Arizona Administrative Code › Title 6 - ECONOMIC SECURITY › Chapter 5 - DEPARTMENT OF ECONOMIC SECURITY - SOCIAL SERVICES › Article 74 - LICENSING PROCESS AND LICENSING REQUIREMENTS FOR CHILD WELFARE AGENCIES OPERATING RESIDENTIAL GROUP CARE FACILITIES AND OUTDOOR EXPERIENCE PROGRAMS › Section R6-5-7411 - Application for Renewal of License and Operating Certificates

Current through Register Vol. 30, No. 28, July 12, 2024
A. No earlier than
				90 and no later than 60 days prior to the expiration date of a license, an
				agency may apply to the Licensing Authority for renewal of its license and any
				operating certificates. The Licensing Authority does not have a duty to notify
				the agency of license expiration. The agency shall contact the Licensing
				Authority to request a renewal application and to schedule a DHS health and
				safety inspection. The agency shall schedule its own fire inspection. Failure
				to timely apply or obtain inspections may result in suspension of the agency's
				license until the renewal process is completed.
B. An agency shall apply for renewal on a
				Department application form containing the information required in this
				Section.
C. An agency shall submit
				copies of the completed renewal application and supporting documents to the
				Licensing Authority. If the agency has not amended, changed or updated the
				information or documentation since the agency last applied for or renewed its
				license, the agency shall indicate "no change" on the documents submitted with
				the renewal application.
D. With a
				renewal application, the agency shall also submit the following documentation:
1. A current financial statement prepared by
				an independent certified public accountant who is not employed by the
				agency;
2. A certificate of current
				insurance coverage as prescribed in
				R6-5-7426;
3. A copy of the agency's current budget and
				the agency's audit report for its preceding fiscal year;
4. Identification of and the following
				background information on the agency, facility, and administrators:
a. Name, address, and telephone and
				telefacsimile numbers for the agency and all facilities operated by the
				agency;
b. Name, title, business
				address, and telephone and telefacsimile number of:
i. The person who serves as the chief
				executive officer (CEO) as prescribed in
				R6-5-7432(A);
ii. The person who serves as the program
				director as prescribed in
				R6-5-7432(B);
iii. The person with delegated authority to
				act when the CEO is absent;
iv. The
				person in charge of each separate facility as prescribed in
				R6-5-7432(C);
v. Persons holding at
				least 10% ownership interest in the applicant; and
vi. The agency and facility medical
				directors, if applicable;
c. The educational qualifications and work
				history for each person listed in subsection (D)(4)(b), with that person's
				attached resume, employment application, or curriculum vitae;
d. A list of the members of the agency's
				governing body described in
				R6-5-7424,
				including name, address, position in the agency, term of membership, and any
				relationship to the applicant;
e. A
				list of licenses or certificates for provision of medical or social services
				currently or previously held by the applicant or persons listed in subsection
				(D)(4)(b), including those held in this state or another state or country; the
				list shall include the dates the person held the license or
				certificate;
f. A written
				description of any proceedings for denial, suspension, or revocation of a
				license or certificate for provision of medical, psychological, behavioral
				health, or social services, pending or filed, or brought against the applicant
				or a person listed in subsection (D)(4)(b), including those held in this state
				or another state or country; and
g.
				A written description of any litigation in which the applicant or a person
				listed in subsection (D)(4)(b) has been a party during the 10 years preceding
				the date of application, including, collection matters and bankruptcy
				proceedings.
5. An
				organizational chart for the agency and each separate facility, showing
				administrative structure and staffing, and lines of authority.
6. The following information on staff:
a. A list of applicant's paid staff,
				including:
i. Name;
ii. Position or titles;
iii. Degrees, certificates, or licenses
				held;
iv. Business
				address;
v. Date of hire;
vi. Date of last physical; and
vii. Date of submission for fingerprinting
				and background clearance;
b. For any staff whose primary residence is
				the facility:
i. The name and date of birth of
				any persons residing with a staff member;
ii. Evidence that any adult residing with a
				staff member has submitted fingerprints and criminal background information as
				prescribed in
				R6-5-7431
				and is free from communicable diseases posing a danger to children in care, as
				prescribed in
				R6-5-7431(H);
				and
iii. Evidence that the staff
				member's children who reside at the facility have current
				immunizations.
7. Copies of any written complaints the
				agency has received about its performance at its facilities during the expiring
				license year and the agency's response to the complaints; and
8. A written description of any changes in
				program services or locations, or the children served by the agency.