CarePolicy Personal Home Care Agency Policies and Procedures User Guide

: May 15, 2024
: carepolicy

Table of Contents

Personal Home Care Agency Policies and Procedures
Introduction
Statement of Purpose
Statement of Policy
Document Control & Approvals
State Compliances
References
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POLICY AND PROCEDURE MANUAL
[AGENCY NAME]
Personal Care Home

CarePolicy Personal Home Care Agency Policies and
Procedures

Version 1.0
[Month, Year]

Personal Care Home
Policy and Procedure Manual
Version 1.0

Personal Home Care Agency Policies and Procedures

Copyright [Year] © [AGENCY NAME]
Disclaimer: All rightsreserved. No part of this publication may be utilized, reproduced,stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, recording or otherwise, without the prior written consent of the publisher.
[Agency Name] [Agency Address] [Contact Number]

Introduction

[Agency Name] is committed to providing exceptional care to the residents of our community. Our agency is dedicated to contributing to our residents’ quality of life and delivering the highest standard of care possible. We understand that making the best decisions for an aging or ill family member is a priority, and we aim to assist clients by creating personalized care plans that cater to their specific needs. With our compassionate caregivers, we strive to ensure client satisfaction by matching them with a caregiver who will provide the care they deserve.

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 clients at [Agency Name]. The goal of this plan is to coordinate resident’s care in a manner that is seamless from the resident’s perspective. This policy shall be made available for review, upon request, to clients 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:

Federal and State Law of Georgia
Needs of our members and the community we serve;
Our mission, goals and strategic objectives;
Agency policies and procedures;
Performance Improvement and member Safety Plan; and
Organizational capability to provide the requisite staffing, facilities and services.

We strongly adhere to compliance requirements stated by Georgia Law, Department of Health 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;

Ve r .
N o .| Rev.
No.| Page
N o .| Description of Amendment| Approved By| Date
---|---|---|---|---|---
| | | | |
| | | | |
| | | | |

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

Description| Ti t l e| S i g na ture| Date
---|---|---|---
Prepared By| | |
Reviewed By| | |
Approved By| | |

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

State Compliances

1253.1 Personal Care Services
A. [Agency Name] ensures that subcontractors render personal care services according to each member’s care plan. [Agency Name]’s Registered Nurse (RN) supervises all personal care services according to each member’s care plan.
Subcontractors provide the amount of personal care services needed by each member on a schedule that respects the member’s choice (time of day, etc.) and ensures that member’s hygiene and health needs are met.

B. [Agency Name]’s RN lists personal care tasks needed by the member on the member care plan and supervises these tasks. [Agency Name]’s RN supervises the delivery of personal care services to assure that the subcontractor delivers services appropriately and safely. Personal care services performed by the subcontractor include, but are not limited to:

Assisting with basic personal care and grooming, including bathing, care of hair, clothing, ambulation, and transfers
Assisting with toileting, including helping the member to and from the bathroom, and assisting with bowel and bladder training as directed by [Agency Name]’s RN
Arranging other grooming services requested or required by the member, such as a haircut. The home may charge fees for certain services if those fees are clearly stated in the admission agreement and agreed upon at the time of admission. The member and/or the member’s representative must agree to the schedule and additional cost of these services.
Monitoring the member’s self-administration of medications
Providing meals and snacks, including modified or special diets and assisting with feeding and monitoring nutrition and intake status
Performing household services essential to the member’s health, safety and comfort. Examples of such activities include the necessary changing of bed linens or the rearranging of furniture to enable the member to move about more easily in the home
Arranging for transportation for medical appointments January 1, 2023 Alternative Living Services – Group Model XII-3
Obtaining initial prescriptions, medications, and refills for members (unless indicated otherwise in the ALS admission agreement). Subcontractors may not charge a fee for this service.
Providing laundry service as a part of personal care.

Subcontractors may not charge a fee for:

Laundering member’s bed linens and clothing. The subcontractor is not responsible for the cost of dry cleaning a member’s clothes.
Minor mending unless the item requires special care not normally available in a home setting.
Subcontractors may not substitute dry cleaning or commercial laundering for routine laundering of the member’s clothing. Subcontractors may contract to have bed linens commercially laundered; however, the member may not be charged for this service.

C. Members living in subcontract homes may not receive the following CCSP/SOURCE services:

Emergency Response System
Personal Support Services
Home Delivered Meals NOTE: Advanced notice to HDM providers is required by Case Management when members will transition to Alternative Living Services (ALS) and discharge from the HDM option. Collaboration with the HDM provider will ensure payment for meals delivered has paid based on consumption before ALS can begin. (4/2021)
Respite Care

D. Senior Center Attendance: If a member attends a senior center, the provider agency informs the member’s care coordinator. If the member wishes to return to the personal care home, the subcontractor arranges transportation. [Agency Name]and its subcontractors cannot require a member to attend a senior center, Adult Day Health (ADH), or any other event the member does not wish to attend.

E. Specialized Health Items: The member or the member’s representative pays for the cost of specialized health items such as adult diapers, dietary supplements, shampoo, and other personal items. If the member or the member’s representative requests, [Agency Name] obtains the above-mentioned items for the member’s use. The facility’s admission agreement specifies how such items will be supplied. The member may not be charged a fee for obtaining these supplies.

F. Services Not Appropriate or Reimbursable: Services that are not appropriate or reimbursable as personal care services include:

Insertion and irrigation of catheters
Irrigation of any body cavities
Application of dressings involving prescription medication and aseptic techniques, including care of mild, moderate, or severe skin conditions
Administration of medication, including giving injections into veins, muscles, or skin.

EXCEPTION: Trained and qualified staff members may administer insulin and epinephrine. A statement signed by the member’s physician, certifying which staff have been trained and are qualified to administer insulin and epinephrine, is maintained in the member’s and employees’ files.

G. Home Health Agency Restrictions: CCSP/SOURCE members living in ALS facilities may receive skilled services through the Medicare/Medicaid home health programs on a short-term, intermittent basis.
Physician’s orders for home health services must be on file at the ALS facility. The care coordinator must authorize Medicaid home health services. [Agency Name] informs the care coordinator of the member’s receipt of Medicare home health services.
Procedures: The following procedures govern the provision of respite care services:

Senior Center Attendance:

[Agency Name] informs the member’s care coordinator if the member attends a senior center.
If the member wishes to return to the personal care home, the subcontractor arranges transportation.
The member cannot be forced to attend any event the member does not wish to attend.

Specialized Health Items:

The member or the member’s representative pays for the cost of specialized health items such as adult diapers, dietary supplements, shampoo, and other personal items.
[Agency Name] obtains the above-mentioned items for the member’s use upon request.
The admission agreement specifies how such items will be supplied, and the member may not be charged a fee for obtaining these supplies.

Services Not Appropriate or Reimbursable:

[Agency Name] does not provide services that are not appropriate or reimbursable as personal care services, including insertion and irrigation of catheters, irrigation of any body cavities, application of dressings

1253.2: Family-Model Subcontracting Policy and Procedures

Purpose: This policy outlines the procedures for [Agency Name]to subcontract with licensed personal care homes to provide medically supervised personal care services to CCSP/SOURCE members.

Policy: The provider agency must ensure that the facility has provided direct services to members prior to applying for registration with the CCSP/SOURCE. The facility must have a non-restrictive permit issued by the Georgia Department of Community Health, Healthcare Facility Regulation Division.
Procedure: To register a facility with the CCSP/SOURCE, [Agency Name] must perform the following:

A. Locate, evaluate and subcontract only with licensed 2 – 6 bed personal care homes (subcontractors) to deliver medically supervised personal care services to CCSP/SOURCE members. The provider agency will assess all potential subcontractors to determine if they are compliant with all provisions of the applicable CCSP/SOURCE manuals and with the rules and regulations for personal care homes. The provider agency conducts the assessment prior to the execution of any contract to deliver CCSP/SOURCE services and before placement of or billing for CCSP/SOURCE members in the home. During the pre-placement visit, the provider agency will complete the Pre-placement Screening Form (Appendix A of the Alternative Living Services Manual). The screening form, verifying the initial on-site visit, must be maintained in the provider agency’s subcontractor files. The provider agency’s file must demonstrate that any deficiency cited against a potential subcontractor has been corrected prior to the submission of the registration materials for that subcontractor.

B. Within 30 calendar days of the execution of the subcontract, the provider agency will submit registration materials for each subcontractor to the CCSP/SOURCE Unit. The provider agency will submit the following to the Division:

o a copy of the Pre-Placement Screening Form (Appendix A of the Alternative Living Services Manual) signed by the subcontracted home provider stating that all the information given is true o a copy of the facility’s Personal Care Home Permit.
o a copy of the subcontract (see 1253.2 D of the Alternative Living Services Manual) o a copy of the facility’s latest HFR inspection reports (dated within one year) indicating the facility is in compliance o a copy of the Fire Safety Inspection (dated within one year) indicating the facility is in compliance with fire/safety regulations.
o a copy of the facility’s floor plan that identifies each room and placement of furnishings in members’ bedrooms.

C. A subcontractor is not approved for placement of CCSP/SOURCE members until the Division has notified the Area Agency on Aging and Case Management, in writing, that the home has been registered. The Division reserves the right to delay or deny registration of any subcontractor. The Division also reserves the right to terminate a contract between a provider agency and a home(s). The Division will review the documentation submitted by a home and issue its decision thereafter.

Compliance: [Agency Name] will comply with all provisions of the applicable CCSP/SOURCE manuals and with the rules and regulations for personal care homes. [Agency Name] will maintain accurate records of all subcontractors and their compliance status. Any deficiencies cited against a subcontractor will be corrected prior to the submission of registration materials for that subcontractor.

D. Member Intake and Evaluation [Agency Name] conducts member intake and evaluation in compliance with the Georgia Department of Community Health and Rules of Department of Community Health, Chapter 111-8 Healthcare Facility Regulation, 111-8-62 Rules and Regulations for Personal Care Homes.
We offer members the opportunity to choose the subcontracted personal care home in which they wish to live. If the member does not have a preference, we assign them to the subcontracted personal care home most appropriate for them.

To ensure the completion of all necessary personal care home admission forms, [Agency Name]is present when the subcontractor admits a CCSP/SOURCE member to the CCSP/SOURCE home. We assure that forms required for admission to the subcontracted home do not conflict with CCSP/SOURCE policies and procedures.

E. Supervision of Subcontractors [Agency Name] supervises subcontractors in all aspects of member care to ensure complete and continued compliance with provisions of CCSP/SOURCE and the Rules and Regulations for Personal Care Homes, Chapter 111-8- 62. Our failure to ensure a subcontractor’s compliance with all relevant rules and regulations results in adverse action against our agency.

F. Contract Between Family Model Provider and Subcontractor The contract between the family model provider and the subcontractor must contain all the elements listed in Section 601.1 (J) of the CCSP/SOURCE General Manual. In addition, the contract must clearly state:

Provider agency’s name, name of the personal care home as listed on the personal care home permit, and name of the governing body
Responsibilities of the provider agency, including RN supervision. Note: RN supervisory work for the management agency cannot be performed by the PCP/Nurse Practitioner signing the level of care for the waiver members/residents in the home. (1/2021)
Responsibilities of the subcontractor, including Section 601.1 (O) of the CCSP/SOURCE General Services Manual and the responsible party to document in the DCH online incident reporting system. (1/2021)
Amount of per diem payment, including terms of payment, and monthly payment dates
Conditions under which either party may terminate the subcontract, including an escape clause and the subcontractor’s signed agreement that they received an explanation of the advantages and disadvantages of a short-term or long-term contract. Rev 9/2011

G. Status of Subcontractors [Agency Name] knows the status of all subcontractors and notifies the CCSP/SOURCE Unit and the AAA, in writing, of any changes in status within five business days of the change. Family-model provider agencies may not place a CCSP/SOURCE member in a home that has not been approved/registered by the CCSP/SOURCE Unit. The family-model provider agency is responsible for and assures performance of administrative and supervisory functions and understands the administrative and supervisory responsibilities relative to the CCSP/SOURCE. Responsibility may not be delegated to another agency or organization.

H. Adversely Discharged Subcontractors [Agency Name] does not contract with a family model home that has been adversely discharged from another provider agency within twelve (12) months. The CCSP/SOURCE Unit must review compliance with regulatory agencies and the Long-Term Care Ombudsman Program prior to granting approval for a subcontractor to register or re-register. The Division will not register subcontractors who have had deficiencies which endangered the health, safety, or welfare of members. Examples of such deficiencies include, but are not limited to: