Lead Direct Support Professional Training Manual

Table of Contents

Employees

Schedule Floats Site Supervision Performance Training Work Injuries Leaves of Absence

Individuals Receiving Services

Team Member Expectations Person Served Meetings Individual Admission and Moves Documentation Guidelines Data Tracking Incident Reports Appointments Medical Documentation Medication Responsibilities Psychotropic Medications Person Served Finances Activity Schedule Primary Counselors Person Served Appearance Licensing Requirements

House

Home Appearance, Safety, and Maintenance Home Safety Checklist Vehicle Maintenance Fire and Severe Weather/Tornado Drills Meal Menus House Finances

Other

Lead DSP Checklist Required Employment Postings Cell Phone Use and Availability Lead DSP Offboarding

Staff Schedule

Writing, maintaining, and filling the staff schedule is the responsibility of the Lead. Although the Program Director will be as helpful as possible when needed, it does remain the Lead’s responsibility to make sure there is adequate staff coverage at the site. If you are proactive with the schedule and manage it effectively, you will have fewer emergencies and less stress.

The schedule for the upcoming week should be submitted to the Program Director by the end of the shift every Thursday and available to staff at least one week before it begins. Open shifts should be filled as far in advance as possible. It’s helpful to check in with your staff to learn who has the availability and willingness to pick up extra shifts so that when a staffing concern comes up, you know who to contact first.

It is the Lead’s responsibility to look at every shift to be sure the staffing is adequate. This means having confidence that the quality and abilities of the staff are adequate to offer the needed support to the person served on every shift. Every effort should be made to avoid “weak” shifts, as those often result in issues with persons served and incident reports. Consistency in staff is critical to the success of our persons served, so staff should be encouraged to work their scheduled shifts and not switch shifts unless necessary and approved through a supervisor.

Typically, each site will have six DSP positions: one Mon-Fri 3pm-11pm, one Mon-Fri 5pm-11pm, one Sun-Wed 11pm-8:30am, one Thurs-Sat 11pm-8:30am, and two Sat-Sun 8:30am-11pm. Some sites may have additional positions.

Overtime should be diligently avoided. Only in emergent situations and when all other options have been exhausted should overtime be approved. Overtime approval must come from the Program Director. Leads and PDs are expected to explain overtime when necessary, so be prepared to do so following any overtime at your site. Expect to specify what measures failed to avoid overtime. Whenever possible, the Lead should assist staff in shaving hours to avoid overtime.

If a staff is requesting a permanent change in position (either site or scheduled shifts), please direct them to complete a Transfer Request Form on the website to communicate this to Human Resources. All permanent schedule changes must be approved by HR and the Program Director. Staff schedules should not deviate from the hours listed on the template. Creating “custom” schedules for employees can create chaos when a staff transfers or resigns.

Leads must inform the Program Director whenever they wish to deviate from their scheduled 8:30am-5pm shifts. Otherwise, the PD will expect the Lead to be on site per their schedule. Time Off Requests are to be submitted two weeks in advance. When you do take time off, make sure to find coverage for your open shifts ahead of time – this should not be left for the Program Director.

Leads are not to flex their schedules. For example, if you stay 30 minutes late one day, you would be expected to work your full 8:30am-5pm shift the following day and would not shave 30 minutes off. Remember, consistency is essential. In addition, you should be leading your DSPs by example – if a Lead is not working their shifts as scheduled, DSPs will likely try to do the same. The Reliability Policy applies to Leads as well as DSPs, and Leads may receive points for reliability concerns.

The exception to this, however, is if you are unable to find coverage for an open shift and need to come in to work the shift. For example, if you have an overnight staff no call/no show, cannot find another staff able to come in, no floats are available, and you have discussed with your Program Director that no other options are available, you will need to work the shift yourself. If this occurs, you will be permitted to take a day off to make up for it. In order to take an eight hour shift off, the shift that the Lead covers must be at least six hours. However, you should exhaust all options before going in to work a shift yourself.

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If a Lead covers a portion of a shift, such as anything less than six hours, it will be considered an extension of the work day and there will be no additional compensation. Please keep in mind that this should be a rare circumstance. As soon as coverage is secured at the site, the Lead is expected to clock out; just as expected of DSPs. It would not be acceptable for a Lead to stay a few extra hours, as an additional staff person, in order to complete six hours so a day could be taken off later in the week. It is an expectation that the Program Director be involved in the steps of this process. Once a shift swap has been completed, please notify the Payroll Specialist and Program Director so payroll can be processed accordingly.

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Float Staff

To help fill vacant shifts, Zumbro House has Direct Support Professionals designated as Float Staff. Float DSPs are able to work at any site and can move from site to site to fill in, depending on need. Floats have the same duties as regular DSPs and are held to the same standard. Float staff are based at Sander 1 and will remain at that site until assigned to a different program.

Only Leads and Program Directors should call to request floats. Floats are directed to only accept assignments from Leads and PDs. Their phone numbers and schedules are only available to Leads and PDs. DSPs are not able to determine whether a float is needed. They could mistakenly use a float that is needed more urgently elsewhere or could attempt to manipulate the system to leave a shift early.

Floats cannot be requested before the beginning of their shift. Floats are intended to be fill-ins as necessary – i.e., for no-shows, late arrivals, or emergent situations. If you are aware of an open shift ahead of time, you should make every effort to fill it without relying on floats.

There is a Float Staff Schedule on your Google Drive. This is always updated with current staff, their schedules, and their contact information. Do not print this schedule as it may change frequently.

To request a float, follow these steps:

1. Check the Float Staff Schedule2. Contact the first person scheduled for the shift and tell them your name, title, and site

a. Ask if they have been assigned to a siteb. If that person has been assigned, contact the next float available

3. If all floats have been assigned, a. Ask if they are single staffed or if they are the second staff

If single staffed, you cannot pull them for your program – contact the other float staff scheduled If the second staff, a site with no staff will take priority, so you can pull them for your program

b. If not, assign them to go to your program Discuss anything they may need to know for their time at your site Remind them to contact the site supervisor to inform them of their new assignment

Floats are expected to answer all calls and texts while on the clock. If you contact a float staff during their shift and they do not respond, they can be assigned discipline points. Floats cannot decline an assignment. They use their personal vehicles, not company vehicles, to travel between assignments. Once assigned, they are expected to arrive within 15 minutes.

When assigned to a site, Floats are accountable to the supervisor of the designated program. Directives from the Lead and the PD must be followed. This means that the designated site’s supervisor will be responsible for completing documentation for any reliability or performance concerns.

Upon arrival at the site, they should review a few things: Check the times of medication passes and who will receive medications during the shift

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Check voicemail and email for updates on any pertinent information Review site-specific programming, such as the activity schedule and meal plan Review programs books and be familiar with which documents are to be referenced if there are any questions

(IAPP, CSSPA, Snapshot)

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Site Supervision

A key responsibility of the Lead DSP is supervising the site, including evenings and weekends. To help keep you updated, Direct Support Professionals fill out a Shift Report Form at the end of every shift. Please request that your staff submit this every shift and follow up if they do not. In addition, ask them to fill it out thoroughly – if a DSP submits Shift Reports with “N/A” as the answer to every question, this does nothing to provide you with the information you need and implies that these necessary tasks have not been completed.

The Shift Report Form includes many questions to prompt our DSPs to remember to complete tasks and to fill you in on all details from their shifts. Included are questions regarding activities and appointments completed, primary counselor check-ins, medical concerns, maintenance concerns, and other things you may need to know. This form goes only to the Lead to serve as a confidential form of communication.

It is essential that the Lead know what’s happening at the site, even when not present. If a staff person believes that their supervisor isn’t paying attention, they are much less likely to perform necessary work tasks and more likely to break company policies. Here are some tips for ensuring thorough supervision of the site:

Talk with the individuals at your site – Our persons served often know when DSPs are breaking policies or neglecting duties. However, they may not tell you unless you ask about it. When you come in for your shifts, conduct informal interviews with the individuals to see how the evening or weekend shifts went. It is helpful to ask specific questions. For example, “Did you go on all scheduled activities?” will get you more information than “How was the weekend?”

Talk with your staff – Check in with your staff regularly. Ask how their shifts are going, if they have any concerns with coworkers, etc. Again, they may not tell you about a concern unless asked.

Shift observations – If you ever believe there may be an issue with a staff person’s performance, you can have a shift observation completed. Contact the Zumbro House front desk (frontdesk@zumbrohouse.com) to request that a shift observation be completed, listing specific dates and times that you are concerned about. A shift observation will be completed and you will be alerted to any disciplinary issues.

Weekend supervision checks – Every weekend, a Lead is scheduled to complete supervision checks at our programs. The assigned person rotates every week, and the Lead scheduled for the week will be permitted to take that Wednesday off. Your supervisor will let you know when this is assigned to you, and you will then be provided with a map of the quickest route between sites and a list of things to check on, such as whether the alarm is on, if the activity schedule is being followed, or if all scheduled DSPs are present. This information will then be reported to the administrative office, and you will be informed of any disciplinary issues from your site.

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Employee Performance

Coaching and giving feedback

This is one of the most important aspects of the Lead position. The performance of your staff is a direct reflection on your performance. The coaching and performance improvement suggestions that you give to staff have a substantial effect on the quality of care provided to the person served. For that reason, it is essential to address any performance issues promptly and consistently. Allowing staff performance issues to “slide” would be negligent to the primary duties of the Lead DSP and a disservice to our persons served. You are not only monitoring staff compliance with internal policies and licensing standards, but you are also expected to provide feedback to your staff regarding interactions with the individuals served at your program. If you observe a staff’s interaction with a person served and feel that an alternative approach would work better, it must be addressed. The persons served reflect the behavior of our staff, so helping our staff interact appropriately is critical to their success and will help minimize behavioral issues.

We also have a responsibility to our employees who really want to do a good job. If we are not addressing performance concerns to help them do better, we are taking that opportunity away from them. Even more concerning, missing the opportunity for the persons served to have a better staff person.

Giving employees feedback is not always easy. You may not have had to do that in the past, you may be unsure of how they will react, you may be uncomfortable with the conflict, you may need them to pick up an extra shift and want to avoid upsetting them, and you have to work closely with that person at the house! The trick is to be fair and consistent. If you are fair and consistent, employees will expect you will say something to them if their work is not up to standards. As long as they feel they are treated fairly and that we want to see them succeed, they will likely not be too upset. You can consult with your Program Director for advice on approaching these conversations.

Your best tools are ones that are already provided to you: Policies and Procedures, Snapshots, job descriptions, Behavior Support Plans, IAPPs, House Guidelines, etc. Always refer to those documents when coaching an employee – they should know that we are not just making up rules as we go. Feel free to reach out to your Program Director or other administrative staff as applicable if you need more resources.

When coaching your staff, it’s helpful to explain why we do things a certain way. Without this, DSPs may feel that we are just giving them rules. However, all of our policies are in place for a reason. If your staff understand these reasons, they will be more likely to comply.

What is most important is that you are addressing concerns with the employee as soon as possible after discovering a performance concern. Feedback that is not given promptly is not nearly as effective – if you wait, the employee may show the concern again or may not even have a clear recognition of what the situation was.

Performance monitoring

Here is a good motto to adhere to: INSPECT what you EXPECT! If staff know you won’t be checking on something, they are much less likely to follow through with that task. That doesn’t mean they are a terrible staff; that is just human nature! Spot checks of DSP duties must be done regularly. This doesn’t have to be a time-consuming task; just choose a few items and double check quickly that they have been completed – and completed up to the standard that Zumbro House expects.

Always remember, the Lead has to take accountability for what goes on in their site. Make sure the staff is well trained and that you are addressing and documenting all performance issues. If you overlook incomplete or improperly completed job tasks, then you are communicating to the employee that it is not important. This further creates an atmosphere where rules are considered optional. Enforcing all house rules and company policies consistently will result

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in a better run site. If the Lead is not holding staff accountable for their performance, then they are neglecting a major part of the Lead DSP job duties.

Documentation of performance

You may have heard this before: if it is not documented, it did not happen. The same applies to documentation of employee performance. If you discover performance concerns but do not follow up with documentation, we cannot use that information to move forward in the disciplinary process if needed.

Documentation of performance concerns must always remain confidential. Document these concerns per Zumbro House’s Discipline Policy.

As you are documenting performance, keep the following tips in mind:

Write it all down – Although you may mean well, nothing undermines the credibility of an employer more than incorrect or incomplete information created later because we are relying on memory to complete it. You may think a particular situation is so outrageous or unique that you will not forget it, but your information will only be viewed as completely credible if it has been promptly documented.

Stick to the facts! – Do not guess, exaggerate, or offer personal opinions. The documentation must be clear, concise, and objective; include only the facts.

Strictly business – Only refer to the situation at hand and the facts surrounding it. If you add in any irrelevant details, such as another staff person’s offhanded comments, it may damage the credibility of your documentation and someone could make the case that you were unable to be objective.

Use company documents and Policies and Procedures for support – The most commonly used documents are the DSP Job Description, Staff Reliability and Discipline Policies, and the Security Policy. You can use 245D, CHC, and Employee Policies and Procedures, the Medal Program, and any other documents that employees are trained on.

Make sure staff are aware of those policies and have access to them – Record this in your documentation.

Don’t make promises – especially ones you cannot keep. If you tell an employee that you will address their concerns but do not follow through, your credibility and authority is damaged.

Be a historian – It is useful to write, for example, “This employee was counseled on 2/3/16, again on 7/3/16, and once more on 2/4/17, all regarding…” As you can imagine, writing that this employee has been spoken to about this issue “at least three times” would be much less informative and credible.

Always be fair! – Treat all employees fairly and consistently. Not only do we, of course, need to be fair to our staff, but this will also help to avoid accusations of preferential or discriminatory treatment.

Reliability Policy

Zumbro House’s Reliability Policy provides guidelines for staff reliability. As a Lead DSP, you will be responsible for reporting on your staff’s reliability. Variances to their schedules – such as a late arrival or a call off without proper notice – will result in points accrued. An employee can be terminated if they reach ten points within one year. The points correspond to the severity of the infraction and are listed on a chart in the Reliability Policy. Points expire one year after they are assigned. To report these, you will fill out a form on the Zumbro House website under Employees Only > Employee Performance. See the Reliability Policy for more information.

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Make sure to be prompt when reporting reliability issues! The longer a conversation is put off, the less likely the staff person is to change their behavior. It is helpful to explain to your staff why reliability is so important. In order to ensure that we are always providing the best services that we can, we need staff to be at work when scheduled. There are many issues that can be caused by unreliable staffing:

Your staff cannot leave until they are relieved. If a staff person is consistently stuck late at work due to late relief staff, they will likely become frustrated with their position.

The staffing ratio will not be met, meaning that we are not able to provide adequate supervision and will not be able to complete activities as scheduled.

Unreliable staffing brings down morale for both staff and persons served. Consistency is essential for providing the best supports that we can.

You may have to come in during your time off to cover a shift.

Discipline Policy

Zumbro House also has a policy for staff discipline. Like the Reliability Policy, staff can accrue up to ten points in one year. Points for the Discipline Policy are less clear-cut than for the Reliability Policy but will also depend on the severity of the issue. A minor infraction will likely be one point. A major infraction will likely be five points. Also like the Reliability Policy, you will fill out a form to communicate your concerns with Human Resources. This form is also on the Employee Performance page of the website. See the Zumbro House Discipline Policy for more information.

There is a wide variety of infractions that can result in discipline points. Examples include sleeping at work, inappropriate interactions with persons served, inappropriate use of company resources, excessive cell phone use, etc.

Supervision forms and meetings

Supervision meetings are expected to take place between the Lead and the Program Director once each month. During these meetings, house documents, staff issues, resident progress, and work processes are reviewed. These meetings are designed to ensure that the structures set up in the programs are being done regularly and correctly. These meetings are vital in upholding the quality of services that is expected of ZH Leads.

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Training

New employee training

New employees are hired weekly. DSP Orientation takes place every Thursday and focuses on introducing the employee to the company and their role. They learn the basics for their jobs. The following are some of the topics covered in Orientation:

Maltreatment Rights EUMR & Prohibited Procedures First Aid Medication Administration Training Bloodborne Pathogens & Infection Control HIPAA & Data Privacy Safe Transportation

When a new hire is assigned to your site, you will receive an email with a Shadow Sheet, which includes the employee’s name, phone number, scheduled shadow shift, and regular shift schedule.

New employees are required to shadow another employee before working unsupervised. It is strongly encouraged that shadow shifts are completed by the Lead. If this is not possible, please make sure that training is completed by a strong staff and that they are prepared to train the new employee. Please reach out to the trainer to discuss this responsibility and provide instructions for shadow shifts to ensure all required topics are covered.

Take the time to train the new employee well. This will make them a better DSP and create fewer problems for you in the future! Also, encourage your staff to be helpful to and welcoming of new employees. They should understand that the more they help to train the new employee, the better coworker they will have.

Instructions for shadow shifts can be found on the website under Staff Orientation and Training > Training Document Library. These must be used for all shadow shifts to ensure thorough and consistent training. The following are some of the topics that must be covered:

Tour of the site, including: location of staff keys, emergency supplies, cleaning supplies, meds, etc. Alarm: have them arm and disarm the alarm in front of you to ensure they know how to use it Discuss each person served: behaviors, incidents, approaches, medical concerns, legal matters (i.e. probation

and provisional discharge conditions), ADL & IADL needs, etc. Daily documentation: MARs, Health Progress Notes, Data Tracking Office: staff email, ADP, ZH website, shift report forms Site-specific programming: activity schedule, meal plans, etc. Cleaning requirements (be specific!)

A new employee cannot start working until you hear from the Training Coordinator that they are cleared to start. The state has certain requirements that must be met before a person works unsupervised. To ensure compliance, it is important that you do not allow a new employee to work until you are informed that they are cleared.

Transfers

If an employee transfers to your site from another Zumbro House site, they will need to train at your program prior to working unsupervised. They will need to read the individual’s documents, including the Snapshot, IAPP, CSSP, CSSP

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Addendum, and Rights Restriction, if applicable. You will need to ensure they receive a tour of the site, that they learn site-specific details, that they meet all residents and are informed of their needs regarding behaviors, health issues, ADLs, etc. They will need to fill out a form online to document this training. This form is found on the Zumbro House website under Staff Orientation & Training, in the Training Document Library.

Ongoing training

All training hours are documented and filed at the office and become part of an employee’s personnel file. Completing required training is an expectation of the job as well as a requirement for licensing. The employee’s ability to meet those training requirements will be reflected in performance appraisals and other performance management documents as necessary.

There will be mandatory training posted on the website to complete annually via an electronic form. All staff hired prior to the beginning of the year will be required to complete annual training for that year (for example, 2018 annual training will be required for all staff hired during or before 2017).

The Lead should first set an example and complete the training in a timely manner, and then encourage the staff to complete training through emails, memos, or whatever else it takes to get them to complete the training.

Staff members who do not complete the training by the end of the year will be suspended, as completion of annual training is a licensing requirement. Lists of staff members who have not completed the training will be supplied to the supervisors, and Leads will be expected to help communicate expectations for completion with those staff.

Training requirements

For Direct Service Staff who have: been employed less than 12 months

been employed more than 12 months

less than 5 years documented experience 30 hours required 24 hours required

more than 5 years documented experience 30 hours required 12 hours required

As you can see, the numbers are fairly high for newer employees. Updates will be given to the supervisors and shared with the Leads throughout the year as to employee progress on obtaining the required number of hours.

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What to do if a staff is injured at work

Workers Compensation laws require employers to manage employee injuries in a specific way. Employers are required to track injuries, any time missed from work due to an injury, or any time that is worked with restrictions (such as a lifting restriction) as a result of the injury. We are required to file reports with our insurer according to very specific timelines. In order for us to manage claims effectively and get the employee the coverage they need, we need to gather as much information as possible about the injury and how it occurred. This will also allow us to review that information to see if there is a way to prevent that injury from occurring in the future. There may be penalties against the company if the requirements are not met, so prompt communication is the key to success!

If an employee gets injured during their shift, they are going to notify you. It is your responsibility to notify the Program Director right away to determine if a First Report of Injury should be completed. If the employee needs medical treatment, tell them they must tell the medical provider that they were injured at work and give them the company name and address. The employee should pass along the office address and the phone number for Human Resources (651-264-1004). The employee must provide us with documentation of that appointment and any recommendations from the doctor.

The form that they will likely return is called a “Report of Work Ability” and needs to be passed along to the Program Director and Human Resources as soon as it is received. It will contain confidential information regarding the employee’s health status and should be kept private and protected. The information will include if the employee has any restrictions that need to be followed, if they are authorized to be off work, and when, if any, follow up appointments are scheduled. Any work missed due to an injury incurred while at work must be reported by the Lead or Program Director to Human Resources promptly.

If the employee has any physician prescribed restrictions as a result of the injury, those must also be reported to Human Services, prior to returning to work. The Human Resources representative and the supervisor will determine if it is safe for the employee to return to work with the restrictions.

If the employee is receiving ongoing treatment for their workplace injury, all information from the doctor and Report of Work Ability forms must be turned in promptly to HR or the Program Director.

As mentioned above, we will look closely at all situations where someone is injured to assess if something can be done to lessen the risk for other injuries in the future. Take a look at the First Report of Injury form – located on the Zumbro House website under Employees Only > Staff Communication – to see what kind of information is needed. If you know what is going to be needed, you will be able to ask the employee the right questions about the situation.

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Leave of Absence

Since the Lead is responsible for the schedule, it is likely that the Lead will be the first person aware that an employee needs a leave of absence. There are several types of leaves available to Zumbro House employees, but the most important of those for Leads to be aware of is Family and Medical Leave (FMLA).

Family and Medical Leave

The Family and Medical Leave Act (FMLA), enforced by the US Department of Labor, requires employers to provide up to twelve weeks of unpaid, job-protected leave to eligible employees for the following reasons:

For incapacity due to pregnancy, prenatal medical care, or childbirth; To care for the employee’s child after birth, or after placement for adoption or foster care; To care for the employee’s spouse, child, or parent, who has a serious health condition; or For a serious health condition that makes the employee unable to perform their job; or Military Caregiver Leave to provide care for a covered family member with a serious illness or injury incurred in

the line of duty; or Qualifying Exigency Leave (Military) – See Leave of Absence Policy for more details

Employees are eligible for FMLA if they have worked for Zumbro House for at least 12 months and have worked at least 1250 hours in their last 12 months of employment.

If an employee talks to you about needing to take a leave for a medical reason or any of those listed above, contact the Program Director and Human Resources. Human Resources will make the determination whether the employee is eligible for FMLA. If the employee is not eligible for FMLA, a personal leave will be considered.

Employees may not always be able to ask for this type of leave in advance. Illnesses can come on unexpectedly. For this reason, it is important that we are always asking ourselves about FMLA if an employee is missing work. For example, if an employee calls in sick for more than three shifts in a row, you should be talking with Human Resources to see if the employee and the situation meet the eligibility requirements.

The Human Resources Representative will be tracking all time off during a Family and Medical Leave. It is important to communicate to that person any conversations that you have with the employee regarding return to work or their employment/health status.

Personal Leave

Personal leave covers all other leaves for personal reasons, for medicals reasons when employees do not qualify for FMLA, or any other non-medical reason. Each Personal Leave request will be considered for approval on its own merits, and the following will be taken in to consideration:

The reason for the request; The amount of time required; The employee’s performance record; and The employee’s length of service.

Personal leaves for medical reasons will require documentation regarding the necessity of the leave from the employee’s physician. Zumbro House may choose to accommodate any temporary restrictions that an employee may have to support them in avoiding a medical leave. Please refer to the Employee Policies and Procedures on the website

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for the most current information regarding personal leave. You may direct any employee to contact HR with their questions.

Military Leave

Military leave is available to Zumbro House employees, except for temporary employees, who enter military service for active duty. Please refer to the Zumbro House Employee Policies and Procedures for a more detailed description of this leave. You may refer the employee to the Human Resources Representative to answer any questions they may have.

Other

For any leave requests that do not meet the definitions listed above, speak to your supervisor. As with all requests for leaves, refer the employee to the Employee Policies and Procedures located on the Zumbro House website.

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Team Member Expectations

Guardians and Case Managers are our customers, along with the persons served. You are expected to provide the utmost in service to our customers. Our desire is to have the team member end every telephone, email, and in-person contact with a positive feeling about Zumbro House. Guardians and case managers have entrusted their persons served to Zumbro House. It is important that your demeanor and communication express to their team members that we have the best interest of the person served in mind.

While the Program Director is the point of contact for persons served team members, it is likely that the Lead will interact with guardians or case managers occasionally. In these situations, the Lead must represent the company professionally and create good will with team members. The Lead should not discuss an individual’s programming with their team. Instead, any opinions or input from the Lead should be directed to the Program Director.

Questions from team members should be referred to the Program Director. If you hear of any complaints, concerns, or even the hint of a bad feeling from a team member, it is essential that this be passed along to the Program Director. It is important to us that teams are satisfied with our services. If a Lead neglects to inform the PD about a concern of any kind, they will be subject to disciplinary action.

It is essential that the Lead ensure thorough communication with the Program Director, so the Program Director can ensure thorough communication with the team. Communication is the key to the success of our persons served, and we would never want a team member to feel that our communication with them is inadequate.

Customer satisfaction surveys are sent to case managers and guardians. They are asked to rate services on a scale from 1-5 in areas such as house cleanliness, friendliness of the staff, and experience with the Lead. Zumbro House uses this tool in appraising the Lead’s performance.

Please speak with your Program Director to discuss any team specific communication needs.

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Person Served Meetings

Your responsibility as a Lead may vary regarding person served meetings, so ask your Program Director for some direction. Sometimes, a person served meeting takes place at the house. It is your responsibility to make sure that the house is in top-notch condition and cleanliness (as it always should be!) on the day of the meeting. It is also the Lead’s responsibility to be sure that the individual looks their best. Persons served should have a nice haircut, combed hair, and be dressed in their best clothes for a meeting. It impresses team members when the individuals (especially those who have historically looked disheveled) are dressed well and look good. A jacket and tie is appropriate, with pressed dress pants. The individual’s appearance, fair or not, reflects on the quality of service we provide.

If an individual looks unclean and disheveled, their team may assume that our quality of service matches. It is never acceptable for a person served to wear torn or stained clothing, have messy hair, or have poor hygiene – especially on the day of the meeting. If a Direct Support Professional, instead of the Lead, will be working at the site while the person served gets ready for a team meeting, the Lead will need to contact that DSP to communicate the expectations. The staff person working with the individual must ensure proper hygiene and appropriate clothing choices.

Keep in mind that for some team members – the case manager, for example – this may be the only change they get to see our program and the Person Served. If we make a poor impression or if the individual’s appearance is unkempt, that team member will likely conclude that this meets Zumbro House expectations. We want it to be very apparent that we have high expectations for both our program sites and for the persons served.

Also consider that for some of our persons served, these meetings can be stressful. When we help the person served look great, chances are that they will feel better as well. Nice clothes and a neat appearance will help to boost their confidence and encourage pride in their accomplishments.

It is difficult to imagine how you would feel to have a group of people sitting around a table discussing your most private information. Many individuals appreciate support from the Lead in preparing an agenda for the meeting. Prior to the meeting, you should sit down with the person and discuss items that the person would like to address in the meeting. The Lead should then communicate those topics with the Program Director. Individuals may want to discuss accomplishments they have made and any changes they would like to see for the upcoming year.

After a person served meeting, there may be changes to their plans, new guardian expectations, or new programs to be implemented. All staff at your site must review the individual’s documents any time there is a change to their Snapshot, CSSP, CSSP Addendum (i.e. meeting report), or the Individual Abuse Prevention Plan. As program supervisors, you and the Program Director will be responsible for ensuring that these changes are communicated to staff.

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Person Served Admissions and Moves

When an individual moves in or out of a Zumbro House program, the Lead will need to ensure that we are prepared. Keep in mind that this is a big move for the individual, and we should do everything we can to make this a positive experience for them. This means being welcoming and ensuring the environment is comfortable. Try to make them feel at home and plan to check in with them frequently while they are settling in.

There are several tasks that must be completed before an admission. Some of those tasks include:

Ensure maintenance tasks have been completed: Is there a bed available? A dresser available? Have repairs been made, walls painted, and carpet shampooed?

Purchase a new bedding set, pillow, and towel set, and make the bed for them Ensure a bedroom/apartment key is available

There are also tasks that must be completed on and after their admission day:

Greet the individual, provide a site tour, and introduce them to their housemates and staff Check in their medications and create a MAR if one is not available Read all necessary documents and ensure all staff do the same Complete a Change of Address with the Post Office Change address with the police department or BCA, if applicable Complete Fire and Severe Weather Drills within 24 hours

These are just some of the required tasks for individual admissions. The Individual Move-In Checklist on the Zumbro House website provides more detailed instructions.

Any time an individual moves internally, between Zumbro House sites, both Leads must be present for the move to ensure it goes smoothly. Complete a Medication Transfer Form and a Finance Transfer Form. These forms are available on the website and are signed by both Leads to confirm accuracy.

When an individual moves out of your program, you will be expected to assist with packing and organizing belongings to include medications, funds, and personal property. Remember that moving out of the program is likely a big event in their life, and we want to ensure that they are discharged in a position to continue to be successful. Talk with the individual to make sure they are comfortable with their discharge plan.

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Documentation Guidelines

Person Served Files

Please ensure that the Table of Contents is used to organize the books for all persons served. Please ensure that their books are kept neat and in good shape. Keeping the books in order will help ensure that staff members are able to locate and complete all necessary documentation. If books are not organized per the Table of Contents, staff will be unable to find necessary forms, leading to incomplete or lost documentation. Pages that are half torn or falling out of the books must be corrected – use hole punch reinforcements if needed.

As a Lead DSP, it is your responsibility to ensure that documentation is completed accurately and promptly. You should take the time to review your persons served books frequently and follow up with any staff members who have neglected to document or have documented incorrectly. By the end of the month, you will need all required paperwork to be thoroughly and accurately completed. If you wait until the end of the month to review your documentation, it will be much harder to correct it before it needs to be turned in to the administrative office.

Central Filling at the Office

At the end of each month, the following documents must be pulled from the person served books: Medication Administration Records Health Progress Notes Symptom and Outcome Tracking Sheets Medication Receipt Forms

These documents, in addition to any appointment referral forms, medication destruction forms, physician orders, etc. must be brought to the Lead Meeting each month to be turned in. Before turning in your paperwork, please review for thorough and accurate completion.

You should have an envelope with these documents and the Monthly Paperwork Checklist for each person served. The Monthly Paperwork Checklist can be found on the Zumbro House website under Employees Only, in the Leads tab. Each page of documentation must have the individual’s first and last name, the month, and the year.

What if you need to refer to something filed at the office?

If you need access to information filed at the office, you can call your Program Director, and they will be able to assist if they are at the office. You can also contact Quality and Compliance Support to help locate your information.

Plan ahead – if you know that you will need a piece of information later, make a copy or record the information that you need. This will save time in searching for the information later.

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Symptom and Outcome Tracking

As a Lead, you will be responsible for monitoring and compiling data tracking information for the individuals that you serve. You should be regularly checking on the documentation completed by your staff. Are they documenting thoroughly? Does it appear to be accurate? Check on specific days. If you know that an individual exhibited verbal aggression on the 12th of the month, there should be a “yes” documented on their symptom sheet for that behavior on the 12th. If you know that an individual completed their exercise goal the previous evening, check to make sure the staff marked “yes” on their exercise goal. If you find incorrect documentation, you will need to follow up with your staff.

Incomplete or inaccurate data tracking is unfair to the individuals that we serve. Their support teams use this information in their team meetings to help determine any changes to their protocols, privileges, or goals. If they are using inaccurate information, they will not be able to make a properly informed decision. In addition, the individual’s providers, such as psychiatrists, use this data to determine changes to medications or treatments.

At the end of every month, you will pull the data tracking sheets from each individual’s book and count the responses. This information is then sent to Quality & Compliance staff. When tallying your data, please remember the following:

For Target Symptoms, we ideally would like the numbers to be low (this would mean that the individual is not exhibiting this behavior often). If your numbers are high, think about if that is reasonable. For example, you may count 11 “yes” answers for verbal aggression for the month. If you know that an individual has had several instances of aggression, you would conclude that your count is reasonable. However, if you know that an individual very rarely shows aggression, you would need to question the accuracy of those 11 “yes” answers.

For Outcomes, please consider the same. If you count zero “yes” answers for an exercise goal, but know that the person has been exercising regularly, you will know that your documentation is inaccurate. Follow up with your staff if you believe their documentation is inaccurate.

Also for Outcomes, it is essential that we encourage progress toward goals. If we don’t take the time to remind the individuals of their goals, help them complete them, and provide time on the schedule for them, we are denying them of tools that they need to make progress. Remind your staff to be familiar with each individual’s outcomes and how and when to complete them.

Counting Data: Target Symptoms

For each symptom, provide the number of “yes” responses out of the number of total responses. If your staff documented every day in the month, it will be out of the number of days in the month. If your staff did not document every day, your total will be the number of days that documentation was completed. For example, if your staff missed documenting on four days in February, your data will be out of 24 rather than 28.

Counting Data: Outcomes

Outcomes are the goals set by the individual and their team members. Counting outcomes can be a bit more complicated. The way the goal is counted will depend on the frequency of completion.

Daily goals

Many goals are offered every day. For example, an individual may have a goal to request medications daily without staff prompting. These will be counted the same way as Target Symptoms – i.e. the number of ”yes” responses out of the number of days documentation was completed.

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Weekly goals

Some goals are weekly. Any time an individual has a goal that is to be completed on a weekly basis (whether it is once, twice, or three times each week), that goal will be counted out of four because there are four weeks in the month. With these, you are counting the number of weeks that the goal was completed, not the number of instances that it was completed).

For example, someone may have a goal to participate in activity planning once weekly. If they complete this every week, they will have four out of four for the month.

It is common for individuals to have a goal to complete a task three times per week – for example, exercising three times weekly. In these instances, you will still be counting the week rather than the individual instances. This means that they must complete the goal all three times during that week to get credit for the week. If they only complete the goal once or twice during a week, they will not get credit for that week.

Monthly goals

Individuals may also have goals to complete a task once per month. Your count for a monthly goal can only either be zero out of one (0/1) or one out of one (1/1).

Others

Some goals may be trickier to count. For example, someone may have a goal to wake up on time every weekday. This would be out of the number of weekdays in the month. Be sure to read carefully to make sure goals are counted accurately.

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Incident Reports

Any time there is an incident that is inconsistent with routine operations and services provided, an Incident Report will need to be filled out. Your staff must contact you any time this occurs. Situations that require an IR include the following:

Person served injury Missing person Harm to self or others Inappropriate sexual behavior Verbal or physical aggression Property destruction Medication refusal Medical emergency – including all trips to urgent care or the ER Police involvement Automobile accident

Documentation on an Incident Report must be objective and accurate. This is meant to be a communication tool. This is not meant as a form for staff to share their personal opinions. The person filling out the IR should address what led up to the situation, what the situation entailed, how staff minimized the severity of the incident, and how we followed up with it.

Incident Reports must be filled out by the end of the shift in which an incident occurred. There are firm deadlines for reporting incidents to team members and the overseeing agency, which is why it is essential that the Incident Report is completed promptly.

If two or more individuals are involved in an incident, separate IRs must be completed for each individual, withholding the names of all but one person served. For example, if two individuals are fighting and an IR is needed, you would fill out two using the full name of one and a placeholder name (i.e. Peer 1) in place of the other name. Then, you would submit a separate IR swapping the names. This is to ensure that we maintain the confidentiality of all individuals.

When directing a DSP to fill out an Incident Report, please ask them to read the instructions on the reporting form to ensure it is filled out correctly.

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Appointments

As the Lead, you will be responsible for coordinating appointments for your persons served. It is essential that this responsibility is taken seriously and that all required appointments are scheduled.

When scheduling appointments, make sure to keep a few things in mind: Activity schedule – Will any planned outings interfere with this appointment? Staff – Is the staff scheduled this day an appropriate person to complete this appointment? Can you rely on your

staff to be at work and on time to complete the appointment? Time of day – Is there adequate staff to supervise both the appointment and the other individuals? Is this a time

of day that works well for the individual? Do they prefer morning or afternoon appointments? Are there other things going on at the site at this time that could cause problems?

In preparation of the appointment, consider the following: Is the referral form completed entirely with a medication list attached? (see below for more information) Is the appointment on the house calendar and Google calendar? Is the staff clear on the clinic location and how far away it is? Any anticipated issues with parking or traffic? Is the resident aware of the appointment? We ask that they be ready one hour before the appointment. Is there a vehicle available with enough gas? Have I communicated directly with the staff responsible for taking the resident to the appointment?

It is recommended that the Lead DSP complete the majority of appointments at the site, as the Lead has the most knowledge regarding the individual’s medications and history and will be able to ensure accurate and thorough documentation and communication. In addition, it provides consistency and helps to develop a positive relationship with the provider or clinic.

For some appointments, it may be adequate to send a Direct Support Professional – a dental cleaning, for example. However, the Lead should personally complete more important appointments, especially psychiatry, appointments regarding major medical concerns or changes, appointments requiring thorough and detailed communication with the provider, etc.

Referral Forms

It is essential that we obtain documentation of every appointment scheduled for all individuals served. The first half of the form is to be completed by Zumbro House staff, and the second half is to be completed by the provider. Referral Forms must be filled out completely and accurately. The following information is required:

Individual’s name Individual’s date of birth Diagnoses Allergies Provider and clinic name Date Staff accompanying Type of and reason for appointment Medication list

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The form is our way of documenting that we have given a physician all of the information they need. For example, what if a person served is allergic to penicillin, but it is not written on the referral? We may take them in for a sinus infection, and their physician could prescribe penicillin. The person served would have an allergic reaction and need to be rushed to the emergency room. We would be held responsible for this error because it would have been prevented by providing the doctor with complete information.

The same goes for accurate completion of current medications section. Many of the individuals we serve see multiple health care providers, meaning the prescriptions for their medications could come from multiple different doctors. If one provider is unaware of the medications prescribed by another, they would not be able to consider any potential contraindications. Because of this, an accurate and thorough list of medications must be provided at each appointment. It is acceptable to bring a copy of their current MAR instead of writing their medications by hand.

Because the information on the Referral Forms is so critical, the Lead DSP, or a trusted designated staff, should complete them in advance whenever possible. Many houses have designated the Sunday overnight to complete all appointment forms for the upcoming week. If this task is delegated to a DSP, the Lead is still responsible for ensuring that referral forms are filled out thoroughly and accurately. If forms are filled out ahead of time, it is then very easy for the staff attending the appointment to just grab the form and go.

There are specific referral forms for certain types of appointments: the Dental Referral Form, Ophthalmology Referral Form, Lab Referral Form, Annual Physical Form with Standing Orders, and Psychotropic Medication Evaluation. Please ensure that the correct form is used for each appointment. The Medical Referral Form is to be used for any appointments that do not fit into the above categories (for example: a visit to their primary provider regarding a specific concern, a physical therapy appointment, or a neurology appointment). Because the Medical Referral Form can be used for a variety of appointments, it is essential that the form indicates the type of appointment, location of appointment, and reason for the visit. All appointment forms can be found on the Zumbro House website. In addition to these forms, please ensure that all appointments are documented in the Health Progress Notes.

At the end of the appointment, the provider must provide us with documentation of the appointment. They should fill out the bottom half of the Referral Form. In addition, electronic visit summaries are very helpful. If a doctor provides us with a summary print out, please ensure it is kept and brought in with the rest of your monthly paperwork.

All completed referral forms should be reviewed by the Lead, as the Lead should be aware of the outcome of all appointments. Ensure that any necessary follow up is scheduled and completed. If a follow up appointment is needed, it should be scheduled before even leaving the doctor’s office whenever possible. If setting up the appointment is delayed, it is more likely to be forgotten or missed. If there is a medication change, this must be communicated (see the section below on medication changes).

Completed referral forms should be kept in the folder behind the individual’s MAR in the Person served program book until the end of the month. These completed forms are documentation that the appointment did happen, the outcome of the appointment, treatment or medication changes or recommendations, etc. As you are gathering monthly paperwork to bring to the Lead Meeting, make sure to include all completed referral forms.

Appointment Tracking

In your Google Drive, there are Appointment Tracking spreadsheets for each individual at your program. These are used so that Leads, Program Directors, and administrative staff can all access information regarding the appointments.

Appointment Tracking must be updated every Monday. Please ensure this is done weekly! Every week when you check and update your tracking, you will update the date at the top of the page to indicate to administrative staff that this has been done.

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The top portion of the tracker is a list of all necessary, recurring appointments and their frequency. This should always be updated with the date of the most recent appointment, a summary of that appointment, and the date of the next appointment (or the month it will be due if not yet scheduled). In your summaries, please be detailed. For example, if there is a medication change, make sure to list the name, dose, and frequency. This information is used frequently by administrative staff. This also provides a comprehensive view of their appointment and medication history, which helps us look for patterns in their mental and physical health.

These appointments include:

Annual Physicals

Annual Physicals must be completed annually. Standing Orders are signed at the Annual Physical each year. Insurance will not cover this appointment until one full year from the last appointment. Standing Orders expire one year after being signed, at the end of that month. Because of this, you will have a small window to fit in an Annual Physical without allowing Standing Orders to expire. For example, if a person has a physical on March 3 of 2017, they would have between March 3, 2018 and March 31, 2018 to get the appointment done at a time that it will be covered by insurance and that Standing Orders will not expire. Please put a copy of the standing orders in the individual’s book upon your return to the program. A current copy of standing orders should always be present in the person’s book.

Labs

Labs are to be completed as requested by an individual’s providers. These are typically done with the Annual Physical every year. However, other providers occasionally request labs. It is common for psychiatry providers, in particular, to request labs to assist with medication monitoring.

Dental

Dental check-ups are typically either semi-annual (every six months) or annual, depending on insurance coverage. The date listed on this portion of the Appointment Tracking should be the date of the last check-up (exam and cleaning). Individuals may go to the dentist more frequently for things such as fillings, deep cleanings, or other concerns. These appointments should be noted in the running list of appointments sectioned below.

Ophthalmology

Usually, ophthalmology (eye) appointments happen annually. This can vary, though. Some individuals may go every other year. Some may go semiannually.

Psychiatry

The frequency of psychiatry appointments will vary person to person. Often, an individual will have psychiatry appointments every three months or every six months.

Below that portion is a running list of all appointments. Every appointment that an individual attends should be added to this running list. Ensuring that all appointments are on this list will ensure that you access to all of their past appointment information, so that past medication changes or dental concerns, for example, will be available to you at all times.

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Google Calendar

You will also use your Google account to maintain a calendar of appointments for your site. This is a separate tool used in sync with the appointment tracker. This calendar provides a monthly visual of the appointments and meetings at your site. This dynamic tool allows administrative staff to view all scheduled appointments. In addition, they can add appointments and meetings as needed. Note that while a Program Director may add items from time to time, this is not an expected responsibility of their position. It is the responsibility of the Lead to ensure this calendar is updated at all times and that all necessary appointments are scheduled as recommended by health care professionals.

You should check and update the Google Calendar frequently, as least weekly, to ensure that it is up to date and accurate. It is helpful to bring a printed copy of the calendar to appointments or to have the Google Calendar app on your phone. This way, when you schedule a follow-up appointment, you can check for any potential timing conflicts. All appointments should be added to the calendar as soon as you are able.

When creating an event in the calendar, you can include your own notes to serve as a reminder as the appointment approaches. This can include the clinic location, any preparation needed (for example, instructions for fasting), estimated length of the appointment. This could be printed and given to the staff attending the appointment to provide additional information.

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Medical Documentation

Medication Administration Records

Medication Administration Records, or MARs, will be delivered by Bloomington Drug each month. Although Bloomington Drug is very reliable, the sheets must be checked for accuracy upon delivery. The Lead must double check the accuracy before the MARs are put into the Person Served program book for use. You will be checking that any medication changes are reflected, ensuring there are no typos or other miscellaneous errors, etc.

If there are any issues, contact the pharmacy and get them straightened out. The pharmacy will be able to answer any questions you may have. If there is an error, they can correct it on their end so that the MARs are accurate for the following month. Please make sure this is done promptly to ensure that issues are resolved before it is time for the new MAR to be used.

Throughout the month, it is the Lead’s responsibility to check the MARs daily to ensure that all medications are being passed and documented correctly. In addition, please do an extra thorough check of all MARs and medication cards at least once weekly to ensure everything is on track. Complete a Medication/Treatment Discrepancy Form for any errors that are discovered in your reviews. See the below section on medication administration errors for more information on Discrepancy Forms.

Any missing documentation must be completed prior to the end of the month. Before bringing your MARs in with your monthly paperwork, review them thoroughly. Ensure that documentation errors are corrected and that Discrepancy Forms have been submitted for any medication errors. This must be done before submitting completed MARs to the Woodbury office for filing – by the time they are brought to the office, there should be no holes on the MARs.

Medication Changes

All changes must be discussed with the Program Director prior to starting the medication. Some medications require approval from outside of Zumbro House. This does not mean to delay starting the medication until you see the PD – you must contact them so that the medication can be started as soon as possible.

When transcribing the medication change to the MAR, you must be extremely careful that the information is exact. The handwriting must be legible and the order must be written in a way that is clear to the staff person reading it. If it is not, medication errors would likely occur. The transcription must include:

The name of the medication (as it is listed on the medication card or bottle) Dosage Frequency of administration (e.g. twice daily) Exact times of administration (e.g. 8AM and 8PM) must be written in the “time” column Route Any special instructions (e.g. “shake well” or “take with food”) Prescribing doctor and start date

Use the other entries already on the MAR as a guideline. Writing your new entry with the same formatting as the already-printed entries will help to ensure all necessary information included. If you have any questions regarding documentation of the medication change, please reach out for guidance. Your Program Director, the nurse, or Quality & Compliance administrative staff will be able to help.

If there is a change in dose or frequency to a medication that the individual is already taking, you will need to discontinue the current order and rewrite the new order in a new space on the MAR. You cannot cross out and change

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dosages once the month has started – if this is done, all documentation prior to the change would be incorrect. To accurately document the change, it is essential that the MAR reflects a discontinuation of the current dose and that the new dose is written in a new space.

Once the change has been made, make sure to communicate the change with all staff at the site. It is helpful to alert staff via email, text, or a note and to draw attention to the change on the MAR (using a post-it note, for example) to ensure all DSPs are aware of the change.

In addition to ensuring communication regarding the change with the Program Director and all Direct Support Professionals, please make sure the change has been sent to the pharmacy. This can be done by faxing the Referral Form to Bloomington Drug. Providers should send orders directly to the pharmacy, but we must ensure that the pharmacy does receive all orders. In particular, providers occasionally neglect to send discontinuations to the pharmacy. It is important that we send documentation of discontinuations to ensure that Bloomington Drug is aware that the medication is to be removed from the MAR and not delivered with the next cycle of medications.

Medication Administration Errors

It is an expectation that all staff, not just Leads, complete Medication/Treatment Discrepancy Forms any time a medication or treatment error is discovered. Make sure to hold your staff accountable for this expectation. If a DSP informs you of a medication error, please direct them to fill out a Discrepancy.

As you complete your daily MAR checks, follow up with any holes that you find. Was it missed? Was it given, but not signed for? In addition, you should ensure that all PRN and Standing Order medications have been documented on the last page of the MAR, and in the Health Progress Notes, in addition to being initialed on the MAR.

If your MAR is missing documentation, please follow up with the responsible staff promptly. Let them know that they will need to fill in their missing documentation during their next shift. It is helpful to also note this on the MAR using post-it notes. Missing documentation needs to be filled in no later than the end of the month, but do not wait until the end of the month to work on getting it filled in. The more promptly you follow up with staff, the more likely they are to remember to fill in their missing documentation and not to forget to document in the future.

Medication errors include:

Given to the wrong person Given on the wrong date Given at the wrong time Wrong medication given Wrong dose given Given via the wrong route Not given

If you discover a medication error, fill out a Medication/Treatment Discrepancy Form, contact the nurse, and document in the Health Progress Notes. In your HPN entry, include instructions from the nurse and how staff followed up with the error. If you catch a missed medication within a few hours of the medication window, it is possible that the medication can still be given. Make sure to call the nurse immediately to inform of the error and check if the medication can be administered.

All medication or treatment errors must have a corresponding Discrepancy Form. Please make sure that any Discrepancies that you submit are detailed and thorough. It is very difficult to look at these forms on a later date and remember what the situation was if they are not completed thoroughly.

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When a staff person makes a medication error, a retraining will be assigned to ensure the staff is competent to administer medications and prevent future errors.

First error: Verbal retraining with the Lead. There are several forms that are useful for retraining DSPs, including the MAR Documentation Guidelines and Medication Administration Protocols (both should be in each program book, in front of the MAR) and the Safe Medication Policy (in 245D Policies and Procedures).

Second error: Retraining and a Supervised Medication Pass with the Lead. You will supervise the DSP as they pass medications and ensure that the medication pass is completed per the Medication Administration Protocols. The Training Coordinator will provide a Supervised Medication Pass Form, which will need to be completed and returned.

Third error: Retake the Medication Administration Class at the Woodbury office with our Home Care nurse.

If, following a retraining, you still have concerns regarding a staff person’s competency to administer medications, please discuss this with your Program Director. Feel free to reach out to the Quality and Compliance Department if you are interested in additional resources for retraining staff on medication administration.

Medication errors are removed from the staff’s personnel record six months after the date of the error.

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Medication Responsibilities

Beyond ensuring proper documentation, Leads are responsible for other aspects of medication administration, including keeping the medication cycle on track, ensuring adequate supply, stocking standing order medications, and destruction of medications.

Medication Cycle

Our pharmacy will automatically bring us refills for all scheduled oral medications. This is called the “cycle” and will be delivered every four weeks, with 28 dosages per pack. When this arrives, it must be checked in on a Medication Receipt Form, then properly organized and labeled to ensure that all DSPs know when the new packs are to be started.

All packs should be started on the same day. If you have extra dosages left over in your current bubble pack, set them aside to be destroyed and start the new pack. If you are short pills and would need to start your new pack early, contact the pharmacy and order what you need to last until the start date. This may not seem important, but consistency is essential. If bubble packs are disorganized and punched incorrectly, it is much more difficult for staff to decipher and they will be more likely to make an error.

Medication Supply

All medications that are not considered a part of the cycle will need to be reordered as needed. These are medications that the pharmacy will not be aware when we run out: as needed medications, topicals, sprays, powders, etc. It is important that we never run out of medications for a person served!

Every medication on an individual’s MAR should be present at the site. You and your DSPs will regularly check these medications and reorder when running low, typically at about one-quarter full. Never wait to reorder until they run out of the medication! It’s recommended that overnight staff put the most effort into checking these, as they have the most down time during their shifts, but overall it is the responsibility of the Lead to ensure that we never run out of medications.

Standing Orders

As Lead DSP, you will be responsible for ensuring there is a supply of standing order (over the counter) medications. We should always have things like Tylenol, Sudafed, Milk of Magnesia, etc. on hand. These medications will come out of your house budget and should be regularly restocked.

Medication Destruction

Anytime there are medications at the site that have been discontinued, are expired, or are just extras that should not be used, those medications need to be destroyed. Medications cannot be thrown in the trash or flushed! If a medication is thrown in the trash, a person could take it back out. If a medication is flushed, it enters our streams and rivers, adding various drugs to our water. This can, depending on location, end up in our drinking water.

To ensure responsible disposal of medications, there are drop-off bins located at various locations in the area. Check with Quality and Compliance staff or your Program Director for information on the closest location to your site.

Before disposing any medication cards or bottles, all identifying information – name, date of birth, prescription number, medication name, etc. – must be torn off or blacked out. We have a responsibility to maintain the confidentiality of our persons served.

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Psychotropic Medications

Many of the individuals we support take psychotropic medications – medications that are prescribed to alter mood or behavior. These medications can have significant effects on someone who takes them. Because of this, we have some additional requirements to follow.

Any time someone is taking a psychotropic medication, we must have an informed consent signed by the guardian. This form shows that we have given the guardian all of the information about the medication(s) and that they are giving us permission to administer it to the person served. For new psychotropic medications, we have to have this in place BEFORE the medication is started (unless it meets the criteria as an “emergency initiation”). This is why it is very important that the Program Director is aware of all new prescriptions before they are started. For this reason, it is the Lead DSP’s responsibility to attend all psychiatric medication monitoring appointments. When a new psychotropic medication is prescribed, contact your Program Director as soon as you are able so that we can obtain consent and start the medication promptly.

We must also have a Behavior Support Plan. This plan should be a training tool for staff, as it tells how to be proactive with the person served, what the behaviors look like, how staff should interact with the person served, and how staff should react should the behaviors occur or escalate. A copy of the Behavior Support Plan should be kept in the individual’s program book and be available to staff. The next thing that we must do is keep data on the behaviors that we are attempting to reduce or eliminate. That is what your behavior data tracking sheets are for. Ideally we would like to have some baseline data, meaning how frequently the behaviors are occurring before a new medication is started. It is very important that the Lead monitor data tracking sheets throughout the month to ensure that staff are documenting accurately. This is information that will be used to interpret if the medication is having any effect on the person served, if the dose needs to be adjusted, etc.

We also need to monitor for side effects. You and your staff should keep an eye out for any side effects, especially after changes to or addition of new psychotropic medications. If any side effects are noted, discuss this with your Program Director right away. Formal side effects monitoring may be required by a provider – if so, this is to be completed by the Lead.

A psychiatric provider may instruct us to complete MOSES (Monitoring of Side Effects Scale) for anyone taking psychotropic medications. In addition, if the person served is taking a psychotropic medication that is under the “antipsychotic” classification, another side effect monitoring tool may be completed – the DISCUS (Dyskinesia Identification System: Condensed User Scale). This scale checks for signs of Tardive Dyskinesia.

If a DISCUS is required, it will also need to be completed when an antipsychotic medication is discontinued, at one, two, and three calendar months after the discontinuation to check for presence of Tardive Dyskinesia. So even if a medication is discontinued, that does not mean we can stop monitoring for side effects. Please check with your Program Director if you are completing these and believe it is time to stop.

If one of the persons served at your house takes a psychotropic medication on an as needed (PRN) basis, there is additional documentation required. For every psychotropic PRN medication that is prescribed, there must be a corresponding protocol for administration of that medication. That protocol is on a PRN Psychotropic Medication Administration Plan form and must be available to all staff. It should tell the staff what target behaviors to look for, what interventions should be attempted before administering the PRN, and what exact behaviors the person served must be

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displaying in order to give the medication. This protocol is approved by the individual’s IDT and signed by their psychiatric provider.

One last thing we must monitor when someone is taking psychotropic medications is that they are not losing any skills or positive characteristics as a result of the medication. We do not want the individuals we serve to seem “drugged up” or like “zombies.” We want to make sure that they are able to do as many things independently as possible, that they are able to participate in activities they enjoy, that they maintain their positive attributes, etc. Sometimes finding a balance between decreasing the behavior and not slowing them down too much can only be found by trial and error.

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Person Served Finances

Zumbro House has been given the responsibility for managing funds for many of our persons served. This is a serious responsibility and we must keep detailed and accurate records of all individuals’ accounts and spending. Person served checkbooks must be safeguarded from theft or loss. Mismanagement of person served funds could be reportable under the Vulnerable Adults Act, so our recordkeeping needs to be meticulous.

Checking and Savings Accounts

Persons served should be ordering and using duplicate checks. Although they are slightly more expensive, it creates additional documentation of person served spending.

Person served checkbooks must be kept in a secure location where only the Lead and the Program Director can access them. Any extra check blanks or saving account deposit/withdrawal slips must also be kept in the secure location. Transactions from checking or savings accounts must be completed by the Lead.

Persons served should have their debit cards on them. We will not hold any cash or debit cards unless it is discussed with Program Director and the individual’s team.

All transactions must be recorded on the Person Served Checking/Savings Ledger/EBT Ledger.

Deposits should always be made in full. For example, imagine you are taking a person served to the bank to deposit their Social Security check, which is for $725, and they need to withdraw $20 in cash as well. Deposit the entire $725 into their account and then in a separate transaction, write a check to “cash” for the $20. Writing a check for cash is a better option than using a withdrawal slip from the bank. It creates better documentation and leaves little room for errors. Separating the transactions in this way will ensure the ledger clearly shows deposits and withdrawals.

If you are depositing more than one check in a single transaction – for example, a personal needs check and a paycheck – write a detailed description in the checkbook register that reflects the amount of each check. For all deposits, the register should reflect the origin of the check rather than just writing “deposit.” The paystub or check stub from the deposit should be faxed to the office (for monthly reporters only) and then attached to a receipts page behind the ledger.

Checks must be deposited within seven days. Choosing one day each week to complete all banking – every Monday, for example – will ensure all transactions are completed promptly. The Lead DSP should be the only staff person completing bank trips.

Person served bills received at the house must be paid within seven days. It is essential that the balance of the individual’s account is double-checked (also considering any outstanding checks) before writing out the check to avoid the possibility of an overdraft. If the person served does not have adequate funds to pay a bill, the Lead should discuss this situation with the Program Director.

At the beginning of each month, enter the automatic withdrawals the person served will have for the month, if applicable, such as gym membership fees. Adding these to the ledger early in the month will ensure avoidance of overdrafts later in the month.

Attach receipts for checking/savings/EBT transactions for the current month to blank pages behind the ledger. The receipts should be stapled to the pages without overlapping. If you use tape to fasten the receipts, make sure the tape does not cover any of the ink on the receipt – the tape will cause the ink to fade over time. Do not mix checking receipts with cash receipts – this will make it confusing for you and more difficult to balance the checkbook at the end of the

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month. When the individual’s checking statement arrives, put it with your financial documentation and receipts until the end of the month.

At the end of the month, the bank account statement, full month transaction history, the receipts for the past month, and the checking ledger must be compiled and balanced. You should begin by going through the checking ledger and matching the receipts or vouchers for every transaction. Vouchers for checking account purchases should be extremely rare. If receipts are repeatedly being lost or misplaced, this will be addressed as a disciplinary issue. Make sure there are no missing or skipped check numbers. If a check has been voided for some reason, the voided check should be attached to the receipt pages.

Now you are ready to reconcile the checkbook register to the bank statement.

You can use the Checkbook Balancing Form and follow these steps to reconcile the checkbook:

Reconcile the checks – Determine if there are checks that have not yet cleared the bank. In the checkbook register, check off each check listed on the statement, making sure the amount you recorded is the amount the statement shows.

Reconcile the deposits – Make sure each deposit shown on the bank statement has been recorded in the checkbook register. Direct deposits of paychecks or social security checks can be easily forgotten. Check off the deposits in the checkbook register as you did for checks.

Record interest earned and bank fees – Check the bank statement for any interest earned or any fees and record them in the checkbook register.

List outstanding checks – Now, go through the checkbook register, and in column 2 of the Checkbook Balancing Form, list any outstanding checks (the checks that you did not check off when reviewing the statement). Include any checks from previous months still outstanding. Total the column of outstanding checks.

List outstanding deposits – Go through the checkbook register, and in column 1 of the Checkbook Balancing Form, list the outstanding deposits from current and past months not checked when reviewing the statement. Total the column of outstanding deposits.

Record the bank’s ending balance – On line 1 of the bottom portion of the Checkbook Balancing Form, enter the ending balance shown on your bank statement.

Enter outstanding deposits – On line 2 of the bottom section of the Checkbook Balancing Form, enter the total outstanding deposits from column 1. When using the form from the website, this calculation is done automatically.

Enter outstanding checks – On line3 of the bottom section of the Checkbook Balancing Form, enter the total outstanding checks from column 2. The total is entered automatically when using the form from the website.

Calculate your balance – The form on the website calculates the balance automatically. If not, use a calculator to total lines 1 through 3, as indicated by a plus or minus sign on the form. Enter your new total on line 4. This should equal the balance in the checkbook register. If it does not balance, go back and check for math errors or

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any other errors in the checkbook register (such as reversing numbers, subtracting rather than adding, forgetting automatic payments, etc.)

Tip: If the balance is off, see if the amount divides easily by 9. If it does, the problem may be a transposed number (such as recording a check as $53.94 instead of $53.49).

After everything is balanced and accounted for, paper clip together the bank statements, full month transaction history, the receipt pages for that month, the Checkbook Balancing Form, and the Person Served Checking/Savings Ledger/EBT Ledger. This will go in your envelope for person served finances, brought to the Lead Meeting the following month. (See the section on documentation guidelines for more information regarding person served filing). Make sure that you keep copies of the statement, the ledgers, and the balancing form for reference as you start next month’s finances.

FYI – Even if there is no activity in an account for the month (which is fairly common for savings accounts), a ledger must be submitted which states “no activity for this month” or something similar. On the bottom of the checking and petty cash ledgers, it asks if the person served has another type of account, such as checking or savings. Be sure to answer the question, so the office staff reviewing the finances is aware of what accounts they do and do not have.

Person Served Petty Cash

Person served cash must be carried on them. We do not keep any cash in the safe.

Asset Limits

Most of the individuals we serve have a $2000 asset limit. This means that the total of their checking, savings, and cash on hand should be less than $2000 at any given time. Social Security contacts the person served bank every few months to ensure that their balance does not exceed $2000 on the last day of the month. If a person served goes over their asset limit, they are at risk of losing their Medical Assistance and any other benefits they are receiving. Since we are responsible for assisting with their funds, it is our responsibility to keep an eye on what they have for assets. When an individual’s total assets reach $1500, the Lead must notify the Program Director to discuss and develop a plan for spending it down (with approval from the guardian or case manager, as needed). Some individuals have higher asset limits for various reasons. If you are not aware of an exception for any individual, assume their limit is $2000.

Unpaid room and board can cause a person served to go over the asset limit very easily. See the section below for payment of rent requirements.

Rent Responsibilities

If you have ever rented an apartment, house, condo, etc., you know that rent is always due at the beginning of the month. For our persons served who are responsible for some of their rent (referred to as Room and Board), it is also due after the beginning of the month. The payments are due at the office no later than the 15 th of each month. The accounts receivable representative from the office will communicate what amount is due for each person served either to the Program Director or to the Lead directly.

Completion of Financial Paperwork

There may be several forms of financial paperwork that come to the house for the person served. It is essential that you are paying close attention to the mail and passing these along to the Program Directly as they are received. If in doubt, fax it in to the office. All of the individuals we serve are eligible for Medical Assistance (MA) and some receive Group Residential Housing income (which is explained below). There is a recertification process for those and the forms will likely be sent to the person served at the house. Fax the letter explaining the form to the office, along with the color of

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the form (usually white, purple, blue, or orange). We usually only have about 10 days to get them returned to the county for processing. If those forms are not completed and sent in, the person served could lose their MA. This would mean losing medical coverage to see their doctors, inability to pay for medications, and inability to pay for services from Zumbro House and any additional placement (a day program, for example). There are other forms as well, such as the Household Report Form, which are required for some persons served each month. If you get something that you are not sure about, contact your Program Director right away to make sure we meet any set deadlines.

In order for the office to be able to complete these forms, it is essential that all person served paychecks and bank statements get faxed into the office, along with the cash ledger completed to date no later than the 25 th of the month. The original pay stubs and bank statements can be attached to your person served funds documentation, but they must be faxed to the office as soon as they are received.

General Billing Information

What the charges are for a Peron Served to live in a facility such as Zumbro House:

Room and Board – This is like rent, and for our persons served, this dollar amount is designated to cover food, linens, shelter, etc. It is the same amount for every person served. The amount is set by the State of Minnesota, not by Zumbro House.

Program Rate – This is a rate that is negotiated with the county when a person served is placed in one of our programs. This is the dollar amount that pays for staffing and all other expenses not covered by Room and Board.

What income sources our persons served might have:

Group Residential Housing (GRH) – If they qualify, this would help pay all or a portion of their Room and Board.

Social Security (RSDI) – Social Security for disabled adults that qualify under a parent. This is considered earned income and the person served is often required to pay all or a portion of their Room and Board out of this check.

Supplemental Security Income (SSI) – This is unearned income, and it is used to supplement their earned income. To qualify, an individual earns below the current rate established by the Federal Government. A formula is used to determine the amount of money received based on their earnings. Typically, the amount received is adjusted according to the money earned two months prior. Because of this, a three-paycheck month could substantially reduce the amount received from SSI two months later. When this happens, it can be frustrating to an individual having to pay an additional amount toward Room and Board in a month when they are back to receiving two paychecks.

Earned income – this would include any income a person served earns through employment and from RSDI.

Generally, no matter how much an individual receives from RSDI or SSI, they receive their personal needs money from the total, with the remaining being paid toward their Room and Board or program costs. There are some exceptions to this rule.

What is “personal needs”?

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Personal needs money is a predetermined amount that a person served is able to keep out of their unearned income. It is intended to cover the cost of medication co-pays, personal items such as hygiene supplies, and other personal needs. Because this amount is not substantial, it is important that we assist the persons served to budget their money effectively.

Do not throw ANYTHING away!

Anything that is received from the county or look even remotely important must be kept and forwarded on to the office. Even if you think you have already sent the same exact thing, please send it again. Sometimes there is such a minor change on one of those reports that it could easily be mistaken as a copy. One of those missed changes could cause Zumbro House to incorrectly bill for or collect for a person served. Make sure to consult with your Program Director if you receive something you do not recognize or are unsure about.

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Activity Schedule

All activities should be planned in advance. It can be a challenge to work everyone’s plans into the schedule if you have an active house. Teaching the individuals at your site to work cooperatively is very important! This is a great opportunity to teach the individuals in the house how to work together.

When planning activities, remember there are many things to do that are free or very cheap. Watch the newspaper and check local resources for ideas on local free activities and events. Many places around the metro offer specific days that they are open to the public for free or reduced cost.

Many of the individuals enjoy getting together with other houses to do things as well. This is a great way to keep them connected and encourage friendships! However, these activities can require lots of planning to ensure adequate supervision and avoid potential conflicts. Any visits between ZH sites require pre-approval from the Program Director.

Activities should be kept within a ___ mile radius. As our sites are located in the metro area, there are plenty of nearby options for activities and there shouldn’t be a need to go beyond that radius. If you believe there is a reason for your site to go on an activity further than ___ miles away from the site, please check with your Program Director for approval.

Activity planning is to be completed with persons served weekly so they are able to give input on their preferred activities for the schedule. Activity planning sessions should be scheduled for the same time each week and should involve all individuals at the program. Persons served at your program should be encouraged to come to activity planning prepared with any activities they would like to schedule for the following week. This can include things such as recreational activities or visits with family members.

Once the group has agreed on the week’s activities, type up the activity schedule, paying close attention to details and ensuring enough time is left for each activity or appointment. When creating the schedule, please consider which staff would be the best fit for each activity, and use this knowledge to determine which days to schedule each activity. The schedule should include all planned outings for the site: activities, appointments, primary counselor check-ins, person served work/day program schedules, etc. In addition, the activity schedule should include time set aside to work on the individuals’ outcomes, such as exercising, cooking, or reading. Please check the individuals’ outcomes to determine the frequency of these tasks and ensure the schedule reflects this.

After typing the schedule, send it to your Program Director no later than the Thursday before the schedule begins. The Program Director will review on Friday to ensure that everything on the schedule is safe, appropriate, and well-planned. Make sure to note if there is anything included that you are unsure about, such as the appropriateness of an outing. Some outings may require team approval or the development of a safety plan, so it is essential that the Program Director is able to review the schedule prior to implementation. After approval, you will post the schedule in the common area of the site on Monday morning. A current activity schedule must be posted at all times.

Keeping the persons served involved in activities that they enjoy will reduce the number of behaviors that occur. Everyone feels better and can deal with stress and frustration a little easier when they have other things to look forward to. Keeping the schedule packed with enjoyable activities will help ensure that residents have fun things to look forward to and will reduce down time.

Make sure that your DSPs are aware of what should be done if there is a bit of down time on the schedule. This is a great time to help persons served work on their goals (for example, helping them to search for a new recipe to cook or ledger their purchases). Other ideas for down time include puzzles, coloring, card games, and board games. Staff can also use this time to clean the site, review company policies or individual protocols, organize supplies, etc. There is always a lot to be done at the site!

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It is important to not deviate from the planned activity schedule. It is vital that there are no surprises for the residents. They look to the activity schedule to plan their day/evening and it is disruptive to them if the schedule is not followed. Because of this, not following the activity schedule can cause anxiety among persons served. Deviating from the activity schedule also results in some risk that an activity may not be appropriate or safe. Please reinforce this to all of your staff regularly. Direct Support Professionals are not authorized to make changes to the activity schedule and must contact the Lead if they believe there is a need to deviate from the schedule (for example, due to weather concerns).

Be sure to reinforce with staff that unplanned activities are not allowed without authorization from the Lead or the Program Director. Unplanned activities are a violation of our policies and will be addressed with disciplinary action up to and including termination of employment.

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Primary Counselor Responsibilities

The Primary Counselor system is a great way to ensure that the individuals we serve receive the connection and support they need to be successful. It is also a good way to delegate some of the tasks to your DSPs so you are not directly responsible for completing every detail.

It is the role of the Primary Counselor to develop a relationship with the assigned individual that is encouraging, supportive, and assists the person to function at the highest level possible. Primary Counselors are to meet with their assigned individual weekly to complete all tasks on the Primary Counselor Checklist. This includes a 1-on-1 session, reviewing upcoming appointments and activities, ensuring they are working on their goals, ensuring laundry is clean and organized, ensuring hygiene tasks are being completed and that the individual has adequate hygiene supplies, etc. The Primary Counselor is to follow the Primary Counselor Checklist, which can be found on the website. The checklist should be placed in the front pocket of the person served program book when completed.

It is the responsibility of the Primary Counselor to provide an update to the Lead. This should be included in the Shift Report Form. You must hold the Primary Counselor accountable for this – this system will not be successful if DSPs are not held accountable for the tasks assigned. If the Primary Counselor system fails at your site, you will end up having to do more of the work yourself. More importantly, the individual is missing out on the additional support and communication provided by the check-ins. Remember, not all individuals will approach staff if they have concerns to discuss, have issues with completing goals, need assistance with laundry, etc. It is essential that Primaries meet with their assigned individuals weekly to discuss these things.

It is important that when you assign a Primary Counselor, they understand the expectation of that role. Review the Primary Counselor Checklist with them and walk them through the procedure. It can be helpful for the Lead to complete a primary check-in with that staff present so they can see how it should be done. Remember to reassign any time a Primary Counselor resigns or transfers to a new site.

When assigning Primary Counselors, consider:

Staff strengths and approaches Staff relationship with the person served Timing of schedules (for example, if an individual leaves to visit their family every weekend, you would not

choose a weekend staff to serve as their Primary)

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Appearance of Persons Served

How a person served looks is not just a reflection on them, but a reflection on Zumbro House as well. It is our responsibility to encourage the individuals we serve to take pride in their appearance. When they leave the house – whether to go for a walk, to their day program, to an appointment, etc. – they should be clean, have combed hair, and wear clothes that fit and are free from holes or stains. We may not know when a parent or case manager might stop by unexpectedly, so it is important to look acceptable when at home, too.

Of course, as we should always be setting a good example for our persons served, staff should be encouraged to take pride in appearance as well. If a staff person regularly has stained or torn clothes, poor hygiene, or an otherwise unkempt appearance, persons served may follow suit.

When the person served has a team meeting, we want them looking their best. They should have a haircut, have all hygiene taken care of, and wear nice clothing appropriate for a meeting. This is often the only time that some team members are able to see the person served. We want them to make a great impression as well as demonstrate the high expectations that Zumbro House has for them. It is the Lead’s responsibility to plan ahead and make sure the person served has a haircut (if needed) and has appropriate clothes picked out. It is perfectly acceptable to delegate this responsibility to a Primary Counselor, but the Lead must still check in to ensure the person served is prepared for their meeting day.

When any person feels like they look good, they are naturally going to feel better about themselves. When a person served feels better, they are less likely to be easily irritated and may have less behavioral challenges. It is important for us to support the individuals we serve in increasing their self-esteem and taking pride in their successes. The Lead is responsible for ensuring that the individuals we serve look good on a day-to-day basis. If you are not satisfied with the appearance of your persons served, it is your responsibility to ensure that all staff persons raise their standards to meet yours. Person served appearance is the simplest and most obvious way that we can showcase our services.

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Licensing Requirements

We have requirements that dictate most of the programming, forms, reports, etc. that we need to complete. Everything has a purpose – none of it is just for fun!

Zumbro House is licensed to provide services by two governing agencies. The Minnesota Department of Human Services (DHS) grants us a license to provide what is called “waivered services.” Each house has a licensed capacity of three or four individuals served, and we must follow the standards outlined in Rule 245D. In addition, we are licensed through the Department of Health for Comprehensive Home Care programs (Bossen and Sander programs).

245D tells us how we should coordinate services with individuals’ teams, develop programs, meet with teams, intake and discharge individuals, monitor medications, provide needed health care, communicate with other licensed providers (such as a day program), prepare for and respond to emergencies, and much more.

At least every other year, a licensor from DHS comes to Zumbro House for a licensing review. They choose a random sampling of about 10% of our persons served, making sure to choose someone who is newly admitted and someone who takes psychotropic medications. They review the file, making sure each required piece has been completed and shared with the appropriate members of the individual’s team. The DHS licensor is extremely thorough – if there has been a mistake such as a report not completed on time, a guardian signature missing, etc., they will find it. This is why we are so vigilant about paying attention to all the details.

The DHS licensor will also review a sample of staff personnel files. The licensor will check to make sure that the staff meets the minimum training requirements and that the background study was done promptly and returned from DHS. This is why we are always bugging Lead to make sure training is completed. Administrative staff will send reminders to Lead DSPs in addition to calling DSPs directly – if staff are reminded by both administrative staff and their Lead, they will be more likely to complete their training promptly. It is very important that you are reminding staff to complete any required trainings and that you ensure they are aware of how to access them. All trainings are accessible through the Zumbro House website. Staff can be removed from the schedule if they do not complete a training by the required due date, as incomplete training puts the company out of compliance and would leave us open to a citation.

If the DHS licensor finds any areas where we have not met the requirements, they can write us a citation. We then may have to change a procedure, put a double check system in place, or otherwise somehow demonstrate how we are going to correct the citation moving forward. Yes, sometimes this means new paperwork for us. If we would happen to get the same citation two reviews in a row, the company could be given a fine or other negative action could be taken against our action.

Also, if the licensor believes there may be significant concerns with the company and they find patterns of missing or incorrect information, they can expand to a full review. This would mean they would look at the files for every individual that we serve. As you can imagine, this would be very time consuming and stressful for everyone involved. It is very important that every member of the team – Direct Support Professionals, Leads, Program Directors, and administrative staff – follow through on their assigned piece of the puzzle to ensure that we are all successful.

The second governing agency is the county, who grants us an Adult Foster Care license. The licensor from the county comes out once yearly and reviews several things. Physical plant and safety is a large portion of what the county licensor will check. See the section on the Home Safety Checklist for information regarding what they will be checking. If the licensor finds any violations, Zumbro House will likely be given 30 days to correct them. However, if the violations have an effect on person served safety, other action may be taken. We should keep our sites in a condition that exceeds licensor expectations at all times. We should always be ready for an unannounced visit from the licensor.

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In addition, the licensor will look carefully at the cleanliness of the house. Corners, areas behind doors, vents, ceiling fans, blinds, shower curtains, etc. must be regularly cleaned and maintained. There should be no dust or dirt buildup! Person served bedrooms are deep cleaned each and every week (with staff assistance), so there is no reason for there to be dust or grime under beds, behind doors, or in the closets. If there are items that are not getting cleaned, follow up with your staff and ensure that they understand the expectations. Be detailed with your expectations. If there is a performance issue and cleaning is not being completed, this issue must be addressed. If there are issues that are not addressed or communicated to the Program Director, the Lead DSP will be held responsible.

A violation of a licensing standard at a single location reflects poorly on the entire organization. The individuals we serve deserve a clean and healthy place to live, and it is our responsibility to provide it! Please remember – these requirements represent the minimum of what we need to be doing. We should exceed licensing expectations every day.

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House Appearance, Safety, and Maintenance

The appearance of the house is very important. It should be in “visitor condition” at all times! Visitor condition means that if anyone were to stop by – a guardian, case manager, licensor, family member, etc. – the house is clean, organized, and presentable. It is all of our responsibility to provide the persons served with a clean, healthy, and safe environment. The Lead is responsible for the appearance of the house at all times. The Lead should make sure that the DSPs at the site are cleaning the house to a high standard. Further, it is the Lead’s responsibility to ensure that all safety and maintenance needs are attended to at the house. Maintain a high standard. Remember: these are the homes of the individuals we serve, and they deserve to live in a safe a clean environment.

Complete regular walk-throughs of your sites and note any maintenance or cleaning needs. You may notice things such as bathroom caulking coming off, rusty vents that need painting, or cigarette butts thrown on the ground. These are things that require follow up.

Our standards for cleaning are very high. Since we have awake overnight shifts, we ask overnights to put the most effort into keeping the site clean. However, while cleaning is most heavily assigned to overnight staff, it is the expectation that all staff at the site ensure a clean environment. There is an Overnight Checklist on the Zumbro House website that is not required, but is helpful to provide overnight DSPs with cleaning expectations. If you choose not to use this, please create a cleaning list and provide this to staff. Remember, not all staff may be used to cleaning as thoroughly as we expect and they may miss details if they try to remember each task without a list. Providing detailed lists of required cleaning will help to ensure the house is up to our standard.

There should never be visible dirt or messes. Floor should be swept and mopped. Any marks or dirt on walls should be cleaned off. There should be no cobwebs or dust evident – the lower levels in particular may need extra checks on this. Again, Leads are responsible for the appearance of the site. As discussed earlier, make sure to INSPECT what you EXPECT. Do a quick check each day to ensure overnights are completing assigned cleaning, and submit a Discipline Form if it is not done. Assign additional cleaning responsibilities as you see necessary.

Work Orders

If there are any maintenance issues, submit a work order. Work order forms are found on the Zumbro House website and are to be completed by the Lead (or Program Director), not DSPs. Be detailed and thorough in your work orders. If a work order is missing details or does not adequately describe the problem, maintenance may not be able to tell which tools are needed or how much time to set aside to complete the task.

Never assume that a maintenance concern has been addressed if you have not personally addressed it. Report even small issues – this way, they can be addressed before they become bigger concerns. (However, you may be asked to fix some minor issues). It is important to share the priority of your issue. A low priority issue may be chipping paint. Moderate priority could include a dent in the wall. A high priority task might be a leaky faucet or running toilet. Urgent tasks would include things like a broken window or a malfunctioning furnace in the winter. In the event of an emergency – for example, a stranded vehicle or flooding basement – contact Joe directly rather than submitting a work order.

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Safety

The most common workers compensation injury category is slips, trips, and falls. Although these are the most common injuries, they are also the most preventable. We want to reduce the risk of injury for both persons served and staff. Here are some things that you can do to reduce the risk:

Make sure there are no cables or cords near any walkways Clean up spills immediately, even if the mess is not yours Pick up anything that is on the floor, even small items such as pens or paperclips Have a stepstool or ladder available to access anything out of reach – standing on furniture, boxes, or any other

potentially unstable surfaces can be dangerous When lifting even slightly heavy items, make sure to use proper body mechanics, using your legs instead of your

back to lift the weight Before lifting anything, be sure that your pathway is clear and your view is not blocked Close drawers and cupboards after each use – don’t leave something open if you are walking away from it for

any amount of time Avoid bending, twisting, and leaning backwards when seated; this isn’t good for the chair and you will be likely

to tip over backward You may feel you could know your way around the site even blindfolded, but you should still always look where

you are going

There are many more safety tips that could be included – these are just some that seem to apply to many of our sites. Leads, as well as Program Directors, should talk about safety often and ensure all DSPs at the site are aware of these safety tips. It is everyone’s responsibility to ensure that we are providing a safe environment to live in and work in! Ask your staff to let you know if they notice any hazards or maintenance issues at your location.

Fire Hazards

According to FEMA, house fires kill over 4000 and injure over 25,000 Americans each year. We would be crazy to believe that a house fire could never happen at a Zumbro House site! House fires can accelerate very quickly – a can become life-threatening in just two minutes and the house can be engulfed in flames in just five minutes.

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Home Safety Checklist

The Home Safety Checklist is a tool that the county licensor will use to do your house inspection once each year. It is the standard that the county expects in our houses throughout the year. As a Lead DSP, you are to complete the Home Safety Checklist once per month. You can find a copy of the checklist on the website.

It is the sole responsibility of the Lead DSP to ensure that the house is compliant with all items listed on the Home Safety Checklist at all times. This means keeping extra batteries on hand, ensuring all required items are present in first aid kits, making sure there is no combustible storage near a heat source… The list of requirements is long! While you may remember many of the items month to month, there are too many items to try to remember. Completing the Home Safety Checklist monthly is the only way to ensure that we are not missing any details.

When completing the Home Safety Checklist, it is important that you check on each item listed, rather than just assume it is complete. For example, you may believe that your first aid kit has all required items, but you should double check to be sure. There should never be a smoke alarm or flashlight that does not have working batteries. With monthly checks, we can at least be sure that anything not working has only been in that condition for less than a month, since your last check.

If you discover any issues, make sure to follow up with them! For example, if items are being stored under the stairs, move them to a different location. Or if water is coming out too hot, the water heater will need to be adjusted. If you are not sure of the solution to the issue, discuss with your Program Director to develop a plan.

If you find any maintenance issues that need to be addressed, submit a work order to report the concerns. Make a note on the checklist that you have notified maintenance. Make a note to yourself to follow up if the issue is not promptly addressed. See the next section for more information on work orders.

We should be ready for a licensor to look at our properties at all times without prior notice. If the Home Safety Checklist is completed thoroughly, we will always be ready!

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Vehicle Maintenance

Leads must pay attention to the general maintenance of the site vehicle. Since you use this vehicle much more often than your supervisor does, it is important that you take on this responsibility. Do not let vehicle maintenance concerns go unreported or unaddressed. We need to ensure safety of our persons served and of our staff.

Submit work orders for any maintenance concerns needed. If the vehicle will not be safe to drive until the concern is corrected, please make sure staff are aware that it should not be driven! We need to ensure safety, which means not putting our persons served at risk by using a potentially unsafe vehicle. Contact a supervisor to find a solution if this situation occurs. In case of emergency (for example, if the vehicle has a flat tire and is stuck at a location other than the site), contact Joe from Maintenance for assistance.

You may be asked to bring your vehicle in for repairs or for an oil change. This is typically done at Tires for Less. They will bill Zumbro House. Major repairs will not count against your house budget. Smaller items – such as wiper blades, a bottle of oil, or a snow brush – will come out of your house budget and should be picked up at Walmart while supply shopping.

Oil changes are to be completed every six months, with additional oil top offs at the mid-point between changes. This means that every three months, you will either go in for an oil change or top off the oil in the vehicle yourself. For example, you might have the oil changed in April, top it off in July, have it changed in October, and top it off again on January. You will be informed when it is time to complete these tasks.

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Fire Drills and Tornado/Severe Weather Drills

The Zumbro House Fire Drill Form and the Tornado/Severe Weather Drill Form are located on the Zumbro House website. It is the responsibility of the Lead to ensure drills are completed as required in order to remain in compliance with our license. Please follow the Fire/Tornado Drill Calendar for the current year and communicate scheduled drills with your staff. Each site will complete a drill each month, alternating fire and tornado/severe weather drills (for example, a fire drill in January, tornado drill in February, fire drill in March, etc.).

These drills are an opportunity for both persons served and staff to learn and practice what to do in case of a fire or severe weather. Even if everyone believes they are prepared in case of an emergency, regular drills are essential to ensure that staff and persons served will be able to react quickly and safely.

Drills should be conducted at varying times of day, in varying conditions, and using all possible exits. It’s best for drills to be a surprise to the persons served. When preparing for drills, decide if you are going to have any exits blocked. It is important to help the persons served think about what route of evacuation they will take if the fire is blocking their path.

When the drill is announced, make note of the time. It is important to pay close attention to how quickly the staff and persons served are able to evacuate. Getting out of the house in less than two minutes is the goal for a fire drill. A house fire can become deadly in that small amount of time. Note if anyone refuses to participate, needs additional prompting, needs physical assistance, etc. We need to be aware of there are any concerns with an individual’s ability to evacuate. If these things occur repeatedly, a plan may need to be discussed with the individual’s team.

Monthly drills can seem like a repetitive task. However, when an emergency situation actually occurs, people may panic. In an emergency, there is no time to stop and think about what to do. They will not be able to execute a safe evacuation if they have not practiced the skills. It is important to encourage both staff and persons served to take drills seriously.

Drill forms are found on the Zumbro House website. Before submitting your form, print it out and keep it in a log on-site so you have records of completion as well. Make sure to fill out the drill form thoroughly!

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Menu – Nutritional Guidelines

Healthy eating habits and getting enough exercise affect how we feel every day. They affect how much energy we have, how tired we are or how easily we get tired, and how we deal with stress or cope with situations that we are faced with. Remembering this, it is easy to see why it is so important that we encourage our persons served to live healthy lifestyles. When an individual has a healthy lifestyle, they are more likely to handle stress more easily, have improved self-esteem, have fewer incidents, and have improved physical health.

When planning meal menus for your site, it is important that you keep in mind allergies, portion control, and health conditions. If you serve an individual with food allergies, please be extra careful and ensure there is no risk that the person could accidentally ingest anything that could cause an allergic reaction. Follow USDA guidelines for portion control and follow recommended calorie intake. Be cautious with health conditions – diabetes in particular is common and can be very dangerous if meals are not planned properly.

In addition, please make sure to keep individual preferences in mind! Try to choose meals that your persons served will enjoy eating. This means finding a balance of both nutrition and flavor.

If you know that an individual won’t eat a certain food, plan a way for them to get those nutrients from a different food – for example, if someone doesn’t eat meat, make sure that other foods high in protein are on the menu. Also, make sure to plan some variety on the menu – they shouldn’t be left to eat the same meal every night.

As you are planning your menus, keep the following tips in mind:

Make smart choices from every food group. In order to get balanced nutrition, you have to eat a variety of nutrient-packed foods every day. A healthy eating plan is one that:

Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk products Includes lean meats, poultry, fish, beans, eggs, and nuts Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars

Mix up your choices within each food group!

Focus on fruits. Eat a variety of fruits, and choose fresh, frozen, canned, or dried fruits rather than fruit juices. For a 2000 calorie diet, eat 2 cups of fruit each day.

Vary your veggies. Eat more of…o Dark green veggies: broccoli, kale, other dark leafy greenso Orange vegetables: carrots, sweet potatoes, pumpkin, winter squasho Beans and peas: pinto beans, kidney beans, black beans, chickpeas, lentils

Get your calcium-rich foods. Eat 3 cups of low-fat or fat-free milk (or an equivalent amount of low-fat yogurt or low-fat cheese) daily.

o 1.5 oz cheese = 1 cup milk

Make half your grains whole. Eat at least three ounces of whole grain cereals, breads, crackers, rice, or pasta every day. One ounce is about one slice of bread, one cup of breakfast oatmeal, or ½ cup of cooked rice or pasta. Look to see that grains such as wheat, rice, oats, or corn are referred to as “whole” in the list of ingredients.

Go lean with protein. Choose lean meats and poultry. Bake it, broil it – avoid frying as much as possible. Add some variety to your protein choices, as well – add fish, beans, peas, nuts, and seeds.

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Read the Nutrition Facts labels on food.

Keep low: o Saturated fatso Trans fatso Cholesterolo Sodium

Get enough of: o Potassiumo Fibero Vitamin Ao Vitamin Co Calciumo Iron

Use the % Daily Value (%DV) column when possible: o 5% DV or less is lowo 20% DV or more is high

Check the serving size and calories per serving

Make your calories count! If a food is high in calories and low in nutrients, it may not be worth eating

Avoid added sugars – added sugars add calories with very little nutrients. Some names for those added sugars include sucrose, glucose, high fructose corn syrup, corn syrup, maple syrup, and fructose.

Know your fats: o Look for foods that are low in saturated fats, trans fats, and cholesterol – avoiding these helps reduce

the risk of heart disease! o Most of the fats that you eat should be polyunsaturated or monounsaturated fatso Total fat intake should be about 20-35% of your calories

Reduce sodium and increase potassiumo Research shows that eating less than 2200 mg of sodium (about 1 tsp of salt) per day may reduce the

risk of high blood pressureo Most of the salt that we eat comes from eating processed foods, not form the salt shaker! o Potassium helps to counteract the effect of sodium on blood pressure

Along with nutrition, it’s important that we encourage exercise! In order to be healthy, we need to burn off the calories that we are putting in! Consider this: consuming just 100 calories per day more than you can burn can make you gain about one pound per month, or 12 pounds per year. Yikes!

About 20-50% of your daily caloric intake depends on how physically active you are. According to the Center for Disease Control and Prevention (CDC), adults need at least:

Muscle-strengthening activities on 2 or more days each week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, arms)

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AND

2 hours and 30 minutes of moderate-intensity aerobic activity per week

OR

1 hour and 15 minutes of vigorous-intensity aerobic activity per week

OR

An equivalent mix of moderate-intensity and vigorous-intensity aerobic activity

We should be encouraging our persons served to get the recommended amount of exercise into their routines. It is okay to exercise in small increments of time – 10 minutes at a time is okay! Aerobic activity gets you breathing harder and gets your heart beating faster. Moderate intensity means that you are working hard enough to get your heart rate up and break a sweat. Vigorous activity means that you are breathing hard and fast and your heart rate has increased quite a bit. If you are working at the vigorous level, you will not be able to speak more than a few words without pausing for a breath.

Exercise can have many benefits:

Weight control Better sleep Reduced risk of cardiovascular disease Reduced risk of type 2 diabetes Reduced risk of some cancers Strengthened bones and muscles Increased chances of living longer Improve your mood and health!

Better mood = fewer incidents!

Make sure that there is time for exercise on the activity schedule each day. If individuals at your site refuse to exercise or get discouraged, remind them why exercise is good for them. If we are enthusiastic and supportive with exercise, they will be more likely to put the effort in.

Remember: It is our responsibility to be conscious of the health of the individuals we serve. Please refer to the Healthy Living Policy on the Zumbro House website (in Policies and Procedures) for more information.

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House Finances

As a Lead DSP, you will be issued a company debit card. With this card, it is the Lead’s responsibility to ensure the house has all the needed supplies. Keeping the house stocked with needed supplies requires some planning ahead and establishing routine for shopping. Without that established, it will be difficult to stay on top of house needs while staying within your house budget.

Security

Please ensure the company debit card is kept in a secure location that will minimize the opportunity for loss or theft. If the card is lost or stolen, contact your supervisor immediately so that the card can be canceled to prevent unauthorized use. Please sign the back of your card to make it more difficult for a person to use should the card get lost. The company debit card should never be given to staff to use to purchase items for the house. The Lead is responsible for all purchases made with the debit card.

Budget

Houses: Your budget is $230 per person served per calendar month. $200 of that is to be spent on food for persons served. The other $30 is to be spent on house supplies. It is critical that you stay within this budgetary restriction. If you have a person served move in or out of your program during the month, your budget amount will be pro-rated for the remaining days of the month. You should contact accounting if this occurs to make sure you are aware of your correct budget. Extending beyond the allotted budget is not allowed and may result in disciplinary action. If you ever believe there is a reason to spend beyond your budget, you must discuss with a supervisor for authorization.

Because the budgets for supplies and food are separate, you should purchase them separately. For example, when shopping, you should separate out your office, cleaning, and household supplies and purchase those items. Then, you will purchase all of your food items on a separate transaction.

# Persons Served Food Budget Supplies Budget Total Budget1 200 30 2302 400 60 4603 600 90 6904 800 120 920

Apartments: You will not be purchasing food with your budget as the persons served purchase their own groceries. Your company card will be used just for supplies.

Receipts

Every single charge to the company card must have an accompanying receipt, without exception. The employee will be liable for any purchases made with the company credit card that do not have corresponding receipts. If you forget to get a receipt, please contact the vendor – most companies will print duplicate receipts. If a missing receipt is requested from accounting, the Lead will have two days to find the receipt or obtain a duplicate from the vendor.

When submitting your receipts, make sure to keep the receipts for groceries separate from the receipts for supplies. This will help ensure more accurate and efficient tracking of expenses.

Approved Uses for the Company Card

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Groceries

All groceries must be purchased at Aldi, Walmart, or the dollar store. These stores offer exceptional value and will allow you to purchase more within the budgeted amount.

Before grocery shopping, meal planning should be completed, and a grocery list should be created based on the menu. Make sure to always shop with a list! If you don’t have one, you may forget necessary items, or you could accidentally buy unnecessary items that could go unused. If you ensure that you purchase using a grocery list and that staff stick to the meal menu, you will always have exactly the needed amount of food at the site.

Your overall goal is to stretch your grocery budget, so you are buying the most and healthiest food within your allotted budget. Buying in bulk will help you stretch your budget and allow you to buy more products for the same price. Avoid buying individually or convenience packaged products such as yogurts, soda, pudding, or chips. Buying in bulk also helps to discourage staff pilfering.

You should be buying the least expensive of any given item, meaning looking for generic store brand instead of name brands, taking advantage of sales, and checking coupons. Taking the time to comparison shop will help stretch your budget. Prepare ahead by dividing bulk purchases into menu or meal requirements. This will help eliminate the chance that individuals will be served more than the recommended serving size. In addition to allowing for overeating, serving more than the recommended portions will negatively impact your budget.

Avoid buying boneless and skinless meats, since they tend to be priced higher. Buying less expensive cuts of meat is helpful as well. There are many lean and flavorful cuts of meat that are not overly expensive. Look for good deals in the frozen food section – turkey roasts and Jenny-O turkey-ham roasts are fairly inexpensive examples of healthy, low-fat meats that the individuals you serve will enjoy.

See the section on meal planning for more information.

Household, Office, and Medical Supplies

Please limit the purchasing of these items to Walmart or the Dollar Store, as these places provide the best value and will allow you to stretch your budget.

Household supplies will include things like cleaning supplies, paper towels, tablecloths, house games, and kitchen tools. Office supplies include paper, pens, staples, stamps, and other needed office items. Medical supplies are items for your medication cabinet, such as medication cups, bandages, thermometer covers, antibiotic ointment, and standing order medications. Note that standing order medications do need to be purchased by the Lead within the house budget. It is important to have these on hand. However, if there is an extended need for a standing order medication, the person served should be asked to purchase their own. See the section on standing order medications for more information.

Person Served Outings

Zumbro House does not pay for staff to participate in person served activities, such as bowling or arcades. If staff wishes to participate, they will need to pay for it out of their own pocket. Zumbro House will not pay for staff or person served food, drinks, or any other desired purchases during community activities.

Activities will require staff to pay for admission should be avoided, and only in rare instances will this be approved. There are sometimes options that do not require staff to pay admission. For example, some movie theaters will allow DSPs to accompany a person served without purchasing their own ticket. It is helpful to keep a list of these activities.

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Zumbro House does not pay for staff meals on out to eat night. Staff may eat the prepared dinner with the persons served, but they may not eat house food during other times, including breakfast or lunch. Please remind staff that they must plan ahead for meals.

All purchases should fall into one of the above categories. They are also listed on the House Expense Ledger. Anything outside of the above categories should be listed as “misc,” approved by your supervisor, and noted as such on the House Expense Ledger. Gift cards may not be purchased with the company debit card.

Staff Pilfering

Unfortunately, staff pilfering is a common problem. This bites into your budget and takes food and supplies away from persons served. Whether a staff person takes home a roll of toilet tissue, a ream of printer paper, or a pork roast, staff pilfering is stealing from the individuals we are supposed to be taking care of. Your budget covers what is needed to provide support to the individuals that we serve.

It is critical that you are continually aware that this is a possibility and that you store your supplies securely in a locked closet or cabinet and keep only the minimum accessible. You are also encouraged to keep an informal inventory of your supplies and groceries. If you are noticing inordinate amounts of food or supplies missing, staff pilfering may be the culprit. If you suspect staff pilfering, contact your Program Director or Human Resources.

Completing the House Expense Ledger

Begin each month with a blank House Expense Ledger form. This form is available on the Zumbro House website. Enter your budget amount for the month on the first line (labeled “Beginning Balance”). Each purchase should be listed in chronological order, from the first of the month through the end of the month. Purchases should be recorded on the House Expense Ledger as they are made, the transaction number should be written on the receipt, and the receipt should be kept in an envelope. Prompt entry of each purchase will be conducive to a smooth month-end process, minimizing the time needed during that busier portion of the month.

The description for each purchase must be specific, including what was purchased (i.e. groceries, household supplies, etc.) rather than just the store where the purchase was made. Use person served initials when applicable. Writing specific descriptions will allow the accounting department to review the ledgers efficiently without having to make follow up calls to ask about certain expenditures. Balance your ledger after every purchase so you are always aware of your remaining balance.

Purchases must be recorded in the month they are made. For example, you cannot make a purchase on February 28 th and record it on your March budget.

The House Expense Ledger is for debit card transactions only. If you ever need to make a return, make sure the store credits that money back to the card rather than giving you cash. There will also be a receipt for that return to be numbered and recorded (as a deposit). It is never acceptable to buy something with the debit card and then have a person served pay the house for it with cash.

The House Expense Ledger, along with your receipts organized in chronological order, must be brought to the Lead Meeting with the rest of your financial paperwork. Getting them in promptly allows accounting to review the information and ensure the account is reimbursed quickly.

The debit card statement is reviewed at the office. Each receipt is matched up with the statement and checked for accuracy. Any variance from the policy as outlined above will require explanation by the employee and may result in

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disciplinary action. Please contact your supervisor if you are unsure about any aspect of the above outlined expectations or if you are unsure if a specific expenditure is approved.

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Lead DSP Checklist

The Lead DSP Checklist is a useful tool to help ensure all regular duties are completed. It lists tasks that require ongoing attention and allows you to log the date that you check each task. The checklist is not required and does not need to be submitted to the office, but is a good way to stay on top of all the tasks required of a Lead.

Please note that this checklist is not intended to cover all regular tasks that must be completed, but is simply a tool to help with some of your duties.

The following are descriptions of the tasks included on the Lead DSP Checklist. The checklist is available on the Leads section of the Zumbro House website.

Staff Schedules

Check frequently to ensure all of your shifts are covered. Write down each open shift that you are aware of and ensure that you find coverage promptly. If a staff requests time off with less than two weeks notice, it is their responsibility to cover their shift. However, in this situation, you will still need to follow up with them and make sure coverage is found, as you are ultimately responsible for ensuring staffing of each shift.

Food Supplies

Complete grocery shopping at least weekly. Ensure adequate groceries to cover the week’s meal menus and snack. Fresh produce (fruits and vegetables) must be available daily. At least one week’s worth of additional food should be available in case of emergency.

Current Openings

Submit the Current Openings Form no later than 5pm every Monday. This is necessary to ensure that the Recruiter has accurate information regarding your vacant positions.

Primary Counselor Check-ins

Each resident must be assigned a DSP to be their Primary Counselor. This staff must check in with the individual once each week. Add times for check-ins to the activity schedule. Check weekly to ensure these are completed and follow up if any check-ins are not done.

Data Tracking

After the last day of each month, tally the responses on each individual’s Data Tracking sheets. Submit these totals to the Quality and Compliance Department on the first of each month.

Medications

At least weekly, complete a thorough review of each MAR to ensure accuracy. Please ensure the following:

All medications on the MAR are accurate All prescribed medications are on the MAR Side effect sheets are present for each medication the MAR (found in tab 4) Adequate supplies of each medication are present at the site

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Please note that you should still be reviewing MARs daily as well! On your daily checks, you will be reviewing to ensure medications are being administered as ordered and documented accurately. Submit Discrepancy Forms for any errors found.

Financial Paperwork

Some financial information is needed by the administrative office by the 25th of each month. This includes copies of each individual’s bank statement and copies of paystubs for all persons served who work. (Paystubs are not needed for individuals who are employed by Zumbro House.)

LOA Forms

Update your LOA Forms every Monday to communicate LOA information for billing purposes.

Appointments

Schedule all necessary appointments. Ensure appointments are completed as scheduled and that all required documentation is completed. Update your Appointment Trackers every Monday.

Activities

Activity planning must be completed weekly to allow persons served to have input on the schedule for the following week. The Lead must create and post a new schedule weekly. The current schedule must be posted at all times.

House Inspections

Complete regular informal inspections of your site to check any maintenance concerns: leaky faucets, chipping paint, water damage, etc. Submit detailed work orders for any issues found. In addition, you’ll check that cleaning is being completed. Make sure to follow up with staff if assigned cleaning tasks are not done.

Ledgers

Enter all transactions to your ledgers promptly. This includes person served ledgers and house ledgers. Keeping up with this regularly will prevent last minute issues at the end of the month.

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Required Employment Postings

We are required by law to have several informational posters up in an area of the house where staff can access them. They must be easily visible. The required postings are as follows:

Employee Rights and Responsibilities Under the Family and Medical Leave Act Minnesota Workers’ Compensation – Employee Rights and Responsibilities Safety and Health Protection on the Job (OSHA) Minimum Wage (MN Department of Labor and Industry) Know Your Rights Under Minnesota Laws Prohibiting Age Discrimination Unemployed? – You Have the Right to Apply for Unemployment Benefits Job Safety and Health – It’s the Law Equal Employment Opportunity is the Law Employee Rights Under the Fair Labor Standards Act (Federal Minimum Wage)

If you are missing any of these postings, please contact Human Resources. They will provide you with a new posting. It is your responsibility to ensure that your site has all required postings at all times.

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Cell Phone Use and Availability

Because of the nature of the services that we provide, it is essential that supervisory staff persons can be reached in an emergent situation. As a Lead DSP, you will be on call at all times. Leads are expected to answer phone calls or return phone calls (those that require a return call) within 15 minutes. If there is a time that you will be unable to answer your phone for a period of time, you must notify your Program Director so that we can ensure a supervisor is available in case of emergency.

DSPs should only call the Lead when there is an emergency, to notify of an incident, or other urgent matters. If you receive phone calls regarding non-urgent matters, instruct your staff to instead send an email, leave a note, or otherwise handle the situation. If needed, talk them through the situation and ask them how they think the situation should be handled. This may build their confidence and ability to make a decision on their own next time.

To avoid unnecessary phone calls, ensure that your DSPs are properly trained, provide them with the resources they need, and plan ahead for evenings, weekends, and any other times you are not at work. For example, if you have a busy day on the activity schedule, discuss the schedule with the staff ahead of time to ensure they know how the day should go. Planning ahead will cut down on the amount of non-emergent phone calls you receive.

You will need to change your outgoing voicemail greeting to a scripted greeting informing of your position within Zumbro House.

“Hello, you have reached [Lead name], Lead Direct Support Professional for [site name] with Zumbro House. I am sorry that I missed your call. If you leave your name, phone number, and I detailed message, I will respond when I am able. If

the matter is urgent and you cannot reach me within 15 minutes, please contact [Program Director’s name] at [PD’s phone number]. Thank you.”

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Lead DSP Offboarding

Leading up to a Lead DSP’s last day in their position, the Program Director and the Controller may discuss a transition plan to ensure a smooth transition from one Lead to the next. The custody of the finances may vary depending on the notice provided by the Lead DSP vacating the position.

Client Finance

On or before the Lead’s last day, their Program Director must complete a physical count of cash on hand at the house. Both the LC and PD should count together and agree to the cash on hand. The management of the finances will then be in the PD’s trust. The LC must provide the ledger and receipts that support the cash balance so that the PD can easily confirm that the balance of cash is equal to the ending balance on the ledger. If the LC is unprepared for the count, they will have24 hours to get ledgers and receipts in order.

The LC and PD must provide a report of the count and ledger balance to the Accounting Assistant at the Woodbury office.

The Accounting Assistant will audit the ledgers and reconcile to the cash count provided by the LC and PD, then report the outcomes to the PD and the Controller.

When necessary, the PD will collect any missing receipts or cash from the LC prior to the LC’s final sign off. The PD ay request assistance from HR as applicable.

On or before the LC’s last day, the PD must collect the following items from the LC:

Client finances House ledgers and receipts US Bank credit card Holiday gas card Login/password information used to access paystubs or other data Any other Zumbro House property, which may include folders, notes, calendars, flash drives, etc.

The PD will inform the Director of Operations and the Controller of any unresolved/incomplete items.

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Resources and Tips

Because of the broad nature of this position, you will likely encounter new or unique situations and be unsure of how to proceed. In these situations, use your resources! Below is a list of some resources and tips that may be helpful.

This manual – Keep this manual and refer back to it as needed. Lead DSP Finance Manual Zumbro House Employee Policies and Procedures – Information regarding employment policies, compensation

policies, employee benefits, and other expectations and logistical information. Available on the ZH website. Zumbro House 245D Policies and Procedures – Information regarding admissions, data privacy and HIPAA,

safety and emergency procedures, sanitation and health, grievances, healthy living (nutrition), incident procedures, individual funds, individual rights, maltreatment, quality improvement, record keeping, safe medication assistance and administration, and service continuity, coordination, suspension, and termination. Available on the ZH website.

Zumbro House Comprehensive Home Care Policies and Procedures (for CHC programs) – Information regarding adverse events, nurse assessments, diabetic care, confidentiality, delegation of home care tasks, grievances, incidents, infection control, maltreatment, person served education, records, prescriber orders, quality improvement, service plans, staff training and supervision, TB screening, and medication administration, management assessments, management coordination and care plans, storage, disposal, documentation, incidents/errors. Available on the ZH website.

Positive Support Rule – Information on person-centered planning and service delivery, working with people with mental illness, developmental disabilities, and high behavioral needs, permitted procedures, and restrictions and restraints. Available on the ZH website with more information at mnpsp.org.

Websites for organizations/departments such as the Food and Drug Administration, Center for Disease Control and Prevention, MN Department of Human Services, and MN Department of Health all provide useful information and tools.

Use a planner – This job covers a wide variety of responsibilities. Trying to remember everything on your own will likely result in forgotten tasks. It’s helpful to keep a planner or binder with everything you’ll need to remember.

Don’t hesitate to reach out to your Program Director and other administrative staff! We want you to be successful in your position and will make sure you have the tools to do so.

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