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