Abe Lincoln Releasable Small

1
From: Lowenberg,Cristina (DFPS)

Sent: Tuesday, July 22, 2014 8:50 AM
To: Shaw,Jean (DFPS)
Subject: FW: DONE / Policies
Attachments: RSMC P&P.docx; Manual Overview Updated 11.25.13.pdf
Cristina Lowenberg
Residential Child Care Licensing Supervisor
401 E. Franklin Suite 350P
El Paso Texas 79901
Phones: Office (915) 834-5736 or Cell (915) 929-8487
Fax : 512/934-9672
CONFIDENTIALITY NOTICE: This communication is intended only for the use of the individual or entity to which it is addressed and
may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If you have received this email
in error please notify the sender by email, delete and destroy this message and its attachments. If you are not the intended recipient,
you are notified that any use, dissemination, distribution, or copying of the communication is strictly prohibited.
From: WATFORD RANCH [mailto:sales@watfordranch.com]

Sent: Friday, J uly 18, 2014 9:19 AM
To: Lowenberg,Cristina (DFPS)
Subject: FW: DONE / Policies

Pleaseseeattached

Attachment 1: "Residential Services for Migrant Children" is what we are calling the social service side of the
program. we might change later, but it is descriptive enough for now. I am attaching a 144 page internal
program policy. It needs revision, but it is a great start. Please let state know that we are in the process of
revising it, and will provide them with a final copy prior to the facility accepting any children.

Attachment 2: ORR Manual Overview

Attachment 3: ORR/DUCS Policies and Procedure Manual (sending in another e-mail). Its 16MB.

________________________
Sergio Medina

1
Subject: FW: TX LIC APP 1 of 3
Attachments: TX LIC APP 1 of 3.pdf
Cristina Lowenberg
El Paso Texas 79901
Fax : 512/934-9672

Subject: FW: TX LIC APP 1 of 3

3 rd email
1
Subject: FW: original docs
Attachments: 1. APPLICATION 2960.doc; 2. Background Check 2971 (2).doc; 3. Controlling Person
Form 2760 (2).doc; 4. Personal History 2982 SM (2).doc; 5. Fee Schedule 3011 (2).docx;
6. Applicant Affidavit 2985E.doc; 7. Governing Body Designation 2911.doc; 8. Plan of
Operation 2948.doc; Columbia Transcript.pdf; Medina LCSW Verification.pdf; Medina
Resume 2014.pdf; Rice Transcript.pdf
Cristina Lowenberg
El Paso Texas 79901
Fax : 512/934-9672

Subject: FW: original docs

2nd email of docs
DepartmentofFamilyandProtectiveServices(DFPS) Form 2971i
Revised Oct 2013
CHILD CARE LICENSING REQUEST FOR BACKGROUND CHECK
CCL
Texas law gives you the right to know what information is collected about you by means of a formyou submit to a state government agency. You
can receive and review this information, and request that incorrect information about you be corrected by contacting your licensing representative.

Page 2 of 2
NOTE: If you are submitting your request via the Internet please DO NOT submit this form to your licensing office.

Is there a fee for processing background check requests?
Background check processing fees are included in the annual fee for Listed Homes. All other operation types, you must pay a $2 fee
for each person listed on this form or submitted via the Internet. Submit the appropriate Fee Schedule for your operation, along with
the fee(s), to: DFPS, Accounting Division MC: E-672, P.O. Box 149030, Austin, TX, 78714-9030. Failure to submit fee payments
can result in adverse action including suspension or revocation.

The fee for obtaining a fingerprint check is $39.95 for a prospective or current foster or adoptive parent and is $41.45 for all other
individuals. The fee must be paid to the DPS Fingerprinting Service Center for each person obtaining fingerprint checks at the time
the fingerprint check is run. See http://www.dfps.state.tx.us/site map/forms.aspfor the appropriate FAST Pass form to obtain a
fingerprint-based check.
DepartmentofFamilyandProtectiveServices(DFPS) Form 2971
Revised Oct 2013
CCL

Page 2 of 4

Initial 24 Month Check Fingerprint Check Required FBI Results in DPS Clearinghouse
Social Security Number

ID Type - Drivers License or ID Number -State

First Name

Middle Name

Last Name

Street Address

City

State

Zip

County

Telephone No. (A/C)

Date of Birth

Gender
M F
You must list any other city in Texas where this person has been a resident, and any addresses, including county, where the person has lived outside
of Texas in the previous five years:

Relationship of person to requestor
Adoptive Parent Caregiver Director Foster parent Household Member Licensed Administrator
Other Staff Staff Volunteer Other:
For Foster/Adoptive Homes only: Relationship between child/children to be placed and the foster/adoptive parent(s) or prospective foster/adoptive
parent(s) Relative Fictive Kin Unrelated
Date Hired /Used by the
Operation/Agency

Ethnicity (must accompany race)
Hispanic Other
Race
White Asian
Black American Indian/Alaskan Native
Unable to Determine Native Hawaiian/ Pacific Islander
Other names used (married, maiden, etc.) First Name

Middle Name

Last Name



First Name

Middle Name

Last Name

Street Address

City

State

Zip

County

Telephone No. (A/C)

Date of Birth

Gender
M F

Operation/Agency

Hispanic Other
Race
White Asian

Middle Name

Last Name

Revised Oct 2013
CCL

Page 3 of 4



First Name

Middle Name

Last Name

Street Address

City

State

Zip

County

Telephone No. (A/C)

Date of Birth

Gender
M F
Operation/Agency

Hispanic Other
Race
White Asian

Middle Name

Last Name



First Name

Middle Name

Last Name

Street Address

City

State

Zip

County

Telephone No. (A/C)

Date of Birth

Gender
M F
Operation/Agency

Hispanic Other
Race
White Asian

Middle Name

Last Name

Revised Oct 2013
CCL

Page 4 of 4



First Name

Middle Name

Last Name

Street Address

City

State

Zip

County

Telephone No. (A/C)

Date of Birth

Gender
M F
Operation/Agency

Hispanic Other
Race
White Asian

Middle Name

Last Name



First Name

Middle Name

Last Name

Street Address

City

State

Zip

County

Telephone No. (A/C)

Date of Birth

Gender
M F
Operation/Agency

Hispanic Other
Race
White Asian

Middle Name

Last Name

Texas Dept of Family and
Protective Services
Controlling Person Form
Child Care Licensing
Form 2760
Sept 4, 2012
Page 2

First Name

Middle Name

Last Name

Suffix


Middle Name

Last Name

Suffix

Date of Birth

Drivers License No.

Driver's License State

SSN

Individual's Mailing Address

City

State

Zip

Telephone No. (A/C)

Title, Position or Relationship
Licensed Administrator
Center Director
Board Member

Governing Body Member
CEO
Owner

Primary Caregiver in Child Care Home
Spouse of Primary Caregiver
Adult Living in Child Care Home
Other:
Effective Date of
Position
If person is associated with a Child Placing Agency, indicate if the person is associated with the Main or Branch office:
Main Branch If Branch, what number:

First Name

Middle Name

Last Name

Suffix


Middle Name

Last Name

Suffix

Date of Birth

Drivers License No.


SSN


City

State

Zip

Telephone No. (A/C)

Center Director
Board Member

CEO
Owner

Other:
Effective Date of
Position

First Name

Middle Name

Last Name

Suffix


Middle Name

Last Name

Suffix

Date of Birth

Drivers License No.


SSN


City

State

Zip

Telephone No. (A/C)

Center Director
Board Member

CEO
Owner

Other:
Effective Date of
Position

First Name

Middle Name

Last Name

Suffix


Middle Name

Last Name

Suffix

Date of Birth

Drivers License No.


SSN


City

State

Zip

Telephone No. (A/C)

Center Director
Board Member

CEO
Owner

Other:
Effective Date of
Position

Texas Dept of Family and
Protective Services
Controlling Person Form
Child Care Licensing
Form 2760
Sept 4, 2012
Page 3

Instructions for Controlling Person Form

Who must complete the controlling person form?
The applicant, designee, or head of the governing body must complete and sign this form.
Whose names must be entered on the Controlling Person Form?
Controlling Persons include each:
(1) Owner of the operation or member of the governing body of the operation, including, as applicable, an executive, an
officer, a board member, a partner, a sole proprietor and the sole proprietor's spouse, or the primary caregiver at a child-
care home and the primary caregiver's spouse;
(2) Person who manages, administrates, or directs the operation or its governing body, including a day care director or a
licensed administrator; or
(3) Person who either alone or in connection with others has the ability to influence or direct the management, expenditures,
or policies of the operation. For example, a person may have influence over the operation because of a personal, familial,
or other relationship with the governing body, manager, or other controlling person of the operation.

A person does not have to be present at the operation or hold an official title at the operation or governing body in order to be a
controlling person. An employee, lender, secured creditor, or landlord of the operation is not a controlling person unless the person
meets the definition as stated above.
When do I complete this form?
Complete and sign this form when:
(1) You submit an application to licensing for a permit; and
(2) Within two days after a person becomes a controlling person at your operation.
Where do I send the form?
Mail the form to your local Licensing office.
General Instructions:
Do not leave any blanks. Write none, not applicable, or NA if the item does not apply.
Operation Information:
Enter the operation name and operation number (if already licensed, certified, registered or listed). The remaining operation information
is self-explanatory.
Signature/date:
The applicant, designee, or head of the governing body must sign and date the form.
Controlling Person Information:
Name: List every name used by this person, including a woman's maiden name and previous married names. Write out
the middle name, do not use only the middle initial. Add additional pages, as necessary.

Address and phone: Enter the personal mailing address and phone number for the person listed.

Title, Position, or Relationship: Select the appropriate choice.
Licensed Administrators refers to Licensed Child Care Administrators or Licensed Child Placing Administrators
Center Director refers to a director of a child care center or home
Primary Caregiver of a Child Care Home, Spouse of Primary Caregiver, and Adult Living in Child Care Home are
terms only associated with licensed, registered, or listed child care homes

Effective Date of the Position: Enter the date the person began the role of a controlling person.
Page 2:
This page is provided in case you have many controlling persons for your operation. Make as many copies of Page 2 as you need to list
all the names you need to submit. Only one Page 1 is required each time you submit the form.
Texas Dept of Family
and Protective Services
PERSONAL HISTORY STATEMENT
Form2982
J uly 2010
1 of 4

Texas law gives you the right to know what information is collected about you by means of a formyou submit to a state government agency. You can
receive and review this information, and request that incorrect information about you be corrected by contacting your licensing representative.

Name (Last, First, Middle)
MEDINA, SERGIO
Soc. Sec. No.*

TX. Drivers License No.*

Date of Birth
10/28/1975
Mailing Address
537 LISBON STREET
City
SAN FRANCISCO, CA
Zip Code
94112
Home Telephone No. (A/C)
415-707-9163
Name of Operation
Abraham Lincoln Transitional Lodge
Capacity
3500
Your Title or Position at the Operation
President and CEO, Refugee and Immigrant Services
Operation Address
SE Corner of I-10, and FM 1110
City
Clint, TX
Zip Code
79836
Telephone No. (A/C)
701-339-5411
*Indicate if you do not have a Social Security number or a Texas drivers license.

1. EDUCATION:
Elementary or High School (check highest year completed)
1 2 3 4 5 6 7 8 9 10 11 12
Did you graduate or receive
a GED?..

Yes

No

LOCATION
DATES ATTENDED GRAD-
TYPE OF MAJ OR FIELD
NAME OF SCHOOL CITY AND STATE From To
UATED
DIPLOMA OF STUDY

Mo. Yr. Mo. Yr. Yes No
OR DEGREE
College or University
Rice University Houston, TX 9 1994 5 1998 BA Sociology
Columbia University School of Social
Work
New York, NY 9 1999 5 2001 MSW Social Work
Technical or Vocational

Describe any other special training you have had which you feel is pertinent. Including Continuing Education Units. Give dates, locations, and the name of
the organization or agency sponsoring the training.
Hundreds of continuing ed courses in: child welfare, trauma informed care, community care licensing, child protection, child abuse, human
trafficking, working with immigrant and refugee children, HIV/AIDS, ethics, law, human development, etc.
List any professional licenses, certifications, or credentials you hold.

Licensed Clinical Social Worker in the State of California, License number: 24146

2. EMPLOYMENT AND EXPERIENCE Show all positions held within the last 10 years beginning with current or last employer.
DATES EMPLOYED
Full Part

From To POSITION
Time Time
EMPLOYER ADDRESS
Mo. Yr. Mo. Yr.

4 2014 cu rrent Associate Executive Director
Covenant House California,
Oakland
200 Harrison Street, Oakland, CA 94607
9 2013 1 2014 Child Protection Consultant
UN High Commissioner for
Refugees, International Catholic
Migration Commission
Bujumbura, Burundi, East Africa
HQ: Geneva, Switzerland
8 2008 5 2013 Senior Program Director Catholic Charities of Santa Clara
County
2625 Zanker Road, San J ose, CA 95134
8 2004 8 2008 Regional Supervisor Lutheran Immigration and Refugee
Services
700 Light Street, Baltimore, MD 21230
Use additional sheets as necessary.
Form2982
J uly 2010
Pg. 2 of 4

A. Describe the duties of each position listed above that were in the areas of child-care services, child-care personnel supervision, skill-based instruction,
recreational or youth development program, and program management or administration.

In each position, oversaw the provision of child welfare services and social services to children and youth. In each position, I lead teams who
conducted assessment and evaluation, mental health treatment, case management, advocacy, legal service coordination, family reunification, and
education. I trained social workers on principles of child and youth development, and supervised their adherence to the highest standards of
ethics, and state requirements. At Catholic Charities, I was the administrator of a Foster Family Agency, and certified approximatley 200 foster
homes and ensured they were in compliance. At Lutheran Immigration and Refugee Services, I conducted site visits to more than 50 group homes
on a regular basis, across the United States, to evaluate their delivery of child welfare residential services, and worked with them to improve care.

B. Describe any other experience you have had which you feel is pertinent. Include volunteer work in the description. Give dates and locations.

I have 15 years +child welfare experience with foreign born children, and with domestic youth. I have experience translating state and federal
regulations into policies and procedures, and supervising programs to ensure adherence to standards.

3. PREVIOUS LICENSES/REGISTRATIONS/LISTINGS

A. Has the Texas Department of Family and Protective Services or any other agency ever registered or listed you to care for children?
Yes No
If Yes, when were you registered or listed? Address (Street, City, ZIP)
From:

To:

County and State

If you were registered under another name, what was the name?

B. Has the Texas Department of Family and Protective Services or any other agency ever licensed you to care for children? Yes No
If Yes, what kind of license did you have?

When were you licensed?
From: To:
Name of operation

Operation Address (Street, City, State and ZIP)

County

Form2982
J uly 2010
Pg. 3 of 4

C. Are you now a foster parent? ................................................................................................................................................................. Yes No

D. Have you ever been denied a permit to care for children? .................................................................................................................... Yes No
If Yes, when were you denied?

For what type of child care were you denied?

Operations Address (Street, City, State and ZIP)

County

What was the reason for the denial?

E. Have you ever had a child-care permit revoked or have you ever been barred/prohibited from operating? .......................................... Yes No
If Yes, when did the revocation or bar occur?

What was the reason for the revocation or bar?

Operations Address (Street, City, State and ZIP)

County

If the revocation or bar occurred in another state, list the name and address of the regulatory body that issued the revocation or bar

Indicate the type of child care permit that was revoked or the type of child care you were barred from operating?

F. Has an operation that you owned or operated ever been placed on probation? ...................................................................................... Yes No
If Yes, when was it placed on probation?

What was the reason it was placed on probation?

Operations Address (Street, City, ZIP)

County

4. PEOPLE IN THE HOME: For Child Care Operations in Homes Only:
(Complete only if child care will be provided in the home where the caregiver and family reside.)
The following people 14 years old or older live in my home in addition to myself. Use additional sheets as necessary.
NAME (Last, First, Middle) AGE DATE OF BIRTH SOCIAL SECURITY NO.* TX. DRIVERS LIC. NO.* RELATIONSHIP

5. HEALTH

A. Are you physically and/or emotionally fit to act as the director/administrator of a child care operation? .......................................... Yes No

If No, please explain.

B. Is any person listed in #4 physically and/or emotionally impaired? ..................................................................................................... Yes No

If yes, please explain.

6. CHILD ABUSE/NEGLECT
Have you or has any person listed in Item #4 ever been investigated for abusing or neglecting a child by any of the following agencies?

A. Child Protective Services of the Texas Department of Family and Protective Services ........................................................................ Yes No

B. County child welfare agency ................................................................................................................................................................. Yes No

C. Law enforcement agency (police, sheriff, etc.) ..................................................................................................................................... Yes No

D. Child welfare agency in another state ................................................................................................................................................... Yes No

E. Other (specify) ....................................................................................................................................................................................... Yes No

If Yes to any of the above, what was the childs name?

How was the child related?

Form2982
J uly 2010
Pg. 4 of 4

When did this occur?

Where?

7. CRIMINAL CHARGES/CONVICTIONS

A. Have you or has any person listed in Item #4 ever been convicted of a felony or misdemeanor? ........................................................ Yes No
If Yes, give name of person(s)

Date of Conviction

Location

Give details including type of conviction and disposition:

B. Do you or does any person listed in Item #4 have felony or misdemeanor charges pending with the county or district attorney or is anyone now
complying with the terms of a deferred adjudication? ......................................................................................................................... Yes No
If Yes give name of person(s)

Type of Charge

County where charges are pending or length of deferred sentence.

Court No.

Location

Give details:

8. FOR DIRECTOR OF LICENSED CENTERS ONLY
Please attach all additional documentation relevant to your education, training, and job experience to this form (e.g.: an original DFPS child care
director's certificate, college transcripts, original training course certificates, or C.D.A. credential). All original documentation will be returned to you
after qualifications are evaluated.

I certify that this information contains no willful misrepresentation or falsification and that it is true and complete to the best of
my knowledge and belief. I hereby authorize the Texas Department of Family and Protective Services to contact the persons
listed on this form. I understand that the Department may contact others and, at any time, seek verification of any and all
information on this form., I understand that any willful misrepresentation is cause for immediate denial of the application or
later revocation of the license.

Signature

Date

Texas law gives you the right to know what information is collected about you by means of a formyou submit to a state government agency.
You can receive and review this information, and request that incorrect information about you be corrected by contacting your licensing representative.

Form 2985 / 3-04
AFFIDAVIT FOR APPLICANTS FOR EMPLOYMENT WITH A
LICENSED OPERATION OR REGISTERED CHILD-CARE HOME

AN APPLICANT FOR TEMPORARY OR PERMANENT EMPLOYMENT with a licensed child-care facility, licensed
child-placing agency or registered child-care home whose employment or potential employment with the facility,
agency, or home involves direct interaction with or the opportunity to interact and associate with children must
execute and submit the following affidavit with the application for employment:

STATE OF
COUNTY OF
I swear or affirm under penalty of perjury that I do not now and I have not at any time, either as an adult or
as a juvenile:

1. Been convicted of;
2. Pleaded guilty to (whether or not resulting in a conviction);
3. Pleaded nolo contendere or no contest to;
4. Admitted;
5. Had any judgment or order rendered against me (whether by default or otherwise);
6. Entered into any settlement of an action or claim of;
7. Had any license, certification, employment, or volunteer position suspended, revoked, terminated, or adversely affected because of;
8. Resigned under threat of termination of employment or volunteerism for;
9. Had a report of child abuse or neglect made and substantiated against me for; or
10. Have any pending criminal charges against me in this or any other jurisdiction for;

Any conduct, matter, or thing (irrespective of formal name thereof) constituting or involving (whether
under criminal or civil law of any jurisdiction):

1. Any felony;
2. Rape or other sexual assault;
3. Physical, sexual, emotional abuse and/or neglect of a minor;
4. Incest;
5. Exploitation, including sexual, of a minor;
6. Sexual misconduct with a minor;
7. Molestation of a child;
8. Lewdness or indecent exposure;
9. Lewd and lascivious behavior;
10. Obscene or pornographic literature, photographs, or videos;
11. Assault, battery, or any violent offense involving a minor;
12. Endangerment of a child;
13. Any misdemeanor or other offense classification involving a minor or to which a minor was a witness;
14. Unfitness as a parent or custodian;
15. Removing children from a state or concealing children in violation of a court order;
16. Restrictions or limitations on contact or visitation with children or minors resulting from a court order protecting a child or minor from
abuse, neglect, or exploitation; or,
17. Any type of child abduction.

Except the following (list all incidents, locations, description, and date) (if none, write NONE)
__________________________________________________________________________

The failure or refusal of the applicant to sign or provide the affidavit constitutes good cause for refusal to hire the applicant.

Signed:____________________________________________ Date: _________________________________

Subscribed and sworn to (or affirmed) before me this __________ day of ________________________________

Signature of notary officer: _____________________________________________________________________
(seal, if any, of notarial officer)

My commission expires:_________________________
GOVERNING BODY/DIRECTOR DESIGNATION
Form2911
October 2012

Texas law gives you the right to know what information is collected about you by means of a formyou
submit to a state government agency. You can receive and review this information, and request that incorrect
information about you be corrected by contacting your licensing representative.

e-Application Confirmation #:______________
Enter confirmation #above if an application was submitted online
SECTION A - GOVERNING BODY DESIGNATION

Name of Operation:
Operation Number:

Address:
SE Corner of I-10 and FM1110
Governing Body or Organization Name
Watford Ranch
Telephone Number (A/C)
701-339-5411
Address: Street City State Zip
453 South Broadway, Nyack, NY 10960
Please Print the Name of Chief Executive Officer of Governing Body
Kelly Hering
701-339-5411
Mailing Address: Street City State Zip
Name of Designee of Governing Body:
Kelly Hering
201-315-5173
453 South Broadway Nyack New York 10960

I hereby designate the person stated above as official representative (designee) to speak for and act on our
organizations behalf.

I understand that all correspondence, copies of compliance documents, will be sent to the designee.
I understand that as the permit holder, the governing body is ultimately responsible for maintaining
compliance with the childcare licensing law and minimum standards.
I understand that all waivers and variances must be requested and signed by me or by the designee.
I understand that anytime there is a change in the designee or director of an operation, the governing body is
responsible for notifying the licensing division.
I understand that the licensing division will notify the governing body of any remedial action against the
operation.
I DO DO NOT want to also receive routine compliance information.

Chief Executive Officer of Governing Body (Signature) Title Date

SECTION B - DIRECTOR DESIGNATION

I (we) hereby designate

Sergio Medina, CEO, RISE

as director of

Abraham Lincoln Transitional

located at

SE Corner of I-10 and FM 1110
Authorization:

Signature of Owner, Governing Body or Designee Title Date
Texas Dept of Family Form2948
and Protective Services J une 2010
PLAN OF OPERATION FOR LICENSED CENTER OPERATIONS

Texas law gives you the right to know what information is collected about you by means of a form
you submit to a state government agency. You can receive and review this information, and request
that incorrect information about you be corrected by contacting your licensing representative.
Plan of Operation
Page 1 of 8

e-Application Confirmation #:________________
Enter confirmation #above if an application was submitted online

Instructions: The following information must be submitted with an application to operate a Licensed Child
Care Home or Center. The information must reflect how the operation plans to maintain compliance with the
minimum standard rules for the type of operation you are applying. The CCL representative will review the
information with you at your inspection prior to issuance of the initial or non-expiring permit.

I. Permit Holder Responsibilities:

1. Who will be the person(s) responsible for ensuring that the Minimum Standard Rules are in
compliance at all times?

Governing Body Designee Watford Ranch, Charles McGuire, CEO

Center Director Sergio Medina, President and CEO, RISE

Child-Care Home Primary Caregiver

2. If the director or primary caregiver is not present at the center, what person will be in charge?
This person must be able to perform any duties normally performed by the director/primary
caregiver.
Director of Administration

3. The records of children, employees, caregivers and household members require constant
updating of the information. How do you plan to maintain these records in order for all of the
information to be current?
The Director of Administration will supervise staff to ensure that they update a census that is up-to-date at
any given time. The Director will keep a census, as well, of all staff on duty, shift history, and time-in
and time-out, using timesheet trackinig. All visitors will be required to sign in and register at the security
gate, and time-in and time-out will be logged. Licensing and Governing Body will have access to this
information at any time by getting in contact with the Director of Administration, who will be supervised
by the Center Director.

4. Parents must be kept informed of the policies of the operation, events that will take place, when
their child has been hurt or ill, when there has been an outbreak of a communicable disease, and
other issues that occur. What method(s) will you use to ensure that parents are informed?
By nature of the children we intend to serve, parents are not available or immediatley reachable, as all of
the children in our care are designated by the federal government as 'unaccompanied' which is a legal
determination made by the U.S. Department of Health and Human Services. However, we will make
every effort to, in those instances where we do have emergency contact information about the child
collected during the assessment phase, contact parents if any of the above issues or concerns arise related
to their child.

Operation Name: Abraham Lincoln Transitional Lodge
Location Address: SE Corner of I-10 and FM 1110, Clint, EL Paso County, Texas

Plan of Operation
Page 2 of 8
5. Background checks must be submitted upon hire and every two years. How will you document
sending this information to licensing and track when background checks are due?
Each staff hired will undergo the required background checks. Human Resources on site will provide
each new hire with documentation to submit to complete the background check. A copy will be provided
to the staff, and one will be kept on file in the employee's records.

A spreadsheet or calendar reminder will be set for 60 days before the individual's 2 year anniversary with
the organization, and human resources will contact the individual to set up the background check. The
calendar reminders will be managed by the HR department so that the information is tracked by
whomever is employed under HR, regardless of new staff coming on board.

6. How will new employees be oriented in the minimum standard rules, the policies of the
operation, the procedures for handling emergencies, how to recognize the signs of child
abuse/neglect and sexual abuse and the responsibility for reporting these and the location and use
of a fire extinguisher? Please have a copy of the orientation curriculum available for the
licensing rep to review.
Every staff member, before having contact with an individual child, will under 5 days (40 hours) of
training. The training will encompass state licensing regulations, child welfare regulations, recognization
of signs of physical abuse, sexual abuse, and neglect, including situations that fall under mandated
reporting. Staff will all undergo CPR and First Aid training, and how to respond in the event of an
emergency, including knowing the location and operating of a fire extinguisher.

7. Caregivers must receive training annually. How will you ensure that your caregivers receive the
required hours of training?
Human Resources and the Training Department will provide a monthly training schedule, and will
manage enrollment and certification of employees. Staff are required to complete a minumum of 24
hours of training to maintain employment.

8. Licensed centers only: Do you have a preservice training curriculum or will you only hire
caregivers who already meet the requirement of preservice training? If you have a curriculum,
please have a copy available for your licensing rep to review at your inspection.
We are developing a 5 day curriculum that is in development, and will provide to licensing once
complete.

Plan of Operation
Page 3 of 8
II. Operation/Physical Facilities
1. Each child must have 30 square feet of indoor activity space. On your attached floor plan,
indicate which age group and how many children will be in each room or area. (attach floor plan)
Please see attached

2. The operation must have a variety of equipment and materials and ensure that it is age
appropriate. On an attachment, list the equipment and materials you will have for each age group
you plan to serve. This should include both indoor and outdoor equipment and materials.
Please see attachment

3. How many toilets will your operation have?
approximately 1000 campus wide

4. How many sinks will your operation have?
approximately 1000 campus wide

5. How will children be supervised when they are using the restroom?
There will be a 24/7 presence in housing units when children are present. Privacy will be given
to all children, and staff will remain attentive to ensure children are getting ready appropriately
for school, or other activities, and are safe on the premises.


Plan of Operation
Page 4 of 8
III. Activities and Child Caregiver Ratio

1. What methods of discipline and guidance will you and your caregivers use when children
misbehave?
The facility is a no-touch facility. Staff, unless required to care for infants and toddlers, will not
physically touch children except during normal societal interactions (handshakes, side hugs, pat
on the back).

A child who is acting out will first be redirected, and if the acting out escalates, deescalation
techniques will be used to diffuse the situation. Children who act out even more will be
separated from other children, and be given a cooling off period.

Overall, the staff will be trained to use positive reinforcement, to the greatest extent possible, and
not negative reaction to poor behavior, to set a tone of positive regard.

In emergency situations such as a fight or an otherwise aggressive act, staff will act to protect all
children from such acts. Such incidents will follow the required reporting call, and will be
handled in a way that the least amount of required intervention is used.

2. On an attachment, list the activities that are appropriate for each age group you plan to serve.
Include indoor and outdoor, active and quiet activities. Include a sample schedule for each age
group.
see attached

3. In what area will the children rest and what type of napping equipment will they use?
During school days, all classrooms will have sleeping mats for children ages 5 - 8, for nap time.

At home, children will live in a traditional family home set-up, complete with couches, chairs,
and normal household furniture in the living areas, and in their bedrooms.

4. Licensed centers only: On the floor plan attachment that you used to identify the rooms to be
used for each age group,(II,1), add the number of caregivers that you will need when the room is
at its full capacity.
At all times, there will be 2 staff to supervise a maximum home capacity of 12 children per
home.


Plan of Operation
Page 5 of 8
IV. Activities Away from the Operation
1. If you plan to take field trips, how will you ensure that the appropriate minimum standard rules
are maintained?
Given the sensitivity of the needs of these children, no field trips are planned at this time. The
campus is large enough such that activities will be on site.

2. If you plan to have water activities, will you have swimming or a wading pool at your operation
or will you take the children to a swimming pool away from the operation? What is your plan to
ensure the safety of the children while they are in swimming or wading pools either at your
operation or away from the operation?
none on campus, and none planned

3. If you plan to provide transportation, how will you ensure the appropriate minimum standard
rules are maintained and ensure the safety of the children?
The program plans on leasing vehicles for trips to service providers outside the campus. The
children transported will be driven by screened drivers, they will wear their seatbelts, and
certified car seats will be utilized in accordance with TX state law.

The vehicles will be under lease, and will be maintained for safety on a regular schedule dictated
by the leasing agent.


Plan of Operation
Page 6 of 8
V. Safety, Sanitation and Fire

1. How will you ensure that the operation, both indoors and outdoors, is maintained to protect the
health and safety of children?
The Property Managers will have a continuous presence on campus, and will be in charge of
mainting the facility up to safety standards. Staff (youth care workers, case managers, and other
managers and directors) will receive training on the requirement to report any facilities issues
that might pose a potential risk to health and safety.

2. What is your plan for identifying persons who are authorized to pick up a child?
The process to reunify children with caregivers is extremely strict. The program will follow
federal guidelines for reunification where there is a "substantial and verifiable prior relationship,
that the sponsor meets all the qualifications to reunify with the child." The process for verifying
relationship involves combing through birth certificates to establish parentage, or family
relationship, and through verifying the sposnor's ID with backup IDs, and with running a federal,
state, and local background check.

For a child being reunified, security will be notified that x sponsor is coming to reunify with y
child, and the individual will be allowed on the facility. A sponsor who does not have pre-
authorization, will not be allowed on campus.

3. Licensed centers only: In areas that are enclosed or have an obstructed view, how will caregivers
observe children at all times? How will caregivers with the children in these areas be able to be
observed at all times?
The only areas that are obstructed from view, because of the open campus floor plan, will be the
children's bedrooms and bathrooms. Caregivers will ask children to keep their doors open during
the day, and cracked slightly at night for privacy. Caregivers will be awake and alert at night,
and will conduct rounds on 30 minute intervals to ensure that everyone is safe.

4. How will you ensure that the building, grounds, equipment and supplies are maintained in a
clean and sanitary manner?
The Property Manager will create a regular inspection schedule, a mechanism for residents and
staff to report any concerns, and will have the resources to make the corrections. The Property
Managemer will also strictly implement the guidelines set forth by the State of Texas in terms of
health and safety of residential centers.

5. How will you ensure that children and caregivers wash their hands as specified in the minimum
standard rules?
Posters in English and Spanish will be posted in every lavatory, and the need to wash hands will
be integrated into the curriculum.

6. How will you ensure that you and your caregivers follow diapering procedures as specified in the
minimum standard rules?
All staff who work with infants and toddlers will receive specific training on how to follow
diapering minimum standards. Specifically, those who care for infants and toddlers will receive
a specific training module specific to this area.

Plan of Operation
Page 7 of 8

7. What is your plan to ensure the safety of children in case of fire or other emergency? Identify the
designated re-location areas in and outside of the operation.
A disaster plan will be implemented to prepare for fire, tornado, or any other natural disaster.
The plan will cite where is the assembly points on campus, or outside of campus. Each house
will have the required number of fire extinguishers, and each facility, school, gym, and office
building will have the required number as well.

A safety committee will be convened that meets monthly, reviews the disaster plan, and ensures
that fire marshalls are in placed, and that the emergency plan is executable at any given time.
The safety committee will also ensure that communication system are fully operational since that
is the main way to coordinate a response.


Plan of Operation
Page 8 of 8
VI. Physical Health and Well-Being

1. What is your plan when a child gets ill or injured while at the operation?
Because of the size of the facility, and the number of children on site, the program plans to hire
doctors, nurses, and caregivers, who will follow protocol for caring for sick or injured children.

2. How will you ensure that medication is given properly?
A registered nurse, and only that individual, will be authorized to dispense medication. That
nurse will be licensed by the State of Texas to meet the required dispensing requirements.

3. How will you ensure that the nutritional needs of the children are met on a daily basis? What
meals will you serve? Will the parents be required to supply any food? If you are serving meals
and snacks, on an attachment provide a sample menu for a week.
The food menu will be created based on state and federal guidelines on nutritional requirements.
The menu will be designed to adhere to that guide. Breakfast, lunch, and dinner will be served.
Snacks in-between meals will be offered that include fruits, juices, and other low-calorie, low-
carb, high protein, high vitamin snacks like yogurt, and nuts.

Parents will not be required to supply food.

Sample menu attached.

Please include any required attachments and any forms or checklists you may use to help you maintain
compliance with the minimum standard rules.

1
Subject: FW: Fax
Attachments: FaxB134.TIF
Cristina Lowenberg
El Paso Texas 79901
Fax : 512/934-9672
From: Suarez,Anna M (DFPS)

Sent: Friday, J uly 18, 2014 12:49 PM
Subject: Fax

1
Subject: FW: Fax
Attachments: Fax45F2.TIF
Cristina Lowenberg
El Paso Texas 79901
Fax : 512/934-9672

Sent: Friday, J uly 18, 2014 12:49 PM
Subject: Fax

1
Subject: FW: Abraham Lincoln / drug testing policy
Attachments: Emergency Behavior Intervention.pdf; Drug Testing Policy.pdf
Cristina Lowenberg
El Paso Texas 79901
Fax : 512/934-9672
From: Sergio Medina [mailto: ]

Sent: Saturday, J uly 19, 2014 10:54 AM
Cc: WATFORD RANCH
Subject: Abraham Lincoln / drug testing policy

Hi Cristina,

Please see attached. We are adopting these policies, and will include them in our policies and procedures with
more specifics before place our first child.

And also, just so you know, we will provide you with a full copy of our Standard Operating Procedures, in one
document, with all required practices that adhere specifically to Texas Code.

Thanks
Sergio

DrugTestingpolicyasrequiredby745.4151oftheTexasAdministratorCode:Whatdrugtestingpolicymustmy
residentialchildcareoperationhave? Your residential child-care operation must either adopt the model drug
testing policy or have a written drug testing policy that meets or exceeds the criteria in the model policy.
Although this policy only covers drugs, coverage of alcohol may be included. The department recommends that
an operation obtain legal advice before adopting and implementing any drug testing policy

2
Emergency Behavior intervention policies: 748.237. What emergency behavior intervention policies must I
develop if the use of emergency behavior intervention is permitted at my operation. At a minimum, you must develop
written emergency behavior intervention policies to implement the requirements in Subchapter N of this chapter (relating
to Emergency Behavior Intervention).
________________________
Sergio Medina

1
Subject: FW: 2819, and revised Plan of Operation
Attachments: 2819.doc; Plan of Operation V2.pdf
Cristina Lowenberg
El Paso Texas 79901
Fax : 512/934-9672

Subject: FW: 2819, and revised Plan of Operation

Hi Cristina,
Firstofseveralemails.
Thanks,
Charles
GOVERNING BODY/ADMINISTRATOR OR EXECUTIVE DIRECTOR
DESIGNATION
Form2819
October 2012

Texas law gives you the right to know what information is collected about you by means of a formyou submit to a state
government agency. You can receive and review this information, and request that incorrect information about you be
corrected by contacting your licensing representative.

SECTION A - GOVERNING BODY DESIGNATION

Name of Operation:
Operation Number:
201-315-5173
Address:
SE Corner of I-10 and FM-1110
Governing Body or Organization Name
ABRAHAM LINCOLN TRANSITIONAL LODGE
701-339-5411
Address: Street City State Zip
Print the Name of Chief Executive Officer or Head of the Governing Body
KELLY HERING CHIEF OPERATING OFFICER
201-315-5173
Name of Designee of Governing Body:

201-315-5173KK
453 South Broadway

I hereby designate the person stated above as official representative (designee) to speak for and act on our
organizations behalf.

I understand that as the permit holder, the governing body is ultimately responsible for maintaining
compliance with the childcare licensing law and minimum standards.
I understand that all waivers and variances must be requested and signed by me or by the designee.
I understand that anytime there is a change in the designee of an operation, the governing body is
responsible for notifying the licensing division.
I understand that the licensing division will notify the governing body and all controlling persons of compliance
documents and remedial action against the operation.

Authorization:

Chief Executi ve Officer, Head of Governing Body or Each Partner (Signature) Title Date

SECTION B - ADMINISTRATOR/EXECUTIVE DIRECTOR DESIGNATION

I (we) hereby designate

Kelly Hering, COO
as administrator OR
executi ve director of

Abraham Lincoln Transitional

located at

SE Corner of I-10 and FM-1110

Authorization:

Signature of Chief Executi ve Officer, Head of Governing Body or Each
Partner, or Designee
Title Date
GOVERNING BODY/ADMINISTRATOR OR EXECUTIVE DIRECTOR
DESIGNATION
Form2819
October 2012

Texas law gives you the right to know what information is collected about you by means of a formyou submit to a state
government agency. You can receive and review this information, and request that incorrect information about you be
corrected by contacting your licensing representative.

FORM 2819
FORM INSTRUCTIONS
GOVERNING BODY/ADMINISTRATOR OR EXECUTIVE DIRECTOR DESIGNATION

PURPOSE OF THIS FORM
This form is an optional form to assist residential operations in reporting changes.

To identify the person appointed by the governing body of a residential operation that is not a sole
proprietorship to act for the governing body in a specified capacity. The designated representative or
designee is the person assigned by the governing body to speak for or act on its behalf.

To designate an administrator of a residential child-care operation, in writing, as required by TAC
748.307(3) and 749.507(2). Independent foster homes may also use this form to notify DFPS of a
change in the executive director.

PROCEDURE
Section A The governing body completes and submits to licensing each time the operation appoints a
designee.

Section B The operation completes and submits to licensing each time the governing body designates an
administrator or executive director of a residential operation.

1
Subject: FW: Fax - fee schedule
Attachments: Fax344E.TIF
Cristina Lowenberg
El Paso Texas 79901
Fax : 512/934-9672

Sent: Monday, J uly 21, 2014 9:48 AM
Subject: Fax - fee schedule

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1

From: Lowenberg,Cristina (DFPS)

From: WATFORD RANCH [mailto:sales@watfordranch.com]

From: WATFORD RANCH [mailto:sales@watfordranch.com]

From: WATFORD RANCH [mailto:sales@watfordranch.com]

From: Suarez,Anna M (DFPS)

From: Suarez,Anna M (DFPS)

From: Sergio Medina [mailto: ]

From: WATFORD RANCH [mailto:sales@watfordranch.com]

From: Suarez,Anna M (DFPS)

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