ADH-CDH Provider

Thank you for your interest in contracting as a vender through Aj's Safe Place as an Adult/Child Developmental Home Provider (ADH/CDH).

An Adult Developmental Home provides support to an adult with developmental disabilities who cannot live with his or her own family. These adults are placed by the Arizona Department of Economic Security’s Division of Developmental Disabilities (DDD) along with strong family involvement to ensure that the adult is receiving the specialized care he or she needs. Adults placed by DDD are usually long term because there is typically a need for a permanent home. The Adult Developmental Home program specifically places adults, ages 18 and older that have been diagnosed with a developmental disability. These developmental disabilities include: Intellectual Disabilities, Cerebral Palsy, Autism and Epilepsy. An Adult Developmental Home may provide support for up to three adults that have a developmental disability.

A Child Developmental Home provides parenting to a child with developmental disabilities who cannot live with his or her own family. These children are placed by the Arizona Department of Economic Security’s Division of Developmental Disabilities (DDD). Children placed by DDD can be temporary or long term. The case plan for many of these children is reunification with their biological family or adoption. The Child Developmental Home program specifically places children, ages 0 to 18 years of age that have been diagnosed with a developmental disability. These developmental disabilities include: Intellectual Disabilities, Cerebral Palsy, Autism and Epilepsy. A Child Developmental Home Provider may provide support for up to three children that have a developmental disability.

Applicants must be at least 21 years of age, pass a prescreening, complete  Developmental Home Provider course work listed below.

We offer equal opportunities to all vendor applicants on the basis of demonstrated ability, experience and training. We take pride in supplying the highest quality direct care providers in the State of Arizona. We are contracted with the State of Arizona and most of our requirements are based on their mandates for being a certified provider. Below is a list of trainings that you must take in order to become certified in the State of Arizona through Aj's Safe Place. If you already have some of these items please provide a copy of the certificates upon request. Again thank you for your interest!

This is a list of trainings that you must take to become an ADH Provider. (Adult: 18-99)

*ADH Orientation to Aj's Safe Place (2 units)
*CPR & Bloodborne Pathogens (4 Units)
*First Aid & Assisting with Medication Administration (4 Units)
*ADH Training

*Cultural Competency (2.5 units)
*Incident Reporting (2 units)
*Article 9 (4 Units)
*Exploring Developmental Disabilities (2.5)
*Habilitation (2 Units)

After you are licensed, you are required to complete 10 hours of Continuing Education each year in order to renew your license.

In consideration of your application for licensure, Aj's Safe Place, and the Office of Licensing, Certification, and Regulation (OLCR) will need you to provide various types of documentation to support your qualifications.

Proof of Income (one of these)
-Pay Stubs -W2-Tax Returns-1099 Form (self-employed)

Proof of Homeowners/Renters Insurance
-Declarations page

Criminal History Declaration (Aj's Safe Place will provide this form)
-Level One AZ Department of Public Safety Fingerprint Clearance Card
-Criminal Self-Disclosure Declaration

Transportation
-Valid Driver’s License (State, License Number, Expiration Date, Restrictions)
-Liability Insurance (Company Name, Coverage Expiration Date)
-Vehicle Registration (Car Year, Make, Model, Vehicle Identification Number, Expiration Date)

Reference (Aj's Safe Place will provide reference forms)
-3 Character References from people who are familiar with you and your family, but who are not related
-1 Employment Reference if you are currently working, or have worked, with children or adults with developmental disabilities.
-School References if you have school aged children (5-17)

Children’s Immunizations
-Immunization Records
-Statement of affiliation with a religion which is opposed to immunizations
-Statement of applicant opposition to such immunizations

Physician’s Statement
-Physician’s Statement (Aj's Safe Place will provide form)
-Health Self Disclosure (Aj's Safe Place will provide form)

Emergency Evacuation Plan
-Emergency Evacuation Plan

We are looking forward to meeting and getting to know you and your family. If you have any questions please do not hesitate to contact Aimie Ayiyi at (602) 570-2306 or AOwens@ajssafeplae.com.

Thank you for taking an interest in our members and making them a part of your family.

Dog Rabies Vaccinations
-Rabies Vaccination Verification (Breed of dog and vaccination expiration date)
-Pet coverage must be listed on Insurance Declarations page specific to breed