Inclusive Adult Family Home Disclosure of Services

The scope of care, services, and activities listed on below may not reflect all required care and services inclusive Adult Family Home, referred as "Home" here after, must provide. The home may not be able to provide services beyond those disclosed here, unless the needs can be met through “reasonable accommodations.” The home may also need to reduce the level of care they are able to provide based on the needs of the residents already in the home. For more information on reasonable accommodations and the regulations for adult family homes, see Chapter 388-76 of Washington Administrative Code.

Table of Contents

About the Home

Personal Care

Medication Services

Skilled Nursing Services and Nursing Delegation

Specialty Care Designations

Staffing

Cultural or Language Access

Medicaid

Activities

About the Home

Our motto is: Where love and laughter live. Our mission is to work hard each day to exceed the expectations of our clients & their families. The home is HCA owned and managed. The home is very peaceful, and bright, with lots of flowers. The home features large rooms that are full of natural sunlight and are very inviting.

Personal Care

“Personal care services” means both physical assistance and/or prompting and supervising the performance of direct personal care tasks as determined by the resident’s needs, and does not include assistance with tasks performed by a licensed health professional. (WAC 388-76-10000)

1. EATING

If needed, the home may provide assistance with eating as follows:

When deemed appropriate by the provider, the home may provide the following:

* Supervising & cueing clients who are at risk for choking/aspiration

* Altering the texture of food. IE: cutting into bite-sized pieces, chopping and/or pureeing solid foods

* Feeding clients as indicated

2. TOILETING

If needed, the home may provide assistance with toileting as follows:

When deemed appropriate by the provider, the home may provide the following:

* Reminding clients to visit the bathroom regularly

* Supervise or provide stand-by assistance while toileting

* Assistance with the use of a bedside commode, bedpan, or urinal

* Changing of briefs/pads and incontinence as needed

3. WALKING

If needed, the home may provide assistance with walking as follows:

When deemed appropriate by the provider, the home may provide the following:

* Reminding client to use assistive devices

* Cueing clients on the correct use of all medical devices

* Standby or contact assistance with or without the use of a gate belt during walking

* Encouraging regular exercise

4. TRANSFERRING

If needed, the home may provide assistance with transferring as follows:

When deemed appropriate by the provider, the home may provide the following:

* Supervision or standby assistances with transfers

* One person assistance with transfers

* Provide Hoyer lift transfers as indicated

5. POSITIONING

If needed, the home may provide assistance with positioning as follows:

When deemed appropriate by the provider, the home may provide the following:

* Cueing and reminding clients to change position or turn

* One person's assistance with changing position or turning while in the bed or chair

* Provide turning on a regular two (2) hour schedule for clients at high risk for skin breakdown/bedsores

6. PERSONAL HYGIENE

If needed, the home may provide assistance with personal hygiene as follows:

When deemed appropriate by the provider, the home may provide the following:

ADULT FAMILY HOME DISCLOSURE OF SERVICES REQUIRED BY RCW 70.128.280 Page 3 of 5

DSHS 10-508 (REV. 05/2015)

* Assistance with oral care

* Assistance with shaving and hair styling

* Assistance with showers at least twice weekly or as the client is able

* Bed bath if the client is unable to use the shower

* Application of deodorant, lotions, and makeup

* Assistance with nail care, toenail trimming

7. DRESSING

If needed, the home may provide assistance with dressing as follows:

When deemed appropriate by the provider, the home may provide the following:

* Supervision and standby assistance during dressing

* Provide total assistance with dressing

8. BATHING

If needed, the home may provide assistance with bathing as follows:

When deemed appropriate by the provider, the home may provide the following:

* Supervision during showers

* Cueing clients during showers

* Provide total assistance with showers

* Skin assessment during each shower when indicated

9. ADDITIONAL COMMENTS REGARDING PERSONAL CARE

Staff at the home encourage clients to be as independent as possible

Medication Services

The type and amount of medication assistance provided by the home are as per WAC 388-76-10430:

When deemed appropriate by the provider, the home may provide the following:

* Reminding clients to take their medications on time

* Assist clients with the administration of oral medications

* Total assistance with medication administration

ADDITIONAL COMMENTS REGARDING MEDICATION SERVICES

Staff at the home have been trained to be delegated various tasks.

Skilled Nursing Services and Nurse Delegation

The home provides the following skilled nursing services as per WAC 388-76-10405:

The home is owned and managed by an HCA who has many years of working in long-term care. When deemed appropriate by the provider, The home may contract with an RN delegator for nurse delegation.

The home has the ability to provide the following skilled nursing services by delegation:

When deemed appropriate by the provider, staff at the home may perform all delegatable tasks under specialty care Designation.

Specialty Care Designations

We have completed DSHS approved training for the following specialty care designations:

Mental illness

Dementia

When deemed appropriate by the provider, the home may provide special care and attention to clients with a diagnosis related to mental illness and/or dementia.

Staffing

Staff is based on the needs of our clients. Our staff has received all required Washington State training.

Cultural or Language Access

The home is particularly focused on residents with the following background and/or languages:

English is the primary language spoken at the home. Sensitivity and respect for our client's ethnicity, cultural beliefs, and practices are important to our staff. When deemed appropriate by the provider, the home may assist with specific requests surrounding ethnic requests.

Medicaid

The home will accept Medicaid payments under the following conditions:

The home requires 12 months of private pay funds and 6 months of advanced notification prior to the start of a Medicaid conversion. We also accept Medicaid as the only form of payment when admitting to the home if no private pay funds are available from the start of admission. We have 2 beds available for private pay residents who convert to Medicaid that have a DSHS-assessed minimum daily rate of $112 per day.

The home has a Medicaid policy that is disclosed to clients and families prior to admission.