Division of Family and Children Services

Family and Child Safety Unit

FAMILY VIOLENCE AGENCY MONITORING TOOL

1
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

TABLE OF CONTENTS
Topic Page
5 5 5 6 7 8 9 10 10 11 12 12 13 13 15 15 16 17 17 18 18

Shelter/Facility..... General/Overall Outside ..... Common Area.. Living Room.... Bedroom. Bathroom Kitchen... Food Dining Room....... Laundry Area.. Donation Area. Play Area. Play Ground. General/Overall Outside.. Health and Safety Fire . Natural Disaster .. Bomb Threat Intruder Other Incidents Substances.... Accidental Injuries...

2
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

TABLE OF CONTENTS (contd)

Medical Concerns... Agency Responsibilities Agency Guidelines Crisis Calls Client Services.. Children Services.. Community Resource Client Rights... Confidentiality.... Personnel New Hire Employees. All Employee Information. Work Rules Training. Volunteers. New Volunteers Volunteer Information Training.. Board of Directors.. Financial Management.. Audit/Tax Preparation Insurance Payroll Data Tracking.

Topic

Page
18 20 20 21 22 27 29 30 32 34 34 35 36 37 38 38 38 39 40 42 42 43 43 44

3
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

Division of Family and Children Services Family and Child Safety Unit FAMILY VIOLENCE AGENCY MONITORING TOOL DEFINITIONS
Area of Review-Performance standards of agency operations.

I, O, D- Methods used to assess the area of review (standards). I-Interviews O-Observation D-Documentation DM, M DM-Did not meet M-Meet P &P- Policies and Procedures that demonstrate the agencys operational measures. Policies- A written general course of action formulated for the operation of an agency. Procedures- An established written method of accomplishing a specific duty; steps used to apply or implement the policy. The steps should include: what actions and duties are required to implement this policy how are the actions completed who is responsible when or how often is this policy monitored Practice- Agency implementation of the policies and procedures. Unit Information-DHS reviewers means to assess the agencys compliance of the standard.

4
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

SHELTER/FACILITY
Facility must be maintained in conformity with regulations adopted by State and Local Fire Marshals, Division of Community Health and the Georgia Department of Natural Resources

Area of Review
A. General /Overall Inside

Unit Information

P&P I,O,D DM, M

Practice DM,M

The agency has policies, procedures and practices that demonstrate the overall care of the facility for the items listed below: 1. Facility is clean and properly sanitized to prevent the spread of infection/disease 2. Walls and woodwork are maintained and in clean condition 3. Agency provides regularly scheduled pest control in the facility 4. All entrances and exits including windows and doors are securable 5. The agency has a monitored security system at the shelter 6. Electrical service is inspected/approved annually by a local fire marshal or qualified electrician 7. Installation and maintenance of emergency lights 8. Installation and maintenance of smoke detectors 9. Fire extinguishers are maintained and installed in visible location

Review manual and tour shelter Review manual and tour shelter Review manual, tour shelter, pest control Review manual and tour shelter Review manual, tour shelter, security contract, test system Review manual, tour shelter, copy of inspection report Review manual and tour shelter Review manual and tour shelter Review manual, tour shelter, review extinguisher tags Review manual and tour shelter; one detector per floor (for agencies with gas appliances only) Review manual and tour shelter Review manual and tour shelter

10. Installation and maintenance of Carbon Monoxide Detectors 11. Agency provides a confidential area for private interviews 12. General area must accommodate residents with impaired mobility B. Common Area (s) (Stairwell, Hallway) The agency has policies, procedures and practices that demonstrate the overall care of the common area for the items listed below: 1. Furnishings are clean and in good repair

Review manual and tour shelter

5
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

SHELTER/FACILITY
Area of Review
2. Agency has no lead, chipped or peeling paint on room walls/windows/stairs/furniture/cabinets/doors/porch 3. All electrical outlets, which are not being used must have outlet coverings 4. All blind cords are secured and out of reach of children 5. Common Area is free of any hazards which could cause an accidental injury 6. Hazardous materials are securely stored and out of childrens reach 7. Evacuation plans are accurate and posted in each room 8. Electrical switches, devices and fixtures are maintained 9. All areas have adequate lighting 10. All areas have adequate heat 11. All areas have adequate ventilation/air conditioning 12. All vent covers and ceiling fans are free of dust, dirt and mold 13. Handrails are securely fastened on at least one side of the interior stairway 14. Walls and woodwork are maintained and in clean condition 15. Child gates are installed and maintained for the safety of children C. Living Room The agency has policies, procedures and practices that demonstrate the overall care of the living room for the items listed below: 1. Furnishings are clean and in good repair 2. Walls and woodwork are maintained and in clean condition 3. Agency has no lead, chipped or peeling paint on room walls/windows/furniture/cabinets/doors 4. All electrical outlets, which are not being used, must have outlet coverings 5. All blind cords are secured and out of reach of children 6. Living Room is free of any hazards which could cause an accidental injury 7. Hazardous materials are securely stored and out of childrens reach 8. Evacuation plans are accurate and posted in each room 9. Electrical switches, devices and fixtures are maintained

Unit Information
Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual andtour shelter Review manual and tour shelter Review manual and tour shelter

I,O,D

P&P DM, M

Practice DM,M

Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter

6
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

SHELTER/FACILITY
Area of Review
10. Living room has adequate lighting 11. Living room has adequate heat 12. Living room has adequate ventilation/air conditioning 13. All vent covers and ceiling fans are free of dust, dirt and mold D. Bedroom The agency has policies, procedures and practices that demonstrate the overall care of the bedroom (s) for the item listed below: 1. Furnishings are clean and in good repair 2. Walls and woodwork are maintained and in clean condition 3. Agency has no lead, chipped or peeling paint on room walls/windows/s/furniture/cabinets/doors 4. All electrical outlets, which are not being used must have outlet coverings 5. All blind cords are secured and out of reach of children 6. Bedrooms are free of any hazards which could cause an accidental injury 7. Hazardous materials are securely stored and out of childrens reach 8. Evacuation plans are accurate and posted in each room 9. Electrical switches, devices and fixtures are maintained 10. Bedrooms have adequate lighting 11. Bedrooms have adequate heat 12. Bedrooms have adequate ventilation/air conditioning 13. All vent covers and ceiling fans are free of dust, dirt and mold 14. At least one bedroom must accommodate residents with impaired mobility 15. The agency provides bedding, towels, washcloths, soap, and access to other supplies for the personal hygiene of residents 16. The agency ensures each bedroom and its contents are properly cleaned and disinfected before next room assignment

Unit Information
Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter

I,O,D

P&P DM, M

Practice DM,M

Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter, client interviews Review manual and tour shelter, client interviews, staff interviews

7
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

SHELTER/FACILITY
Area of Review
17. The agency provides an individual bed for each resident at least 36 inches wide and 72 inches long with comfortable springs, a protected mattress and a pillow 18. Safe Cribs are provided for each infant 19. Each bedroom accommodates beds, storage for personal belongings, and free movement

Unit Information
Review manual and tour shelter

I,O,D

P&P DM, M

Practice DM,M

Review manual and tour shelter, ct. interviews Review manual and tour shelter Review manual and tour shelter; equipped with side-hinged, permanently mounted doors with positively latching hardware which ensures opening of the door by a single motion, such as turning a knob or pressing with normal force Review manual and tour shelter

20. Resident bedroom doors open and close properly 21. Bedrooms have at least one window opening to the outside
E. Bathroom (s)

The agency has policies, procedures and practices that demonstrate the overall care of the bathroom (s)for the items listed below: 1. Bathroom furnishings are clean and in good repair 2. Agency has no lead, chipped or peeling paint on room walls/windows/furniture/cabinets/doors 3. All electrical outlets, which are not being used must have outlet coverings 4. All blind cords are secured and out of reach of children 5. Bathrooms are free of any hazards which could cause an accidental injury 6. Hazardous materials are securely stored and out of childrens reach 7. Evacuation plans are accurate and posted in each room

Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter (Note: Bathrooms within bedrooms may not need an evacuation plan)

8
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

SHELTER/FACILITY
Area of Review
8. Electrical switches, devices and fixtures are maintained 9. Bathroom (s) have adequate lighting 10. Bathroom (s) have adequate heat 11. Bathroom (s) have adequate ventilation/air conditioning 12. All vent covers and ceiling fans are free of dust, dirt and mold 13. At least one functional toilet, sink and bathtub or shower are provided for every six residents 14. Bathroom (s) without windows have forced ventilation to the outside 15. Non-slip strips or surfacing is installed in tub/shower areas 16. At least one bathroom must accommodate residents with impaired mobility F. Kitchen The agency has policies, procedures and practices that demonstrate the overall care of the kitchen for the items listed below: 1. Kitchen must be kept in clean and in sanitary condition 2. Furnishings are clean and in good repair 3. Walls and woodwork are maintained and in clean condition 4. Agency has no lead, chipped or peeling paint on room walls/windows/furniture/cabinets/doors 5. All electrical outlets, which are not being used must have outlet coverings 6. All blind cords are secured and out of reach of children 7. Kitchen is free of any hazards which could cause an accidental injury 8. Hazardous materials are securely stored and out of childrens reach 9. Evacuation plans are accurate and posted 10. Electrical switches, devices and fixtures are maintained 11. Kitchen has adequate lighting 12. Kitchen has adequate heat

Unit Information
Review manual and tour shelter Review manual and tour shelter Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. (e.g. chairs, grab bars etc.)

I,O,D

P&P DM, M

Practice DM,M

Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter.

9
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

SHELTER/FACILITY
Area of Review
13. Kitchen has adequate ventilation/air conditioning 14. All vent covers and ceiling fans are free of dust, dirt and mold 15. Cooking appliances shall be suitably installed in accordance with approved safety practices 16. Metal hoods or canopies are suitably installed and maintained in accordance with approved safety practices 17. An ample supply of cookware, utensils and dishes are made available for residents use 18. Cookware, utensils and dishes are in efficient condition and kept clean at all times G. Food The agency has policies, procedures and practices that demonstrate the provision and safe keeping of food for the items listed below: 1. The agency provides residents and their dependent children sufficient food and nutrition, which meets the minimum USDA standards, and provides three meals a day 2. Emergency food available on 24 hour basis 3. Maintains refrigeration at 40 degrees Fahrenheit or less and Freezer at 0 degrees Fahrenheit 4. All food items shall be stored in tightly sealed containers, once opened H. Dining Room The agency has policies, procedures and practices that demonstrate the overall care of the dining room for the items listed below: 1. Furnishings are clean and in good repair 2. Walls and woodwork are maintained and in clean condition 3. Agency has no lead, chipped or peeling paint on room walls/windows/furniture/cabinets/doors

Unit Information
Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter.

I,O,D

P&P DM, M

Practice DM,M

Review manual and tour shelter.

Review manual and tour shelter; knowledge of USDA standards. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter.

Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter.

10
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

SHELTER/FACILITY
Area of Review
4. All electrical outlets, which are not being used must have outlet coverings 5. All blind cords are secured and out of reach of children 6. Dining room is free of any hazards which could cause an accidental injury 7. Hazardous materials are securely stored and out of childrens reach 8. Evacuation plans are accurate and posted in each room 9. Electrical switches, devices and fixtures are maintained 10. Dining room has adequate lighting 11. Dining room has adequate heat 12. Dining room has adequate ventilation/air conditioning 13. All vent covers and ceiling fans are free of dust, dirt and mold
I. Laundry Area

Unit Information
Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter.

I,O,D

P&P DM, M

Practice DM,M

The agency has policies, procedures and practices that demonstrate the overall care of the laundry area for the items listed below: 1. The agency provides access to and use of laundering facilities and supplies 2. Agency has no lead, chipped or peeling paint on room/ walls/windows/furniture/cabinets/doors 3. Walls and woodwork are maintained and in clean condition 4. All electrical outlets, which are not being used must have outlet coverings 5. All blind cords are secured and out of reach of children 6. Laundry area is free of any hazards which could cause an accidental injury 7. Hazardous materials are securely stored and out of childrens reach 8. Evacuation plans are accurate and posted 9. Electrical switches, devices and fixtures are maintained 10. Laundry area has adequate lighting 11. Laundry area has adequate heat 12. Laundry area has adequate ventilation/air conditioning 13. All vent covers and ceiling fans are free of dust, dirt and mold

Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter.

11
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

SHELTER/FACILITY
Area of Review
J. Donation Area The agency shall provide policies and procedures for the overall care of the donation area for the listed items below: (Note: Donation area requirements will be based upon structure and use) 1. Walls and woodwork are maintained and in clean condition 2. Agency has no lead, chipped or peeling paint on room walls/windows/furniture/cabinets/doors 3. All electrical outlets, which are not being used must have outlet coverings 4. All blind cords are secured and out of reach of children 5. Donation area is free of any hazards which could cause an accidental injury 6. Hazardous materials are securely stored and out of childrens reach 7. Evacuation plans are accurate and posted in each donation area 8. Electrical switches, devices and fixtures are maintained 9. Donation area has adequate lighting 10. Donation area has adequate heat 11. Donation areas utilized by clients will have adequate ventilation/air conditioning 12. All vent covers and ceiling fans are free of dust, dirt and mold K. Play Area The agency has policies, procedures and practices that demonstrate the overall care of the play area for the items listed below: 1. Furnishings are clean and in good repair 2. Walls and woodwork are maintained and in clean condition 3. Agency has no lead, chipped or peeling paint on room walls/windows/furniture/cabinets/doors 4. All electrical outlets, which are not being used must have outlet coverings 5. All blind cords are secured and out of reach of children 6. Play area is free of any hazards which could cause an accidental injury

Unit Information

I,O,D

P&P DM, M

Practice DM,M

Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter.

Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter.

12
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

SHELTER/FACILITY
Area of Review
7. Hazardous materials are securely stored and out of childrens reach 8. Evacuation plans are accurate and posted in each room 9. Electrical switches, devices and fixtures are maintained 10. Children toys are sanitized, cleaned and in good condition 11. Play area has adequate lighting 12. Play area has adequate heat 13. Play area has adequate ventilation/air conditioning 14. All vent covers and ceiling fans are free of dust, dirt and mold L. Play Ground The agency has policies, procedures and practices that demonstrate the overall care of the play ground for the items listed below: 1. Secure play space for children 2. Playground equipment is installed and maintained ina safe manner 3. Play ground area is free from hazards, nuisances, refuse and litter 4. Outdoor toys are maintained and in good condition M. General /Overall Outside The agency has policies, procedures and practices that demonstrate the overall care of the outside area for the items listed below: 1. Agency has no lead, chipped or peeling paint on the walls/windows/stairs/furniture/doors/porches 2. Maintenance of the yard area to be free from hazards, nuisances, refuse and litter 3. Sidewalks, fire escape routes and entrances shall be free of any hazards 4. Exterior stairways must have securely fastened handrails on open sides 5. Agency has a designated area outside of the building for smoking, away from childrens play area 6. Agency maintenance and monitoring of private water system according to the state and local standard and/or regulations

Unit Information
Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter.

I,O,D

P&P DM, M

Practice DM,M

Review manual and tour shelter Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter.

Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual and tour shelter. Review manual, tour shelter, review county regulation

13
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

SHELTER/FACILITY
Area of Review
7. Agency maintains and monitors the sewage disposal systems 8. Agency maintains and monitors that the garbage is stored in non combustible, covered containers and removed from agency premises weekly 9. Residents with impaired mobility must be able to access outside area

Unit Information
Review manual, tour shelter review county regulation. Review manual, tour shelter, review county regulation. Review manual and tour shelter.

I,O,D

P&P DM, M

Practice DM,M

14
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

HEALTH AND SAFETY

The agency must have written health and safety policies

Area of Review
Agency has posted a Notice Concerning Critical Incident Reporting in a common area that is accessible to clients and the general public Fire The agency has policies, procedures and practices that outlines the protocol in case of a fire, to include the following: 1. The staff personnel in charge of monitoring the protocol 2. An accounting of occupants

Unit Information
Review manual, tour shelter;

I, O, D

P&P DM, M

Practice DM,M

3. Reporting event to proper authorities 4. Relating of emergency procedures to staff and residents 5. Fire Drill to be performed quarterly or more often as required by the local fire marshal 6. Protocol for the maintenance of the crisis line 7. Emergency housing for residents 8. The investigation, evaluation and documentation of event and follow up procedures on incident reporting form Natural Disaster The agency has policies, procedures and practices that outlines the protocol, in case of a natural disaster, to include the following: 1. The agency personnel in charge of monitoring the protocol 2. An accounting of occupants

Review manual, staff interviews. Review manual, logs/ forms, staff interviews. Review manual, documentation logs, reporting forms, staff interviews. Review manual. Review manual; drill occurs on different shifts; drill documentation. Review manual, logs/ forms. Review manual, incident reporting form, staff interviews. Review manual, incident reporting form.

Review manual, staff interviews. Review manual, logs/ forms, staff interviews.

15
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

HEALTH AND SAFETY

Area of Review
3. Reporting event to proper authorities

Unit Information
Review manual, documentation logs, reporting forms, staff interviews. Review manual. Review manual; drill occurs on different shifts; drill documentation . Review manual, logs/ forms. Review manual, incident reporting form, staff interviews. Review manual, incident reporting form.

I, O, D

P&P DM, M

Practice DM,M

4. Relating of emergency procedures to staff and residents 5. Disaster drills to be conducted semi-annually 6. Protocol for the maintenance of the crisis line 7. Emergency housing for residents 8. The investigation, evaluation and documentation of event and follow up procedures on incident reporting form Bomb Threat The agency has policies, procedures and practices that outline the protocol, in case of a bomb threat, to include the following: 1. The agency personnel in charge of monitoring the protocol 2. An accounting of occupants

3. Reporting event to proper authorities 4. Relating of emergency procedures to staff and residents 5. Protocol for the maintenance of the crisis line 6. Emergency housing for residents 7. The investigation, evaluation and documentation of event and follow up procedures on incident reporting form

Review manual, staff interviews. Review manual, logs/ forms, staff interviews. Review manual, documentation logs, reporting forms, staff interviews. Review manual. Review manual, logs/ forms. Review manual, incident reporting form, staff interviews. Review manual, incident reporting form.

16
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

HEALTH AND SAFETY

Area of Review
Intruder The agency has policies, procedures and practices that outline the protocol, in case of an intruder, to include the following: 1. The agency personnel in charge of monitoring the protocol 2. An accounting of occupants 3. A safety plan for residents and staff

Unit Information

I, O, D

P&P DM, M

Practice DM,M

4. Reporting event to proper authorities 5. Relating of emergency procedures to staff and residents 6. The investigation, evaluation and documentation of event and follow up procedures on incident reporting form 7. Intruder drills shall be conducted semi-annually Other Incidents The agency has policies, procedures and practices that outline the protocol, for other incidents, as listed below: 1. Possession of weapons, to include the investigation, evaluation and documentation of event and follow up procedures 2. An assault of client on client (including child on child) or client on staff, to include the investigation, evaluation and documentation of event and follow up procedures on the incident reporting form 3. Theft, to include the investigation, evaluation and documentation of event and follow up procedures on incident reporting form

Review manual, staff interviews. Review manual, logs/ forms, staff interviews. Review manual, staff interviews, safety plan. Review manual, documentation logs, reporting forms, staff interviews. Review manual. Review manual, incident reporting form. Review manual; drill documentation.

Review manual, documentation logs, reporting forms, staff interviews. Review manual, documentation logs, reporting forms, staff interviews. Review manual, documentation logs, reporting forms, staff interviews.

17
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

HEALTH AND SAFETY

Area of Review
4. The destruction of property, to include the investigation, evaluation and documentation of event and follow up procedures on the incident reporting form Substances The agency has policies, procedures and practices that outline the protocol regarding substances, as listed below: 1. Illegal drugs found on the property or in possession of a client to include, the investigation, evaluation and documentation of event and follow up procedures on the incident reporting form 2. Alcohol found on the property or in possession of a client to include, the investigation, evaluation and documentation of event and follow up procedures on the incident reporting form 3. A client is under the influence of alcohol or other substances to include the investigation, evaluation and documentation of event and follow up procedures on the incident reporting form Accidental Injuries The agency has policies, procedures and practices that outline the protocol regarding accidental injuries as listed below: 1. Emergency medical care 2. The investigation, evaluation and documentation of event and follow up procedures including the use of the DHS Critical Incident Reporting procedure Medical Concerns The agency has policies, procedures and practices that outline the protocol regarding medical concerns as listed below: 1. Meeting the medical needs of clients, including emergency prescription and non-prescription medicine 2. Safe storage of client medications

Unit Information
Review manual, documentation logs, reporting forms, staff interviews.

I, O, D

P&P DM, M

Practice DM,M

Review manual, incident reporting form Review manual, incident reporting form., different for each client Review manual, incident reporting form., different for each client

Review manual, staff interviews. Review manual, DHS Critical Incident Reports

Review manual, staff interviews, review medical supplies of over the counter medication; Review manual, staff interviews.

18
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

HEALTH AND SAFETY

Area of Review
3. Control and prevention of contagious diseases 4. First Aid kit shall be maintained and kept at each location

Unit Information
Review manual, staff interviews. Review manual, review kit.

I, O, D

P&P DM, M

Practice DM,M

19
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

AGENCY RESPONSIBILITIES
The agency must provide all of the following core services. Related policies shall be created, implemented and revised as needed; Residential/client policies/procedures shall be created, implemented and revised as needed.

Area of Review
The agency has policy, procedure and practice that demonstrates 80% of adults served must be victims of domestic violence The agency has policy, procedure and practice that demonstrates that the organizational chart is current and accurate to include the Board, staff and volunteers Agency Guidelines The agency has policies, procedures and practices that demonstrate the agency guidelines to include the items listed below: 1. Residential handbook should include: A.) An explanation of services provided by the agency B.) Agency confidentiality policy C.) Clients rights D.) Shelter guidelines 2. Non-Residential handout should include: A.) An explanation of services provided by the agency B.) Agency confidentiality policy C.) Clients rights

Unit Information
Review manual. Review manual.

I, O, D

P&P DM, M

Practice DM,M

Review manual; client handout. Review manual; client handout. Review manual; client handout. Review manual; client handout, guidelines (shelter rules) Review manual; client handout. Review manual; client handout. Review manual; client handout.

20
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

AGENCY RESPONSIBILITIES
Area of Review Unit Information
Review manual, review guidelines (e.g. roles and responsibilities of advocates, roles and responsibilities for clients, criteria to receive services, agency responsibilities, meeting requirements, children services including mandated reporting requirement, length of program, termination options; client handout).

I, O, D

P&P DM, M

Practice DM,M

D.) Agency guidelines for non residents 3. Client receives handbook within 24 hours of face to face contact Crisis Calls The agency has policies, procedures and practices outlining the agency responsibilities for crisis calls to include the following: 1. 24 hour crisis line available and answered by center staff or volunteers without the use of answering machines/service 2. Agency has a minimum of two telephone lines, one of which is the designated crisis line 3. Crisis line numbers are listed in the local telephone book and widely distributed in areas served by the agency 4. Crisis line is toll free and/or accepts collect calls 5. Crisis line should provide: A.) Emotional support

Review manual, client file, client interviews.

Review manual, test crisis calls. Review manual. Review manual, brochures, phone book, staff interviews. Review manual, brochures, phone book, staff interviews. Review manual, crisis call logs/form, client interviews, test calls. Review manual, review crisis call logs/form, client interviews, test calls.

B.) Safety Planning

21
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

AGENCY RESPONSIBILITIES
Area of Review
C.) Information/ referrals regarding services 6. All crisis calls are documented within a format that includes an outcome 7. Crisis call logs and forms are maintained for a minimum of 6 years 8. Procedures to meet the crisis callers needs including the following: A.) The protocol used by staff and volunteers to determine bed availability within their shelter B.) Bed availability updated by the staff on the DHS Family Violence Unit website on a daily basis C.) The protocol used by staff and volunteers to make referrals to alternative lodging when the agency is at capacity D.) The protocol for the provision of transportation to the shelter or alternative sites for clients in crisis E.) The protocol for staff and volunteers to meet the needs of Non-English speaking clients F.) The protocol used for staff and volunteers to meet the needs of the Hearing Impaired via the TTY machine G.) The protocol used to provide services for male victims Client Services The agency has policies, procedures and practices for how client services are provided to include the following: 1. Residential services to include:

Unit Information
Review manual, review crisis call logs/form, client interviews, test calls. Review manual, review log/ form. Review manual, location of logs.

I, O, D

P&P DM, M

Practice DM,M

Review manual, shift change process, staff interviews. Review manual, review DHS website. Review manual, staff interviews. Review manual, staff interviews. Review manual, staff interviews, resource guide, and language line contract. Review manual, staff interviews. Review manual, staff interviews.

22
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

AGENCY RESPONSIBILITIES
Area of Review
A.) Involvement by the justice systems is not a requirement of admittance or for continuance of services B.) Criteria for admission C.) Intake process D.) Client files to include the following items: I. Agency intake form with identifying information II. Admissions agreement III. Emergency health releases with name/phone/address of emergency contact person IV. Each residential childs name, birth date, gender, and any other emergency medical information V. Child care release VI. Provisions of safe keeping of monies and valuables VII. If offered as information, the forwarding address of the resident VIII. Release of information form IX. Confidentiality agreement

Unit Information
Review manual, client handbook, client interviews, example of justice systems-police or protection orders). Review manual, staff interviews. Review manual, client interviews. Review manual, client files. client circumstances Review manual, client files. Review manual, client files.

I, O, D

P&P DM, M

Practice DM,M

Review manual, client files. Review manual, client files. Review manual, client files, log, client interviews. Review manual, client files. Review manual, client files. Review manual, client files.

23
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

AGENCY RESPONSIBILITIES
Area of Review Unit Information
Review manual, review safety plan examples: the survivors court appearances, resumption of or beginning new job, an order for visitation of children by the batterer, a batterer being servedstay away orders or being released from jail after an arrest involving the survivor and/or children. Review manual, staff interviews. A.) Criteria for admission Review manual, staff interviews. B.) Intake process C.) Client files to include the following items : I. Agency intake form with identifying information II. Each non-residential childs name, birth date, gender and any other emergency medical information III. Release of information form IV. Confidentiality agreement

I, O, D

P&P DM, M

Practice DM,M

X.) Documentation of all safety plans 2. Non residential services to include:

Review client files. Review manual, client files. Review manual, client files, staff interviews. Review manual, client files, staff interviews.

24
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

AGENCY RESPONSIBILITIES
Area of Review Unit Information
Review manual, review safety plan examples: the survivors court appearances, resumption of or beginning new job, an order for visitation of children by the batterer, a batterer being served stay away orders or being released from jail after an arrest involving the survivor and/or children. Review manual, client interviews, staff interviews, client files. Review manual, client interviews, staff interviews, client files. Review manual, client interviews, staff interviews, client files. Review manual, client interviews, staff interviews, client files. Review manual, client interviews, client files, support group logs. Review manual, client interviews, client files, support group logs. Review manual, client interviews, client files, support group logs. Review manual, client interviews, client files, group logs, written agreement.

I, O, D

P&P DM, M

Practice DM,M

V.) Documentation of all safety plans 3. The agency provides legal advocacy for residential and non residential clients 4. The agency provides social services advocacy for residential and non residential clients 5. The agency provides TANF assessments for residential and non residential clients 6. The agency provides transportation services for basic client needs 7. The agency provides housing assistance to residential and non residential clients 8. The agency provides weekly support groups for residents 9. The agency provides support groups twice per month for non residents 10. The agency provides voluntary parenting support/education for parents at the agency or through a written agreement with a referral agency

25
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

AGENCY RESPONSIBILITIES
Area of Review
11. Residential and Non Residential individualized service plans

Unit Information
Review manual. Service plans should include: identified goals, documentation of services, updated weekly, prioritize clients needs, including safety planning, identify resources available to clients, goals and objectives specific to the clients own goals, record goals in a program-approved service plan, goals correlate with survivors length of stay, if in a shelter, progression toward completion of clients goals and objectives, adaptation to clients changing needs, as appropriate.

I, O, D

P&P DM, M

Practice DM,M

12. Clients exit procedure to include the following: A.) Exit interview provided with follow-up services offered to each adult client B.) Safety Plan is developed for clients and their dependent children C.) Agency evaluation to assess agency services

Review manual, client files, staff interviews. Review manual, client files, staff interviews Review manual, client files, staff interviews, evaluation

26
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

AGENCY RESPONSIBILITIES
Area of Review
13. Professional standards used by staff to write client case notes

Unit Information
Review manual, to include areas such as individual contacts, group sessions, referrals and activities conducted by the client or staff in fulfillment of the service plan; Case notes to include: Entries are legible, in chronological order, daily for residential shelters and per contact for nonresidential, formatted as hand written: in black or blue ink, signed and dated by recorder, comprehensive, objective, and factual, corrected by drawing line through error and initialing (NO WHITEOUT), are not made on sticky notes or scrap paper, lines are drawn through unused lines and then initialed, agency approved abbreviations are used, clearly identifies client, only necessary facts are recorded, notes do not contain any diagnosis or clinical assessments, notes on one client do not include other client names.

I, O, D

P&P DM, M

Practice DM,M

14. Client files are well organized Children Services The agency has policies, procedures and practices that demonstrate how the agency provides childrens services, to include the items listed below: 1. Intake for each residential child to assess childs needs 2. Intake and age appropriate orientation provided for non residential child as needed

Review manual, sequential file order, files bound together.

3. Age appropriate orientation provided to each residential child

Review manual, childs files, and staff interviews. Review manual, childs files, staff interviews; based upon site visit Review manual, children files, staff interviews

27
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

AGENCY RESPONSIBILITIES
Area of Review
4. Agency prohibition of corporal punishment, physical or verbal abuse of children 5. Counseling and support services provided or referred 6. Child advocate provides weekly support group services and structured activities to the following: A.) Residential and Non-Residential children to include structured activities

Unit Information
Review manual, staff interviews, client handbook. Review manual, staff interviews, children files. Review manual, staff interviews, and calendar. Review manual, children files. Review manual, children files.

I, O, D

P&P DM, M

Practice DM,M

B.) Non-Residential children as needed.

7. Structured activities provided by the agency for residential and non residential children emphasizing the following: A.) Exploring feelings and adjusting to new environment B.) Conflict resolution skills development C.) Building positive socialization skills D.) Education regarding health and safety issues as related to domestic violence E.) Building self esteem 8. Consent form for children to participate in agency sponsored outings (field trips) 9. Childrens files are well organized

Review manual, children files, calendar of events, staff interviews. Review manual, children files, calendar of events, staff interviews. Review manual, children files, calendar of events, staff interviews. Review manual, children files, calendar of events, staff interviews Review manual, children files, calendar of events, staff interviews. Review manual, consent form. Review manual, file order, files bound together.

28
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

AGENCY RESPONSIBILITIES
Area of Review
10. Child care services offered to include services provided by agency or a community resource as needed Community Resource The agency has policies, procedures and practices that portray the agency as a community resource, to include the listed items below: 1. Agency shows community relationships and linkages with community agencies 2. Agency provides education and awareness to the communities served 3. The agency updates the community resource directory annually and ensures that this information is readily accessible to victims and staff 4. The agency has guidelines to reach out to the underserved populations in their service area 5. All community publications must have prior approval by DHS and identify DHS as a sponsoring agency

Unit Information
Review manual, documentation

I, O, D

P&P DM, M

Practice DM,M

Review manual, documentation. Review manual, community events sign in sheet, community check ins. Review manual, directory. Review manual. Review manual, community publications.

29
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

CLIENT RIGHTS
Policies and procedures regarding clients rights shall be created, implemented and revised as needed.

Area of Review
The agency has policies, procedures and practices prohibiting the deprivation of any client rights to include the following items: 1. The equal provision of services to clients regardless of political affiliation, religion, race, color, sex, handicap, national origin, age (including teen boys), gender (men), sexual orientation, legally emancipated clients and disabled clients 2. The clients right to make phone calls and how this information is communicated to the client 3. The clients right to receive and send uncensored mail and how this information is communicated to the client 4. The clients right to vote and how this information is communicated to the client 5. The clients right to serve on a jury and how this information is communicated to the client 6. The clients right to inspect and request copies of their records 7. Client termination to include the following: A.) Clearly defined reasons for involuntary termination from the agency services B.) Documentation of progression towards involuntary termination of client from the agency services 8. A grievance process

Unit Information
Review manual, client handbook.

I, O, D

P&P DM, M

Practice DM,M

Review manual, client handbook, and client interviews. Review manual, client handbook, and client interviews. Review manual, client handbook, and client interviews. Review manual, client handbook, and client interviews. Review manual, client handbook, and client interviews Review manual, client closed files, client handbook. Review manual, client closed files. Review manual, client handbook, grievance process.

30
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

CLIENT RIGHTS
Area of Review Unit Information
Review manual; Sign is clearly posted in the shelter, in each office location of the agency with the Executive Directors name, phone number and email, Board Presidents name, DHS Family Violence Consultants name, phone number and email Review manual; Sign is clearly posted in the shelter.

I, O, D

P&P DM, M

Practice DM,M

9. The agency has policies, procedures and practices regarding the DHS information poster 10.The agency has policies, procedures and practices regarding the display of the most current approval certificate in a prominent location within the shelter

31
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

CONFIDENTIALITY
Policies, procedures and practices regarding client confidentiality shall be created, implemented and revised as needed, including:

Area of Review
The agency has policies, procedures and practices that protects the confidentiality of all clients, to include the following: 1. Agency determines whether or not to publish and disseminate the shelters location, including who has the authority to do so 2. Visitors sign a confidentiality statement regarding the non disclosure of the agency location or client/staff/volunteer information 3. Minor visitors are briefed about confidentiality and adults sign and accept responsibility for minors 4. Outlining who has access to client records and client personal information 5. Obtain informed and voluntary written consent from the client for the disclosure of information contained in the client record. The consent shall include, but not be limited to: A.) Name of the person and agency to whom disclosure is made

Unit Information
Review manual, review pamphlets or information describing shelter services Review manual, visitor logs, staff interviews Review manual, files/logs with signed confidential statements Review manual, staff interviews

I, O, D

P&P DM, M

Practice DM, M

B.) Specific information disclosed/purpose of disclosure C.) Dated signature of client or guardian and witness D.) Expiration date of the consent
E.) Guidelines to revoke consent

Review manual, client records, client handbook, staff interviews Review manual, client records, staff interviews Review manual, client records, Review manual, review consent form Review manual, consent form, methods indicating that the consent is revocable at the written request of the person giving consent and that the client has been informed of this right

32
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

CONFIDENTIALITY
Area of Review
6. Requiring the maintenance of client files in a secure location for a minimum of six years following the completion of services 7. The confidentiality of client/staff/volunteers regarding health care issues, as required by HIPPA guidelines 8. Clients confidentiality addressed regarding court orders, to include: A.) How information will be released without client consent if a court order is received B.) Notification of a current and former client C.) Safety planning with current or former clients when records are subpoenaed

Unit Information
Review manual, client handbook Review manual, client handbook

I, O, D

P&P DM, M

Practice DM, M

Review manual, client handbook, staff interviews Review manual, client handbook, staff interviews Review manual, client handbook, staff interviews

33
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

PERSONNEL
Personnel policies should be created, implemented and revised as needed. The following should be included:

Area of Review
New Hire Employees The agency has policies, procedures and practices for newly hired employees to include items listed below: 1. Agency has a staff recruitment and selection process 2. A description of the agency orientation procedure for new staff to include: agency orientation, the history, philosophy and structure of the organization 3. New hire confidentiality process that includes a signed confidentiality statement upon hire, acknowledging non disclosure of the agency and of any client /volunteer/ staff information including medical information according to HIPPA guidelines 4. A protocol that all new hires must undergo a criminal history investigation check during their probationary period, according to DHS fingerprint guidelines 5. A protocol/policy that all direct service staff must have an annual TB

Unit Information

I, O, D

P&P DM, M

Practice DM,M

Review manual Review manual, personnel files. Review manual, personnel files

Review manual, personnel files.

Review manual, personnel files.

screening
6. Description of the new hire training process to include the following: A.) Direct service staff shall complete 34 hours of training. Training should include: Prior to being scheduled for unsupervised work, position training and Domestic Violence 101 training (including partner violence where the victim is: Male, Gay, lesbian, bi-sexual, transgender, or questioning, Differentlyabled, Elderly) -5 hours Prior to being scheduled for unsupervised work, position shadowing/on the job training (including shelter guidelines) - 5 hours First available front line advocacy training by the Georgia Coalition Against Domestic Violence or local advocacy training- 24 hours Review manual, personnel files.

34
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

PERSONNEL
Area of Review
B.) A training manual will be provided to each participant

Unit Information
Review manual, personnel file, signature of staff receipt, staff interviews. Review manual, personnel file, staff interviews. Review manual, personnel file, staff interviews.

I, O, D

P&P DM, M

Practice DM,M

C.) Staff will receive training on Universal Health Precautions (including H.I.V.) within the probationary period D.) Staff shall receive First Aid and CPR training from a qualified, certified trainer within the probationary period All Employee Information The agency has policies, procedures and practices for all employees to include the items listed below: 1. Agency maintains a current personnel file for each employee to include the following: A.) An application for employment B.) Verification of citizenship C.) Verification of degrees/certificates and professional/personal reference(s) D.) Copies of W- 4 form 2. Agency has guidelines on employee rights in regards to their personnel records to include the items listed below: A). The confidential maintenance of personnel records B.) Process to release personnel records C.) Person (s)responsible for maintenance of records D.) Who has access to records E.) The right for an employee to inspect his/her records F.) The right to submit rebuttal documents 3. Written job description provided to each employee 4. Job description to include the following: A.) Job title

Review manual, personnel file Review manual, personnel file Review manual, personnel file Review manual, personnel file Review manual, personnel file

Review manual, personnel file Review manual, personnel file Review manual, personnel file Review manual, personnel file Review manual, personnel file Review manual, personnel file Review manual, personnel file Review manual, personnel files

35
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

PERSONNEL
Area of Review
B.) Tasks and responsibilities of job C.) Required skills, knowledge and experience D.) Definition of employment classification- full time, part time, temporary, exempt/non exempt 5. The agency has a personnel policy and procedures manual that will be provided to each employee Work Rules The agency has policies, procedures and practices regarding work rules (according to fair labor laws), grievance procedures, and disciplinary guidelines Training The agency has policies, procedures and practices regarding training requirements as listed below: 1. Each staff has completed 10 hours of training annually 2. The training requirements for the child advocate (may be a part of the 10 hours annual training requirement for each staff) to include: A.) The developmental stages of childhood, including Physical, Social, Cognitive and Emotional Stages B.) Developmentally appropriate ways of working with children C.) Working knowledge of family violence and its effects on children

Unit Information
Review manual, personnel file Review manual, personnel file Review manual, personnel files Review manual, staff interviews, signed receipt in personnel files. Review manual, staff interviews, signed receipt in personnel files

I, O, D

P&P DM, M

Practice DM,M

Review manual

Review manual, childrens program, personnel file, childrens file Review manual, childrens program, personnel file, childrens file Review manual, childrens program, personnel file, childrens file Review manual, childrens program, personnel file, childrens file

D.) Assertive discipline techniques

36
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

PERSONNEL
Area of Review
E.) Non-violent conflict resolution

Unit Information
Review manual, childrens program, personnel file, childrens file Review manual, childrens program, personnel file, childrens file Review manual, staff interviews.

I, O, D

P&P DM, M

Practice DM,M

F.) The warning signs of child abuse 3. Debriefing opportunities for staff to prevent burnout

37
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

VOLUNTEERS
Volunteer policies should be created, implemented and revised as needed. The following should be included:

Area of Review
Volunteers The agency has policies, procedures and practices that demonstrates how the agency utilizes volunteers, according to each of the items listed below: 1. Minor volunteers must be supervised by appropriate personnel 2. Agency documentation of the number of volunteers and number of hours worked New Volunteers 1. Agency has a volunteer recruitment and selection process 2. Signed confidentiality statement by volunteers to include non-disclosure of agency, of client, staff or volunteer information, prior to beginning work 3. Agency provides criminal history investigation for volunteers (except volunteer groups) according to DHS guidelines 4. Direct service volunteers shall complete 10 hours of training prior to being scheduled for work to include: agency orientation, domestic violence 101, position training and position shadowing 5. A volunteer manual shall be provided to each volunteer to include work rules 6. Universal Health Precautions training (to include HIV) should be offered to direct service volunteers 7. Direct services volunteers working with children will receive First Aid/ CPR training within probationary period Volunteer Information The agency has policies, procedures and practices for volunteers to include the items listed below: 1. Agency maintains a current volunteer file to include: A.) Completed volunteer application B.) Identification

Unit Information

I, O, D

P&P DM, M

Practice DM,M

Review manual Review manual, volunteer logs, volunteer files. Review manual, volunteer logs, volunteer files. Review manual, volunteer files. Review manual, volunteer files.

Review manual, volunteer files. Review manual, volunteer files. Review manual, volunteer files.

Review manual, volunteer files.

Review manual, personnel file. Volunteer files. Volunteer files

38
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

VOLUNTEERS
Area of Review
C.) Drivers license for volunteers transporting clients. Volunteers transporting clients in their personal vehicle must also have current auto insurance D.) Signed volunteer job descriptions for each ongoing volunteer E.) Signed receipt of volunteer manual Training The agency has policies, procedures and practices regarding training requirements as listed below: 1. Direct service volunteers shall complete 10 hours of training annually

Unit Information
Volunteer files Review manual, volunteer files Review manual, volunteer files

I, O, D

P&P DM, M

Practice DM,M

Review manual, volunteer files

39
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

BOARD OF DIRECTORS
Board membership policies should be created, implemented and revised as needed. The following should be included:

Area of Review
The agency has policies, procedures and practices that demonstrate board involvement for the listed items below: 1. All agency policies and procedures manuals are reviewed and updated as needed 2. Agency has a strategic planning developed 3. Agency demonstrates maintenance of 25% of funding from local sources 4. Board membership guidelines include: A.) Minimum of 3 members B.) Membership reflect demographics of community C.) Membership include victims of family violence D.) Majority of board membership represents each county served E.) Membership has at least one representative from local, municipal, or county law enforcement F.) Each new Board member within the first year of service has completed an orientation to include DV 101 and nonprofit Board G.) Each experienced Board member (after one year) are provided at least one face to face discussion to include Domestic Violence related topics and Nonprofit Board governance yearly H.) A minimum of one board member must attend the DHS contractor training annually 5. Board administration guidelines to include: A.) Financial reports provided to the governing body at least quarterly

Unit Information
Review manual, minutes and agenda Review manual, strategic plan Review manual, minutes, and plan. Review manual, board list. Review manual. Review manual. Review manual. Review manual, board file. Review manual, board file, board interviews. Review manual, board file, board interviews. Review manual, board interviews.

I, O, D

P&P DM, M

Practice DM,M

Review manual, minutes and agenda.

40
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

BOARD OF DIRECTORS
Area of Review
B.) Board annually reviews and approves total agency budget C.) Investigation of allegations of the mismanagement, theft and inappropriate use of funds to include the notification of DHS D.) Review and investigate staff, community or client complaints E.) Hiring, evaluation and dismissal of the agency director to include the notification of DHS F.) Executive Director responsibilities G.) Executive Director participation in board meetings H.) A plan to ensure that all duties of the Executive Director are carried out in her absence

Unit Information
Review manual, minutes and agenda Review manual, incident report Review manual, board interviews, formal documentation Review manual, E.D.s personnel file (evaluation) Review manual, E.D.s personnel file ( job description) Review manual, agenda, minutes, personnel file Review manual

I, O, D

P&P DM, M

Practice DM,M

41
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

FINANCIAL MANAGEMENT
Financial management policies should be created, implemented and revised as needed. The following should be included:

Area of Review
The agency has policies, procedures, and practices that demonstrate financial management to include the listed items below: 1. 25% of funding comes from local sources (other than State and Federal)

Unit Information
Review manual, annual budget, audit, annual report Review manual; review reconciliation of bank statements within 30 days of close out, prevention of duplicate payment of bills/invoices (paid stamp, check register, accounts payable software, etc.). Review manual, process Review manual, process. Review manual, process. Review manual, donations, documentation Review manual, stats and expenditure reports

I, O, D

P &P DM,M

Practice DM,M

2. Management of accounts receivable/accounts payable

3. Internal control process and procedures should demonstrate the agency financial checks and balances to include a minimum of 3 people to verify 4. Maintenance of petty cash 5. Client financial assistance 6. Verification of receipt and acknowledgement of donations 7. Gathering and reporting statistics and financials to DHS monthly by the 10th working day of the following month, with no error Audit/Tax Preparation The agency has policies procedures and practices for audits and tax preparation to include the following:

42
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

FINANCIAL MANAGEMENT
Area of Review
1. Procedure for conducting an annual independent audit 2. Tax preparation Insurance The agency has policies, procedures, and practices for insurance to include the following: 1. Maintenance of the agency property insurance 2. Maintenance of the auto insurance on all agency owned vehicles 3. Maintenance of the directors and officers insurance 4. Bonding/insuring staff/volunteers with access to agency funds 5. Maintenance of worker compensation insurance Payroll The agency has policies, procedures and practices that demonstrate payroll measures for the items listed below: 1. Appropriate payment made to employees according to established payroll procedures

Unit Information
Review manual, submission as required in contract, review last independent audit and summary Review manual, 990.

I, O, D

P &P DM,M

Practice DM,M

Review manual, insurance policy. Review manual, insurance policy. Review manual, insurance policy. Review manual, insurance policy. Review manual, insurance policy.

Review manual Review manual to include travel payment is after taxes, reimbursements cost not to exceed DHS rate.

2. Travel reimbursement and per diem made to employees

43
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10

DATA TRACKING
Area of Review
The agency has policies, procedures and practices that demonstrate the use of the data system to include the following: 1. Each program within the agency is actively using the Alice program to enter data 2. Data is backed up on a weekly basis 3. Person responsible for data back up 4. Data system is password protected

Unit Information
Review manual, agency observation, staff interviews. Review manual, agency observation, staff interviews. Review manual, agency observation, staff interviews. Review manual, agency observation, staff interviews.

I, O, D

P&P DM, M

Practice DM,M

44
GA. Dept. of Human Services/Family Violence Unit Monitoring Tool- 1/10