irli:1ing hours needed bj!.~ed on q,470
chi!d c~\'e and 'lIpervlsl~n hours work~d.
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f...I,t i 11 K!V ELEMENTS OF THE RATE CLA8SFICATlON
';'::d i, LEVEL (RCL) SYSTEM
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AI_ Ire Mtablllh.d lIfldllr lhil ftCL. .~. toIIhl4h o,...11lte .lllroup he-
,ros""'1 1nIc: 011' of fOllrteDn "CLe. ,clIODtdlng \0 ttIe Iwal of c.... .nd
toMe" pl'8l1lclld.
Tile RCL pro~ ua.. . polllt .~tMn 1.0 m".lIr.the :evel or Intlll\ll1Y of
c.... .nd lelYlc.. pt'ovldtld.
Polma .. 1I...1II1n .... nll"'ll" of ....r child per IIlOnlh" hau... of ..Me.
pIOIIi4Ied In v.. folla<<'". lhrn RCL prOGr.m co",ponenla.
. Child Care IlId lupIlVlIIlln
. Social Wellte AclMtl..
. ...mal....1th r,.ltlMnl8e1Y1cea
1. ' 'or e;hUd 0... .IId lUJ*YIalon, .a~h bour of 1e!'V1ce prov1Qed III
weIghted It~ t.O for 1M minimum '-I,
MelllIon.! WIo\lIhlillll' .... comp~'" blaecl \lPOn ..h ohlld eI..
_rket'. lev. Iilf .lIparl.llCit. IdU.;atlofl and O"'1lolnlJ In~rlll".
a. Por Social WClr\ 4cllvfti.., Iha number of _nllce hou... pl'ClYldIId are
MI.ht8d (....lIn,,1I polntll !Maud on 1111 profMllonal Itwl of lIIoh
.eel.1 work" 11IwldInt theM "1I/10tI.
a. For ~ta, ~Illth T.....r,t Sarvlll'" ttll number of dll'lCt hOIlfl
(IndivtidUlI and g/Ollp th.repy only)." welgMad ("""116d polnt.i
b.-..d on the pror.ulonal Uctnalng statui of 11M ,.,son p:ovlcllflll
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Thl ,"per eltlld pll Il'ontJ," h~tI ate eompU1ld l:Iy dhlldlng tilt nUlllbtt of
h01l1l .f "f\I~ pnMded fHI' monlt,ln ..ch of ttleso th"8 P"'O\'Im
componentll b~ 10".4 of 1 Pllllram',llc.,.ec! C:'PIl:I~.
. ,SA muat lie IIMd II 1~ divldlllfl hc;tor Ifth. program'. 11I:.".tCl OIpaony
..,... I'll" lilt.
HoIlI1l GOuntld for CIIHd ear,lII1d $.';>4frvlalon pOlrrtlt a,.. lImlUcl' &0 ~
AWAISJ HOUIIB. The PAID-AWAKE holl",UlIIIlatiOn 1.IIIPpI". to Soallll
Work ActM'" .nd 1111$1 HAith T",aDlllnt S.rvlc:tt, VOluntHrtlma or
itJttmahlp h:Mlf'l ~.t a.. nqt pill4 It In .pproved .mollnt .r, dlaalfoljred.
In computlng I group home program', poInt lovel for c:JlIdlflcltlon purpOl~1
110 maN than 84 HOURI PER W!l!1( will be coun" tor .n)' IlOuP 110m' aIIff.
ragatdl... of tM llumbtr ar 1I0u... thllt uch .tal'\' p.,.OIl ION.llt worl<ll.
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COUNTY SUPPORT LETTER
Musl incluae the following atatements:
" Till prog.'.m i. ""d.d In thll COI~l1ty,
2. The ~""oe' i'llIplbl. of ef'~;'/e:y end t1ficie~l:y opere~:'lg the pr~lP,m
~. Tl\II provider is willing and able to 80Cl1j)' A,.CC-FC c~i1arc.n for plecamft.'lL
4 The court)' cl~lIll';'l'lit,..lhlIt Ih.~. Is no 'ncrease cost to .h. (S~) Gltl<<a1
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tts?Jt Countv-County In '..mien the majority Of ;an agency's group
home faCilities are loCated, If the program ha' tacilltl88 in more thaI"
ClM county, lhfl hest county Shall be ~lIt Of the faCility where the
greatest nUMber Of children are plaood,
fJ:fmarv fJ~lna CcuQf.lC-lhe oounty(ies) whIch places ttie greatest
percentage of cnnciren fo the horre.
Welf.... and Instlt",Uons Code (WIC) S8c~on:
Cl 11482(ij(2) lIlnl1 (k}(3)(O
Manual of Policies and prot:eclures (l''''PPj Sections:
a 1 ~-402 411 (c) - Nit"" program of fris~'~g provldor
a 11-402,422 (ei - N.... pre;ram ol.".w orovidor
o '1-402.433.. P.." Cfass~laltlon Level (~CL) :neri3se
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P.14/14
TOTFt.. P.14
SEP-13-01 01:58 PM FAMILY SERVICE AGEHCY SB 9098813871
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aan Bern,rdlno omc:e.:
1888 North .S" St., San Bernardino, CA 92405
(909)888.8737' (908)881-3871 Fax' (9011)888-48811 HoUlna
Altern,tlve Chotc:..:
218 W. 8th St., San Bernardino, CA 92401
(8011)888.4440" (909) 888-0888 Fax
September 13,2001
To: Mr. JoeBeUandi
Senior PIaoncr
City of San Bernardino
From: JeflTey P. Johnson. M.A.
President/CEO
Subject:
Infonnation pel18lning fur our AgcllCY's request fur a Conditional Use
Permit &om the City of San Bcmatrdlno.
Dear Mr. BeUandi,
Thank you fur your phone I;8U this morning about where the c:Iu1dren woulcl come
tom if they arc placed at our future I.evel12 group home.
San Bernardino County has three major departments that rcfi:r our children to group
home placetnents. The first department is the nc;partment ofBehavioraI """lib. tben
the DcnIirtment orChndrcn"s ~ and lastly the Prabttion lll:putment.
All oftlte children that we would place at our group hOtne would be coming tom San
Bernardino CoIDlly only.
I recently received a copy orlhe San Bernardino County Group Home Analysis, which
wa.~ published in March of2000.
At the present lime within the City limits of San Bernardino we have three Leovel14
group oomes and two Levc:112 group holllCS functioning here at this time.
As you arc aware, we arc requesting a Level 12 group home rating 1i'om the State of
California and we have 110 plans in the future to apply tor a1evel13 or 14 ReI. ~.
I hope this information bas helped you.
ohnson. M.A. .;:.<
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cc:; Program Center Fili:: :' - .
Fonllln. Office: .. c. ..
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Fontana, CA. 92325 ~.~c
(QOD) 822-3533 . (909) 822.30SO "a.
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, : 23'406 Grisi Fo"'\ Dr: . .. 15402 Sage St. 31. 101-102
. erliillinll, CA 1124.25; ~lc:1OlYille, CA 112392
(9~91 338-4889." (809) 3*li~30 .Fax (909) 843-11953
ATTACHMENT C
FAMILY SERVICE AGENCY OF SAN BERNARDINO (909) 886-6737 FAX (909) 881.3871
...
. .
M .
FSA
1669 North "E" Street, San Bernardino, CA 92405
CRISIS ACCESS LINE: (800) 832-9119Tall Free
9161 N. Sierra Ave., #202
Fontana. CA 92335
(909) 822-3533
216 w. 6th Street
San Bernardino. CA 92401
(909) 888-4440
Chairman
Tom Davis
Past Chairman
Anne Benjamin
Vice Chairman
Jesse Valenzuela
Karen Bell
Secretary
Suzette Borror
Trea.ur.r
Phyllis Poulos
Directors
Judi Battey
Narciso Cardona
Mark Emoto
Wes Farmer-
David Moore
Brenda Perez
23406 Crest F oresl Dr.
Crestline. CA 92325
(909) 338-4689
September 15, 2003
rr::> \"2 ~~ @\\)\
\O)@.. ~LS\\r
\j\~ .
Ms. Valerie Ross
City Planning
City of San Bernardino
300 North "D" Street
Third Floor
San Bernardino, CA 92418
If"!' Ul" _,-~, ,,;"'>',Ii;"-:~'':'
C ,,",'.V"~i Or'h"""
\"i;:: --OE?At";
Subject:
Conditional Use Permit No. 01-09
Dear Ms. Ross:
Presldenl/CEO Family Service Agency of San Bernardino would like to request a one-time
Christine Edgcombe, MLS/AC"' , fth C d't!' aI U P 't N 01 09" 12 ths
extension 0 e on I on se emu o. - lor mon .
Vice Presldenl
Operallonl/CFO
Marilyn Campbell
Medical Dlreclor
David H. Whitbread, MD
Clinical Dlreclor
Pom Hart, MFT
Dlreclor of Community
Programs
Margwen Nichols, MS
Corporate Adm. Asst.
Linda Montgomery
. Ex-Officio
AN ACCREDITED
FAMILY SERVICE
AGENCY
.
UNITED WAY
MEMBER AGENCY
SERVING SAN
BERNARDINO
COUNTY
Since the pennit was issued Family Service Agency has faced some delays in
going forward with the project due to the untimely passing of the President/CEO
(Jeffi'ey Johnson) and subsequent budget constraints in State and County funding
relative to the project.
We would appreciate your consideration of this extension to allow time necessary
to go forward.
Sincerely,
, ~'
o 'a
(/~ /. L':i)~~
Christine L. Edgcombe, MLSI AC
President/CEO
City of StUl BWUlrdillo
Devdopment services
Department
Application for Appeal
APPEAL FROM A DECISION OF THE (check one)
o Development Services Director;
o DevelopmentlEnvironmental Review Committee; or
all Planning Commission
Case number(s):
,cuP 61 6, .?
A Yo 3> - I ro
Project address: 216 \vest 6th Street, San Bernardino C'1I Cl?dn<;
Appellant's name: FAMILY SERVICE AGENCY OF SAN BERNARDINO
Appellant's address: 1669 N. "E" Str....t S,," RAr""r~i);J.Q. C1\ 9JHlJO
Appellant's phone: 909 886 6737
Contact person's name: Christine Edgcombe , Pres/CEO - David Moor.. Ro"rn mAmn9~
Contact person's address:166'l N _ "R" St-
San Bernardino, CA 92405
Contact person's phone: tltl6 bl J I
1669 N. "E" St.
San Bernardino, CA 92405
884 9477 x104
Pursuant to Section 19.52.100 of the Development Code, an appeal must be filed on a City application form
within 15 days following the final date of action, accompanied by the appropriate appeal filing fee.
Appeals are normally scheduled for a determination by the Planning Commission or Mayor and Common
Council within 30 days of the filing date of the appeal. You will be notified, in writing, of the specific date and
time of the appeal hearing.
OFFICE USE ONLY
Date appeal filei.: 1j 0 ') / ZOo 3
Received by: _ ~ ~/~
A(~ b(3~-O-31-Z5"-
00"v
5/1101
REQUIRED INFORMA nON FOR AN APPEAL
Specific action being appealed and the date of that action: one' year extension. of the
Conditional Use Permit denied by the Planning Commission on
October 22. 2003.
Specific grounds for the appeal: ( a) The only action sought at the Planning Commission
meeting was a I-year extension of time
(b) City Planning Staff recommended that the
conditional use permit be extended and that no further changes were
reQl]ir~d for ~hp px~pn~inn_
(C) The Planning Commission was prejudice in their
decision to deny the extension because even though the CUP runs with
the land they refused to grant the extension because the applicant
Action sought: may not be the entity that will run the level 12 qroup home.
) ,..-
/
n,....~i f"'In C!t""lngh+- ; II:! rn rIQ'1" &Q cd- +-h~+- t-hg ,...,i....y r(",\l1n~i 1 gr.::lni- +-np.'" -yt=>.::IY
extension of time for the Conditional Use Permit.
Additional information:
Signature of appellant:
Date:
11/3/03
President/CEO
2
;/1101
OFFICE OF THE CITY CLERK
RACHEL G. CLARK, C.M.C. - CITY CLERK
300 North "D" Street. San Bernardino. CA 92418-0001
9119.384.5002. Fax: 909.384.5158
www.cLsan-bernardino.ca.us
oM
December 16, 2003
Ms. Christine L. Edgcombe
Family Service Agency
1669 North "E" Street
San Bernardino, CA 92405
Dear Ms. Edgcombe:
At the meeting of the Mayor and Common Council held on December 15,2003, the following
action was taken relative to the Appeal of the Planning Commission's denial of Conditional Use
Permit No. 01-09 to renovate an existing building to establish a 72-bed group home at 216 West
6th Street in the CR-2, Commercial Regional, land use district:
That the hearing be closed; that the Mayor and Common Council deny the appeal
and uphold the Planning Commission's denial of Conditional Use Permit No. 01-
09 (Extension of Time No. 03-06) and continue to January 5, 2004 at 7 p.m. to
allow Development Services to bring revised Findings of Fact to the Council; and
requested that the applicant submit a new application.
If we can be of further assistance, please do not hesitate to contact this office.
Sincerely,
C\--toL~ju--L~) (:Ct!vL~,-
Rachel G. Clark, CMC
City Clerk
RGC:lls
cc: Development Services
CITY OF SAN BERNARDINO
ADOPTED SHARED VALVES: Integrity. Accountability. Respect for Human Dignity. Honesty
,
...
OFFICE OF THE CITY CLERK
RACHEL G. CLARK, C.M.C. . CITY CLERK
300 North "D" Street. San Bernardino' CA 92418-0001
909.384.5002' Fax: 909.384.5158
www.ci.san-bernardino.ca.us
SM
January 6, 2004
Ms. Christine L. Edgcombe
Family Service Agency
1669 North "E" Street
San Bernardino, CA 92405
Dear Ms. Edgcombe:
At the meeting of the Mayor and Common Council held on January 5, 2004, the following
action was taken relative to Conditional Use Permit No. 01-09 and Extension of Time No. 03-
06, a request for a one-year extension of time to renovate an existing building to establish a 72-
bed group home at 216 West 6th Street in the CR-2, Commercial Regional, land use district:
That the Mayor and Common Council adopt the Revised Findings of Fact
supporting denial of Conditional Use Permit No. 01-09 (Extension of Time No.
03-06).
If we can be of further assistance, please do not hesitate to contact this office.
Sincerely,
') . . '). C (&.A/.:....
. 1\..,UI..I\..I....."-
./ \
Rachel G. Clark, CMC
City Clerk
RGC:lls
cc: Development Services
CITY OF SAN BERNARDINO
ADOPTED SHARED VALUES: Integrity' Accountability' Respect for Human Dignity' Honesty
,
.
.
CITY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION
STAFF REPORT
SUBJECT: Conditional Use Penn it No. 01-09 (Extension of Time No. 03-06) - A request for
a one year Extension of Time from September 18,2003, to September 18, 2004, to
renovate an existing building to establish a 72-bed group home.
BACKGROUND
At their meeting of December 15, 2003, after receiving input and comments from the applicant
and applicant's representatives. the Mayor and Common Council denied Conditional Use Pennit
No. 01-09 (Extension of Time No. 03-06) per the recommendation of the Planning Commission
and continued for two weeks for Development Services to bring proposed Findings of Fact to the
Council. Section 19.36.050 of the Development Code states that all of the Findings of Fact must
be made in order to approve a Conditional Use Pennit. Findings 2 and 5 cannot be made.
FINDINGS OF FACT IN SUPPORT OF DENIAL
2) Is the proposed use internally consistent with the General Plan?
No, the proposed project is not internally consistent with the General Plan objective and
policy as follows:
General Plan Objective 1.6 states: "Control the development of land uses which may
adversely impact the character of the City and quality oflife of its residents'.
General Plan Policy 1.7.2 states: "Require that all development in each land use
classification adheres to the requirements and standards of the zone in which it is
located".
Since the project description was altered, the proposal would not promote land use
compatibility. As a result, the proposed project is not internally consistent with the
General Plan. The proposed project would negatively impact the character of existing
residential neighborhoods in this area. Specifically, the proposed project would result in
significant intrusion into the immediate adjacent residential neighborhoods to the north
and east.
Based on changes to the project, as represented by the applicant, the Mayor and Common
Council denied the Extension of Time because the project was considerably different
from what was approved through the Conditional Use Pennit. The applicant and their
representative stated that the clients would be from both San Bernardino and Riverside
Counties, instead of San Bernardino County alone. In addition, the applicants'
representative stated that the facility would house both boys and girls instead of boys
only as per the original application. The representative also stated that the security
arrangements have changed in that the facility would not be a lock-down facility.
.
5) Are the location, size, design, and operating characteristics of the proposed use
compatible with the existing and future land uses within the general area in which the
proposed use is to be located and will it create significant noise, traffic or other
conditions or situations that may be objectionable or detrimental to other permitted uses
in the vicinity or adverse to the public interest, health, safety, convenience, or welfare of
the City?
The proposed project could be detrimental to the public interest, health, safety,
convenience, or welfare of the City in that the original project description was modified.
The modified project was never reviewed or analyzed as to its feasibility relating to
staffing, security, financing and other related issues. The proposed project is no longer
the same project that was approved in September 2001. The proposed project could
allow uses that would operate in a manner that would not be consistent with the existing
and future land uses within the general area. The proposed project could create conditions
that would be detrimental or objectionable to other permitted uses in the vicinity and
adverse to the welfare of the City. In addition, circumstances have changed on-site and in
the surrounding area. The condition of the buildings has severely deteriorated in the past
few years. And, the area itself has experienced a growing drug problem that could be
problematic to the clients of the facility and/or to residents in the surrounding area.
FINANCIAL IMPACT
N/A
RECOMMENDATION
That the Mayor and Common Council adopt the Findings of Fact supporting denial of Conditional
Use Permit No. 01-09 (Extension of Time No. 03-06).