Opening hours : Mon-Friday 9AM-5PM
281-786-4880
I hereby authorize Ascentia Healthcare LLC to initiate automatic deposits to my account at the financial institution named below. I also authorize Ascentia Healthcare LLC to make withdrawals from this account in the event that a credit entry is made in error.Further, I agree not to hold Ascentia Healthcare LLC responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account.This agreement will remain in effect until Ascentia Healthcare LLC receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form to the Payroll Department.
All unlicensed applicants seeking employment whose duties will involve any direct contact with individuals/client shall be notified prior to initiating the employment process that this Agency will initiate a CRIMINAL HISTORY CHECK, perform searches on NURSE AIDE REGISTRY, EMPLOYEE MISCONDUCT REGISTRY, TEXAS HHSC OIG and US DEPARTMENT OF HHS OIG.
Verification of employability of unlicensed applicants shall be obtained through the NURSE REGISTRY and EMPLOYEE MISCONDUCT REGISTRY at the DHS 1-800-452-3934, to determine if the applicant is listed in either registry as having abused, neglected, or exploited a resident or consumer, or misappropriated a resident or consumer’s property and is therefore unemployable. Any applicant listed in either registry as having such a finding of misconduct shall not be employed by this agency. All checks will be initiated at applicants’ notification of the employment process.
The Agency shall not employ or immediately discharge any employee involved in direct contact with individuals/client who is designated in the NURSE AIDE REGISTRY and/or EMPLOYEE MISCONDUCT REGISRY as having committed an act of abuse, neglect, exploitation or, misappropriation of a resident’s or consumer’s property.
CRIMINAL HISTORY CHECK may be requested by the Agency on any employee during their course of employment after notification to the employee.
Search on the NURSE AIDE and MISCONDUCT REGISTRY will be performed annually.
TEXAS HHSC OIG and US DEPARTMENT OF HHS OIG will be performed prior to hire and monthly on all employees.
All applicants will sign a STATEMENT OF EMPLOYABILITY (ADDENDUM A) stating that 1) They have not been convicted of any of the crimes under Convictions Barring Employment Offenses as outlined in the Health and Safety Code Section 250.006, pursuant to SB 1245 and HB 1418, effective September 1, 2001. 2) They are not listed in the NURSE AIDE REGISTRY and/or EMPLOYEE MISCONDUCT REGISTRY for reportable conduct as stated in Human Resources Code 48.002 and the Health and Safety Code, Section 253In an Emergency situation, a prospective employee may be hired prior to the receipt of the results of a CRIMINAL HISTORY CHECK, if the applicant is not listed as unemployable in the NURSE AIDE REGISTRY or EMPLOYEE MISCONDUCT REGISTRY. CRIMINAL HISTORY CHECK will be requested within 72 business hours of employment. The Agency recognizes an EMERGENCY as any time there is a potential for the number employees falls below the desired staffing which may put the participant/individuals/client’s health and safety at risk.
If notification is received by the Agency that an employee has been convicted of one of the Convictions Barring Employment Offenses, the employee will receive notification of DPS findings and will immediately terminated.
If notification is received by the Agency that an employee has other than Convictions Barring Employment conviction, the Administrator may place the employee on temporary leave of absence without pay.
• The employee must complete an appeal process with the DPS if the information is inaccurate. A certified fingerprint card and request for a corrected criminal history check must be provided to DPS. • If the employee requests a review within twenty (20) days of receipt of the notice, the required documentation will be forwarded to the Administrator and scheduled for determination.
A notice of determination will be sent to the person after the review process is completed. Factors considered by the Administrator include: • The misdemeanor or felony classification of the offense at the time it was committed • The age of the person when the offense was committed • Evidence of rehabilitation • Employment history • Mitigating circumstances at the time the offense was committed • Other matters as the employee wish to submitAll matters should be submitted in document form and may include letters, affidavits transcripts, letters of recommendation or character references, or employment records. Should the person fail to request and administrative review within twenty (20) days of the notice, the Agency will proceed with termination proceedings.
The STATEMENT OF EMPLOYABILITY and VERIFICATION OF EMPLOYABILITY which will be maintained in the personnel file. The CRIMINAL HISTORY record, if printed, will be shredded within 30 days. The I-9 and CRIMINAL HISTORY will be kept in a separate file and will be managed by ADMINISTRATOR.
All criminal records received by the Agency are privileged information and are for the exclusive us of DPS and the Agency for which the information is requested. The records may not be released or otherwise disclosed to any person or agency except on court order or with the written consent of the person being investigated. An employee or person commits a Class B misdemeanor in violation of Government Code 411.085 subsection (a), unauthorized purpose, or discloses the information to a person who is not entitled to the information or provides a person with a copy of a criminal history record. An employee or person commits a felony of the second degree if the person obtains, uses, or discloses criminal history record information for remuneration purposes. All violators will be reported to the appropriate authority. Employees shall be terminated upon conviction of violations. When the criminal history information is obtained, and the applicant is not employed, the records should be shredded.
ADDENDUM ABy execution of this document, I acknowledge that I have been informed by Agency that the criminal history check will be performed on my name. I have informed Agency of all names that I have used in the past (i.e. maiden, aliases). I understand that my employment is temporary pending the results of the criminal history check.I have not been convicted of the following crimes:
ADDENDUM B A person may not be employed in a position which involves direct contact with a patient/client before the fifth anniversary of the conviction date of:
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I, {text-58} , acknowledge that a Computerized Criminal History (CCH) check will be performed by accessing the Texas Department of Public Safety Secure Website and will be based on name and DOB identifiers I supply. (This is not a consent form.) Authority for this agency to access an individual’s criminal history data may be found in Texas Government Code 411; Subchapter F.Name-based information is not an exact search and only fingerprint record searches represent true identification to criminal history, therefore the organization conducting the criminal history check is not allowed to discuss with me any criminal history record information obtained using this method. The agency may request that I have a fingerprint search performed to clear any misidentification based on the result of the name and DOB search. Once this process is completed the information on my fingerprint criminal history record may be discussed with me.In order to complete the process I must make an appointment with the Fingerprint Applicant Services of Texas (FAST) as instructed online at www.txdps.state.tx.us /Crime Records/Review of Personal Criminal History or by calling the DPS Program Vendor at 1-888-467-2080, submit a full and complete set of fingerprints, request a copy be sent to the agency listed below, and pay a fee of $24.95 to the fingerprinting services company.
Agency Name: Ascentia Healthcare LLC
Please:Check and Initial each Applicable SpaceCCH Report:
Retain in your files
Ascentia Healthcare LLC DOES NOT have Workers Compensation coverage to protect you from damages because of work-related illness or injury.
ATTENDANT JOB DESCRIPTION
KNOWLEDGE, SKILLS, ABILITIES:
OTHER REQUIREMENTS/CONSIDERATIONS: **Please refer to PCA Guidelines**
REPORT TO IMMEDIATE SUPERVISOR/MANAGER:
PERSONAL CARE
MEAL PREPARATION
HOUSEHOLD
GARNISHES AND WAGE ASSIGNMENTS
In accordance with state and local regulation, we comply with garnishments and wage assignments directed against an employee's earnings.
TOBACCO-FREE WORK PLACE
Our Agency seeks to foster the health and safety of all its employees. Tobacco products pose a significant risk to the health of the user. Additionally, in sufficient concentrations, side-stream smoke can be hazardous to nonsmokers in the work environment. We are committed to ensure that each employee has a safe and healthy working environment and to create and maintain tobacco-free work places. All applicants and employees are hereby notified of the tobacco-free work places. The use of tobacco related products is prohibited in all areas of the facility/member’s residence. Anyone wishing to smoke must smoke only at smoking designated area. All employees shall abide by the terms of the tobacco-free work places policy as a condition of employment.
ALCOHOL AND DRUG-FREE WORK PLACE
CITIZENSHIP
Employees must be a citizen of the United States or submit authorization from the United States Government permitting gainful employment in this country. Alien Registration Card, Visa or other Immigration and Naturalization Service document must be presented at time of application.
CONFIDENTIALITY OF PROTECTED HEALTH INFORMATION
It is both the Agency’s and the employee’s responsibility to ensure that every patient’s health information is protected at all times. By signing below, you are indicating the acknowledgement of HIPAA and understand that a thorough orientation of the agency’s policy regarding patient’s Protected Health Information will be provided to you upon hire.
I understand that I may be handling Protected Health Information. I further understand that there are specific guidelines associated for use and disclosure of Protected Health Information. The agency has sanctions and fines for all individuals failing to comply with HIPAA Rules and Regulations.
PROTECTION OF HEALTH INFORMATION
There are specific guidelines to ensure patient’s Protected Health Information is kept private. I understand that my employment with the agency involves handling Protected Health Information. I will ensure patient’s records are protected by enforcing the following measures:
HOW INFECTIONS ARE SPREAD
Infections are commonly spread by:
FOOD SAFETY AND FEEDING ASSISTANTS
You must serve food to residents in a sanitary manner. Residents are at a higher risk of developing a foodborne illness. This is because they may have a weakened immune system and their resistance to infections is weaker than normal.
Foodborne illness occurs when foods are not prepared or served properly, or when they are contaminated by people who are ill or who have poor personal hygiene.
PREVENT FOODBORNE ILLNESS
GOOD PERSONAL HYGIENE
GENERAL CLEANLINESS
HANDWASHING
Handwashing is the single most important thing you can do to prevent infection and foodborne illness.
WHEN DO YOU WASH YOUR HANDS?
Wash your hands before and after assisting patient.
And wash your hands after each of the following:
PROPER HANDWASHING METHOD
Proper handwashing is more complicated than just running water and soap over the hands. The proper procedure is:
HAND SANITIZERS
Hand sanitizers should not be used as a substitute for hand washing. If you use hand sanitizers, you must still wash your hands. If your hands are contaminated or soiled, a hand sanitizer is not adequate
GLOVES
Gloves should never be used to avoid hand washing, you must wash your hands before putting on gloves. Gloves should not be washed and should never be reused.Bacteria and perspiration build up under gloves, so you should change them frequently. When you take off your gloves, you must wash your hands before putting on a new pair.You should wear gloves when handling the patient’s food. You should also wear gloves during feeding when you have a sore on your hand, or when your hands will come into direct contact with the patient’s mouth.
Change your gloves:
SAFE FOOD SERVICE
HOW TO HANDLE DISHES, UTENSILS, AND CERTAIN FOOD ITEMS
Cups and Glasses:
Plates:
Spoons, Forks and Knives:
Handling Bread:
Condiment Packages (catsup, dressing):
Testing Food Temperatures
THIS AGREEMENT is between Ascentia Healthcare LLC (the "Employer"); and {text-69} (the "Employee").
WHEREAS the Employer provides staffing (caregivers) to Medicaid/Private Pay members (in their homes) throughout the Houston Metropolitan area and the surrounding cities. The scheduled hours and assigned locations are varied from case to case.IN CONSIDERATION both parties acknowledge and agree as follows:
Employment
The Employee acknowledge that the initial assigned cases(s) is agreed upon in terms of location and schedule. In addition, he/she will, at all times, faithfully and to the best of his/her skills, abilities, experiences and talents, perform all of the duties required as set forth in his/her job description and attendant orientation. In carrying out these duties and responsibilities, the Employee shall comply with all Employer policies, procedures, rules and regulations, both written and oral, as are announced by the Employer from time to time. It is also understood and agreed to by the Employee that his assignment, duties and responsibilities and reporting arrangements may be changed by the Employer in its sole discretion without causing termination of this agreement.
Furthermore, if the Employee is removed from an assigned case due to hospitalization, member/LAR request and/or due to member’s passing, the Employee shall sign the “Available to Work” log at the Employer’s office within 24 hours and every Mondays thereafter until the Employer assign another case as it becomes available. Failure to sign the log will have adverse effect on unemployment benefits.
Once another case is assigned and the Employee chooses to decline the case, the Employee has to notify the Employer in writing and the reasons of declination. “Available to Work” log process is continued and enforced.
Probation Period
It is understood and agreed that the first ninety days of employment shall constitute a probationary period during which period the Employer may, in its absolute discretion, terminate the Employee's employment, for any reason without notice or cause.
Performance Reviews
The Employee will be provided with a written performance appraisal at least once per year (or as needed) and said appraisal will be reviewed at which time all aspects of the assessment can be fully discussed.
Termination
Non- Competition
Entire Agreement
This agreement contains the entire agreement between the parties, superseding in all respects any and all prior oral or written agreements or understandings pertaining to the employment of the Employee by the Employer and shall be amended or modified only by written instrument signed by both of the parties hereto.
IN WITNESS WHEREOF the Employer has caused this agreement to be executed by its duly authorized officers and the Employee has set his hand as of the date first above written.
MINIMUM WAGE NOTICE & ACKNOWLEDGEMENTEFFECTIVE SEPTEMBER 1, 2019
Ascentia Healthcare will pay employees a minimum wage as follows:
The minimum wage for the CAS/FC program is $8.11 per hour for PAS (Personal Attendant Services).
All others will be paid at the below:
The federal minimum wage is $7.25 per hour.
Read instructions carefully before completing this form. The instructions must be available during completion of this form.
ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) they will accept from an employee. The refusal to hire an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.
Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.)
For aliens authorized to work, provide your Alien Registration Number/USCIS Number OR Form I-94 Admission Number:
OR
If you obtained your admission number from CBP in connection with your arrival in the United States, include the following:
Some aliens may write "N/A" on the Foreign Passport Number and Country of Issuance fields. (See instructions)
Preparer and/or Translator Certification (To be completed and signed if Section 1 is prepared by a person other than the employee.)
I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct.
Section 2. Employer or Authorized Representative Review and Verification
(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR examine a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents" on the next page of this form. For each document you review, record the following information: document title, issuing authority, document number, and expiration date, if any.)
CertificationI attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States.
Employer's Business or Organization Name
ASCENTIA HEALTHCARE LLC
Employer's Business or Organization Address (Street Number and Name): 24707 Malca Manor Dr
City or Town: KATY
State: TX
Zip Code: 77493
Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)
If employee's previous grant of employment authorization has expired, provide the information for the document from List A or List C the employee presented that establishes current employment authorization in the space provided below.
Acknowledgement of Responsibility for Reporting Abuse, Neglect and Exploitation and Reasonable Suspicion of Crime(Form must be completed by the employee, contract employee or volunteer with the original kept at the facility.)
A. Reporting Abuse, Neglect and Exploitation
All DADS state supported living center employees, contract employees and volunteers must immediately, if possible, but in no case more than one hour, notify the facility director and the Texas Department of Family and Protective Services if there is suspicion of abuse, neglect or exploitation.Abuse, neglect and exploitation include, but are not limited to:
The proper use of restraints and techniques to manage aggressive behavior are not considered abuse or neglect if used according to facility procedures.I acknowledge my responsibility as an employee, contract employee or volunteer of the state supported living centers to report abuse, neglect and exploitation. I understand that I should report any incident that I suspect may be abuse, neglect or exploitation even if I am not sure. I realize I may be criminally liable for failing to report abuse, neglect or exploitation.
B. Reporting Reasonable Suspicion of Crime Against an Individual
All DADS state supported living center employees, contract employees and volunteers must immediately notify the facility director/designee and the DADS Consumer Rights and Services section at 1-800-458-9858 and the local law enforcement agency if they have a reasonable suspicion a crime against an individual has occurred. Reporting must occur within two hours if the individual sustained a serious physical injury or within 24 hours if the individual did not sustain a serious physical injury.
Agency Name & Address:
Ascentia Healthcare LLC - 24707 Malca Manor Dr., Katy, TX 77493
