The Indiana Department of Health (IDOH) works collaboratively with the Department of Child Services (DCS) to ensure Indiana Administrative Code is met in facilities licensed as a Child Caring Institution (CCI), Child Caring Institution Emergency Shelter (CCI-ESC), Private Secure Facility (PSF), Group Home (GH), and Group Home Emergency Shelter (GH-ESC) throughout Indiana.
IDOH determines compliance for these DCS facilities in regards to Health, Food, and Sanitation surveys and Health and Nutrition Program Reviews.
More information regarding the DCS facility types referenced can be found at https://www.in.gov/dcs/placement/.
Health, Food, and Sanitation (HFS) Surveys
A HFS survey is completed annually, at minimum. The unannounced survey consists of a site visit to the licensed facility and a basic record review of facility staff and children. The focus of the HFS survey bases around the health program implementation, nutrition program implementation, and a review for any safety and sanitation issues outlined in Indiana Administrative Code.
Indiana Administrative Code (IAC) for DCS Facilities
The specific code requirements for each facility can be found at these locations in the link above:
465 IAC 2-9 Child Caring Institution (CCI)
465 IAC 2-10 CCI Emergency Shelter Only (ESC)
465 IAC 2-11 Private Secure Facility (PSF)
465 IAC 2-12 Group Home (GH)
465 IAC 2-13 GH-ESC
In addition, a facility licensed as a Child Caring Institution (CCI), Child Caring Institution Emergency Shelter (CCI-ESC), or a Private Secure Facility (PSF) which utilizes a commercial kitchen must also meet IDOH’s Food Safety guidelines under Title 410: Department of Health, Article 7 of the IDOH Food Safety Guidelines.
Effective July 1, 2024, code regarding health requirements for all DCS residential facility types underwent changes that have not yet been reflected on required state forms. All requirements are now listed under IC 31-27-8 and IC 31-27-9. Please familiarize yourself with the new requirements prior to submitting any survey documentation or health and nutrition applications.
Health and Nutrition Program Reviews
- Health Program Review
The Health Program review is completed to provide a written statement of the facility’s knowledge of and intent to follow the health requirements listed in Indiana Administrative Code (IAC), to provide a reference for the interpretation of a portion of licensing rules, and to provide a means to address a comprehensive health program for the children at the facility.
Health Program reviews are required to be submitted every two (2) years for review. IDOH will send a courtesy reminder to the facility approximately six (6) months prior to program expiration. IDOH encourages you to submit documentation for review of your programs in a timely manner. It may take up to one month from submission for approval of your programs.
What to send:
- Completed State Form #45879
- First Aid directives and supplies with consulting physicians original signature and date
- Order for over the counter/as needed medications with consulting physicians original signature and date
- Copy of the facility’s employees health examination form
- Copy of the facility’s record form used to record physician’s monthly report of psychotropic medications
- Copy of the facility’s children dental examination form
- Copy of the facility’s children health examination form
- Copy of the facility’s children health assessment form (Emergency Shelters only)
How to submit:
All required forms and accompanying requested documentation should be completed in their entirety prior to submission. Programs lacking documentation or with incomplete state program forms will require resubmission.
It is preferred all program documentation and required forms be submitted to IDOH via the email HFSsurvey@health.IN.gov.
Resources for Health Program Creation
Health Program SF45879
Child Physical Examination Health Record SF49964
Adult Physical Health Examination SF49970
Dental Examination Form SF49962
First Aid Directives SF45877
First Aid Supply List SF45877
Follow up Visit Record
Health Evaluation Checklist - Emergency Shelters Only SF49965
Psychotropic Medication Documentation SF49966
Over the Counter/PRN Medication List Example - Nutrition Program Review
The Nutrition Program review is completed to provide a written statement of the facility’s knowledge of and intent to follow the nutrition/food service requirements listed in Indiana Administrative Code, to provide a reference for the interpretation of a portion of licensing rules, and to provide a means to address a comprehensive nutrition program for the children at the facility.
Nutrition Program reviews are required to be submitted every two (2) years for review. IDOH will send a courtesy reminder to the facility approximately six (6) months prior to program expiration. IDOH encourages you to submit documentation for review of your programs in a timely manner. It may take up to one month from submission for approval of your programs.
What to send:
- Completed State Form #46683
- Four weeks’ worth of menus
- One main dish casserole recipe which includes protein with appropriate quantity of food and serving sizes noted. The recipe must be one listed on the menus supplied for review.
- Simple drawing of the kitchen (either included in Section 7 or attached)
- Vendors contract (if applicable). The contract must be currently dated and signed. It must specify the following: which meals and food components will be provided by the vendor; if food is to be delivered in bulk or unitized; if the vendor or the facility supplies milk.
- Emergency Food Plan (only for facilities with a vendor contract). The plan must include one of the following:
- Secondary Vending Contract with an alternative vendor for emergency situations. It must meet the specified items listed in the Primary Vendor's Contract detailed above.
- Written plan to prepare and administer meals along with two (2) additional weeks of emergency use menus.
- Copy of the vendors certificate to operate (if applicable) for both the primary and secondary vendors
- Most recent water sample report (only if utilizing well water)
How to submit:
All required forms and accompanying requested documentation should be completed in their entirety prior to submission. Programs lacking documentation or with incomplete state program forms will require resubmission
It is preferred all program documentation and required forms be submitted to IDOH via the email HFSsurvey@health.IN.gov.
Resources for Nutrition Program Creation
Cleaning Schedule SF49959
Documentation of Nutrition and Sanitation Training for Children SF49972
Documentation of Nutrition & Sanitation Training for Staff SF49974
Manual Utensil & Equipment Washing SF49958
Sanitizing Solution Concentrations SF49973
Supplemental Nutrition Program Help SF56948
Nutrition Program SF46683
Menu SF56954
Contact the Program
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Indiana Department of Health Home and Community Based Care 2 North Meridian Street, 4B Indianapolis, IN 46204 | Jennifer Hasbrook 317-618-0737 JHasbrook@health.IN.gov |