(b) Along
with Form 3720 "Request for Certification of Other Qualified Agencies", each
applicant shall submit the following:
a. For
program design and program administration, policies and procedures:
1. A description of the OQA program goals and
objectives and how it supports consumer directed care;
2. A description of the OQA policy regarding
intake and admission and/or exclusion criteria;
3. An explanation of how the agency will
ensure that clients will have choice over his/her personal care worker(s) and
indicate if a client will be able to choose his or her personal care worker
other than from the agency's own pool of workers;
4. An indication if the agency will allow
clients who have a legal representative to participate in the
program;
5. An explanation of what
supports or education are offered to each client on how to manage his or her
care and management of his or her personal care worker;
6. A description of how a client's plan of
care is designed including who is involved in developing the plan and how the
OQA monitors its use, such as face to face interviews with the client, and how
BEAS case managers are involved;
7.
Specification of any other monitoring process(s) the agency uses or plans to
use for ensuring the quality of personal care services such as client
satisfaction surveys. If available, include samples of the tools used to
collect this information;
8. A
description of the annual OQA program evaluation plan indicating measurable
goals and objectives and how progress will be measured;
9. A current, dated organizational chart of
the OQA program illustrating lines of authority, responsibility/communication,
and staff assignment, including date, staff names, and position
titles;
10. A description of the
policies for programmatic access related to the American with Disabilities Act,
for example, alternative formats, and include the program's web
address;
11. A description of and a
copy of the written confidentiality policy;
12. A description of and a copy of the
agency's policies and procedures for screening potential staff members
including the procedures for conducting criminal history checks and BEAS state
central registry checks on potential personal care workers;
13. An explanation of what customer service
system procedures the agency currently utilized or what the agency plans to
utilize, to include a toll-free number for clients, the hours the toll-free
number is staffed, and if the agency has a messaging service, and the
procedures that are in place for returning calls; and
14. An indication of how the agency informs
each client of his or her rights and responsibilities for participating in the
program, and include a copy of the written rights and responsibilities,
grievance procedures, and service-termination policies you provide to each
client; and
b. For
staffing, supervision, and training:
1. A copy
of the staff orientation plan including for certified personal care
workers;
2. A description of the
policies regarding staff supervision provided to personal care workers by the
OQA;
3. The OQA program job
descriptions that delineate the roles and responsibilities for the executive
director and the director of personal care services;
4. An indication of how the agency informs
each personal care worker of his or her rights and responsibilities and include
a copy of the written rights and responsibilities, grievance procedures, and
service termination policies the OQA provides to each personal care
worker;
5. Identification of how
the OQA informs the client and his or her worker about how to report incidences
to the state according to the requirements of the state's adult protection and
the department's ombudsman's program laws and indicate if the agency would like
pamphlets on the adult protection law to provide to clients;
6. An explanation of the process for
resolving incidences and/or reporting incidences to the state according to the
requirements of the state's adult protection laws. Indicate if you keep a
record of incidences.
7. A copy of
the emergency back-up plan the agency provides to clients in the event a
personal care worker fails to report to work and how the agency informs the
client of these procedures. Indicate if the agency has a worker registry that
the client may access to find a substitute worker;
8. A description on how training is provided
to the individuals employed by your agency to provide personal care services
and include what the qualifications of the person(s) providing the training and
the type and frequency of ongoing training provided;
9. Details on the schedule for regular in
service OQA staff training for OQA staff including an indication of:
i. If the OQA provides additional/ongoing
training to caregivers, if the OQA determines additional training is needed;
or
ii. If the OQA routinely
provides additional training, and if so how often is the additional training
provided; and
10. A copy
of the training manual, workbook, or other written training
instructions.
