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Outcomes (06/18) Page 2 of 2 <br />c. A quarterly on site home visit by RN made at least every 3 months and an annual visit. <br />Aide must be observed in performance of duties. <br />d. A telephone contact made with aide and client/designated person by RN during non- <br />quarterly review month. <br />e. The provider agency will assure that competency testing is appropriately administered. <br />The aide will demonstrate the tasks before the RN and competency testing reflects the <br />task and the knowledge required of the aide. A check list may be used. The date of <br />competency testing is documented and signed off on by the RN and by the aide who is <br />being competency tested. <br />f. The provider agency will assure that the aide has sufficient training to pass a <br />competency test for the level of service provision requested. The provider agency will <br />have written documentation of the competencies completed, trainings completed, etc. <br />All information will be dated and signed by RN. <br />g. Provider agency will comply with all necessary documentation needed by Orange <br />County Department of Social Services including but not limited to an assessment <br />addressing the following areas: social, environmental, activities of daily living, <br />instrumental activities of daily living, economic, physical, and mental. <br />h. RN will document information regarding economic status at least quarterly. (For <br />example: Client has sufficient income to meet current needs.) <br />i. RN will participate in and sign Orange County DSS In-Home Aide Service Plan. <br />j. RN will participate in and sign Orange County DSS Adult Services Functional <br />Assessment. <br />M. Protective Service In-Home Aide requests are to be staffed within 24 hours and the hours to be <br />worked are to be strictly adhered to. Referral acceptance by the Contractor is conditional on <br />worker availability. The Contractor will notify the County within two hours if the request <br />cannot be honored. <br />N. Provide backup service when a client’s usual In-Home Aide is unavailable. <br />O. High Risk In-Home Aide Service requests are to be staffed within five days. All other requests <br />are to be filled within ten working days of the request. <br />P. Changes in the service hours are to be made by the County. Requests for changes may be made <br />by the Contractor, but are not finalized until notification is given by the County. <br />Q. The Contractor will immediately notify the County when Protective Services Cases are not <br />staffed, when In-Home Aide workers are absent, and/or when any of the following occur: <br />a. The client dies. <br />b. The client enters a rest home, nursing home, or hospital. <br />c. The client moves from the original address on the request. <br />d. The client refuses to accept the services or to comply with care requirements. <br />e. There are significant factors that affect the client or significant changes in a client’s <br />situation. <br /> <br /> <br /> <br />___________________________________ ____________________________________ <br />Signature Title <br /> <br /> <br />___________________________________ ____________________________________ <br />Agency/Organization Date <br /> <br /> <br />(Certification signature should be same as Contract signature.) <br />DocuSign Envelope ID: 04F36197-9976-45D7-BDCC-F429CFE8B0F9 <br />Angency Director <br />1/16/2024Beautiful Remissions LLC