Form RFA809C "Resource Family Visit - Corrective Action Plan" - California

What Is Form RFA809C?

This is a legal form that was released by the California Department of Social Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2017;
  • The latest edition provided by the California Department of Social Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form RFA809C by clicking the link below or browse more documents and templates provided by the California Department of Social Services.

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Download Form RFA809C "Resource Family Visit - Corrective Action Plan" - California

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STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
County/Agency:
FOR COUNTY/AGENCY USE ONLY
Address/Contact Information:
Amended: _____________________
(Date Of Original Report)
RESOURCE FAMILY VISIT – CORRECTIVE ACTION PLAN
Purpose of Form: Use this form to document all deficiencies that require a Corrective Action Plan (CAP).
It is the intent of the RFA worker to conduct all interactions and communications with the Resource Family with courtesy and respect and to be minimally
disruptive to the Resource Family and the children in their care while also ensuring that the home is a safe and nurturing placement.
Resource Family Name: ____________________________________ Resource Family ID Number: ________________________________
DESCRIBE HOW THE
DESCRIBE EACH DEFICIENCY
DUE DATE
DEFICIENCY WILL BE CORRECTED
I acknowledge receipt of this report and understand my appeal rights as explained on the following page of this form.*
RF PRINTED NAME:
RF SIGNATURE:
DATE:
TELEPHONE NUMBER:
RF WORKER PRINTED NAME:
RF WORKER SIGNATURE:
DATE:
TELEPHONE NUMBER:
RF WORKER SUPERVISOR PRINTED NAME:
TELEPHONE NUMBER:
*
RFA Worker: Check this box if a Resource Family parent was not available to sign the report. Immediately mail the report by
certified mail to the Resource Family address of record.
RFA 809C (9/17) (Mandatory)
(Confidential/Public: Depending on type of information)
Copy: Resource Family
Distribution: Original: County
Page ______ of _____
_
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
County/Agency:
FOR COUNTY/AGENCY USE ONLY
Address/Contact Information:
Amended: _____________________
(Date Of Original Report)
RESOURCE FAMILY VISIT – CORRECTIVE ACTION PLAN
Purpose of Form: Use this form to document all deficiencies that require a Corrective Action Plan (CAP).
It is the intent of the RFA worker to conduct all interactions and communications with the Resource Family with courtesy and respect and to be minimally
disruptive to the Resource Family and the children in their care while also ensuring that the home is a safe and nurturing placement.
Resource Family Name: ____________________________________ Resource Family ID Number: ________________________________
DESCRIBE HOW THE
DESCRIBE EACH DEFICIENCY
DUE DATE
DEFICIENCY WILL BE CORRECTED
I acknowledge receipt of this report and understand my appeal rights as explained on the following page of this form.*
RF PRINTED NAME:
RF SIGNATURE:
DATE:
TELEPHONE NUMBER:
RF WORKER PRINTED NAME:
RF WORKER SIGNATURE:
DATE:
TELEPHONE NUMBER:
RF WORKER SUPERVISOR PRINTED NAME:
TELEPHONE NUMBER:
*
RFA Worker: Check this box if a Resource Family parent was not available to sign the report. Immediately mail the report by
certified mail to the Resource Family address of record.
RFA 809C (9/17) (Mandatory)
(Confidential/Public: Depending on type of information)
Copy: Resource Family
Distribution: Original: County
Page ______ of _____
_
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
RESOURCE FAMILY VISIT-CORRECTIVE ACTION PLAN (CAP) REPORT – The RFA 809C is
to be used to document if a Resource Family is not meeting the requirements of one or more of the
Written Directives or any applicable law, and the steps the Resource Family and the County will take to
ensure that the Resource Family meets the requirements of the Written Directives or any applicable law.
The RFA 809C documents deficiencies observed during a Resource Family visit as documented on
the RFA 809.
DEFICIENCIES – A nonconformance with Written Directives or any applicable laws. Resource Families
must be notified in writing of all Written Directives or any applicable law deficiencies. Deficiencies may be
identified on the left side of this form with references to the applicable section.
CORRECTIVE ACTION PLAN – The Corrective Action Plan (CAP) is a plan developed by the County or
Department which describes how the Resource Family is not meeting the requirements of one or more of
the Written Directives or any applicable law, and the steps the Resource Family and the County will take to
ensure that the Resource Family meets the requirements of the Written Directives or any applicable law.
The County shall request and consider feedback from the Resource Family when developing the CAP. It is
incumbent that the County establishes a time limit for the CAP. In order to set a time limit, the County must
take into consideration the seriousness of the deficiency, the number of children or non-minor dependents in
care involved, and the availability of resources and support. The more specific the plan, the less chance
exists for any misunderstanding in setting time limits and reviewing corrections. If a Resource Family
encounters problems beyond his/her control in completing the corrections within the specified timeframe,
they may request and be granted an extension of the correction due date by the County. The CAP will be
documented on the RFA 809C.
CORRECTION NOTIFICATION – The Resource Family is responsible for completing all corrections and
promptly notifying the County of corrections. Resource Families are advised to keep a dated copy of any
letters sent to the County concerning corrections, or if corrections are telephoned to the County, the date,
person contacted and information given.
APPEAL RIGHTS – The Resource Family has a right, without prejudice, to discuss any disagreement in this
report with the County concerning the proper application of the Written Directives or any applicable laws.
When visiting a Resource Family during the course of an investigation, the County shall ensure that the
Resource Family is aware of their rights and responsibilities during the investigation process, including
appeal rights for any actions which may result.
APPEAL REVIEW – The County has a duty to review the facts presented without prejudice. Upon review of
the facts and in accordance with Written Directives or applicable law, the County may amend any portion of
the action taken or may dismiss the violation.
RFA 809C (9/17)
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