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<br /> <br /> <br />Contract-Scope of Work (7-2008) Page 1of 2 <br />ATTACHMENT B – Scope of Work Federal Tax Id. or SSN 56-2460614 <br /> Contract # 68-2096 <br />A. CONTRACTOR INFORMATION <br />1. Contractor Agency Name: Senior Care Of Orange County, Inc. dba SOLTYS PLACE <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 care services <br />4. Status: Public Private, Not for Profit Private, For Profit <br />5. Contractor's Financial Reporting Year January through December <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 <br />Codes and Definitions for the DSS 5027 and 4263. The Contractor will provide Day <br />Health Services for Adults (SIS Code 155) and Day Care Services for Adults (SIS Code <br />030) to clients of the Orange County Department of Social Services (DSS) and <br />Department on Aging (DOA). Services will be authorized via the DSS 5027 and the <br />DOA Purchase of Service Authorization form. Such services will include: <br /> <br />155 – Day Health Services for Adults: Daily care means the provision of an organized <br />program of services during the day in a community group setting for the purpose of <br />supporting an adult’s personal independence, and promoting his/her social, physical, and <br />emotional well-being. Services must include a preadmission health assessment; assistance <br />with activities of daily living including feeding, ambulation, or toileting as needed by <br />individual participants; health care monitoring of each participant’s general health and <br />medical regimen, which includes documenting the periodic assessment of the vital signs, <br />weight, dental health, general nutrition, and hygiene of each participant; documenting and <br />reporting changes in health status to caretakers; assistance to participants and caretakers <br />with medical treatment plans, diets, and referrals as needed; health education programs <br />for all participants and health care counseling tailored to meet the needs of participants’ <br />admission to day health and periodically thereafter when not otherwise available without <br />cost, food and food services to provide a nutritional meal and snacks as appropriate to the <br />program. Services must be provided in a home or center certified to meet State Standards <br />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 <br />program of services during the day in a community group setting for the purpose of <br />support adults’ personal independence, and promoting their social, physical, and <br />emotional well-being. Services must include a variety of program activities designed to <br />meet the individual needs and interests of the participants, and referral to and assistance <br />in using appropriate community resources. Also included are medical examinations <br />required for individual participants for admission to day care and periodically thereafter <br />Docusign Envelope ID: C9194704-21CD-4866-9E25-A9ED83A9530F