Quality Assurance Program Monitoring Tool for Center Name FY

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1 Quality Assurance Program Monitoring Tool for FY Revised June 2013

2 CENTER NAME: TABLE OF CONTENTS - Program Tool SECTION AREA Assigned Section I Health & Safety Program Section II General Program Program Section III Hotline Program Section IV Support Services Program Section V Shelter Services Program Section VI Batterer's Intervention Program (BIP) Program Section VII Supporting Tools Program F.A.C. F.S. LEGEND Florida Administrative Code Florida Statute Department of Children and Families 3

3 Scoring Summary I. Health and Safety #REF! #REF! #REF! II. General Program #REF! #REF! #REF! III. Hotline 0 0 #DIV/0! IV. Support Services #REF! #REF! #REF! V. Shelter #REF! #REF! #REF! VI. Batterer's Intervention Program (BIP) 0 0 #DIV/0! VII. Supporting Tools #REF! #REF! #REF! Total #REF! 4

4 : Section I: Health and Safety A. Participant Risk Prevention and Incident Reporting 1. Has the Center developed and implemented written policies and procedures to assure major incidents are properly addressed, recorded, and submitted to FCADV as required? #DIV/0! 2. Has the Center evaluated the severity of the incident(s) and taken appropriate action and/or followed-up as required? 9 3. Does the Center notify FCADV as soon as practical, and in no event more than 24 hours, after any incident that involves death or serious injury of a participant or their dependent, as well as any action by the participant or Center staff that results in an inquiry by public media? 4. Do persons who know, or have reasonable cause to suspect, that a child is abused or neglected, report such knowledge or suspicion to as provided for in Section F.S.? F.A.C. 65H (8); FCADV P.S. pg. 9; Contract, Notice Requirements, Section 13 (d) F.A.C. 65H (6) (b); Contract, Notice Requirements, Section 13 (d)(v) Total #### #### #### #REF! 5

5 : FCADV FY Section II: General Program Yes No N/A A. PROGRAM REQUIREMENTS #DIV/0! 1. Does the Center have a comprehensive, up-todate database of information and referral resources that is made available to staff and volunteers and is available for review by monitor(s)? 2. Does the Center collect, compile, and submit to FCADV a monthly record of all services provided? Does the record include the gender, age, ethnicity, and, if applicable, other information as required by contract, of the people served? B. PROGRAM SERVICES F.A.C 65H (1) F.A.C 65H (11); Contract, Service Units, Section Do counseling services incorporate supportive advocacy services such as crisis intervention, safety planning, assessment of risk, and intervening with the various social and legal agencies on behalf of the Center participant, including legal advocacy, medical advocacy, housing advocacy, interpretation services, and additional services as needed? F.A.C. 65H (2) (a); Contract, Service Provision, Section 10 (b); P.S. pg Types of Support Services (A) 6

6 : FCADV FY Section II: General Program Yes No N/A 2. Does the Center provide the minimum core services as set forth in Section , F.S.; F.A.C., 65H-1; the FCADV contract and Program Standards? 3. Does the Center identify who is eligible for services and how those services are accessed? 4. Does the Center offer services, per its eligibility policy, without consideration of a person's age, race, religion, color, disability, national origin, marital status, or gender (F.A.C. 65H (1) and the FCADV contract)? Additionally, does the Center offer its services without consideration of a person's sexual orientation, citizenship, language spoken or immigration status? F.S.; F.A.C.65H (1-9); Contract, Service Provision, Section 10 (b); P.S. pg. 10, Center Services F.A.C. 65H (1); Contract, Service Provision, Eligible Individual Determination, Section 10; P.S. pg. 4, Eligibility for Center Services F.A.C. 65H (1); Contract, Service Provision, Section 10 (a) (iii); P.S. pg. 4, Eligibility for Center Services 7

7 : FCADV FY Section II: General Program Yes No N/A 5. Is the intervention staff, whether residential or outreach, available on-site 24 hours/day and 7 days a week to meet the needs of survivors/participants? 6. Are all program participants informed of who is available to provide advocacy and assistance and how they may access this advocacy and assistance? 7. Are counseling, service management and advocacy services offered by the Center empowerment-based, woman-centered and survivor-directed? 8. Is it true that the Center does not provide couples counseling in any form? 16; F.A.C. 65H (4,5); Contract, Purpose/Scope of Service, Section 7 16 (B) Availability of Services 16 (A) Parameters 19 Restricted Methods; Contract, Service Provision, Section 10 (d) (iii) 8

8 : FCADV FY Section II: General Program Yes No N/A 9. Is it true that the Center does not provide family counseling that includes the presence of the alleged abuser? 19 Restricted Methods; Contract, Service Provision, Section 10 (d) (iii) 10. Are support groups gender specific and not offered as mixed-gender groups? Exceptions to this may be made for transgendered participants. 11. Is it true that participants are not charged for domestic violence services? C. Grievances 1. Has the Center developed a written grievance procedure that is distributed to each individual upon acceptance into the Center or posted for outreach program participants or other non-shelter participants? 19 Restricted Methods 16 (C) Parameters; Contract, Service Provision, Section 10 (d) (ii) 8 Grievances #DIV/0! 9

9 : FCADV FY Section II: General Program Yes No N/A 2. Does the grievance policy contain the following: a) procedures to follow if an individual believes she/he has been wrongfully denied access to the Center s services? 8 Grievances b) procedures to follow if an individual chooses to express dissatisfaction about her/his experience with staff or services received through the Center? 8 Grievances c) procedures to follow if an individual chooses to express dissatisfaction about an action(s) of domestic violence Center staff? 8 Grievances Total #### ### ### #REF! 10

10 : FCADV FY Section III: Hotline A. Staffing #DIV/0! 1. During after-business hours, weekends, and holidays, are the administrative and outreach phones answered by an answering device that clearly directs caller to the hotline? 14 Staffing (G) (2) 2. Is the hotline answered by Center staff or volunteers 24 hours a day, 7 days a week to provide crisis intervention, safety planning, information, and referral to victims of domestic violence or on behalf of a victim? 13 Staffing (A); F.A.C 65H (5); Contract, Manner of Service Provision, Section 11 (c) (iii) 3. Is the hotline staffed by domestic violence advocates who have successfully completed the 30 hours of domestic violence competency-based core training and are registered for privileged communications? 4. Is it true that the hotline is not answered by a prompting device or an outside answering service, and that the use of an answering machine, voice mail, or an answering service for the hotline is not permitted under any circumstances? F.A.C. 65H (5) (a); Contract, Section 11 (b) (i); P.S. pg. 13 Hotline F.A.C. 65H (5) (b); 13 Staffing (D) 11

11 : FCADV FY Section III: Hotline B. Protocol #DIV/0! 1. Does the Center have a protocol for responding to hotline calls as follows: 13 Statement of Policy a) Callers are immediately assessed for danger and lethality followed by a safety plan appropriate to their situation. b) Staff informs callers, as needed, of FCADV's hotline number ( ) or the local shelter s crisis-line number to assure quick, free access. c) Staff offers appropriate local and statewide information and referrals if requested. d) to respond with available resources as appropriate to meet the safety needs of callers and to ask callers if they need further support. e) callers are made aware of the potential communication risks and the ways to minimize the risks on any telephone, computer or other communication devices which includes, but is not limited to, caller-id, call block and *69 constraints 2.All hotline calls are documented, including calls from professionals and third parties, in a standard manner. 14 Protocol 14 Protocol 14 Protocol 14 Protocol 14 Confidentiality 15 Documentation 12

12 : FCADV FY Section III: Hotline 3. Does the Center have TDD/telephone relay service for deaf or hard-of-hearing callers? FCADV P.S. pg.15; F.A.C 65H (3) and F.A.C. 65H (5) (a) Total #DIV/0! 13

13 : Section IV: Support Services A. Intake and Assessment 0 ## ## #REF! 1. Are prospective participants informed of the Center's admission criteria? F.A.C. 65H (1) 2. If an individual is ineligible for services, does the Center provide referrals to other organizations that can provide assistance? 3. Is a completed, individualized service management (delivery) plan in the participant file which includes, at a minimum, the following information?: a) Name? F.A.C. 65H (1) F.A.C. 65H (3 ) (b); FCADV P.S. (A) (5) pg.18; Contract, Manner of Service Provision, Section 11 (a) (i) F.A.C 65H (3) (b) (1); FCADV P.S. (A) (1) pg. 18; Contract, Section 11 Manner of Service Provision (a) (i) (a) 14

14 : Section IV: Support Services b) Ethnicity? c) Age/DOB? d) Safety planning? F.A.C 65H (3) (b) (1); FCADV P.S. (A) (1) pg.18 Documentation of Support Services; Contract, Section 11 Manner of Service Provision (a) (i) (a) F.A.C 65H (3) (b) (1); FCADV P.S. (A) (1) pg.18 Documentation of Support Services; Contract, Section 11 Manner of Service Provision (a) (i) (a) F.A.C 65H (3) (b) (2); Contract, Section 11 Manner of Service Provision (a) (i) (h) 15

15 : Section IV: Support Services e) Service referrals? f.) Is a lethality assessment conducted for each shelter resident housed 72 hours or more and each non-resident who has received two or more separate counseling sessions? F.A.C 65H (3) (b) (2); Contract, Section 11 Manner of Service Provision (a) (i) (d) FCADV P.S. (A) (2) pg.18 Documentation of Support Services; Contract, Section 11 Manner of Service Provision (a) (i) (i) g.) Is a description of the abuser included in the outreach and/or resident's file? FCADV P.S. (A) (4) pg.18 Documentation of Support Services; Contract, Section 11 Manner of Service Provision (a) (i) (j) 16

16 : Section IV: Support Services h.) Has a child basic needs assessment been conducted for each child in emergency shelter for 72 hours or more? i.) Have the parents/guardians given signed permission for the Center staff to assess their child? (Does the service file contain a signed consent form or a signed declination of consent?) FCADV P.S. Documentation pg.18; FCADV P.S. Children's Services pg. 21; F.A.C. 65H (6) (a); Contract, Section 11 Manner of Service Provision (a) (f) 21 Children's Services; Contract, Section 11 Manner of Service Provision (a) (m) B. Confidentiality ### ## ## #REF! 1. For immediate reference, does the Center keep a copy of Section Florida Statutes readily available to Center staff/volunteers when 12 Confidentiality confronted with confidentiality issues? of Shelter Stay 17

17 : Section IV: Support Services 2. Are shelter participants advised of an advocate s duty to release confidential information in the following circumstances?: a) Child abuse NOTE: Any person who knows, or has reasonable cause to suspect, that a child is abused or neglected shall report such knowledge or suspicion to the Department as provided for in Section , F.S. b) Summoning emergency services such as fire or law enforcement? c) Maintaining safety and health standards of the shelter facility? FCADV P.S. (A) (8), pg. 18; F.A.C. 65H (2) (d); F.S ; Contract, Service Provision, Section 11 (a) (i) (k) FCADV P.S. (A) (8), pg. 18; F.A.C. 65H (2) (d); F.S ; Contract, Service Notice Requirements, Section 13 (d) (i); , F.S. FCADV P.S. (A) (8), pg. 18; F.A.C. 65H (3) (d); F.S FCADV P.S. (A) (8), pg. 18; F.A.C. 65H (3) (d); F.S

18 : Section IV: Support Services 3. Is access to participant identifying information limited to staff members who have a legitimate interest in the case and have a need to know to carry out their job duties? 4. Does the Center advise residents that contracted persons who provide routine or situational services to Centers are allowed to come to the Center/shelter on a periodic basis and for their safety, are residents informed in advance of the visit in the case that she may choose to avoid the possibility of being seen by, or having contact with that person? F.A.C. 65H (1); F.S FCADV P.S. (A) (7), pg. 18 Documentation of Support Services C. Release of Information #DIV/0! 1. Is a signed Authorization to Release FCADV P.S. (A) Confidential Information Form completed for any contact with individuals or groups not employed by the Center to provide advocacy that is initiated only with the participant's permission, and on behalf of the specific participant? (9), pg. 18; F.A.C. 65H (3)(d); Contract, Section 11 Manner of Service Provision (a) (g); F.S Does the Release of Confidential Information Form include the following: a) Individual s name? FCADV P.S. (C) (2), pg. 17; F.A.C. 65H (3) (d) 19

19 : Section IV: Support Services b) Specific information to be released (a new form is executed for each new piece of information to be released)? FCADV P.S. (C) (2), pg. 17; F.A.C. 65H (3) (d) c) To whom the information is to be given? FCADV P.S. (C) (2), pg. 17 d) Specific expiration date for release of information? FCADV P.S. (C) (2), pg. 17; F.A.C. 65H (3 (d) e) Individual s signature? FCADV P.S. (C) (2), pg. 17; F.A.C. 65H (3) (d) f) Revocation statement? FCADV P.S. (C) (2), pg. 17; F.A.C. 65H (3) (d) D. Service Management/Plan #DIV/0! 1. Is service management a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet participant needs? FCADV (B) pg. 17, Types of Support Services; F.A.C. 65H (3) 2. Does the service plan include safety planning and service referrals? F.A.C.A 65H (3) (2); Contract, Manner of Service Provision, Section 11 (a) (i) (h) 20

20 : Section IV: Support Services 3. Are service management staffings held biweekly for the purpose of ensuring effective communication among staff about the progress of participants toward meeting their self-identified goals and objectives, and for addressing individual participant issues? 4. Does the advocate assist the survivor in developing a safety plan, as necessary, for traveling to and from appointments that are away from the shelter? F.A.C. 65H (3)(c); FCADV P.S. (E), pg. 10 FCADV P.S. (C) pg.16 Availability of Services 5. Has each child in emergency shelter for 72 hours or more been given service recommendations by a domestic violence advocate with experience working with children? FCADV P.S. Children's Services, pg. 21; F.A.C. 65 H (6) (a); Contract, Service Provision, Section 10 (b) (i) (4) 21

21 : Section IV: Support Services 6. Does the Center provide one-on-one case management (service management)? 4. Does documentation of advocacy include: FCADV (B) pg. 17, Types of Support Services; F.A.C 65H (3); Contract, Service Provision, Section 10 (b) (i) (6) a) dates of contact? FCADV P.S. (B) (2), pg. 19; Contract, Section 11 Manner of Service Provision (a) (d) b) a description of the services received? 18; Center Services; Contract, Section 11 Manner of Service Provision (a) (d) 5. Do service notes include: a) all notes entered in chronological order FCADV P.S. (C) (1), pg

22 : Section IV: Support Services b) all notes have full signature or initials of the advocate, if using Alice, the sign-on by the user shall automatically count as the signature. FCADV P.S. (C) (2), pg. 19 c) entries are made immediately after all individual contacts d) correction fluid is not used. (Errors shall be corrected by drawing one line through it, writing error and initialing this change; then continuing with note.) e) only necessary facts are recorded. FCADV P.S. (C) (3), pg. 19 FCADV P.S. (C) (4), pg. 19 FCADV P.S. (C) (5), pg. 19 f) notes do not contain any diagnoses, clinical assessments, or advocates personal opinions. FCADV P.S. (C) (6), pg. 19 g) notes on one individual do not include other individuals names. FCADV P.S. (C) (7), pg. 19 h) appointments are not documented in the file until they actually occur and appointment cancellations are not documented in service file. 6. Does documentation of Safety Planning include: a) Service notes or a standardized form indicating safety planning was explained and discussed during initial residential and outreach intake? FCADV P.S. (C) (5), pg. 19 Standards FCADV P.S. (D) (2), pg

23 : Section IV: Support Services b) Service notes or a standardized form indicating safety planning was discussed, or an attempt was made to discuss safety planning, when the individual s plans changed or an event occurred that indicated a need to modify the plan to address the event? FCADV P.S. (D) (3), pg. 19 E. Exit Interviews #DIV/0! 1. Has the Center made and documented in the file every attempt to provide an exit interview to each participant prior to their departure? FCADV P.S.(A) (10), pg. 18, Exit Interview, pg. 11; Contract, Manner of Service Provision, Section 11 (a) (i) (e) 2. Does the Center have an exit interview that includes: a) assessment of programs and services provided? FCADV P.S. (A) pg. 11 Exit Interview b) equal access to services without discrimination? FCADV P.S. (A) pg. 11 Exit Interview c) assessment of respectful treatment by staff? FCADV P.S. (A) pg. 11 Exit Interview 24

24 : Section IV: Support Services d) participant has knowledge of domestic violence dynamics? e) assessment of children's services? FCADV P.S. (A) pg. 11 Exit Interview FCADV P.S. (A) pg. 11 Exit Interview f) safety planning? FCADV P.S. (A) pg. 11 Exit Interview g) goal planning? FCADV P.S. (A) pg. 11 Exit Interview h) development and revision of an individual safety plan? FCADV P.S. (B) pg. 11 Exit Interview i) information on provision of outreach services? FCADV P.S. (B) pg. 11 Exit Interview Total #### ### ### #REF! 25

25 : Section V: Shelter A. Shelter Facility 1. Are emergency services and shelter open and staffed 24 hours per day, 7 days a week including FCADV P.S. (A) holidays? pg. 10; F.A.C. 65H (4); Contract, Service Provision, Section 10 (b) (i) (1) 2. Is safe, temporary housing (emergency shelter) provided for adult survivors of domestic violence FCADV P.S. and their dependents for more than 24 hours? Center Services, pg. 10; F.A.C. 65H (4); Contract, Service Provision, Section 10 (b) (i) (1) #DIV/0! 26

26 : Section V: Shelter 3. Does the Center take precautionary measures to provide for the safety, confidentiality, privacy, and well-being of all participants receiving services including: a.) a building which has an accessible design? (The accessiblity is attested to by the Center on the self-evaluation form and general observation by monitors.) b.) Is the shelter facility(s) in good repair, free from health and safety hazards, clean, and free of vermin infestation? (2); F.A.C. 65H (3); F.A.C. 65H (1); Contract, Manner of Services, Section 11 (a) (i) (k); Contract, Administrative Requirements, (b) (d); Contract, Authorities for Service Provision and Administration, Section 9 (1); Contract, State and Federal Laws/, Section 18 (b) (2) (b) 27

27 : Section V: Shelter c.) Is it true that electronic surveillance systems are not installed in participants' living quarters of the shelter facilities? (Electronic surveillance systems may be installed at entrance and exit doors and parking areas.) d.) Is smoking prohibited within the shelter facilities, all outdoor play areas, and in vehicles when being used to transport Center participants pursuant to Chapter 386, F.S.? e.) Does the shelter facility have sprinklers or smoke alarms in each bedroom and in all hallways and common areas? f.) Does the Center ensure that each shelter facility has an annual sanitation inspection through their county health department? g.) Is a current sanitation inspection report maintained in the Center records and made available for inspection upon request? h.) Does the Center ensure that an annual fire safety inspection is performed in accordance with Section F.S.? i.) Is the current fire inspection report maintained in the Center records and is it available for inspection upon request? (2) (c) (2) (i) (2) (i) FCADV P.S. (A) (5) pg. 11; F.A.C. 65H (2) (j) (2) (j) FCADV P.S. (A) (5) pg. 11; F.A.C. 65H (i) FCADV P.S. (A) (5) pg. 11; F.A.C. 65H (i) 28

28 : Section V: Shelter j.) Do all outside doors remain locked from the outside at all times? k.) Are all windows secured against entry? l.) Is all outside and entrance way lighting in place and functioning? m.) Does the shelter facility have a telephone that is centrally located and readily available for staff member and participant use? n.) Is there at least one cellular telephone available for use at all times in the event of power and telephone outages? o.) Are emergency numbers such as those for emergency medical services, fire department, law enforcement, hospital, and the poison control Center posted by each telephone? p.) Does the Center prohibit narcotics, alcohol, or other impairing drugs from being present on the premises? q.) Are firearms or weapons, as defined in Section F.S., prohibited within any Center building or upon any person located on the premises, excluding federal, state, or local law enforcement officers? (2) (d) F.A.C. 65H (2) (d) (2) (d) (3) (3) (3) (2) (g) (f) 29

29 : Section V: Shelter r.) If an outside play area is available for children, is the area free of debris and broken or dangerous materials? s.) Is playground equipment routinely checked for safety? If yes, by whom? t.) Does the outdoor play area have and maintain safe and adequate fencing or walls a minimum of four feet in height? u.) Is the fencing, including gates, continuous and without gaps that would allow children to exit the outdoor play area? v.) Is the base of the fence at ground level and free from erosion or build-up to prevent inside or outside access by children or animals? w.) If the play area is in view of the public, is their privacy fencing around it? (2) (e) (2) (e) (2) (e) (2) (e) (2) (e) (2) (e) B. Length of Stay/Admission #DIV/0! 1. Is the Center's allowable stay available to individuals at least six weeks? 2. Does the Center inform individuals about any conduct or conditions that may affect eligibility status or reduce the length of stay? 5 Length of Shelter Stay 5 Length of Shelter Stay 30

30 : Section V: Shelter 3. Is it true that the Center does not place restrictions on the number of times an individual may enter shelter? 4. Is it true that the Center does not require a time limit before an individual may re-enter shelter? 5. Is it true that the Center does not maintain a no re-admit list? 6. Is it true that disclosure of the shelter location is not an automatic cause to disqualify a person from re-admission? 6 Restrictions on Acceptance to Shelter 6 Restrictions on Acceptance into Shelter 6 Restrictions on Acceptance to Shelter 6 Criteria for Non- Acceptance to Shelter C. Alternate Accommodations #DIV/0! 1. Does the Center facilitate admission to safe, alternate accommodations for individuals when the shelter is full? 7 Space Limitations D. Involuntary Exiting #DIV/0! 1. Is involuntary exiting done in accordance with Center policies and procedures, which shall include the requirements in FCADV Standards? 6 Involuntary Exiting 31

31 : Section V: Shelter 2. Prior to involuntarily exiting an individual from shelter and except where the immediate health, safety, or welfare of individuals or Center is in jeopardy, does the Center ensure that: a) efforts have been made to inform the resident of the problem or conduct? FCADV P.S. (A) pg. 7 Involuntary Exiting b) the resident has been informed that, if the problem or conduct was not corrected, it may result in involuntary exiting? FCADV P.S. (B) pg. 7 Involuntary Exiting c) the resident was provided with opportunities to correct the problem or conduct? FCADV P.S. (C) pg. 7 Involuntary Exiting d) multiple attempts have been made through repeated discussions, and the resident chooses not to correct the problem or is it conduct that disrupts other survivors ability to receive safe and effective services? FCADV P.S. (D) pg. 7 Involuntary Exiting E. Curfew 1. Are curfews prohibited in the shelter? FCADV P.S. (A) pg. 11 Total #### ### #### #REF! 32

32 FCADV FY : Section VI: Batterer's Intervention Program (BIP) A. Staff, Volunteer, Facilitator, Survivor Interactions 1. Based on policy and practice, if the Center has a BIP, are the staff and/or volunteers who work with batterers prohibited from providing services to survivors in: FCADV A.S. VII (1) pg. 6 BIP Programs a. support groups? FCADV A.S. VII (1) (a) pg. 6 BIP Programs b. individual counseling? FCADV A.S. VII (1) (b) pg. 6 BIP Programs c. children's services? FCADV A.S. VII (1) (c) pg. 6 BIP Programs d. outreach services? FCADV A.S. VII (1) (d) pg. 6 BIP Programs 2. Based on policy and practice, are Center staff or volunteers who work with batterers prohibited from attending survivor-related supervisory staffings? FCADV A.S. VII (2) pg. 6 BIP Programs #DIV/0! 33

33 FCADV FY : Section VI: Batterer's Intervention Program (BIP) 3. Based on policy and practice, are Center staff and volunteers who work with batterers prohibited from working in batterers' programs that are located in the same service delivery area? FCADV A.S. VII (4) pg. 6 BIP Programs 4. Based on policy and practice, are Center staff and volunteers who work with batterers prohibited access to survivor files? FCADV A.S. VII (3) pg. 6 BIP Programs 5. Does the Center have a prohibition against Center staff or volunteers sharing survivor information with BIP facilitators? FCADV A.S. VII (5) pg. 6 BIP Programs 6. Are BIP facilitators prohibited from answering survivor inquiries about batterer attendance? (BIP support staff only may assist the survivor with this.) 7. Are BIP facilitators prohibited from having any direct contact with survivors? FCADV A.S. VII (5) pg. 6 BIP Programs FCADV A.S. VII (5) pg. 6 BIP Programs Total #DIV/0! 34

34 : Section VII: Supporting Tools A. Policies and Procedures #DIV/0! 1. Based on review of Center policies and procedures, were there any issues or inconsistencies with requirements of the Florida Administrative Code Contract; F.A.C. 65H-1; Program Standards 65H-1, Program Standards and the FCADV Contract? If so, refer to the Program Policy Review Checklist. B. Self-Evaluation and Attestation #### #### #### #REF! 1. Based on the review of the Self-Evaluation and Attestation form, were any programmatic issues or inconsistencies identified? If so, refer to the Self- Evaluation and Attestation form. FCADV Fiscal Guide; Contract; F.A.C. 65H-1; Administrative Standards; Program Standards C. Civil Rights Checklist and Attestation #### #### #### #REF! 1. Based on the review of the Civil Rights Questionnaire/Checklist and Attestation form, were any issues or inconsistencies identified? If so, refer to Contract; F.A.C. 65H-1; Program Standards the Civil Rights Questionnaire/Checklist and Attestation. D. Observation Checklist #### #### #### #REF! 1. Based on the completion of the Observation Checklist, were any issues or inconsistencies identified? If so, refer to the Observation Checklist. Contract; F.A.C. 65H-1; Program Standards Total #### #### #### #REF! 35

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