Fillable LICENSING CORRECTIVE ACTION PLAN (CAP) (Connecticut Office of Early Childhood)

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LICENSING CORRECTIVE ACTION PLAN (CAP) (Connecticut Office of Early Childhood)

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Page _____ of _____
LICENSING CORRECTIVE ACTION PLAN (CAP)
NAME OF CAMP: ___________________________________________________ LICENSE #: ________________ FILING TOWN: __________________________
LOCATION ADDRESS: ___________________________________ TOWN: __________________________ INSPECTION REPORT DATE: __________________
CAPs submitted that do not conform to the instructions provided on the back will not be accepted. Read the instructions carefully before completing this form. In accordance
with this agency’s policy, your CAP will be posted online and made accessible to parents and others seeking information pertaining to your camp program.
Inspection Report
Item # or
Regulation
Corrective Action Taken
NOTE: Your response should include a clear concise explanation of the changes the program has made
to correct the violation to ensure compliance.
Exact Date
Corrected
Check if
Accepted
(OEC Use
Only)
Based on the inspection report, the licensee was cited for failure to comply with the regulations listed above. I hereby declare that the licensee has complied with the regulation(s)
in the above manner. I understand the Agency reserves the right to re-inspect the above program to verify compliance with the regulations and to request a meeting with the
licensee when necessary to review patterns of non-compliance. Understanding the penalties for false statements, I attest that the information I submit on this form is true.
Operators/Owners are required by regulations and statutes to be in compliance at all times.
By checking this box, and typing my name below, I am electronically signing my CAP. RETURN TO:
Connecticut Office of Early Childhood
Signed: _______________________________________________ _______________ 450 Columbus Blvd, Suite 302
(Owner/Director) (Date) Hartford, CT 06103
Email: youthcamps@ct.gov
Owner/Director’s Cell Phone #: ________________________
Please see the reverse side for guidance in completing this CAP, sample CAPs and instructions for Resolving Disputed Violations
Page _____ of _____
NAME OF CAMP: _________________________________________________________ LICENSE #: _________ INSPECTION REPORT DATE: _____________
Inspection Report
Item # or
Regulation
Corrective Action Taken
NOTE: Your response should include a clear concise explanation of the changes the program has made
to correct the violation to ensure compliance.
Exact Date
Corrected
Check if
Accepted
(OEC Use
Only)
Based on the inspection report, the licensee was cited for failure to comply with the regulations listed above. I hereby declare that the licensee has complied with the
regulation(s) in the above manner. I understand the Agency reserves the right to re-inspect the above program to verify compliance with the regulations and to request a
meeting with the licensee when necessary to review patterns of non-compliance. Understanding the penalties for false statements, I attest that the information I submit
on this form is true.
By checking this box, and typing my name below, I am electronically signing my CAP.
Signed: _______________________________________________ _______________
(Owner/Director) (Date)
Please see the reverse side for guidance in completing this CAP, sample CAPs and instructions for Resolving Disputed Violations
Instructions for Completing an Acceptable Corrective Action Plan (CAP)
How a violation(s) was corrected must be included; statements shall not simply indicate that corrections are “done” or “will be fixed”
Copies of documents may be attached but the CAP must still describe what has been done to correct the violation(s); attached documents are only required when
specifically requested by OEC staff
Personally identifiable information such as children’s names, initials or dates of birth shall not be included
The date the violation was corrected must be listed
In cases where a permanent correction is not immediately possible, how and when the violation will be corrected and what immediate temporary measures have been put
in place should be identified
Statement must be easy to read
Sample CAPs:
All staff/camper health records are now current and on site
A current fire marshal certificate has been obtained
Medication(s) along with the authorized prescriber’s orders and parent permission are on site for the campers who need medication
All medications have been removed from the first aid kit
Written first aid instructions have been signed and dated by the camp physician/APRN
Medication was placed in the original container and is stored locked
A current food inspection report has been obtained
All perishables are adequately refrigerated
All medication authorization forms have been signed, corrected, updated and are now on file at the camp
The individual care plan has been signed by all staff responsible for the child’s care and by the child’s parent
The physician/APRN has signed off on all cases in the abstract record. Once a week all cases in the abstract record will be reviewed and signed off by the
physician/APRN
Written policies and procedures governing the archery range have been developed, are on site at the camp and have been implemented
The equipment and supplies specified in the first aid instructions are now on site at the camp
The individual care plan has been signed by all staff responsible for the child’s care and by the child’s parent
Whenever swimming activities are occurring, there will be a staff person at the pool who possesses current and acceptable lifeguard and CPR certifications
Resolving Disputed Violations
If you are cited for a violation of the youth camp licensing regulations and you do not understand the violation or why you were cited, you should:
Ask the inspector to explain the violation, and show you which regulation was violated.
If you still disagree that there is a violation of a regulation, you may ask for a supervisory review. You may call (860) 500-4450 and ask to speak with the youth camp
supervisor or in the case of a complaint investigation, ask to speak with the supervisor of the investigations unit.
If you still wish to dispute the violation after a supervisory review, you may contact the Agency at (860) 500-4450 and request a managerial review. The manager will
decide if the evidence shows a violation exists.
An Operator/Owner may request a formal hearing only when the Agency issues a statement of charges and the licensee wishes to contest a proposed action against the
license.
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LICENSING CORRECTIVE ACTION PLAN (CAP) (Connecticut Office of Early Childhood)

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Completed 23 March 2021

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