Online RRA Application – Recovery Residence Association

Section 1: Recovery Residence (RR) Operator Contact Information

Incomplete applications will not be processed. If you have multiple recovery residences, please submit separate applications for each one for membership consideration. If you need additional help with filling out this application, please contact the RRA at info@rrasd.org or call (858) 609-7977.

Name of Operator:*

First Last

Do you have a co-operator?*

Yes
No

Name of Co-Operator:*

First Last

Operator Mailing Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Operator Phone:*

Is the number lsited above a (Please check one):*

Mobile
Landline

***The RRA must be able to leave a voicemail.

Email:*

Please list any qualifications or certifications that benefit your Recovery Residence business:

Do you currently have a business license?*

Yes
No

If yes, list business licence #:

Do you currently have a contract (i.e., State, Probation or County Behavioral Health Services)?*

Yes
No

If yes, please explain:

How many RR homes do you operate?*

Have you applied to the RRA in the past?*

Yes
No

If yes, when did you applied:

Whom may we thank for referring you to the RRA?*

Section 2: Recovery Residence (RR) Home Information

If you have multiple recovery residences, please submit separate applications for each one for membership consideration.

Name of Recovery Residence:*

Recovery Residence Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

RR Landline Phone Number:

***The RRA requires each RR to have a landline phone number.

Website

Type of Recovery Residence:

Select All
nonprofit organization
part of another nonprofit
other

If other, please explain:

Section 3: Recovery Residence On-Site Manager Information

RRA Requirement: On-site Manager available 24 hours a day and 7 days a week (on-site and/or by mobile phone)

1. On-Site Manager Name*

First Last

a) On-Site Manager Email Address*

b) On-Site Manager Mobile Phone Number*

c) Language(s) spoken:

d) Please list skills, experience or training certification:

2. On-Site Manager Name

First Last

a) On-Site Manager Email Address

b) On-Site Manager Mobile Phone Number

c) Language(s) spoken:

d) Please list skills, experience or training certification:

Section 4: Housing Features | Amenities

Note: Offering amenities is not an RRA membership requirement

Private room housing fee per day:*

(i.e., $25)

Shared room housing fee per day:*

(i.e., $25)

# of beds:*

(if at maximum capacity)

# of rooms:*

# of bathrooms:*

Bed linens included (i.e., fitted sheet, top sheet, blanket, pillow, pillow case)?*

Yes
No

Type of rooms:*

Select All
Private Rooms
Shared Rooms

Type of populations accepted:*

Select All
Co-Ed
Males Only
Females Only
Justice Involved
Transitional Age Youth (18-24 Yrs. Old)
Women with Children
Men with Children
Other

If other, explain:

Meals provided?*

Yes
No

# of meals provided:*

Hygiene packet provided?*

Yes
No

(i.e., body soap, shampoo, toothbrush, toothpaste, deodorant and comb to individuals upon entry into the home)

If yes, please explain what is included:

Laundry on-site:*

Yes
No

Is your laundry equipment coin-operated machines:*

Yes
No

Do you provide laundry supplies/soap free of charge?*

Yes
No

Additional features:

TV
Cable
Wi-Fi
Computer Station
Entertainment (nooks, movies, games)

Nearest bus stop?*

(miles)

Bus stop location? (Give Street name or cross streets):*

Nearest convenience store? (miles):*

Housing access/walk-ability?*

Select All
Easy to access house; no hills or stairs
Hills or stairs required to access house
Wheelchair Access

Section 6: Certification

Consent*

I agree to following:

By signing this application, the undersigned applicant certifies and represents to the RRA all of the following:

1. That all of the information contained in this application is true and complete. Applicant acknowledges that any false or misleading statement made by the applicant or applicant’s representatives or staff in connection with this RRA membership application or with the application to have an recovery residence home approved by the RRA, will be grounds for denial and/or revocation of RRA membership and the removal of the applicant’s recovery residence from the RRA approved list and online directory;

2. Operator and their staff will comply with all applicable federal, state and local laws with respect to the operation and maintenance of each of the above-described recovery residence (including, but not limited to, compliance with all Fair Housing laws, state and local building codes, and health laws). Applicant acknowledges and agrees that a violation of applicable law may be grounds for denial and/or revocation of RRA membership and listing of applicant’s recovery residence from RRA approved list and online directory;

3. Applicant and their staff have not been found to be in violation by the California Dept. of SocialServices' Community Care Licensing Division and are not the subject of a pending investigation by the state or local enforcement agencies in connection with the operation of any recovery residence which they own or manage. Applicant acknowledges and agrees that a violation of applicable law by applicant or their staff can be grounds for denial and/or revocation of RRA membership and the listing of applicant’s recovery residence from RRA approved list and online directory;

4. Operators understand the limitations of operating as a recovery residence and does not provide care or supervision that would require licensing. Operators certify that they do not:

i. assist individuals with dressing, grooming, bathing
or hygiene;

ii. assist individuals with medications, including storing
medications where the individuals do not have
access to them on their own;

iii. make arrangements for medical or dental care;

iv. maintain house rules for the specific protection of
the independent individuals (house rules can be
used to establish general guidelines for
management of the house, cleanliness, etc.);

v. supervise individuals' schedules and/or activities.
RRA Operators and On-Site Managers recognize
that individuals will be program participants;

vi. maintain or supervise individuals' cash resources or
property;

vii. monitor food intake or special diets of individuals.

5. Applicant acknowledges and agrees that membership in the RRA and the listing of any of the undersigned's recovery residences is a privilege and at the sole discretion and decision of the RRA.

6. Applicant acknowledges and agrees to adhere to RRA Quality Standards and RRA MembershipRequirements.

Section 7: RRA Membership Requirements

Consent*

I agree to the following:

The Recovery Residence Association (RRA) supports and promotes high-quality recovery residences in the San Diego County region. By joining the RRA, members receive a variety of benefits, including marketing tools and resources, professional development opportunities, and affiliation with a trusted county-wide association. RRA Members (operators), on-site managers and individuals may take advantage of RRA activities.

To gain membership, RRA members are expected to adhere to the following requirements:

I. RRA membership application must be completed.

II. RRA membership course is to be completed within 60 days of application date.

III. Members must agree to adhere to the RRA Quality Standards, indicators, and applicable legal requirements.

IV. Members must turn in necessary documents including but not limited to, House Rules, Provider/HousingParticipant Document, and Safety Compliance Form.

V. Member home(s) must pass two site visits (one announced and one unannounced) conducted by the RRA’s Peer Review Accountability Team (PRAT).

VI.Additional RRA requirements:

1. Members agree to complete one training each quarter.

2. Members agree to complete an annual RRA affiliate survey.

3. Members agree to complete annual PRAT training and participate as a PRAT member conducting one site visit annually.

4. Members agree to respond promptly to RRA requests and inquiries.

5. Members will update RRA staff of any changes to their RR listing (i.e., operatorship, licensing status, addresses, and/or telephone numbers) and respond to verification inquiries within three business days.

6. Members will promptly communicate with RRA, treatment providers and law enforcement (if applicable) if the following occur:

i.Incident Report – within 24 hours

ii.Grievances – within three days

7. Members can use RRA name or logo if authorized in writing by the RRA and must cease and desist if membership is terminated.

Violation of RRA membership requirements will be evaluated by RRA leadership and may be grounds for termination of RRA membership and removal from the RRA directory.

RRA membership is voluntary. By signing below, I confirm that I have read, understood, and will comply with all of the terms set forth by the Recovery Residence Association to gain and maintaining membership.

House Rules

Provider/Participant Document

Signature*

RRA Member Application

Section 1: Recovery Residence (RR) Operator Contact Information

Section 2: Recovery Residence (RR) Home Information

Section 3: Recovery Residence On-Site Manager Information

Section 4: Housing Features | Amenities

Section 6: Certification

Section 7: RRA Membership Requirements

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RRA Member Application

Section 1: Recovery Residence (RR) Operator Contact Information

Section 2: Recovery Residence (RR) Home Information

Section 3: Recovery Residence On-Site Manager Information

Section 4: Housing Features | Amenities

Section 6: Certification

Section 7: RRA Membership Requirements

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