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REQUIRED POSTED INFORMATION

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PURPOSE & KEY TERMS

The purpose of this section is to help the learner identify what documents are required to be posted and visible to residents and visitors in your AFH.

Residents’ Bill of Rights Complaint Procedure Inspection Report Ombudsman Poster AFH License Emergency evacuation

plan/floor plan Weekly menus House rules

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OBJECTIVES

The learner will be able to: Describe the types of information required to be in

a private pay contract; Develop a private pay contract that fully describes

how much the resident is being charged and under what conditions the cost would increase or decrease;

List types of unacceptable clauses.

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INTRODUCTION

Oregon Administrative Rules for AFH specify which forms and information must be posted or maintained in your home: A copy of any form with an SDS number may be

downloaded from the web at https://apps.state.or.us/cf1/FORMS/; or

A copy may be requested from your local office. The provider cannot change the numbered

forms and all required posted documentation must be posted in a prominent place in the home.

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INTRODUCTION CONTINUED

Documents discussed without a SDS number will need to be developed by you for use in your individual AFH: The EQC Manual has a number of worksheets

that have been developed for your use.

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REQUIRED POSTED DOCUMENTS

Documents required to be posted are: Residents’ Bill of Rights (SDS 305); Complaint Procedure (SDS 519); Most current Inspection Report (SDS 517/517A)*:

*Completed by DHS staff. Ombudsman Poster (ORS 441.124); AFH License (SDS 904); Emergency evacuation plan/ floor plan; Weekly menus; House rules; and Notice – Intercoms and other Monitoring Devices (SDS

906N).

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MANDATORY FORMS CONTINUED

MANDATORYSDS 305 - Residents’ Bill of RightsSDS 305A – Signature version not

shown

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MANDATORY FORMS CONTINUED

MANDATORYSDS 519 - Complaint Procedure This document explains the

complaint procedure to residents and visitors;

A copy must be posted in your home;

The document can be obtained at the local licensing office.

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MANDATORY FORMS CONTINUED

MANDATORYSDS 517 - Inspection Worksheet The licensor or other DHS staff

will give you a copy of your inspection report upon completion of every inspection visit;

The most recent inspection report must be posted.

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MANDATORY FORMS

MANDATORYSDS 517A - Inspection Report The licensor or other DHS staff

will give you a copy of your inspection report upon completion of every inspection visit;

The most recent inspection report must be posted.

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MANDATORY FORMS CONTINUED

MANDATORYOmbudsman Poster Informs residents, their families

and friends how to contact an ombudsman if they feel that is necessary;

The State Long-term Care Ombudsman Program is an independent agency that advocates for residents in long-term care;

They can help resolve disputes, refer residents to needed services and visit with residents on a regular basis.

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MANDATORY FORMS CONTINUED

MANDATORYSDS 904 - AFH License The local office issues after all

licensing requirements are met; The license is not transferable to

another provider or dwelling; The license indicates who the

provider is, the address of the AFH and the classification which the provider has qualified;

All AFH licenses must be renewed annually;

The license classification is determined at the time of application, dependent on experience and the kind of care you want to provide.

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MANDATORY FORMS CONTINUED

AFH License Classifications: Class 1:

Residents requiring assistance in up to four ADLs; If little or no experience providing care or you want to care for

residents who have minimal care needs. Class 2:

Requires at least two years of full-time experience providing care to seniors and adults with disabilities;

Residents who are dependent in up to four ADLs. Class 3:

A health care professional or have at least three years of full-time experience providing direct care and at least two medical professional references;

Residents dependent in more than four ADLs but no more than one total bed care or totally dependent person at a time.

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MANDATORY FORMS CONTINUED

MANDATORYEmergency evacuation plan/floor plan You must develop, post and keep current a drawing of your home’s floor

plan: The floor plan must show the location and size of all bedrooms, indicate which

bedrooms are resident rooms and where the provider(s) sleep; The location of fire exits, evacuation routes, smoke detectors and fire

extinguishers must be noted on the floor plan; If the layout of your home changes in any way, you must update the floor plan

and keep a current copy posted. DHS must be made aware of changes; Examples of situations that may require you to redo your floor plan could be

relocation of smoke detectors or fire extinguishers; a bedroom changed from a resident’s room to a provider’s room; or an altered evacuation route;

If you have questions about whether or not a new floor plan must be developed or posted, call the local licensor.

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Emergency evacuation plan/floor plan sample

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MANDATORY FORMS CONTINUED

MANDATORYWeekly menus: Menus for the coming week must be prepared and posted in a location

accessible to the residents and their families; Posting the menu allows everyone to see the type of meals served, whether

or not the meals are nutritious and whether meal choices are similar to the potential resident’s;

Current residents should be involved in meal planning; Remember to include menu items that meet specific needs such as sugar-

free offerings for residents with diabetes.

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MANDATORY FORMS CONTINUED

SAMPLE ONLY

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MANDATORY FORMS CONTINUED

MANDATORYHouse rules: You are responsible for developing AFH House Rules and posting in your AFH; DHS approves all AFH House Rules. If at a later date you change your house

rules, DHS must approve the changes and all residents must be made aware of the changes when posted;

House rules are meant to give potential residents an idea of how your house is run. House rules help residents understand what to expect if they live in your AFH: Any restrictions or limitations on the use of tobacco, alcohol, telephones, visitation,

pets or meal schedules must be noted in the rules developed for your home; House rules must note any intercoms or monitors used in resident areas and

describe under what circumstances they are used; The house rules must not violate Medicaid law, the Residents’ Bill of Rights or

AFH rules; they must not be in conflict with the family atmosphere of the home.

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MANDATORY FORMS CONTINUED

MANDATORY:SDS 906N Must be posted even if you do not have intercoms or other monitoring

devices.

June 2012

June 2012 DHS-Office of Licensing and Regulatory Oversight 20

DISCUSSION/QUESTIONS