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Best Quality Home Care Agency LLC

ADMISSION PACKET

Welcome Letter

We would like to thank you for choosing our Agency to service your homecare needs. The owners of our Agency are experienced in the home services industry. We are dedicated to working diligently to find better solutions for your unique homecare situations.

The Agency’s mission is to provide quality, reliable services to you. Our staff delivers the highest standards in home services. Our administrative and office staffs coordinate all these services to provide seamless, effortless service for you. There is always someone for you to call when you have changes or need questions answered.

At Best Quality Home Care Agency LLC, we collaborate with you and your family members to provide the services you need when you need them.

Our Agency maintains a client record of the services we provide. Your record is secured, and its privacy protected at all times. You may request a copy of your record by sending your request to us in writing. By signing your admission documents, you are authorizing our Agency to collect and maintain that record by either paper charts or electronic medical record.

You can contact us Monday through Friday during business hours, 9 AM-5 PM, at our office phone. After normal business hours, should you need assistance you can call us through our answering service by calling our regular phone number which is forwarded to on call after hours. Either our on-call Supervisor or on call scheduler will return your call.

Although we fully expect you to be extremely pleased with our services, if ever you should have a complaint, please feel free to call our corporate office directly at: (440) 373-7192 and the OH State Hotline as listed in your Client Rights.

We evaluate our Agency on an annual basis, reviewing all aspects of our services. A summary of the evaluation report is available to Clients/general public upon written request. When you are discharged from service you will receive a satisfaction survey requesting feedback on our service and programs. We hope you will take the few minutes to complete the survey and return it so that we may continue to address areas where there is an opportunity to improve.

Although the medical record is the property of Best Quality Home Care Agency LLC, should you ever need access to your medical record, you may obtain copies by submitting a written request to the office that provides your services.

We look forward to providing you with excellent home care service and thank you for choosing Best Quality Home Care Agency LLC.

Best Regards,

Kamola Ismanova,

Agency Manager

Guide to Safety in the Home

People of all ages have accidents. Please take a few minutes to review the safety guide; you can protect yourself and those around you by taking some precautions.

Falls

Falls are the most frequent and most serious accidents in the home. There are several things you can do to prevent falls:

  • Remove throw rugs when client is relying on ambulatory aides such as walkers and canes or has a shuffling gait
  • Use nonskid tape or backing on throw rugs. Tack down the edges of all carpets • Be sure there are firmly anchored non-slip treads, good lighting and a solid, easy-to grasp handrail that is rounded or knobbed at the end of stairs.
  • Consider painting or taping the top and bottom steps so they’ll be easily noticed.
  • Make sure there is a clear walkway through every room. Avoid using halls/stairways for storage.
  • Be sure halls/stairways are well lit.
  • Don’t walk on a freshly washed or waxed floor until it is dry.
  • Wipe up any spills immediately to avoid slips.
  • Avoid wearing only socks, smooth-soled shoes, or slippers on uncarpeted floors.
  • In the bathroom, be sure mats are nonskid and there are treads in the tub or shower.
  • Keep outdoor stairs, porches, and walkways free of wet leaves, snow, and ice.
  • Make sure stairs and walkways are in good repair.

Protect Yourself and Your Family from Fire and Burns

  • Don’t smoke in bed or when sleepy.
  • Use portable heaters according to manufacturer’s instructions. Turn off before going to bed.
  • Have your home checked if there are signs of any wiring problems.
  • Check hot water temperature. Experts suggest setting hot water at 120 degrees Fahrenheit or lower.
  • Keep pot handles turned away from front of stove. Use potholders when necessary.
  • Never leave unattended food cooking on the stove

Be Prepared

  • Install smoke detectors and check them regularly
  • Keep multipurpose fire extinguisher charged and handy
  • Make a fire escape plan. Check fire exits to be sure they open easily and are free of clutter
  • If you live in an area where weather conditions change suddenly, make sure you have an evacuation plan or call your city hall regarding the emergency evacuation plan

STATE RESOURCES

Ohio Department of Transportation 614-466-7170

Ohio Department of Health 614-995-7466

The Department of Aging 800-266-4346

Energy Assistance Programs sponsored by the Ohio Development Services Agency help low-income Ohioans of all ages deal with the high costs of heating or cooling their homes.

  • Home Energy Assistance Program, Emergency HEAP, Percentage of Income Payment Plan& Home Weatherization Assistance Program - For more information on these programs, call 800-282-0880

Telephone Assistance - the Public Utilities Commission of Ohio operates the Lifeline Telephone Assistance Program to help make basic local telephone service more affordable for income-eligible Ohioans. The discount can be applied to home or mobile service. For more information on these programs. 800-282-0880.

For Food Assistance Contact your local Area Agency on Aging

Ohio Area Agencies on Aging 866-243-5678

Ohio Ombudsman Programombudsman@odh.ohio.gov, or 614-466-3543

Ohio Alzheimer’s Association 216-721-8457

Ohio State toll free Abuse Hotlines:

Abuse Hotlines: Elder: 855-644-6277 Child: 855-642-4453

Homecare Services

Best Quality Home Care Agency LLC

6325 York Road, Suite 201, Parma Heights OH 44130

(440) 373-7192

Personal Care Services

Personal Care services includes the provision of services such as assist with personal care, light housekeeping, meal preparation.

Companion Services

Companion services include transportation to medical appointments and other activities, meal preparation, shopping, light housekeeping, companionship and household management.

Caregivers are not allowed to use their own cars for transportation purposes due to high risks of car accidents , high gas prices. Caregivers can accompany clients to their medical appointments , shopping centers , grocery shopping . 

Senior Transportation Programs: Your area agency on aging or local senior center may be able to help eligible older adults make essential trips, such as for medical appointments, errands, shopping, and more. Call 1-866-243-5678 to be connected to the agency serving your community. 

If client requests to do shopping alone for caregiver , client is responsible for transportation of safety of Caregiver . Care giver should not be walking more than 10 minutes if shopping mall is further client responsible for Bus ride cost or Taxi ( Uber) cost . 

Applications for Taxi : Uber , Lyft  

Applications for food shopping : Walmart , Amazon fresh , Amazon , Uber Eats . 

Homemaker Services

Homemaker services includes assistance with instrumental activities of daily living and may include housekeeping tasks, meal preparation.

If you have any questions, or need further information, please call our office.

ADVANCE DIRECTIVES - YOUR RIGHT TO DECIDE

Under federal law, you have the right to complete an “advance directive’ which outlines one’s desire in advance on what type of treatment you want or do not want under special, serious medical conditions (conditions that would prevent you from telling your doctor how you want to be treated)

There are different kinds of Advance Directives, including, but not limited to those listed below.

• Living Will • Health Care Surrogate/Proxy • Durable Power of Attorney for Health Care

If you have executed any of these documents, please advise your Admission clinician and they will make a copy of the document for our records.

If you do not currently have an advance directive in place, we encourage you to consult an attorney or the state Department of Aging for additional information and forms. If you create an Advance Directive, please advise us immediately.

The agency has adopted policies regarding the implementation of your advance directive. It includes the incorporation of the document into your clinical record, communication of the directive to caregivers, and the assurance that the provision of your care is in no way conditional upon an advance directive or the refusal of medical or surgical treatments.

The agency will in no way place conditions on the provision of care, or in any way discriminate against patients, based on their right to refuse medical treatments or the creation of an Advance Directive.

Our objective is to assure that the patient’s rights are respected and that any such decisions or documents will not place conditions on the provision of care.

Our Agency Advance Directive (AD) Policy/Procedures:

1. The existence of an AD will be asked about upon admission to our agency.

2. Clients who are cognitively impaired shall have AD information provided to family or a surrogate.

3. If an AD has been executed, the client record will indicate such and efforts will be made to obtain a copy for placement in the client record.

4. If the client has not executed an Advance Directive, they will be directed to Elder services or legal counsel for execution assistance.

Client’s Rights and Responsibilities

These Rights and Responsibilities will be followed by all employees of Best Quality Home Care Agency LLC that provided services to you in your place of residence. You receive a copy of these rights upon admission to Best Quality Home Care Agency LLC, and at re-assessments. You have the right to exercise these rights at any time without fear of reprisal or discrimination in care/services.

You have the right to:

1. Receive considerate and respectful care in the home at all times, be treated with dignity and have property treated with respect.

2. Receive access to care and service without regard to race, creed, gender, age, handicap, veteran status, sexual preference or lifestyle, or to whether or not any advance directive has been executed.

3. Be informed of organizational ownership and control (upon request) and of the disciplines that will be providing you care.

4. Participate in the development of and make informed decisions regarding the plan of care, and receive an explanation, in advance, of any services proposed and the frequencies suggested in a way that is understandable to the client, changes in service, and alternative services that may be available.

5. This Client Bill of Rights is provided to our clients in advance of providing pre-planned care. Our clients have the right to exercise his/her rights at any time. Either you or your designated representative is authorized to exercise your rights.

6. Be informed in advance about care to be furnished and of any changes in the care to be furnished including advance notice if changes to the plan of care are occurring.

7. Receive complete written information on the plan of care, including the name of the home workers and the supervisor responsible for the services and Best Quality Home Care Agency LLC phone number and to be able to identify Agency staff by name badge identification.

8. Receive and access services consistently and in a timely manner in accordance with our Agency’s stated operational policy.

9. Refuse medication and treatment, counseling, or other services without fear of reprisal or discrimination. Client shall not receive any experimental treatment without the client’s specific agreement and full understanding of information explained.

10. Be fully informed of the consequences of all aspects of care, unless medically contraindicated, including the possible results of refusal of medical treatment, counseling or other services.

11. Privacy and confidentiality about one’s health, social and financial circumstances and about what takes place in the home (your medical record) is protected at all times and maintained by Best Quality Home Care Agency LLC.

12. Know that all communications and records will be treated confidentially, and that no information will be given out without a written release from the client or family.

13. Expect that all home care personnel, within the limits set by the plan of care, will respond in good faith to the client’s requests for assistance in the home.

14. Receive information on Best Quality Home Care Agency LLC’s policies and procedures including information on charges, names and professional qualifications and supervision of personnel, hours of operation, and discontinuation of service; request a change of caregiver and ownership information.

15. Participate in the plan for discontinuation of service with the right to appeal and to be notified in advance of treatment options, transfers, when and why care will be discontinued.

16. Receive education, instructions and requirements for continuing care when the services of Best Quality Home Care Agency LLC are discontinued. Clients shall participate in the selection of options for alternative levels of care or referral to other organizations as indicated by the client’s need for continuing care.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

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Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

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Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

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Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

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Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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