Fillable Form Rfa 9099 - Complaint Investigation Report (Page 3 of 3) in pdf

State of California – Health and Human Services Agency

California Department of Social Services

INSTRUCTIONS

COMPLAINT INVESTIGATION REPORT – Complaint visits are made to Resource Families to investigate

allegations made concerning the family. If multiple visits are needed to complete a complaint investigation,

each individual visit to the home is recorded as a complaint visit, RFA 9099. California law requires an

unannounced visit to the home occur within 10 calendar days of receipt of a complaint. This report is a record

for the Resource Family and the County. Based on the investigation finding(s), this report may be public or

confidential. Therefore, care must be taken not to disclose personal or confidential information on a public

document. Inquiries concerning the location, maintenance and content of these reports may be directed to the

Resource Family Worker or office whose address and telephone number are listed on the front.

CENSUS – The number of children or nonminor dependents a Resource Family has under their care at the

time of the visit.

RESOLUTIONS – One of the following resolution codes are checked by the Resource Family Worker:

Substantiated: Means that the investigation concluded that based on a preponderance of the evidence,

meaning that it is more likely than not, the allegation in a complaint occurred.

Inconclusive: Means that the investigation concluded that the allegation in a complaint is not substantiated

or unfounded.

Unfounded: Means that the investigation concluded that the allegation in the complaint is false, meaning that

there is no credible evidence that the allegation in the complaint occurred.

Needs Further Investigation: This box should be checked if a determination cannot be reached at the

conclusion of the Resource Family visit. A followup visit to conclude the investigation will be made within the

specified days of completion.

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 related

to a complaint investigation are only issued for a complaint finding of substantiated and documented on the

RFA 9099C.

CORRECTIVE ACTION PLAN – The Corrective Action Plan (CAP) is a plan developed by the County 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 the time limit for the CAP. In order to set the time limit, the County must take into consideration the

seriousness of the deficiency, the number of children or nonminor 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. The Resource Family who encounters

problems beyond his/her control in completing the corrections within the specified timeframe may request and

be granted an extension of the correction due date by the County. The CAP for deficiencies related to

substantiated allegations will be documented on the RFA 9099C.

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 9099 (10/17)

Instructions

Form Rfa 9099 - Complaint Investigation Report Page 3

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