PERSON-TO-PERSON CARE CENTER
Grievance Policy POLICY: Person to Person Care GH Residential Contract and Polices
Residential Agreement
This contract is made on __________ between Person to Person Care and $ __________.
The resident agrees to pay __________ each month. For this amount the Facility agrees to
provide or make available the following standard services:
1) RENT: Due and payable on the 5th of each month. There will be no other charges made
to this rate unless specifically stated in addendum A. A thirty (30) day advanced written
notice will be given to the resident or responsible party in cases of rate increases. This
amount may not exceed % of base SSI benefit.
If, however, the Individual's total available income is less than the SSI maximum rate,
the individual shall pay % of the available income from his or her SSI benefit. The
Individual shall always be guaranteed at least $ __________ per __________ for personal needs.
2) Monies for room and board shall be paid to the Person to Person Care Group Home
program unless otherwise stated in writing. The Program shall issue a receipt to the
Individual and if applicable, to the representative payee, showing the amount of payment
received and the period covered. Person to Person Care GH will keep a copy of this receipt
for his/her records.
3) This agreement is governed and superseded, if necessary, by SSI regulations and
representative payee guidelines. Representative payee responsibilities are attached, if applicable.
Necessary transportation when provided by the facility is free of charge and is not part of the rent.
BASIC SERVICES; PROVIDER RESPONSIBILITIES
Provider agrees to the following residential habilitation responsibilities:
Protect the health, safety, and well-being of the Residents served.
Training. Provide specific training activities that assist Residents to acquire, maintain, or
improve activities of daily living skills. The training focuses on personal hygiene skills,
homemaking skills, social, and adaptive skills to help the Resident live in the community.
Providers shall train and encourage Residents to use public transportation in areas where it is
available and appropriate to the Residents' ability.
Scheduling appointments and transportation will be provided if needed. Guidance provided
to understand outcomes if required will be provided and follow-up issues will be discussed with
Individual or parent/guardian if applicable.
RESIDENT RIGHTS
The following area represents rights that each resident Person to Person Care GH has. If a
resident has a specific assessed need that requires restrictions or limitations to the listed
rights, the limitations will be documented in one of their person-centered plans.
ROOM CHOICE
Room choice will be respected.
Home-like Environment
Residents have the choice to decorate their bedroom in a way that shows their hobbies and
preferences. Residents may choose to furnish their rooms with personal furniture, furniture
arrangements, paintings, pictures, bedding, curtains and other home-like decorations.
Residents must get written permission to paint their bedroom or to make other alterations
to the room.
ACCESSIBILITY
Access to the home
Individuals will have access to all parts of the home. Any part of the home that is not accessible
will be clearly marked and documented as to why.
If individual requires private room it will be offered dependent upon availability. If no private
room at admission, choice will be offered when openings occur or choice to seek another
placement with private room will be strongly encouraged.
If the group home has private rooms, Residents may choose to have a private room. If a
private room is not available at the time you ask to live in one, your name will be placed
on a wait list for one. When the private room becomes available, the Provider will notify you.
Changing semi-private rooms. If you want to change semi-private rooms, and someone
lives in the room already, the person in the room must agree with the change.
Roommate Choice
Resident will not be auto-assigned a roommate. Residents must work with each other to
request roommate changes. All roommate change requests and decisions will be documented.
Some requests may be denied for health, safety, or welfare reasons. Provider will explain
the reason for any roommate change request denials. If the choice is not available at the time
of the request, the Provider will notify Residents when their choice is available. This is a co-ed
facility but all roommates shall be of the same sex. Roommate selection will be done based on
bed availability. Once a roommate has been identified, each person will agree to treat each
other and each other's belongings with respect.
In addition to the house rules, roommates may make additional agreements that will further
facilitate a harmonious living arrangement (such as times the TV, radio, and/or lights will be off,
cleaning behind oneself, etc.).
Home-like Environment
Residents have the choice to decorate their bedroom in a way that shows their hobbies and
preferences. Residents may choose to furnish their rooms with personal furniture, furniture
arrangements, paintings, pictures, bedding, curtains and other home-like decorations.
Residents must get written permission to paint their bedroom or to make other alterations
to the room.
ACCESSIBILITY
Access to the home
Individuals will have access to all parts of the home. Any part of the home that is not accessible
will be clearly marked and documented as to why.
Medication storage areas must always be locked per 65G-7, F.A.C.
File storage areas must always be locked to protect Individual's records.
ACCESS TO THE COMMUNITY
Individuals have rights to access the community. Transportation will be provided when needed.
Staff will be available to transport to community activities. Choice will be available to individual
as to where they want to go, when they want to go, and who they want to go with. Choices and
flexibility to schedule all activities will be provided and respected.
Work Opportunities
Individuals have a right to work or seek job placement in the community. Depending on need
and/or ability, residents will be assisted with job search, application and interview process and
will receive assistance requesting job coach and/or supportive employment service from APD.
Supports and preferences will be individually documented in a Support Plan. Transportation may
be provided if needed.
Right to Have Visitors
Individuals have the right to have visitors in their home. There are no set visitation hours, but
respect to other residents living in the home should be considered. If residents' visitation rights
have been restricted, their person-centered plan will be documented to reflect the abridgement
of their rights.
Right to Access Technology
Personal Cell Phones
Individuals have the right to have their own phone and use accordingly.
House Phone
A house phone for residents is available at all times. Individuals will have a main phone available
for their use.
Computers
Individuals have the right to have their own computer and will be provided access to the Internet.
Television
Individuals will have access to the main television in the common area. Choices of viewing will be
done diplomatically between all residents. Personal TVs will not be provided by the facility in each
room; however, individuals have the right to have their own TVs in their bedrooms.
Radios
Individuals have the right to have their own radio in their room and other technological options
such as MP3, cell phone, and computer. They have the right to choose their own music. Individuals
will use earphones to respect roommate and housemates' personal space.
Furnishing
Individuals can buy their own furniture. All choices of furniture will be respected, dependent
upon available space in the bedroom. All choices of decorations will be respected, dependent
upon available space in the bedroom.
Resident will have the option of a complete refund or staying with new owners. At that time a
new contract will be executed. All residents will be given in writing 30-day notice. Assistance
will be provided in locating a new facility if that is their choice.
OTHER CAUSES OF DISCHARGE OF RESIDENT
Death
Notice of termination requirement in the contract is waived and all refunds will be prorated.
Facility will return all funds and property to the resident's personal representative (if appointed)
within 10 days.
If no representative has been appointed, facility will release to next of kin named in the
beneficiary designation from our facility. If there is no such named person, funds will be placed
in an interest-bearing account and property will be safeguarded until such time as the funds and
property are disbursed pursuant to the Florida Probate Code. Such funds and property will be
kept separate from those of the facility.
Medical Reason
Notice of termination requirement in the contract is waived and all refunds will be prorated.
Facility will return all funds and property to the resident's personal representative (if appointed)
within 10 days.
CLOSURE OF FACILITY
A thirty-day notice will be issued prior to closure. All residents will be issued a refund prior to
the closing. Any advance payments for services not received will be refunded within 7 days of
the closure.
EVICTION PROTECTION
Neither the residential habilitation services nor the lease/written agreement can ever be
terminated due to age, race, gender, religion, sexual orientation, disability, or socioeconomic
status.
REFUNDS
Given to any resident who decides to move. Refund will be prorated based on the daily rate for
any unused portion of the payment beyond termination date after all outstanding charges are
paid. All refunds will be given in the form of a check within ten (10) days of discharge.
All residents have the legal rights of the Bill of Rights as posted in facility, reviewed at time of
intake and placed in each resident's file. The residents have the right to express their grievances.
At any time to any staff or member of their circle of supports with any concerns, complaints or
questions they have.
GRIEVANCE AND COMPLAINTS PROCESS
Allegations of abuse, neglect, and exploitation must be reported directly to the Department of
Children and Families' Abuse Hotline at 1-800-962-2873. These situations will not be addressed
using the group home grievance and complaints process.
The aggrieved Resident, or person acting on his/her behalf will meet with the person whom the
complaint is directed, or with the person who is most involved in the conditions resulting in the
complaint. This meeting is informal and designed to provide a solution.
If a solution cannot be reached, the aggrieved Resident and their representative may ask the
Program Manager for an appointment. The meeting must be held within five (5) days of receipt
of the grievance. The aggrieved Resident, their representative and the Program Manager will
discuss the problem and will try to solve it in a satisfactory way.
If a solution cannot be reached, an appointment may be scheduled with the Administrator/Owner.
The request for the meeting with the Administrator/Owner must be made within five (5) days of
the meeting with the Program Manager. The Administrator/Owner will have notes from the previous
meetings and will discuss the situation with the aggrieved Resident and their representative
privately, and will try to solve the problem in a satisfactory way. This is the final level for the
resident grievances.
A written summary of the formal grievance heard by the Administrator/Owner will be documented
and will include the problem and the remediation/corrective action plan.
Residents and their representatives will be informed of their right to be represented by an
advocate or advocacy agency. A signed release of information form is required for Person to
Person Group Home staff to discuss the grievance with such advocates. The Resident will be
informed of their right to contact the Regional Agency for Persons with Disabilities Office at
1-800-615-8720.
Hotline numbers are posted on the board available to use. The resident also has the right to
express their feelings at the monthly meetings that take place in the facility. The residents have
no specific duties or obligations other than to get along with others and to not cause any
disruptions to the facility or the rules unless otherwise documented.
It is agreed that when a resident, upon written certification of his physician or determination by
the Administrator, becomes physically or mentally ill as to jeopardize the health or comfort of
themselves or other residents, and/or requires services beyond which this facility is licensed to
provide, the resident will be required to leave this facility and the responsible party will be
notified in writing to make arrangements for transfer.
In cases of temporary illness, not to exceed seven (7) days, temporary bedside care will be
offered or provided.
The resident will furnish this facility a report of physical exam done within thirty (30) days of
admission. The form will be provided by the facility.
A copy of this contract will be in the resident file and a copy of that file will be furnished upon
departure from this facility.
THIS FACILITY IS NOT AFFILIATED WITH ANY RELIGIOUS ORGANIZATION. THIS FACILITY IS NOT
A NURSING HOME AND THEREFORE IS NOT LICENSED TO PROVIDE COMPLEX 24-HOUR NURSING CARE.
I have read and acknowledge receipt of the above contract, the facility rules, and a copy of the
resident bill of rights.
