EXHIBIT A. Part 1 Statement of Work Specific Needs Services Contract

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1 EXHIBIT A Part 1 Statement of Work Specific Needs Services Contract I. INTRODUCTION. The Department of Human Services (DHS) has identified the need for a model of care designed for Medicaid eligible service recipients whose care needs cannot be met in the current Aging and People with Disabilities Long Term Care settings. The Individuals to be served under this contract are defined in the Target Group. Contractor shall provide Complex Behavioral services as described herein for up to 51 Medicaid eligible Individuals who are authorized to receive services at the Contractor s owned and operated licensed Assisted Living Facility located at: Ridgeview Assisted Living Center 872 Golfview Drive Medford, Oregon II. DEFINITIONS. In addition to all terms defined in the Contract, the definitions in OAR apply to and are incorporated by reference into this Contract. If a conflict exists between any terms defined in this Contract and the terms defined in OAR , the conflicting terms with the greater level of expectation or delivery shall take precedence. Activities of Daily Living or ADL means those personal, functional, activities required by an Individual for continued well-being, health, and safety. Activities of Daily Living consist of eating, dressing, grooming, bathing, personal hygiene, mobility (ambulation and transfer), elimination (toileting, bowel, and bladder management), cognition and behavior. Contractor, through its direct care staff, is responsible for providing these supports and related Instrumental ADLs in a manner that incorporates the Individual s preferences, personal routine and self-direction. 1

2 Activity Plan means the separate document that provides a description of services defined in OAR (4) that is developed for each Individual based on their activity evaluation and should include strategies for how these activities can become part of the Individual s daily routines. The Activity Plan is developed by the Activities Director and must be aligned with the Behavior Support Plan through the Service Planning Team. The Activity Plan is part of the Service Plan required by OAR Activity Director means the staff who is responsible to develop, oversee and provide or direct activities required under OAR , OAR and as described in this contract. Area Agency on Aging or AAA means the DHS designated agency charged with the responsibility to provide a comprehensive and coordinated system of services to older adults or persons with disabilities in a planning and service area. The term Area Agency on Aging is inclusive of both Type A and Type B Area Agencies on Aging as defined in ORS and described in ORS to Behavior Support Plan means the separate document that describes the individualized proactive behavior support strategies which are designed to replace challenging behaviors with functional, positive behaviors and which identifies caregivers interventions to help them deescalate, reduce or tolerate the challenging behavior. The proactive behavior support strategies must focus on environmental, social, and physical factors that affect the behavior(s). This Behavior Support Plan is developed by Resident Care Coordinator for each Individual and updated quarterly by the Service Planning Team. The Behavior Support Plan must be separate from but in alignment with all services in the Individual s Service Plan required under OAR Community Attendants means the Contractor s direct care employees or other employees who escort and assist an Individual with their Behavior Support Plan, Activity Plan, ADL, IADL, communication, health and safety needs while Individuals are engaging in activities outside of the Contractor s facility. Family or natural supports can provide this function on behalf of the Contractor if they are have necessary legal authority or the Individual s permission. Crisis Prevention Institute or CPI is the procedure for providing training to Contractor s employees who work with Individuals to provide elements of positive behavior support and non-aversive behavior intervention. CPI uses principles for 2

3 safely resolving situations when confronted by anxious, hostile, or violent behavior, while protecting the therapeutic relationships with Individuals. DHS Designee refers to the DHS or AAA Case Manager or Diversion/Transition Coordinator who is primarily responsible for coordinating the Individual s care with the Contractor, participates in admission, discharge and service planning activities and participates on the Individual s Service Planning Team. Home and Community Based Care means home and community-based long-term services and supports, and refers to assistance with daily activities that generally helps older adults and people with disabilities remain in their homes or in alternative settings approved by the state. Instrumental Activities of Daily Living or IADL means those tasks required for self-management, and consists of housekeeping including laundry, shopping, transportation, medication management, and meal preparation Individual means the client, resident or person who is eligible for and receives Services under this contract. Nursing Service Plan means the separate document that provides a description of services developed by the Registered Nurse based on the Individual s initial nursing assessment and subsequent reassessments. The Nursing Service Plan must describe all licensed nursing services the Individual will receive and be in alignment with the individual s Service Plan, Behavior Support Plan and, as applicable, Rehabilitation Plan. On-Call means available to participate in Individual specific consultation even when not present at the Contractor s Service location. On-Site means on or at the Contractor s Service location or facility and is available to provide immediate supports and services to Individuals and other employees. "Person-Centered Planning" means a process, either formal or informal, for gathering and organizing information that helps: i. determine and describe choices about personal goals, activities, and lifestyle preferences; ii. encourage and support an Individual s autonomy and ability to self-direct their routines and activities on a daily basis; iii. design strategies and networks of support to achieve goals and a preferred lifestyle using strengths, relationships, and resources; and 3

4 iv. identify, use and strengthen naturally occurring opportunities for support at the Individual s home and in the community. "Positive Behavioral Support" means the theories and practices describing a proactive approach to behavior and behavior interventions that: i. Emphasizes the development of functional alternative behavior and positive behavior intervention; ii. Uses the least intrusive/restrictive intervention possible; iii. iv. Ensures that abusive or demeaning interventions are never used; and Evaluates the effectiveness of behavior interventions based on objective data. Rehabilitation Plan means a description of services created and reviewed annually by Contractor s licensed therapist to assist an Individual with increasing, maintaining or developing physical, occupational, speech, respiratory, cognitive, or physical skills. Rehabilitation Services means the Individual s adjunct or ancillary health services or therapies defined in a Plan and which are provided under direction of licensed therapist to include, but not limited to mental health, speech, physical, respiratory, occupational or other services. Resident Care Coordinator (RCC) is the designated employee who meets the qualifications and continuing educations requirements of a Behavior Consultant per OAR , 0210; maintains certification and who has a job description to provide the services noted in Behavior Support Services Chapter 411, Division 046. RN means a registered nurse with an unencumbered Oregon nursing license. Service Plan is the written document required by Oregon Administrative Rules for Residential Care and Assisted Living Facilities Each Individual must have a Service Plan that contains section(s) or references a separate Nursing Service Plan, Activity Plan, Behavior Support and, and, if receiving services, Rehabilitation Plan. Service Plans must be reviewed in total by the Service Planning Team quarterly or more frequently if the Individual s health or behavior deteriorates, are being considered for eviction, have experienced unexpected medical or behavioral deterioration or required an ER visit or hospitalization. 4

5 Service Planning Team (SPT) means a group who is responsible for overseeing the Service Plan implementation and ensuring that the Service Plan is coordinated with all Services provided. At a minimum, the SPT includes the Individual and/or their legal representative, Contractor s Administrator, Registered Nurse, Resident Care Coordinator and DHS Designee. The Activity Coordinator, Social Services Coordinator and any related health professionals should be invited as needed or as requested by DHS. Specific Needs Services refers to the payment process and standards identified in OAR (1) (4). Programs with Specific Needs Services contracts provide specialized services designed to meet the needs of Individuals in a specific Target Group which exist as the result of a condition or dysfunction resulting from a physical disability or a behavioral disorder which requires more than the minimum scope of services of Contractor. Target Group means an Individual who meets all of the following criteria: Is eligible for DHS services under the current funding Services Priority levels described in OAR through and Has two of the following needs: o Cannot be served in any standard Home and Community Based Care setting; and o Requires weekly contact with an onsite nurse; or o Requires a Behavior Support Plan with daily interventions; or o Has complex care coordination needs with Medical or Rehabilitation providers; or o Is receiving Enhanced Care Outreach, Mental Health or Substance Abuse Services Transition Care Conference means a conference arranged by the Contractor of persons who are currently providing services to an Individual prior to the Individual s placement. The following persons must attend or participate in the conference by phone: Contractor s Administrator or designee, RN, Resident Care Coordinator and the DHS Designee from both the discharging and receiving counties. The Individual who will be admitted to the program or the Individual s representative must be included and/or have input on all transition 5

6 plans before finalization. If members participate by conference call, it must be documented. III. CONTRACTOR S SERVICES (the Work) A. Contractor shall perform all Work and operate its Assisted Living Care Facility in accordance with OAR through and all applicable federal laws. The Department enters into this contract in anticipation of requiring Contractor s services. The Department makes no guarantee as to the number of persons who may be referred to Contractor for services. In addition, The Department is not an employer nor is Contractor an employee under this agreement. Persons hired by Contractor in the provision of specified services are employees of Contractor. B. Contractor shall designate an administrative employee as Contractor s primary contact for communications between Contractor and DHS. Contractor shall provide information regarding any changes to this staff designee to DHS within 10 days of Contract execution or change in staff designee by Contractor. C. A majority of all beds at this location must be occupied by persons who meet Target Population. D. Contractor shall notify DHS Designee of all issues, including any unexpected changes in an Individual s condition or absence of an Individual from the Contractor s Assisted Living Care Facility, which may affect Contractor s Work or payment for Contractor s Work. E. Contractor agrees to participate in DHS review of the Assisted Living facility within 90 days of Contract execution, as well as prior to the extension of the Contract term, and provide DHS with any business records requested by DHS for evaluation of Contractor s performance. IV. ELIGIBILITY: DHS will have no financial responsibility for Services provided to an Individual until such time as the subject Individual s eligibility has been determined, the placement and payment have been authorized by DHS, and the Transition Care Conference has occurred. Service payment eligibility becomes effective on the date of placement or the effective date of eligibility upon execution of this Contract. 6

7 V. ADMISSION PROCESS: a. Contractor must notify Contractor Administrator of any Medicaid Individual who is being screened for admission under this Contract, and provide information necessary for prior approval of the admission and payment initiation. b. Contractor shall conduct face to face screening of all potential Individuals being considered for placement, and then review information with all relevant Service Planning Team members. Face to face requirement for screening may be waived by the Contract Administrator. c. The Contractor s Administrator, Resident Care Coordinator and/or RN must participate in a minimum of one Transition Care Conference with the DHS Designee of both discharging and receiving counties and a representative of the agency currently providing services to the individual. Purpose of this meeting or conference call is to verify the appropriateness of placement. Conference must address: i. Identifying transition planning roles ii. Reviewing existing service plan and identify staffing needs iii. Reviewing medical needs and steps needed to ensure coordination of medical benefits and Services, including physician assignment iv. Reviewing legal and financial needs, including guardianship and representative payee assignments v. Identifying Individual specific transition planning needs and an admission date vi. Coordinating how to get Individual or Individual s designated representative input, authorization for admission plans and arrange for visits. VI. DISCHARGE / EXIT PLANNING: a. No individuals served under this contract may be involuntarily discharged from the facility without the prior review and documented approval by the Contract Administrator and Individual s Service Planning Team. b. Administrator shall ensure that the Service Planning Team is convened in a timely manner to conduct discharge reviews. i. Agreement by all members that discharge is the only option for 7

8 the individual. ii. Verify that all service plan and positive behavior support interventions, including staffing adjustments, were implemented. iii. Explore any additional strategies or resources the program would need to withdraw the discharge/exit decision and/or support the persons return to the program. iv. Ensure that the DHS Designee has the time and resources they need to review with the individual and/or their legal guardian the discharge decision, their rights and how to access any assistance they need to assure basic health, safety and if necessary legal supports. v. Begin development of a transition plan to identify and support the individual s transition to an alternative setting, regardless of whether the discharge is voluntary or involuntary. c. Contractor shall complete a Form SDS 492 within 5 business days following a vacancy and send to Contract Administrator, documenting all discharges. Form SDS 492 may be downloaded at: RIDKEY=SDS%200492,,APD%20Specific%20Needs%20Contract% 20Resident%20Termination%20- %20To%20be%20completed%20by%20provider,se0492.doc,se0492.p df,,,,,, d. Involuntary moves, transfers and discharges must be in accordance with the OAR and 5(a) and 5(b). The team must carry out Risk Management planning for any persons who is receiving an involuntary move out notice per OAR VII. SERVICE PLANNING TEAM (SPT): Contractor must designate an administrative employee who has a position description that includes responsibility for scheduling, facilitating, coordinating, overseeing and documenting quarterly Service Planning Team (SPT) meetings per OAR The Service Planning Team must: 8

9 a) Include at a minimum, the following persons in the SPT meetings: the Individual and/or their legal representative, Contractor s Administrator or Administrative designee, RN, RCC and DHS Designee. Social Services Coordinator, Activities Director, mental health, rehabilitation and health care providers shall be invited to participate in the SPT as needed. b) Develop an initial service plan based on the individual s assessment, in accordance with the facility licensure. Within 14 calendar days of admission, an Activity, Behavior and a Nursing Plan must be attached to and aligned with the service plan. Rehabilitation Plans must be attached to and aligned with the Service Plan if the person is receiving these services. c) Document participation and attendance in the quarterly Service Plan Team meetings. Participation by conference call is acceptable. Team members who are unable to attend the meeting must receive copies of the updated service plans. d) Ensure the quarterly Service Plan is in alignment with Behavior, Nursing and Activity plans and, as needed, Rehabilitation plans. These distinct Plans may be referred to or incorporated into the body of the Service Plan as long as caregiver tasks are clearly delineated and accessible. e) Implement Policies and Procedures for communicating and documenting Service and all attached Plan(s) changes to direct care staff in a timely manner. All staff review of the Service Plans must be documented. f) Ensure Service and all attached Plan(s), in additions to licensure requirements, are person centered and address each Individual s goals and lifestyle preferences. g) Designate a member to review the Service Plan with the Individual in a manner which encourages the Individual s fullest participation possible in the planning process, assures the Individual s preferences, goals and ability to self-direct are maximized and that the Individual is given opportunity to choose IADL, ADL and activities on a daily basis. The Individual s response to this review must be documented. h) Review all Services the Individual receives under this Contract, including interventions carried out by Contractor s staff and other healthcare providers or therapists documented in the Service and attached Plans at least quarterly or more frequently if the Individual s health or behavior deteriorates. 9

10 i) Identify changes that are needed to the Service Plan, or any attached Plans, and oversee communication and implementation of these changes. All changes to these plans or the Service Plan must be documented. VIII. STAFFING: Contractor shall ensure that staffing is in compliance with the licensing rules of the Contractor s Assisted Living facility, described in OAR , and be sufficient to meet the scheduled and unscheduled needs of Individuals. In addition: a) Contractor shall ensure Contractor s employees who work with Individuals must be experienced, qualified, well-trained and have completed, submitted and passed a criminal history check. b) Copies of completed criminal history approval letters must be made available to the DHS Designee or DHS upon request. c) Contractor shall prepare and submit job descriptions, including training plans, to DHS Contract Administrator for approval within 90 days of Contract execution and thereafter upon request. d) Contractor shall ensure that Contractor s supervisory, nursing and emergency staff are identified and available to Contractor s direct care staff on a 24-hour basis. e) Emergency backup and on call information for an RN, RCC and Contractor s Administrator must be available to Contractor s direct care staff on all shifts to minimize avoidable emergency placements and provide crisis management. Direct Care Staffing: Contractor shall provide five (5) direct care staff on days, five (5) direct care staff on evening and three (3) direct care staff on nights. Additional increase in staffing must be instituted when it is warranted by Individual acuity. All Contractor s direct care staff shall receive training related to each Individual s Service Plan including all needed nursing, activity, behavior and rehabilitation interventions. Direct care staff must be trained in CPI so the Individual s independence, choice, preferences and ability to self-direct their care is maximized. 10

11 Direct care staff are responsible for carrying out the Services described in this Contract and in the Individual s Service Plan, including supervision and support of Individuals both onsite and in the community Duties include I/ADL care, minor housekeeping, laundry assistance, delegated nursing tasks, medication administration, health treatments, activities, behavioral interventions, meal assistance including feeding, preparation for and escorts on community outings for community activities and medical appointments. i. There must be a minimum of 2 qualified direct care staff available on the premises 24/7, 7 days a week. ii. One direct care staff on day and evening shift must be a designated medication aide. iii. One direct care staff on day and evening shift must be trained and designated as the community attendant/diabetic aide to ensure that Individual Nursing Plans can be implemented including escort to community medical appointments. Administrative Team: The Contractor must assure 1.5 FTE Administrator who meets requirements under OAR , as well as a 1.0 FTE Administrator Assistant. Persons in the Administrator and Administrator Assistant positions must have experience with operational aspects of running a residential program for people in the target population, supervising direct care staff and understand quality assurance procedures. Job descriptions must designate responsibility for the following: a) Screening of referrals and other activities related to admission. b) Providing or ensuring availability of 24/7 continuous supervision, as well as ensuring access to emergency backup is available for direct care staff. c) Development and provision of any Individual-specific training needed to implement the Individual s Service Plan. d) Schedule and provide facilitation of the Service Planning Team. e) Review each Individual s Service Plan with direct care staff at least quarterly. f) Manage staffing decisions including hires and training, performing staff screening, staff scheduling, conducting initial staff on-site training, and scheduling on-call coverage for all Contractor staff. g) Oversee the implementation of all training required by this Contract. h) Respond to Individual needs and issues while on site. 11

12 i) Conduct record reviews and quality assurance checks of staff documentation. j) Ensure that Contractor s staff has all supplies necessary for daily life as well as emergency events. k) Liaison with DHS Contract Administrator and DHS Designee. l) Develop and implement policies and procedures necessary to implement Services in this Contract. Resident Care Coordinator: Contractor shall provide 2.0 FTE for Resident Care Coordinators. Persons in this position must meet the requirements of a Behavior Supports Consultant per OAR are responsible for coordinating and overseeing all direct care training and implementation of Behavior Support Services for Individuals. Responsibilities of these positions include: i. Ensure that a Person Centered Evaluation, which is started at screening, is completed within 14 business days of admission. ii. Ensure the Behavior Support Plan, completed within 14 days of admission, identifies: o The behaviors of concern o Identify individual specific intervention and strategies that direct care staff can implement o Any changes to the Individual s Activity Plan will supplement and support the Behavior Support Plan o A crisis stabilization and emergency plan is developed to prevent or minimize injuries, property damage, placement failure and emergency hospitalizations. o Individual specific intervention and strategies which direct care staff can implement. iii. Assist in the screening of admission to the facility. iv. Review direct care staff input on the Behavior Support Plan. v. Provide individual specific coaching and group teaching for direct care staff to ensure that they can implement the strategies defined in each person s Behavior Support Plan. vi. Ensure direct care staff and Service Planning Team receives updates on all changes to the Individual s Behavior Support Plan. vii. Assist in coordination with mental health and addictions services if an Individual receives these services. 12

13 viii. Complete all documentation as required in OAR Activity Services: Contractor must provide 4 FTE staff to oversee and implement activity services. At least one (1.0) FTE must be designated as an Activity Director and meet the requirements of a Behavior Supports Consultant per OAR The Activity Director will develop, oversee and ensure services and tasks required under OAR , OAR and as described in this contract are provided. Activity services staff must be onsite day and evening shifts, 7 days per week to ensure implementation of Individual Activity Plans. Services must include: a) A documented Individual specific activity evaluation completed within 14 business days of admission, prior to the Individual s quarterly service plan meeting or whenever the Individual continually refuses to participate in activities offered. At a minimum, the activity evaluation must address the following: i. Past and current interests; ii. Current abilities and skills; iii. Emotional and social needs and patterns iv. Physical abilities and limitations; v. Adaptations necessary for the Individual to participate; and vi. Identification of activities needed to supplement the Individual s Behavior Support Plan. b) Development of an Activity Plan within 14 days of admission based on the activity evaluation for each Individual. The Activity Plan must include structured and non-structured activities which meet the preferences of each Individual and which are available on day and evening shifts, seven days per week. Activities may include but are not limited to: i. Occupation or chore related tasks; ii. Scheduled and planned events (e.g. entertainment, outings); iii. Spontaneous activities for enjoyment or those that may help diffuse a behavior; 13

14 iv. One-to-one activities that encourage positive relationships between Individuals and staff (e.g. life story, reminiscing, music); v. Spiritual, creative, and intellectual activities; vi. Sensory stimulation activities; vii. viii. Physical activities that enhance or maintain an Individual individual s ability to ambulate or move; and Outdoor activities. c) Activity Plans must be reviewed and updated on a quarterly basis by the Activity Director, or more frequently if the Individual experiences a change of condition. d) Direct care staff must receive training as needed so that each Individual can do activities 24/7 continuously. Social Services: Contractor shall provide a 1.0 FTE for provision of social services. This person must provide the following services: i. Family support services, in-house peer support groups. ii. Referrals to community groups and services. iii. Assistance with legal and financial issues including but not limited to court issues, representative payee services, assistance with paying bills, managing money and if needed providing application for guardianship. iv. Advocacy to assist Individuals in need of obtaining legal identification, immigration status resolution, hearings, starting or retaining benefits and access to needed community services including vocational or education opportunities, volunteer groups, support groups and transportation. Nursing Services: The Contractor shall have a minimum of 2.0 FTE licensed nurses with an unencumbered Oregon nursing license. A Registered Nurse must be onsite 7 days a week and provide on-call services but is not required to be onsite 24/7 at the service location. Contractor shall assure an adequate number of nursing hours are provided relevant to the census and acuity of the target population. In addition to nursing requirements of OAR (4) Contractor shall provide: 14

15 a) Continuous access to an On Call Registered Nurse. b) RN available to screen prospective admissions to determine if the Individual s needs can be met by Contractor s staff and comply with the Services described in this Contract. c) Nursing Service Plan developed within 14 business days of admission for each Individual addressing any health conditions, addiction issues, nutritional needs, preventative health care, delegated or non-delegated nursing tasks, durable medical equipment, medical treatments, rehabilitation plans, as-needed medications and ADL interventions which will require caregiver teaching. i. The Nursing Service Plan must be in alignment with the Service Plan and reviewed quarterly by the RN or more frequently if the Individual experiences a change of condition. ii. The Nursing Service Plan must identify all coordination necessary with the Individual s health and rehabilitation providers. iii. The RN is responsible for providing or ensuring that all Contractor s staff have the training they need to support each Individual s Nursing Service Plan. d) RN available to participate on each person s quarterly Service Planning Team. e) Delegation, teaching and documentation of tasks of nursing care as regulated by OAR Chapter 851, Division 047 and defined in the Nursing Service Plan. f) Review of the Contractor s medication system and ensure OAR is followed regarding the teaching of medication administration. g) Provision of intermittent direct nursing services within the scope of their license(s) to Individuals who require nursing services and where the task cannot be delegated to direct care staff. VIII. GENERAL HEALTH SERVICE: Contractor will ensure that the Contractor s Administrator or RN has the responsibility to ensure that: a) Policy and protocols exist and are followed to ensure that an Individual s change of condition, and any related interventions, are communicated to direct care staff on each shift. 15

16 b) Individuals are assisted in accessing the health care services they need or to which they are entitled from outside providers. c) All medical and rehabilitation plans are in alignment with the Individual s Service Plan. i. Contractor s staff must be trained to implement Rehabilitation Plans developed by licensed specialists (Occupational Therapist, Physical Therapist, Speech Therapist, etc.) ii. Direct care staff acting as community attendants will be provided for escort, support and, as needed, communication during offsite medical and rehabilitation appointments. d) Transportation and Community Attendants for local non-emergent transports are arranged or provided for by the Contractor s Assisted Living facility as needed to local community activity and health related appointments. Services are provided to meet health care needs, activity needs or to support interventions identified in the Service, Nursing, Activity or Behavior Support Plan, ensure the Individual s safety, and verify information needed for the Individual s Service or Nursing Plan is exchanged. IX. STAFF TRAINING. Contractor s employees who are working in the Contractor s Assisted Living Facility must, in addition to standard licensing requirements defined in OAR for new employee and inservice training, receive the following documented training: a) New Staff Orientation. Contractor shall ensure that each new staff shall be scheduled for a minimum of: i. 2 hours formal orientation on topics such as addiction, HIV, universal precautions or blood borne precautions; and ii. 3 training days on the floor with an experienced care giver; and iii. iv. 1 hour with the Administrator or designee to review policy and procedures Crisis Prevention Institute (CPI) or state approved equivalent training and certification within 90 days of hire. b) New Resident Orientation. Contractor shall ensure all staff receive an Individualspecific orientation prior to each Individual s admission, to ensure Contractor s staff can meet the Individual s Service needs upon Assisted Living placement. c) Employee In-service Training: Contractor shall ensure that the total employee inservice hours, including licensing requirements, meet a minimum of 28 hours per year per employee, including annual updates to CPI (or state approved equivalent). 16

17 i. All Contractor s direct care staff must receive person centered training necessary to provide ADL care, medication administration, delegated nursing tasks, implement behavior support plans, assist with activities and act as community attendants. o A majority of topics and hours must be focused on issues that pertain to the target populations and that are not administrative or related to licensure. Topics may include but are not limited to: HIV/AIDS care, psychotropic medication, diabetes, behavioral accommodations, person centered planning, communication, addiction disorders ii. iii. iv. In addition to the requirements of licensure, the Administrators, Resident Care Coordinators, Social Services Director and Activities Director must have a minimum of 8 hours per year training in person centered care or positive behavior support. Activities Director must have an additional 8 hours training per year on Activities, Addictions issues, Occupational or Rehabilitation Therapy, in addition to all other requirements listed in this contract. Training plans and verification of completed staff training with dates, hours, topics and presenters noted shall be submitted Contract Administrator annually, but may be requested more frequently. X. PHYSICAL ENVIRONMENT. Contractor shall ensure that: a) The Service location meets OAR environmental standards for Assisted Living. b) All individuals must have a private room unless the person voluntarily requests a roommate and is supported by the Service Planning Team. c) Provide all equipment necessary for safe evacuation. d) Access is provided to the following: a quiet community area, smoking area, community area with television and space for exercise. e) Access/exit doors to the community must have audible monitors but Individuals must be able to access the community without restrictions. i. If restriction on community access is needed for the Individual s health and safety then the Service, Activity and Behavior Plan must be modified to include opportunities for the person to be accompanied to the community on a regular basis. 17

18 XI. COORDINATION WITH OTHER AGENCIES: Services must be in compliance with pertinent regulations of other agencies which include but are not limited to OAR and OAR XII. ADMINISTRATIVE REQUIREMENTS: i. Contractor must make written notification to DHS at least 90 days prior to a voluntary termination of its Contract to assure a smooth, safe transition of the Individuals to another care setting. ii. Contractor agrees to participate in Contract Administrator or DHS Designee review of the facility prior to the extension of the contract term. iii. In addition to Exhibit B. 13. Records Maintenance, Access, Contractor shall ensure that all records are available for DHS review upon request. XIII. 90 DAY REVIEW: Contractor must agree to participate in an initial program review 90 days after either contract execution, a specific rate adjustment or a contract amendment, which may result in modifications to the rates, staffing and Services described in agreement. 18