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Inland Regional Center

info@inlandrc.org

1365 S. Waterman Ave., San Bernardino, CA, 92408, US

INLAND REGIONAL CENTER

NEW RESIDENTIAL SERVICE PROVIDER ORIENTATION QUALIFICATIONS

ALL APPLICANTS MUST MEET THE MINIMUM QUALIFICATIONS AND SUBMIT APPLICATION ALONG WITH THE FOLLOWING:

  • Proof of Direct Care Staff Experience. California Code of Regulations (CCR), Title 17, Chapter 3, Subchapter 4, Section 56002 (a) (12). Volunteer work not accepted. Experience must be current within the last three (3) years. IRC will verify this experience.
    • If interested in providing Level 2 supports, must have a minimum of 6 months prior experience providing direct supervision and special services for persons with developmental disabilities; Title 17, Ch.3, SubCh.4, Section 56037 (d)(1). Submit 6 months of payroll stubs to verify experience.
    • If interested in providing Level 3 supports, must have a minimum of 9 months prior experience providing direct supervision and special services for persons with developmental disabilities; Title 17, Ch.3, SubCh.4, Section 56037 (e)(1). Submit 9 months of payroll stubs to verify experience.
    • If interested in providing Level 4 supports, or higher, must have a minimum of 12 months prior experience providing direct supervision and special services for persons with developmental disabilities; Title 17, Ch.3, SubCh.4, Section 56037 (d)(1). Submit 12 months of payroll stubs to verify experience.
  • Proof of Community Care Licensing Orientation (CCL) certificate. Provides proof for the type of home applicant wishes to open ( RCFE, SFH, ARF). The Riverside CCL phone number is (951) 782-6645. You may obtain additional information from the following website: http://www.cdss.ca.gov/inforesources/Community-Care-Licensing
  • Proof of Administrators Certificate. Provides proof of completing the Department of Developmental Services (DDS) Administrators Certification Program. You may obtain additional information from the following website: http://www.cdss.ca.gov/inforesources/CCLD_ACS
  • Proof of Direct Support Professional (DSP) I. Provides proof of attending and passing the Regional Occupational Program (ROP) DSP training. A complete listing of the ROP sites and DSP information can be found on the following website.  http://www.dds.ca.gov/DSPT/Training.cfm
  • Professional resume. Resume should include information pertaining to residential facility experience that would pertain to the type of home they wish to open from a Level 2, 3 and 4 (See proof of Direct Care Staff Experience) .

  • Three professional letters of reference. Letters must be signed by the person making the reference and include contact information of the person that is writing the reference.  At least one letter must be from a professional in this scope of work.

  • Copy of identification. (State-issued driver’s license/ID card, Passport/Passport Card) 

Facility must be opened within two (2) years of successfully completing the orientation; otherwise, the class must be repeated.

Confirmation of Eligibility

NEW RESIDENTIAL SERVICE PROVIDER ORIENTATION APPLICATION

Applicant Information

Applicant Name
Street Address

Experience

Dates of Employment
Dates of Employment
Dates of Employment

Education

Degree Information
Degree Information
Degree Information

Professional References

Contact Information
Contact Information
Contact Information

Why are you attending?

Are you taking this orientation so that you may:
What kind of facility are you interested in opening?
What level of support are you planning to provide the facility?
Have you ever been vendored by another Regional Center?
Attach Quality Assurance evaluation here:

Applicants applying for this NRSPO who are currently vendored providers for IRC or any other regional center must have services in good standing. 

Providers with Substantial Inadequacies (SI's), or Type A deficiencies with Community Care Licensing in the past 24 months shall provide a written description of the SI's and/or Type A deficiencies and of all corrections that have been made.  Applicants must also disclose any past, present, or pending licensure revocations, probation or denials, including but not limited to:

  • CCL
  • Public Health Licensing
  • any agency providing services to people with disabilities, children, or the elderly.
Do any of the conditions above apply to you
Have you attended the NRSPO before?
Date NRSPO was attended

REQUIRED ATTACHMENTS

Use the box below to attach the following to your application:

  1. Proof of Direct Care Staff Experience
  2. Proof of Community Care Licensing Orientation Certificate (if opening a new home)
  3. Proof of Administrators Certificate
  4. Proof of Direct Support Professional (DSP) Certificate, at least DSP 1 must be completed
  5. Professional Resume
  6. 3 Professional Letters of Reference
Required Attachments
Your signature below indicates that all information provided is true and correct, as well as grants Inland Regional Center permission to contact the references you have listed above.

NOTE: Title XVII, Division 2, Chapter 3, Article 2, Section 54314 states Ineligibility for Vendorization as follows:

(a) The following applicants shall not be vendored:

(1) Any officer or employee of the State of California

(2) Any applicant in which an officer or employee of the State of California has a financial interest, as defined in the Government Code, Section 87103, except as permitted by Public Contract Code, Section 10430(g), effective January 1, 1992.

(3) Employees and board members of any regional center with a conflict of interest pursuant to Title 17, Sections 54500 through 54525, unless the conflict is eliminated or waiver obtained pursuant to Title 17, Sections 54522 through 54525.

(4) Any applicant in which the regional center employee or board member has a relationship which creates a conflict of interest pursuant to Title 17, Sections 54500 through 54525, unless the conflict is eliminated or waiver obtained pursuant to Title 17, Sections 54522 through 54525.

(5) Consumers, to provide services for, or to, themselves except to:

  • Provide transportation services to themselves as specified in section 54355(g)(5); and
  • Serve as their own Supported Living Service vendors as specified in Title 17, Section 58616
  • Except as specified in Section 54318 of these regulations, any applicant located outside the state.