West Office 12630 N. 103rd Ave. Ste. 123

Sun City, AZ 85351 623.792.8112

Fax 623.792.8117 AlexA@ITC-AZ.com

Central Office 1241 E. Washington Street, Ste. 101

Phoenix, Arizona 85034 602. 253. 5480

Fax 602. 253. 5512 RodM@ITC-AZ.com

East Office 1345 E Main Street, Ste. 110

Mesa, Arizona 85203 480. 969. 5480

Fax 480. 969. 5512 BrianF@ITC-AZ.com

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Part 1 – Introduction ....................................................................................... - 3 - Introduction ……………………………………………………………………………………….… - 3 - Purpose of Handbook……………………………………………………………………….…. . . - 3 - Mission Statement…………………………………………………………………………………. - 3 - Value Statement……………………………………………………………………………………. - 3 - Vision Statement……………………………………………………………………………….…… - 3 - Part 2 – Being an Employee of ITC ....................................................................... - 4 - Equal Employment…………………………………………………………………………………. - 4 - Working Principles & Attitudes………………………………………………………….………. . - 4 - Employment is At-Will…………………………………………………………………………. . . . - 4 - Working Ethically……………………………………………………………………………..……. - 5 - Outside Employment………………………………………………………………………..……. . - 5 - Appearance…………………………………………………………………………………..……. . - 5 - Rules of Conduct……………………………………………………………………………..……. - 5 -

A. General Rules of Conduct…………………………………………………………… - 5 - B. Specific Rules of Conduct…………………………………………………………… - 6 - C. Conduct for Which Employees Will Be Disciplined…………………………..…. . - 6 -

Gifts – Borrowing Policy………………………………………………………………………..…. - 7 - Employee Training……. ………………………………………………………………………..…. - 7 - Transportation Policy……………………………………………………………………………..…. - 8 - Smoking Policy…………. ……………………………………………………………………. . …. - 8 - Drug Free Workplace…. ……………………………………………………………………….…. - 8 - Respectful Work Environment (Includes Sexual Harassment & Molestation)………. . ……. - 8 - No-Solicitation/Distribution Policy……………………………………………………………..…. - 9 - Attendance…………………………………………………………………………………………… - 9 - Discipline………………. …………………………………………………………………………... - 10 -

A. Oral Warning. …………………………………………………………………….…. - 10 - B. Written Warning………………………………………………………………..……. - 10 - C. Suspension. . . ………………………………………………………………………. - 10 - D. Discharge…. …………………………………………………………………………. - 10 -

Part 3 – Employment Information ............................................................... - 11 -

Hiring Practices…………………. . ………………………………………………………………. - 11 - Personnel Records…………………………………………………………………………..……. - 11 - Classification of Employment…………………………………………………………………. . . . - 11 - Probationary Period…………………………………………………………………………. . . …. - 11 -

A. Office Hours. ……. …………………………………………………………………. - 11 - B. Training………. . ……………………………………………………………………. - 11 - C. Timecards and Service Documentation……………………………………..……. - 12 -

Rehire……………………………………………………………………………………………. . . . - 12 - Insurance……………………. . . …………………………………………………………………. . . - 12 - 401(K)………………………………………………………………………………………………… - 12 - Termination of Employment Relationship……………………………………………………. . . . - 12 -

A. Voluntary. ……………………………………………………………………………. - 13 - B. In-Voluntary…. . . …. …………………………………………………………………. - 13 -

Employee Grievance Procedure……………………………………………………………….… - 13 - Exit Interview……………………………………………………………………………………. . . . - 13 - Employment Verifications and References. …………………………………………………. . . . - 13 -

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Part 4 – Employee Compensation Procedures and Schedule .................. - 14 -

Compensation………………………. . …………………………………………………………. . . . - 14 - A. Pay Periods……………. …………………………………………………………. . . . - 14 - B. Overtime/Call-In Pay/Personal Leave/Funeral Leave/Jury Duty Leave/Voting. - 14 -

Holidays……. ……………………………………………………………………………………. . . . - 14 - Unpaid Time Off . . . ………………………………………………………………………………. . . . - 14 - Pay Period Schedule . . . …………………………………………………………………………. . . . - 15 - Timecards…………. ……………………………………………………………………………. . . . - 16 - Respite Hours…………………………………………………………. . ………………………. . . . - 16 - Habilitation Hours………………………………………………………………………………. . . . - 16 - Habilitation Notes………………………………………………………………………………. . . . - 17 - Attendant Care Progress Notes………………………………………………………………. . . . - 18 - ITC Documentation………………………………………………………………………………… - 18 -

Part 5 – Performance & Evaluations ........................................................... - 19 - Employee Performance Evaluation………………………………………………………. . …. . . . - 19 - Periodic Member Evaluations………………………………………………………………. … . . - 19 -

Part 6 – Policies for Working with Members .............................................. - 20 - HIPAA………………………………………………………………………………………………….. -20- CPR and First Aid………………………………………………………………………………. …. . . - 20 - Respite and Double Respite . . ………………………………………………………………….. . . . - 21 - Habilitation and Double Habilitation . . …………………………………………………………. . . . - 21 - Providing Service for Siblings of ITC Members. …………………………………………. ... . . - 21 - Day Program and Transportation. . ……………………………………………………………. . . . - 21 - Attendant Care and Housekeeping. . …………………………………………………………. . . . - 22 - Double Dipping…. ………………………………………………………………………………. . . . - 22 - Home Certification…………. . ……………………………………………. ……………………. . . . - 22 - 24 Hour Shifts…………………………………………………………………………………….….… - 22 - Non Provision of Service (GAPS)……………………………………………………………. ... . . . - 22 - Positioning and Ambulation of Members…. ………………………………………………. . . . - 23 - Responding to Seizures…. ……………………………………………………………….…….. . . . - 23 - Swimming Pools/Bodies of Water………………………………………………………………….. - 23 - Major Health Problems. . . ………………………………………………………………………. . . . - 23 - Incident Reports. . …………………………………………………………………………..……. . . . - 24 -

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Part 1 – Introduction Introduction You are provided this information on Personnel Policies and Procedures to assist you and ITC (also referred to as ITC) in a consistent flow of operations. The information provided should increase your understanding of the Policies and Procedures outlined for ITC. Our objective is to maintain and assure compliance throughout this corporation. This handbook does not constitute a contract of employment, or offer to contract. This handbook is a reference guide for employees. It is the responsibility of each ITC Employee to become familiar, acknowledge and understand these Policies and Procedures. We welcome any suggestions which will keep our Policies and Procedures up to date or improvements to better serve our members. The selected Policies and Procedures contained in this handbook are for general information, use, and guidance. They are directed specifically to our employees. The Policies and Procedures described in this handbook have been implemented by ITC, which may change or revise these Policies and Procedures at any time as it deems appropriate, without prior or written notice, and without discussion or negotiation. For those cases in which federal or state law is more stringent than the policies included in this handbook, the law will take precedence. Remember you are the most important person in providing quality service to our members. We hope that this information assists you in providing the best possible service to our members and enables you to work effectively within ITC. Purpose of Handbook This Handbook is provided to you as an orientation guide and is intended as a source of information only. Nothing in this handbook is to be taken as a contract of long term employment. These are general guidelines. The policies and procedures contained in this handbook may be changed, altered, modified or discontinued at any time and without prior notice at the discretion of ITC. Keep in mind that your employment is subject to the terms and conditions set out in the ITC Employment Application and clearance with the Arizona State Department of Public Safety Fingerprint Clearance Card Unit. The Employee Handbook is not intended to alter or modify the at-will employment relationship entered in by you and ITC. The Employee Handbook is intended to provide you with additional information about ITC and its relationship with its employees. Your at-will employment at ITC is terminable at the option of either you or ITC. Any modification of this at-will relationship must be in writing, signed by an ITC Manager and specifically identified as a modification of the at-will employment relationship. You should not rely on any representations regarding your employment which are not contained in the Employment Application or the Employee Handbook unless it is in writing, signed by an ITC Manager, and specifically identified as a modification of the at-will employment relationship. If at any time during your employment with ITC you have a belief or understanding that your at-will employment relationship with ITC has been changed, altered, or modified, please contact your ITC Manager for clarification of your employment status. Mission Statement To provide a quality service that ensures safety, compassion, knowledge, and care by listening and helping our members through consistency, teamwork, and high ethical standards. Value Statement Reliability, commitment, compassion, respect, hard work, and encouragement are the values towards which our company's employees strive. It is these values that give ITC a solid reputation in the Home Healthcare Industry. These are the Standards of Excellence for all ITC employees. Vision Statement All employees are required to complete a two hour one-on-one orientation with a member care coordinator prior to starting their employment with ITC. In addition, caregivers are required to pass a criminal history background check, article 9 training, and become certified in CPR and First Aid and ongoing training throughout the year. ITC caregivers go above and beyond the call of duty. This means ITC expects the staff to make the extra effort to ensure our members are receiving the highest level of care. Our quality assurance program is state of the art and all caregivers are evaluated regularly to ensure that they are meeting our standards of excellence.

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Part 2 – Being an Employee of ITC Equal Employment Opportunity ITC is an equal opportunity employer and does not discriminate against employees or job applicants on the basis of race, religion, color, sex, age, national origin, sexual orientation, disability, veteran status, or any other unlawful criterion. ITC will:

1. Recruit, hire, train and promote persons in caregiver positions without regard to race, religion, color, sex, age, national origin, sexual orientation, disability, veteran status, or any other status or condition protected by applicable state law.

2. Ensure that all personnel actions such as agency-sponsored training, social and recreational programs

will be administered without regard to race, religion, color, sex, age, national origin, sexual orientation, disability, veteran status, or any other status or condition protected by applicable state law.

If any employee has a suggestion, problem, or complaint with regard to equal employment he/she should contact their ITC Manager. Working Principles & Attitudes The primary concern of each employee must be to provide the highest quality of service to each of our members. Each member is entitled to respect and understanding. They are also able to give input, either verbally or through written documentation, about their personal needs. Cooperation, respect, friendliness, and thoughtfulness shall be displayed towards fellow employees. Honesty, trustworthiness and professionalism are expected at all times in all your activities and interactions with others as you represent ITC. Any time there is a difference of opinion between the member and the caregiver, it shall be discussed privately.

• At all times you shall respect the privacy and dignity of each person whom is affiliated with ITC. • You shall encourage and promote the involvement of family members and friends as a natural support

system for all members served. Working together, we as a company can achieve far more than we can separately. Each of us brings something special and unique to ITC and we make it a daily practice to seek out, encourage, and respect the values that we and our members bring ITC. Our members well being & satisfaction is critical to our success. We can accept no less! Employment is At-Will At-will employment can be terminated by either party, at any time, and for any reason. This includes termination with or without cause and with or without prior notice. Additionally, employees are asked to voluntarily terminate their position when and if the member chooses another caregiver, member’s support plan is disapproved, or member becomes deceased. All jobs are based on “Merit” not seniority. Nothing is guaranteed but earned. Any oral statements, promises, or assurances to the contrary are not binding on the employer and should not be relied upon by the employee or job applicant. If you believe such assurances have been made, ask your ITC Manager for confirmation. ITC will not be responsible for, and will not be bound by, any statements that are not affirmed in writing by ITC Management. The at-will status of the employment relationship shall not be altered, absent a written affirmation of such change signed by your ITC Manager and specifically identified as an amendment to the employment at-will relationship. Apart from those policies as required by law, ITC may change its policies and practices at any time without prior notice or negotiation.

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Working Ethically As an employee, you are expected to devote your best efforts and attention to the performance of your duties. You are expected to use good judgment to adhere to high ethical standards and avoid situations that create an actual or potential conflict between your personal interest and interest of ITC or the members. A conflict of interest exists when your loyalties or actions are divided between the interests of ITC, the member and/or another competitor. While it is not practical to describe every potential conflict of interest that could develop, some of the more common conflicts to avoid are noted below.

• Working for a competitor or member or engaging in self-employment in competition with the Company. (see section on Outside Employment)

• Disclosing confidential company information (e. g. , disclosing personnel records, phone lists, etc. ), or

using confidential company information for personal gain or for the detriment of ITC. • Working for a member and accepting gifts or borrowing in any form from them (see Gifts – Borrowing

Policy) Outside Employment ITC does not wish to limit your outside activities, however, should an employee hold another job, paid or unpaid, ITC requires acknowledgement in writing to the corporate office detailing the duties and scheduled hours of work to assure there is no conflict of interest with ITC employment. If ITC management feels this outside employment is causing a decrease in work performance, ITC management may put employee on probation or take disciplinary action up to and including termination. Appearance ITC expects its employees to dress appropriately at all times and wear their ID badges while working. Your appearance should be neat and clean so that the person you work with will have a favorable impression of your capabilities. Always be prepared to work and have your member folder handy (which is provided by ITC) with the necessary paperwork for the member. The care you give, the way you dress, and your concise and timely paperwork are your top priorities at ITC. Make sure that you understand your job assignment, and if you have any questions, ask your ITC Manager. Make sure you read and understand the Individual Support Plan of the person(s) you provide service to. Remember, you are there as a professional; always keep in mind that while you are working with the person you give care to, you work for ITC. Rules of Conduct A. General Rules of Conduct We recognize that for most employees discipline is not an issue. However, we feel that you have a right to know what we expect of you. Therefore, we require you to familiarize yourselves with all ITC rules and regulations pertaining to your position and duties, as well as overall ITC policy, and to abide by these rules and regulations. For Administrative, Professional, and Supervisory staff you are required to follow and enforce ITC policies consistently. The following Rules of Conduct are presented as a guideline to all employees to establish professionalism and safety within ITC. All rules and regulations may be supplemented to comply with federal, state and local regulations or any changes in ITC policy. Violation of these rules may result in discipline, ranging from verbal or written warnings to termination. You must comply with standards of conduct that ITC has established. Work rules are necessary for good management, employee safety, effective work, and fairness. Listed below are examples of unacceptable conduct. The list below should not be interpreted as a complete list, as it would be impossible to list every example of unacceptable conduct in the work place, but should give concrete examples of what is considered unacceptable for ITC Employees.

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B. Specific Rules of Conduct You must adhere to the following rules of conduct. Violations of these rules will result in discipline up to and including termination at the discretion of ITC. The list is not intended to be all inclusive; there may be other offenses which warrant disciplinary action, including termination.

a. No employee will be in unauthorized possession of any property of ITC, its members or employees or attempt to remove such property from ITC premises.

b. Employees will perform all work in a professional and safe manner. Employees must comply with all

applicable safety regulations and procedures.

c. Employees will not remove from ITC premises, or disclose to others, information in ITC records or relating to ITC matters without prior written authorization.

d. The possession on ITC premises of a firearm or a weapon of any kind is prohibited.

e. The use, sale, or possession of illegal drugs, reporting for work or working while under the influence of

illegal drugs or alcohol, and the use or possession of alcohol while on the job or conducting ITC business is prohibited.

f. ITC believes that your work environment should be safe, secure, and free from harassment. To

accomplish this, you must act in a professional manner toward fellow employees, members and members of the larger community. To maintain confidentiality it is important that you follow ITC’s rules of conduct.

g. While providing services for your members; the use of mobile phones (including texting), personal digital

assistants (PDA), or any other electronic devices, for personal use, is strictly prohibited. This includes while driving. This is to ensure the effectiveness of services provided to our members. ITC employees are asked to keep these devices at home or turned off.

h. ITC employees will be assigned an identification badge. This badge will contain your name, photo and employee title. ITC requires their employees to wear an ID badge, and the badge must be in plain view while providing services with your member. If your ID badge is lost or stolen, you must obtain a replacement. Failure to wear your ID badge may lead to disciplinary action.

C. Conduct for which employees will be disciplined The following types of conduct will result in discipline up to and including termination. The type of discipline will depend on the specific facts and circumstances surrounding the violation. However, you should remember that employment with ITC is at will, and either you or ITC can terminate your employment at any time, with or without cause. Grounds for disciplinary action:

a. Unsatisfactory job performance.

b. Malicious or willful misconduct or destruction or damage to ITC property or supplies, or to the property of another employee, a member, or a visitor.

c. Stealing or removing ITC property or property of another employee, a member, or a visitor without

permission.

d. Obtaining your job by giving false or misleading information; falsifying any employment documents or records, including time records; and other acts of dishonesty.

e. Bringing or possessing firearms, weapons, or other hazardous or dangerous devises or substances onto

ITC or member property.

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f. Possession, use, or sale of alcoholic beverages or illegal drugs on ITC or a member’s property, or reporting for duty while under the influence of alcohol or illegal drugs.

g. Refusal to perform tasks as designated in the Individual Support Plan.

h. Fighting (physical or verbal) on ITC’s property or while with a member.

i. Abusive treatment of others (physical and/or verbal abuse) including: harassing, threatening, or intimidating another employee or a member, or attempting to coerce a supervisor.

j. Failure to follow Agency procedures for maintaining confidentiality of ITC, personnel or member

information.

k. Failure to contact your ITC Manager when you are not going to report to work. It is your responsibility to call, not someone else’s.

l. Pleading guilty to or being convicted of any crime other than a minor traffic violation.

m. Falsifying records or time reporting.

n. Violation of the rights of persons being served.

o. Failure to pass Federal and State Fingerprint Clearance Criminal Records Check.

p. Falsification of any notes including Doctor’s notes.

Gifts – Borrowing Policy Accepting gifts or gratuities from ITC members, their families, or business representatives except as provided herein is not permitted. Doing so will result in disciplinary action, up to and including termination. On occasion, you may encounter a situation where refusing to accept a gift from a member may offend or insult them. If the gift is of little or no monetary value (such as fruit, flowers, baked goods, etc. ) you may accept it. However, if the value of the offered gift would make acceptance inappropriate, politely refuse the gift, then notify your supervisor of the occurrence after leaving the member’s home. Acceptance of money from a member or a member’s family member is never appropriate. “Borrowing” of any item (including money) from a member or their family members will be considered theft, and will be treated as a serious matter. Borrowing (even with the member’s agreement) may result in disciplinary action. Employee Training At ITC, all employees are required to continue developing their skills and increase their knowledge by participating in educational training opportunities related to their work as approved or directed by ITC. Caregivers are responsible for attending and successfully completing State required training in order to better serve our members. Requirements for caregivers at ITC before employment are certification in CPR, First Aid, Article 9, and ITC Orientation. Unless approved in advance in writing from an ITC Manager, completion of training is considered the employee’s responsibility to attend and successfully complete such requirements. Training is not a paid activity. Successful completion or non-completion will be reflected on the employee’s work evaluation. In agencies providing services for state-funded programs, caregivers must complete 6 hours of continuing education per year. ITC provides trainings for ongoing caregiver education. A training certificate will be placed in the employee file. At all times you shall ensure the services provided and the work performed will be in strict compliance with all applicable rules, regulations and laws governing the delivery of services provided by ITC.

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Transportation Policy Employees at ITC are not required to provide transportation for members. However, there are circumstances where the ITC member will need transportation to and from various locations which may include but is not limited to the doctor’s office, grocery store, therapy visits, etc. There are five steps you must complete in order be eligible to transport members.

1. Complete a driver evaluation 2. Complete a satisfactory vehicle inspection (It is mandatory that your vehicle is kept in the same condition

as it was on the date of the initial inspection) 3. Provide a copy of your valid driver’s license 4. Provide a copy of your current automobile insurance policy (this must be for the same vehicle used in the

vehicle inspection) 5. Provide a copy of your current vehicle registration (this must be for the same vehicle used in the vehicle

inspection)

In the event that a vehicle is used to transport a member you are required to carry your own valid Arizona state minimum coverage insurance. When transporting a member you agree to practice safe driving procedures including: no phone calls, no texting, no eating, etc… In addition, you agree to not hold ITC, liable for any personal / auto / property damages. ITC employees are only allowed to drive the members’ family vehicle if it has insurance & registration and the family agrees not to hold ITC liable for any damages. If transporting a member during HCBS services (Respite, Habilitation, Attendant Care) you will bill the driving time as Respite, there is no mileage reimbursement. If transporting during a day program (DTA, DTT, DTS), personal vehicles will not be used. ITC will provide state certified company vehicles for all day program services. If you are permitted to drive a company vehicle under certain conditions, like the summer program, you must fill out and turn in a daily driving log. Only ITC caregivers and members are permitted to be transported in the company vehicle. If a member has an enhanced ratio; that enhanced ratio will be in effect for all transportation provided during the day programs. If there is an accident while driving a company vehicle an incident report must be filled out along with a signed written statement and photographs of the damage. Any and all other incidents while driving a company vehicle must be reported as well, such as a ticket, flat tire, or a crack in the windshield. For Administrative, Professional and Supervisory staff, you must use the company vehicle to transport members, attend intakes, or other member appointments. If the company vehicle is not available and you need to use your own personal vehicle, office staff must fill out a mileage form and be given prior authorization by an ITC manager. Remember the priority is to use the ITC vehicle. REMEMBER IF THERE IS A LIFE THREATENING SITUATION, DIAL 911 IMMEDIATELY and then contact your ITC representative. If you do not want to transport members or if for any reason you cannot complete one of the aforementioned requirements you will not be eligible to transport members and must sign a non-driver waiver. Smoking Policy A mutually comfortable environment for our employees and members depends upon the thoughtfulness and cooperation of both smokers and non-smokers. ITC has a responsibility to provide and maintain a healthy working environment. Research has proven to show that smoking is a serious health risk to smokers and those around them. Accordingly, smoking is not permitted in any ITC office or while working with any ITC members. Drug Free Workplace It is the commitment of ITC to provide a work environment that is free from the use, possession, sale or distribution of illegal drugs or controlled substances and from the improper or abusive use of legal drugs or alcohol. Just as importantly, ITC requires that all employees perform their job duties without having unacceptable levels of legal drugs or controlled substances or any levels whatsoever of illegal drugs or alcohol within their system. In order to reach its goal of a drug free workplace, ITC will utilize every reasonable measure available, including drug and alcohol testing of employees. If you have an accident while on the job, a drug and/or alcohol test maybe

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required. ITC has a zero tolerance policy for any and all illegal drug use as well as alcohol consumption on the job. Any employee who violates this policy is subject to disciplinary action up to and including termination. Respectful Work Environment It is ITC policy that no employee shall harass any co-worker on the basis of race, color, religion, gender, national origin, ancestry, age, medical condition, disability, marital status, sexual orientation, or veteran status. ITC does not discriminate and as an ITC employee you are not to discriminate against anyone. We do not tolerate violence or the threat of violence in the work place. We take threats of violence seriously. We do not discuss information of a private nature “gossip” concerning any employees of this company on or off the job. There will be absolutely no retaliation allowed. Harassment includes but is not limited to: verbal, physical, and visual harassment; solicitation of sexual favors; unwelcome sexual advances, and creating or maintaining an intimidating or hostile work environment. Was That Sexual Harassment?

1. Must be unwelcome 2. Reasonable person standard 3. Physical harassment 4. Back rubs and other touchy-feely behavior 5. In your personal space 6. Bulletin boards, the walls, and other areas of visual sexual harassment 7. Provocative clothing 8. Stripping telegrams 9. Vulgar jokes 10. Flirting, propositions, and compliments 11. Profanity and obscene gestures 12. No downloading/viewing of pornography

If you feel you have been harassed or have witnessed such harassment, you are strongly encouraged to report such incidents to an ITC Manager. You will not face retaliation of any kind if you report or complain about harassment. ITC will investigate all reports of harassment. If warranted, the company will take appropriate corrective action to maintain and foster a work environment free of harassment. Any employee who violates this policy is subject to disciplinary action, up to and including termination. If you make a false allegation against any individual/employee, you may be subject to immediate termination and or civil litigation. No-Solicitation/Distribution Policy Solicitation by employees for funds, membership, or individual commitment to outside organizations or causes, or distribution of literature from outside organizations is prohibited during working time, or if such solicitation takes place on ITC premises, a member’s home, or otherwise interferes with work being performed by any employee. Working time is the time when an employee’s duties require that he/she be engaged in ITC work tasks, but does not include an employee’s own time, such as time before and after a shift. Attendance ITC’s primary goal is to provide exceptional care for the member in an environment that promotes positive growth for both the member and caregiver. Quality care includes uninterrupted services from familiar staff; therefore, regular attendance helps promote our objective to provide quality care. Employees are expected to work as scheduled per the member’s needs. Absenteeism and tardiness reflect on an employee’s overall attendance record. It is important that you report to work as scheduled at all times. Each person is served with a regular service schedule. The trading of hours or assignments is not permitted without the advance written consent of the ITC Manager. Occasionally the employee may be asked to adjust his/her schedule to ensure care of the person served. If your attendance reflects unacceptable absenteeism

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and/or tardiness, the ITC Manager may meet with you to discuss attendance and/or tardiness. If you display poor or irregular attendance and/or tardiness, the ITC Manager may take such action as he or she deems necessary, including termination. When it is necessary to be absent or tardy, the employee must notify the ITC Manager prior to the start of the employee’s scheduled shift and as far in advance as possible. It is solely the employee’s responsibility to provide notice of absence or tardiness. It is not acceptable for an employee’s spouse, relative and/or friend of ITC to report the absence or tardiness. In an event of absence (other than a true emergency) you will need to notify the ITC office a minimum of 24 hours in advance. Any irregular attendance, unexcused absences or unreported absences may result in disciplinary action up to and including termination. An unexcused absence is one in which the employee calls the office the day he/she is out and gives a reason to ITC. ITC considers an absence unacceptable in which a spouse, relative, or friend of ITC reports the employee’s absence. An unreported absence is one in which the employee does not contact ITC by any means the day he/she is out. If you are out due to an injury or illness for more than two (2) consecutive days, ITC reserves the right to request a doctor’s statement of illness and/or a release to come back to work. For Administrative, Professional and Supervisory staff, it is beyond your scope of authority to override a Doctor’s note. Always follow the Doctor’s note. Discipline ITC expects high quality work from its employees, and expects you to conduct yourself in a business-like manner. If discipline is necessary, the nature and circumstances of the incident will determine the appropriate disciplinary action to be administered. Disciplinary action may take the form of an oral warning, a written warning, suspension, or termination, all at management’s discretion. A negative performance evaluation shall constitute a written warning. ITC has the right to determine what discipline is appropriate. Disciplinary action may consist of any of the following, although there is no standard series of disciplinary steps ITC must follow. In certain circumstances, your conduct may lead to immediate discharge. A. Oral Warning:

You will receive a verbal reprimand in private by the ITC Manager who will point out an unsatisfactory element of job performance. The verbal reprimand is intended to be corrective or cautionary. The ITC Manager will record the date and content of the reprimand and documentation will be placed in the personnel file for future reference.

B. Written Warning: The written reprimand will be issued and signed by both you and the ITC Manager. A copy will be given to you and a copy will be placed in your personnel file.

C. Suspension: The employee will be informed of the specific offense, and a written statement will be placed in his/her personnel file. The written statement shall include the date and specific nature of any previous warnings and/or disciplinary action, as well as the date, time and specific nature of the incident for which the employee is receiving the instant suspension. The written warning shall include the possibility of future disciplinary action up to and including termination.

D. Discharge: The employee will be informed of the specific offense, and a written statement shall be placed in his/her personnel file. The statement shall include the date, time and specific nature of any previous warnings and/or disciplinary action, as well as the date, time and specific nature of the incident for which the employee is being terminated.

Discipline shall be imposed on a case-by-case basis. In some situations, immediate termination may be the only appropriate penalty. In other circumstances, the ITC Manager may impose a less severe form of discipline. There

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is no guarantee of any specific penalty for any specific offense. Further, your employment with ITC is as an at will employee. As such, you may be terminated at any time, with or without cause. Part 3 – Employment Information Hiring Practices ITC is an equal opportunity employer. This means that employment decisions (including termination and discipline) are based on merit and business needs, not on race, color, citizenship status, national origin, ancestry, sex, sexual orientation, age, religion, creed, physical or mental disability, physical handicap, marital status, or veteran status. ITC complies with applicable laws and regulations regarding reasonable accommodation for handicapped and disabled employees. All applicants must complete an application form and an interview and orientation shall be conducted. Applications shall remain active for up to sixty (60) days. Selection of employees is based on, but not limited to, the applicant’s education or training, proven job skills, employment stability, character, and ability to perform the essential functions of the job with or without reasonable accommodation. All employees must be cleared by the Arizona State Department of Public Safety Fingerprint Clearance Card Unit, E-Verify, and Office of Inspector General. Qualified applications shall be extended a conditional offer of employment. Background Checks All caregivers must obtain and maintain a Class 1 Fingerprint Clearance Card, sign a Criminal History Affidavit, be subject to Office of Inspector General, Central Registry and Child Protective Services Background checks and E-verify background check. Three personal references will also be called to verify character and work ethic. Personnel Records ITC maintains personnel records on each employee. These files are kept by ITC Managers and are available for review only by the individual employee and his/her management. Please contact your ITC Manager directly if you wish to review your file. Under no circumstances may the files or any portions thereof be removed from the area where they are maintained. A Manager must be present when a file is reviewed. Employees may make copies of their resume or documents containing their signature. Documents other than the resume that do not contain the employee’s signature may not be copied, unless required by state law. It is the employee’s responsibility to keep management informed of address changes, emergency contacts, W-4 changes, paycheck changes, etc. , so that personnel records may be kept current. Classification of Employment Hourly employment in a caregiver position is dependent upon member needs, availability, and scheduling. Each Individual Support Plan is scheduled and approved annually by a team from the Arizona Department of Developmental Disabilities, which means each support plan is based on the needs of each specific member. Probationary Period The probationary period for introductory employees shall be the first three (3) months of employment. During this period, the employee will have an opportunity to learn and adjust to his/her new position. During the probationary period ITC will evaluate the employee to determine whether he/she is able to meet the requirements of an ITC employee. After the completed 90 day probationary period an Employee Work Evaluation will be completed by ITC, and conducted every anniversary hire date, thereafter. Successful completion of your introductory period is not a guarantee of continued employment, other than as an at-will employee as otherwise discussed herein. The probationary period may be extended at ITC’s discretion or due to a break in service by the employee during the probationary period. As explained earlier, during your probationary period, and thereafter during the entire course of your employment, you will be an at-will employee. Work Procedure A. Office Hours

Usual office hours are: Monday – Friday 8:00 AM – 5:00 PM.

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An ITC answering machine or phone service provides 24-hour accessibility. Calls are forwarded to an emergency line in the evenings and on weekends for emergency needs.

B. Training

Employees are required to attend and complete training sessions required by the state of Arizona. These trainings will be based on Caregiving Fundamentals and Developmental Disabilities. Employees will be responsible for signing attendance forms and completing all training workshops and tests for such trainings. A training certificate will be kept in the employee file. ITC will offer continuing education. ITC contract with the Department of Developmental Disabilities (DDD) requires caregivers to complete 6 hours of continued education per year. ITC will provide mandatory trainings throughout the year. This will help you achieve the 6 hours required. Article 9 and other trainings outside of ITC will be accepted as part of your 6 hours as well as online training on the ITC website. ITC will insure that you will get opportunities to meet the state requirement of 6 hours.

C. Timecards and Service Documentation

Employees will receive instructions during their orientation in completing proper time reporting. ITC will exercise care in complying with wage determination and hour regulations (set forth by the State of Arizona for each individual support plan). Cooperation of employees will be expected and appreciated. Compensation for incomplete timecards, whether they are late, improperly completed, or submitted subsequent to the date and time due, will be paid the following pay period after corrections have been made. Proper service documentation is submitted with each timecard. Compensation for hours submitted without proper service documentation will be withheld until the pay period following satisfactory completion of documentation. Time sheets are due to the corporate office AZ the day following the last day of the pay period no later than 10:00 AM.

Rehire Employees who are rehired shall be treated as newly hired employees.

Insurance ITC’s insurance plan provides employees and their dependents access to term life, short-term disability, accident, cancer, vision and dental insurance benefits. Eligible employees may participate in the insurance plan subject to all terms and conditions of the agreement between ITC and the insurance carrier. Details of the insurance plan are described in the Colonial Life Plan Description. A Colonial Life plan description and information on cost of coverage will be provided in advance of enrollment to eligible employees. Contact your ITC manager for more information about health insurance benefits. Termination of Employment Relationship ITC strives to provide all employees with fair and reasonable conditions of employment at all times. In order to carry out its business obligations and priorities in the most efficient manner possible, ITC adheres to the principles of at-will employment whereby either ITC or the employee can terminate the employment relationship at any time and for any reason and with or without prior notice. A. Voluntary

If you wish to resign from ITC you must provide a written statement to the ITC Manager. For Caregivers, Administrative, Professional and Supervisory staff this letter must be submitted with proper notice prior to the effective date. It must also state the specific reason or reasons for the resignation. Your resignation will be handled by the ITC Manager. A proper resignation will result in eligibility for rehire. Failure to provide advance notice of resignation as set forth may result in a loss of benefits. Also, an employee must actually work the time between resignation notification and resignation; leave time is not time actually worked. ITC will consider you to have voluntarily terminated your employment if you do any of the following:

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1) Resign from ITC; 2) Do not return from an approved leave of absence on the date specified by ITC; 3) Fail to report to work for two (2) consecutive days without prior notification of absence.

B. In-Voluntary

You may be terminated for poor performance, misconduct, excessive absences, tardiness, etc.

However, since your employment is at-will, you and ITC have the right to terminate your employment for any legal reason or no reason, with or without prior notice to the other. ITC may need to terminate employment because of reorganization, job elimination, economic downturns, or lack of work. Should ITC decide that such a termination is necessary, ITC will try to give as much advance notice as is possible.

Employee Grievance Procedure In an effort to provide a responsive listener for anyone who has a complaint, the following procedure is provided. The employee will be given an honest and fair review of his/her complaint without reprisal.

1. The individual or their agent shall file a written statement listing the reasons for the grievance, the person(s) involved, and suggestions for a possible solution.

2. ITC shall distribute within 5 working days a copy of this written grievance to all parties listed. Included with this statement, ITC shall specify a date, time, and location for a hearing of the grievance.

3. All involved parties (including the service recipient and their agent) may attend the hearing and are encouraged to do so.

4. All parties shall meet with the intent of coming to a compromise with which all parties can live. 5. All parties shall be notified at the hearing that a written decision shall be made within (10) working days

and that written notification of the decision shall be given to each party listed in the grievance. 6. It is the responsibility of each party involved to respond to the grievance in a timely and productive

manner.

Exit Interview All employees who leave employment with ITC through resignation or termination shall be given an exit interview. At the time of the exit interview, the employee shall return all ITC property in their possession the person conducting the exit interview. Employment Verifications and References ITC is extremely concerned about the accuracy of information provided to individuals outside the company regarding current or former employees. Consequently, no employee may provide, either on or off the record, any information regarding current or former employees to any non-employee. This includes letters of reference. Your ITC Manager should be promptly advised of any formal or informal requests for information about current or former employees. Your ITC Manager will normally verify only a former employee’s dates of employment and position or positions held. A written disclosure authorization and release is required before any additional information is furnished Part 4 – Employee Compensation Procedures and Schedule Compensation A. Pay Periods Pay periods run bi-monthly and paychecks will be distributed on the 8th and 23rd of each month, except when this day falls on a weekend, in which case the paychecks will be distributed the following Monday. To ensure timely payment for hours worked, time sheets must be turned into the corporate office on the 1st and 16th of each month no later than 10:00 AM. Paychecks are released at 8:00 AM on the appropriate pay date. They WILL NOT be released if timesheets have not been properly completed and submitted. If requested under an unusual circumstance paychecks can be mailed, or may be picked up by proxy with written approval from you. All employees will sign for their paychecks, and proxies (if approved) will also be required to sign.

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B. Overtime/Call-in pay/Personal Leave/Funeral Leave/Jury Duty Leave/Voting Employees are not given overtime, call-in pay, personal leave, funeral leave, jury duty leave, voting leave, and annual leave. The amount of the paycheck represents the full amount of earnings, less deductions. Taxes are withheld to comply with federal, state, and local laws. Should the employee believe there is a computation error in a paycheck; they should notify their ITC Manager prior to cashing the payroll check. This Agency does not give call-in pay, if for some reason you are unable to attend to your job duties, please call the office in advance so we can schedule another caregiver to fill in and complete the allocated hours on the support plan. Remember you will only be paid for hours actually worked and cannot work more hours than the allocated hours on the support plan. Employees called for jury duty must notify their ITC Manager as soon as possible to allow for a replacement for the employee’s scheduled hours. When jury duty assignments do not conflict with work schedules employees will be expected to report for scheduled work. If jury duty by an employee jeopardizes member care, it may be necessary for the facility to seek his/her release from this duty. Holidays ITC caregivers are responsible to care for their members as scheduled. All ITC offices will be closed on the following holidays:

• New Year’s Day • Martin Luther King Day • Presidents’ Day • Memorial Day

• Independence Day • Labor Day • Columbus Day • Veterans Day

• Thanksgiving • Christmas • New Year’s Eve

*Please refer to the ITC yearly calendar Unpaid Time Off With the ITC Manager’s advance written approval, you may be granted time off without pay for occasions of an immediate, nonrecurring nature that must be performed during regular work hours. Time off would typically involve personal matters such as settlement of a home purchase, doctor or dental visits that cannot be scheduled for no-working hours. Pay Schedule for 2013:

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Please refer to the above schedule for times and dates of payroll. The timecards are due no later than 10:00 AM on the 1st and 16th of each month. The pay period schedule is from the 1st to the 15th and from the 16th to the 31st. Billing and Payroll for ITC is processed twice monthly. This means if your timecard is not turned in by 10:00 AM it will not be processed until the following pay period. In order to avoid a delay with your paycheck your timecard must be turned in on time and must be filled out correctly. If you have any concerns or questions regarding your timecard or paycheck please call the ITC office. Timecards

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A timecard must be completed for each member, each pay period. The timecard should be filled out each day that you work with the member in order to ensure accuracy. Fill out the date, time in, time out, and total hours. In order to fill out the service provided write the number of hours, out of the total for the day, spent providing that service. For example, if your total hours for the day were 8 you may have spent 2 hours providing habilitation and 6 hours providing respite. Write these numbers under the service, not just a check mark. Have the responsible person initial each day for the hours worked. You and the person responsible for signing for services should not sign at the bottom of the timecard until the end of the pay period. Proper service documentation is submitted with each timecard including habilitation notes and attendant care progress notes. Compensation for hours submitted without proper service documentation will be withheld until the pay period following satisfactory completion of documentation. Respite Hours Respite hours worked in a day cannot exceed 12. 75 hours. There is no monthly limit for respite hours. Once a year the Division of Developmental Disabilities authorizes a certain number of respite hours for a member. You are required to be aware of this yearly limit for each of your members, as well as how many hours have been used. You will not be compensated for hours worked over the yearly limit. Habilitation Hours Habilitation hours worked in a day cannot exceed 4 hours. Each member has a monthly and a yearly limit for habilitation hours. You are required to be aware of these limits for each of your members, as well as how many hours have been used. You will not be compensated for hours worked over the monthly or yearly limits.

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Habilitation Notes

Habilitation notes must be filled out for habilitation hours worked. They must be submitted on the 2nd of each month, regardless of what day the 2nd falls on. Habilitation notes are required in order to receive compensation for habilitation hours worked. If habilitation notes are not turned in a timely manner you will be notified by ITC staff to turn them in by 10:00 a. m. the following day. If you fail to turn in your habilitation notes again you will temporarily be removed as the habilitation provider for your member and a temporary replacement will cover the habilitation shifts. You will not be eligible to provide habilitation services until you have submitted missing habilitation notes and retaken Habilitation Training provided by ITC. Fill in the number of hours worked each day that month and make sure they do not exceed the allotted monthly hours. Each member with authorized habilitation hours has habilitation goals as part of their individual support plan. For each goal, grade the member’s performance using the key. For the percentage of how often a member is meeting a goal the options are 0 or 0%, 1 or 25%, 2 or 50%, 3 or 75%, and 4 or 100%. Anything between these numbers should be rounded up or down to the closest option. These numbers mean:

• 0% - the member refuses to work on the goal • 25% - the member frequently refuses to work on the goal, requires a lot of help with the goal, or struggles

a great deal when working on the goal • 50% - the member sometimes refuses to work on the goal, occasionally requires help with the goal,

needs frequent prompting in order to work on the goal, or struggles somewhat when working on the goal • 75% - the member needs occasional prompts to work on the goal, or rarely struggles when working on

the goal • 100% - the member always completes the goal independently and without prompting

If your member completes a goal 100% two months in a row or you feel the goal is inappropriate, contact your member care coordinator so that the goals in the member’s individual support plan can be updated. In the box for comments and plans explain the teaching strategies used to work on each goal, their effectiveness, and your plans for improvement. This documentation is required by the state and must be filled out carefully and accurately.

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Attendant Care Progress Notes

Attendant care progress notes must be filled out for attendant care hours worked. They must be submitted on the 2nd of each month, regardless of what day the 2nd falls on. Attendant care progress notes are required in order to receive compensation for attendant care hours worked. For each month worked fill in the number of hours worked under the appropriate day, explain the member’s progress, any behavioral issues or medical issues, and give comments, recommendations and any barriers. This documentation is required by the state and must be filled out carefully and accurately. ITC Documentation ITC time cards, Habilitation notes, Attendant Care notes, letterheads, fax covers, etc… cannot be used for anything other than work related tasks and are the property of ITC. For Administrative, Professional and Supervisory staff, your ITC email account is not to be used for personal use and is only to conduct ITC business. Staff members are not to take any hard or electronic forms or documents out of the office.

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Part 5 – Performance & Evaluations Employee Performance Evaluation ITC is concerned about its employees. It is ITC’s desire to assist in the development of a positive self-image of all employees. It is also ITC’s aspiration to assist in the development and productivity of its employees. Evaluation of work performance is an important part of fulfilling that aspiration. Each employee shall be evaluated by his/her supervisor periodically. The evaluation will consist of a written review, which shall be placed in the employee’s personnel file, and a discussion of the written review with the employee. The employee has an opportunity to discuss any or all written evaluation documentation. He/she will also have an opportunity to sign the evaluation which only acts as acknowledgment that the employee has reviewed the evaluation. By signing the employee does not imply that the employee concurs with the evaluation in whole or in part. The employee will also be given a copy. Subsequent to the initial probationary period, if work performance is unsatisfactory, any employee may be placed on PROVISIONAL OBSERVATION for a period of up to 90 days. Written notice will be provided to the employee, and placed in the employee’s personnel file. It will include reference to the deficiency in performance, and expectations for future performance. The provisional observation may be extended upon consultation with the employee, and the ITC Manager. After provisional observation, if performance is not satisfactory, termination may occur. If performance is satisfactory, the employee will return to his/her regular status. However, regular status is not a guarantee of continued employment, but is understood to be the same at-will relationship discussed in previous sections of this document. See Section 2 – Employment is at will. If at any point work performance is unsatisfactory and the employee has been placed on PROVISIONAL OBSERVATION within the past twelve months, termination may occur. Please note that the PROVISIONAL OBSERVATION discussed here is a response to an unsatisfactory work performance. Specific infractions of rules and the disciplinary action steps that may be taken are discussed under “Rules of Conduct”. Periodic Member/Personal Care Evaluations ITC conducts monthly member service evaluations with the specific ITC member and his/her family, friends and/or any other persons in charge of their well-being. ITC also conducts quarterly home visits for attendant care members at which time a service evaluation is done. This member service evaluation is mandatory and will be used as part of the employee performance evaluation & also a tool to ensure the proper care is being given. If the result of this evaluation is unsatisfactory at any time, disciplinary actions will be taken which can include termination. This is the quality assurance measure ITC management will use to evaluate the job performance of the caregivers. It is also a tool to help ensure that all services are being rendered to a high standard of care. If your member requests a change in caregiver you are required to contact the ITC office immediately.

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Part 6 – Policies for Working with Members Administrative Safeguards Administrative safeguards refer to the policies and procedures used by ITC to comply with HIPAA standards. The Program Director is the designated Security Officer and is responsible for knowing HIPAA regulations and ensuring that office staff and caregivers are trained in and follow HIPAA regulations. The Security Officer also:

• Updates HIPAA policies and procedures. • Oversees the implementation of the policies and procedures contained in this Employee Handbook. • Ensures that all ITC employees are trained in HIPAA and the policies and procedures of ITC. • Reviews activity that takes place at ITC and in the field to detect security risks. • Investigates and responds to security incidents and takes appropriate action in the event of a breech in

security, and eliminates or mitigates any damaging effects. All ITC Employees are required to participate in a formal HIPAA training entitled Confidentiality Awareness. The training involves reviewing the HIPAA rules on the ITC website, and then taking the HIPAA Training Test. Successful completion of the training and test is required in order to work with a member. The Security Officer will review with each test-taker any content associated with a failed item on the test. Anyone receiving a grade less than 80% on the test must repeat the training. The ITC employee is responsible for protecting member information and other sensitive information that they have access to, whether it is in a document, electronic, transmitted, or received. They are responsible for protecting all confidential information that they may overhear or observe. Some examples of privacy violations are discussing member information in a public area without taking reasonable precautions. If, during the course of work, an ITC employee observes or overhears information about a member, they are responsible to keep that information confidential and not share it with anyone. PHI (Protected Health Information) or confidential documents should never be discarded in the garbage. Place in a secure shred bin or use a shredder. ITC caregivers must protect their members PHI by keeping all documents, i.e. HAH notes, in a secure area when not in use. They will have their mobile phones locked if they have their member’s phone number or address programed in their contacts. ITC employees need to take extra precaution to protect personal information. Member PHI is typically released to another party only when the release is requested, in writing, by the member or member’s legal guardian. When a request is received to disclose PHI, the request is reviewed by the Security Officer. Only the minimum necessary amount of information will be disclosed. When an ITC Employee is undertaking a member orientation typically only the Individual Support Plan and Pre-Service Orientation should be disclosed. ITC Employees are required to report any violations of HIPAA standards to the Security Officer. When security incidents are reported or discovered, the Security Officer will investigate the situation and complete an Incident Report. He/she will then institute appropriate corrective measures to help ensure that similar violations do not occur in the future. Corrective measures may include re-education, policy revision, building modification, and/or equipment alterations. Access to PHI is limited to ITC employees, and further restricted by virtue of what information is needed by the employee to complete a job function and/or an orientation training. CPR and First Aid Caregivers are required by the State of Arizona to be CPR (Cardiopulmonary Resuscitation) and First Aid certified, and to keep their certification current and updated. During Orientation, each new caregiver is given the address and phone number of a local CPR/First Aid training center in order to become certified. Caregivers have 90 days to get this certification, but ITC strongly urges all caregivers to obtain it as soon as possible. Caregivers are required to be certified in both areas because there is always a chance they could face a life or death situation, and it is crucial they do not panic, keep composure, and stay calm. There are situations where a

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caregiver may need to use their training to sustain a member until an ambulance or medical aid arrives. They should keep the member in the position they are found, and if the member is conscious, the caregiver should explain the situation to them. In the case of a fire, a caregiver should first and foremost remove the member from the room or house where the fire is located, and then proceed to call 911. The caregiver should also know how to prevent and handle the spread of diseases. The simplest way is for the caregiver to wash his or her hands, especially when they must touch the member or prepare and handle food. However, should a caregiver’s skin be accidentally exposed to blood, they should wash the area immediately with soap and water but NEVER apply bleach to the wound or open exposure. If a CPR or First Aid certification expires, it is up to the caregiver to update this information as soon as possible. Respite and Double Respite When providing respite care your purpose is to provide short term care to relieve the primary caregiver. You are expected to provide supervision and support the member’s emotional, physical, and mental well-being. Any transportation done during this time (for example if you pick the member up from swimming lessons) is still part of the respite service because it is done in order to provide relief to the primary caregiver. Double or triple respite is provided when you care for more than one ITC member in order to relieve the primary caregiver. The maximum number of members you can care for at one time is three. You may only provide one service at a time. Giving respite for one member while giving habilitation for another is not allowed. Ask your ITC manager about compensation rates for double or triple respite. Habilitation and Double Habilitation Habilitation services provide a variety of interventions such as special developmental skills, behavior intervention and sensorimotor development, designed to maximize the function of members. Each member with authorized habilitation hours has habilitation goals as part of their individual support plan. These goals will be designed to:

• Enable members to acquire knowledge and skills • Increase or maintain self-sufficiency of the member • Provide training/assistance in essential activities required to meet personal and physical needs • Maintain the health and safety of the member

You will work on these goals with the member using a variety of teaching strategies and approaches. Habilitation hours are documented in habilitation notes (see pg. 20) which are required by the state to track a member’s progress on their habilitation goals. Double or triple habilitation is provided when you work with more than one ITC member on habilitation goals at the same time. The maximum number of members you can work with at one time is three. You may only provide one service at a time. Giving respite for one member while giving habilitation for another is not allowed. Ask your ITC manager about compensation rates for double or triple habilitation. Providing Services for Siblings of ITC Members Providing services for siblings of ITC members is not authorized or compensated by ITC. If a caregiver is providing respite only for a member it is at the discretion and liability of the caregiver to provide care/supervision for a sibling. When a caregiver chooses to provide care/supervision for a sibling they must first fill out and sign a release form with the ITC office. ITC will not be held liable for any incidents that may occur with siblings. Day Treatment and Training Programs and Transportation Day programs during the summer or after school provide specialized sensory-motor, cognitive, communicative and behavioral training, as well as supervision and as appropriate, counseling, to promote the development of

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skills in independent living, self-care, communication and social relationships. Transportation services to and/or from the day program are provided only if the member’s natural supports cannot provide transportation. Attendant Care and Housekeeping Attendant care and housekeeping services provide a qualified attendant to assist a member to attain or maintain safe and sanitary living conditions and/or maintain personal cleanliness and activities of daily living. The goal of this service is to assist the member to remain in his/her home or participate in community activities. Your duties in providing this service may include:

• Dusting • Cleaning Floors • Cleaning Bathrooms • Cleaning Windows (when necessary to maintain sanitary living conditions) • Cleaning Oven and Refrigerator (when necessary to safely prepare food) • Cleaning Kitchen • Washing Dishes • Changing Linens and Making Beds • Routine Maintenance of Household Appliances • Washing, drying and folding the member's laundry (ironing only if their clothes cannot be worn otherwise) • Shopping for and storing household supplies and medicines • Assistance with showering, bathing, toileting, dressing and shampooing • Assisting with transfer to and from wheelchair and/or bed • Assistance with eating • Assistance with routine nail and skin care • Assistance with self-medication or medication reminders

Attendant care progress notes are required by the state as documentation for providing attendant care. Double Dipping The State of Arizona only pays for one service at a time. If you transport a member to and from therapy, school or any other service that the state pays for you cannot bill for the time the member is receiving the other service. In such cases the time between when you drop off a member and pick them up is your own time to use as you please. If the member cannot be left unsupervised during the service the member’s guardian must schedule the service at a time when they can transport the member. If the service is not paid for by the state you can stay to supervise the member and bill for these hours. Home Certification If your home is certified with the Department of Developmental Disabilities (DDD) you may provide the same service for up to 3 DDD members at a time in your home. If you would like to have your home certified contact your ITC manager. There is a checklist of safety qualifications that must be met in order for your home to qualify. Once you have met these qualifications your ITC manager will submit a request for inspection to the Office of Licensing, Registration, and Certification (OLCR). The OLRC will contact you and set up a time to inspect your home within 30 days. 24 Hour Shifts Under the circumstance that your member needs you to provide a 24 hour shift (Overnighter) it is required to have the Overnight Authorization form signed and dated by the guardian. This authorization form needs to be filled out prior to the date of the shift and can be obtained at the ITC office. Non Provision of Service (GAPS) All scheduled services with DDD members must be provided. This is a state requirement. If you absolutely cannot provide services as scheduled (for example if you are ill or if your car breaks down) you must contact your ITC manager and notify them as soon as possible. ITC will then contact your member or their guardian and offer to send a backup provider until you can again provide services as scheduled.

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Positioning and Ambulation of Member Many members need help moving and positioning themselves from one spot to another, so caregivers must know how to properly move a member. The most important thing to remember is to always support and move the member in the direction of his or her stronger side. If a member is having trouble breathing, moving them into a sitting position can often clear the airway and alleviate breathing problems. When giving a member a bath by permission of guardian, always check the temperature of the water before putting him or her in the bathtub. If the water is too hot or cold, it can cause severe health problems, and remember to NEVER leave a member unattended while they are in the bath. Responding to Seizures If you are providing services for an individual diagnosed with Epilepsy (seizures) it is required that you take a Seizure Management training provided by ITC. This training can be given at the Mesa and Phoenix offices or found online. If a person you are supporting is experiencing a seizure, respond the way that you have been trained in your First Aid training and the training given by ITC. Always follow the individual person’s seizure protocol found in the member’s ISP. Each person served by DDD has an ISP that includes a listing of “risks” that may affect the person. A person with seizures should have a risk assessment that outlines specific steps to follow when this person has a seizure. What not to do during a seizure:

• Do NOT attempt to stop the seizure! • Do NOT restrain the person or try to hold them down in any way! • Do NOT force anything between their teeth or put anything in their mouth! • Do NOT give the person anything to eat or drink until s/he has fully recovered consciousness!

Swimming Pools / Bodies of Water It is ITC policy that no employee shall allow their member to participate in aquatic actives in the caregiver’s swimming pools and/or other bodies of water, i.e. lakes or rivers. Members may participate in aquatic actives in a public pool as long as a life guard is on duty. Members may also swim in their own home/apartment swimming pool with the proper authorization from the member’s parent/guardian. Major Health Problems There are many major medical problems that members can suffer from. This includes dehydration, which is too little fluid in the body. Other health problems include heart attack, which is known as a myocardial infarction and occurs when the blood supply to part of the heart is interrupted. A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain. Cancer is a class of diseases in which a group of cells display uncontrolled growth, invasion, or the spreading of cells to other locations in the body. Hypertension is high blood pressure. Diabetes is a symptom of disordered metabolism which results in abnormally high blood sugar levels. If a member is diabetic, caregivers should know what to do in the case of hypoglycemia. This is when the body has an insulin reaction and low blood sugar. Symptoms of hypoglycemia include:

• Shakiness • Dizziness • Sweating • Hunger • Headache • Pale skin color • Sudden moodiness or behavior changes, such as crying for no apparent reason • Clumsy or jerky movements • Seizure • Difficulty paying attention, or confusion

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• Tingling sensations around the mouth The quickest way to treat hypoglycemia is with some form of sugar, including 3 glucose tablets, a ½ cup of orange juice (or any kind of fruit juice), or 5-6 pieces of hard candy. If a member passes out from hypoglycemia, CALL 911 IMMEDIATELY, but do NOT inject insulin into their body. However, caregivers should always know where a member’s insulin is and when they are supposed to take it on a regular basis. Another major medical health issue facing many members is Alzheimer’s disease. It is a progressive and fatal brain disease that is the most common form of dementia and has no current cure. When caring for someone with Alzheimer’s, it is important to be flexible and patient. Also, engaging a member in daily activities can help structure time. When planning an activity for someone with Alzheimer’s, the activity should focus on the person, the activity, the approach, and the place. However, unpredictability is common in Alzheimer’s. There are many factors that can contribute to a member experiencing behavioral changes, including physical discomfort caused by an illness or medications, over-stimulation from loud noises or a busy environment, unfamiliar surroundings such as new places or inability to recognize home, and complicated tasks. If a member is on medications, caregivers are not allowed to give them to his or her member, but they ARE responsible for knowing where it is located, when it is to be taken, how much is to be taken, and everything else pertaining to the member’s medication. Sometimes the caregiver may have to call in the prescriptions for the member, as well as pick them up. Caregivers are allowed to remind the member to take the medication and give them a glass of water if needed. If your member becomes deceased you are required to contact the ITC office as soon as possible. Incident Reports An incident is defined as an occurrence, which could potentially impact the health and well-being of an individual enrolled with the Division or the community. Incidents include, but are not limited to:

• Death of an individual • Potentially dangerous situations due to neglect of the individual • Allegations of sexual, physical, programmatic, verbal/emotional abuse • Suicide threats and attempts • Individual missing • Accidental injuries which may or may not result in medical intervention • Violation of individual’s rights • Provider and/or member fraud • Complaints about a community residential setting, resident or qualified vendor • Allegations of inappropriate sexual behavior • Use of behavior management techniques not part of a behavior plan • Theft or loss of individual money or property • Use of emergency measures • Medication errors • Community disturbances in which the individual or the public may have been placed at risk • Serious work related injuries • Threats to Division employees or state property; and non-member/non-employee accidents on

state property

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• Environmental circumstances which pose a threat to health, safety or welfare of individuals such as loss of air conditioning, loss of water or loss of electricity

• Unplanned hospitalization or emergency room visit in response to an illness, injury, medication error

• Unusual weather conditions or other disasters resulting in an emergency change in operations • Provider drug use • A circumstance that poses a serious and immediate threat to the physical or emotional well-being

of an individual or staff member All ITC employees are required to report any serious incidents from the above list immediately after the member is safe. All other incidents need to be reported within 24 hours of it occurring. To report an incident you need to call the Mesa, or Phoenix office and give as much detail about the incident, who, what, where, when, and how. If it is after hours or on the weekend, leave a message and someone will get back with you.

Thank you for joining the ITC Team!