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- California Room & Board Coalition©
  Member Application Package
  Coalition Membership demonstrates your willingness to maintain housing that is healthy, safe, well- managed, and provides an environment conducive to the wellness and recovery of hospital or Behavioral Health consumers and others. Once you have met all of the membership requirements, your facility will be evaluated, then placed on the California Room & Board Coalition© subscriber database to be used as a resource by hospitals, socials workers, Behavioral Health Providers and other interested parties. Please provide requested information.
- CONFLICT OF INTEREST DISCLOSURE STATEMENT
  The purpose of this disclosure statement is to identify, address, and resolve any employment, activity or enterprise that may be inconsistent, incompatible, or in conflict with the duties of a Room & Board Operator associated with the California Room & Board Coalition©.
- Coalition Member Name*
- Position
- Facility Name
- Phone Number
- Facility Address:
- Address line 1
- Address line 2
- City
- State
- Zip Code
- Are you currently employed by (or contracted to provide services for) any California Behavioral Health Organization and/or Alcohol and Drug Program?
- Please Specify
- State or Government Employment / Affiliation
  Please list below all current State or Government Employment / Affiliation. Indicate self-employment, if applicable.
- Employer/Organization Name
- Date Employment Commenced
- Phone Number
- Address line 1
- Address line 2
- City
- State
- Zip Code
- Type of Service / Organization
- Position Title
- Work Schedule and Duties Performed (brief)
- OPERATOR INFORMATION
  Owner/Operator’s Name(s):
- First Name
- Last Name
- Contact Information
- Email
- Telephone
- Alternative Phone
- On-site Manager’s Contact Information
- Facility Name
- Facility Address
- Address line 2
- City
- State
- Zip Code
- Mailing Address
- Address line 1
- Address line 2
- City
- State
- Zip Code
- FACILITY INFORMATION
- Type of Facility
- Specification
- Facilities
- Number of Bedroom(s)
- Number of Bathroom(s)
- Do you have Kitchen?
- Specification for No.
- Resident Capacity
- Total Resident Capacity
- Number of Roommates per Room
- Accommodate
  - Male
  - Female
  - Co-ed
- Monthly Rental per Person
- Rental Due Date
- Do you have an unusual reporting process?
  - Yes
  - No
- Please upload unusual reporting process.Upload
- What is your bed retention policy?
- Tenant Agreement
- The Facility House Rule (Please attach a copy) Upload
- What are the Progressive Disciplinary Actions?
- First Offense
- Second Offense
- Third Offense
- Fourth Offense
- What are the Terms and Conditions for Eviction? ( FAQs )
- Deaf and Hard of Hearing / ADA Friendly
- Is your accommodation ASL and ADA friendly?
- Policies and Procedures for ASL/ADA Policies File Upload
- See minimum amenities and accommodations below.
- Minimum ASL/ADA Accommodations Required.
  
  1. Visual fire alarms: Install flashing strobe lights or other visual alerts throughout the housing to warn residents of fire alarms or other emergencies.
  2. Vibrating alert systems: Implement vibrating bed or pillow shakers, as well as wearable devices, to notify residents of important events like doorbells, phone calls, or alarms.
  3. Open floor plan: Opt for an open layout to enhance communication and visual connectivity between rooms, making it easier for deaf individuals to interact with others.
  4. Visual intercom systems: Install video intercoms with visual displays to enable easy communication with visitors at the door.
  5. Tactile and visual cues: Incorporate tactile or visual cues in public spaces, such as braille signage and well-placed visual indicators for restroom facilities.
  6. Closed-captioning options: Offer televisions and media systems with built-in closed captioning capabilities to allow deaf residents to enjoy audiovisual content.
  7. Visual emergency alerts: Implement visual emergency alerts in common areas, such as hallways and community rooms, to ensure all residents are aware of any critical situation.
  8. Adjustable lighting: Provide adjustable lighting options to create optimal visual conditions for individuals with varying degrees of hearing loss or preferences.
- HOUSE AMENITIES AND RESPONSIBILITIES
- Are residents assigned chores?
  - Yes
  - No
- Are visitors allowed?
  - Yes
  - No
- What are the rules/policies regarding visitation?
- Is there a curfew?
  - Yes
  - No
- If yes, what time is the curfew?
- Number of Meals Included?
- How many meals per day?
- Snacks included?
  - Yes
  - No
- Is there a secured area available for personal property?
  - Yes
  - No
- Smoking allowed?
  - Yes
  - No
- If yes, where can residents smoke?
- Do residents have access to a telephone?
  - Yes
  - No
- Are there specific rules that govern the use of phones?
  - Yes
  - No
- What is the distance to the nearest public transportation?
- Pet Friendly?
  - Yes
  - No
- Size / Kind / Number of Pets
- AMENITIES
- Are linens and/or towels provided?
  - Yes
  - No
- Are toiletries provided? (Shampoo, conditioner, soap, etc.)
  - Yes
  - No
- Is toilet paper provided?
  - Yes
  - No
- Are washer and dryer available for resident use?
- Is it available at all times?
- Explain why
- Laundry supplies provided?
  - Yes
  - No
- Do residents have access to common areas in the Room & Board (ex. living room, patio, pool, etc.)?
- What are the rules?
- Does each bed have a mattress and box spring encasement to prevent the infestation of bed bugs?
  - Yes
  - No
- What is your procedure for resident property left behind after the end of the rental period? Upload your documents (if you have) Upload
- HOUSE MANAGER INFO
- Do you have a House Manager?
- Is the operator/house manager on premises at all times?
- House Manager's Name(s):
- First Name
- Last Name
- Date of Birth
- Contact Information
- Email
- Telephone
- Alternative Phone
- PHOTO RELEASE
- *I grant to CA Room and Board Coalition © (CRBC), its representatives and employees the right to take photographs of me and my property in connection with the above-identified subject. I authorize CA Room and Board Coalition © (CRBC), its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that CA Room and Board Coalition © (CRBAC) may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I have read and understand the above:
- RELEASE OF LIABILITY
  (Insurance and Business License) As an active member of the California Room and Board Coalition, I understand that it is my responsibility as the owner/operator of the room and board facility indicated to provide evidence of licensing and/or general liability insurance that properly identifies the property use as recommended.
- *I agree to participate and hold harmless the California Room and Board Coalition based on any incident past, present, or future that may arise as a result of failure to maintain or provide evidence of coverage and permission to operate the unlicensed room and board facility listed below.
- CODE OF ETHICS
  
  The Code of Ethics establishes standards of conduct required and expected of all Room & Board operators and staff to ensure proper operation of Room & Boards as well as the Coalition. These standards are intended to strengthen Coalition efforts and to maintain and promote wellness, recovery and resilience in the residents we serve.
  
  The Code of Ethics must be acknowledged and adhered to by all Coalition members. Signature indicates agreement to hold yourself and your staff accountable to this Code. Operators must use ethically sound judgment to ensure their actions do not discredit the Coalition or conflict with their business operations.
  
  ✔ Treat residents with dignity and respect.
  ✔ Respect the privacy, personal rights, and basic legal rights of all residents.
  ✔ Maintain an alcohol and (illicit) drug-free environment.
  ✔ Create and maintain an environment free from physical violence or threats of violence or intimidation.
  ✔ Do not grant special consideration, treatment, or advantage to any person beyond what is available to every other person in a similar circumstance. Do not favor or discriminate against anyone. Make merit-based decisions.
  ✔ Payee services shall be arranged through the Social Security Administration or DPOA (if applicable). Room & Board Operators and their staff will not engage in any financial arrangements outside of the rental agreement.
  ✔ Uphold the duty of good faith and fair dealing between operators and residents by treating each other honestly and reasonably.
  ✔ Coalition Members will work collaboratively to maintain the integrity of the Core Values.
  
  Violation of the established Code of Ethics may result in revocation of membership from the California
  Room & Board Coalition© as well as suspension from the Room & Board distribution list.
- By affixing your signature to this document, you are confirming your awareness and acceptance of our authority to modify your membership and/or listings as necessary, terminate your membership and/or listings in cases of delayed or incomplete payments, and request supplementary information prior to publishing new listings.
- *I agree to abide by the Code of Ethics AND acceptance of membership terms in the California Room and Board Coalition©.
- Website Profile
- Username & Password recommended use uppercase and lowercase letters, numbers and special symbols.
- Username*
- Password*
- Repeat Password*
- First Name*
- Last Name
- Picture ProfileUpload
  
  (We recommend a photograph that includes the front of the house without any individuals in the frame).
- E-mail*
- Phone*
- Subscription Plans
  Yearly - $2,200 / 1 Year
  6 Monthly - $1,650 / 6 Months
  Month to Month - $275 / 1 Month
  Discount Code:
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Register

California Room & Board Coalition© Member Application Package

CONFLICT OF INTEREST DISCLOSURE STATEMENT

Facility Address:

State or Government Employment / Affiliation

OPERATOR INFORMATION

Owner/Operator’s Name(s):

Contact Information

On-site Manager’s Contact Information

FACILITY INFORMATION

Facilities

Resident Capacity

What are the Progressive Disciplinary Actions?

Deaf and Hard of Hearing / ADA Friendly

Minimum ASL/ADA Accommodations Required.

HOUSE AMENITIES AND RESPONSIBILITIES

AMENITIES

HOUSE MANAGER INFO

PHOTO RELEASE

RELEASE OF LIABILITY

CODE OF ETHICS

Website Profile

(We recommend a photograph that includes the front of the house without any individuals in the frame).

Subscription Plans

California Room & Board Coalition©
Member Application Package