By Signing below, I agree that I have received training regarding documentation, and procedures from the orientation or annual education. I understand the information provided and have the opportunity to ask questions. I agree to abide by all Premier's Services, Policies and Procedures.

The Personal Care Assistant performs personal care services for recipients living in the community. Clients must be in stable medical condition and not have acute care needs. The Personal Care Assistant works within the guidelines of a care plan established by the recipient/responsible party, the PHN and the Qualified Professional.

1. Bowel and bladder care.


2. Skin care, including prophylactic routine and palliative measures documented in the Plan of Care.


3. Range of motion exercises.


4. Respiratory assistance.


5. Assist with transferring, turning and positioning of client.


6. Assist with medications (normally self-administered)


7. Application and maintenance of prosthetics and orthotics


8. Cleaning of equipment.


9. Assistance with food, nutrition and diet activities


10. Accompany client to obtain medical diagnoses or treatment.


11. Provide services necessary to maintain client's personal health and safety


12. Assist client to complete daily living skills such as personal/oral hygiene


13. Assist with incidental household services.

Personal Care Assistant May Not:

1. Provide services except as employee of an enrolled provider agency


2. Provide services not outlined in the plan of personal care services.


3. Provide services that are not supervised by the recipient/responsible party.


4. Provide person care services to clients for whom they are legal guardians.


5. Perform sterile procedures.


6. Give injections of fluids into veins, muscles or skin.

See ADA requirements

By singing below, I agree that I have read and understood the above job description of the Personal Care Assistant.

Federal and State laws prohibit discrimination in employment because of sex, race, creed, religion, national origin, age, handicap, marital status, status with regard to public assistance or veteran's employment. We are an equal opportunity employer.

List below your complete employment history for the last five years, starting with the most recent position first.

PREMIER HOME HEALTHCARE LLC is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment
without regard to sex, race, color, national origin or ancestry, age, handicap, marital status, source of income, class, physical characteristics, sexual orientation or political beliefs. As an employer, we comply with government regulations and affirmative action responsibilities. Solely to help us comply with government record keeping, reporting and other legal requirements, please complete this Voluntary Self-Identification Information form. This data is for analysis and affirmative action only and submission of this information is voluntary. This data will be kept in a confidential file separate from your Application for Employment.

*According to the American with Disabilities Act, the term "disability" means, with respect to an individual, a physical or mental impairment that substantially limits one or more of the major life activities of that individual, a record of such an impairment, or being regarded as having such an impairment.

In the event that a client of our Company is admitted to a hospital, care facility or incarcerated for any period of time, the Company must be notified upon admittance. It is the responsibility of both the client and the PCA to notify the Company immediately if a client is taken to the hospital, care facility, or incarcerated at any time.

Under no circumstance can staff provide PCA services for a recipient while admitted into any such facility. The Company may not bill or submit hours for medical assistance payment while the client is admitted. The Company may also request that discharge paperwork be sent to the office to be kept in clients' confidential file.

Fax or Mail discharge paperwork to:

Company Address to:

505 E Grant ST Ste 203
Minneapolis, MN 55404
T 612-208-1839
F 612-208-1834

Medicaid fraud is committed when an employer or employee is untruthful regarding services rendered to Medicaid Participant Directed Attendant Care Program recipients in order to obtain improper payment. The Medicaid Fraud and Residential Abuse Unit of the Minnesota Attorney General's Office investigate and prosecute people who commit fraud against the Medicaid program. Medicaid fraud is a felony and conviction can lead to substantial penalties (including but not limited to: imprisonment up to ten years, or a fine up to $1,000 or an amount equal to twice the amount of the assistance or benefits wrongfully obtained, or both).

Additionally, individuals convicted of Medicaid Fraud will be excluded for a minimum of five years from any employment with a program or facility receiving Medicaid funding.

Medicaid Fraud may result from not following these rules:

• Recipients/responsible parties must sign PCA time sheets
• Do not sign blank time cards
• Only sign timecards for time that PCAs have worked
• PCAs/Support workers cannot be paid when they are traveling to and from your house or if they are "on call" by phone or pager
• PCAs cannot not get paid for time they are not with you

Suspected cases of fraud will be referred to local police authorities and the Attorney General's Medicaid Fraud Control Unit for further investigation and possible prosecution. I certify that I have read and understand what constitutes Medicaid Fraud and agree to not commit fraud as described above on time cards.

By signing below, I agree to the policy and procedure. I agree to comply and failure to do so may result in termination of client contract (services) and/or termination of employment with the company.

IT’S IMPORTANT TO KNOW:

While the Company believes wholeheartedly in the policies and procedures described here, they are not conditions of employment. The Company reserves the right to apply or not apply, and to modify, revoke, suspend, terminate or change any and all plans, policies, or procedures described, in whole or in part, at any time without notice.

The language used in this handbook is not intended to create, nor is it to be construed to constitute a contract between the Company and any one of its employees. I further understand that employment may be terminated by the Company at any time without prior notice. I also understand that the policies and procedures in this handbook may be
changed at any time at the sole discretion of the Company with or without prior notice.

All parties are responsible for complying with all rules and regulations related to the Personal Care Assistance (PCA/WAIVER) program. This includes, but is not limited to: State Vulnerable Adults Act, Data Privacy, PCA/WAIVER regulations, including medication administration, and Department of Labor laws governing overtime, etc.

It is a federal crime to provide false information on timecards and/or electronic time documentation for PCA/WAIVER billings for medical assistance. Your signature (or telephone input when using the Dial number Documents) verifies the time and services are accurate and that the services were performed as specified in the PCA/WAIVER Care Plan/CSSP.

I have read, understand and agree to abide by all the Company policies and procedures and the terms set forth therein.

Every effort should be made by an employee and supervisor to resolve any and all work conflicts. Under normal conditions, if the employee has a job-related problem, question or complaint, it should be discussed with the supervisor. The simplest, quickest and most satisfactory solution often will be reached at this level. To this end, a continual stream of communication between employees and supervisors is encouraged.

When the issue personally involves the supervisor with whom the employee would ordinarily discuss the problem, the employee may bypass that individual and proceed to the next level of supervision. At any time, the advice and guidance of the Program Director may be
consulted. The interests of the employee will not be prejudiced in any manner.

All personnel should use sound judgment in resolving work related conflicts. If a problem arises which cannot be resolved through
conversations between the employee and the supervisor, the grievance procedure should be implemented.

The Company is committed to the fair and equitable treatment of all employees and welcomes any suggestions or concerns regarding improvements in employee relations.

AGENCY POLICY:

By accepting employment with Premier Home Healthcare LLC, you have obligated yourself to carefully refrain from discussing any client’s condition or personal affairs with anyone outside the agency, unless expressly authorized to do so. Do not pass on medical information to clients and visitors unless you have been instructed to do so by your supervisor. In addition, all information seen or heard regarding clients, directly or indirectly, is completely confidential and not to be discussed even with your family.

Your job as a Premier Home Healthcare LLC employee requires that you govern yourself by high ethical standards. Failure to recognize the importance of confidentially is not only a breach of this agency's policies but can also involve an employee in legal proceedings. Information about clients or the agency is not to be given to media. This is essential for protection of both the client and the agency. Very strict laws regarding the release of information concerning clients bind agencies.

I have read and agree to abide by the above policy on confidentiality. I realize that violating this policy may result in termination of my employment.

It is my decision to utilize my or the client's vehicle (at the client's discretion) to transport Company clients. I understand that there are certain risks that are associated with my decision. I assume responsibility for the risks that are attached to this decision.

I hereby acknowledge and agree that the Company shall not be liable for any injury, loss or damage, to myself and/ or my personal property, arising out of or as a result of in any way, from my decision. Furthermore, I acknowledge that it is my responsibility to maintain the appropriate insurance coverage.

I release and endlessly discharge the Company from any liability that may attach to the company as a result of my decision. This is a full and final release of any and all actions, causes of actions, claims and demands for damages, loss and injury, however arising, which may be sustained as a result of my decision in the present and future.

•All time sheets must be turned in to our office by 12 p.m. no later than the THURSDAY after the pay period end date. (If timesheets are not turned in by the deadline, checks will not be issued until the next pay period) NO EXCEPTIONS.
•No reminder calls will be made. It is your responsibility to make sure timesheets are in the office by the date due. Late timesheets will be processed for the next pay period. (Pay period schedule with time sheet due dates, available upon request)
•Timesheets can be dropped off to our office, mailed to our office, fax to 612-208-1834 or emailed to premierhomehealthcares@gmail.com
•We do not guarantee mail services. Direct Deposit is available to all employees
•No White Out
•Blue/Black Ink Only

Always make sure you have the following thing filled out correctly and complete on your timesheets:

• Dates/ Location of Recipient stay in hospital/Care Facility/Incarceration box:

If client stay in hospital/care facility /incarcerated dates
must be filled out (admit date to discharge date)
Leave blank if does not apply

• The 'Recipient Name' box is filled in completely
• The 'Individual PCA Provider Name' box is filled in completely
• The Dates are filled in mm/dd/yyyy in chronological order
• The Activities performed each day are documented with your Initials (checkmarks or X's not accepted)
• Any Activities boxes left blank (not performed) must have a line through it
• Any Columns left blank must also have a line all the way down the page
• Ratio Staff to Participant Box: Always circle 1:1 (one staff to one recipient)
• Time In & Time Out must be filled in and AM/PM must be circled
• Any Visit One or Visit Two boxes left blank must have an 'X' to indicate you did not work that day/ shift
• Visit Two Row is for employees that work twice in the same day. (If you did not work 2x on any given day place an X in the box to indicate that)
• Daily Total Box must be filled in with the total# of hours worked each day
• Time Sheet Total Box must be filled in with the total# of hours worked that week
• Signature Boxes: Recipient Name and MA# or DOB must be filled in completely
•PCA Name and PCA Provider Number must be filled in completely
•The Signatures must be original and dated (mm/dd/yyyy) by both the PCA and the Recipient or Responsible Party
•Use of white out is not allowed
•Time Sheets must be legible and neat

Blank timesheets can be mailed or e-mailed to you upon request.
If you have any questions/concerns please Contact our office @ 612-208-1839 or e-mail us at premierhomehealthcares@gmail.com