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Stap. aard Assm~ce to Comply w/th Older 2~mericans-Act <br /> P~equirements Regarding Client t~j~hts. <br /> for <br />Agencies Pro,Sd~ng Ia-Hom.e Services through the <br />Home and Comrmm'_~y Care Block Grant for Older Adults <br /> <br />- As a provider of one or more of the services listed below, our agency agrees to notify.all Home and <br /> Co .mm.m~..C?e Block C?~t cli.en, ts receive, g a~.y of the below listed services provided by this agency <br /> of the the~ fights as a sermce reclpzent. Servmes included in th{s assurance include: <br /> -Ia-Home Aide <br /> -Home Care (home health) <br /> -Housing and Home lmprovemem <br /> -Adult Day Care or Adult Day Health Care <br /> <br />Notification will include, at a mlnimnm, all oral review of the information outlined below as well as. <br />provirti~g each service recipient with a copy of the in~'ori,,;~tion in written form. In addition, l~roviders <br />of ia-borne servi.ces will establish a procedure to doc~rment that client'fights information has been .. <br />d~. cussed with ii-home services clients (e.g. copy of signed Client Bill of nights statement). <br /> <br />Client Rights inf6r a~ation to be communicated to service recipients will include, at a m~nim~m, the <br />fight to:' <br /> -be folly infozmed, in advance, about each in-home service to be pro-tided aucl a.uy cha~ge in ' <br /> service(s) that may affect the well~be'rog of the participant; <br /> aPdjarticipate in planuing and changing any in-home service provided unless the client/s <br /> udicated incompetent; <br /> -voice a grievance vrkh:respect to service that is or fails to be provided, without discaqmqnation. <br /> or reprisal as a result of voicing a grievance; <br /> -confidentiality of records relating to the individual; <br /> · -have property treated with respect; and <br /> -be fully informed both orally and ia writing, in advance ofreceiving an ii-home service, 'of <br /> the iadividual' s rights and obliga~ons. <br /> <br />Client Rights will be cli.~tr~uted to, and discussed with, each new client receiving one or mo~e of the <br />above listed services prior to the on-set of service. For al~ exi~ng clients, the above information w/ll <br />be provided no later than the next regnhrly scheduled service reassessment. <br /> <br />Agency Name: Cabarrus County Department of Social Services .. <br /> <br />Nsme of Agency Adrnln~trator: , <br /> <br />James F, Cook <br /> <br />(Please return this fo~m to your Area Agency on .AgOg and retain a copy for your flies.) <br /> <br /> <br />