Opportunity Homes, Inc. Service Guide

Contents: Page 1. OHI Mission …………………………………….. 2 2. Individual Medication…………………………… 3 3. Individual/Staff Ratios ………………………….. 5 4. Billing……………………………………………. 5 5. Cleaning Process ………………………………... 6 6. Activities without Staff Supervision…………….. 7 7. Bills……………………………………………… 7 8. Individual Financial Resources: Cash…………… 8 9. Individual Financial Resources: Checking…….... 9 10. Individual Financial Resources: Rep Payee…….. 10 11. Petty Cash………………………………………. 11 12. Individual Nutrition…………………………….. 12 13. Vehicle Care ………………………………….... 14 14. Staff Phone Use ………………………………… 15 15. Team Meetings/Staff Trainings………………..... 15 16. Timesheets …………………………………….. 16 17. Chain of Command …………………………….. 17 18. Staff Breaks/Meals at Work…………………….. 17 19. OHI Service Options……………………………. 18 20. Definitions…………………………………….... 21 21. Medicaid Documentation Requirements ………. 21 22. Consumer Choice and Rights. …………………. 22

Revised 3-2013 1 OPPORTUNITY HOMES, INC. MISSION

Utilizing residential options, the mission of Opportunity Homes, Inc., is to assist individuals with disabilities in skill development and choice making which will allow them to access supports and services necessary to reach their potential.

Revised 3-2013 2 INDIVIDUAL CONSUMER MEDICATION

WHAT ARE THE GENERAL EXPECTATIONS OF ME IF THE ISP (Individual Service Plan) SAYS THAT AN INDIVIDUAL CONSUMER TAKES HIS/HER OWN MEDICATION OR “SELF-ADMINISTERS”?

While the ISP may give greater specifics, generally:  The individual consumer should be supported to pick-up his/her medication at the pharmacy OR request for the medication to be delivered to his/her home.  The individual consumer should be supported (as necessary) with any questions he/she may have when taking medication independently. Explore resources available to answer these questions like doctors, nurses, the pharmacist, etc.  The individual should talk with the physician and/or pharmacist as to time restrictions of taking the medication. PLEASE REMEMBER THAT INDIVIDUAL CONSUMERS TAKING THEIR OWN MEDICATION DO NOT FOLLOW MEDICATION MANAGER POLICY.  The individual consumer should be knowledgeable of the medication he/she is taking in conjunction with the reasons why the medication is being taken.  The individual consumer should be supported in planning ahead if they will be gone during the time they generally take medication. Again, please remember that if the individual consumer takes their own medication, they do not follow medication manager policy, and will not have specific med times. However, staff is responsible to provide informed choice.

WHAT ARE WE RESPONSIBLE FOR WHEN WE ADMINISTER AN INDIVIDUAL CONSUMER’S MEDICATION?  ONLY STAFF WITH A MEDICATION MANAGEMENT CERTIFICATE CAN ADMINISTER MEDICATION. UNTIL YOU COMPLETE THE TWELVE HOUR TRAINING FOR CERTIFICATION YOU ABSOLUTELY MUST NOT ADMINISTER ANY KIND OF MEDICATION.  Using the 6 rights of med administration is mandatory 100% of the time we are administering medication. The six rights include: o right drug o right dose o right person o right time o right route o and right charting  Administer medication and complete the process as instructed in your Medication Management class. Agency employees are expected to use manuals and take the time necessary for accurate administration!  The Medication Records will be in front of you to reference when each medication is given.  Sign off on each medication immediately after it is given.  If it is the first time that month that you have administered medication, be sure to sign the back of each Medication Record with your legible full name and title.  Report unsigned medication to your supervisor immediately.

Revised 3-2013 3  Medication error(s) and unsigned medication passed may result in disciplinary actions up to and including termination!  ONLY use ballpoint pen in black or blue ink to sign the Medication Records.

***If you are on shift and are NOT medication managed, it is your responsibility to: o Know each individual consumer’s medication times. o Call your supervisor or the on-call phone immediately if no one shows up to pass medication. Please do so allowing sufficient time so someone can be contacted to come in before a medication error occurs.

WHAT FORMS DO WE FILL OUT IF WE ADMINISTER MEDICATION? When individual consumers pick up medication:  Staff will “check in” medication (count and document) using the Doctor Order/Medication Change form. This will be in the “Medication” section of each individual’s file. Any prescribed medication will be recorded before it is administered. Even if all the meds are the same as they were the month before, they are still to be checked in every month!

When administering medication:  The Medication Record (pink daily medication sheet) will be in front of you and you will make reference to that with each medication given.  Medication Records are located in individual files.  Medication Records must be updated immediately when a medication is added or discontinued. Clearly mark the start and stop dates on the Medication Records by drawing a vertical line on that date (in the row for that specific medication) and marking the word “start” or “stop” along with the date it is to start or stop.

If a medication needs to be destroyed or discontinu  Contact your Program Manager or Service Coordinator.  Medication managers will fill out the Discontinued Medication sheet.  Securely send the medication to be destroyed to the main office.  DO NOT DESTROY MEDICATION BY YOURSELF. Medication will always be destroyed by two people. At least one of the two must be a member of the administrative staff. Document a discontinued medication: o On the pink daily Medication Record o On the Doctor Order/Medication Change form o In their Medical Contact Notes o On the Discontinued Medication form with your supervisor.  Communicate changes so all team members are aware.

Counting psychotropic medication:  Psychotropic medications will be counted 2 times per day.  All staff can count psychotropic medication.  Staff will sign the Psychotropic Medication Count form when completed.  All discrepancies will be reported immediately to supervisor.

Revised 3-2013 4 WHERE WILL AN INDIVIDUAL CONSUMER’S MEDICATIONS BE KEPT? Each individual consumer will choose where to store their medication unless a Rights Restriction is in place; look in their ISP (Individual Service Plan) to be sure. Skills trainers will utilize informed choice and education to assure that the medication is kept in a safe environment (examples: humidity in bathrooms or direct sunlight can break down medication resulting in diminishing therapeutic purpose.)

It is considered a restriction of rights for an individual consumer’s medication to be stored in the staff office or any location to which the individual consumer does not have access. This would also include any locked area to which the individual consumer does not have a key.

INDIVIDUAL to STAFF RATIO

HOW DO I CALCULATE INDIVIDUAL to STAFF RATIOS? The individual: staff ratio form is completed within site-based services. To complete it you will take the number of individual consumers to the number of staff on shift (this does not include staff who are shadowing or training). For example, if there are 4 individual consumers and 2 staff on at a particular time, the ratio sheet for that time would read “4:2”. Remember, if an individual is gone without an OHI staff for more than one hour, their ratio sheet should be marked “FV” to note a family/friend visit or “NSS” to show no staff supervision during that time. Other individual consumers’ ratio sheets would therefore change in addition, to show the decreased individual: staff ratio The ratios are rounded in 15 minute increments

WHEN SHOULD I COMPLETE THE INDIVIDUAL to STAFF RATIO SHEETS? They need to be completed every time a staff person is on shift.

WHERE DO I RECORD THIS INFORMATION? Each site will have a binder containing ratio sheets (i.e.: a communication book).

WHERE IS THIS INFORMATION KEPT? Forms for the current month are kept at the site in the communication book. Completed forms will be kept in the filing cabinet at its respective site after being signed by administrative staff.

BILLING

WHO IS RESPONSIBLE FOR BILLING?

Daily Services: The overnight staff is responsible for using the ratio sheets and family visit forms to complete the billing spreadsheet. These forms must be completed nightly and turned in to the administrative office the morning of the 1st business day of each month. In addition to completing the billing spreadsheet, the overnight staff is responsible for completing the Site Hours of Service form and turning it into the administrative office the morning of the 1st business day of each month. This is necessary to verify billing.

Revised 3-2013 5 When we have served an individual consumer for at least one hour within any 24 hour period, OHI will bill for the day of services. So, if an individual consumer left for a family visit on Friday and arrived home at 11:00pm on Saturday, OHI will bill for both days.

Hourly Services: Hourly billing is completed by administrative and support staff in the administrative office. Documentation is completed on edoc daily and billing is entered using the duration of service listed on each edoc entry.

Billing is submitted to the appropriate funding source by administrative staff.

CLEANING PROCESS

WHO IS RESPONSIBLE FOR CLEANING THE INDIVIDUAL CONSUMERS’ HOMES? Individual consumer’s homes will be cleaned by the individual consumer alone, the individual consumer with staff support or staff alone.

WHO IS RESPONSIBLE FOR WHICH TASKS?  Staff should support individual consumers per their ISP (Individual Service Plan) and Supports Training in helping them to learn to use cleaning products, how often to clean, etc.  The overnight staff will have daily/weekly/monthly checklists to complete. These lists will include deep-cleaning that the individual consumers may not have the capabilities to complete.

WHAT IF AN INDIVIDUAL IS UNABLE TO CLEAN OR IS ABLE TO BUT CHOOSES NOT TO?  If an individual has physical limitations that do not allow them to clean, staff will do it for them. Example: If an individual has back problems and cannot bend over to clean the tub, staff could do the tub while the individual consumer cleans the sink.  If the individual consumer chooses not to clean after staff has provided and documented informed choice and it has become a health and safety issue, staff will do it. Example: Moldy dishes in the sink…this can equal dependant adult abuse under the Iowa Caregivers Law. This type of refusal of service is to be documented using a Risk Management/Loss Control report.  Remember to provide training to the individual consumer about safety and health issues.  If regular cleaning becomes an issue, an individual consumer’s IDT (Interdisciplinary Team) may explore options such as a weekly cleaning service.  Also talk about trading or compromising with others living in the house before staff completes a routine cleaning task.  Utilize approaches that empower the individual to want to complete tasks. Remember, it is better to ‘do with’ than to ‘do for’. Instead of saying “Do you want to wash your dishes” say “Would you like to wash or dry?” Many people served enjoy the one-on-one time and this approach may be a win/win way to get the task accomplished.  If an individual consumer requires support in the area of cleaning, this should be reflected in their assessments and ISP. OHI will assist a person with cleaning only if the IDT is aware of the assessed need and has approved the support and intervention of OHI staff with the

Revised 3-2013 6 cleaning process. Changes in an individual consumer’s abilities or participation in cleaning tasks are to be communicated through Risk Management/Loss Control reports. This form of data collection is necessary to communicate a change in assessed needs/recommended supports with the IDT.

ACTIVITIES WITHOUT STAFF SUPERVISION

HOW DO I KNOW IF AN INDIVIDUAL CONSUMER CAN BE ALONE WITHOUT STAFF SUPERVISION? If an individual can be alone without staff supervision, their ISP (Individual Service Plan) will specify for how long, where, and for what activity. This is specified as approved alone time. For example, some individual consumers may have alone time approved in their home, but not in the community.

WHERE CAN I FIND THIS INFORMATION? The Service & Level section of the ISP (page 1) will state the above information.

BILLS

WHO PAYS THE BILLS? Within site-based services: Depending on the bill, either the individual consumers alone will pay, or the individual consumers and OHI will pay shared bills. Within hourly services: The individual consumer, their roommates and/or families are responsible.

WHAT BILLS DO INDIVIDUALS AND OHI SHARE (site-based services)?  Gas, electric, water, sewer, and garbage are shared.  The individual consumer is responsible for his/her own phone bill including long distance charges, as staff will use a separate line. Staff is not to use the individuals’ phone. If the individuals choose not to answer it, let the phone ring.  Individuals are responsible for their cable and/or internet bill.

WHERE ARE THE BILLS SENT?  All bills to be paid by individual consumers will be sent to their address and will be in one of the tenant’s names.

WHAT DO WE DO WITH A BILL WHEN AN INDIVIDUAL RECEIVES IT IN THE MAIL?  Staff will support individual consumers with timely bill payments per their ISP.  If OHI pays a portion of the bill (site-based services), it will be put immediately in the office box to be copied at the administrative office and a check will be cut for OHI’s portion of the bill. When the bill is submitted, it should include the site number and the amount OHI owes.  Bills in which the individual consumers share (such as utilities, cable, internet, and phone) will come in one of the individual consumer’s name. Staff will support the individual consumers with splitting up the bills and with writing a check to the company. A tracking

Revised 3-2013 7 system will be utilized within site-based services noting when and who made reimbursement payments.  Note: Overnight staff is responsible for dividing the bills and communicating to the day staff what checks need to be written and when bills need to be sent out.

***IF A PERSON HAS FINANCIAL SUPPORT IDENTIFIED IN THEIR ISP (Individual Service Plan), WE ARE RESPONSIBLE FOR THE TIMELY PAYMENT OF BILLS. LATE FEES WILL BE COVERED BY STAFF, NOT BY THE INDIVIDUAL CONSUMERS!!!

HOW ARE THE BILLS DIVIDED?  If the individual consumers are paying without OHI contribution (their phone, internet, and cable bills in site-based services) the bill is divided by the number of people living in the house.  If OHI pays a portion of the bill, divide the bill by the number of people in the house plus OHI. For example (the electric bill): If 3 individual consumers live in the house, divide the bill by 4.  If there is a vacancy at the site, OHI will pay the previously described portion as though there is no vacancy.

DOES OHI PAY FOR ANYTHING ELSE?  OHI will contribute paper supplies (toilet paper, paper towels, etc.) within site-based services. Staff will notify the administrative office at least one week in advance of the items required. These will come from the office stock.

INDIVIDUAL FINANCIAL RESOURCES: CASH

WHO IS RESPONSIBLE FOR THE INDIVIDUAL CONSUMER’S CASH? If an individual has developed the skills to keep track of their own cash, they will do so. They will acquire the cash from their financial institution by cashing their paychecks or personal checks, etc.

WHAT IF AN INDIVIDUAL CONSUMER HAS NOT DEVELOPED THE SKILLS? If an individual consumer has not developed the skills to track their money independently, staff will support them by helping to keep track of their cash. The IDT (Interdisciplinary Team) will help them decide how to handle cash-on-hand issues. The individual consumer’s ISP (Individual Service Plan) will provide staff with specific direction.

WHERE IS THE MONEY KEPT? The individual consumer decides where they would like to keep their cash-on-hand unless a Right’s Restriction is present. Staff must provide informed choice to promote a safe and secure storage environment.

***Keeping individual consumer’s money in the staff office or in any location to which the individual consumer does not have access is considered a restriction of rights and must be identified in the individual consumer’s ISP BEFORE it is implemented.***

It is not considered a restriction of rights if the individual consumer’s money is kept in a lock box in their own room AS LONG AS they have a key to the lock box.

Revised 3-2013 8

WHO WILL DECIDE HOW MUCH MONEY THE INDIVIDUAL CONSUMER WILL UTILIZE FOR THE DAY/ACTIVITIES? If staff tracks an individual consumer’s cash, staff will help them decide through informed choice how much money is needed for a particular day/activity. The individual consumer utilizes the informed choice to make the decision – not staff! If an individual consumer tracks their own cash, they can spend their cash as they decide for their own needs.

HOW IS AN INDIVIDUAL CONSUMER’S CASH TRACKED IF STAFF IS RESPONSIBLE? When staff takes money from an individual consumer’s cash-on-hand, it must be recorded on the Individual Control Sheet/Personal Money bag form in each individual consumer’s money bag IMMEDIATLEY! The individual consumer and staff must also initial when this has occurred. Receipts for expenditures will be kept in their money bag, UNLESS the purchase was made with payee money; then the receipt is kept and then sent to the OHI main office on the 1st business day of the next month.

WHEN SHOULD THIS BE RECORDED AND HOW? When staff assists an individual consumer with depositing money into their cash bag or taking money from their cash-on-hand, IT MUST BE SIGNED IN/OUT IMMEDIATELY! IF IT IS NOT SIGNED IN/OUT IMMEDIATELY, YOU MAY BE CHARGED WITH THEFT FOR THE FUNDS NOT ACCOUNTED FOR. Each entry must be initialed by the staff person adding/removing the funds and by the individual consumer.

DOES EVERYONE HAVE A TRACKING SHEET? No. Tracking sheets are utilized for individual consumers who have not developed money skills and for whom staff tracks their money. If an individual consumer tracks their own cash, they will not have a money tracking sheet.

HOW OFTEN SHOULD INDIVIDUAL MONEY BE BALANCED? If staff tracks an individual consumer’s cash, it should be balanced (by counting all the money in the bag and comparing that to the balance written on the money tracking sheet) at the end of EVERY SHIFT.

WHAT SHOULD I DO IF THE MONEY BAG BALANCE IS OFF? If there is a discrepancy, the last people on shift are responsible for paying the difference back to the individual. This is why it is imperative that money is checked in/out immediately after adding/removing it from the cash bag. Read past documentation for possible information on where money may have been spent and notify your supervisor at the next opportunity, but within 24 hours.

INDIVIDUAL FINANCIAL RESOURCES: CHECKING ACCOUNTS

WILL WE SUPPORT EACH INDIVIDUAL CONSUMER WITH THEIR CHECKING ACCOUNTS? If an individual consumer has a checking account where OHI is not the representative payee, staff will support them with it per their ISP (Individual Service Plan) and Supports Training.

Revised 3-2013 9 HOW OFTEN WILL STAFF NEED TO BALANCE PERSONAL CHECKING ACCOUNTS? The personal checking accounts must be balanced within 5 days of receiving the bank statement. The worksheet on the back of the statement MUST be completed and utilized to ensure the balance is accurate.

Note: OHI works to maintain a balance of $50.00 within representative payee accounts in order to provide for unexpected expenses that may arise throughout the month. Staff is expected to provide education on the benefits of maintaining a similar balance within personal accounts.

WHAT WILL BE DONE AFTER A STATEMENT HAS BEEN RECONCILED /BALANCED? Staff will enter in the ledger the words “statement reconciled”, with their first initial, last name, and title.

On the bank statement, the individual and staff will sign their full names.

If OHI is the representative payee for an individual consumer, see instructions on pages 12 & 13. In both cases, staff is responsible for checking the balance of the account to assure a positive balance and to provide intervention according to the mission and ISP.

INDIVIDUAL FINANCIAL RESOURCES: Representative Payee

WHAT IS A REPRESENTATIVE PAYEE? A representative payee receives Social Security and/or Supplemental Security Income (SSI) payments for someone who cannot manage or directs someone else to manage his/her money. The main responsibility of a payee is to use the funds to pay for the current and foreseeable needs of the beneficiary and to save any remaining funds for the beneficiary. (From SSA Representative Payee Guide).

HOW CAN I TELL IF OHI IS AN INDIVIDUAL CONSUMER’S REPRESENTATIVE PAYEE? A. The individual consumer’s ISP will state that they have a representative payee in two places: 1) page 1 of the ISP and 2) the “Rights Restrictions/Things We May Need To Do Even If (individual consumer’s name) Does Not Agree” section. B. The individual consumer’s checks and bank statements for the payee account will say “Opportunity Homes, Inc. for (individual consumer’s name)”.

CAN ANY STAFF SIGN AN INDIVIDUALCONSUMER’S REPRESENTATIVE PAYEE CHECKS? NO! Only the Executive Director, Program Manager, and Specialty Services Coordinator are authorized to sign representative payee checkbooks.

Note: All receipts for purchases from representative payee accounts will be kept and sent to the office the 1st business day of each month. Whenever possible, the check number used to pay the receipt will be marked on the receipt.

Revised 3-2013 10 IF AN INDIVIDUAL CONSUMER HAS A REPRESENTATIVE PAYEE, WILL IT ALWAYS BE OHI? No. Some individual consumers may have a parent, a guardian, or other institution who will serve in this role. If someone else serves as an individual consumer’s representative payee, this will still be outlined in the “Rights restriction/Things We May Need To Do Even If (individual consumer’s name) Does Not Agree” section as well as on page 1 of the ISP.

HOW WILL INFORMATION BE ENTERED INTO THE CHECKBOOK LEDGER? A. Consistently record each entry in the white or the gray row. Do not skip back and forth. B. All entries will be recorded immediately in the ledger and will be made in blue or black pen WITH THE EXEPTION of the balance, which will ALWAYS be written in pencil. C. The balance column must be completed after each entry. D. In the “Fee” column of the ledger, the staff who accompanied the individual to make the purchase will initial the purchase. Initials must be present with each entry.

REMINDERS: o Record all withdrawals immediately o Record all deposits immediately o The checkbook ledger for a representative payee account should be a model for accurate ledger accounting.

WHAT SHOULD THE MONEY IN THE REPRESENTATIVE PAYEE ACCOUNT BE USED FOR? First and foremost, this money must go for bills, food, shelter and clothing. Remaining money (if any) may be saved or used for the current needs of the individual.

HOW WILL THE CHECKBOOK AND STATEMENT BE RECONCILED? OHI representative payee checkbooks will be reconciled by the Specialty Services Coordinator.

PETTY CASH

WHAT IS PETTY CASH? Petty cash is money on hand within a program to be used for incidental needs related to programming and service provision such as staff admission to an event being attended by individual consumers.

WHAT IS THE PROCEDURE TO USE PETTY CASH?  When taking money from petty cash, sign the money out on the Petty Cash sheet. Be sure to initial the entry and complete the balance column.  Receipts must be kept for all items purchased with petty cash. The exception to this is van upkeep (wash, vacuum, etc). In this instance, hand written receipts will be accepted. Car washes should be completed at a business that gives a receipt, whenever possible. Tickets for movies attended w/ individual consumers suffice as a receipt.

Revised 3-2013 11  Please note that if you take money for an activity with an individual, any change must be returned to the petty cash and checked back in on the Petty Cash form.  All receipts must have staff’s FULL legible name, program (to include site number if applicable), date, amount, and what was purchased.

WHO COUNTS THE PETTY CASH AND WHEN IS IT DONE? Within site-based services: The staff on the overnight shift is responsible for counting the petty cash each night. Within the hourly program: The staff taking the money will verify the balance.

WHO RECONCILES PETTY CASH AND WHEN IS IT DONE? Within site-based services: The staff on shift for the overnight on Sunday will reconcile the petty cash and will send the Petty Cash Reimbursement form to the administrative office. Receipts are attached to the reimbursement form prior to turning it in to the main office. Checks will not be cut for less than $5.00. Within the hourly program: The Petty Cash Reimbursement form will be completed by a skills trainer as needed and will be turned in to a Service Coordinator. Checks will not be cut for less than $5.00.

WHAT CAN PETTY CASH BE USED TO PURCHASE? Petty cash can be used for the following: tickets to events or movies with individual consumers, washing/vacuuming the van, soup/benefit suppers, or any social event that the individual consumer chooses to participate in and there is a fee. Any other items will be approved by a supervisor before purchase.

WHAT CANNOT BE PURCHASED WITH PETTY CASH? Petty cash may not be used for eating out with individuals or for staff snacks. It also may not be used for office items. If you question whether you should use petty cash for a particular item, please ask your supervisor first.

INDIVIDUAL NUTRITION

HOW DOES AN INDIVIDUAL CONSUMER DECIDE WHAT TO EAT FOR MEALS? Depending on the individual consumer’s assessed level of need, the ISP (Individual Service Plan) will provide direction on the level of intervention necessary for meal planning and preparation. While it is not the responsibility of OHI staff to make individual consumers eat healthy food, it is our responsibility to provide individualized options, information and skills training to each individual consumer.

WHAT DOES THIS REALLY MEAN? We need be creative and do all we can to assist the individual consumers we serve with having access to food that is good to put in their bodies. If an individual consumer does not have the skills to cook and doesn’t have an understanding of nutritional recommendations (I should eat a lot more fruit and veggies than ice cream during a day, whole wheat bread is much better for me than white, etc.) it is irresponsible of us to say that no intervention was provided to that individual consumer when eating an unhealthy diet because it was ‘their choice’. It is our job to provide training and information so the individual consumers we serve can make informed decisions.

Revised 3-2013 12 HOW WILL WE KNOW IF SOMEONE IS ON A RESTRICTED DIET? If an individual consumer has a doctor-ordered nutritional restriction, it will be noted in their ISP. Check to see whether nutrition (cooking, etc) is listed as a support or an expectation (goal). Some individual consumers may have Rights Restrictions regarding food or nutrition. Check to see if they have a specific menu or meal plan and support them in following it according to their ISP.

WHAT IF AN INDIVIDUAL CHOOSES NOT TO FOLLOW A DOCTOR’S DIETARY RECOMMENDATIONS? It is our responsibility as staff to give the individual consumer all the information necessary to make healthy choices about food. Example: If an individual consumer is on a low-sodium diet and chooses to eat a TV dinner (which is high in sodium) we will give them information about the negative effects of that on their body, as well as offer other options for food. Make every effort to see that the alternate options offered are ones the individual consumer might like.

CAN INDIVIDUAL CONSUMERS COOK A MEAL TOGETHER? Yes. If the individual consumers have decided to make a meal together, staff will support them with sharing the cost, preparation, clean-up, etc. Remember that some individual consumers will be able to participate more than others. Staff will assist those individual consumers to allow them to take part in a group meal if they choose to do so.

Staff will support individual consumers who take cold lunch to a work site per their ISP to assure that those meals are nutritional as well.

CAN I BRING FOOD TO WORK TO GIVE TO INDIVIDUAL CONSUMERS? This is generally discouraged.

SOME IDEAS and OPTIONS:  Decorah and Cresco have great Farmer’s Markets in the summer! Lots of fresh veggies are available there from local vendors.  If an individual consumer loves a certain dish, but can’t eat it all or tires of it before the leftovers are gone, support them with packaging and freezing it in individual portion sizes.  People tend to eat a greater volume of veggies when added to other dishes than when served as a side.

OTHER NOTES ON INDIVIDUAL CONSUMER NUTRITION:  It is our job to provide for individual health and safety according to the services approved in their ISP. If an individual consumer consistently decides to eat meals that have poor nutrition value, what options are you giving them and what information are you providing for them to make better choices? Think outside the box and be creative!  TV dinners, frozen pizzas, etc... are convenient and fast (for individual consumers and staff) but they are saturated with sodium and fat and have few nutrients. Remember that these items in moderation will not negatively impact a diet, but daily consumption can have a very harmful effect on the people we serve.

REMEMBER THE INDIVIDUAL CONSUMER’S RIGHTS AND RESPONSIBILITIES. THEY HAVE THE RIGHT TO EAT WHAT THEY LIKE, AND THE RESPONSIBILITY TO MAKE HEALTHY CHOICES. IT IS OUR JOB TO GIVE THEM THE OPTIONS AND INFORMATION TO ALLOW THEM TO MAKE THOSE HEALTHY CHOICES.

Revised 3-2013 13 VEHICLE CARE

WHO OWNS THE VEHICLES? Opportunity Homes, Inc.

WHO IS IN CHARGE OF VEHICLE UPKEEP? All staff is responsible for the care and upkeep of the vehicles owned by OHI. No garbage should be left in the vehicle.

DO I HAVE TO RECORD ANYTHING WHEN THE VEHILCE IS SERVICED? Yes.  Whenever regular maintenance or repairs are completed on an OHI vehicle, the Inspection of Agency Owned Vehicles form must be filled out by staff and the place of business where the vehicle is being repaired.  If the van/car is dirty and needs to be washed/vacuumed, take money from petty cash to pay for it. (This is one instance where a hand written receipt is acceptable.) Some car washes now provide receipts. Utilize those particular car washes if possible.

HOW OFTEN SHOULD THE OIL BE CHANGED? The oil needs to be changed every 3,000 miles or every 3 months (which ever comes first). Typically, vehicles in Decorah have oil and general maintenance done at Clarks’ (Bob’s Standard). In Cresco, vehicles are typically serviced at Northeast Iowa Motors.

HOW OFTEN SHOULD THE TIRES BE ROTATED? The tires should be rotated every 6,000 miles (every other oil change).

WHO PAYS FOR GAS? Gas will be charged at Kwik Star in Decorah and at Kwik Star in Cresco. If at all possible purchase the cheapest grade gas at Kwik Star. The agency receives a discount on gas purchased there. Vehicles will always maintain ½ to a full tank of gas.

Remember, when signing a receipt for gas or vehicle maintenance/up-keep, be sure the specific PROGRAM is written on the receipt along with your LEGIBLE signature.

WHAT IF I’M IN AN ACCIDENT? Each vehicle has a camera and Driver’s Accident Report forms. All accidents will be documented through photographs and the above form when applicable. (Every accident will be documented using the Driver’s Accident Report form.) Staff will care for the individual consumers first and foremost. The on-call cell phone will be notified at the earliest possible time.

HOW DO I KNOW A VEHICLE WILL BE AVAILABLE (HOURLY ONLY)? Decorah: Vehicle sign out schedules are located in the main administrative office. Sign up for the vehicle by noting your name and the time slot for which you’ll need to use the vehicle. Precedence is given to those transporting individual consumers, so be flexible. If a vehicle is absolutely necessary and all hourly vehicles are checked out, call your supervisor. A site-based van may be available.

Revised 3-2013 14 Cresco: Staff will contact the Cresco office phone and will inquire as to vehicle availability. If available, staff at the site will indicate on the vehicle schedule what hourly staff plans to take the vehicle and when they plan to take it.

WHAT IF I HAVE TO DRIVE MY OWN CAR FOR WORK? If a vehicle was not available, a Mileage Reimbursement form is available at the (main administrative office, Cresco satellite office and all sites). All mileage in personal vehicles must be tracked according to person and program. Mileage Reimbursement forms are submitted to the administrative office on the 1st of the month.

IS THERE ANYTHING ELSE THAT NEEDS TO BE RECORDED? The 1570 mileage form will be completed for individuals approved for transportation each time an individual receiving services is transported. Overnight staff will enter the 1570 mileage onto a spread sheet and send the flash drive over the 1st business day of the month. The 1570 mileage forms from agency vehicles are submitted to the administrative office the 1st business day of each month.

***The administrative office must verify the presence and type of insurance on any staff vehicle used for transporting an individual consumer. This verification will occur BEFORE transporting a person served. ***

STAFF PHONE USE

IS IT OKAY TO MAKE PERSONAL CALLS FROM WORK? When making phone calls of a personal nature, please limit your time to a few minutes. While you may have the need to communicate with someone outside the agency, remember that you are at work.

CELL PHONES ARE NOT ALLOWED ON SHIFT! All personal cell phones must be turned off (NOT ON VIBRATE) or left in your car or at home while you are on shift.

TEAM MEETINGS/STAFF TRAININGS

WHO GOES TO WEEKLY TEAM MEETINGS? Full time employees are required to attend team meetings. Part-time people are welcome and absolutely encouraged to attend relevant team meetings and all-staff trainings.

Team meetings are considered a regularly scheduled shift for full-time staff. Not attending is considered to be an unexcused absence. Requests to be absent from team meetings will be handled as a PTO request and must be at least 2 weeks in advance.

Team meetings are scheduled on a program-by-program basis. Check with your supervisor for the day and time.

Revised 3-2013 15 WHO GOES TO STAFF TRAININGS? Staff trainings are mandatory for all employees in order to fulfill the job description.

WHEN ARE STAFF TRAININGS? Notice for staff trainings will be communicated through a memo sent out with pay stubs, through Edoc, through weekly reminders or verbal communication. Be sure to check your pay stub for memos and upcoming training information as you will be expected to reply to these in a prompt manner and will be held accountable for not following through with the information given to you.

Meetings for part-time staff who do not attend weekly team meetings will be held at alternate times. Notification for these meetings will be facilitated by supervision. These meetings may be mandatory based on the training/topic.

TIME SHEETS

WILL I NEED MORE THAN ONE TIME SHEET IF I WORK AT MORE THAN ONE SITE/PROGRAM? YES. You will need a time sheet for every site/program you have worked at during that pay period. If you worked at 7 sites, you will hand in 7 time sheets.

WHEN ARE TIME SHEETS DUE? For site-based services: Time sheets need to be kept at the site where the shift was worked. The overnight staff will enter the time sheets (in military time) into the computer and will turn in the time sheets and flash drive to Site 7 sometime during the day on Sunday. Timesheets are verified against service documentation prior to submission to payroll.

For hourly services: Timesheets are to be turned in at the end of each staff person’s work week. Documentation will be handed in on a daily basis. Timesheets are verified against service documentation prior to submission to payroll.

WHEN DO WE GET PAID? Payday is every other Thursday. If payday falls on a holiday, deposits will be made the business day prior to the holiday. You will be notified in advance if any changes to this need to be made.

WHAT IS THE WEEKLY PAY PERIOD? One pay week begins at midnight Sunday and ends at 11:59pm on the following Saturday.

DO I REALLY HAVE TO HAVE A CO-WORKER SIGN MY TIME SHEET? YES, if there is a co-worker available to sign you in/out. If you are the first person on shift, then administration staff will verify your hours against service documentation.

HOLIDAYS: If all individuals in the home go on family visits the site will shut down for the duration that the individuals are gone. Staff will call the on-call phone when the last individual leaves for his/her family visit, and the site shuts down. Staff will also call the on-call phone when the first individual arrives home from a family visit, and the site opens back up.

Revised 3-2013 16 CHAIN OF COMMAND

WHO DO I CALL IF I HAVE QUESTIONS/A PROBLEM?

DURING OFFICE HOURS: Call the Decorah office 563-382-8140 or the Cresco office 563-547- 2595 and ask to speak to your immediate supervisor (Service Coordinator). If you need immediate assistance and the Service Coordinator is not available, ask to speak to the Program Manager. If the Program Manager is unavailable, ask to speak to the Executive Director.

IF YOU HAVE AN EMERGENCY/URGENT QUESTION AFTER REGULAR BUSINESS HOURS CALL:  Service Coordinator on-call phone: 563-379-6030  Program Manager: Deanna Heimerdinger OR  Executive Director: Shanna Hale: 563-380-2631

AS A LAST RESORT, CALL: *Program Manager/Executive Director at home:

**Deanna Heimerdinger 563-203-1429 **Shanna Hale 641-985-2699

NOTE: Please be sure that if you are calling someone at home that the subject warrants immediate attention. If it is something that can wait, please do. Use your judgment. Also, supervisors have voicemail that can be reached by dialing the main office 563-382-8140 and their extension.

STAFF BREAKS AND MEALS AT WORK

DO WE GET DESIGNATED BREAK TIMES? No. If you need to take a break, communicate this with your co-worker and take a break. Please remember to take breaks at appropriate times so you don’t leave your co-worker swamped while you take your break.

**Within the hourly program, breaks will be off-the-clock.

HOW OFTEN CAN WE TAKE BREAKS? This depends on the program in which you are working. Staff is encouraged to take advantage of natural down time during their shift and to use it accordingly.

CAN I LEAVE DURING A BREAK? No.

WHERE DO I TAKE MY BREAK? You need to stay in/around the house.

Revised 3-2013 17 CAN I SMOKE AT WORK? No. Smoking is not allowed on property where OHI provides services, while staff is “on the clock” or in OHI vehicles.

CAN I BRING MY LAPTOP/PERSONAL COMPUTER, HOMEWORK or A BOOK/MAGAZINE TO READ WHILE I’M ON BREAK? No.

MEALS

HOW WILL I EAT AT WORK? If you want to eat while at work, bring your own food. Individual consumers do not have food that is shared with staff. Each site will have a small staff refrigerator and a microwave in the office area. Each administrative office has a refrigerator to be used by hourly staff. STAFF IS ENCOURAGED TO EAT AND TALK WITH INDIVIDUAL CONSUMERS DURING MEAL TIMES. If you aren’t going to eat, you are encouraged to sit with an individual consumer while they eat and talk with them. ***It is expected that staff will serve as role models for individual consumers through the food that is brought and eaten when at work.***

CAN I USE THE INDIVIDUAL CONSUMER’S DISHES/KITCHEN APPLIANCES? Staff is discouraged from using the individual consumer’s dishes and kitchen appliances. If you have to borrow a dish, YOU MUST ASK PERMISSION. Also, you must wash it immediately after use and put it back where you found it.

WHAT IF AN INDIVIDUAL CONSUMER OFFERS ME PART OF THEIR MEAL? Sampling a small amount of a dish that an individual consumer has made is okay if it is reinforcing to that individual consumer. Please keep in mind that leftovers can be taken to work for lunches. Encourage the individual consumers to save it for that rather than staff eating it.

OHI’S SERVICE OPTIONS

SUPPORTED COMMUNITY LIVING-HCBS ID The Medicaid Home and Community Based Intellectual Disability Waiver (HCBS ID) provides service funding and individualized supports to assist people with staying in their own homes or communities when they would otherwise require care in a medical institution (provision of these services must be cost effective). The individual must be financially eligible for the program, have a diagnosis of mental retardation/intellectual disability or a diagnosis of a mental disability equivalent to mental retardation as determined by a psychologist or psychiatrist. This service is designed to assist the consumer with daily living needs/skills. Assistance may include, but is not limited to: personal and home skills, community skills, personal needs, transportation, and treatment services. ID Waiver services are individualized to meet the needs of each person receiving the service. However, decisions regarding what services are appropriate are based on the individual’s needs as determined by the individual and their interdisciplinary team.

Revised 3-2013 18 Services are habilitative in nature and provide for development of skills towards individual achievement. Opportunity Homes, Inc. provides HCBS-SCL services to people on a daily (site-based) and an hourly (drop-in) basis.

SITE-BASED SCL Within daily services, scheduling of skills trainers is based on the demands of service needs exhibited by persons living in the home. This is a daily (up to 24 hours) service for adults 18 years of age and older, provided in a group living environment. This service applies to individual consumers who live outside of their family, legal representative or foster family home and for whom a provider has primary responsibility for supervision or structure. The ratio of individual consumers to skills trainers is dependent on the needs of the individual, to include individual schedules and demands. When employees are hired, Opportunity Homes, Inc. strives to match personalities of employees with the individual consumers they may be working with. This allows for a more successful employee/individual consumer relationship and further supports the success of each individual consumer with their desires of skill development. Training of skills and skill development are prevalent within site-based services as well as hourly services. Also prevalent within site-based services is supervision of individual consumer needs.

HOURLY SCL Individuals who receive hourly services are often assigned a skills trainer who works one on one with them. Skills trainers often have a caseload of 5-10 individual consumers. Opportunity Homes, Inc. strives to assign skills trainers based on the personality of the individual consumer as well as of that employee. This further supports the success of the individual with their desires of skill development. Within hourly services, service provision is centered entirely on the training of skills and skill development. Supervision of individual needs is not provided. Opportunity Homes, Inc. will provide the individual consumer the opportunity to be involved in an individualized service, based on individual needs and desired outcomes, designed to maintain or improve the person’s abilities and skills so they can continue to reside independently. The focus of programming is to decrease dependence on Opportunity Homes, Inc. staff whenever possible.

RESPITE (HOURLY) Respite services provided by OHI are hourly-based services and are designed to give the primary caregiver a break from service provision. Respite services are designed to provide the daily care that would otherwise be provided by the primary caregiver. Staff hours are scheduled based on the individual and family’s needs for care.

CHAPTER 24 (HOURLY) Chapter 24 services are hourly-based services. Individual consumers who experience mental retardation or are dually diagnosed may be eligible for these services. This program provides support to persons who have a wide variety of disabilities and are capable of living semi- independently in a community setting. This may include the provision of assistance in all areas of life skills including budgeting, cooking and home management. Service provision is similar to the provision of Supported Community Living services; however, they are funded differently and are regulated by a different regulatory entity. Chapter 24 services provided by Opportunity Homes, Inc. are habilitative in nature and provide development of skills toward individual achievement. These

Revised 3-2013 19 services are provided within each individual consumer's home and community.

HOME- BASED HABILITATION (HOURLY) Home-Based Habilitation services are specifically geared for those with a diagnosis of chronic mental illness. The intent is to assist people with the acquisition, retention or improvement of adaptive living skills to allow the person to live in the least restrictive setting possible. These services can be provided in the individual’s home or community and may assist with a variety of skill areas. This service is available to be provided on a daily basis, though Opportunity Homes, Inc. currently only provides it on an hourly basis. These services are funded and regulated in a similar manner to the HCBS waiver.

WHAT IS THE DIFFERENCE IN THE SERVICES WE PROVIDE?

HCBS SCL ID-Waiver  20 Outcomes  Medicaid requirements for documentation  Habilitative  Children or adults  Federal, State and County money o County money comes from the Mental Health Fund which is funded by county property-tax payers

RESPITE  No skill development  Meant to give primary caregiver a break  Supervision and safety are the expectations of service provision  Cannot be provided while the primary caregiver is at work  Medicaid service  Can be provided to adults and children

CHAPTER 24 – SCL  Benchmarks and performance indicators  County money  Adults only  Habilitative

HOME-BASED HABILITAITON

 Provided to adults only  Must have a diagnosis of chronic mental illness  Waiver-like services (same rules) but is considered a “state amendment plan” rather than a Medicaid waiver  Federal and state money

Revised 3-2013 20 DEFINITIONS Outcome – A final product or the end result.

Process – A systematic series of actions directed to some end.

Strength – The quality or state of being strong; physical power; intellectual or moral force, a strong or valuable attribute.

Barrier – Anything that obstructs or limits.

Critical Thinking – Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.

Treatment Plan – The Individual Service Plan.

Expectation – An act or state of expecting.

Support – 1. The ongoing process of providing the least amount of structure necessary for individuals to live, learn, work and recreate independently; and 2. A set of interventions designed to help people use their own strengths to meet their own needs.

Crisis Plan – Assigned responsibility of task completion through specific direction.

Informed Choice – An informed choice is more than giving two options. It’s about education on the possible outcome of each option. This education needs to be within the person’s cognitive capability to understand. No one should be in a potentially or blatantly risky, exploitive or abusive situation as a matter of personal choice.

MEDICAID DOCUMENTATION REQUIREMENTS

1. SITUATION – What is going on with the individual consumer and what are they communicating to you. 2. STAFF INTERVENTIONS – Staff should indicate how the intervention techniques were used in assisting the individual during skill development. This would include prompts, strategies, verbal/social praise, etc. 3. INDIVIDUAL RESPONSE – Staff should indicate how the consumer responded to the situation and to staff intervention. 4. RESOLUTION & FOLLOW UP – Indicate the result of the intervention as well as what approach worked and what didn’t work. What was the conclusion or the final/end result?

Revised 3-2013 21 CONSUMER CHOICE & RIGHTS

CHOICE – It only occurs when the person comprehends and can clearly articulate the benefits and consequences of such. The person must be able to clearly demonstrate to any one of the following: a family member, guardian, case manager, funder of service, the DHS or HCBS Specialist that the choice is understood. The key to determining a choice is reflected in the person’s scores on the SIS assessment as well as their assessed level of skill on other OHI assessments. The individual consumer must be able to consistently, over a period of time, demonstrate ALL related skill sets necessary in making a choice at hand!

RIGHT – All rights are inherent; however the consumer must be able to demonstrate comprehension by use of skill sets prior to staff labeling the behavior as an exercise of such. In addition, rights are paired with a responsibility. The skill sets to demonstrate comprehension of the responsibility that makes the right inherent have to be present prior to behavior being identified as a right of the individual consumer.

It is NOT an INDIVIDUAL CONSUMER CHOICE or RIGHT TO: *have a dirty room when the individual consumer doesn’t have cleaning skills. *eat an unbalanced meal when the individual consumer doesn’t have the skills to identify the five food groups. *eat only microwave meals when the individual consumer doesn’t have the skills to use other kitchen appliances. *sleep until mid-afternoon when staff does NOT offer intervention(s) meaningful to the individual consumer. *grocery shop and purchase whatever the individual consumer wants when he/she has no concept of money and does not have meal planning skills. *purchase the same food over and over when the individual consumer does not understand what other options are available or how to prepare other foods. *dress in mismatched, seasonally inappropriate clothing when the individual consumer does not have the skills to match clothes or recognize the impact of outdoor temperature. *wear dirty or worn clothing when the individual consumer does not have the skills to complete laundry without staff support or identify when clothing needs to be replaced. *have moldy and expired food in various kitchen storage places when the individual consumer does not have the skills to read a label or does not understand the passage of time. *go out into public with a dirty or smelly body when the individual consumer does not have the skills to recognize the need to check the mirror or determine that soap is necessary to clean the body. *spend money when the individual consumer doesn’t have the skills to understand the value and cannot manage money without staff support. *watch TV or movies all day when the individual consumer cannot self-direct daily activities. *go for days without showering when the individual consumer does not have the skills to recognize the need for a shower or needs staff support to complete any or all of the process of showering. *fold and put laundry away when the individual consumer does not have the skills to fold or hang properly. *to leave counters and other surfaces in a manner that promotes bugs and rodents when the individual consumer does not have the skills to complete deep cleaning.

Revised 3-2013 22 OPPORTUNITY HOMES, INC.

Acknowledgement of Receipt

I, ______, hereby acknowledge by my signature below that I have received a copy of the Opportunity Homes, Inc. Service Guide.

______Employee Signature Date

______Witness Signature Date

Revised 3-2013 23