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<br />Contract-Scope of Work (06/04) Page 1of 3 <br />ATTACHMENT B <br />SCOPE OF WORK <br /> <br />Orange County Department of Social Services and Department on Aging <br /> <br /> Federal Tax Id. or SSN__56-2460614__________ <br />Contract # _68-2073__________________ <br /> <br />A. CONTRACTOR INFORMATION <br />1. Contractor Agency Name: Senior Care of Orange County, Inc. <br />2. If different from Contract Administrator Information in General Contract: <br />Address <br /> _______ ___ ______ <br />Telephone Number: _ Fax Number: Email: <br />3. Name of Program (s): Adult Day Health Service <br />4. Status: ( ) Public (X) Private, Not for Profit ( ) Private, For Profit <br />5. Contractor's Financial Reporting Year July 1, 2022 through June 30, 2023 <br /> <br />B. Explanation of Services to be provided and to whom (include SIS Service Code): <br /> <br />The North Carolina Division of Social Services (SIS) User’s Manual provides Service Codes and <br />Definitions for the DSS 5027 and 4263. The Contractor will provide Day Health Services for <br />Adults (SIS Code 155) and Day Care Services for Adults (SIS Code 030) to clients of the Orange <br />County Department of Social Services (DSS) and Department on Aging (DOA). Services will be <br />authorized via the DSS 5027 and the DOA Purchase of Service Authorization form. Such services <br />will include: <br /> <br />155 – Day Health Services for Adults: Daily care means the provision of an organized program <br />of services during the day in a community group setting for the purpose of supporting an adult’s <br />personal independence, and promoting his/her social, physical, and emotional well-being. <br />Services must include a preadmission health assessment; assistance with activities of daily living <br />including feeding, ambulation, or toileting as needed by individual participants; health care <br />monitoring of each participant’s general health and medical regimen, which includes <br />documenting the periodic assessment of the vital signs, weight, dental health, general nutrition, <br />and hygiene of each participant; documenting and reporting changes in health status to caretakers; <br />assistance to participants and caretakers with medical treatment plans, diets, and referrals as <br />needed; health education programs for all participants and health care counseling tailored to meet <br />the needs of participants’ admission to day health and periodically thereafter when not otherwise <br />available without cost, food and food services to provide a nutritional meal and snacks as <br />appropriate to the program. Services must be provided in a home or center certified to meet State <br />Standards for adult day health or combination of adult day care/adult day health. <br /> <br />030 – Day Care Services for Adults: Daily care means the provision of an organized program of <br />services during the day in a community group setting for the purpose of support adults’ personal <br />independence, and promoting their social, physical, and emotional well-being. Services must <br />include a variety of program activities designed to meet the individual needs and interests of the <br />participants, and referral to and assistance in using appropriate community resources. Also <br />DocuSign Envelope ID: 113F180E-1B72-48F8-A6EB-7BD2F8A4E76A