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35 <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 /> Signature Title <br /> Agency/Organization Date <br /> (Certification signature should be same as Contract signature.) <br /> Outcomes (06/18) Page 2 of 2 <br />