"CACFP Preoperational Visit Form for Sponsored Facilities" - Georgia (United States)

CACFP Preoperational Visit Form for Sponsored Facilities is a legal document that was released by the Georgia Department of Early Care and Learning - a government authority operating within Georgia (United States).

Form Details:

  • Released on August 1, 2007;
  • The latest edition currently provided by the Georgia Department of Early Care and Learning;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Georgia Department of Early Care and Learning.

ADVERTISEMENT
ADVERTISEMENT

Download "CACFP Preoperational Visit Form for Sponsored Facilities" - Georgia (United States)

509 times
Rate (4.5 / 5) 25 votes
CACFP Preoperational Visit Form for Sponsored Facilities
Administrative and Center Sponsor Use Only
Date of Visit:
Time In:
Time Out:
Reviewer:
Legal Name of
Center:
DBA Name
Address:
Licensed Capacity:
(If applicable)
County:
# Enrolled:
Telephone #
Child Care Center
At Risk After School Care Program
Program
Adult Care Center
Emergency Shelter
Type:
Outside School Hours Care
Head Start
Title XX/Pre-K Cat 1 or Title XIX
Organization
Non-Profit
Profit
Type:
Free or Reduced Meals (child)
Type of Food
Self-preparation
Central Kitchen
Service:
School Food Authority
Food Service Management Company
Licensing/Approval to Operate
Licensing
Bright from the Start (DECAL)
Department of Defense (DOD)
Type:
Other Federal, State, or local authority
Approval Type:
Head Start Performance Standards
Indicate approving authority:
Alternate
Licensure:
CACFP Child Care Standards
Exempt from licensure/approval per CACFP regulations
Child care
(At Risk, Outside School Hours, and Emergency/Homeless shelters only)
centers only
Record the meal type and
components served on date of visit:
YES
NO
N/A
1.
Are meals listed on the current menu creditable and contain all required components?
2.
For child care centers that are not licensed or approved by a Federal, State, or local authority, has the
center completed the CACFP Child Care Standards form and is the center in compliance?
a) If using CACFP Child Care Standards to qualify, does the center have documentation of a current
Certificate of Occupancy or satisfactory fire/building inspection within the last 12 months?
b) If using CACFP Child Care Standards to qualify, does the center have documentation of a current
health/sanitation permit or satisfactory inspection within the last 12 months?
3.
Has the person in charge of CACFP operations and other key staff at the center received the preapproval
training provided by the sponsoring organization?
4.
Does the center demonstrate knowledge of the sponsor’s procedures for submission of claim
documentation at the end/beginning of each month?
5.
Is center staff fully aware that all records pertaining to the CACFP must be maintained for a minimum of
three years after the last claim submission?
6.
Is the center fully aware that all funds received through the CACFP program may only be used for
allowable food program costs as determined by FNS Instruction 796-2 Rev. 3 and Bright from the Start
policies and memos?
7.
If a pricing center, has the center developed a free and reduced written policy statement
?
8.
For child care centers, is the center aware that the enrollment information must be updated on an annual
basis?
9.
For child care centers that enroll infants, does the center have an acceptable plan to offer infant meals to
households?
10.
Determine if the center will use CACFP funds to pay for administrative costs other than those costs to be
paid to the sponsoring organization. Does the center know that no more than 15% of the center’s
reimbursement may go toward administrative costs, including fees paid to the sponsor?
11.
Does the center demonstrate knowledge of recording all costs charged to the CACFP on the Monthly
Record of Operating Costs and Monthly Record of Administrative Costs form? Are receipts maintained?
Revised 8-07
Page 1 of 3
CACFP Preoperational Visit Form for Sponsored Facilities
Administrative and Center Sponsor Use Only
Date of Visit:
Time In:
Time Out:
Reviewer:
Legal Name of
Center:
DBA Name
Address:
Licensed Capacity:
(If applicable)
County:
# Enrolled:
Telephone #
Child Care Center
At Risk After School Care Program
Program
Adult Care Center
Emergency Shelter
Type:
Outside School Hours Care
Head Start
Title XX/Pre-K Cat 1 or Title XIX
Organization
Non-Profit
Profit
Type:
Free or Reduced Meals (child)
Type of Food
Self-preparation
Central Kitchen
Service:
School Food Authority
Food Service Management Company
Licensing/Approval to Operate
Licensing
Bright from the Start (DECAL)
Department of Defense (DOD)
Type:
Other Federal, State, or local authority
Approval Type:
Head Start Performance Standards
Indicate approving authority:
Alternate
Licensure:
CACFP Child Care Standards
Exempt from licensure/approval per CACFP regulations
Child care
(At Risk, Outside School Hours, and Emergency/Homeless shelters only)
centers only
Record the meal type and
components served on date of visit:
YES
NO
N/A
1.
Are meals listed on the current menu creditable and contain all required components?
2.
For child care centers that are not licensed or approved by a Federal, State, or local authority, has the
center completed the CACFP Child Care Standards form and is the center in compliance?
a) If using CACFP Child Care Standards to qualify, does the center have documentation of a current
Certificate of Occupancy or satisfactory fire/building inspection within the last 12 months?
b) If using CACFP Child Care Standards to qualify, does the center have documentation of a current
health/sanitation permit or satisfactory inspection within the last 12 months?
3.
Has the person in charge of CACFP operations and other key staff at the center received the preapproval
training provided by the sponsoring organization?
4.
Does the center demonstrate knowledge of the sponsor’s procedures for submission of claim
documentation at the end/beginning of each month?
5.
Is center staff fully aware that all records pertaining to the CACFP must be maintained for a minimum of
three years after the last claim submission?
6.
Is the center fully aware that all funds received through the CACFP program may only be used for
allowable food program costs as determined by FNS Instruction 796-2 Rev. 3 and Bright from the Start
policies and memos?
7.
If a pricing center, has the center developed a free and reduced written policy statement
?
8.
For child care centers, is the center aware that the enrollment information must be updated on an annual
basis?
9.
For child care centers that enroll infants, does the center have an acceptable plan to offer infant meals to
households?
10.
Determine if the center will use CACFP funds to pay for administrative costs other than those costs to be
paid to the sponsoring organization. Does the center know that no more than 15% of the center’s
reimbursement may go toward administrative costs, including fees paid to the sponsor?
11.
Does the center demonstrate knowledge of recording all costs charged to the CACFP on the Monthly
Record of Operating Costs and Monthly Record of Administrative Costs form? Are receipts maintained?
Revised 8-07
Page 1 of 3
YES
NO
N/A
12.
Does the organization allow enrollment or participation regardless of race, color, national origin, sex,
age, or disability?
13.
During the visit, did it appear that discriminatory practices were avoided?
14.
Were point of service meal counts correctly taken on this date?
15.
Does center staff demonstrate appropriate knowledge of completing the Daily Menu and Food Service
record?
16.
If the center is applying for the At Risk After School Care program, review activities offered. Are
enrichment and/or educational activities offered and actively delivered by staff?
17.
Do serving areas have appropriate sized chairs and tables available for participant use?
18.
Is the kitchen adequate to serve the number of children it proposes to serve?
19.
Are foods and food supplies stored at least six inches above the floor?
20.
Are dishwashing/sanitizing methods accurate?
21.
Is frozen food properly thawed?
22.
Is the refrigerator at 45 degrees or below?
23.
Is the freezer at 0 degrees or below?
24.
Are cleaning supplies/pesticides stored separately from food items?
25.
Are hair restraints and hygiene practices in place?
26.
Is the kitchen free of insects and rodents?
27.
Is the kitchen area and equipment clean?
Adult Centers
Complete the following questions only for programs that have an adult care program.
YES
NO
N/A
Refer to Bright from the Start CACFP Policy 33.
28.
Does the center provide care for functionally impaired adults 18 yrs. of age or older?
29.
Does the center have records that indicate the age of all enrolled adults?
30.
Are those adults who are not functionally impaired 60 years of age or older?
31.
Does the center have records that indicate that each adult under the age of 60 meets the functionally
impaired criterion?
32.
Does the center have records that indicate that participants reside in their own home or group living
arrangements where the adult primarily has care for him/herself, which makes them eligible for CACFP
meal reimbursement?
33.
If the center enrolls participants with various living arrangements, does the center have a process in
place to determine who is eligible for CACFP meals and meals are claimed only for eligible participants’
meals?
34.
Does the center have individual plans of care for each functionally impaired adult?
35.
Are individual plans of care reviewed and updated on a reasonable frequency (i.e. quarterly or yearly)?
36.
Does the center provide care for eligible adults less than 24 hours per day?
37.
Does the center provide a structured comprehensive program that provides a variety of health, social
and related support services to enrolled adults?
38.
If the center operates multiple programs for which participants are not eligible for CACFP meals, does
the center have a process in place to determine which meal recipients are CACFP eligible and that
meals are claimed for only eligible participants’ meals?
39.
Does the center ensure that meals are not claimed for adults who come to the center only to
participate in the following programs?
a)
Workshops, single day or series
b)
Substance abuse programs
c)
Vocational or prevocational training
d)
Social programs or events
Page 2 of 3
Revised 8-07
Describe areas not in compliance or that need improvement. If areas can be improved, indicate the steps the organization will take.
(Attach additional sheets as needed.)
Describe any technical assistance provided to center.
Center is Eligible to Participate on the CACFP: Yes
No
Approval Recommended:
Yes
No
If no for either item, reason must be stated above and appeal procedures must be provided.
Signature of Center Contact
Date
Signature of Sponsoring Organization Reviewer
Date
Page 3 of 3
Revised 8-07
INSTRUCTIONS FOR COMPLETING PRE-OPERATIONAL VISITS
FOR SPONSORED FACILITIES
ADMINISTRATIVE and CENTER SPONSOR USE ONLY
The center review form is designed to be used by Administrative and Center sponsors in performing a pre-operational
visit of potential applicants. The best practice is to provide training to the sponsored facility, then conduct the pre-
operational visit to determine if the center is practicing correct procedures. Sponsoring organizations should review a
meal service during the pre-operational visit to determine how the meal is prepared, served, and documented and to
provide technical assistance regarding recordkeeping. Follow the instructions below when completing a pre-operational
visit.
Date of Visit: Record date of review and indicate arrival and departure times and the reviewer’s name.
Name and Address of Center: Enter the legal name and the name the center is doing business as. If the center is
licensed by Bright from the Start, the license is issued to the legal entity and the doing business name is listed as well.
Enter the address, county located and the telephone number of the center.
Licensed Capacity: If licensed by Bright from the Start, enter the capacity of the center at 35 sq. feet and if applicable
the licensed capacity for the two extra hours at 25 sq. feet. This information can be found on any licensing review
document. For those facilities that are not licensed by Bright from the Start, enter NA for not applicable.
Number Enrolled: Enter the number of enrolled eligible participants. For child care centers, this number includes
infants regardless of whether the center intends to claims meals for infants. For adult centers, only the number of enrolled
adults that meet the participant eligibility criteria should be counted.
Program Type: Check the type of program operated by the center. If the center operates both the child care program
and the At Risk After School Care Program at the same location, check both programs.
Organization Type: Check whether the center is a non-profit or profit organization. For organizations that are for-profit,
indicate the eligibility method being used to qualify. Adult Care centers cannot qualify using the free or reduced price
meal eligibility method.
Type of Food Service: Check how and/or where meals will be prepared. If the center will be using a food service
management company, ensure that the Bright from the Start procurement manual is provided and the requirements are
covered in training. Provide the applicable forms to the center. If a formal procurement is required, contact Nutrition
Services for guidance.
Licensing/Approval
In order to qualify for the CACFP, child care centers must meet one of the three licensing or approval types.
Licensing Type:
If the center is licensed by Bright from the Start as a group day care home or child care center, check the DECAL box. If
the center is on a military installation and licensed by the Department of Defense, check the DOD box.
Approval Type: For Head Start programs that are not licensed in Georgia, check the Head Start Performance Standards.
For other child care programs that are not licensed in Georgia, but have been approved by a Federal, State, or local
government entity, check this box.
Adult centers, because they are not licensed in Georgia, must be approved by a Federal, State, or local government entity.
Therefore, this type of approval is the only type that can be checked for an Adult Care center.
Indicate the authority (government entity or program) under which the center is approved to operate.
Alternate Licensure: Child care centers which are not licensed or approved by a Federal, State, or local authority may
use the CACFP Child Care standards to qualify. The center or the sponsor may elect to complete the CACFP Child Care
standards instrument. Adult care centers cannot qualify using CACFP Child Care standards so this item is not applicable
to them.
Centers that operate the At Risk After School Care Programs, Outside School Hours Centers, and Emergency/Homeless
Shelters only are not required by CACFP regulations to be licensed, approved, or meet alternate licensure requirements
(compliance with CACFP child Care Standards) and should check the Exempt box.
Sponsoring Organization Center Review Instructions (Rev. 8/07)
Page 1 of 6
While these types of centers are not required by CACFP regulations to be licensed, At Risk After School Care Programs
and Outside School Hours Centers may either be required to be licensed or have an exemption from licensure in the State
of Georgia. These types of centers must also comply with any State and local health and safety standards.
Meal Served: Record the meal type, i.e. breakfast, lunch, snack, and the components served.
For each question, check “Yes” if the center is meeting the requirement. Check “No” if the center is not meeting
the requirement, or check NA if the item is not applicable. Some items checked as “no,” will disqualify the center
from participation. For other items, provide technical assistance and determine whether the center has the
capacity to maintain corrective action.
Item 1:
Observe the posted menu and determine if the meal contains all the required components. For further guidance on meal
pattern requirements, refer to 7 CFR 226.20 and the Food Crediting Guide.
Compare food items served on the day of review to the written menu prepared by the center. Menus should accurately
reflect which food items were served to meet the meal pattern requirements. Menu substitutions should be appropriate
and recorded on the menu. Provide technical assistance for all non-creditable items and nutrition education to improve
meal quality.
Items 2:
Federal, state, or local licensing or approval is required for all adult care and child care centers, except those centers that
participate only as At Risk After School Care Centers, Outside School Hours, and Emergency/Homeless Shelters. If the
child care center is licensed or has some type of Federal, State, or local approval to operate from a government entity,
then check NA. If not, the center must comply with CACFP Child Care Standards. The sponsor must check NA for this
item for adult centers as adult centers must have some type of Federal, state, or local licensing or approval.
Child Care Centers that are not licensed by a Federal, State, or local authority must comply with CACFP Child Care
Standards and have a current health/sanitation permit or satisfactory report of inspection conducted by local authorities
within the past 12 months and a current Certificate of Occupancy or satisfactory report of fire/safety inspection conducted
by local authorities within the past 12 months.
Centers that are using CACFP Child Care Standards to qualify must use the Bright from the Start Child and Adult Care
Food Program Child Care Standards form to conduct an evaluation of their center to assess compliance with the
standards. If a standard is not met, the center must take steps to become compliant. If the organization takes the steps to
become and remain compliant with the standard, the center can consider itself compliant and may qualify for the CACFP.
If the center cannot meet and permanently maintain compliance with the CACFP child care standards, it is not eligible to
participate. Centers qualifying under the CACFP Child Care Standards must conduct an evaluation at least once a year
and ensure compliance to continue participation.
Centers must submit the Alternate Licensure Self-Certification form with an initial application and maintain the CACFP
Child Care Standards form at the center. Refer to the Add-a-Site checklist for the documents that are needed for each
type of center.
Item 3:
Sponsors are required to conduct training with key staff at each center prior to making an application for the CACFP.
Bright from the Start has defined “key staff” at sponsored facilities as the individuals that are responsible for the operation
of the CACFP at the center. Determine whether the person(s) actually performing these administrative duties for the
CACFP has received training.
Item 4:
Determine if the center has a procedure in place to submit records to the sponsor in a timely manner according to the
agreement with the center? If not, provide training to the center to ensure records are submitted so that claims for
reimbursements are not delayed.
Item 5:
Each sponsored center must maintain all records to support the claim for reimbursement per 226.10(d) for three years
after the date of submission of the final claim for reimbursement for that fiscal year. Determine where and if the center’s
procedures for maintaining these records will meet these requirements.
Item 6:
The center should be provided either a paper or electronic version of FNS Instruction 796-2 Rev. 3 which provides
guidance on costs that may be paid with CACFP reimbursement.
Item 7:
Sponsoring Organization Pre-Operational Visit Instructions (Rev. 8-07)
Page 2 of 6
Page of 9