Unique In-Home Health Care, LLC

ATTENDANTS QUALIFICATION FOR HIRE

The Attendant, ___________________________________________ meets the following
minimum qualifications as a Personal Care Attendant:

1. Are you at least 18 years of age? Yes No

2. Are you able to meet the physical and mental demands required to perform specific tasks
required by a particular consumer? Yes No
3.
4. Do you agree to maintain confidentiality? Yes No

5. Are you emotionally mature and dependable? Yes No

6. Able to handle emergency type situations? Yes No



_________________________________________ ___________
Attendant Signature Date








Unique In-Home Health Care, LLC


ATTENDANT TRAINING

I. Welcome/Introduction of Staff/General Orientation
II. Agency Policies
A. Operation of Business
B. Personnel File Completion
C. State of non-family member relationship
D. Application Process
E. Processing of consumers and/or attendants inquiries and problems
F. After office hours emergencies
III. Payroll:
A. Timesheets, documentation and pay schedule
B. Attendance/absentee/tardy, scheduling & availability
C. Preparation of time sheets, documentation and submission to vendor
D. Allowable and non-allowable tasks
E. Utilization of units and monthly monitoring
F. Preparation of bi-weekly time sheets- signed by both consumer and
attendant




Unique In-Home Health Care, LLC


EMPLOYEE DATE OF HIRE

ATTENDANTS NAME: ____________________________________________________________
POSITION: ____________________________________________________________________
ADDRESS: _____________________________________________________________________
CITY: ____________________________________ STATE: __________ ZIP: _______________
PHONE NUMBER: ____________________________ CELL: ____________________________
DATE OF FIRST CLIENT CONTACT: __________________________________________________
DATE OF HIRE: _________________________________________________________________
TERMINATION DATE: ____________________________________________________________
REASON FOR TERMINATION:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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Unique In-Home Health Care, LLC


DRUG FREE WORKPLACE POLICY
The provisions of this Drug Free Workplace policy states that it is unlawful to manufacture,
distribute, dispense, possess, or use any controlled substance on the premises of the
workplace, including parking areas.

POLICY:
The policy of Unique In-Home Health Care LLC is to maintain an alcohol and non-prescription
drug-free workplace. Unlawful manufacture, use, possession or distribution of alcoholic
beverages and controlled substances is prohibited.
Attendants who violate this policy are subject to disciplinary action including suspension or
termination. An employee will be required to submit alcohol and drug testing if the agency has
reasonable cause to believe that the employee is under the influence of alcohol or an illegal
drug while on the job and/or in the workplace. Reasonable cause is based on objective,
observable behavior, speech, odors or physical impairment. The supervisor will escort the
employee right away to the doctor for testing the same day. Refusal to test or any attempt to
frustrate the test will be grounds for termination of employment. A positive drug or alcohol
test will result in termination of employment for the Attendant.
While waiting for alcohol/drug testing results, an employee will be suspended from work
without pay. If results of the test are negative, no adverse action will be taken. Alcohol and
drug testing required of the agency will be paid at the attendants expense. Results of testing
will remain confidential.
If an attendant is convicted of a criminal alcohol/drug statue violation occurring in contracting
federal agency, the Attendant must notify their supervisor immediately. The notification
requirement is the same for employees who receive a suspended sentence or probation. Any
Attendant who is convicted under a drug statue, will be subject to disciplinary action up to and
including termination. Attendants, may at his or her own expense also be required to
successfully complete a drug abuse assistance or rehabilitation program approved for such
purpose by a federal, state or local health, law enforcement or other appropriate agency, in
addition to, or lieu of, disciplinary action.
_________________________________________ ___________
Attendant Signature Date
Unique In-Home Health Care, LLC


EMPLOYEE EDL VERIFICATION REQUEST

Verification Number: 573-522-2448

Verification Web:


Employee Name: _______________________________________________________________


Social Security #: ________________________________________________________________


Confirmation Number: _______________________________________ Date: ______________













Unique In-Home Health Care, LLC


EMPLOYEE FAMILY CARE SAFETY REGISTRATION FEE

To all employees:
If you are not registered with the Family Care Safety Registry, you must register. There will be a
ten dollar ($10.00) registration fee for employees to register. If not paid at the time of hire,
Unique In-Home Health Care, LLC will deduct ten dollars ($10.00) from your first paycheck.
By my signature, I understand that Unique In-Home Health Care, LLC will deduct the
registration fee from my first paycheck.


_________________________________________ ___________
Employee Signature Date











Unique In-Home Health Care, LLC


CONSUMER EXPECTATIONS
Consumers Are Expected To:
Explain tasks as outlined in care plan supplement, that they want completed.
Provide cleaning supplies.
Sign completed time sheet each time the Attendant provides services.
Ensure that information on the sheet is accurate.
Notify the provider/Attendant in advance when they cant be home for scheduled visit.
Notify the provider/vendor if there are problems with services.
Accept or select the Attendant without regard to race, color, national origin, sex,
religion, political beliefs, or disability.
Consumers Have The Right To:
Appeal the agencys decision regarding the care plan, or denial, reduction or
termination of services within ninety (90) days of the date of the decision.
Request a hearing within ten (10) days of the notice if they wish to continue receiving
services pending the hearing.
If the agencys decision is upheld, you (Consumer) may be held responsible for the cost
of any services received while the appeal is pending.
Receive services without regard to race, color, national origin, sex, religion, political
beliefs, or disability.
Consumers May NOT:
Threaten or abuse or allow other members of the household to threaten or abuse the
aide/attendant or vendor or vendor staff (physically, verbally or sexually). This will
result in services being terminated.
Expect the aide/attendant to service your pets, friends or visitors.
Allow services to be provided in the participants home without being present. (Engage
in activities that would be considered fraud of the program; for example: falsifying time
sheets)


Unique In-Home Health Care, LLC

CONSUMER EXPECTATIONS continued

Participants in the Agency option:
May expect the aide/attendant to:
Act in a professional manner
Be on time for scheduled visits
Notify you if they are unable to deliver services
Arrange a make-up visit satisfactory to you

May NOT expect the aide/attendant to:
Accept food or drink, except water
Accept gifts or tips
Give you a ride
Be a maid

Participants in the Consumer-directed option are expected to:
Select, hire, fire, train and supervise the attendant
Prepare timesheets and submit bi-weekly to the vendor
Ensure that units of service delivered to not exceed those authorized
Use only attendants who are registered, screened and employable pursuant to the
Family Care Safety Registry (FCSR), Employee Disqualification List (EDL), and applicable
state laws and regulations.


BY MY SIGNATURE, I FULLY UNDERSTAND THE CONSUMER EXPECTATIONS.


_________________________________________ ___________
Attendant Signature Date


Unique In-Home Health Care, LLC


CONSUMER RIGHTS AND RESPONSIBILITIES
Consumers are expected to:
1. Select, hire, train and supervise the attendant
2. Use only attendants who are registered, screened and employable pursuant to the
Family Care Safety Registry (FCSR), Employee Disqualification List (EDL), and applicable
state laws and regulations.
3. Prepare timesheets and submit bi-weekly to the vendor
4. Explain tasks that are to be completed
5. Sign and complete time sheets each time the attendant provides services
6. Select an Attendant without regard to race, color, national origin, sex, religion, political
beliefs, or disability
Consumers may not:
1. Threaten or abuse the aide/attendant or vendor staff (physically, verbally or sexually).
2. Engage in activities that would be considered fraud of the program
Consumers have the right to:
1. Appeal the agencys decision regarding the care plan, or denial, reduction or
termination of services within ninety (90) days of the date of the decision.

You must request a hearing within ten (10) days of the notice if you wish to continue
receiving services pending the hearing decision. If the agencys decision is upheld, you
may be held responsible for the cost of any services received while the appeal is
pending.

2. Receive services without regard to race, color, national origin, sex, religion, political
beliefs, or disability.

BY MY SIGNATURE, I FULLY UNDERSTAND THE CONSUMER RIGHTS.
_________________________________________ ___________
Attendant Signature Date

Unique In-Home Health Care, LLC


INQUIRIES AND PROBLEMS
If Personal Care Attendants have a complaint, he/she may file the complaint with the
Supervisor, who will then forward it to the Administrator. An investigation of the complaint will
be initiated immediately and will proceed with the following steps:
The Administrator will address the complaints and attempt to solve the problem or
differences.
The administrator will discuss the problem with the person filing the complaint or with
the consumer and, if necessary, the attendant providing the services.
The Administrator will make a decision and report back to the person filing the
complaint.
If warranted, the Administrator may conduct an investigation to gather information pertinent
to the complaint. Complaints will be handled as quickly and confidentially as possible. The
Administrator will make a final decision disposition of the complaint. Depending on the
seriousness of the complaint, a written response will be issued within 15 days of the complaint
notice.
Non-Retaliation Clause: No one will be intimidated, harassed, threatened, or suffer any
penalty because you file a complaint. Law prohibits any penalty or reprisal against involved
persons.


_________________________________________ ___________
Attendant Signature Date






Unique In-Home Health Care, LLC


ATTENDANT RIGHTS AND RESPONSIBILITIES

All Attendants must follow these rules and responsibilities to:
1. Comply with applicable state laws and regulations regarding reports of abuse and
neglect and/or exploitation.
2. Not commit any acts of abuse, neglect or exploitation.
3. Not take anything from the consumers home (stealing).
4. Be hired, trained and supervised by the consumer.
5. Not consume any alcoholic beverages or use medication or drugs for any purpose other
than medical, in the consumers home prior to service delivery.
6. Be registered, screened and employable pursuant to the Family Care Safety Registry,
Employment Disqualification List and applicable state laws and regulations.
7. Sign and complete daily time sheets each time you provide services.
8. Notify the vendor if you have problems
9. Not to provide services when the consumer is in the hospital.
10. Not engage in activities that would be considered fraud of the program (for example-
falsifying timesheets)
11. Not provide services to consumers pets, friends or visitors.
12. Not provide services in the consumers home without them being present.
13. Act in a professional manner.
14. Be on time for scheduled visits.
15. Notify the consumer if they are unable to deliver services.
16. Arrange a make-up visit satisfactory to the consumer.
17. Not accept food or drink, except water.
18. Not accept gifts or tips.
19. Not be a maid.

_________________________________________ ___________
Attendant Signature Date


Unique In-Home Health Care, LLC


WORKING FOR IMMEDIATE FAMILY MEMBERS

Personal Care Attendant Release of Family Member Relationship

The Department of Senior Service rules and regulations prohibit the spouse of the consumer
from being the personal care attendant for the consumer.

I, __________________________________________________, fully understand that I am not
to render services nor accept a consumer assignment for my spouse.


_________________________________________ ___________
Attendant Signature Date











Unique In-Home Health Care, LLC


ABUSE AND NEGLECT POLICY

It is the Attendants responsibility to comply with all applicable state laws and regulations
regarding reporting all instances of abuse or neglect.

Division of Health and Senior Services Abuse/Neglect Hotline: 1-800-392-0210

Child Abuse Hotline: 1-800-392-3738


Policy

Abuse/Neglect is strictly Prohibited.
(1).The following words and terms, as used in this rule mean:

(A) Class I neglect failure of an employee to provide reasonable or necessary services to
maintain the physical and mental health of any consumer when that failure presents
either imminent danger to the health, safety or welfare of a consumer, or a substantial
probability that death or physical injury would result;

(B) Class II neglect failure of an employee to provide reasonable or necessary services to a
consumer according to the individualized treatment or habilitation plan, if feasible,
according to acceptable standards of care. This includes action or behavior, which may
cause psychological harm to a consumer due to intimidating, causing fear or otherwise
creating undue anxiety

(C) Medications
Medication Error- a mistake in prescribing, dispensing or administering medications. A
medication error occurs if a consumer received an incorrect drug, drug dose, dosage
form, quantity, route, concentration or rate of administration. This includes failing to
administer the drug or administering the drug on an incorrect schedule. Levels of
medication errors are:
1. Minimal medication error is one in which the consumer experiences no or
minimal adverse consequences and receives no treatment or intervention other
than monitoring or observation.
2. Moderate medication error is one in which the consumer experience short-term
reversible adverse consequences and receives treatment and or intervention in
addition to monitoring or observation; and


Unique In-Home Health Care, LLC

ABUSE AND NEGLECT POLICY cont.

3. Serious medication error is one in which the consumer experience life
threatening and/or permanent adverse consequences or results in
hospitalization.

Serious medication errors may be considered abuse or neglect and shall be
subject to investigation by the Department of Mental Health.

(D) Misuse of funds/property, the misappropriation of conversion, for any purpose, of a
Consumers funds or property by an employee or employees with or without the
consent of the consumer.

(E) Physical abuse
1. An employee purposefully beating, striking, wounding or injuring any consumer;
2. In any manner whatsoever, an employee mistreating or maltreating a consumer
in a brutal or inhumane manner. Physical abuse includes handling a consumer
with any more force than is reasonable for a consumers proper control,
treatment or management.

(F) Sexual abuse, any touching, directly or through clothing, of a consumer by an employee
for sexual purpose or in a sexual manner. This includes but is not limited to:
1. Kissing
2. Touching of the genitals, buttocks, or breast
3. Causing a consumer to touch the employee for sexual purposes
4. Promoting or observing for sexual purpose, any activity or performance involving
consumers including any play, motion picture, photography, dance or other
visual or written representation;
5. Failing to intervene or attempting to stop inappropriate sexual activity or
performance between consumers; and/or
6. Encouraging inappropriate sexual activity or performance between consumers

(G) Verbal abuse, an employee using profanity or speaking in a demeaning, non-
therapeutic, undignified, threatening or derogatory manner to a consumer or about a
consumer in the presence of a consumer.



_________________________________________ ___________
Attendant Signature Date

Unique In-Home Health Care, LLC


TIME SHEET POLICY

I understand that my attendant cannot be paid for time while I am in the hospital. Falsification
of time sheets constitutes Medicaid fraud.
The policy of Unique In-Home Health Care LLC is to report all suspected fraud to the
Department of Health and Senior Services. Daily timesheet falsification will cause you to lose
your services.
Timesheets must be signed daily by the consumer and the attendant and kept at the
consumers residence.
Signatures verify that all dates and times entered are true and accurate.
This form MUST be signed and dated.

I have read the above and fully understand the policies:


_________________________________________ ___________
Attendant Signature Date








Unique In-Home Health Care, LLC


HIPAA STATEMENT


_________________________________________
Attendant Name (PRINT)


I have been advised that all consumer information, including personal and medical information
may not be discussed with anyone other than those persons who have proper authorization.

I fully understand that my disclosure of any of this information is a cause for immediate
termination.


_________________________________________ ___________
Attendant Signature Date