Unlicensed Facility On-Site Monitoring Checklist

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Unlicensed Facility Quarterly Health and Safety Monitoring Checklist – Facility Walkthrough


Compliant?

Compliant?
    1) General Safety and Security
Y
N
n/a

Y
N
n/a
Controlled entry/exit of premises 



Knives/sharp objects inaccessible to UC 



Prohibited from allowing entry of any individual (except UC in the process of admission) who meet any COVID-19 criteria



 Cleaning chemicals maintained in a locked area



Alarms system for all areas of the residential structure   



Medical supplies/prescriptions inaccessible to UC  



Video monitoring in common and living areas and classrooms 



Other unsafe areas inaccessible to UC



Video monitoring for exterior of building & surrounding premises 



Vehicle(s) inspection stickers up-to-date



Ability to download video footage permanently



Vehicle(s) appear to be in good repair (including fire extinguisher and first aid kit)



System for tracking and regulating UC movement



Vehicle (s) contain working seat belts



Meeting UC to floor staff ratios/appropriate supervision 



Evacuation procedures posted prominently on each floor and at eye level for children and youth



“Mirrored windows”/window in offices where staff meet with child 1:1



Fire extinguishers and smoke detectors in good working order and inspected (as required)



Infants/Toddlers – age appropriate furniture (e.g. cribs/bedding, high chairs, toys, outlet covers)



Play equipment safe and in good repair







Compliant?

Compliant?
    2) Confidentiality
Y
N
n/a

Y
N
n/a
Case files in secure location (open and closed) 



Case files safe from physical damage



Only individuals with a need to know basis have access to the case files 



Pre-programmed telephones (Required: UC SA Hotline, CPS, Local Community Service Provider; Highly recommended: Top 3 consulates and LSP)  



Private place for UC to make phone calls (including pre-programmed phones)
























Compliant?

Compliant?
    3) General Residential Structure - Indoors
Y
N
n/a

Y
N
n/a
Clean



Kitchen



Child-friendly (e.g. no safety/trip hazards)



                UC dietary restrictions posted/accessible



Furniture and building are properly maintained



Food stored in a sanitary manner



Well-ventilated 



Bathrooms



Adequately heated/cooled



Soap



Identified UC Medical Quarantine/Isolation Space



Toilet paper



Bedrooms



Working toilets



                Natural light/Dark at night



	Hot/cold water



Provision of appropriate linens



Separated by gender



Adequately accommodate all UC (per State Licensing)



Appropriate privacy



Separated by gender (per licensing)



Hygiene/grooming items



Adequately accommodate all youth (e.g. individual bed with mattress for each youth)



Towels



Provision of appropriate bed linens














Compliant?

Compliant?
    4) Documents that should be posted/accessible to youth (Spanish, English, and any other language as needed)
Y
N
n/a

Y
N
n/a
Posters with phone numbers for UC to report sexual abuse/harassment



Care Provider AND ORR Pamphlets on sexual abuse/harassment



Notice to Pregnant Females (Garza vs. Azar) next to posters



Extra copies of UC grievance forms



Grievance Procedures (in common areas)



Program Rules



Saravia Notice (English and Spanish posted next to Garza and Sexual Abuse/Harassment notices) – posting currently applicable to Secure, Staff Secure and RTC – effective 10/22/2020












Compliant?

Compliant?
    5) Other
Y
N
n/a

Y
N
n/a
UC/Staff provided/wearing face masks and/or offered face masks, as applicable



Emergency Evacuations Notification List (must be posted in office area and includes: ORR contacts, DHS contact, and local law enforcement)



Car Seats (if transporting young children)



No Touch Thermometers available



Sufficient supply of Face Mask / Hand Sanitizers / Gloves








Walkthrough NOTES

    1) General Safety and Security


    2) Confidentiality



    3) General Residential Structure


    4) Documents that should be posted




	
    5) Other




On-Site Monitoring Checklist - Other


Observed?

Observed?
Services to Potentially Observe
Y
N
n/a

Y
N
n/a
Education



Group counseling/community meeting 



Recreation – large muscle, outdoors



Meals




	
Reviewed?

Reviewed?
Logs/Schedules to Potentially Review
Y
N
n/a

Y
N
n/a
Fire Drills Logs



Grievance binder



Daily (Shift) logs



Group Counseling Curriculum



System for inspecting vehicles



Visitor Logs



Prescription/Non-prescription medication logs



Care Provider Policies for UC to Request Emergency and Non-Emergency Health Care Services



Spot Inspections and Quarterly Safety Assessments



UC Temperature Tracker



Facility inspection checklist (safety check)
















Other NOTES
Services to Observe











	
Logs to Review