M-SARR RECOVERY RESIDENCE ONSITE CHECKLIST FOR NEW MEMBERS

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DATE

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?

Yes

Clear selection

General or professional liability insurance for program and staff?

Yes

Clear selection

(If renting property) written permission and a lease from owner to operate a recovery residence?

Yes

Clear selection

A certificate of occupancy or reasonable accommodation certificate?

Yes

Clear selection

An annual operating budget?

Yes

Clear selection

Any paid staff positions?

Yes

Clear selection

An accounting system to fully document residential transactions (w/ receipts)?

Yes

Clear selection

Resident records secured with limited access to authorized staff only?

Yes

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?

Yes

Clear selection

Mission and Vision Statement in a Brochure, Newsletter, or Annual Report?

Yes

Clear selection

Policies/ Procedures Handbook for Residents?

Yes

Clear selection

Policies/Procedures Handbook for Staff or Volunteers?

Yes

Clear selection

Position Descriptions for all Staff or Volunteers?

Yes

Clear selection

Grievance Policy signed by Residents?

Yes

Clear selection

Confidentiality Policy signed by Residents?

Yes

Clear selection

Code of Ethics?

Yes

Clear selection

Alcohol and Drug Free Environment Policy?

Yes

Clear selection

Applicant Screening Process? (Resident Admission Criteria)

Yes

Clear selection

Resident Application?

Yes

Clear selection

Resident Contract?

Yes

Clear selection

House Rules, Resident Rights and Responsibilities?

Yes

Clear selection

Relapse Policy?

Yes

Clear selection

Onsite Urinalysis Procedure?

Yes

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?

Yes

Clear selection

Certification or training to dispense medication?

Yes

Clear selection

Certification or training to conduct CPR/ 1st Aid?

Yes

Clear selection

Do you have (or ever had) a Peer Recovery Support Specialist or Coach?

Yes

Clear selection

Memberships in any other associations /recovery support organizations?

Yes

Clear selection

Relationships with city, county, or state officials?

Yes

Clear selection

Board, Council, or Advisory Committee affiliations/ commitments?

Yes

Clear selection

Receive grant funding or have MOUs/ contracts with other organizations for financial support?

Yes

Clear selection

Corporate sponsorships or innovative partnerships?

Yes

Clear selection

Collect/report accurate outcome data for continuous quality improvement?

Yes

Clear selection

Plans for expansion or growth? Absolutely

Yes

Clear selection

COMMENTS

Best Practices:

Action Items:

Recommendations:

RECOVERY SUPPORT SERVICES

Do you: Y/N

Have a Written Personal Recovery Plan for each resident?

Yes

Clear selection

Conduct orientation process, obtains emergency contact info/ demographics?

Yes

Clear selection

Provide a safe, structured, and recovery supportive environment?

Yes

Clear selection

Permit smoking in INSIDE your recovery residence?

Yes

Clear selection

Foster a recovery oriented relationship between residents and staff through house meetings, social activities, life skills/ workshops?

Yes

Clear selection

Enforce policies/ procedures that address residents who relapse with hazardous items search, drug screening, and/ or secure prescription medication storage?

Yes

Clear selection

Inform residents of local treatment/ recovery support services available (12 step meetings, recovery community centers, advocacy opportunities, ministries?

Yes

Clear selection

When making referrals, provide at least 3 third party clinical/ recovery support service providers?

Yes

Clear selection

Require residents to attend religious or clinical services on or offsite as a condition of admission?

Yes

Clear selection

Clearly identify person in charge of residence to all residents?

Yes

Clear selection

Rules regarding noise, parking, loitering, and smoking outside of your residence?

Yes

Clear selection

Provide contact info to neighbors of person in charge to resolve issues upon request?

Yes

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?

Yes

Clear selection

Exit signs are visible above doorways?

Yes

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?

Yes

Clear selection

Do you have Fire/ Emergency Evacuation Drills? How often?

Yes

Clear selection

Emergency Contact List posted?

Yes

Clear selection

Evacuation Plan posted in common area of each floor?

Yes

Clear selection

Fire Extinguishers are functioning, been inspected and/ or tagged with date of expiration?

Yes

Clear selection

Fire Extinguishers are in the kitchen and on each floor with bedrooms/ sleeping quarters?

Yes

Clear selection

Fire Extinguishers are in plain sight and/ or clearly marked locations?

Yes

Clear selection

Smoke Detectors are functioning and on each floor?

Yes

Clear selection

Carbon Monoxide Detector is functioning and mounted near the furnace (for gas operated)?

Yes

Clear selection

Do you or landlord address emergency and routine repairs in a timely manner?

Yes

Clear selection

Verify resident files are stored in locked file cabinet and/ or locked office

Yes

Clear selection

Verify medication is stored in a locked cabinet and/ or locked office (if applicable)

Yes

Clear selection

Verify there is adequate space for food and personal item storage

Yes

Clear selection

Verify there is 1 toilet, sink, and shower per 6 residents or adhere to local requirements

Yes

Clear selection

Verify there is a community room large enough to accommodate house meetings

Yes

Clear selection

Verify sleeping rooms provide adequate space to accommodate number of residents assigned

Yes

Clear selection

Is the air quality warm/ cool enough to accommodate residential living quarters?

Yes

Clear selection

Is there evidence of insect or rodent infestation in any area of the residence?

Yes

Clear selection

Is there evidence of water damage, mold, or mildew in any area of the residence?

Yes

Clear selection

Is the interior and exterior of the residence functional, safe, and clean?

Yes

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./

Member Print Name

MSARR Reviewer Print Name

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