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Membership Application - RRA
Thank you for your interest in joining the Recovery Residence Association (RRA)! Before completing and signing the RRA Application, please read the enclosed information, including RRA Membership Requirements and RRA Quality Standards. If you need additional help with filling out this application, please contact the RRA at info@rrasd.org or call (858) 609-7977.
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Section 1: 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), their staff, and associates 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 prior to becoming a RRA member.
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, Housing Service Agreements and Safety Compliance form.
V. Member home(s) must pass annual site visits (one announced and one unannounced) conducted by the RRA’s Peer Review Accountability Team (PRAT) to ensure adherences to RRA Quality Standards.
1. Additional RRA requirements: Members agree to complete one training each quarter.
2. Members agree to complete an annual RRA affiliate survey.
3. Members agree to respond promptly to RRA requests and inquiries.
4. Members will update RRA staff of any changes to their RR listing (i.e., operatorship, staff or associate changes, licensing status, addresses, and/or telephone numbers) and respond to verification inquiries within three business days.
5. 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
6. 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.
Section 2: 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, their staff, and associates in connection with this RRA membership application or with the application to have a recovery residence 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. Applicant, their staff, and associates will comply with all applicable federal, state and local laws with respect to the operation and maintenance of the above-described recovery residence (including, but not limited to, compliance with all fair housing laws, state and local building codes, health laws and employments 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, their staff, and associates have not been found to be in violation by the California Dept. of Social Services' 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, their staff, and associates 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;
i. Applicant, their staff, and associates understand the limitations of operating as a recovery residence and does not provide care or supervision that would require licensing. Applicant certifies that applicant, their staff and associates do not represent recovery residence as providing care and supervision, including:
i. Do not assist individuals with dressing, grooming, bathing or hygiene;
ii. Do not assist individuals with medications, including storing medications where the individuals do not have access to them on their own;
iii. Do not make arrangements for medical or dental care;
iv. Do not maintain house rules for the specific protection of the independent individuals (house rules can be used to establish general guidelines for the management of the house, cleanliness, etc.);
v. Do not supervise individuals' schedules and/or activities. RRA Applicant, their staff, and associates recognize that individuals will be program participants;
vi. Do not maintain or supervise individuals' cash resources or property;
vii. Do not monitor food intake or the special diets of individuals.
4. Applicant, their staff, and associates 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.
Section 3: Safety Compliance
Consent
*
I agree to the safety compliance:
*
By agreeing to the following section, the undersigned represents and certifies to the Recovery Residence Association (RRA) all of the following:
1. Applicant, their staff, and associates of recovery residence(s) listed on this application;
2. I verify that all smoke, carbon monoxide detectors and fire extinguishers located at recovery residence(s) listed on this application have been checked and charged within the last three months, and are in proper working condition;
3. I verify that electricity, water (including working toilets and bathing facilities) and heat (or air conditioning) located at recovery residence(s) listed on this application are in working order and function appropriately for normal living conditions; and
4. I understand that the RRA is relying on the truthfulness and accuracy of all statements in this section, and that if it is later discovered that any of the foregoing statements is untrue, such discovery would be grounds for removal of recovery residence from the RRA’s online directory and the suspension or revocation of the Member’s membership in the RRA.
Signature
*
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.
Date
Date Format: MM slash DD slash YYYY
Section 4: Recovery Residence (RR) Operator Contact Information
Name of Operator:
*
First
Last
Operator Mailing Address:
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Operator Phone:
*
Is the number listed above a (RRA must be able to leave a voicemail):
*
Mobile
Landline
Fax number:
Email Address:
*
Operator's Emergency Contact
Name
First
Last
Phone
Email
RR Information
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
Other
If yes/other, please explain:
How many recovery residences 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?
*
How many recovery residences are you applying for?
*
1
2
3
4
Section 5: Recovery Residence (RR) #1 Information
Type of Recovery Residence (mark all that applies):
nonprofit organization
part of another nonprofit
other
If other, please explain:
Name of Recovery Residence:
*
Recovery Residence Address:
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Does the recovery residence have a landline phone number?
*
Yes
No
Recovery Residence Phone Number (In order to pass site visit, landline phone must be available):
*
No landline explanation, please describe when a phone line will be installed. (In order to pass site visit, landline must installed to meet quality standards.)
*
Recovery Residence Website
Please check one:
*
I own my home
I rent this home
Recovery Residence On-Site Manager Information
Operators shall ensure that staff and associates are screened and comply with all applicable federal, state and local laws with respect to operation of recovery residence including employment laws. RRA Requirement: On-site Manager available 24 hours a day and 7 days a week (on-site and/or by mobile phone)
On-Site Manager Name
*
First
Last
On-Site Manager Email Address
*
On-Site Manager Mobile Phone Number
*
Language(s) spoken:
Please list skills, experience or training certification:
Housing Features | Amenities
Note: Offering amenities is not an RRA membership requirement
Type of rooms:
*
Select All
Private Rooms
Shared Rooms
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 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
Stairs required to access bedroom
Section 6: Recovery Residence (RR) #2 Information
Type of Recovery Residence (mark all that applies):
nonprofit organization
part of another nonprofit
other
Name of Recovery Residence:
*
Recovery Residence Address:
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Does the recovery residence have a landline phone number?
*
Yes
No
No landline explanation, please describe when a phone line will be installed. (In order to pass site visit, landline must installed to meet quality standards.)
*
Recovery Residence Phone Number (In order to pass site visit, landline phone must be available):
*
Website:
Please check one:
*
I own my home
I rent this home
Recovery Residence On-Site Manager Information
Operators shall ensure that staff and associates are screened and comply with all applicable federal, state and local laws with respect to operation of recovery residence including employment laws. RRA Requirement: On-site Manager available 24 hours a day and 7 days a week (on-site and/or by mobile phone)
On-Site Manager Name
*
First
Last
On-Site Manager Email Address
*
On-Site Manager Mobile Phone Number
*
Language(s) spoken:
Please list skills, experience or training certification:
Housing Features | Amenities
Note: Offering amenities is not an RRA membership requirement
Type of rooms:
*
Select All
Private Rooms
Shared Rooms
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 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
Stairs required to access bedrooms
Section 7: Recovery Residence (RR) #3 Information
Name of Recovery Residence:
*
Recovery Residence Address:
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Does the recovery residence have a landline phone number?
*
Yes
No
No landline explanation, please describe when a phone line will be installed. (In order to pass site visit, landline must installed to meet quality standards.)
*
Recovery Residence Phone Number (In order to pass site visit, landline phone must be available):
*
Website:
Please check one:
*
I own my home
I rent this home
Recovery Residence On-Site Manager Information
Operators shall ensure that staff and associates are screened and comply with all applicable federal, state and local laws with respect to operation of recovery residence including employment laws. RRA Requirement: On-site Manager available 24 hours a day and 7 days a week (on-site and/or by mobile phone)
On-Site Manager Name
*
First
Last
On-Site Manager Email Address
*
On-Site Manager Mobile Phone Number
*
Language(s) spoken:
Please list skills, experience or training certification:
Housing Features | Amenities
Note: Offering amenities is not an RRA membership requirement
Type of rooms:
*
Select All
Private Rooms
Shared Rooms
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 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
Stairs required to access bedrooms
Section 8: Recovery Residence (RR) #4 Information
Name of Recovery Residence:
*
Recovery Residence Address:
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Does the recovery residence have a landline phone number?
*
Yes
No
No landline explanation, please describe when a phone line will be installed. (In order to pass site visit, landline must installed to meet quality standards.)
*
Recovery Residence Phone Number (In order to pass site visit, landline phone must be available):
*
Website:
Please check one:
*
I own my home
I rent this home
Recovery Residence On-Site Manager Information
Operators shall ensure that staff and associates are screened and comply with all applicable federal, state and local laws with respect to operation of recovery residence including employment laws. RRA Requirement: On-site Manager available 24 hours a day and 7 days a week (on-site and/or by mobile phone)
On-Site Manager Name
*
First
Last
On-Site Manager Mobile Phone Number
*
Language(s) spoken:
Please list skills, experience or training certification:
Housing Features | Amenities
Note: Offering amenities is not an RRA membership requirement
Type of rooms:
*
Select All
Private Rooms
Shared Rooms
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 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
Stairs required to access bedrooms
Required Document
RRA Membership requires submission of house rules and provider/participant documents for review and approval prior to scheduling initial home visits. One may submit house rules and rental agreements below or in the future.
House Rules (RRA Membership requires submission of House Rule for review and approval.)
Provider/Participant Document (Document defines the agreement between treatment provider and operator with housing program participants. RRA Membership requires submission for review and approval.)
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