Respite Care DEFINITION

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1 DEFINITION Respite Care programs provide temporary relief to caregivers with responsibility for the care and supervision of adults or children who: have physical, emotional, developmental, cognitive, behavioural, or mental health disabilities; are at risk of abuse or neglect; or are in foster care. Respite Care is provided in a supportive, enriching, and therapeutic environment, in the caregiver's home, in the service provider's home, in a program facility, or in the community. Services can be provided on a planned or as needed basis, including in response to a crisis. Families experiencing medical emergencies and stressful home situations such as domestic violence or homelessness may request crisis nursery respite care. Generally, care is provided for a few hours or days at a time. Crisis nursery and short term residential respite services can extend to a few weeks or a month at a time. When services are provided in response to a crisis, the timeframes may be less predictable and dependent upon resolution of the crisis. Respite care providers can include employees, independent contractors, volunteers and foster parents. Note: In the field of Adult Services, the term "respite services" often refers to an array of respite services that includes respite care in the person's home or in a facility (CA-RC), in-home homemaker and home health aid services (CA-HCS), medical or social day programs (CA-ADS), foster care (CA-FC), and residential respite services (CA-RC). Note: Please see CA-RC Reference List for a list of resources that informed the development of these standards. Note: When an organization is completing the Family Foster Care and Kinship Care Services Standards (CA-FKC) their respite program is covered under CA-FKC 18: Respite Care unless they provide respite services for children and families outside of the family foster care/kinship care program. In this instance, the organization will also need to complete RC to capture all aspects of assessment, service planning, and coordination for these Table of Evidence Self-Study Evidence - Provide an overview of the different programs being accredited under this section. The overview should describe: a. the program's service philosophy and approach to delivering services; Page 1

2 b. eligibility criteria; c. any unique or special services provided to specific populations; and d. major funding streams. - If elements of the service (e.g., assessments) are provided by contract with outside programs or through participation in a formal, coordinated service delivery system, provide a list that identifies the providers and the service components for which they are responsible. Do not include services provided by referral. - Provide any other information you would like the peer review team to know about these programs. - A demographic profile of persons and families served by the programs being reviewed under this service section with percentages representing the following: a. racial and ethnic characteristics; b. gender/gender identity; c. age; d. major religious groups; and e. major language groups - As applicable, a list of groups or classes including, for each group or class: a. the type of activity/group; b. whether the activity/group is short-term or ongoing; c. how often the activity/group is offered; d. the average number of participants per session of the activity/group, in the last month; and e. the total number of participants in the activity/group, in the last month - A list of any programs that were opened, merged with other programs or services, or closed - A list or description of program outcomes and outputs being measured On-Site Evidence No On-Site Evidence On-Site Activities No On-Site Activities Page 2

3 CA-RC 1: Access to Services Respite care is available to meet the needs of caregivers. Rating Indicators 1) All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards. 2) Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g., - Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or - Procedures need strengthening; or - With few exceptions procedures are understood by staff and are being used; or - For the most part, established timeframes are met; or - Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations (CA-HR 6.02) and training (CA-TS 2.03); or - Active client participation occurs to a considerable extent. 3) Practice requires significant improvement, as noted in the ratings for the Practice standards. Service quality or program functioning may be compromised; e.g., - Procedures and/or case record documentation need significant strengthening; or - Procedures are not well-understood or used appropriately; or - Timeframes are often missed; or - A number of client records are missing important information  or - Client participation is inconsistent; or - One of the Fundamental Practice Standards received a rating of 3 or 4. 4) Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g., - No written procedures, or procedures are clearly inadequate or not being used; or - Documentation is routinely incomplete and/or missing; or  - Two or more Fundamental Practice Standards received a rating of 3 or 4. Page 3

4 Table of Evidence Self-Study Evidence No Self-Study Evidence On-Site Evidence - Outreach strategies and informational materials On-Site Activities - Interview: a. Program director b. Relevant personnel CA-RC 1.01 Respite providers assess the need for respite care in the community and collaborate with other organizations to promote available, affordable respite care. Research Note: Research on respite care for children shows that most families access respite care through referral from a social service or medical provider. CA-RC 1.02 Outreach strategies connect caregivers with respite care before they become overwhelmed with care-giving responsibilities. Research Note: Literature suggests that a lack of trust in the organization or the provider and limitations on the location of respite care can be barriers for some Research Note: Studies on respite care for adults repeatedly show that respite care is underutilized. One study found that 5% of caregivers surveyed used respite care. Another study found that caregivers of adults often wait until caregiving becomes overwhelming before accessing services, and researchers caution that this may limit the ability to keep the adult in the home. Page 4

5 CA-RC 2: Screening and Intake The organization's screening and intake practices ensure that individuals receive prompt and responsive access to appropriate services. Rating Indicators 1) All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards. 2) Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g., - Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or - Procedures need strengthening; or - With few exceptions procedures are understood by staff and are being used; or - Referrals procedures need strengthening; or - For the most part, established timeframes are met; - Active client participation occurs to a considerable extent. - In a few rare instances urgent needs were not prioritized. 3) Practice requires significant improvement, as noted in the ratings for the Practice standards. Service quality or program functioning may be compromised; e.g., - Procedures and/or case record documentation need significant strengthening; or - Procedures are not well-understood or used appropriately; or - Urgent needs are often not prioritized, or - Services are frequently not initiated in a timely manner; or - Applicants are not receiving referrals, as appropriate; or - A number of client records are missing important information  or - Client participation is inconsistent; or - Screening and intake done by referral source and no documentation and/or summary of required information present in case record; or - One of the Fundamental Practice Standards received a rating of 3 or 4. 4) Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g., - There are no written procedures, or procedures are clearly inadequate or not being used; or Page 5

6 - Documentation is routinely incomplete and/or missing; or  - Two or more Fundamental Practice Standards received a rating of 3 or 4. Table of Evidence Self-Study Evidence - Screening procedures On-Site Evidence No On-Site Evidence On-Site Activities - Interview: a. Program director b. Relevant personnel c. Respite providers d. Caregivers - Review case records (FP) CA-RC 2.01 Caregivers and providers discuss: a. how the caregiver's request and the dependent person's needs match the organization's services; b. what services will be available and when; and c. concerns about using respite care. NA Another organization is responsible for screening, as defined in a contract. (FP) CA-RC 2.02 Prompt, responsive intake practices: a. ensure that applicants are treated equitably; b. give priority to individuals with urgent needs and emergency situations; c. support the timely initiation of services; and d. provide for initial screening or placement on a waiting list, if applicable. Page 6

7 Interpretation: Crisis respite programs have protocols in place for prioritizing referrals. CA-RC 2.03 Caregivers who cannot be served, or cannot be served promptly, are referred or connected to appropriate resources. Interpretation: When a crisis respite program is at full capacity and cannot provide services to a family, the organization assists the family in developing a plan to provide safe care for the child or adult and refers the family to another appropriate emergency service provider. NA The organization accepts all clients. CA-RC 2.04 During intake, the organization gathers information to identify critical service needs and/or determine when a more intensive service is necessary, including: a. personal and identifying information; b. emergency health needs; and c. safety concerns, including imminent danger or risk of future harm. Page 7

8 CA-RC 3: Assessment Caregivers participate in an individualized, strengths-based, culturally responsive assessment. Interpretation: The Assessment Matrix - Private, Public, Canadian, Network determines which level of assessment is required for COA's Service Sections. The assessment elements of the Matrix can be tailored according to the needs of specific individuals or service design. Rating Indicators 1) All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards. 2) Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g., Â - Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or - Procedures need strengthening; or - With few exceptions procedures are understood by staff and are being used; or - For the most part, established timeframes are met; or - Culturally responsive assessments are the norm and any issues with individual staff members are being addressed through performance evaluations (CA-HR 6.02) and training (CA-TS 2.05); or - Active client participation occurs to a considerable extent; or - Diagnostic tests are consistently and appropriately used, but interviews with staff indicate a need for more training (CA-TS 2.08). 3) Practice requires significant improvement, as noted in the ratings for the Practice standards. Â Service quality or program functioning may be compromised; e.g., - Procedures and/or case record documentation need significant strengthening; or - Procedures are not well-understood or used appropriately; or - Assessment and reassessment timeframes are often missed; or - Assessment are sometimes not sufficiently individualized; - Culturally responsive assessments are not the norm and this is not being addressed in supervision or training; or - Staff are not competent to administer diagnostic tests, or tests are not being used when clinically indicated; or - Client participation is inconsistent; or Page 8

9 - Assessments are done by referral source and no documentation and/or summary of required information present in case record; or - One of the Fundamental Practice Standards received a rating of 3 or 4. 4) Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g., - There are no written procedures, or procedures are clearly inadequate or not being used; or - Documentation is routinely incomplete and/or missing; or  - Two or more Fundamental Practice Standards received a rating of 3 or 4. Table of Evidence Self-Study Evidence - Assessment procedures - Assessment tool and/or criteria included in assessment On-Site Evidence No On-Site Evidence On-Site Activities - Interview: a. Program director b. Relevant personnel c. Caregivers - Review case records CA-RC 3.01 The information gathered for assessments is directed at concerns identified in initial screenings and limited to material pertinent for meeting service requests and objectives. CA-RC 3.02 Assessments are conducted in a culturally responsive manner to identify resources that can increase service participation and support the Page 9

10 achievement of agreed upon goals. Interpretation: Culturally responsive assessments can include attention to geographic location, language of choice, and the person's religious, racial, ethnic, and cultural background. Other important factors that contribute to a responsive assessment include attention to age, sexual orientation, and developmental level. CA-RC 3.03 Assessments are completed within timeframes established by the organization, and updated periodically. Page 10

11 CA-RC 4: Service Planning and Monitoring Each caregiver participates in the development and ongoing review of a service plan that is the basis for delivery of appropriate services and support. Rating Indicators 1) All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards. 2) Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g., Â - Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or - Procedures need strengthening; or - With few exceptions procedures are understood by staff and are being used; or - For the most part, established timeframes are met; or - Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations (CA-HR 6.02) and training (CA-TS 2.03); or - In a few instances client or staff signatures are missing and/or not dated; or - Active client participation occurs to a considerable extent. 3) Practice requires significant improvement, as noted in the ratings for the Practice standards. Service quality or program functioning may be compromised; e.g., - Procedures and/or case record documentation need significant strengthening; or - Procedures are not well-understood or used appropriately; or - Timeframes are often missed; or - In a number of instances client or staff signatures are missing and/or not dated (CA-RPM 7.04); or - Quarterly reviews are not being done consistently; or - Level of care for some clients is inappropriate; or - Service planning is often done without full client participation; or - Appropriate family involvement is not documented; or - Documentation is routinely incomplete and/or missing; or - Assessments are done by referral source and no documentation and/or summary of required information present in case record; or Page 11

12 - One of the Fundamental Practice Standards received a rating of 3 or 4. 4) Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g., - No written procedures, or procedures are clearly inadequate or not being used; or - Documentation is routinely incomplete and/or missing; or  - Two or more Fundamental Practice Standards received a rating of 3 or 4. Table of Evidence Self-Study Evidence - Service planning and monitoring procedures On-Site Evidence - Documentation of case review On-Site Activities - Interview: a. Program director b. Relevant personnel c. Caregivers - Review case records CA-RC 4.01 Caregivers are engaged in a strengths-based planning process for identifying needed services and desired results. CA-RC 4.02 During service planning the organization explains: a. available options; b. the benefits and alternatives of planned services; and c. how the organization can support the achievement of desired outcomes. Page 12

13 CA-RC 4.03 An expedited service-planning process is available when crisis or urgent need has been identified, and service plans are completed within time frames established by the organization. CA-RC 4.04 The service plan is developed with the caregiver prior to the provision of care, and includes: a. description of services to be provided; b. service goals, desired outcomes, and timeframes for achieving them; c. guidelines for requesting additional planned or emergency respite care; d. fees and payment arrangements, when applicable; and e. the caregiver's signature on the initial plan and significant revisions to the plan. Research Note: Research suggests that respite care for caregivers of adults is more effective when used regularly and frequently. CA-RC 4.05 The service plan addresses, as appropriate: a. the family's unmet service and support needs; b. possibilities for maintaining and strengthening family relationships; and c. the need for support of the individual's informal social network. CA-RC 4.06 The worker and a supervisor, or a clinical, service, or peer team, review the case to assess: a. service plan implementation; b. progress towards achieving goals and desired outcomes; and c. the continuing appropriateness of the agreed upon goals. Interpretation: Experienced workers may conduct reviews of their own cases. In such cases, the worker's supervisor reviews a sample of the worker's evaluations as per the requirements of the standard. Timeframes for the review should be adjusted depending upon issues and Page 13

14 needs of persons receiving services, and the frequency and intensity of services provided. Planned respite care should be reviewed at least quarterly, and crisis respite care should be reviewed in a timeframe consistent with the length and frequency of service. CA-RC 4.07 The worker and caregiver regularly review progress towards achievement of agreed upon service goals. Page 14

15 CA-RC 5: Service Philosophy The program is guided by a service philosophy that: a. provides a basis for how the program will meet the needs of service recipients; and b. guides the development and implementation of program activities and services based on the best available evidence of service effectiveness. Interpretation: A program model or logic model can be a useful tool to help staff think systematically about how the program can make a measurable difference by drawing a clear connection between the service population's needs, available resources, program activities and interventions, program outputs, and desired outcomes. Rating Indicators 1) All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards. 2) Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g., Â - Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or - Written service philosophy needs improvement or clarification; or - Procedures need strengthening; or - With few exceptions procedures are understood by staff and are being used; or - Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations (CA-HR 6.02) and training (CA-TS 2.03); or - In a few rare instances required consent was not obtained; or - Monitoring procedures need minor clarification; or - With few exceptions the policy on prohibited interventions is understood by staff, or the written policy needs minor clarification. 3) Practice requires significant improvement, as noted in the ratings for the Practice standards. Service quality or program functioning may be compromised; e.g., - The written service philosophy needs significant improvement; or - Procedures and/or case record documentation need significant strengthening; or - Procedures are not well-understood or used appropriately; or Page 15

16 - Documentation is inconsistent or in in some instances is missing and no corrective action has not been initiated; or - Required consent is often not obtained; or - A few personnel who are employing non-traditional or unconventional interventions have not completed training, as required; or - There are gaps in monitoring of interventions, as required; or - Policy on prohibited interventions does not include at least one of the required elements; or - Service philosophy is not clearly related to expressed mission or programs of the organization; or - One of the Fundamental Practice Standards received a rating of 3 or 4. 4) Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g., - There is no written service philosophy; or - There are no written policy or procedures, or procedures are clearly inadequate or not being used; or - Documentation is routinely incomplete and/or missing; or  - Two or more Fundamental Practice Standards received a rating of 3 or 4. Table of Evidence Self-Study Evidence - Include service philosophy in the Narrative On-Site Evidence No On-Site Evidence On-Site Activities - Interview: a. Program director b. Personnel Page 16

17 CA-RC 6: Support Services for Caregivers Caregivers receive coordinated services and support to help resolve issues related to caretaking. Rating Indicators 1) All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards. 2) Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g., - Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or - Procedures need strengthening; or - With few exceptions procedures are understood by staff and are being used; or - For the most part, established timeframes are met; or - Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations (CA-HR 6.02) and training (CA-TS 2.03); or - Active client participation occurs to a considerable extent. 3) Practice requires significant improvement, as noted in the ratings for the Practice standards. Service quality or program functioning may be compromised; e.g., - Procedures and/or case record documentation need significant strengthening; or - Procedures are not well-understood or used appropriately; or - Timeframes are often missed; or - A number of client records are missing important information  or - Client participation is inconsistent; or - One of the Fundamental Practice Standards received a rating of 3 or 4. 4) Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g., - No written procedures, or procedures are clearly inadequate or not being used; or - Documentation is routinely incomplete and/or missing; or  - Two or more Fundamental Practice Standards received a rating of 3 or 4. Page 17

18 Table of Evidence Self-Study Evidence - A description of services On-Site Evidence No On-Site Evidence On-Site Activities - Interview: a. Program director b. Relevant personnel c. Persons served - Review case records CA-RC 6.01 Providers work with service recipients and their caregivers to: a. coordinate services; and b. resolve obstacles to accessing or receiving services, including transportation or fees. CA-RC 6.02 Caregivers receive support to address issues related to caretaking and caregiver stress and are provided with referrals for needed services including: a. support groups and counselling services; b. health, mental health, and substance use services; c. domestic violence services; d. shelter and housing services; e. social, recreational and day programs; and f. mentor services. CA-RC 6.03 The organization maintains a comprehensive, up-to-date list of community resources. Page 18

19 CA-RC 7: Care and Supervision Care recipients receive individualized care and supervision that promote their safety and well-being. Rating Indicators 1) All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards. 2) Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g., - Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or - Procedures need strengthening; or - With few exceptions procedures are understood by staff and are being used; or - For the most part, established timeframes are met; or - Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations (CA-HR 6.02) and training (CA-TS 2.03); or - Active client participation occurs to a considerable extent. 3) Practice requires significant improvement, as noted in the ratings for the Practice standards. Service quality or program functioning may be compromised; e.g., - Procedures and/or case record documentation need significant strengthening; or - Procedures are not well-understood or used appropriately; or - Timeframes are often missed; or - A number of client records are missing important information  or - Client participation is inconsistent; or - One of the Fundamental Practice Standards received a rating of 3 or 4. 4) Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g., - No written procedures, or procedures are clearly inadequate or not being used; or - Documentation is routinely incomplete and/or missing; or  - Two or more Fundamental Practice Standards received a rating of 3 or 4. Page 19

20 Table of Evidence Self-Study Evidence - A description of services - Procedures and criteria for matching service recipients with providers - Health and safety procedures and protocols - Client/staff ratios On-Site Evidence - Safety/risk data, if available - Monthly client/staff ratios and coverage schedules for the past year, as applicable On-Site Activities - Interview: a. Program director b. Relevant personnel c. Respite providers d. Caregivers e. Care recipients - Review case records - Review coverage schedules at each unit or group (FP) CA-RC 7.01 Families are matched with providers that can meet their needs or receive information to enable them to select a suitable respite provider. Interpretation: Care recipients that require therapeutic or medical treatment should be matched with a provider that has appropriate skills and qualifications. (FP) CA-RC 7.02 Respite providers: a. are familiar with the care recipient's daily routine, preferred foods and activities, and needed therapeutic or medical care; and b. respect the culture, race, ethnicity, language, religion, and sexual orientation of the care recipient. Interpretation: When the care recipient is involved in regular therapeutic, Page 20

21 educational, or employment activities, the respite provider works with caregivers to plan for continued participation. CA-RC 7.03 Respite providers offer activities with enriched content appropriate to the interests, age, development, physical abilities, interpersonal characteristics, and special needs of the care recipient. (FP) CA-RC 7.04 Crisis respite care provides needed developmentally and age appropriate interventions to help the care recipient cope with trauma or stress associated with the crisis. NA The organization does not provide crisis respite care. (FP) CA-RC 7.05 Close supervision of care recipients ensures their safety and improves service quality, and provider-care recipient ratios do not exceed: a. one to four when children are under school age; b. one to eight during waking hours; and c. one to twelve during sleeping hours. Interpretation: Ratios must be adjusted to meet the special needs of individuals that require therapeutic or medical care, or close monitoring. Ratios include all other children or adults being cared for in the home or facility. Ratios demonstrate capacity for safe evacuation of care recipients in case of an emergency. (FP) CA-RC 7.06 When care recipients experience accidents, health problems, or changes in appearance or behaviour, information is promptly recorded and reported to caregivers and administration, and follow-up occurs, as needed. (FP) CA-RC 7.07 Page 21

22 The respite provider returns care recipients only to the caregiver, or another person approved by the caregiver, and follows guidelines for situations when a caregiver poses a safety risk or an individual requires protection. Interpretation: Protocols should provide direction on how to use appropriate organizational or community resources to respond to individuals who are intoxicated by drugs or alcohol, mentally or physically unstable, or who present a safety concern. Page 22

23 CA-RC 8: Service Environment Respite care is provided in an environment that ensures the individual's health and safety. Note: Please see Facility Observation Checklist - Private, Public, Canadian for additional assistance with this standard. Rating Indicators 1) All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards. 2) Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g., - Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or - Procedures need strengthening; or - With few exceptions procedures are understood by staff and are being used; or - For the most part, established timeframes are met; or - Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations (CA-HR 6.02) and training (CA-TS 2.03); or - Active client participation occurs to a considerable extent. 3) Practice requires significant improvement, as noted in the ratings for the Practice standards. Service quality or program functioning may be compromised; e.g., - Procedures and/or case record documentation need significant strengthening; or - Procedures are not well-understood or used appropriately; or - Timeframes are often missed; or - A number of client records are missing important information  or - Client participation is inconsistent; or - One of the Fundamental Practice Standards received a rating of 3 or 4. 4) Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g., - No written procedures, or procedures are clearly inadequate or not being used; or Page 23

24 - Documentation is routinely incomplete and/or missing; or  - Two or more Fundamental Practice Standards received a rating of 3 or 4. Table of Evidence Self-Study Evidence - Policies for prohibited interventions - Procedures regarding care recipients' rights to make telephone calls - Process for reviewing and approving respite homes On-Site Evidence - Documentation of licensing/approval - Sample of safety plans, if applicable On-Site Activities - Interview: a. Program director b. Relevant personnel c. Respite providers d. Caregivers e. Care recipients - Review case records - Observe facility CA-RC 8.01 The family receives respite care in a location appropriate to their needs and preferences. Interpretation: Respite care can be provided in the family's home, the provider's home, the community, or a facility. When the organization does not offer the type of respite care needed or preferred by the family, a referral is made to another provider. (FP) CA-RC 8.02 Prior to use, all facilities and provider homes are licensed or approved as required by law or regulation, and regularly inspected to evaluate: Page 24

25 a. fire, health, and safety hazards; b. cleanliness; c. adequacy and appropriateness of space and furnishings; and d. the safety and appropriateness of toys, materials, or equipment. CA-RC 8.03 When overnight care is provided, accommodations include: a. sleeping arrangements appropriate to the number, age, special needs, and gender of the individuals in the home or facility; b. rooms that are adequately and attractively furnished including a separate bed or crib for each individual with clean linens; and c. a safe, lockable place that locks to store personal belongings. NA The organization does not provide overnight respite care. CA-RC 8.04 When respite care is provided in a facility, space and amenities are adequate for the scope of the service provided, and include: a. indoor and outdoor recreation areas; b. dining, bathing, toileting, and personal hygiene facilities; c. private areas for meetings with individuals and caregivers; d. space for resting; and e. rooms for providing on-site services, when available. NA The organization does not provide respite care in a facility. (FP) CA-RC 8.05 When respite care is provided in the caregiver's home, the provider is familiar with the safety plan for the home. Interpretation: The provider should be familiar with the location of first aid, medical, emergency, and other supplies needed to provide care, and the ways to safely evacuate the individual receiving care. NA The organization does not provide respite care in the caregiver's home. Page 25

26 CA-RC 8.06 Care recipients can have private telephone conversations and any restrictions are: a. requested by the caregiver; b. approved in advance by the program director or an appropriate designee; and c. documented in the case record. NA The organization only provides care for infants and young children. CA-RC 8.07 Care recipients receiving overnight respite care have sufficient uninterrupted sleep and, when practical, follow their usual and familiar routines for bedtime, bathing, and meals. NA The organization does not provide overnight respite care. (FP) CA-RC 8.08 Organization policy prohibits: a. corporal punishment; b. the use of aversive stimuli; c. interventions that involve withholding nutrition or hydration, or that inflict physical or psychological pain; d. the use of demeaning, shaming or degrading language or activities; e. unnecessarily punitive restrictions including cancellation of visits as a disciplinary action; f. forced physical exercise to eliminate behaviours; g. punitive work assignments; h. punishment by peers; and i. group punishment or discipline for individual behaviour. Page 26

27 CA-RC 9: Short Term Residential Respite and Crisis Nursery Services Facilities and services are designed to meet the needs of care recipients that require a short term stay in a residential respite or crisis nursery program. NA The organization does not provide residential respite or crisis nursery services. Note: Please see Facility Observation Checklist - Private, Public, Canadian for additional assistance with this standard. Rating Indicators 1) All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards. 2) Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g., - Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or - Procedures need strengthening; or - With few exceptions procedures are understood by staff and are being used; or - For the most part, established timeframes are met; or - Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations (CA-HR 6.02) and training (CA-TS 2.03); or - Active client participation occurs to a considerable extent. 3) Practice requires significant improvement, as noted in the ratings for the Practice standards. Service quality or program functioning may be compromised; e.g., - Procedures and/or case record documentation need significant strengthening; or - Procedures are not well-understood or used appropriately; or - Timeframes are often missed; or - A number of client records are missing important information  or - Client participation is inconsistent; or - One of the Fundamental Practice Standards received a rating of 3 or 4. 4) Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; Page 27

28 e.g., - No written procedures, or procedures are clearly inadequate or not being used; or - Documentation is routinely incomplete and/or missing; or  - Two or more Fundamental Practice Standards received a rating of 3 or 4. Table of Evidence Self-Study Evidence - Rules and behavioral expectations On-Site Evidence - Schedule of social and recreational activities On-Site Activities - Interview: a. Program director b. Relevant personnel c. Residents - Review case records - Observe facility CA-RC 9.01 Program personnel provide care recipients with predictability and structure by establishing daily routines and rules developed with care recipients and their caregivers. CA-RC 9.02 Care recipients are offered an organized daily program of age and developmentally appropriate social, recreational, educational, and therapeutic activities. Interpretation: The organization and the caregiver plan for continuation of educational services for children and youth, and the organization coordinates educational services with relevant school districts. Page 28

29 CA-RC 9.03 Facilities include: a. sufficient supplies and equipment to meet the needs of care recipients; b. space and equipment for housekeeping, laundry, maintenance, and storage; c. rooms for providing on-site services, as applicable; d. at least one room suitably furnished for the use of on-duty personnel and space for administrative support functions; and e. private sleeping accommodations for personnel who sleep at the facility, if applicable. CA-RC 9.04 The facility accommodates informal gatherings of care recipients, including places to gather in inclement weather. Page 29

30 CA-RC 10: Case Closing Case closing is a planned, orderly process. Rating Indicators 1) All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards. 2) Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g., Â Â - Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or - Procedures need strengthening; or - With few exceptions procedures are understood by staff and are being used; or - Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations (CA-HR 6.02) and training (CA-TS 2.03); or - In a few instances the organization terminated services inappropriately; or - Active client participation occurs to a considerable extent; or - A formal case closing summary and assessment is not consistently provided to the public authority per the requirements of the standard. 3) Practice requires significant improvement, as noted in the ratings for the Practice standards. Service quality or program functioning may be compromised; e.g., - Procedures and/or case record documentation need significant strengthening; or - Procedures are not well-understood or used appropriately; or - Services are routinely terminated inappropriately; or - A formal case closing summary and assessment is seldom provided to the public authority per the requirements of the standard.; or - A number of client records are missing important information; or - Client participation is inconsistent; or - One of the Fundamental Practice Standards received a rating of 3 or 4. 4) Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g., - No written procedures, or procedures are clearly inadequate or not being Page 30

31 used; or - Documentation is routinely incomplete and/or missing; or  - Two or more Fundamental Practice Standards received a rating of 3 or 4. Table of Evidence Self-Study Evidence - Case closing procedures On-Site Evidence - Procedures that address continuation of services for persons whose third party benefits have ended On-Site Activities - Interview: a. Program director b. Relevant personnel c. Caregivers d. Care recipients - Review case records CA-RC The case closing process: a. is clearly defined and includes assignment of staff responsibility; and b. involves the worker, the caregiver, and others, as appropriate. CA-RC Upon case closing, the organization notifies any collaborating service providers, as appropriate. Interpretation: The organization must determine on a case-by-case basis its responsibility to continue providing services to caregivers whose third-party benefits have ended and who are in critical situations. Page 31

32 CA-RC When third-party benefits or payments end or termination of services is probable due to non-payment, the organization works with the caregiver to identify service options, and determines its responsibility to provide services until appropriate arrangements are made. NA The organization does not receive third-party benefits or payments for service. CA-RC When the organization decides to discontinue services against the caregiver's wishes the organization makes every effort to link the person to appropriate services. Page 32

33 CA-RC 11: Personnel Respite care providers are qualified for, and receive support in, providing temporary care to improve individual and family well-being, reduce caregiver stress, and promote family stability. Rating Indicators 1) All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards. 2) Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g., Â - With some exceptions, staff (direct service providers, supervisors, and program managers) possess the required qualifications, including: education, experience, training, skills, temperament, etc., but the integrity of the service is not compromised. - Supervisors provide additional support and oversight, as needed, to staff without the listed qualifications. - Most staff who do not meet educational requirements are seeking to obtain them. - With some exceptions staff have received required training, including applicable specialized training. - Training curricula are not fully developed or lack depth. - A few personnel have not yet received required training. - Training documentation is consistently maintained and kept up-to-date with some exceptions. - A substantial number of supervisors meet the requirements of the standard, and the organization provides training and/or consultation to improve competencies. - Supervisors provide structure and support in relation to service outcomes, organizational culture and staff retention. - With a few exceptions caseload sizes are consistently maintained as required by the standards. - Workloads are such that staff can effectively accomplish their assigned tasks and provide quality services, and are adjusted as necessary in accord with established workload procedures. - Procedures need strengthening. - With few exceptions procedures are understood by staff and are being used. - With a few exceptions specialized staff are retained as required and possess the required qualifications. Page 33

34 - Specialized services are obtained as required by the standards. 3) Practice requires significant improvement, as noted in the ratings for the Practice standards. Â Service quality or program functioning may be compromised; e.g., - One of the Fundamental Practice Standards received a rating of 3 or 4. - A significant number of staff, e.g., direct service providers, supervisors, and program managers, do not possess the required qualifications, including: education, experience, training, skills, temperament, etc.; and as a result the integrity of the service may be compromised. - Job descriptions typically do not reflect the requirements of the standards, and/or hiring practices do not document efforts to hire staff with required qualifications when vacancies occur. - Supervisors do not typically provide additional support and oversight to staff without the listed qualifications. - A significant number of staff have not received required training, including applicable specialized training. - Training documentation is poorly maintained. - A significant number of supervisors do not meet the requirements of the standard, and the organization makes little effort to provide training and/or consultation to improve competencies. - There are numerous instances where caseload sizes exceed the standards' requirements. - Workloads are are excessive and the integrity of the service may be compromised.â - Procedures need significant strengthening; or - Procedures are not well-understood or used appropriately; or - Specialized staff are typically not retained as required and/or many do not possess the required qualifications; or - Specialized services are infrequently obtained as required by the standards. 4) Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g., For example: - Two or more Fundamental Practice Standards received a rating of 3 or 4. Table of Evidence Page 34

35 Self-Study Evidence - Program staffing chart that includes lines of supervision - List of program personnel that includes: a. name; b. title; c. degree held and/or other credentials; d. FTE or volunteer; e. length of service at the organization f. time in current position - Table of contents of training curricula - Procedures for screening respite providers - Procedures and criteria used for assigning and evaluating workload On-Site Evidence - Job descriptions - Documentation of training - Training curricula On-Site Activities - Interview: a. Supervisors b. Personnel c. Respite providers - Review personnel and respite provider files CA-RC Respite care providers have the personal characteristics necessary to provide flexible, affectionate care. CA-RC Respite care providers are competent to: a. assess the need for additional services; b. respect and appreciate the cultural background, heritage, and identity of persons receiving services; c. communicate effectively; d. identify changes in functioning; and e. determine if a crisis situation is imminent and intervene using appropriate resources. Page 35

36 Interpretation: Competency can be demonstrated through education, training, or experience. CA-RC Respite care providers are skilled in the following areas, as appropriate to the services provided: a. methods of engagement; b. helping individuals cope with trauma; c. identification of medical needs or problems; d. the organization's plans for handling emergencies; e. case advocacy; f. use of adaptive equipment, such as braces and wheelchairs; g. providing personal care, including lifting techniques; and h. other areas necessary to serve the target population. Interpretation: Skills can be acquired or improved through education, training, or supervision. (FP) CA-RC Providers are screened and approved prior to having contact with families to ensure they are able to provide the type of care needed, and screenings include: a. a criminal record check for all adults living in the provider's home; and b. relevant caregiving experience. Interpretation: Record checks are conducted in compliance with applicable law. When a finding of child or adult abuse, neglect, or exploitation is indicated, guidelines are used to determine the appropriateness of provider responsibilities. Note: Element (a) is only applicable if respite care is delivered in the provider's home. (FP) CA-RC Personnel and respite care providers that provide personal care or basic health services receive a health evaluation prior to providing care to determine their ability to perform the essential functions of the job, with or without reasonable accommodation. Page 36

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