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Here you will learn how to apply for a state license to provide residential services for children and adolescents who have – or who are at risk of – mental illness, serious emotional disturbance, substance use disorders, intellectual disabilities, or brain injury. DBHDS is responsible for licensing residential facilities that serve these children and adolescents on site. The application and licensing process for residential facilities for children and adolescents changed effective August, 2009. This change was initiated by revisions in the Code of Virginia enacted by the 2009 General Assembly.

• Children's Provider Application Packet
• Children's Residential Facilities Rules and Regulations
• Fees/Renewals
   

To be licensed by DBHDS to provide Children's Residential Services, the applicant must:

1. Submit and receive preliminary approval of the Initial Provider Application [and required attachments].
2. Submit, receive approval of, and demonstrate knowledge of required licensing policies, procedures and forms.
3. Submit and receive approval of required Human Rights Policies and Procedures.
4. Affiliate with a Local Human Rights Committee (LHRC).
5. Request the LHRC to approve the provider's Human Rights Policies and Procedures.
6. Register with the Department of Social Services Office of Background Investigations (DSS OBI).  (When notified that the applicant is fully licensed, request criminal history and central registry background investigations for identified staff as required by Virginia Code §37.2-408.1, and submit Child Protective Services reference checks.)
7. Undergo an on-site review of the physical plant, including interviews about the provider’s service description, policies and procedures. Applicants will demonstrate compliance with regulations and present copies of forms, and sample client and personnel records.

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The Initial Provider Licensing Application packet is for new applicants interested in becoming providers of children's and adolescents' residential services.  In the packet, the applicant will find forms and information needed to successfully apply for a license and manage your program.  Obtain your initial application packet in one of two ways:

• Download for free the Initial Provider Application packet documents;
  or
• Mail your completed order form and your organization check or money order in the amount of $35.00 made out to "Treasurer of Virginia". A helpful training DVD is included with your order.
   

Initial Provider Application packet - (Download the entire application packet or click on the following individual forms as needed.)

1. Licensing Process Overview
2. DBHDS Process for Licensing Children's Residential Facilities
3. Initial Provider Application
4. Children's Residential Facilities Rules and Regulations
5. Human Rights Rules and Regulations
6. Staff Information Sheet  (Word)
7. Policy and Procedure Review Checklist  (Word)  (sample)
8. Background Investigation Unit
9. Contact central registry background investigations through the Department of Social Services Office of Background Investigations (DSS OBI). Required forms can be obtained from their Web site, www.dss.virginia.gov.
10. Annual Operating Budget  (Word)   
11. Physical Environment Review Checklist  (Word)
12. Personnel Review Checklist  (Word)  
13. Individual Review Checklist  (Word)  
14. Direct Care Staff Qualifications
15. References Sheet for Each Owner/Operator  (Word)
16. Human Rights Compliance Provider Verification

Licensing Tools:

• Appropriate Siting
• On Site Review Preparation Checklist 
• Sanitation Inspection Report Form  (Word)
• Self Reporting of Lawsuits
• Serious Injury Report Form  (Word)
• Samples
  • Corrective Action Plan Sample
  • Systemic Violation Sample

There is an Initial Application Fee for applicants interested in becoming providers of children's and adolescents' residential services.  Please mail your completed Initial Provider Application form with your organization check or money order in the amount of $500.00 made out to "Treasurer of Virginia".

New Applicant Training is strongly encouraged prior to submitting your application.

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Prior to submitting your application for a license to provide children’s residential services, you and your program director are strongly encouraged to view the New Applicant Training DVD that explains the process.  The training DVD will enhance your understanding of licensing requirements and program management, and will better prepare you for successful application. 

Should an application be denied, applicants may have to wait at least six months before they can re-apply (Virginia Code § 37.2-418.C), and an additional $500.00 application fee will be required. Providers may not begin service operation until they have received a license from the Commissioner. Only the Commissioner may issue a license.

 Note!   Due to budget reductions, the Office of Licensing is no longer able to offer live training for applicants interested in becoming providers of all other services – with the exception of children's residential services. We highly recommend our training DVD that will provide you with the information you need to successfully apply for a license and manage your program.

The DVD includes a recording of the actual training, plus comments by the offices of Human Rights and Intellectual Disabilities. Also included is the entire application packet containing regulatory information, application materials and management tools. Once purchased, you will own the DVD, be able to refer back to it repeatedly and share it with your staff at a time convenient for you.

To order the DVD — plus the entire application packet — please send your payment of $75.00 along with the completed order form.

(If you only want the application packet, you may send $35.00 and the completed order form–or you may click to download the application packet materials for free.)

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Renewal application  (Word) - Please use this form to renew an existing license to provide children's residential services.  Please mail your completed Renewal Application form with your organization check or money order in the amount of $100.00 made out to "Treasurer of Virginia".

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Service Modification Application  (Word) - Please use this form when you are already licensed to provide children's residential services and want to want to modify the license or add a service or location.  Please submit the completed form 30-60 days prior to implementation of the modification.

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• Regulatory Code, Process and Standards specific to Children's Residential Services were revised Effective January 1, 2009:
  • Children's Residential Facilities Rules and Regulations
     
• Human Rights Regulations

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The Department can only accept payments in the form of your organization check or money order, made out to "Treasurer of Virginia". The following licensing services are available to providers and provider-applicants:

• Initial Applicants:
  • There is a $35.00 fee if you opt to receive the Initial Provider Application packet through the mail; or choose to download the packet for free.
     
  • Training DVD for children’s residential services is $75.00.
     
  • The fee is $500.00 for the Initial Application for providers of children's residential services, due when you submit your completed application form. 
     
• There is a Renewal Fee of $100.00 for renewal of a license to provide children's residential services.
   

Please mail the completed order form with your Organization CHECK or MONEY ORDER, made out to "Treasurer of Virginia", to the following address.  If you have any questions, you may phone (804) 786-9302.  Thank you.

DBHDS, Office of Licensing
Attention: Stella Stith, Office of Licensing
P.O. Box 1797
Richmond, VA 23218-1797

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