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13 <br />Standard Assurance to Comply With Older Americans Act <br />Requirements Regarding Client Rights <br />for <br />Agencies Providing In-Home Services through the <br />Some and Community Care Block Grant for Older Adults <br />As a provider of one or more of the services listed below, our <br />agency agrees to notify all Home and Community Care Black Grant <br />clients receiving any of the below -listed services provided by <br />this agency of the their rights as a service recipient. Services <br />included in this assurance include: <br />-In-Home Aide <br />Home Care (home health) <br />-Housing and Home Improvement . <br />-Adult Day Care or Adult Day Health Gare <br />Notification will include, at a minimum, an oral review of the <br />information.outlined below as well as pro riding each service <br />recipient with a copy of the information in written form. In <br />addition, providers of in-home services will establish a procedure <br />to document that client rights information has been discussed with <br />in-home services clients (e.g. copy of signed Client Bill of <br />Rights statement). . <br />Client Rights information to be communicat6d to service recipients <br />will include, at .a minimum, the right to: <br />-be fully informed, in advance, about each in-home <br />service to be provided and any change in service(s) <br />that may affect the well-being of the participant; <br />-participate in planning and changing any in-home service <br />provided unless the client is adjudicated incompetent; <br />-voice a grievance with respect to service that is or fails <br />to be provided, without discrimination ar reprisal as a <br />result of voicing a grievance; <br />-confidentiality of records relating to tl~e individua?; <br />-have property treated with respect; and <br />-be fully informed both orally and in writing, in advance <br />of receiving an in-home service, of the individual's rights <br />and obligations. <br />Client Rights will be distributed to, and discussed with, each .new <br />client receiving, one or more of the above listed services prior to <br />the on-set of service. For all existing clients, the above <br />information sill be provided no later than the next regularly <br />scheduled service reassessment. <br />Agency Name: __ Orange County~~j- ~,_Qn Acring <br />Name of Agency Administrator: Derr M. Passmore <br />Signature: ~ar~~. ___ Date: a~ <br />(Please return the this farm to your Area Agency an Aginc and <br />retain a copy for your files.) <br />