M-SARR RECOVERY RESIDENCE ONSITE CHECKLIST FOR NEW MEMBERS
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DATE
MM
/
DD
/
YYYY
ORGANIZATION
REVIEWER
PARTICIPANTS
BUSINESS/ MANAGEMENT FUNCTIONS
Do you have the following: Y/N

Documentation as a registered legal business in good standing in MD?
Clear selection
General or professional liability insurance for program and staff?
Clear selection
(If renting property) written permission and a lease from owner to operate a recovery residence?
Clear selection
A certificate of occupancy or reasonable accommodation certificate?
Clear selection
An annual operating budget?
Clear selection
Any paid staff positions?
Clear selection
An accounting system to fully document residential transactions (w/ receipts)?
Clear selection
Resident records secured with limited access to authorized staff only?
Clear selection
COMMENTS
Action Items:
Recommendations:
For any written policies and procedures you have developed, please have an extra copy available for MSARR to add to your member file or you may email an electronic version to your reviewer prior to or immediately following the onsite visit. (Please note: You do not have to create these documents prior to our visit nor will not having them prevent your membership into MSARR.)
POLICIES AND PROCEDURES/ DOCUMENTATION
Do you have the following: Y/N
Mission and Vision Statement in a Brochure, Newsletter, or Annual Report?
Clear selection
Mission and Vision Statement in a Brochure, Newsletter, or Annual Report?
Clear selection
Policies/ Procedures Handbook for Residents?
Clear selection
Policies/Procedures Handbook for Staff or Volunteers?
Clear selection
Position Descriptions for all Staff or Volunteers?
Clear selection
Grievance Policy signed by Residents?
Clear selection
Confidentiality Policy signed by Residents?
Clear selection
Code of Ethics?
Clear selection
Alcohol and Drug Free Environment Policy?
Clear selection
Applicant Screening Process? (Resident Admission Criteria)
Clear selection
Resident Application?
Clear selection
Resident Contract?
Clear selection
House Rules, Resident Rights and Responsibilities?
Clear selection
Relapse Policy?
Clear selection
Onsite Urinalysis Procedure?
Clear selection
COMMENTS
Action Items:
Recommendations:
SUSTAINABILITY/ BEST PRACTICES
Does your organization, staff or regular volunteers have: Y/N
License or authority to provide clinical services in your residence?
Clear selection
Certification or training to dispense medication?
Clear selection
Certification or training to conduct CPR/ 1st Aid?
Clear selection
Do you have (or ever had) a Peer Recovery Support Specialist or Coach?
Clear selection
Memberships in any other associations /recovery support organizations?
Clear selection
Relationships with city, county, or state officials?
Clear selection
Board, Council, or Advisory Committee affiliations/ commitments?
Clear selection
Receive grant funding or have MOUs/ contracts with other organizations for financial support?
Clear selection
Corporate sponsorships or innovative partnerships?
Clear selection
Collect/report accurate outcome data for continuous quality improvement?
Clear selection
Plans for expansion or growth? Absolutely
Clear selection
COMMENTS
Best Practices:
Action Items:
Recommendations:
RECOVERY SUPPORT SERVICES
Do you: Y/N
Have a Written Personal Recovery Plan for each resident?
Clear selection
Conduct orientation process, obtains emergency contact info/ demographics?
Clear selection
Provide a safe, structured, and recovery supportive environment?
Clear selection
Permit smoking in INSIDE your recovery residence?
Clear selection
Foster a recovery oriented relationship between residents and staff through house meetings, social activities, life skills/ workshops?
Clear selection
Enforce policies/ procedures that address residents who relapse with hazardous items search, drug screening, and/ or secure prescription medication storage?
Clear selection
Inform residents of local treatment/ recovery support services available (12 step meetings, recovery community centers, advocacy opportunities, ministries?
Clear selection
When making referrals, provide at least 3 third party clinical/ recovery support service providers?
Clear selection
Require residents to attend religious or clinical services on or offsite as a condition of admission?
Clear selection
Clearly identify person in charge of residence to all residents?
Clear selection
Rules regarding noise, parking, loitering, and smoking outside of your residence?
Clear selection
Provide contact info to neighbors of person in charge to resolve issues upon request?
Clear selection
COMMENTS
Best Practices:
Action Items:
Recommendations:
To ensure safety provisions are met/ maintained, we will verify, and observe the following:
RESIDENCE INSPECTION WALK THROUGH CHECKLIST
Y/N
Certificate or verification that states your residence meets local zoning codes and/ or reasonable accommodation requirements?
Clear selection
Exit signs are visible above doorways?
Clear selection
Have you had or have annual Fire Safety Inspections by the local Fire Department? If so, when was the most recent fire safety inspection conducted?
Clear selection
Do you have Fire/ Emergency Evacuation Drills? How often?
Clear selection
Emergency Contact List posted?
Clear selection
Evacuation Plan posted in common area of each floor?
Clear selection
Fire Extinguishers are functioning, been inspected and/ or tagged with date of expiration?
Clear selection
Fire Extinguishers are in the kitchen and on each floor with bedrooms/ sleeping quarters?
Clear selection
Fire Extinguishers are in plain sight and/ or clearly marked locations?
Clear selection
Smoke Detectors are functioning and on each floor?
Clear selection
Carbon Monoxide Detector is functioning and mounted near the furnace (for gas operated)?
Clear selection
Do you or landlord address emergency and routine repairs in a timely manner?
Clear selection
Verify resident files are stored in locked file cabinet and/ or locked office
Clear selection
Verify medication is stored in a locked cabinet and/ or locked office (if applicable)
Clear selection
Verify there is adequate space for food and personal item storage
Clear selection
Verify there is 1 toilet, sink, and shower per 6 residents or adhere to local requirements
Clear selection
Verify there is a community room large enough to accommodate house meetings
Clear selection
Verify sleeping rooms provide adequate space to accommodate number of residents assigned
Clear selection
Is the air quality warm/ cool enough to accommodate residential living quarters?
Clear selection
Is there evidence of insect or rodent infestation in any area of the residence?
Clear selection
Is there evidence of water damage, mold, or mildew in any area of the residence?
Clear selection
Is the interior and exterior of the residence functional, safe, and clean?
Clear selection
OVERALL COMMENTS/ CONCERNS/ TRAINING NEEDS
Please provide the address and number of beds for each house that successfully met all requirements.
Please provide the addresses of each house and number of beds that DID NOT meet all requirements for membership:
FOLLOW UP/ NEXT STEPS


Organization

- Review Onsite Report upon receipt
- “Action Items” must be addressed prior to becoming an MSARR member.
Any fire and/ or safety “Action Items” may require a return visit to verify issues have been resolved prior to M-SARR membership.
- “Recommendations” may not be required for MSARR membership, but rather suggestions to improve systems, documentation, reporting, and/ or daily operations.

M-SARR

- Send Onsite Report
- Address training and/ or other concerns identified during visit

I hereby attest that the information above is true and complete, and that I am authorized to complete this onsite review on behalf of the organization. I understand that information from this form that is not public information will not be sold or distributed to any third party. However, information from this form may be shared with MD stakeholders or funders in accordance with grants provisions. Further, I consent to and fully understand that any pictures taken today may be used in print, internet, or social media operated by Maryland Recovery Organization Connecting Communities (M-ROCC) to promote my program./
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MSARR Reviewer Print Name
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