HOST HOME PROVIDER
MANUAL
Overture HHP Manual – Last Updated 3/7/2014
This HHP Manual has been issued to ______________________________________
On _____________________________
There are quizzes that you will need to take regarding this manual.
All quizzes are online except for the one on Incident Reports and one on the Manual itself.
To take the online quizzes, go to www.imaginecolorado.org
Go to the top right of the screen and find Services; trainings.
Next go to Web Classes, pay by Credit Card. Overture requires: Confidentiality, MANE, Rights,
HIPAA, and Overview of DD System.
If you have any questions regarding the quizzes, please contact Overture HR at
303-926-8840.
All quizzes must be completed prior to becoming an HHP for Overture. In addition, you must be
current with Medication Administration, CPR and 1st Aid.
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TABLE OF CONTENTS
HHP MANUAL
1. About Overture……………………………………………………………………………..6
Including:
A brief history of the DD System in Colorado Quiz - Online
The current DD System and Overture
Overture Vision, Mission, & Values
2. Your Role as a Host Home Provider……………………………………………….....11
3. Confidentiality and Confidentiality Quiz – Online…………………………………..12
4. HIPAA and HIPAA Quiz – Online............................................................................14
5. Rights and the Human Rights Committee Quiz – Online………………19
6. Mistreatment, Abuse, Neglect and Exploitation and M/A/N/E Quiz – Online…..21
7. Host Home Provider Orientation………………………………………………………23
Including:
Individualized Plan (IP)
Health Services Orientation
Universal Precautions
Emergency Procedures
Medication Overview
Schedules, Routines, Home Visits
8. Individualized Plan (IP) and Individual Service and Support Plans (ISSP)........28
9. Other Overture Training…………………………………………………………………29
10. Documentation and Due Dates……………………………………………………….30
Including:
Yearly: Contractual Documentation Requirements
Home Documentation Procedures
Monthly: Host Home Day
11. Incident Reports – Incident Report Quiz in this manual…………………………32
12. Host Home Provider Contract Responsibilities………………………………...…40
Including:
Documentation Requirements
Class Training Requirements
Back-Up Service Providers
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TABLE OF CONTENTS
POLICIES AND PROCEDURES
1.
M/A/N/E Investigations
2.
Incident Reports
3.
Physical Restraints
Emergency Control Procedures
Safety Control Procedures
4.
Transportation of Persons Served
5.
Grievance Procedures
6.
Dispute Resolution
7.
Life Threatening Injury or Illness
8.
Routine Health and Medical Care
9.
Dietary/Nutrition
10. Medication Administration
11. Psychotropic Medications
12. Confidentiality
13. Suspension of Rights
14. On-Call Notification
15. Performance Improvement Projects
16. Personal Needs Receipt Protocol
17. Host Home Provider Hiring Process
18. Disqualification of Potential Employees and Contractors
19. HHP Contract and Training Requirements
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Host Home Provider Manual
The purpose of this handbook is to establish Host Home Provider expectations and
responsibilities in their agreement to provide care and services for the people Overture serves.
Host Home Provider responsibilities and procedures are mandated by the state of Colorado
Developmental Disabilities Services Rules and Regulations. Additional requirements beyond
those required by the state may be requested as a part of your ongoing training as an Overture
Host Home Provider.
This manual is in no way comprehensive and requests may be made beyond those described
herein. Any questions may be directed to the appropriate Program Manager or the Executive
Director.
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A Brief History of the DD System in Colorado
The treatment of people with disabilities has progressed considerably in the past decades. With
increasing awareness of human rights and the accompanying unacceptable conditions of state
institutions, developmentally disabled persons are approaching a more acceptable quality of life
in our country.
Historically, the treatment of disabled persons varies by culture. Some were perhaps regarded
as saints or mystics, while others were labeled as demon-possessed. Children were regarded
as potential income for their parents through labor, and those who were unable to work might
have met with an unthinkable fate. The definition of mistreatment in the DD System has
changed over the years.
In the 1800s, Dr. Seguin understood that injured or malfunctioning brains caused “disabilities”,
and that there was a possibility of rehabilitation. Some of his techniques are still used today. At
the time, the popular consensus among doctors and scientists was that people with disabilities
were the products of bad genes. They deduced that these people were immoral, indecent, and
needed to be locked up and kept away from society. The role of the caregiver was basically the
equivalent of the prison guard.
In 1910, an institution opened in Wheat Ridge. At the time, the facility was about 23 miles from
Denver and the suburbs expanded to meet it. From then until about 1960, the treatment style
was standardized and inadequate. Non-ambulatory residents were confined to basements; a
rickets epidemic was blamed on the lack of exposure to the sun. At that time, the staff/resident
ratio was 1:40. It is difficult to imagine anyone working or living under such abysmal conditions.
Living and working situations soon improved. People with severe behaviors were given more
attention and additional buildings were constructed. Residents became more involved with daily
chores, making dinners and working in public environments. Ridge ran the largest laundry
facility in Denver and most of the residents worked there and contributed in some way.
Unfortunately, many children were admitted and many would most likely spend their entire adult
life there. Many of the people served by Overture were these children.
In the 1960s, Dr. Sunada joined Ridge to examine and test these people with developmental
disabilities. To his dismay, he discovered that several people were not legally “retarded” and
many were involved in the long process of community integration. The Kennedy administration
gave financial grants to state institutions such as Ridge to allow for more thorough training in
behavior modification. Classes were taught for six hours a day, more training than counselors
receive today. The most important outcome of this implementation was knowledge and proof
that basic skills could be taught to help people become independent. This evolved into the
Individualized Plan, which is one of the foundations of service organizations such as Overture.
At last, instead of managing difficult behaviors all day, the needs of the residents became a
priority. In 1974, a bill of rights was passed for people with developmental disabilities, workers
became advocates and the system gradually changed away from institutions and towards
community integration.
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The Current DD System in Colorado and Overture
Major funding comes from the Medicaid waiver (HCB-DD), which is administered by the state.
The state Joint Budget Committee sets these budgets. State reorganization in 1994 redesigned
the Division for Developmental Disabilities by assigning some services to other state agencies.
Renamed the Developmental Disabilities Services, the office is still the channel for funds
allocated for services which are directed to twenty Community Centered Boards covering the
state. That office monitors direct care services through survey teams through a process of
monitoring and quality assurance done at the local level.
Services provided through Medicaid include residential, day service, and support to persons
living in the family home. Approved service agencies (some private, for profit, and non-profit)
contract with the local county Community Centered Boards to provide any of the services. The
CCB for Boulder County is Imagine! located at 1400 Dixon in Lafayette, CO. In Jefferson
County, the CCB is DDRC and is located at 11177 W. 8th Ave. Suite 300 Lakewood, CO.
Residential programs, such as Overture, have been approved as service agencies through the
state office. This approval is renewed through surveys, which monitor all aspects of the
program. The clients they serve have come from institutions and intermediate care facilities as
they were downsized or from foster or family homes as openings were available.
Parents of adults with autism established Overture due to the need for expertise beyond that
needed to serve most persons with retardation or developmental disabilities. The facility was
intended for anyone throughout the state of Colorado diagnosed with Autism. However, when
Overture received approval to provide residential services within the state system, Overture was
initially required to serve clients from institutional settings. Some of the parents who founded
Overture waited for long periods for Overture placement for their sons or daughters. Some
waited up to six years for a facility until a group home in Boulder County opened.
Persons living in institutions were originally placed there due to the inability of the family to
provide care in the home due to the behaviors of the individual and the need for assistance and
supervision, or due to the choice of the family to have no responsibility for the individual. Life in
the institution complicated the problems to a greater degree and predominantly provided
custodial care. This resulted in behaviors, which were exhibited to get attention, express
frustration and rage, or the inability of the individual to maintain control due to extreme brain
damage. The first persons admitted to Overture represented many such challenging behaviors.
The philosophy from which Overture grew was from a method called “gentle teaching” and
which led to the non-aversive treatment of all residents. This was not the philosophy of most
providers of the time who still used mechanical, medical and physical restraints and a “time out”
room where individuals were isolated with no effort to define and/or assist with the problem
causing the behavior. The philosophy of gentle teaching was tightly adhered to and persons
who came to work for Overture and stayed as valued, conscientious providers were people who
supported a positive, respectful relationship with the clients. This continues to be true at the
present.
Using non-aversive, positive interactions has resulted in success with persons with very
challenging behaviors. Overture has become the local “expert” in non-aversive “gentle teaching.
Our providers’ interaction has a direct effect in changing individuals who formerly exhibited
dangerous, aggressive and insulting behaviors. Gentle, happy individuals who enjoy quality
relationships and the opportunity to function within the community demonstrate our results.
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VISION
Overture is the recognized leader in providing services to people with intellectual and
developmental disabilities, with its uniquely focused and individualized models.
MISSION
The mission of Overture is to support and respect the needs and desires of those with
intellectual and developmental disabilities.
The values guiding the mission are grounded in the belief that emotional and physical
health is central to living a life of experience, opportunity, participation, choice and growth.
We will distinguish ourselves from other organizations by:
 Being the premier provider of services to those with intellectual and developmental
disabilities in the state of Colorado.
 Obtaining and retaining the highest quality care providers.
 Employing and retaining only the most qualified individuals possessing a desire for
ongoing personal and professional growth.
 Adhering to high standards of developing and utilizing best practices in the field.
 Making strong leadership the foundation of our success.
 Consistently maintaining a financial position with ethical and prudent management to
ensure long-term sustainability.
VALUES
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We practice open, honest and direct communication, emphasize active listening by
hearing others before we speak and are congruent in our words and actions.
We treat others with the utmost respect through positive interaction with the people
we serve, care providers, and coworkers.
We take responsibility and serve with integrity as we remember the people we serve
always come first.
We promote teamwork and a positive work environment, where everyone feels
valued and has fun as we support the mission of our organization.
We encourage and promote innovation and positive change.
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OVERTURE PHILOSOPHY
The philosophy of Overture is based on three very important principles:
1) Non-Aversion
2) Integration
3) Proper Relationship
NON-AVERSION means no punishment. Punishment and abuse can take many forms. It is
important that providers are aware of this fact, and are able to distinguish between what are
aversive interactions and what are not. For instance, if someone has a behavioral problem
before a planned activity, and the provider decides to cancel the plans, the outcome of this
action can easily become punitive. If the provider sincerely communicates with the person in
services, explaining that they are uncomfortable with the planned activity because of what has
just happened, this is less aversive than “scolding” the person or telling them they have just
“blown it” because of the behavior. Non-aversion requires appropriate disposition and tone of
voice from the provider.
At Overture, people respect the complexities of individuals and their developmental disabilities.
Evidence suggests that most maladaptive behavior is primarily a communicative interaction.
Other individuals might not be able to control outbursts. Non-aversive approaches do not mean
that there are no consequences for maladaptive behavior (which has been a naive critique of
the philosophy in the past) but it does occasionally require some careful teamwork to arrive at
an appropriate, safe consequence. When Overture began in 1982, we were perhaps unique in
this approach. Today, most governing agencies and various Human Rights Committees
discourage “aversive” consequences.
One fairly straightforward and simple criterion for assuring appropriate non-aversive interactions
is called the “normalization scale.” In other words, are the actions or deeds we use with
individuals with developmental disabilities transferable to situations involving “unlabeled”
people? For instance, some people feel that offering a treat as a reward for a task is
acceptable. Imagine though, if you offered your roommate or partner a candy bar after they did
the dishes. It would seem like an inappropriate, patronizing thing to do in most situations.
It is important to constantly ask yourself, is this dignified way to treat people? If there is any
doubt, then it probably is not. Please talk to your Program Manager about any questions
regarding these issues, or bring it up at IP and IDT meetings; it is extremely important to us, as
well as the individuals in our care.
INTEGRATION is another aspect of our philosophy, and is basically very simple. It means that
we would like the people we serve to have the same access to the community that everyone
enjoys. Now that the ADA (American Disabilities Act) is in place, the people we serve cannot be
excluded from the community, but being entirely welcome is still quite a challenge. Our goals at
Overture are to provide the people we serve with the necessary skills to enable them to have
successful community outings. This is an ongoing process, and some of the people we serve
may never excel in all the social graces. It is our responsibility to teach them what is appropriate
for social situations. Furthermore, if we can reduce the amount of undesirable behaviors that
may exclude or stigmatize them, this is a step towards our goal. We want our providers to have
the foresight to plan outings that will be successful, and want them to have the knowledge about
potential problems. This way, the people we serve may enjoy themselves, and look forward to
more outings in the community.
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PROPER RELATIONSHIP refers to the way providers and Overture staff perceive and treat the
individuals who receive services from Overture. It all begins with a basic respect for the
individual, not an attitude of pity or an extreme polarity between “them” and “us”. We have
discovered that these approaches cause real problems, and most importantly, the people we
serve are very perceptive about being patronized. They have had a lifetime of experience
assessing provider’s motivations. We insist on an approach that is dignified; beyond diagnosis,
labels, and stereotypes.
Proper relationship also deals with what we call “age appropriateness”. In other words,
although some of our folks might have delayed development, it doesn’t mean they need to be
addressed like children. We have also seen the “parental model” at work. Although our work is
synonymous with parenting, we generally discourage referring to them as “kids” or treating them
as a son or daughter. We would rather as a provider perceives them as a peer, friend or client
who just so happen to have a disability.
Most of the time, people are involved in the countless duties of providing care. Some of the
“counseling” that we do is as simple as making a sincere connection that allows for trust to
develop. Some of our higher functioning residents require assistance with issue processing from
our providers. Their issues are sometimes more complicated than others, and you will have an
opportunity to discuss individualized approaches with your Program Manager.
While at Overture, you will discover very soon that you have insights into these aspects of our
philosophy, with your own to discuss and clarify your views on these topics.
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Your Role as a Host Home Provider
Your role as an Overture Host Home Provider is extremely important. You will be a vital member
of the team working to provide the best services possible to the person in your care.
A Host Home Provider is an individual who provides residential supports in their home to
persons receiving comprehensive services who are not family members. A Host Home Provider
is an Independent Contractor and is not a developmental disabilities service agency pursuant
to section 16.220 of the Department of Human Services, Developmental Disabilities Services
Rules.
Overture will contract directly with you, a Host Home Provider. A Host Home Provider
(Contractor) shall perform his/her duties as an independent contractor and not as an employee
of Overture.
Neither the contractor nor any agent or employee of the contractor shall be or shall be deemed
to be an agent or employee of Overture. The contractor shall pay when due all required
employment taxes and income tax withholding, including all federal and state income tax and
local head tax on any monies paid as appropriate. The contractor is not entitled to workers’
compensation or unemployment insurance benefits unless the contractor provides such
coverage or coverage is provided by some entity other than Overture. Overture does not pay
for or otherwise provide such coverage.
The contractor shall have no authorization, expressed or implied, to bind Overture to any
agreements, liability or understanding. The contractor has no authority to enter into contracts or
agreements on behalf of the Agency or the individual(s) served by the contractor.
In the performance of all services, it is mutually understood and agreed that the contractor shall
be, and at all times is, acting and performing as an independent contractor. Overture relies
upon contractor’s expertise and experience in performing the services provided.
There is no requirement that the contractor perform work exclusively for Overture. The
contractor is free to carry on such other employment, and to enter into such other independent
relationships as contractor may desire. This is providing that these other relationships do not
interfere with the services which contractor has agreed to provide.
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Confidentiality
Why Confidentiality is Important
Confidentiality is the responsibility for controlling how private information is used and to whom it
is released. Part of your job as a Host Home Provider is to maintain confidentiality of private
information so that an individual’s information is not used for unauthorized purposes. The
individual must give written permission for any confidential information to be used.
Organizations that require access to information must ensure the confidentiality of information to
the same degree as care providers who initially provided access to the information.
You are expected to make sure that confidential information is not discussed outside of the
team associated with the person you serve. You are also responsible for avoiding unnecessary
disclosure of non-confidential information about Overture and its clients. These guidelines are
not intended to interfere with normal business communication and relationships, but are
intended to alert you to your obligation to use discretion in safeguarding the internal affairs of
Overture and the client(s) in your charge.
Overture file books on the people we serve contain personal information and are not for public
viewing. Your home file books should never be shared with unauthorized individuals. Violating
confidentiality can hurt others, cause information to be misinterpreted or misunderstood, create
a stigma, or could be used for unlawful purposes.
Your obligation to maintain the confidentiality of the Company and client information remains
even after you are no longer a Host Home Provider.
What is Confidential Information
Confidential information includes, but is not limited to:

Client information

Employee data, including phone and address lists

Procedures or manuals

Financial information
Confidential information is also all identifying information contained in any record pertaining to a
person receiving services with Overture. Records on the person in services are not public
records, which means, that records are not open to general public review. Proper authorization
for release of information is necessary. These records are the property of the agency which is
responsible for maintaining and safeguarding their contents. This includes information that is
electronically collected, processed or stored. This includes all types of identifying information
including, but not limited to name, Social Security number, Medicaid number, household number
or any other identifying number or code, street address, telephone number, photograph or any
distinguishing mark.
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Safeguarding Records
Records on the person in services are the property of Overture and their Program Manager is
responsible for safeguarding and maintaining them.
Providers shall not discuss a person receiving services with identifying information in public or
with persons who are not entitled to the record. Identifying information shall not be posted in
areas accessible to the general public, or left unsecured or unsupervised for extended periods
of time.
Records are to be maintained and stored in locked files or a locked room and shall not be
accessible to the public.
(Please see the Overture Confidentiality policy in the policy section of this book).
Quiz
Next, there is a brief online quiz which we ask you to complete using your knowledge and
training to assure an understanding of Confidentiality.
The results of this completed quiz will remain in your Host Home Provider file as a part of your
Confidentiality training documentation.
Please log on to www.imaginecolorado.org
Go to the upper right hand corner of the first page and find trainings.
Follow directions from page 2. Take the quiz on Confidentiality.
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HIPAA
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is comprehensive
federal legislation setting forth national health information privacy standards. HIPAA’s Privacy
Rule attempts to protect the privacy of personal health information by establishing, for the first
time, a nationwide foundation of required practices and procedures to safeguard the
confidentiality of health care information. The Privacy Rule applies to all Overture staff, Host
Home Providers, Respite Providers and any other staff or independent contractors associated
with Overture.
The Privacy Rule applies to essentially any information, whether oral, written, or electronic,
which is created by health care providers or other entities such as Overture, and which relates
to the past, present, or future physical or mental health or condition of an individual, the
provision of health care to an individual, or billing and payments made for the provision of health
care to an individual. Health information subject to the Privacy Rule is called protected health
information. Protected Health Information may be used or disclosed without permission for
certain commonsense purposes, such as treatment, payment, or health care operations. The
Privacy Rule also permits disclosure for some health care purposes, including quality
improvement, peer review, credentialing and training activities. While the rule does not require
permission for these uses and disclosures, it does require Overture to make reasonable efforts
to inform the people we serve that such uses and disclosures may occur. To that effect,
Overture maintains privacy information and release forms for each person it provides services
for.
As an Overture Host Home Provider, you are responsible for completing the Overture HIPAA
training course and exam and for maintaining the privacy of the person in services home file
information. Below are the training course materials, which are designed to give you a greater
understanding of how HIPAA and the Privacy Rule work in real life situations. Please take the
time to read through the study materials and then complete the accompanying exam. Feel free
to contact the Overture HIPAA Privacy Officer with any additional questions.
HIPAA Training Course and Exam
The following course material will help you understand your role in protecting and securing
patient information as required under a set of federal regulations, generally called HIPAA, the
Health Insurance Portability and Accountability Act of 1996. You need to know about HIPAA
because you hold a position of trust and responsibility with Overture.
The on-line test you will take after completing the course material will present you with a series
of patient privacy incidents, with possible answers in multiple-choice format.
Why is HIPAA important to you?
HIPAA compliance requires that everyone who works or contracts for Overture must be trained
in the HIPAA regulations. HIPAA is federal legislation that addresses various elements of
healthcare, including a mandate for the U.S. Department of Health and Human Services to
issue regulations that specify privacy and security protections for healthcare information about
individuals.
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Definitions
The course will begin by reviewing a few definitions that will help you understand your
responsibility as required by HIPAA law.
Patient Information: Patient information is any information, in any form, related to a person’s
visit to a healthcare facility, treatment by a healthcare provider or medical prescription handling.
Patient information can be:
● Staff discussions about the diagnosis or treatment of a patient.
● Patient medical records.
● Pharmacy prescriptions.
● Conversations patients or families have with others in a healthcare facility.
● Computer records and charts.
● Anything YOU see or hear in the course of an individual’s care.
Protected Patient Information: Under HIPAA laws, protected information is any health
information that is electronic, written or spoken, that includes an individual’s or any other way to
identify them, such as Social Security number, phone number, address or date of birth.
Patient Information Privacy: Assuring patient information privacy is giving a person the ability
to control what information about them is made available to others. HIPAA laws are intended to
protect individuals’ privacy by protecting their personal information.
Applying HIPAA to the Workplace
HIPAA does not apply to every kind of information. It applies only to “Individually Identifiable
Health Information,” also known as “Protected Health Information.” This is any information that:
● is created or received by any employer, health plan, provider or information
clearinghouse (third party information processing service), and …
● “Relates to” past, present or future physical or mental health, healthcare or payment
for healthcare, and …
● Identifies the individual in questions, or …
● contains enough specific information that can reasonably be used to identify the
individual.
HIPAA applies to “Individually Identifiable Health Information” in any medium. This includes:
● Written information.
● Information in electronic form
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● Information given verbally
HIPAA requires healthcare professionals to only use or disclose the “Minimum Necessary” set
of Protected Health Information for almost any purpose except treatment of patients.
Except in emergency situations, HIPAA requires that healthcare providers notify patients about
their privacy rights and describe practices intended to protect patient privacy. Patients are
asked to acknowledge receipt of the notice prior to making healthcare decisions. This
acknowledgement by the patient authorizes the use or disclosure of information for purposes of
“Treatment, Payment or Operations” (“TPO”). These uses will be discussed later in the course.
Sensitive Conditions or Treatments
Some kinds of patient information are subject to extra protections. Think twice and use extra
care when using or disclosing information about treatment involving:
● HIV/AIDS
● Abortion and contraception
● Sexually transmitted diseases
● Mental health and psychiatric information
● Alcohol and drug abuse treatment
● Minors
HIPAA does not distinguish between this more sensitive information, and other patient
information.
Application of HIPAA for Overture Staff and Providers
This section of the course will discuss the application of the principles and terms covered so far.
In particular, it will address:
● What you need to know to comply with HIPAA regulations
● How following HIPAA standards reduces risk for you
● When and how HIPAA permits the use and disclosure of patient identifiable
information
Allowed Uses, Disclosures and Application of Information
Under HIPAA, healthcare treatment is any provision or coordination of healthcare, including
case management and risk assessment, referral and consultation.
Treatment information must be shared freely among treating professionals and caregivers to
ensure accurate diagnoses are made and appropriate treatment given. This use of patient
information is not subject to “Minimum Disclosure”.
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Use good judgment! Acceptable uses of patient information in treatment situations would not
include:
● Discussing a patient’s condition with staff members not involved in giving or
supervising care
● Telling professional colleagues not involved in the case about your identifiable
patient’s condition because they might find it interesting.
Acceptable uses of patient information for healthcare operations include such activities
as quality assessment and improvement, provider credentialing, provider training and
evaluation, accreditation and licensing, medical review and auditing, business
administration, and management activities.
In addition, HIPAA permits certain other limited uses and disclosures of patient information by a
provider without patient consent. This includes:
● Marketing, fund-raising, directories
● Governmental and regulatory uses and disclosures such as law enforcement, public
health, licensing and oversight
● Properly supervised research
Any other use or disclosure requires a signed authorization from the person in services.
Summary: All patient information is protected by HIPAA. We must make sure that this kind of
information is used and disclosed for limited purposes, under controlled conditions. How do we
ensure that these privacy limitations are complied with?
Keep patient information private and secure by:
● Knowing who is authorized to receive a patient’s information
● Keeping protected records out of reach of unauthorized individuals
● Keeping protected records out of sight of unauthorized individuals
● Keeping protected information out of hearing of unauthorized individuals
● Obtaining written permission from the patient before disclosing his or her information
to anyone not directly involved in the patient’s care
Protecting Confidential Information
It is good practice in general, and particularly under HIPAA, to keep unauthorized
individuals from overhearing discussions in which the patient is identified.
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Time for the Quiz!
Now you are ready to take the on-line quiz based on what you have read in this course:
Quiz
Next, there is a brief online quiz which we ask you to complete using your knowledge and
training to assure an understanding of Confidentiality.
The results of this completed quiz will remain in your Host Home Provider file as a part of your
Confidentiality training documentation.
Please log on to www.imaginecolorado.org
Go to the upper right hand corner of the first page and find trainings.
Follow directions from page 2. Take the quiz on HIPAA.
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Person’s Rights
Overture values each individual we serve and is committed to upholding and protecting the
rights of these individuals as we would our own or any other citizen. This section summarizes
the rights of each client receiving services from Overture.
No person shall be discriminated against because of race, color, religion, national origin, sexual
orientation, handicapping condition, or because he/she has received habilitation or treatment
services. All persons receiving services through Overture shall have the same legal rights and
responsibilities guaranteed to all other individuals under the federal and state constitutions,
including:
The right to an Individualized Plan.
The right to appropriate medical care and treatment.
The right to humane care and treatment.
The right to give consent for treatment.
The right to religious belief, practice and worship.
The right to fair employment practices.
The right to vote.
The right to have access to personal possessions, property, and funds.
The right to establish a committee to represent their interests and influence with Overture.
The right to communicate policy concerns to Overture.
The right to notification.
The right to be free of discrimination based upon race, religion, color, sexual orientation,
national origin and/or condition of disability.
The right to have mistreatment, abuse, exploitation or neglect investigated.
The right to be free from harm and/or threat of harm.
The right to be treated with honesty, dignity, and as a person with feelings, preferences and
desired outcomes about their life and future.
The right to confidentiality.
The right to privacy, including use of the telephone and uncensored and unopened mail.
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The right to free association, meaning they have the right to decide who will be a part of their
social network, providing these relationships are not exploitative in nature.
The right to be paid for their work according to applicable federal minimum wage law.
The right to be free from intrusive or restrictive procedures (including psychoactive
medications). Any use of intrusive or restrictive procedures will be with their involvement and
consent, or if used as emergency procedures, they will be employed according to Overture
policies and procedures and reviewed for appropriateness by the Human Rights Committee.
Human Rights Committee
The purpose of the Human Rights Committee (HRC) is to safeguard the rights of persons
receiving services. The HRC is an advisory board that meets on a regular basis to review
medications, restrictive procedures, rights suspensions and ISSP information. The data you
document on your log notes will be used as a tool for the HRC to review the person in
your care. As an integral member of the person’s team, you are encouraged to attend all HRC
meetings.
Now you are ready to take the on-line quiz based on what you have read in this section.
Quiz
Next, there is a brief online quiz which we ask you to complete using your knowledge and
training to assure an understanding of Confidentiality.
The results of this completed quiz will remain in your Host Home Provider file as a part of your
Confidentiality training documentation.
Please log on to www.imaginecolorado.org
Go to the upper right hand corner of the first page and find trainings.
Follow directions from page 2. Take the quiz on Rights.
20
Mistreatment, Abuse, Neglect and Exploitation
MANE is defined as any single or repeated act of force, violence, harassment, deprivation,
neglect or mental pressure which reasonably could cause physical pain or injury or mental
anguish or fear. Overture prohibits any form of mistreatment, abuse, neglect or exploitation.
Following are definitions and Overture Host Home Provider procedures and responsibilities for
reporting any suspected instances of MANE.
DEFINITIONS OF MANE
Physical Abuse is any infliction of physical pain or injury. Physical abuse includes but is not
limited to such actions as striking, twisting of limbs, and use of unreasonable force in pulling,
pushing or otherwise inflicting physical injury or pain. This also includes directing a person in
services to aggress another person receiving services. Causing bodily harm to another, even if
between providers, constitutes abuse. If allegations are discovered to be true, providers could
be prosecuted to the fullest extent of the law even if the abuse does not result in serious injury.
This type of offense is considered a felony.
Sexual Abuse is subjecting a person to any nonconsensual sexual conduct or contact classified
as a crime under the Colorado Criminal Code. Sexual abuse includes but is not limited to rape,
fondling, exploiting or inappropriate contact with genitals. Sexual abuse may broadly be defined
as any sexual contact between providers and persons receiving services.
Verbal and Psychological Abuse is any verbal or non-verbal action which creates, is intended
to create, or reasonably could create mental anguish for a person. This includes but is not
limited to any language or action by providers which degrades, threatens, or creates mental
anguish for residents. Examples of this include discriminatory remarks, belittlement, name
calling, or unnecessary exclusion from conversations or activities. This also extends to
threatening to remove or withhold entitlements and/or rights of the residents.
Neglect is an omission or an act by a person who is responsible for another person’s wellbeing. This includes any acts, or deleting any acts which may cause a resident not to receive
the standard of care required by laws or regulations. This includes not providing an atmosphere
of safety or comfortable habilitation, providers refusing to participate in ISSPs or falsifying
residential documents. Neglect also includes failure to provide residents with meals,
medications, adequate clothing or comfort and 24 hour supervision, for reasons such as
impairment, sleeping on the job, or leaving residents unattended.
Exploitation includes any illegal or improper action affecting a person or use of the person’s
resources for another person’s profit or advantage. This includes but is not limited to
misrepresentation or taking advantage of an individual’s trust for another person’s benefit.
Example include misuse of personal needs funds (willful use of prescribed moneys for needs
other than those of the individual), misuse or stealing resident’s personal property, theft of
agency property, food, health care products and medications.
21
PROVIDER RESPONSIBILITY POLICIES AND PROCEDURES
ALL Host Home Providers are responsible for the immediate reporting of any allegations or
suspicions of abuse, mistreatment, neglect or exploitation to the person in services Program
Manager and/or the Executive Director. FAILURE TO DO SO COULD RESULT IN
IMMEDIATE TERMINATION.
Immediately after observing the incident, the provider must contact the appropriate Chestor
House Program Manager and then complete an incident report within 24 hours.
During business hours please contact 303-926-8840 and speak to the Program Manager or the
Executive Director.
After business hours call the Overture Emergency Cell Phone number at
303-931-3203.
If you get Voice Mail, please leave the following information:
1. The name of the individual who was allegedly abused
2. How the person was allegedly abused.
3. When and where the alleged incident occurred.
4. Any information concerning the person allegedly committing the act (i.e., name
comments made, etc.).
5. The immediate action taken to ensure the safety and appropriate care of the person
allegedly abused or neglected.
6. Who is making the call and where the reporter can be reached during business hours.
Overture will thoroughly investigate all reports of suspected MANE incidents. Written reports
will be required of providers and possibly requested from others who have knowledge of such
incidents.
The agency will involve proper medical staff and community sanctioned employees to assist in
investigations. The Executive Director may liaison with law enforcement to establish a mutual
understanding of agency purposes, and assist in mediation and support of policy. On-site police
presence will be requested in all instances of witnessed physical or sexual abuse. Overture will
cooperate with authorities in pursuing appropriate legal action during a sustained investigation.
Next, there is a brief on-line quiz which we ask you to complete using your knowledge and
training to assure an understanding of MANE. The results of this completed quiz will remain in
your Host Home Provider file as part of your MANE training documentation.
Quiz
Next, there is a brief online quiz which we ask you to complete using your knowledge and
training to assure an understanding of Confidentiality.
The results of this completed quiz will remain in your Host Home Provider file as a part of your
Confidentiality training documentation.
Please log on to www.imaginecolorado.org
Go to the upper right hand corner of the first page and find trainings.
Follow directions from page 2. Take the quiz on Confidentiality
(See Overture formal policy in the policy section of this book).
22
Host Home Provider Orientation
This section is designed to introduce you the process that will be followed to orient you to each
person you will provide host home services for.
Individualized Plan
An IP is an individualized plan for each person in services developed at an annual Individualized
Planning Meeting by their Interdisciplinary Team (IDT) to look holistically at their life. The IP
determines the long and short term goals of the person receiving services. It is a legal
document that should represent all facets of the life of the person. You will be notified of the
annual IP by the person’s Case Manager, who monitors their program and chairs the IP
Meeting. Attendance at this meeting is mandatory for all Host Home Providers.
Prior to providing services, the person in services Program Manager will orient you to their IP.
Health Services
The Health Services Department is here to provide you with information, assistance, and
support as you begin your relationship with the new person in your homer. Your phone calls are
always welcomed and you can contact the nurse by calling 303-926-8840x114.
If after hours, contact the emergency cell phone at 303-931-3203.
The health and well-being of all people we serve is of paramount importance. Therefore is it
essential that the person is seen by identified health care professionals at the requested
intervals. It is your responsibility to 1) make all appointments, 2) ensure the person in your care
arrives to their appointment on time, and 3) be prepared to provide needed information to help
the health care professional provide appropriate care.
Missed appointments put the person in services at risk for complications and every effort must
be made to ensure they are seen. When an appointment is missed the situation will be
reviewed and based on findings there may be monetary consequences. Any charges related to
missed appointments will be the responsibility of the Host Home Provider unless other
arrangements have been made in advance with Overture administrative staff.
Prior to caring for a person in Overture’s services, the following topics will be discussed with
you:
1.
2.
3.
4.
5.
Over view of universal precautions.
A copy of the emergency contact list for Overture
Appropriate documentation on the medication and controlled drug sheets.
A review of the person’s current medications and a copy of their medication log.
A review of written information regarding side effects of all psychotropic medications
that have been prescribed for the person in your care.
6. A review about storing and labeling medications, including over the counter
medications.
7. What to do with medications that have been discontinued or have expired.
8. Copy of “standing orders” that has been signed by primary physician
23
9. A review current Health Services’ Problem Page for the person in your home.
10. Review allergies, if appropriate.
11. A copy of the Medicaid card, Medicare card and/or insurance information, when
there is coverage, will be provided.
12. Phone numbers of various health care providers will be provided.
13. A review of all required health care evaluations i.e. physical exam, vision, hearing.
14. A review of all follow-up appointments and upcoming appointments.
15. A review of Health Care Visit forms; additional copies of the form will be provided.
16. Recent reports from specialist – if appropriate.
17. When appropriate copies of specific protocols i.e. seizures, elimination, mobility will
be provided.
18. A review of seizures log and documentation – when appropriate.
19. A review of specific tracking forms related to the person in services i.e. food diary,
blood sugar testing, blood pressure etc.
Universal Precautions
UNIVERSAL PRECAUTIONS means: All human blood and most body fluids are treated as if
known to be infectious.
Diseases are spread when pathogens enter a person’s body, AND 1) there is enough of the
pathogen to cause disease 2) the person is susceptible to the pathogen, and 3) the pathogen
passes through the correct entry site. Pathogens enter the body through various ways:
1) direct contact (touching body fluids from an infected person) – also called blood
borne pathogens when contracted through sharing blood or other fluids
2) indirect contact (touching objects which have touched an infected person’s body
fluids)
3) airborne (when a person breathes in droplets that become airborne when an infected
person coughs or sneezes)
4) vector-borne (transmitted through bites from infected animals, insects, or people)
Examples of blood borne pathogens
 HIV
 Hepatitis B
Modes of Workplace Transmission
 Mucous membrane: fluids are splashed into the eyes, nose or mouth.
 Breaks in skin surface: contaminated blood enters through chapped or cracked skin.
 Parenteral: puncture wound from a contaminated needle or sharp.
Preventing Disease Transmission
 Barriers
- Gloves are the most common barrier and should be worn whenever there is the
potential for contact with blood or other body fluids (i.e. first aid, toileting, dental care,
laundry).
- CPR masks
 Hand washing
- Employees should wash their hands for 20 – 30 seconds using soap and warm water
after removing gloves, before handling food, after using the restroom or after smoking.
24

Disinfecting
- When disinfecting an area, use a solution of 1 part bleach to 10 parts water and always
wear gloves.
Despite following these precautions, you are exposed to blood or body fluids that
contain blood?
 Wash the affected area immediately and thoroughly. Check for any breaks in the skin.
 Report the incident your primary care physician.
Tuberculosis
Tuberculosis (TB) is an airborne transmitted disease that typically affects the lungs.
Hepatitis B
Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus, which is
called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver
cancer, liver failure, and death.
General information about Hepatitis B, the prevention and vaccine:
1. The primary mode of transmission is through direct contact with blood or
sexual intercourse. It may be present in any body fluids; therefore all body
fluids need to be handled carefully.
2. 5% of people who contract Hepatitis become long-term carriers.
3. The virus can live outside the body for 7 days.
4. Hepatitis is an inflammation of the liver. The disease may present without
many symptoms, may cause permanent liver damage, and may cause death,
and people who contract Hepatitis B could be at a higher risk of developing
liver cancer.
5. Persons infected may infect others.
6. There is a vaccine available; a three shot series "thought" to provide lifelong
immunity. It is a three shot series; the second dose is given one month after
the first dose and the third dose is given five months after the second.
7. Boulder County Health Department can provide the vaccine. They will
provide you with more specific information regarding the side effects and
contraindications. The health department staff will be responsible for
maintaining your immunization record and sending reminders.
8. The side effects of the Hepatitis B vaccine are considered low and include:
 allergy is possible
 sore arm
 low grade fever
25
Emergency Procedures
Host Home Providers will work with Overture to guarantee safe, quality care to the people we
serve at all times. In the event of an emergency, first ensure the safety of yourself and the
person you serve. On-call administrative staff is available at all times by cell phone. The oncall emergency phone number for Overture is 303-931-3203. In the event of a significant
emergency CALL 9-1-1 FIRST and then the appropriate Overture number second.
The following is a list of events that require notification to the on-call person after hours which
are 5:00pm to 8:30 am Monday–Friday, weekends and holidays, and the designated Program
Manager during office hours which are Monday through Friday from 8:30am- 5:00pm:
a) Fire
b) Natural Disaster
c) Death
d) Accident with personal injury requiring patient
hospitalization.
e) Any allegation of MANE
f) Illness requiring hospitalization.
g) Police involvement with the person in services or provider.
h) Restraint that goes over 15 min in duration
I) calling 911 for any reason
J) Behavior that is extremely unusual for the person in services.
K) Any event that you feel you need guidance or
assistance from Overture
If assistance is needed after hours, call the Emergency Cell Phone 303-931-3203 and leave a
message if the person does not answer immediately. Be sure to leave a short message
including a phone number so they can return the call. If they do not call back within 15 minutes
try again (cell phones are not always as reliable as we would like). If you perceive there to be a
medical emergency or emergency safety issue call 911 or the police.
Schedule and Routines
You will be responsible for making sure the person in your care maintains their schedule and
daily routines and their Program Manager will review all the details of their schedule and daily
routine with you prior to them entering your home if the information is available. This includes:
Fact Sheet: Each person Overture serves has a current fact sheet listing the people on
their team, including their guardian, Case Manager, Day Program and Host Home
Provider. The person’s Program Manager will review this with you and provide you with
an updated copy when it changes.
Day Program: The people we serve participate in either day program or employment in
the area. Your Program Manager will go over their weekly schedule, the pickup and
drop off procedure and how to contact their job coach/employer.
26
Daily Routine: Each person we serve has a daily routine that is directed in part by the
supports written in their IP. While some are very independent, other need more directed
care to facilitate their daily activities. Their Program Manager will review the daily
routine and schedule with you and a copy of their current support plan will be provided to
you.
Home Visits: During the first six weeks of a placement in your home, an Overture
representative will visit on a weekly basis to assure a smooth transition for both of you.
After that, Program Managers make regular announced and unannounced visits to your
host home to assure the safety and well-being of the person in your care. These are
also an opportunity for you to discuss any issues or concerns you may have.
Additionally, the person’s Case Manager, CCB Investigators or a representative of the
State of Colorado Developmental Disabilities Division may visit your home at any time.
27
Individualized Plan and Individual Service and Support Plans
Within thirty days after beginning to provide services for person we serve, their Program
Manager will review in detail their current IP and any Action Plans and ISSPs connected to it
with you.
Individualized plans are administered by the person’s Case Manager but their entire team,
including you, participates in its implementation. An IP covers a person’s abilities, strengths,
preferences, desires, needs, services and supports needed, decisions made by the IDT, a
description of the results to be obtained from services and supports, documentation of the
authorized services and supports, a list of the IDT participants and their relationship to the
person in services, and a statement of agreement signed by the person and a representative of
the CCB.
Copies of the IP are disseminated to all people involved in developing it within 30 days and it
will be in effect for up to one year.
There are three areas to an IP that you as a Host Home Provider will assist in implementing.
These are Action Plans, Support Plans (ISSP) and Behavioral Support Plans (IBSSP).
Action Plan
An action plan describes a part of the person in services routine. No monthly documentation is
required.
ISSP/IBSSP
An ISSP or IBSSP is an Individual Service and Support Plan developed for goals in which the
person receiving services is expected to increase their current level of skill or to maintain their
current level of skill or for modifying targeted behaviors. Each ISSP or IBSSP must be
developed specifically for the person for whom it is written. The purpose and requirements of
an ISSP include:
 To provide a written statement of the objective or intent that the ISSP is to
accomplish
 A written explanation of the methodology, strategy or procedure that will be
implemented
 A means for consistent implementation between the various service agencies
providing services and supports provided for the person
 Criteria against which the effectiveness of the ISSP shall be measured and
timelines for reviews
 Physical and/or mechanical restraints cannot be a part of an ISSP
As an Overture Host Home Provider, you will be involved on a daily basis in the implementation
and documentation of any ISSPs for the person in your care. Your Program Manager will
provide you with specific explanations and guidance in implementing and documenting the
ISSP.
28
Other Overture Training
Overture asks its Host Home Providers to attend other trainings that will improve services for
the people we serve and their role as a Host Home Provider. In addition to the following, you
may be required to attend additional training sessions based on the individual needs of the
person in your home. Required trainings for all Host Home Providers include:
● Medication Administration
This state sponsored training and certification exam is required of all providers who work with
the people we serve.
● CPR and First Aid
● Physical and Non-Physical Intervention Techniques (if applicable)
● Confidentiality
● HIPAA
● Rights
● M/A/N/E – Mistreatment, Abuse, Neglect and Exploitation
● Overview of DD Services
● Signs and Symptoms of Illness and Infection Control
● Building Cooperative Behavior
● Any other training deemed necessary for a particular individual
The Building Cooperative Behavior training is designed to teach appropriate interaction skills.
This is a FREE class offered by Imagine! You will be asked to participate in these trainings
within the first 90 days as an Overture Host Home Provider. After completion, your
Program Manager may work with both you and the person you serve in the community to
reinforce the principles taught in the class.
29
Required Documentation and Due Dates
Contract Documentation Requirements
There are some items referred to in your contract that you will need to provide to Overture on a
regular basis. These include:
● Proof of Current Colorado Driver’s License.
● Copy of Social Security Card
● Proof of adequate and current Homeowner’s or Renter’s Insurance.
● Proof of adequate and current Automobile Insurance.
● Proof of current Professional Liability Insurance.
● Annual Vehicle Inspection Form
Insurance liability and documentation requirements are described in your contract. All of these
items are due for renewal in the calendar month in which they expire. You are responsible for
ensuring that your training and documentation is complete in order to receive your
monthly host home payment.
Home Documentation Procedures
Each person Overture serves has a permanent file with required paperwork, forms and
necessary health and program information. The Program Assistant will set up your home filing
and documentation requirements with a table of contents for your home file, reviewing each
section of the file and how to maintain it.
Host Home Day
You will be paid for your services for Overture on a monthly basis during Host Home Day. Host
home day is generally the last day of the month; your Program Manager will inform you if it will
occur on another date. At each host home day, you will be provided with a checklist to bring in
with you the following month. This checklist details documentation required to receive your
monthly payment. Monthly checklist items for each person we serve include:
● Personal Needs Balance Sheet.
● Attendance Record for the person in services.
● Medication Administration Record.
● ISSP Documentation.
● Daily, Weekly and Monthly Log Notes.
30
● Fire Drills for each person you serve every 3 months.
● Health Care Tracking.
● Anything owed to HR for HHP tracking.
● Personal Property Update. You must inform the Overture accounting department of
any new possessions of the person you serve that cost $50 or more to add them to their
personal property inventory. You are also requested to inform the accounting department if
items need to be removed from the personal property inventory. A Serial Number must be
provided for anything that has a serial number and plugs in.
Additional items may be required depending on the IP and program documentation needs of the
person in your care and your training and contract documentation requirements.
Personal Needs Funds are allocated for each person in services and it is your responsibility to
administer them throughout the month and account for them at each host home day.






All providers receive a set amount in cash at the beginning of each month.
This set amount is determined annually by Social Security.
These funds are to be used for the person’s personal needs items.
A list of acceptable and non-acceptable items will be given to you, along with their first
month’s allocated money when you begin providing services.
You must submit all receipts and any unspent cash to the Program Assistant on each
host home day.
The Program Assistant and the accounting department will review receipts to determine
whether or not they are allowable expenses and verify the remaining cash is consistent
with expenses.
1. If these are deemed unallowable the money will be deducted from your
monthly host home payment.
2. If you have any questions about allowable expenses, please feel free to
contact the Overture Program Assistant.
3. If the person in services needs additional funds (more than the amount
you are given for Personal needs each month), please contact the
Finance Department to ensure they have the resources and to obtain the
correct form for that purpose or to make other financial arrangements.
4. Receipts for any additional monies received from the Finance Department
must be kept separate from Personal Needs money and must be
recorded on the correct form and turned in on the next Host Home Day.
31
Incident Reports
All incidents and accidents that occur to persons receiving services must be documented on the
appropriate form and submitted to the Overtures Program Manager within 24 hours of the
incident. If the incident occurs during the weekend, an incident report shall be submitted at the
beginning of the next business day. Written incident reports of any nature are routed to the
Case Management Department at Imagine! or other appropriate CCB within 72 hours.
If an incident involves a medical emergency, Missing person, police involvement, press
involvement, allegation of mistreatment, abuse, neglect, or exploitation; or death, the provider
should notify the Program Manager or emergency cell phone contact immediately, who shall
ensure that the person’s Case Manager is notified within 24 hours by telephone, fax, or email.
Notification in these instances is to be followed by a written report within 24 hours.
Incident reports are a significant requirement. These documents are not only required by state
regulation, but serve as an official account that will be reviewed by governing agencies.
Incident reports must be completed in situations that directors, case management, and those at
the State level need to be aware of. These situations include:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Injury to person receiving services
Lost or missing person receiving services
Medical emergencies
Hospitalizations
Death of a person receiving services
Errors in medication administration
Unusual reports or actions
Allegations of M/A/N/E
Use of safety control procedures
Use of emergency control procedures
Destruction of property or stolen property
Significant disruption to program
Require behavioral plan or IDT meeting
Require case management or administrative action
Seizures of an unusual nature.
Since incident reports are legal documents, they need to be written professionally. The
language in the report should reflect dignity and composure, even if the provider is upset, and
should also be concise, factual, and well written. It is very important to describe the
antecedents, or what occurred prior to behaviors. This gives us a context to better understand
the situation. Please refrain from editorializing or embellishing until speaking with directors.
(See formal Policy included in the policy section of this book.)
32
Guide to Required Fields for Completing an Incident Report
Note: An incident is considered the greatest and last incident to occur.
Reporting Agency: The agency you work for, Overture
Name: The name of the person in services
Occurrence Date: The date of the incident
Time: The time of the incident
Duration of Incident: How long did the incident take place?
Location: Specific location of the incident
Was incident observed directly: Yes if you actually saw it happen; No if you did not see it
happen
Type of Incident: Put an X by the type of incident that occurred. Only one choice is allowed.
Note point of injury or pain: Write down exactly what part of the body was injured
Persons notified: notify each person listed if applicable
Description of Incident: What happened? Stick to the facts only.
Describe the events and environment leading up to the incident: describe what was
happening just prior to the incident.
How was the situation handled: What type of intervention or assistance was necessary to
handle the incident?
Was emergency/safety control procedure used: Was some type of restraint procedure used?
Starting time of procedure: When restraint started
Ending time: When restraint ended
Describe the procedure used: Be specific. Name the procedure used.
Why was the procedure used: What was the reason this action was taken?
Has this type of behavior occurred with this person before: Yes or No
Is it likely that this behavior will recur: Could this happen again?
Is there a behavioral ISSP: Is there an ISSP or behavior program for the type of behavior that
occurred during the incident?
Was it implemented: Was the ISSP or behavior program implemented?
Measures to be taken or suggestions for preventing a re-occurrence of this incident:
Describe actions or suggestions of actions which can be taken to prevent this from happening
again.
Report written by: Print your name and then sign and date it.
The section between the two lines:
Is to be completed ONLY if an Emergency Control Procedure or Safety Control
Procedure was used. If one of these procedures was not used, please leave this
section blank.
The following pages contain a sample incident report, filled out according to agency
specifications. Use this as a guideline to assist you in correctly filling out your own incident
reports.
33
34
Name:________________________ Date:__________________
Grade:___________
1. What additional 3 incidents require that you call Overture immediately?
1. MANE
2.
3.
4.
2. Under what circumstances would you NOT write an incident report?
3. Under the heading “Type of Incident” on the form, how many boxes are you allowed to check?
a. Two
b. One
c. As many as needed
4. Within what timeframe should an incident report reach the Overture office?
5. If a critical incident occurs after hours, I am to contact the emergency phone number?
TRUE or FALSE
6. What do you do if an incident occurs on a Friday after the office has closed?
a. Call your Program Manager
b. Fax a copy to Overture office
c. Wait until Monday and contact office
d. Send it by mail for Monday delivery
7. Who completes an incident report?
8. You can use pencil when completing an incident report? TRUE or FALSE
9. It is acceptable to attach extra sheets of documentation to the Incident Report?
TRUE or FALSE
9. Incident Reports are legal documents? TRUE or FALSE
10. If you are unsure if an incident requires a report you should –
a. Call the office and ask whoever answers the phone.
b. Contact the Nurse.
c. Call your Program Manager.
d. All of the above
35
Incident Report Quiz Scenario
Please read the scenario then fill out the blank Incident Report Form
appropriately.
Bill Smith is a Host Home Provider for John Doe.
The date is Thursday, May 30, 2013. Bill awakes John at 7:30 am, per his daily routine, in
order for John to get ready for day program. John tells Bill, “I am not getting up!” John jumps
out of bed and slaps himself on the face. Bill leaves the room and does not provide attention to
John when he slaps himself. A few minutes later Bill returns to the room and prompts John to
get ready. John complies.
John arrives at breakfast table at 7:55 and requests pancakes for breakfast. Bill tells John that
he has already made eggs for breakfast but is willing to make pancakes tomorrow. John begins
to slap himself on the face again. Bill leaves the breakfast table and ignores the behavior.
John then follows Bill into the kitchen and slaps Bill on the arm. Bill continues to ignore the
behavior and attempt to provide redirection to John by asking him to return to table and for
breakfast. John then bangs his head into the wall causing a laceration to his face.
Bill is able to provide first aid when John calms, but the laceration is large. Bill calls the nurse
and tells her what has happened. At 8:40 Bill takes John to emergency room at St. Anthony’s
for evaluation where he receives stitches and is released back to home at 1:40 pm .
Author: Christine Bindi May 2013
36
REPORTING AGENCY:
INCIDENT
Entered in db?
REPORT
Follow-up in db?
Name of Person:
Occurrence Date:
Time:
Duration of Incident:
Location:
If Control Procedure, Duration of Physical Intervention:
Was incident observed directly? Yes
No
TYPE OF INCIDENT (Check 1 box only)
Medical/Injury
Social/Behavioral
Injury to the person in services
Medical Emergency
Hospitalization
Death of the person in services
Seizure of Unusual Nature
Medication Charting Error
Alleged Mistreatment, Abuse, Neglect, Exploitation
OTHER:
WITNESSED BY:
NOTE POINT OF INJURY OR PAIN:
Lost or Missing Person
Aggression toward others
Self-Injurious Behavior
Property Damage
Theft or Vandalism
Unusual Behavior
Emergency Control Procedure (see pg. 2)
Safety Control Procedure (see pg. 2)
Stolen Property of Persons Receiving Services
OR REPORTED BY:
PERSONS NOTIFIED:
Nurse
Case Manager
Program Manager
Guardian/Parent/Provider
Dept. of Health (Group homes only)
Other
Division of Developmental Disabilities – DDD Critical Incident
DESCRIPTION OF INCIDENT:
DATE:
ROUTED:
DESCRIBE THE EVENTS AND ENVIRONMENT LEADING UP TO THE INCIDENT:
HOW WAS THE INCIDENT HANDLED?
Was an Emergency/Safety Control Procedure used?
Yes
No If No, Proceed to
Next section
37
*
<> COMPLETE THIS SECTION ONLY IF ECP OR SCP WAS USED: <>
Starting Time of Procedure:
Describe the Procedure Used:
Ending Time:
Why was the Procedure used?
*
Has this type of behavior occurred with this person before?
Yes
Is it likely that this behavior will recur?
Yes
No
Is there a behavioral ISSP?
Yes
No Was it implemented?
Comment:
No
Yes
No
Measures to be taken or suggestions for preventing a recurrence of this incident:
Report Written By (print/type name):
DATE REPORT WRITTEN:
SIGNATURE OF PERSON COMPLETING REPORT: _________________________________
TO BE COMPLETED BY SUPERVISOR:
Follow-up action requested:
No Follow-up Necessary
Additional Training Needed
Comments:
IDT Meeting/Review Necessary
Other:
Person Responsible for Follow-up:
Follow-up Action Completed:
If Follow-up is not completed in this section, indicate where documentation of Follow-up can be
located:
Date Completed:
Completed By:
Signatures:
Date:
Nurse:
_______________________________________
________________
Case Manager:
_______________________________________
________________
Supervisor:
_______________________________________
________________
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Host Home Provider Contract Responsibilities
As an independent contractor with Overture, you will sign a contract agreeing to provide
services for the person in your care. This contract details the agreement between you and
Overture to provide services. Overture will assist in scheduling trainings and providing
documentation reminders, however, it is your responsibility to keep your information updated
and current. Required documentation and training includes but is not limited to:
● A copy of your current Driver’s License.
● A copy of your Social Security Card.
● Proof of Hepatitis immunization or a signed waiver: If you choose to be
immunized, you pay for this immunization.
● Automobile Insurance: with a minimum of $300,000 coverage.

Completed Vehicle Inspection Form.
● Homeowner’s or Renter’s Insurance: with a minimum of $300,000 coverage.
● Professional Liability Insurance: with a minimum of $500,000 coverage.
● Medication Administration Training
● Signs and Symptoms of Illness and Infection Control Training
● First Aid and CPR Training
● Physical and Non-Physical Crisis Intervention Training
●Your Back-up Service Providers (BUSP): Anyone who provides back-up care for a
person in Overture’s services must be approved by Overture Administration. Prior to
providing care, they must fill out a release for a background check; sign a statement of
confidentiality and evidence of current Medication Administration training, First Aid and
CPR. While Overture will assist you in locating a BUSP, provide the appropriate forms
and training schedules, you are responsible for ensuring your BUSP’s are appropriately
trained and approved.
Please see the Overture Human Resources Department if you have any questions about this
process.
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ACKNOWLEDGMENT OF RECEIPT
I HAVE RECEIVED A COPY OF THE OVERTURE HOST HOME PROVIDER
HANDBOOK. I UNDERSTAND THAT I AM TO BECOME FAMILIAR WITH ITS
CONTENTS AS IT OUTLINES MY RESPONSIBILITIES AND PROVIDES
GUIDELINES FOR THE CARE OF THE PEOPLE IN OVERTURE’S SERVICES.
I FURTHER UNDERSTAND THAT MY CONTRACT AS AN INDEPENDENT
CONTRACTOR WITH OVERTURE IS TERMINABLE AT WILL, SO BOTH THE
ORGANIZATION AND I REMAIN FREE TO END OUR WORK RELATIONSHIP AT
ANY TIME. I ALSO UNDERSTAND THIS HANDBOOK REPRESENTS BRIEF
SUMMARIES OF ORGANIZATION GUIDELINES WHICH ARE SUBJECT TO
CHANGE WITHOUT PRIOR NOTICE, SO THIS HANDBOOK MAY NOT BE ALLINCLUSIVE. I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS AND
CLARIFY INFORMATION IN THIS HANDBOOK.
FINALLY, I UNDERSTAND THAT NOTHING IN THIS HANDBOOK CREATES AN
EXPRESSED OR IMPLIED CONTRACT OF EMPLOYMENT BETWEEN THE
ORGANIZATION AND ME.
_________________________
Host Home Provider Name
_________________________
Host Home Provider Signature
____________
Date
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Overture Host Home Provider Manual Competency Quiz.
HHP Name:___________________________
Date_________________________________
Grade_________________
1.
Give a brief description of Overture’s mission
2.
What does non-Aversive treatment mean?
3.
Describe what a proper relationship would be between a HHP and the
person in services.
4.
List 3 of the person’s rights listed in the manual:
5.
What is the purpose of the Human Rights Committee?
6.
When are fire drills due for each person in services?
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7.
What is an IP? Why is it so important?
8.
What is your responsibility regarding the personal needs money of the
person you serve?
9.
List 3 items required while transporting the people in your care:
10.
Describe the on-call notification process for Overture.
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