Any individual, group or organization requesting consideration for a license as a child placement agency shall submit a packet of information, as described in Subsections A-H below, to PSD. An applicant may be licensed as an adoption agency, a foster care agency, or both. As a condition of receiving a license, the applicant’s proposed policies and procedures and proposed manner of operation shall be in writing and shall comply with the laws, regulations, and standards referenced herein. The application packet shall include:

1. A. Agency description and organization:

   (1) the name or proposed name and location of the agency;

   (2) profit or non-profit status;

   (3) names and addresses of the members of the governing board;

   (4) rules of the governing board and all sub-committees; and

   (5) a signed statement from the governing board acknowledging responsibility for placement and monitoring of children in homes approved by the agency for such placement and acknowledging responsibility for:

   (a) monitoring risks that may expose the organization to liability; and

   (b) monitoring risks that may reveal unsatisfactory service;

   (6) the geographic area of operation.

2. B. Statement of purpose, including:

   (1) a brief history of the existing organization;

   (2) philosophy of the agency;

   (3) the type of child placements the applicant agency proposed to provide;

   (4) the type of services to be provided pertinent to the placement process;

   (5) the type of services to be offered outside of the placement process;

   (6) any applicable and current accreditations or affiliations.

3. C. Personnel:

   (1) The application shall include a list of staff positions, which must include the following minimum personnel requirements:

   (a) state program director, meeting the requirements as described herein at Paragraph (1) of Subsection A of 8.26.5.21 NMAC; the program director may also fulfill the role of placement supervisor and placement worker;

   (b) supervisor, meeting the requirements as described herein at Paragraph (2) of Subsection A of 8.26.5.21 NMAC; and

   (c) treatment coordinator, meeting the requirement as described herein at Paragraph (3) of Subsection A of 8.26.5.21 NMAC.

   (2) The applicant agency shall include a copy of its personnel policy and procedures manual with its application, which shall include, but not be limited to, conflicts of interest, conflict resolution between staff and families, and gifts to staff. (See personnel policies and procedures requirements as described herein at 8.26.5.20 NMAC).

   (3) The applicant agency shall in its application the following information regarding staff and contract providers:

   (a) names, addresses, and telephone numbers of all staff and contract providers;

   (b) resumes;

   (c) documentation of the results of criminal records checks, and abuse and neglect checks, if required (see personnel polices and procedures requirements as described herein at Paragraph (6) of Subsection C of 8.26.5.20 NMAC; and

   (d) documentation of employee and contractor reference checks.

4. D. Policies and procedures: A copy of adopted and proposed policies and procedures addressing agency operations, client rights, client safety, and others as described herein at 8.26.5.18 NMAC.

5. E. Financial operations: The application shall include documentation of financial operations, including:

   (1) a statement of financial responsibility from a certified or registered public accountant which demonstrates that the applicant has access to sufficient funds to provide services for a minimum of six months;

   (2) a letter from a certified or registered public accountant stating that a bookkeeping system is in place and a process of financial review or audit is completed at the end of each fiscal year;

   (3) a complete list of fees for services;

   (4) a projected six month operating budget; and

   (5) proof of professional liability insurance, acceptable to PSD.

6. F. Disclosures: Applicants shall disclose affiliations and parent holding companies, to include financial, religious, professional and political affiliations.
7. G. Other documents and information: The application shall include copies of any legal documents, such as constitution, by laws and articles of incorporation and any other relevant information requested by PSD.
8. H. Changes, additions or revisions: Contemplated changes, additions or revisions to the information contained in the original application shall be submitted to PSD for approval before implementation. PSD may request, in writing and by certified mail, additional information to support the application. The requested information shall be submitted within 30 calendar days of PSD’s request. An agency’s failure to respond to PSD’s request for information within 30 calendar days shall be construed as voluntary withdrawal of an application.

[8.26.5.10 NMAC - Rp, 8.27.6.10 NMAC, 5/29/09; A, 8/15/11]