Children's Administration, Department of Social and Health Services
Children's Administration, Department of Social and Health Services
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Operations Manual

5000. HEALTH AND SAFETY

5100. ADMINISTRATIVE INCIDENT REPORTING (AIRS)

5110. Purpose

This policy establishes uniform requirements for reporting and managing serious and emergent incidents involving the Children's Administration (CA). These incidents are defined as Administrative Incidents and must be reported through the Administrative Incident Reporting System (AIRS). This reporting system has been established to provide early notice and factual information for incidents requiring the immediate attention of the administration. Information from these reports will be used to identify issues, patterns and trends, and to determine if action is needed to improve the health and well being of children, families, and staff members.

For information beyond the scope of this policy see AIRS Companion Guide, Appendix C of this manual.

5120. Scope

This policy's operating procedure applies to:

  1. Children and families receiving services from CA.
  2. Licensed and unlicensed facilities and providers.
  3. Employees, interns, and volunteers of the Department of Social & Health Services (DSHS) as they relate to services CA provides.
  4. Allegations of Employee Misconduct

    Allegations of employee misconduct or criminal conduct are not documented in AIRS. If an allegation of misconduct or criminal conduct may potentially receive media or other high profile attention, notification through the chain of command is made as soon as possible by telephone up to the Office of the Assistant Secretary. Allegations of employee misconduct and/or criminal conduct are addressed by following DSHS Personnel Policy 545 and DSHS Administrative Policy No. 6.01. In addition to these policies, appointing authorities follow the Washington State Patrol (WSP) and DSHS Interagency Agreement and protocol for complying with Executive Order 96-01.

5130. Incidents Requiring an AIRS Report

  1. Child Fatalities/Near Fatalities
  2. Child fatalities and near-fatalities resulting from allegations of child abuse and/or neglect on an open case are reported to the Office of Risk Management by telephone or by completing the Case and Management Information System (CAMIS) referral form within one hour from the time CA received notification of the incident. Child fatalities of Native American children also are reported to their respective tribe.

    1. Child fatalities must be reported in AIRS if:
      1. There is an open case on the family prior to the fatality incident or any CA history on the family within 12 months of the fatality, including information-only referrals.
      2. The fatality occurred in a CA or Division of Child Care and Early Learning (DCCEL) licensed licensed, certified, or state operated facility.
    2. A near-fatality is defined as an act that places the child in serious or critical condition (RCW 74.13.500). Child near-fatalities must be reported if:
      1. The near-fatality is a result of alleged child abuse and/or neglect on an open case or on a case with CA history within 12 months; or
      2. The near-fatality occurred in a CA or DCCEL licensed, certified, or state operated facilit
      3. y.
    3. Child fatalities and near-fatalities must have a new referral created in FamLink when:
      1. They meet the above criteria.
      2. The fatality or near-fatality is reported as being the possible result of child abuse or neglect regardless of whether or not the family has had prior contact with CA.
      3. A new referral is not required when a near-fatality later becomes a fatality due to the circumstances reported in the original referral. An update to AIRS and a note in FamLink will suffice.
    4. The initial report of fatality or near-fatality is input into AIRS by the intake supervisor or Child Protective Services (CPS) program manager at the time of the report. Updates to the initial report are documented in AIRS by the local office assigned to the case or where the case was last opened if the referral is not accepted for services.
  3. Client Related
  4. For the purpose of completing an Administrative Incident Report, a child client is defined as a child (or youth up to age 21) in the care, custody, or supervision of CA (per RCW 26.10) or DSHS as it relates to services CA provides. An AIRS report must be made on the following client related incidents:

    1. Serious Injury: Serious injury of a child client requiring professional medical treatment (beyond first aid treatment) alleged to be the result of (a) physical abuse, (b) unexplained injury or (c) an injury that is not consistent with caretaker(s) explanation. Note: If it is a life-threatening injury, report the incident as a near-fatality.
    2. Allegation of Molestation or Rape: Allegations of molestation or rape by an adult caretaker of a child client who is in the care and supervision of the department, or incidents involving multiple victims or patterns of molestation or rape between child clients placed by the department. Identify if the incident involved two residents in a facility, siblings, the caretaker, or third party adult.
    3. Suicide Attempt: Any suicide attempt that results in injuries requiring hospitalization of a child client.
    4. Placement Exceptions: Child is placed in one of the following placements: a) an institution not designed for foster children, such as adult mental hospitals or detoxification programs where children and adults are co-mingled; b) a foster home without specialized training and support to provide for the safety of children in the home where children reside who are sexually aggressive, physically assaultive or who have demonstrated a pattern of assaultive behavior; c) at DSHS offices due to no placement resources being available or at detention facilities once legal holds are eliminated; d) apartments or motels, unless an appropriate licensed foster home or relative caregiver is not available and only with approval from the Regional Administrator (RA) and a determination that adequate supervision is provided for the child.
    5. Other: Any other client-related critical incident that does not fall into one of the previously identified categories that is believed to require administrative notification and/or attention.
  5. Incidents Involving a Facility or Foster Home (Provider Incident)
    1. An allegation of licensed provider misconduct is reported in AIRS by supervisors or management personnel. These include but are not limited to:
      1. Criminal activity that would disqualify a licensed provider from providing care to children (see WAC 388-06-0170 & 388-06-0180).
      2. Allegation of sexual abuse/sexual exploitation.
      3. A pattern of high-risk child abuse and/or neglect referrals.
    2. When an administrative incident meets one of the reporting requirements mentioned above and occurred in or involved one of the residents or staff in a facility or foster home, the Facility-Foster Home Section in AIRS is completed. Definition of facilities and foster homes include:
      1. Foster homes, facilities, private agencies licensed by the Division of Licensed Resources (DLR).
      2. Licensed childcare facilities licensed by DCCEL or facilities that meet the criteria for child care licensing.
      3. Other licensed, certified, or state-operated facilities.
      4. A person or agency subject to licensing under RCW 74.15.
  6. Staff Safety Incident or Potential Threat of Harm
    (For additional information on staff safety, see Operations Manual 8600).
  7. Individuals reporting a staff safety incident are required to indicate in AIRS whether or not the incident resulted in serious injury that required professional medical treatment. The following staff safety incidents require an AIRS report:

    1. Serious Threat of Harm: A staff person or contracted provider feels their safety was/is in jeopardy, or they were/are at risk of harm as a result of receiving a threat.
    2. Illness Serious/Communicable: Exposure to any blood borne pathogens, tuberculosis (TB), or any other serious/communicable illness (constituting a risk to others on the job) that is classified by the Department of Health (DOH) as requiring further evaluation, testing, and community education.
    3. Environmental Hazard: Exposure of a staff person to any environmental hazard while in the course of carrying out job duties that require medical consultation to ensure the health of that person (e.g. exposure to methamphetamine manufacturing materials, etc.).
    4. Traffic Accident: A traffic accident that occurs while a staff person is in the process of carrying out his or her job duties, whether in a personal or state-owned vehicle.
    5. Physical Assault by Client: Assault of a staff person by a child, parent, or individual identified as a client receiving services from the department. Immediately notify law enforcement and document the jurisdiction and police report case number in the "Community" section of AIRS.
    6. Physical Assault by Other: Assault of a staff person by any other person (non-client) that occurs during the course of the staff person carrying out his or her job duties. Immediately notify law enforcement and document the jurisdiction and police report case number in the "Community" section of AIRS.
    7. Other: Any other serious issue that threatens the safety of staff.
  8. Theft/Vandalism/Property Damage
  9. Report incidents of theft, vandalism, damage, or loss of state or private property in excess of $250.

  10. High Profile
  11. These are incidents that may generate significant interest by the media, the legislature and/or the Governor's Office. Incidents reported as high profile, including those marked high profile by intake, are reported in AIRS and must include an explanation regarding the reason it is considered high profile.

  12. Other
  13. AIRS reports are not limited to the incidents described above. If other types of critical incidents requiring the attention of the administration occur, consult with the CA Office of Risk Management.

5140. Administrative Incident Management and Reporting Procedures

  1. Administrative incidents identified in Section III are entered into AIRS within 24 hours of receipt of the report. The initial report is to include information known to the department at the time of the report.
  2. Intake supervisors and/or CPS program managers input the initial AIRS report on child fatality and near-fatality cases. CPS program managers update and close the AIRS reports on child fatality and near-fatality cases.
  3. Unit supervisors input the initial AIRS report on worker, staff safety, client related, and property loss incidents. Other incidents are input by intake supervisors or unit supervisors as determined by the region.
  4. The supervisor of the unit responsible for investigating the incident ensures an AIRS report was made, updated, and closed when the investigation is completed. If there is not an investigation, the intake supervisor or the supervisor of the unit reporting the incident makes an AIRS report, updates, and closes as appropriate.
  5. When automated transmission using AIRS is not possible, report the incident by phone to the Office of Risk Management and report in AIRS as soon as transmission is possible.
  6. Managers in the chain of command are automatically notified of the incident through AIRS and are required to review the incident report within 48 hours of receipt of the report.
  7. All incident reports are completed and approved by the regional designated chain of command within 10 working days of receipt of a report.
  8. Follow-up reports occur as additional information becomes available.
  9. AIRS will be managed by CA Office of Risk Management.

5150. Reviews of Administrative Incident Aggregate Data

  1. At least quarterly, statewide program managers designated responsible for management and oversight of administrative incidents conduct an internal review to evaluate occurrences, summarize findings, identify areas for further study, and make recommendations to strengthen practice, programs, and systems. Results of the quarterly statewide review are provided to the appropriate directors.
  2. At least quarterly, an internal review of all administrative incidents is conducted by each region and local office. The Office of Risk Management and Division of Program and Practice Improvement provides support and consultation as needed. Summary reports from AIRS are used to evaluate practice and identify trends and strategies to improve outcomes. Results of the local office review are provided to the local office Continuous Quality Improvement (CQI) Standing Team. Results of the regional review are provided to the Regional Management Team.
  3. Twice yearly, the Division of Program and Practice Improvement, in partnership with statewide program managers designated with responsibility for management and oversight of administrative incidents publishes a summary report for CA management review that identifies statewide and regional trends.

5160. Administrative Incident Reporting Timelines

Activity Due
Child fatalities or near-fatalities resulting from alleged CA/N on open cases or on families receiving services within 12 months of fatality Report to Office of Risk Management (ORM) by telephone within 1 hour of receiving information.
All Administrative Incident Reports Report in AIRS within 24 hours of receiving information. When automated transmission in AIRS is not possible, report by phone to ORM or DLR as appropriate.
Regional Administrator (RA) or designee reviews administrative incident report Review within 48 hours of receipt of AIRS email notification.
Completed Initial Administrative Incident Report, including follow-up in AIRS Completed in AIRS within 10 working days.
Child Fatality The Regional CPS Program Manager or designee reviews the case record within 14 calendar days of receiving notification of the child fatality.
Child Fatality The Regional CPS Program Manager or designee provides the RA with a summary of the case within 45 days.
Child Fatality Review (CFR) Final report is completed and documented in AIRS within 180 days of report of fatality.
Executive Child Fatality Review (ECFR) Completion of the final report and documentation in AIRS within 180 days of the report of fatality.
CFR Work Plans Work plans are completed and documented in AIRS within 30 days of the Child Fatality Review or Executive Child Fatality Review.
Quarterly reviews of all administrative incidents documented in AIRS Reviews occur quarterly*:
  • Statewide program managers with responsibility for management of administrative incidents conduct an internal review to evaluate occurrences, potential trends and summarize findings, with recommendations.
  • Regions and each local office review administrative incidents occurring in their jurisdictions
*January-March; April-June; July-September; October-December
Summary report of administrative incidents statewide to CA Management Report provided twice yearly to CA Management by Office of Risk Management in partnership with program managers.
Alleged employee misconduct or criminal conduct that may potentially receive media or other high profile attention Notification through chain-of-command by telephone as soon as possible. Employee misconduct is not documented in AIRS. Follow:
  • DSHS Personnel Policy 545
  • DSHS Administrative Policy No. 6.01.
  • Executive Order 96-01 (WSP/DSHS Interagency Agreement)

5200. CRITICAL INCIDENT REVIEWS

  1. Purpose
  2. Critical Incident Reviews (CIRs) examine all information provided to the department regarding the child and his or her family. The goals of CIR teams are to:

    1. Increase our understanding of the circumstances around a child's death.
    2. Evaluate practice, programs and systems to improve the health and safety of children.
    3. RCW 74.13.640

      "The Department of Social and Health Services shall conduct a child fatality review in the event of an unexpected death of a minor in the state who is in the care of or receiving services described in chapter 74.13 RCW from the department or who has been in the care of or received services described in chapter 74.13 RCW from the department within one year preceding the minor's death.
      Upon conclusion of the child fatality review required pursuant to subsection (1) of this section, the department shall issue a report on the results of the review to the appropriate committees of the legislature and shall make copies of the report available to the public upon request."

      For information beyond the scope of this policy see AIRS Companion Guide, Appendix C of this manual.

  3. Child Fatality Manner of Death Definitions
    1. Unknown/Undetermined: Nature of death is unknown or undetermined at the time of the report.
    2. Natural/Medical: Alleged nature of death is Sudden Infant Death Syndrome (SIDS), or otherwise determined to be a natural/medical death, including attended or expected deaths.
    3. Accidental: This includes, but is not limited to vehicle accidents, falls, drowning, overlay, and/or any other nature of death that is alleged to have been accidental in nature.
    4. Suicidal: Any death alleged to have been suicide by the medical examiner, law enforcement, or attending physician.
    5. Homicide by Abuse: Homicide alleged to have been committed by a parent or caretaker acting in loco parentis.
    6. Homicide by Third Party: Homicide alleged to have been committed by anyone that was not a parent or acting in loco parentis.
  4. Requirements
  5. A CIR is required for a child fatality, near fatality or serious injury when the child is under the age of 18 and one of the following conditions applies:

    1. The child death, near fatality or serious injury is suspicious for abuse or neglect and
    2. There is an open case on the family or any CA family history within 12 months prior to the fatality. This includes information-only referrals within 12 months preceding the death of the child. Cases only open for adoption support do not meet this criteria, unless there has been another active service provided to the family during the 12 months proceeding the death of the child or the death is believed to be the result of child abuse or neglect or
    3. The fatality occurred in a CA licensed, certified, or state-operated facility or
    4. The fatality occurred in a home or facility licensed to provide childcare through DEL.
  6. Critical Incident Reviews
    1. Child Fatality Review (CFR)
      1. Protocols
        1. A CFR is coordinated by the Child Fatality/Critical Incident Review Team (CIRT) Members.
        2. The Child Fatality/Critical Incident review team is a multidisciplinary team comprised of individuals who have not had involvement with the case.
        3. Participants in the ECIR are selected by the Child Fatality/Critical Incident Review Team.
        4. The Child Fatality/Critical Incident review must include professionals who represent the culture of the community in which the fatality occurred. This would include professionals who can address the specific issues of the case such as service providers, foster parent representatives, children advocates, medical professionals, law enforcement, CA staff persons and may include representatives from the legislature. It is important to have professionals who are representative of the client's ethnic and cultural background.

          RCW 74.13.640
          The department shall ensure that the fatality review team is made up of individuals who had no previous involvement in the case, including individuals whose professional expertise is pertinent to the dynamics of the case.

        5. DCFS and DLR staff assigned to the case assists in gathering and providing case information to the CIRT leader for documentation in AIRS prior to the review.
        6. The CIRT leader may arrange for interviews with any persons involved with the family or the deceased child as appropriate for the CIR.
        7. All CIR participants must sign confidentiality statements before reviewing CA records or documents.
        8. The Child Fatality/Critical Incident Review Team supervisor in coordination with the Office of Risk Management, is responsible for tracking the progress and completion of the CIR.
        9. The Child Fatality/CIRT members review the case record within 14 calendar days of receiving notification of the child fatality and provides the RA with a verbal debriefing of the case within 45 calendar days of receipt of the report.
        10. The Child Fatality/CIRT leader must complete the CIR and have the report posted on the public website within 180 days of the department receiving a report of the fatality. The CIR is documented in AIRS under the same incident number identified for the Administrative Incident Report.
        11. The Governor may authorize an extension to the 180-day timeframe per RCW 74.13.640. When this authorization is provided, the justification is documented in the follow-up section of the initial incident report in AIRS.
      2. Reviews
        1. Reviews address practice, internal policy issues, contract issues, and system issues.
        2. Reviews include recommended strategies and implementation steps.
        3. Reviews are used to build community alliances, expertise, and commitments for program improvements, policy, and procedural changes, and improved multi-disciplinary collaboration.
        4. Reviews may identify program and system strengths, communication issues, and specific information regarding child mortality.
        5. Review recommendations may address the total community child protection system and need not be limited to CA or DSHS programs.
        6. Reviews may address individual employee actions and decisions in the specific case under review. Reviews should not name the employee.
      3. Reports
        1. The Child Fatality/Critical Incident Review Team member ensures the issues/recommendations from the CIR are entered in AIRS under the CIR.
        2. The report will not be released until the AIRS Review Report is locked indicating that the report has been approved by the Office of Risk Management.
        3. The Office of Risk Management in collaboration with the RA shares the report with the DSHS Secretary, CA Assistant Secretary, CA Division Directors, and RAs.
        4. The Office of Risk Management provides a copy of all reports to the Office of the Family and Children Ombudsman.
        5. The Office of Risk Management makes CIR reports available to legislative committees and the public, per RCW 74.13.6405:
        6. "Upon conclusion of a child fatality review required pursuant to this section, the department shall within one hundred eighty days following the fatality issue a report on the results of the review, unless an extension has been granted by the governor.
          Reports must be distributed to the appropriate committees of the legislature, and the department shall create a public web site where all child fatality review reports required under this section must be posted and maintained. A child fatality review report completed pursuant to this section is subject to public disclosure and must be posted on the public web site, except that confidential information may be redacted by the department…"

        7. All reports of the CIR team are public record.
        8. Release of information is subject to laws regarding public disclosure and confidentiality. Requests for CIR reports are processed through a disclosure program manager at CA headquarters.
        9. Aggregate information with identifying data, including team recommendations, is disclosed to the public in the annual report.
        10. The CA Office of Risk Management will:
          1. Make available CIR reports to all CA staff persons.
          2. Prepare and distribute a report summarizing team findings and recommendations.
          3. Publish child fatality information in the annual Children's Administration Performance Report.
      4. Work Plans
        1. Upon completion of the CIR, if there are practice and system issues identified during the review process, a CIR Work Plan will be developed and entered into the AIRS system within 30 days of completion of the review.
        2. The Work Plan is based on issues identified in the review. The RA or designee in coordination with the Division of Program and Practice Improvement, and the CA Office of Risk Management develops, the draft Work Plan.
        3. The Division of Program and Practice Improvement and the RA submits the draft Work Plan to the Assistant Secretary for approval.
        4. The approved Work Plan is documented in AIRS by the Office of Risk Management in collaboration with the Regional CPS Program Manager.
        5. Implementation, follow up and tracking of the Work Plan is done by the Division of Program and Practice Improvement in coordination with the CA Office of Risk Management.
        6. The CA Office of Risk Management will:
          1. Provide regular reports from CIRs with summary data to increase social workers' understanding of risks to children.
          2. Prepare and distribute a report summarizing team findings and recommendations.
          3. Publish child fatality information in the annual Children's Administration Performance Report.

5220. Critical Incident Review Matrix

Type of Case
Child Fatalities, Near Fatalities, Serious Injury
CIR No Review Required
1. Open case, no placement, no CA/N alleged X
2. Open case, no placement, CA/N alleged X
3. Open case, placement, no CA/N alleged X
4. Open case, placement, CA/N alleged X
5. Services within 12 months, no CA/N alleged X
6. Licensed care (DLR/DEL), no CA/N alleged X
7. Licensed care (DLR/DEL), CA/N alleged X
8. Adoption support, services within 12 months, no CA/N alleged X
9. Adoption support, services within 12 months, CA/N alleged X
10. Adoption support, no services within 12 months, no CA/N alleged X
11. Adoption support, no services within 12 months, CA/N alleged X
12. Case open for tribal payment only X
13. No services within 12 months X
14. Significant history prior to 12 months, CA/N alleged X
15. Case open for tribal payment only X

Cases with significant history beyond 12 months may require a review. RA has option to request review of any case

5230. Administrative Incident Review Activity

Case Status
  • At time of child fatality or critical incident, services are active in Children's Administration (CA) programs.
  • OR
  • There was an open case that received services from any CA within 12 months prior to child's death or critical incident. Services include "information only" or low risk referrals.
  • Services were provided by a CA licensed, certified, state-operated facility or Division of Child Care & Early Learning (DCCEL) home or facility.
Unexpected
Child Abuse/Neglect (CA/N) Fatality
Child Fatality Review (CFR), or Executive Child Fatality Review is Required

CFR:

  • Participation by local/regional staff and/or others appointed by regional administrator (RA). CA may invite community partners who had involvement with and/or provided services to the child's family
  • CFR prepared and coordinated by regional CPS program manager in Administrative Incident Reporting System (AIRS)
  • Regional CPS program manager completes review within180 days or RA may authorize extension

Executive CFR:

  • Recommended by Director of Field Operations, RA & CA Office of Risk Management.
  • Convened by Assistant Secretary
  • Coordinated by ORM and regional CPS program manager or other RA designee
  • The Executive CFR will include statewide, multidisciplinary participants with no direct involvement in services for the child's family. Executive CFR will determine timeline for completion of report.

Unexpected
Non-CA/N Fatality
CFR is Required

CFR:

  • Participation by local/regional staff and/or others appointed by RA). CA may invite community partners who had involvement with and/or provided services to the child's family
  • CFR prepared and coordinated by regional CPS program manager in AIRS
  • Regional CPS program manager completes review within 180 days or RA may authorize extension

Expected
Non-CA/N Fatality (e.g. medically fragile, terminal illness)
CFR (Optional)

CFR:

  • CFR on expected, non-CA/N fatalities are optional.
  • Participation by local/regional staff and/or others appointed by RA. CA may invite community partners who had involvement with and/or provided services to the child's family
  • CFR prepared and coordinated by regional CPS program manager in AIRS
  • Regional CPS program manager completes review within 180 days or RA may authorize extension

5300. INVESTIGATING ABUSE AND NEGLECT IN STATE REGULATED CARE

5310. Introduction

  1. The Division of Licensed Resources (DLR) Child Abuse and Neglect Section Practice Guide - Investigating Abuse and Neglect in State-Regulated Care is a "how-to" guide to be used by the facility investigators in the course of investigations of alleged abuse and neglect in state-regulated care.
  2. The guide expands the Washington State Risk Assessment Model, developed for investigation of abuse in biological families, to include risk factors specific to state-regulated care. Within the "state-regulated" care sub-group, there are many differences between types of care. The guide helps investigators assess the importance of those differences between types of care, while emphasizing the major similarities that need assessment in the course of an investigation.

5321. Purpose and Scope

  1. CA has a responsibility to ensure that high quality care is provided when a child is under state supervision or when a facility providing care is state-regulated. Minimum licensing requirements (MLR) define a higher standard of care than expected and legally allowed in a biological family unit. As a result, standards for accepting referrals for investigation of alleged abuse and neglect in state-regulated care encompass a wider range of allegations than those involving biological family units.
  2. Child Protective Service (CPS) investigations of reports of alleged abuse or neglect in licensed, certified, and state-operated care facilities (child day care, foster care, group care, hospitals, and institutional care) have five main goals:
    1. To ensure the immediate safety of alleged child victims;
    2. To investigate allegations and make determinations regarding the existence of child abuse and neglect (CA/N);
    3. To assess whether the child in question has been abused or neglected in a state-regulated setting in ways that have not been alleged;
    4. To identify risk factors within the facility which create a substantial risk of future harm to children; and
    5. To ensure consistency and equity toward providers in the investigation of abuse and neglect.
  3. Investigations of alleged abuse or neglect must include assessments of the presence or absence of patterns of CA/N and/or inadequate care as well as documenting specific incidents of child maltreatment.
  4. Investigations of alleged abuse or neglect in licensed care are distinct from investigations of compliance with MLR or certification standards. Nevertheless, when there is an investigation of alleged abuse or neglect in licensed care, the investigator must consider a history of compliance or non-compliance with MLRs or certification standards in his or her overall assessment.
  5. Investigations of alleged abuse or neglect are expected to result in findings related to specific allegations of CA/N. The findings also include the presence or absence of other abuse or neglect in the licensed setting and record the important risk and protective factors present. Findings must have a strong factual basis, be supported by appropriate documentation, and include recommendations regarding disposition of the case.
  6. See the DLR Child Abuse and Neglect Section Practice Guide - Investigating Abuse and Neglect in State Regulated Care for steps to follow for Intake, Investigation, Assessment, and Disposition of allegations of CA/N in state-regulated care.

5400. HEALTH AND SAFETY REVIEWS

CA staff must use the CA protocol Health and Safety Review Standards - Procedures for Group Care and Therapeutic Foster Health and Safety Reviews as the guideline for conducting health and safety reviews of this types of facilities. In addition, staff must comply with the provisions of the CA Practices and Procedures Guide, chapter 4000, section 4421, Health and Safety of Children.