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ATTENDANT APPLICATION CHECKLIST

ATTENDANT APPLICATION CHECKLIST

ATTENDANT APPLICATION CHECKLISTascentiahealthcare2022-10-15T20:26:35+00:00

Verifications checked

APPLICATION FOR EMPLOYMENT

ARE YOU 18 YEARS OR OLDER?
ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED IN THIS COUNTRY BECAUSE OF VISA OR IMMIGRATION STATUS?

EMPLOYMENT DESIRED

Are you employed now?
If so may we inquire of your present employer?
Ever applied to this company before?

EDUCATION

Graduated?
Graduated?
Graduated?
Graduated?

GENERAL

FORMER EMPLOYERS (LIST BELOW LAST THREE EMPLOYERS, STARTING WITH LAST ONE FIRST)

REFERENCES: GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR

IN CASE OF EMERGENCY NOTIFY

Direct Deposit Agreement Form

Authorization Agreement

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.

Account Information

Signature

*Please attach a voided check or deposit slip and return this form to the Payroll Department NO HANDWRITTEN OR TEXT WILL BE ACCEPTED

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 253
In 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 submit
All 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 A
By 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:

  • An offense under Section 19 Penal Code (criminal homicide)
  • An offense under Section 20 Penal Code (kidnapping and unlawful restraint)
  • An offense under Section 21.08 Penal Code (indecency exposure)
  • An offense under Section 21.12 Penal Code (improper relationship b/w educator and student)
  • An offense under Section 21.15 Penal Code (improper photograph and visual recording)
  • An offense under Section 22.05 Penal Code (deadly conduct)
  • An offense under Section 22.011 Penal Code (sexual assault)
  • An offense under Section 22.021 Penal Code (aggravated sexual assault)
  • An offense under Section 22.02 Penal Code (aggravated assault)
  • An offense under Section 22.04 Penal Code (injury to a child, elderly, disabled individuals)
  • An offense under Section 22.041 Penal Code (abandoning or endangering child)
  • An offense under Section 22.07 Penal Code (terrorist threat)
  • An offense under Section 22.08 Penal Code (aiding suicide)
  • An offense under Section 25.031 Penal Code (agreement to abduct from custody)
  • An offense under Section 25.08 Penal Code (sale or purchase of a child)
  • An offense under Section 28.02 Penal Code (arson)
  • An offense under Section 29.02 Penal Code (robbery)
  • An offense under Section 29.03 Penal Code (aggravated robbery)
  • An offense under Section 33.021 Penal Code (online solicitation of a minor)
  • An offense under Section 34.02 Penal Code (money laundering)
  • An offense under Section 42.09 Penal Code (cruelty to animals)
  • An offense under Section 35A.02 Penal Code (Medicaid fraud)
  • Any offense LT HOME HEALTHCARE determines to be contraindicated to employment

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:

  • An offense under Section 31 Penal Code (theft) punishable as a felony
  • An offense under Section 30.02 Penal Code (burglary)
  • An offense under Section 22.01 Penal Code (assault)
  • An offense under Section 32.45 Penal Code (misapplication of fiduciary property or property of a financial institution) punishable Class A misdemeanor or felony
  • An offense under Section 32.16 Penal Code (securing execution of a document by deception) punishable Class A misdemeanor or felony
  • An offense under Section 37.12 Penal Code (false identification as peace officer)
  • An offense under Section 42.01 (a), (7), (8) or (9) Penal Code (disorderly conduct)
  • An offense LT Home Healthcare determines to be contraindicated to employment

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

(AGENCY COPY)

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. 

(This copy must remain on file by your agency. Required for future DPS Audits)

Agency Name:
Ascentia Healthcare LLC

Please:
Check and Initial each Applicable Space
CCH Report:

Printed
Initial

Retain in your files

Employer’s Notice of Non-Coverage Under the Workers Compensation Act

Ascentia Healthcare LLC DOES NOT have Workers Compensation coverage to protect you from damages because of work-related illness or injury.

Employer’s Notice of Non-Coverage Under the Workers Compensation Act

ATTENDANT JOB DESCRIPTION

  1. Provide personal assistance services, including bathing, dressing, bowel and bladder management, transferring from bed to wheelchair, meal preparation, light housekeeping, and other tasks as approved.
  2. Job involves lifting, bending and standing for a long period of time.

KNOWLEDGE, SKILLS, ABILITIES:

  1. Attendant must be reliable, punctual, neat and organized, willing to perform tasks as requested, willing to learn job requirements, able to follow instructions.
  2. Training/Orientation will be provided by family/staff. No prior experience is required; must be willing to learn.
  3. Be certified in CPR and maintain certification current during employment if required.

OTHER REQUIREMENTS/CONSIDERATIONS: **Please refer to PCA Guidelines**

  1. If attendant decides to discontinue employment, he/she must be willing to continue working until a replacement is found, which could be 2-4 weeks, and be willing to train replacement.
  2. Prefer non-smoker. No pets, no children/family/friends/personal visitors brought into client’s home.
  3. Personal care attendant should be in good physical condition, have access to a reliable mode of transportation and/or have a back-up plan for transportation to and from work, perhaps most of all, enjoy helping those in need.

REPORT TO IMMEDIATE SUPERVISOR/MANAGER:

PERSONAL CARE ATTENDANT GUIDELINES/ POLICIES

  1. Dress Code: Scrubs (not unless approved by Administrator) & Closed-toe shoes.
  2. Fingernails need to be short, neat and trimmed – No heavy make-up – No dangling/hoop jewelry - No strong perfume scent – No facial piercing. Hair should be neat and pull away from face.
  3. You must be trustworthy, dependable and respectful to the Individual and other staff members, including management staff.
  4. Tasks performed by Habilitation Services Provider/MCO Authorization must be provided with proper regard for the Individual’s welfare, health, and safety.
  5. DO NOT smoke in Individual’s home. Have respect for Individual’s home and belongings.
  6. DO NOT eat the Individual’s food; always bring your own.
  7. DO NOT accept gifts, tips or money from Individual or from his/her family members.
  8. DO NOT drive the Individual in your vehicle.
  9. Must have dependable transportation to and from work – excessive missing shifts and late to shifts are grounds for termination.
  10. DO NOT use Individual’s credit cards for any reason UNLESS Shopping task is authorized. (must provide receipt to individual)
  11. DO NOT ask to borrow money from the Individual or lend money to him/her – NO EXCEPTIONS!
  12. DO NOT use Individual’s home phone or cell phone for personal reasons.
  13. DO NOT text/talk on the phone during your shift unless it’s an emergency. Earbuds are NOT allowed.
  14. DO NOT discuss the Individual with anyone other than ASCENTIA HEALTHCARE staff. All information is CONFIDENTIAL!
  15. DO NOT take pictures of individual/client or anything else related/belonged to the individual/client – NO EXCEPTIONS!
  16. DO NOT take your children, family or friends to the Individual’s home.
  17. MUST contact ASCENTIA HEALTHCARE immediately if any incidents, accidents or injuries occur to the Individual or self.
  18. Call 9-1-1 if it’s an emergency. *Use Incident Report Form
  19. You must notify the office at least 7 business days for planned time off. In case of illness, please contact ASCENTIA HEALTHCARE immediately to allow ASCENTIA HEALTHCARE time to find shift coverage.
  20. YOU WILL BE PAID FOR THE AUTHORIZED HOURS WORKED. UNAUTHORIZED HOURS WILL NOT BE PAID AND IF PAID, THE MONIES WILL BE RECOUPED FROM YOUR NEXT PAYCHECK.
  21. Grounds for dismissal/termination: No call No Show work, removing the token device & Violations of the Guidelines – Will not be allowed for Available Assignment Log sign-in.
  22. If you were to be removed from an assignment involuntary (i.e. Family request, death) or you request a new assignment, you must go to the office to sign an Available To Work Assignment Log within 24 hours AND every Monday thereafter until you are assigned another case. You agree that if you do not go to the office and sign the log, Ascentia Healthcare can assume that you are not available for work. You understand that your failure to sign the log could adversely affect your unemployment benefits.
  23. Must call In & Out according to the scheduled hours using the EVV system. NO calls or just call In or Out may subject to No pay. NO EXCEPTIONS – It’s the STATE’s policy!!
  24. Must wear Ascentia name badge during assignment. *Badge must be returned, once dismissed, prior to the final paycheck.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

PERSONAL CARE

  • Wash hands before and after care.
  • Encourage Individual/Patient to assist as much as possible.
  • Have emergency phone numbers handy: police, fire department, ambulance, poison control, your assigned supervisor.
  • Use belt or sheet when assisting in and out of bed/chair
  • Lock wheelchair brakes when assisting in and out.
  • Keeps side rails up, if available.
  • Use LOW setting only for hair dryer/heating pad.
  • DO NOT smoke in house.
  • DO NOT put Individual/Patient in tub if he/she is unable to get in and out of tub alone. Use tub bench if possible.
  • DO NOT LIFT Individual without back support or use Hoyer lift if applicable.
  • All incidents must be reported to ASCENTIA HEALTHCARE within the shift which they occur.

MEAL PREPARATION

  • Wash hands before preparing meal.
  • Wash fruits and vegetables before serving.
  • Wash can lid/top before opening.
  • Defrost food in refrigerator.
  • Turn pot handles inward when cooling on stove top to prevent spills/burns.
  • DO NOT leave knives or sharp objects on table or counter tops. Handle with care.

HOUSEHOLD

  • Keep floors dry.
  • Check floors for cords, throw rugs and loose boards to prevent falls.
  • Wear rubber gloves to clean
  • DO NOT mix cleaning products
  • DO NOT use electrical equipment with wet hands.
  • DO NOT MOVE OR LIFT HEAVY FURNITURE OR OTHER OBJECTS.

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

  • Our Agency recognizes that substance abuse in our nation and community exacts staggering cost in both human and economic terms. Substance abuse can be reasonably expected to produce impaired job performance, lost productivity, absenteeism, accidents, wasted materials, lowered morale, rising health care costs and diminished interpersonal relationship skills. We are committed to solve this problem and to create and maintain an ALCOHOL and DRUG-FREE work place. Violation of this policy will be cause for immediate dismissal.
  • The Agency does not presently perform routine drug testing on its employees but may do so at its discretion. If the Agency determines that drug testing is in the best interests of the Agency, all employees will be notified in writing of our intention to require drug testing on specific or all categories of personnel having contact with patients/clients. Drug testing is conducted using urine samples.

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:

  • Patient Protected Health Information will be transported in a protected travel chart when traveling
  • When transmitting and receiving a fax involving Protected Health Information, I will ensure that it is conducted in a private area.
  • Patient Protected Health Information will be returned to the agency upon acknowledgement of the patient being discharged.

HOW INFECTIONS ARE SPREAD

Infections are commonly spread by:

  • direct contact such as touching the source of infection;
  • indirect contact such as touching contaminated objects;
  • airborne routes such as inhaling small pathogens floating in the air; or
  • droplets spread such as contacting drops of secretions placed in the air when someone sneezes, coughs, or talks

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

  • Practice good personal hygiene
  • Practice general cleanliness
  • Use proper handwashing techniques
  • Serve food safely

GOOD PERSONAL HYGIENE

  • Handwashing is the single most important measure you can do to prevent and control infections.
  • Wear clean clothes to work.
  • Bathe daily. Wash your hands.
  • Do not eat or drink while assisting clients/patients.
  • Cuts, sores, and burns should be properly cleaned and covered.
  • If your hands are bandaged, always wear clean gloves to protect the bandage and to prevent it from falling off
    into food.

GENERAL CLEANLINESS

  • If you are ill with a cold, respiratory or gastrointestinal symptom, do not assist patients in feeding.
  • Do not share personal care items.
  • If you perform other duties in the home in addition to feeding, it is a good idea to wear disposable aprons and to keep a change of clothes handy in case your work clothes get dirty.
  • Keep your fingernails short and clean.
  • Nail polish and artificial nails are difficult to keep clean and can break off into food.

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:

  • Using the restroom
  • Touching your hair, ears, nose, or any part of your body
  • Scratching any part of your body
  • Picking items from the floor
  • Smoking or chewing tobacco – NOT ALLOW
  • Clearing away or scraping used dishes and utensils
  • Eating food or drinking beverages
  • Taking out the garbage
  • Sneezing, Coughing
  • After assisting patient with eating

 

PROPER HANDWASHING METHOD

Proper handwashing is more complicated than just running water and soap over the hands. The proper procedure is:

  • Turn the water on and let it run to a temperature as hot as your hands can comfortably stand.
  • Wet your hands under the water and apply soap to them, rubbing your hands together.
  • Pay attention to the areas between the fingers and around the nails.
  • Rub one hand against the other for 20 seconds.
  • Rinse thoroughly under hot running water
  • Do not touch the sink.
  • Using a clean paper towel, dry your hands from the tips of the fingers up to the wrists.
  • Dispose of the towel without touching the waste container.
  • Use a clean paper towel to turn off the faucet and to open the door.

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:

  • As soon as they become soiled or torn
  • Before beginning a different task

SAFE FOOD SERVICE

  • Do not chew gum, eat or drink while assisting patients.
  • Avoid touching hair, face or other body parts during the feeding process.
  • When assisting more than one resident, take extra care to touch only the handles of the utensils and outsides of glasses and cups.
  • Replace dropped or thrown utensils with clean utensils.
  • Do not touch the end of utensils.
  • Deliver trays in a sanitary manner.
  • Carry trays away from the body.
  • Carry one tray at a time.

HOW TO HANDLE DISHES, UTENSILS, AND CERTAIN FOOD ITEMS

Cups and Glasses:

  • When serving, do not stack up cups
  • Carry one glass or cup in each hand.
  • Do not put your fingers in glasses.
  • Keep your hands by the base of the glass,
  • Do not put hand or fingers near the rim of a glass or cup.
  • Hold coffee cups by the handles.
  • Use a tray if you are serving more than two cups or glasses.

Plates:

  • Do not touch the eating surface.
  • Hold the plate from underneath,
  • Keep food items separate.

Spoons, Forks and Knives:

  • Hold spoons, forks and knives by the handles.

Handling Bread:

  • If you are receiving bread from the kitchen for a patient, transport it on a plate or in a bread bag.
  • Do not carry it with your hands.

Condiment Packages (catsup, dressing):

  • Open packets with scissors or tear with your hand,
  • Do not open packets with your teeth or mouth.

Testing Food Temperatures

  • You should check the temperature of hot food before feeding a patient.
  • Hot foods can cause serious burns.
  • Do not test temperatures with your fingers.
  • Using a spoon or fork, place a drop of food on the back of your wrist to check the temperature. If it is too hot on your wrist or causes you discomfort, it is too hot for the patient to eat.
  • By placing your hand above (and not touching) a plate or bowl of hot food, you can feel heat rising. The food may be too hot for the patient to eat,
  • Do not blow on the patient’s food. This spreads germs. Allow the food to cool on its own or by stirring the food.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Employment Agreement Provider Services – Personal Care Attendant

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

  1. The Employee may at any time terminate this agreement and his employment by giving not less than two weeks written notice to the Employer.
  2. The Employer may terminate this Agreement and the Employee’s employment at any time, without notice or payment in lieu of notice, for sufficient cause.
  3. The employee agrees to return any property of Ascentia Healthcare at the time of termination.

Non- Competition

  1. It is further acknowledged and agreed that following termination of the employee’s employment with Ascentia Healthcare for any reason the employee shall not hire or attempt to hire any current employees of LT Home Healthcare.
  2. It is further acknowledged and agreed that following termination of the employee’s employment with Ascenta Healthcare for any reason the employee shall not solicit transferring business from any current clients including clients who have retained by the employee for a period of 36 months.

 


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 & ACKNOWLEDGEMENT
EFFECTIVE 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.

Employer Completes Below form

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.)

Certification
I 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:

  1. sexual contact between an individual receiving services and an employee, contractor or volunteer.
  2. sexual contact between an individual receiving services and someone who has an ongoing relationship with the individual receiving services, such as a family member or guardian.
  3. permitting an obscene or pornographic photograph, videotape or other depiction of an individual receiving services.
  4. any intentional or reckless act or failure to act that causes or may have caused physical injury to an individual receiving services.
  5. any act of inappropriate or excessive force or corporal punishment inflicted on an individual receiving services regardless of whether it results in physical injury.
  6. verbally or non-verbally cursing, vilifying, degrading or threatening physical or emotional harm to an individual receiving services.
  7. any act or omission by an employee, contractor or volunteer that places an individual receiving services at risk of physical or emotional injury.
  8. using an individual receiving services, or that individual's resources, for monetary or personal benefit, profit or gain.

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

info@ascentiahealthcarellc.com
Phone: 281-786-4880
Fax: 281-786-2084

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