Form Fc 9-Exit - Foster Care Group Home Audit Record Of Exit Conference
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2STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
FOSTER CARE GROUP HOME AUDIT
RECORD OF EXIT CONFERENCE
PROVIDER:
PROGRAM NO.:
FY:
DATE AND TIME:
LOCATION:
CDSS AUDIT STAFF:
PROVIDER STAFF:
TITLE:
PROVIDER STAFF:
TITLE:
PROVIDER STAFF:
TITLE:
1. Was provider given a copy of:
Personnel File Review:
__________________
GH Program Audit Report (SR 2G/SR 2P):
__________________
Other Documentation:
__________________
2. Did the auditor explain:
Program Audit Findings:
__________________
Audit Report Procedures:
__________________
Administrative Review Procedures:
__________________
3. Summary of discussion of findings:
SIGNATURE OF AUDITOR-IN-CHARGE
PAGE 1 OF 2
FC 9 - EXIT (11/02)
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