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County Social Service Agency Responsibilities 660-05-25-10

(Revised 11/1/19 ML 3567)

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The County Social Service Agency is responsible to:

  1. Upon request of a license application, provide the following to potential Adult Foster Care providers:
  1. North Dakota Century Code Chapter 50-11
  2. North Dakota Administrative Code Chapter 75-03-21
  3. Qualified Service Provider/Adult Foster Care Provider Handbook
  4. The Following Sections of the North Dakota Department of Human Service Chapter 660-05:
  5. Section 660-05-20 Licensing
  6. Section 660-05-20-15 Application for License
  7. Section 660-05-20-15-05 Additional Information/Verifications
  8. Section 660-05-20-20 Renewal of an AFC License
  9. Section 660-05-25-05 Applicant Responsibilities
  10. Section 660-05-30-05 Standards for Providers
  11. Section 660-05-30-05-05 General Practices – AFC Providers
  12. Section 660-05-30-10 Standards for Respite Care Providers and Substitute Caregivers
  13. Section 660-05-30-10-05 General Practices for Respite Care Providers and Substitute Caregivers
  14. Section 660-05-30-15 Standards for Service Delivery/Allowable Tasks
  15. Section 660-05-30-20 Standards for the Licensed Home
  16. Section 660-05-30-25 Standards for Sanitation
  17. Section 660-05-30-30 Standards for Safety
  18. Section 660-05-30-35 Standards for Meals and Nutrition
  19. Section 660-05-30-40 Standards for Insurance
  20. Section 660-05-30-45 Standards for Preadmission Information and House Rules
  21. Section 660-05-30-50 Standards for Record Keeping
  22. Section 660-05-30-55 Standards for Provider Termination of Care
  23. Section 660-05-30-60 Standards for Voluntary Termination of License
  24. Section 660-05-35 Complaints
  25. Section 660-05-60 Allowable Tasks/Activities
  26. Section 660-05-60-05 Resident out-of-Home with Foster Care Provider
  27. Section 660-05-60-10 Employment Outside of the Home
  1. SFN 1013, “Application to Provide Adult Foster Care”
  2. SFN 800, “Fire Safety Self Declaration”
  3. SFN 823, "Evacuation Disaster Plan"
  4. Adult Foster Care Background Check Documents including:
  5. Information Sheet
  6. SFN 467, “Personal Authorization for Criminal Record Inquiry”
  7. SFN 466, “Background Check Address Disclosure”
  8. Two fingerprinting cards, if required
  1. Conduct a licensing assessment with the applicant. Completing SFN 669, “Initial Licensing Study-Adult Foster Care,” to determine compliance with policies, rules, and state laws relating to adult foster care.  
  2. Request letters of reference (see Forms Appendix for example) from individuals identified on the application form, or interview individuals and document substance of the interview. Three letters of reference (or documented interviews) are required for initial licensure. Individual references must be non-relatives and have knowledge of the applicant’s ability to provide care to older individuals and/or individuals with disabilities. If the applicant currently holds an Adult Foster Care license, letters of reference must be included in the provider’s record.
  3. Review all information pertaining to the application for a license for accuracy and completeness and forward to the Aging Services Division responsible for licensure. Requirements are listed in (Section 660-05-20-15). Include a recommendation as to whether a license should be issued and, if a license is not recommended, provide justification. Indicate the number of individuals the provider will be licensed to care for, not to exceed four individuals. Qualified service provider application and background check paperwork will be sent to the Medical Services Division Office for processing.
  4. If an applicant or current provider resides on an Indian reservation or military base, facilitate completion of SFN 915, “Adult Foster Care Affidavit of Standard of Compliance in Lieu of License” (Section 660-05-20-10).
  5. For license renewal, contact the provider to discuss license renewal and provide the required renewal paperwork. Assist provider in completion of paperwork if warranted. Complete SFN 1031, “Re-Licensing Study - Adult Foster Care." Along with requirements listed for renewal (Section 660-05-20-20). Review all renewal documentation for accuracy and completeness. Forward completed paperwork to the Aging Services Division responsible for licensure. Provide justification if license renewal is not recommended. Indicate the number of individuals the provider will be licensed to care for, not to exceed four individuals. Qualified service provider enrollment renewal paperwork will be sent to the Medical Services Division Office for processing. Forward completed paperwork at least thirty (30) days prior to the expiration of the current license.
  6. Report immediately to the Aging Services Division any changes that affect the ability of the provider to provide service.
  7. Upon receipt of a request to change the number of individuals listed on the AFC license, notify the Aging Services Division responsible for licensing. If there is a request to increase the number of individuals listed on the license, complete a home inspection to ensure the facility meets the standards for an increase. Make recommendation to the Aging Services Division for the increase and to issue a corrected license to the provider.
  8. Evaluate compliance with policies, rules, and state law through on-site inspections, review of records, and interviews with the resident(s), providers. Complete the (SFN 636) Home and Community Based Services (HCBS) Adult Foster Care (AFC) Setting Experience Interview annually with all public and private pay resident(s)in the home or with their legal representatives. Send copies of the SFN 636 to the Aging Services Division annually.
  9. Receive complaints and consult with the Aging Services Division regarding investigation. (Section 660-05-35)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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