FORM H1607




ArchiveTo determine if participating providers are in compliance with the Child and Adult Care Food Program regulations.

The following areas are reviewed during the monitoring review:

·  meal service and analysis;

·  meal service requirements;

·  record keeping;

·  training;

·  five-day reconciliation of meal counts with enrollment and attendance records;

·  household contacts; and

·  civil rights.


When to Prepare

Complete Form H1607 for each monitoring review conducted and not less frequently than three times per year for each day care home (unless monitoring system used is averaging, then provider may only have 2 reviews or may have 4 reviews).

Number of Copies

Complete two copies.


Keep one copy of the form in the program files and give one copy to the day care home provider.

How to Obtain Copies

Make additional copies as needed or download Form H1607 from the SNP website at

Form Retention

Sponsoring Organizations must keep copies of Form H1607 for three years and 90 days from the end of the Program Year. Exception: If audit findings, claims, or litigation has not been resolved by the end of the retention period, all forms and records must be retained until all issues are resolved.


All findings will require technical assistance and corrective action, and may result in disallowances and an amended claim.

Complete all entries on top section of the form. Entries are self-explanatory, except the following:

Reason for Review —

Monitoring – This box is marked for all monitoring reviews that are complete (Form H1607 is completed).

Block Claim – This box is marked if the monitoring review is triggered by a block claim. If a complete monitoring review is conducted, mark the monitoring box also.

Type of Review —

Announced – This box is marked if the monitoring review is scheduled with the center in advance.

Unannounced –This box is marked if the center is not informed of the monitoring review in advance. All monitoring reviews triggered by a block claim must be unannounced.

Monitor Name — The monitor must be a member of the sponsor's administrative staff.

A.     Time of Meal Service

List the approved times for each meal service as indicated on the latest approved Form H1537.

B.     Attendance/Enrollment

List the name of all children in attendance or enrolled on the day of the review. Other items are self-explanatory.

C.    Meal Service/Analysis

Complete the meal analysis for the meal observed, based on the CACFP meal patterns. Refer to the CACFP-DCH Handbook for required quantities.

D.    Meal Service/Analysis

Complete the meal analysis for the meal observed, based on the CACFP meal patterns. Refer to the CACFP-DCH Handbook for required quantities.

E.     Meal Service/Analysis Requirements

1.      Observe the type of meal service implemented, refer to Section 4116 of the DCH Handbook for more information on family style and unit (cafeteria) style service.

2.      Self-explanatory.

3.      Self-explanatory.

4.      Examine applicable Form H1539 and Form H1530-A for the month being reviewed. Are they completed on a daily basis?

5.      Review the month's menus. If substitutions occurred were they documented correctly?

6.      The start and end time for the meal observed should fall within the time range provided on Form H1537.

7.      Review Form H1539 to determine if the correct number of meals/snacks are claimed per child.

8.      Self-explanatory. Providers may claim infant meals that consist of just breast milk or contain at least one component supplied by the provider. If the mother comes to the provider's home to breast feed, the meal is not reimbursable unless the provider supplies other components of the meal pattern.

9.      Request to see any doctors' statements on file and documentation that they are serving the required diet to the child(ren).

10. Are variations in meal patterns documented and approved by SNP? See CACFP-DCH Handbook Section 4112.3 for further information and guidance.

11. Request to see any statements on file for infants whose parent(s) have declined the formula the provider offers.

F.     Record Keeping

1.      Self-explanatory.

2.      Review enrollment forms, or enrollment documentation, to determine if they are no more than 12 months old and contain the following elements:

§  child's name;

§  child's date of birth;

§  enrollment/withdrawal date;

§  days and hours the child is normally in care;

§  meals/snacks normally served to the child while in care;

§  parent/guardian's signature;

§  date of signature.

3.      Review Form H1539 to determine if attendance is taken daily.

4.      Review Form H1539 to determine if meal counts are recorded daily.

5.      Review Form H1607 from the previous monitoring review. If problems were identified, have they been corrected?

6.      Review the WIC information to determine if it is the latest available from HHSC. Leave WIC and Building for the Future brochures for the provider to post and supply to each household.

G.    Training

Refer to CACFP-DCH Policy Alert 2006-6, New Training Requirements for Sponsoring Organizations.

H.     Five-Day Reconciliation

Refer to CACFP-DCH Policy Alert 2006-9, Five-Day Reconciliation of Meal Counts for Sponsoring Organizations, for information on the five-day reconciliation process and procedures.

Worksheet: Complete the worksheet prior to answering the questions.

o Name of Provider, Facility number, Name of Sponsor, Program number and Month/Year of review – Self-explanatory.

o Child's name – Enter the name of child enrolled in day care home - one space for each child.

o Normal Hours in Care, Normal Days in Care, Normal Meals Child will Receive – These items will be obtained from the child's current enrollment form or enrollment documentation.

o Day/Date – Fill in these boxes to indicate the five day period chosen for the five-day reconciliation.

o At? Y/N – Indicate if the child listed is present on the day/date listed.

o Meals claimed – These items will be obtained from the provider's claim for the days/dates chosen for the five-day reconciliation. B = Breakfast, A = AM Snack, L = Lunch, P = PM Snack, S = Supper, E = Evening Snack.

o Comments – Use this section to indicate any discrepancies and explanations provided.

Once the worksheet has been completed return to the form and answer questions 1 through 3 in section H.

I. Civil Rights

1.      Observe the practices of the provider during the monitoring review. Is there any evidence that children are being discriminated against based on their race, color, national origin, sex, age or disability?

2.      If the answer to this question is no, the provider is not in compliance with civil rights. The sponsor must obtain immediate corrective action from the provider and provide additional civil rights training.

3.      Ask the provider to explain the civil rights complaint procedure. If the provider is unable this could be an indication that technical assistance or additional training is required.

4.      Ensure you have provided written civil rights complaint procedures to the provider to distribute to parents. Ensure the provider understands he/she is required to distribute the information.

J.      Findings and Recommendations

1.      List all the findings. Provide technical assistance for each finding. If meals are going to be disallowed inform the provider.

2.      Recommendations: If there are findings, identify the corrective action required and the due date that it must be satisfactorily completed.

K.     Signature

Upon completion of the review the monitor must share the review results, findings and recommendations with the provider. Both must sign and date to acknowledge completion of the review.