411-348-0045 In-Residence Caregiver Applicant Study (1) A program provider submitting an application for licensure of a Host Home must complete and submit an In-Residence Caregiver Applicant Study. The In-Residence Caregiver Applicant Study must contain documentation of all of the following: (a) The names and ages of all occupants of the home, including identification of which adults shall be responsible for providing care and support to children residing in the home and which, if any, adults residing in the home are dependent upon care. (b) Reports of all criminal charges, arrests, or convictions, including the date of the offense and the resolution of those charges, for all occupants of the home. If minor children of an in-residence caregiver are residing in the home, the In-Residence Caregiver Applicant Study must also list reports of all criminal or juvenile delinquency charges, arrests, or convictions, including the date of the offense and the resolution of those charges. (c) Founded reports of child abuse or substantiated abuse, including dates, locations, and resolutions of those reports, for all occupants of the home. (d) Names and addresses of any agencies in the Unites States where any occupant of the home has been licensed or certified to provide care to children or adults and the status of such license or certification, including license or certification for foster or residential care or nursing. (e) Any professional licenses or certifications currently or previously held by the in-residence caregiver or other adult occupants of the home, and the status of each license or certificate. (f) Copy of the in-residence caregiver's current driver’s license and proof of insurance coverage on all vehicles used by the in-residence caregiver to provide transportation to children. (g) Disclosure of any current or past Medicaid Provider Enrollments or Medicaid Provider Identifications held by occupants of the home, including a report of the status of each enrollment. Any reported termination of Medicaid enrollment or identification must include a description of the reason for the termination. (h) Completed character reference checks for the in-residence caregiver. There must be four character reference check sources for each in-residence caregiver who have known the in-residence caregiver for two years or more and can attest to the character of the in-residence caregiver and the in-residence caregiver’s ability to care for children. Three of the reference check sources may not be related to the in-residence caregiver. (i) A physician’s statement for the in-residence caregiver that the in-residence caregiver is physically and mentally capable of providing care, to the extent that there are no known issues that prevent or interfere with the in-residence caregiver’s ability to provide care to a child. (j) A disclosure of all past residences in the last five years for the in-residence caregiver. The disclosure must include the address, city, state, and zip code. (k) A statement from the program provider recommending the in-residence caregiver based on the belief the in-residence caregiver has the necessary skills, knowledge of child development, temperament, and resources to provide a stable and nurturing family home environment for a child placed in the Host Home. The program provider must assess the in-residence caregiver’s ability to demonstrate all of the following attributes: (A) Responsible, stable, emotionally mature adult who exercises sound judgment. (B) Interest, motivation, and ability to nurture, support, and meet the mental, physical, developmental, and emotional needs of a child placed in the Host Home. (C) Willing to receive training and have the ability to learn and use effective child-rearing practices to enable a child placed in the Host Home to grow, develop, and build positive personal relationships and self-esteem. (D) Demonstrates the knowledge and understanding of positive supports and ways of helping a child build positive personal relationships, self-control, and self-esteem. (E) Respects a child's relationship with their parents and siblings and is willing to work in partnership with family members, agencies, and schools involved with a child placed in the Host Home to attain the goals as listed in the child's IEP, ISP, and other care plans. (F) Respects a child's privacy in accordance with the child's age and care needs. (G) Has supportive ties with others who might support, comfort, and provide advice, such as family, friends, neighborhood contacts, churches, or community groups. (H) Demonstrates a lifestyle and personal habits free from abuse or misuse of alcohol or drugs. (I) Is able to realistically evaluate which children the in-residence caregiver may accept, work with, and integrate into their family home. (2) Adults (other than the in-residence caregiver and program provider) having regular contact with a child placed in a Host Home, including volunteers, family members, acquaintances of the in-residence caregiver, and any subject individual as defined in OAR 407-007-0210, must also be identified and documentation of a completed background check must be submitted to the Department with the In-Residence Caregiver Applicant Study. Regular contact applies to visitors who have any role in supervising or providing direct care to children in the home, regardless of frequency of visit to the home. (3) The Department may require documentation of an approved background check on members of an in-residence caregiver’s household who are under the age of 18 if there is reason to believe that a minor household member may pose a risk to children placed in the home. Background checks required by the Department for minor household members must be included in the In-Residence Caregiver Applicant Study. (4) The Department may not proceed with the licensing of a Host Home if the In-Residence Caregiver Applicant Study is not complete. (5) Falsification or omission of any of the information of the In-Residence Caregiver Applicant Study may be grounds for denial or revocation of a Host Home license. Statutory/Other Authority: ORS 409.050, 427.104, 441.715, 443.450 & 443.455 Statutes/Other Implemented: ORS 427.104, 441.705-441.720, 441.740, 441.745, 443.384, 443.392, 443.400-443.445, 443.450, 443.455, 443.880, 443.881 & 443.991 History: APD 36-2019, adopt filed 10/29/2019, effective 11/01/2019