MED BINDER: consent for emergency treatment, copy of medi-cal or insurance information, centrally stored med. Form, PRN auth. Letter, client roster, medication schedule, sign off sheets, medication policy and procedures, emergency numbers, health reports, health care providers list, consents for psychotropic medications.

Medications are kept in a secure setting. Medication procedures, control safeguards, and medical logs are in place. Medication schedule is accurate.

Staff have a working knowledge of the current clients Treatment Plans. They should be able to accurately answer questions on a youths plan and implementation.

Smoke alarms are present and functioning. Fire Drill Log up to date.

First aid kit is in order, locked up, and fully stocked for the home.

Government Meeting binder up to date

Communication logs and reports accuracy.

Observation entries completed and accurate

Major Incident Report Binder up-to-date. Significant Indecent Report filed every month accurately

ICMP and Treatment Plan documents are current.

Client files include all of the required documents.

CCW / Late night documentation is completed and signed by staff and supervisor daily.

Facility has a procedure for ongoing maintenance. House damage reports are completed as needed.

Menus are used and either posted or otherwise available for review. Menu production records and Meal Rosters are current.

Office area is orderly and free of clutter. (Communications are set up, phones are in working order, and office supplies are available.)


A chore schedule is posted and utilized.

Food dated and labeled correctly. No aluminum foil or pots and pans in refrigerators.

Water temperatures-105-120 degrees.

Refrigerator is at 45 degrees. Freezer is at 0 degrees. Logs current. Thermostats in each refrigerator and freezer.

The kitchen is clean and well maintained. Appliances are in good repair, clean, and appropriate kitchen tools are present. Cabinets are clean and orderly and free of debris. Trash cans have a tight fitting cover.

The quality and quantity of available food is wholesome and meets nutritional requirements. Food is available for posted menu.

Plumbing and electrical. Check for evidence of leaks, toilet seal leaks, water damage, any electrical problems or damage

Living room / Hallways

All staff in uniform and present in a professional manner.

Children’s and staff’s bathrooms are clean, sanitary, and appropriately equipped (Decor towels and separate hand towels are in good order).

Each child has all necessary personal hygiene items (hygiene closet is clean and orderly). All hygiene items must be locked up.

There is a staff schedule that indicates appropriate time is allocated for changeover between shifts and general staff meetings on a regular basis. LIC 500 is posted and accurate.

An adequate plan exists for emergency health services and instructions are prominently posted (Emergency Exit Plan). Emergency numbers are clearly posted for emergency medical services inside the staff station cabinet, med room, and med book. Emergency Disaster Plan LIC 610 is current and posted.

There is an activity schedule posted that indicates recreation planning and a variety of recreational and/or educational activities.

Staff following schedule and on task.

Room temperature is between of 68 degrees and 71 degrees while youth are present.

All electrical appliances and fixtures shall be safe and in good repair.

The facility’s public areas (living room, dining room, entrance, hall, etc.) are clean and attractive and present a reasonably homelike atmosphere.

Sufficient age-appropriate games, arts, crafts, and other equipment for indoor activities are available and in good repair.

Furniture, fixtures, and carpets are in good repair, clean, and contribute to a home-like setting.

Blinds, curtains, and drapes are clean and in good repair.

Learning Center - bulletin and white boards are updated, rules are posted. Weekday schedule is being implemented daily. Current season being celebrated.

Youth Rooms

HIPAA-no visible documents, client files triple locked, house locked, no first and last name documents posted, appropriate pictures.

Bed linens are in good repair and available in sufficient quantity (2 sets for each bed). Blankets are in good repair and in sufficient quantity.

Children’s bedrooms are clean, orderly, and appropriately furnished (closets are in order, beds are made, dressers are clean and orderly).

Windows are clean and intact.

Recreation Room

Garages/Recreation areas are clean and orderly. Cupboards are locked, clean, and orderly.

Fire extinguisher equipment appropriate to the facility is present and inspection certificates are current. Extinguishers signed off by Manager for each month at locations.

Forms to be posted in house and updated: Facility License, Foster Rights, USDA poster, Fire Clearance, Staff Injury Poster.


Routine health care providers are listed and posted in the med book and van binder.
(Client Roster - LIC 9020)

The initial appearance of the facility is orderly and attractive. The yard is well maintained, weeds are controlled, and there is no excessive clutter. Equipment and supplies are not stored in the yard or areas used by clients. Outdoor furniture is clean.

Vehicles clean inside and out (all Charis Vehicles on property)

VAN-first aid kit has what is needed, Van binder has consent for medical treatment, copy of insurance or medi-cal card, face sheet, client roster, emergency roadside supplies (flashlight, tools, etc..), Van maintenance log completed weekly. Van inspections being completed twice a month.

Sheds and storage areas are clean and orderly.

Window screens are utilized, clean inside and out, and in good repair.

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.