CarePolicy Residential Home Care Agency Policies and Procedures User Guide

: May 15, 2024
: carepolicy

Table of Contents

INTRODUCTION
MISSION STATEMENT
VISION STATEMENT
OUR VALUES
STATEMENT OF PURPOSE
STATEMENT OF POLICY
DOCUMENT CONTROL & APPROVALS
SERVICES
ADMINISTRATIVE STRUCTURE AND JOB DESCRIPTIONS
QUALITY MANAGEMENT PLAN
Monitoring and Evaluating Quality
References
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**CarePolicy Residential Home Care Agency Policies and Procedures User Guide

**

INTRODUCTION

[AGENCY NAME] is a compassionate, privately-owned organization dedicated to delivering individual with intellectual disability/autism aged 18-65. Our bespoke plans of care are crafted precisely around each individual’s needs and matched with one of our devoted caregivers. Through meaningful access opportunities enabled by strong connections within the community, we strive to create an inclusive environment that prioritizes making the right decisions for those in need

We are dedicated to providing high-quality services to individuals with intellectual and developmental disabilities Pennsylvania. We are a proud ODP (Office of Developmental Programs) provider, committed to promoting independence and enhancing the lives of those we serve.

Our team consists of compassionate and experienced professionals who understand the unique needs of individuals with intellectual and developmental disabilities. We work closely with individuals and their families to develop personalized care plans tailored to their specific needs, goals, and preferences

We are committed to providing a safe and nurturing environment for our clients, and we work closely with community partners and stakeholders to ensure that they receive the best possible care and support. At our agency, we believe that everyone deserves the opportunity to reach their full potential, and we are dedicated to making that a reality for the individuals we serve.

MISSION STATEMENT

Our mission at [AGENCY NAME] a leading ODP provider in Pennsylvania, is to empower individuals with intellectual disability and autism between the ages of 18 and 65 to live fulfilling and meaningful lives. We are committed to providing high-quality, person-centered services that promote independence, inclusion, and dignity.

At [AGENCY NAME] we believe that everyone has the right to access the support they need to achieve their full potential. We strive to create a supportive and inclusive environment that celebrates diversity, respects individual differences, and fosters personal growth.

Our highly trained and compassionate team of professionals works collaboratively with each individual, their families, and caregivers to develop personalized plans that address their unique needs, preferences, and goals.

We are passionate about making a positive difference in the lives of those we serve, and we are committed to continuous improvement and innovation in all that we do. At [AGENCY NAME] we are proud to be a trusted partner in the journey towards greater independence and a higher quality of life for individuals with intellectual disability and autism.

VISION STATEMENT

We envision a future where every person, regardless of their abilities or challenges, is fully included, respected, and valued as a contributing member of their community

At [AGENCY NAME] we are dedicated to empowering individuals with intellectual disability and autism to live their best lives. We envision a world where every person has the opportunity to reach their full potential, pursue their dreams and aspirations, and enjoy a high quality of life

OUR VALUES

Service: providing a helping hand that allows our members to feel valued and cared for by upholding their sense of dignity.
Trust: maintaining honest lines of communication with safe and competent care that protects privacy.
Integrity: fostering an undivided attitude directed towards doing the right thing the first time around, every time.
Respect: promoting esteem and acceptance for and towards everyone we come in contact with.

STATEMENT OF PURPOSE

The purpose of this policy is to define organization-wide processes and activities that maximize the coordination of quality home services to individuals at [AGENCY NAME] . The goal of this plan is to coordinate Member care in a manner that is seamless from the Member’s perspective. This policy shall be made available for review, upon request, to individuals and their designated representatives and shall be readily available for staff use at all times within [AGENCY NAME]

STATEMENT OF POLICY

[AGENCY NAME] prohibits discrimination in all its activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, gender identity, genetic information, and any political beliefs [AGENCY NAME] is consistent with the:

Needs of our Members and the community we serve;
Policies and procedures;
Policies and guidelines of Office of Developmental Programs (ODP)
Organizational capability to provide the requisite staffing, facilities and services

We strongly adhere to compliance requirements stated by Pennsylvania Law, Department of Human Services and follow the best practices implemented in terms of policies and procedures within [AGENCY NAME].

DOCUMENT CONTROL & APPROVALS

Document Revisions shall be recorded in the table below;

Ver. No.| Rev. No.| Page No.| Description of Amendment| Approved By| Date
---|---|---|---|---|---
| | | | |
| | | | |
| | | | |

Document review and approvals shall be recorded in the table below;

De`scription`	`Title`	`Signature`	`Date`
`Prepared By`
`Reviewed By`
`Approved By`

Note : All policies and procedures shall be reviewed at least annually, with recommended change submitted to the governing body for approval, as necessary.

SERVICES

[AGENCY NAME] provides the following services:

Companion Services: Companion services are provided to individuals who require socialization, supervision, and/or assistance with activities of daily living. Our companions are trained to provide socialization, emotional support, and assistance with tasks such as meal preparation, medication reminders, and light housekeeping. We offer a range of companion services that can be customized to meet the specific needs of each individual.
Behavioral Services: Behavioral services are provided to individuals with behavioral health needs, such as individuals with autism spectrum disorder, intellectual disabilities, and mental health conditions. Our team of professionals work closely with clients and their families to identify and address problem behaviors, and develop strategies to improve social, communication, and adaptive skills. We use evidence-based practices, such as Applied Behavior Analysis (ABA), to support positive behavioral change.
In-Home and Community Waiver Services: In-Home and Community Waiver Services are provided to individuals who require support to live independently in their own homes and communities. Our team of professional’s work with clients and their families to develop and implement personalized care plans that address their unique needs and goals. Our services include personal care, respite care, homemaker services, and community integration services, among others.

At [AGENCY NAME] we are committed to providing high-quality, person-centered services that promote independence, dignity, and quality of life for our clients. Our services are designed to meet the unique needs of each individual and are delivered by a team of highly trained and experienced professionals. We work closely with clients and their families to ensure that their goals and preferences are reflected in their care plans, and that they receive the support they need to live their best lives

ADMINISTRATIVE STRUCTURE AND JOB DESCRIPTIONS

Chief Executive Officer (CEO)
Job description : Waiver Compliance Provider Qualification Compliance Quality Management

Chief Financial Officer (CFO)
Job description: Claims Management and Fiscal Reconciliation
SSD Maintenance HCSIS and Promise Enrollment Compliance

Program Specialist
Job description: Incidents Management and/ risk management.

Job Descriptions for Administrative Structure of [AGENCY NAME] :

Waiver Compliance Officer: The Waiver Compliance Officer will be responsible for ensuring that [AGENCY NAME] meets all compliance requirements related to the Medicaid Home and Community-Based Services (HCBS) Waiver Program. This includes maintaining up-to-date knowledge of all applicable state and federal regulationsonitoring the agency’s compliance with these regulations, and implementing corrective action plans as necessary. This position requires a bachelor’s degree in human services or related field and 2 years of experience in a compliance-related field.
Incident Management/Risk Management Specialist: The Incident Management/Risk
Management Specialist will be responsible for managing the agency’s incident reporting
system and ensuring that all incidents are reported, investigated, and resolved in a timely
and appropriate manner. This individual will also be responsible for identifying potential
risks to the agency and developing risk management plans to mitigate those risks. This
position requires a bachelor’s degree in human services or related field and 2 years of
experience in incident management or related field.
Quality Management Coordinator: The Quality Management Coordinator will be
responsible for overseeing the agency’s quality management program and ensuring that
all services provided by the agency meet or exceed applicable quality standards. This
individual will also be responsible for conducting regular audits and reviews of agency
operations to identify areas for improvement and develop corrective action plans as
necessary. This position requires a bachelor’s degree in human services or related field
and 2 years of experience in quality management or related field.
Provider Qualification Compliance Specialist: The Provider Qualification Compliance
Specialist will be responsible for ensuring that all providers who contract with [AGENCY
NAME] meet all applicable state and federal qualifications and standards. This includes
conducting provider background checks, verifying credentials and licenses, and
monitoring ongoing compliance with regulations. This position requires a bachelor’s
degree in human services or related field and 2 years of experience in provider
qualification compliance or related field.
HCSIS and Promise™ Enrollment Compliance Specialist: The HCSIS and Promise™
Enrollment Compliance Specialist will be responsible for ensuring that all clients are
enrolled in the appropriate state systems and that all required data is entered accurately
and timely. This individual will also be responsible for monitoring ongoing compliance
with state system requirements. This position requires a bachelor’s degree in human
services or related field and 2 years of experience in HCSIS and Promise™ enrollment compliance or related field.
SSD Maintenance Coordinator: The SSD Maintenance Coordinator will be responsible for overseeing the agency’s IT infrastructure, including hardware, software, and network systems. This individual will also be responsible for ensuring that all IT systems are maintained and updated in accordance with applicable regulations and standards. This position requires a bachelor’s degree in computer science or related field and 2 years of experience in IT maintenance or related field.
Claims Management and Fiscal Reconciliation Specialist: The Claims Management and
Fiscal Reconciliation Specialist will be responsible for overseeing the agency’s billing and
claims management processes, ensuring that all claims are submitted accurately and
timely, and reconciling all billing and financial data to ensure accuracy and compliance
with regulations. This position requires a bachelor’s degree in accounting or related field
and 2 years of experience in claims management or related field

At [AGENCY NAME] we believe that a well-defined administrative structure and clear roles and responsibilities are essential for providing high-quality care and support to our clients. Our job descriptions reflect our commitment to ensuring that all aspects of our operations are managed with the highest level of professionalism and integrity, in accordance with ODP and AE requirements.

QUALITY MANAGEMENT PLAN

Office of Developmental Programs Priorities for Provider QM Plan Development

Reference: ([42 Pa.B. 7350] 55 Pa. Code Chapter 6100 Section 6100.45
The Pennsylvania Bulletin, 42 Pa.B. 7350, Office of Developmental Programs Priorities for Provider QM Plan Development published 12/1/12)

The Department of Public Welfare (Department) announces its priorities for a provider’s Quality Management Plan under 55 Pa. Code § 51.25(d)(1) (relating to quality management) for providers of Consolidated and Person/Family Directed Support (P/FDS) Waiver services, including Supports Coordination Organizations, targeted services management and providers of base-funded services in a waiver service location.

The Department priorities are as follows:

Achieving compliance with the quality improvement strategy sections found in Appendix A, Appendix B, Appendix C, Appendix D, Appendix G and Appendix I in both the Consolidated Waiver at http://www.dpw.state.pa.us/ucmprd/groups/webcontent/documents/communication/p_01289 7.pdf and the P/FDS Waiver at http://www.dpw.state.pa.us/ucmprd/groups/webcontent/documents/document/p_01 754.pdf
Achieving compliance with incident management policies and procedures established in Bulletin #6000-04-01 ”Incident Management” and including review and analysis of incidents as specified in 55 Pa. Code § 51.17 (relating to incident management).
Improving results of provider and Supports Coordination Organization monitoring reviews and ensuring corrective action plans under 55 Pa. Code § 51.24 (relating to provider monitoring) are successfully implemented.
Improving waiver participant satisfaction with service provision through review of Independent Monitoring for Quality data in the Home and Community Services Information System.
Reviewing and evaluating practices to promote employment and increase the number of
individuals with an intellectual disability who are employed.
Reviewing and evaluating life sharing opportunities and promote an increase in the number of individuals with an intellectual disability who live in life sharing arrangements.
Reviewing and evaluating practices to reduce and eliminate restraints.
Reviewing and evaluating practices to increase awareness and ensure reduction in individual to individual abuse.
Reviewing and evaluating practices to ensure each individual is supported in the use of an effective communication strategy
Reviewing and evaluating practices to ensure each individual receives the most inclusive, least restrictive services and supports.
Diverting individuals from admission to State Centers and State Hospitals

iscal Impact
There are no costs or savings anticipated.

Public Comment
Copies of this notice may be obtained at the local Mental Health/Intellectual Disability (MH/ID) County Program, Administrative Entity (AE) or Regional Office of Developmental Programs (ODP) in the corresponding regions:

Western region: Piatt Place, Room 4900, 301 5th Avenue, Pittsburgh, PA 15222, 412-565-5144
Northeast region: Room 315, Scranton State Office Building, 100 Lackawanna Avenue, Scranton, PA 18503, 570-963-4749
Southeast region: 801 Market Street, Suite 5071, Philadelphia, PA 19107, 215-560-2242 or 215-560-2245
Central region: Room 430, Willow Oak Building, P. O. Box 2675, DGS Annex Complex, Harrisburg, PA 17105, 717-772-6507

Contact information for the local MH/ID County Program or AE may be found at
https://www.hcsis.state.pa.us/hcsis-ssd/pgm/asp/PRCNT.ASP or contact the previously referenced regional ODP.

Interested persons are invited to submit written comments regarding this notice to the Department at the ODP mailbox at [email protected], use subject header “PN Priorities for Provider QM Plan Development” or Department of Public Welfare, Office of Developmental Programs, Division of Program Management, 4th Floor, Health and Welfare Building, Forster and Commonwealth Avenues, Harrisburg, PA 17120.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at 800-654-5984 (TDD users) or 800-654-5988 (voice users).

Monitoring and Evaluating Quality

Policy:
This policy of [AGENCY NAME] shall ensure to implement an ongoing, comprehensive, integrated, teleassessment program of the quality and appropriateness of care or services provided, including services provided under contract or agreement. The findings shall be used to correct identified problems and revise policies and practices, as necessary. Exclusive concentration on administrative or cost-of-care issues does not fulfill this requirement.

The provider shall analyze and revise the quality management plan every 3 years.

Procedures:

The following data shall be evaluated to identify unacceptable or unexpected trends or occurrences:
- Staffing patterns and performance to assure adequacy and appropriateness of services delivered;
- Supervision appropriate to the level of service;
- On-call responses;
- Individual records for appropriateness of services provided;
- Individual satisfaction;
- Complaint resolution;
- Infections;
- Staff concerns regarding individual care; and
- Provision of services appropriate to the individuals’ needs.
A quality improvement committee responsible for the oversight and supervision of the program, shall consist of:
- A member of the administrative staff;
- Representatives from each of the services provided by the organization, including
  contracted services; and
- An individual with demonstrated ability to represent the rights and concerns of
  individuals. The individual may be a member of the organization’s staff, an individual, or an individual’s family member
In selecting members of this committee, consideration shall be given to a candidate’s abilities and sensitivity to issues relating to quality of care and services provided to individuals.