PI-82-06 Attachment C

ATTACHMENT C

CASE RECORD SURVEY

Case Record ID Number	Reviewer:
Sample Number	Date:
Case Data:
Date of Placement
FY 81:

Periodic review date	Completed	None due
Disp. hearing date	Completed	None due
FY 82:
Periodic review date	Completed	None due
Periodic review date	Completed	None due
Disp. hearing date	Completed	None due
Findings:

Major safeguards:	FY 81			FY 82
	Yes	No	Nonedue	Yes	No	Nonedue
Written case Plan
Periodic Review
Dispositional Hearing
of the remaining 18 protections.
FY 81:	ACCEPTANCE		( )	NOT ACCEPTANCE		( )
FY 82:	ACCEPTANCE		( )	NOT ACCEPTANCE		( )

CASE PLAN

	YES	NO	N/A
IS THERE A WRITTEN CASE PLAN’
Does the plan describe the type of home or institution in which the childis to be placed’
Does the plan give the reason(s) forthe placement and for the particulartype of placement chosen’
Have efforts been made to place thechild in the least restrictive (most family-like) setting available con-sistent with the best interests andspecial needs of the child’
Have efforts been made to place thechild in close proximity to theparent's home consistent with thebest interests and special needs ofthe child’
Does the plan make provision to carryout any judicial determination madewith respect to the child’
Does the plan provide a mechanism forassuring the proper care of the child’
Does the case plan include a plan forassuring that services are provided tothe CHILD AND PARENTS to improve theconditions in the parent's home andfacilitate return of the child home orother permanent placement of the child’
Does the case plan include a plan forassuring that services are providedto the CHILD AND FOSTER PARENTS toaddress the needs of the child whilein foster care’
Does the plan discuss the appropriate-ness of the services THAT HAVE BEEN PROVIDED the child under the plan’

PERIODIC REVIEW

	YES	NO	N/A
IS THE STATUS OF THE CHILD REVIEWED NO LESSFREQUENTLY THAN ONCE EVERY SIX MONTHS BYEITHER A COURT OR AN ADMINISTRATIVE REVIEW’
Have the periodic reviews determined the continuing need for and appropriateness of the placement’
Have the periodic reviews determined the extent of compliance with the case plan’
Have the periodic reviews determined the extent of progress made toward alleviating or mitigating the causes necessitating the placement in foster care’
Have the periodic reviews projected a likely date by which the child maybe returned home or placed for adoption or legal guardianship’
IF the last periodic review was an administrative review, was it open to the participation of the parent's of the child’
IF the periodic review was an administrative review, was it conducted by a panel of appropriate persons at least one of whom is notresponsible for the case management of, or the delivery of services to, either the child or the parents who are the subject of the review’

PROCEDURAL SAFEGUARDS

	YES	NO	N/A
WAS A DISPOSITIONAL HEARING TO DETERMINETHE FUTURE STATUS OF THE CHILD HELD INACCORDANCE WITH SECTION 475(5)(C) NOLATER THAN 18 MONTHS AFTER ORIGINALPLACEMENT AND PERIODICALLY THEREAFTER’
Were the parents notified concerningthe agency's intent to petition thecourt to remove the child from thehome’
Were the parents notified of any changes in the child's placement’
Were the parents notified of any changes affecting visitation rights’

Attachments:

Attachment A - Report on State Eligibility
Attachment B - State Agency Administrative Review
Attachment D - Policy Guidance for Certain Section 427 Requirements
Attachment E - Case Record Sample Survey for Section 427 of the Social Security Act (SSA) Eligibility Determination