Apply for Membership

Section 1: Recovery Residence (RR) Operator Contact Information

Incomplete applications will not be processed.

Name of Operator:*

First Last

Operator Mailing Address:*

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

Operator Phone:*

Is the number listed above a (RRA must be able to leave a voicemail):*

Landline
Cell

Email:*

Please list any qualifications or certifications that benefit your Recovery Residence business: (i.e., Certified Peer Specialist, CPR and First Aid Certified)

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?*

Section 2: Recovery Residence (RR) Information

Type of Recovery Residence (mark all that applies):

nonprofit organization
part of another nonprofit
other

If other, please explain:

Do you have more than one recovery residence you are applying for? Please select the amount of recovery residence below:*

1
2
3
4

1. Name of Recovery Residence:*

1. Recovery Residence Address:*

Street Address Address Line 2 City State ZIP Code

1. Does the recovery residence have a landline phone number?*

Yes
No

1. Recovery Residence Phone Number (In order to pass site visit, landline phone must be available):*

1. 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.)*

1. Recovery Residence Website

2. Name of Recovery Residence:*

2. Recovery Residence Address:*

Street Address Address Line 2 City State ZIP Code

2. Does the recovery residence have a landline phone number?*

Yes
No

2. Recovery Residence Phone Number (In order to pass site visit, landline phone must be available):*

2. 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.)*

3. Name of Recovery Residence:*

3. Recovery Residence Address:*

Street Address Address Line 2 City State ZIP Code

3. Does the recovery residence have a landline phone number?*

Yes
No

3. Recovery Residence Phone Number (In order to pass site visit, landline phone must be available):*

3. 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.)*

4. Name of Recovery Residence:*

4. Recovery Residence Address:*

Street Address Address Line 2 City State ZIP Code

4. Does the recovery residence have a landline phone number?*

Yes
No

4. Recovery Residence Phone Number (In order to pass site visit, landline phone must be available):*

4. 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.)*

Section 3: 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)

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:

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: 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.

Section 7: 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 an 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;

4. 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. 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 Applicant, their staff, and associates 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, 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.

6. Applicant, their staff, and associates acknowledges and agrees to adhere to RRA Quality Standards and RRA Membership Requirements.

Section 8: 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:

1. RRA membership application must be completed.

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

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

4. Members must turn in necessary documents including but not limited to House Rules and Provider/Housing Participant Document.

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

6. Additional RRA requirements:

i. Members agree to complete one training each quarter.

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

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

v. 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.

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

• Incident Report – within 24 hours
• Grievances – within three days

vii. 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.

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.)

Signature*

RRA membership is voluntary. By signing above, 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.

RRA Membership Application

Section 1: Recovery Residence (RR) Operator Contact Information

Section 2: Recovery Residence (RR) Information

Section 3: Recovery Residence On-Site Manager Information

Section 4: Housing Features | Amenities

Section 6: Safety Compliance

Section 7: Certification

Section 8: RRA Membership Requirements

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