SOW for CNA 20.docx

STATEMENT OF WORK

CONTRACT SCOPE/OVERVIEW

This contract will cover the requirements of Per Diem Direct Care Staff (DCS) with the Department of Human Services (DHS) Polk Center . Polk Center is an Intermediate Care Facility for individuals with an intellectual or physical injury or illness, problematic behavior and/or developmental disability. Polk Center has a current census of 180.

LOCATION

The location is Polk Center, 1 Lakewood Circle, Polk, PA 16342. The resource may be assigned to any of the five residential buildings on campus.

SERVICE HOURS

Polk Center maintains 3 shifts for Residential Service Aides/DCSs, seven days per week, 24 hours per day

11:00 PM – 7:30 AM

The awarded supplier will provide per diem DCSs based on the needs of Polk Center. The facility will make all efforts to contact the supplier 24 hours before the required shift; however, there may be emergency requirements where a 24 hour notification cannot be provided in which case the per diem DCS will arrive at the facility no later than 2 hours after notification.

A ½ hour (30 minute) unpaid lunch and two paid 15 minute breaks will be given to the resource(s) performing duties under this contract. Time of breaks and lunch is dependent on shift assignment and Polk Center needs.

DCS’S will be required to work the amount of hours per day as specified on any of the three shifts. Any reduction or increase in this amount of hours must be pre-approved by the Contract Administrator in advance.

Hours worked will be verified by a signing in/out system at a designated area, and monitored by contract administration.

DCS RESPONSIBLITIES

Responsible and accountable for assisting lead work, development, delivery and monitoring of daily services in the areas of self-care, socialization and health maintenance as specified in each person’s Individual Support Plan (IHP/ISP) with overall coordination and direction coming from the Residential Services Aide Supervisor (R) in conjunction with guidance and instruction from the Residential Service Worker (RSW) and Residential Services Supervisor (RSS) and/or other program staff on the Interdisciplinary Team (IDT).

Assists in the implementation of each ISP by conducting specified Support Plans/Actions in order to maximize the delivery of Active Treatment.

Assists with monitoring and revision of each individual's IHP/ISP by recording/reporting required information regarding Training Plans/Supplemental Procedures in order to maximize effectiveness of services toward meeting the individual's most pressing needs.

Records information in assigned individuals' unit records in order to document and communicate information to other members of the team.

Complies with policies/procedures.

Advocates for assuring individual privacy, personal dignity and Rights are continually maintained.

Provides opportunities of choice of activities, dress, and meals for individuals served. This is done in a manner that minimizes risk but provides an opportunity for growth in the individual’s daily activities.

Complete related duties and assignments by interacting regularly with unit and facility staff in order to maintain effective unit operations.

DCS ESSENTIAL FUNCTIONS:

· Carries out daily routine of the Individual Support Plan (ISP).

· Assists, guides, and encourages Individuals with daily needs.

· Provides daily routine physical care to Individuals.

· Lifts, positions, and transfers ambulatory and non-ambulatory Individuals with assistance of other employees and assistive devices.

· Assists/transports people that use non-motorized wheelchairs, lifts, litters or other assistive devices to be ambulatory.

· Observes and reports Individual’s behavior.

· Escorts Individuals to various activities, both on and off campus.

· Perform CPR, Heimlich maneuver, and other emergency procedures / evacuations.

· Participates in housekeeping functions.

· Understands / interprets oral and written instructions.

The frequency and duration of these activities may vary from unit to unit and shift to shift. Each unit must maintain sufficient numbers of physically able employees to operate within established health and safety standards. These capabilities are essential to all components of the job in order to ensure the health and safety of the Individuals served.

MANDATORY TRAINING

All contract staff is required to attend orientation and/or training for a period as determined by Polk Center and will be required to attend training during the normal day time business hours. Training will be provided by Polk Center staff.

· Sign In/Out procedures

· Missions, Vision and Values

· Workplace violence, Right to Know, Fire Prevention Code, Bomb Threat, General Safety, Safe Environment, Active Shooter

· HIPAA Confidentiality

· Nursing Services Overview

· Bathing/Changing Procedure

· CPR, First Aid

· Mental Health

· Documentation, Communication Logs, Monitoring Forms

· Cultural Diversity

· Dietary Food Consistencies

· 1:1 Intervention and Supports

· F.O.O.D/Tray tags/Diet Changes

· Dysphagia Overview

· Helping Others Eat and Drink Safely

· Oral Hygiene

· Communication Training

· Aging, Dementia

· Custodial Overview

· Lifting

· Bed/Wheelchair Safety

· Garage – Vehicle Training

· Pre-meal Hygiene

· Active Treatment

· Bed Checks, Group Books Documentation

· Disability Rights Network

PERFORMANCE STANDARDS

Polk Center reserves the right to reject or remove any contract staff if they cannot perform their duties at an acceptable level in order to meet the center’s standards of care and practice. The supplier may be expected to replace the contract staff immediately or as directed by Polk Center.

The facility will provide all contract staff with an Identification Badge and key(s) which must be returned to facility upon completion of shift unless otherwise approved by contract monitor. Failure to return may result in payment being withheld and charges for replacement/rekeying issued to contractor.

Each shall be required to sign a statement regarding confidentiality of patient records and guaranteeing patient rights.

EMERGENCY/MEDICAL INTERVENTIONS

Adhere to infection control / Universal Precautions policies and procedures.

Responds to medical emergencies, announces medical emergency, takes appropriate actions for which specifically trained. These could include cardio-pulmonary resuscitation (CPR), first aid, foreign body airway obstruction management, or other emergency treatment procedures. Following emergency, takes appropriate action according to Polk Center Policies and Procedures.

Responds to disaster / emergencies, e.g., fires, earthquakes, floods, hazardous materials incidents, bomb threats, utility interruptions or transportation accidents; follows basic emergency procedures as contained in Polk Center Policies and Procedures.

COMPETENCY MAINTENANCE ACTIVITIES

Attend and participate in ongoing mandatory facility and departmental training programs. Attend in-service training programs.

FOLLOW PATIENT RIGHTS

Commit no acts of individual abuse or neglect.

Cooperate with administrative investigations.

Maintain confidentiality of patient information.

Acts as an individual’s advocate, recognizes and protects the rights.

Identifies, describes, and reports individual abuse allegations per Polk Center policy.

PROFESSIONAL CONDUCT

Demonstrate professional conduct with coworkers/patients.

Demonstrate ethical behavior in the work place.

Maintain a non-discriminatory work environment.

Abide by the Governor’s Code of Conduct and Polk Center policies and procedures.

Adhere to scheduled work hours.

Comply with sign in/out procedures.

DECISION MAKING

Individual care decisions are made only in consultation with the RSW, RSS or RSAS.

REQUIREMENTS PROFILE

Successful Completion of Facility Orientation and Mandated Training Possess current CPR certification Must have current tuberculous screening test (TB test) Must have current criminal background check

INVOICING INSTRUCTIONS

Payment Provision: The Contractor will be reimbursed only for services actually accepted by the Contract Administrator. Invoices will be verified and approved by the Contract Administrator prior to payment being made. The Contractor shall be paid upon satisfactory completion of work performed, and submission of an invoice on the Contractor’s letterhead.

Invoices must be submitted via US Mail to:

Copy must be submitted via US Mail to :

Polk Center, P.O. Box 94 Polk, PA 16342 Attention: Business Office