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• - LOCATION OF <br /> SERVICE: Any of these: <br /> 1. Rome of the patient <br /> P. Offices or training location of the service <br /> providing agency <br /> 3. Licensed domiciliary home or family care home <br /> ACCESS TO SWIM Patient and/or caregiver may be referred by self , <br /> physician, family members , friend or other service <br /> provider. <br /> Referral accompanied by name, address, and phone number, <br /> if available, of applicant. <br /> PELTVERT <br /> CHARACTERISTICS: The specific services to be provided shall be <br /> determined by an appropriate professional staff <br /> member (e.g. , registered nurse, social worker, home <br /> economist, etc.) <br /> ▪ An appropriate in-home assessment shall Fe made and <br /> documented within ten (10) days of referral. <br /> ▪ All contacts must be documented. <br /> ▪ An emergency contact person identified and <br /> maintained on each participant. <br /> ▪ A monitoring contact will be made at least quarterly <br /> to each service recipient during the period. <br /> $TAFFIVG <br /> )tE4l'IREMENTS : The provider shall assure supervision of all respite <br /> care workers. <br /> • All respite aides shall be at least eighteen (18) <br /> years of age and older. <br /> • Ability to follow oral and written instructions and <br /> keep necessary records. <br /> • Understanding of care of disabled , ill or <br /> convalescing people. <br /> • Staff assignments shall be determined by the level <br /> of, care needed (e.g. , chore, homemaker, registered <br /> nurse) . <br /> ▪ Assigned staff must have the appropriate training to <br /> provide services to a given client. <br /> 7ROHIMITED E RVICg <br /> ACTIVITIES: Accepting gifts <br /> ▪ Landing or borrowing money or articles <br /> • Minor home repairs <br /> • Pet grooming <br /> ▪ Yard maintennnce <br /> • Heavy household cleaning (cleaning closets, washing <br /> walls) <br /> 9 <br />