EFFECTIVE HOME CARE, LLC

Please print clearly. This application must be completed and all questions regarding your training and work experience answered. All information on this application is confidential, EFFECTIVE HOME CARE, LLC will not contact your present employer without your consent

Upload the following documents:

1. Social Security Card
2. Valid passport or Green Card (work authorization)
3. Certificate of Naturalization with ID card
4. Two reference letters
5. Complete physical examination with all lab reports
6. Direct deposit form

Valid passport or Green Card (work authorization)

Certificate of Naturalization with ID card

Complete physical examination with all lab reports

Two reference letters

Direct deposit form

The information listed in my application is complete and true. I understand that if employed, false statements on this application are cause for dismissal. I will comply with all of the agency's rules and regulations regarding my employment, EFFECTIVE HOME CARE, LLC may request Information regarding my background which will include work and personal references.

EFFECTIVE HOME CARE, LLC

110 NEPTUNE AVENUE, #2B

BROOKLYN, N.Y. 11235

TEL: 718006-1666

FAX: 718-806-1506

RELEASE: I hereby give permission for the above-named agency to verify my document orally.

EFFECTIVE HOME CARE LLC

REFERENCE REQUEST

Release of Information: I hereby release from all liability the company, institution or person named above and authorize them to release all information regarding my employment with them.

The person identified above has applied for a position at EFFECTIVE HOME CARE LLC, would you kindly complete the reference information below and return the reference information. This information will be kept confidential. Thank you.

Position held at your organization: __________________________________________________________________

Reference's relationship to applicant: __________________________________________________________________

Dates of Employment: From______________________________ To:______

Reason for Leaving: __________________________________________________________________

Would You Re-Employ? Yes ☐ No ☐, If no why? ________________________________________________________

EFFECTIVE HOME CARE LLC

REFERENCE REQUEST

Release of Information: I hereby release from all liability the company, institution or person named above and authorize them to release all information regarding my employment with them.

The person identified above has applied for a position at EFFECTIVE HOME CARE LLC, would you kindly complete the reference information below and return the reference information. This information will be kept confidential. Thank you.

Position held at your organization: __________________________________________________________________

Reference's relationship to applicant: __________________________________________________________________

Dates of Employment: From______________________________ To:______

Reason for Leaving: __________________________________________________________________

Would You Re-Employ? Yes ☐ No ☐, If no why? ________________________________________________________

EFFECTIVE HOME CARE, LLC

110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235

TEL: 718-806-1666 / FAX: 718-806-1506

Work available days and hours for Split shift (12 hours shift Day time or Night time)

EFFECTIVE HOME CARE,

LLC110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235

TEL: 718-806-1666 / FAX: 718-806-1506

Welcome to EFFECTIVE HOME CARE, LLC.

 

This letter will confirm that EFFECTIVE HOME CARE, LLC is offering you a position as a________beginning__________Your base salary will be $___________per hour/per visit and your overtime rate will be$___________per hour.

Regular payday is every Friday.

Please note as of September 25, 2009, the New York Department of Health has made it mandatory for all Home HealthAide and Personal Care Aide training program. Certified Agencies and Licensed Home Care Agencies such as ours toenter in its Home Care Registry all information pertaining to the receipt of your certificate prior to your employmenthistory and date of hire.

If you completed your training after September 25, 2009 the school that you attended will enter your information andEFFECTIVE HOME CARE, LLC's authorized Human Resources personnel will verify your certificate via the Registry.

Once your information has been entered into the New York State Department of Health Home Care Registry it will beviewable by interested parties such as the Department of Health, Federal and State Agencies, Home Care agencies and ifnecessary by your clients and/or their primary caregivers. The New York State Department of Health has created theHome Care Registry to ensure that our clients will continue to receive safe and compassionate care from the best personpossible, EFFECTIVE HOME CARE, LLC is licensed by the New York Department of Health therefor it is our obligation tocarry out the Rules and Regulations.

We are excited to have you join our team and look forward to working with you.

Sincerely,

HR Supervisor

By signing this letter, I acknowledge I have been advised of my rate of pay, overtime, Regular pay day and the HomeCare Registry. I understand that any information obtained in the use of this authorization may be used to evaluate mysuitability for employment and/or continued employment.

EFFECTIVE HOME CARE, LLC

POLICY AND PROCEDURE MANUAL

POSITION DESCRIPTION

A Home Health Aide is an individual who provides personal care, home management and other related home health supportive services in order to assist the individual to continue living in their home environment when there are disruptions due to Illness, disability, social disadvantage or other problems in the home. The Home Health Aide is under the direct supervision of the licensed nurse. The HHA provides care in accordance with the DOH Matrix: Permissible and Non-Permissible Activities: HHA Services.

Successful completion of a New York State Department of Health approved Home Health Aide training program as demonstrated by a valid Home Health Aide Certificate.

• Ability to speak, read and write in English sufficiently to understand and interpret the HHA Plan of Care, document care provided on the HHA Time and Activity report and able to call agency to report change and/or issues related to the patient and/or 911 In case of an emergency.
• Ability to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume and distance. Holds a valid Home Health Alde Certificate.
• Ability to apply common sense understanding to carry out simple one or two step Instructions. Ability to deal with standardized situations with only occasional or no variables.

MOST FREQUENT CONTACT: Patients/Patients families; Agency staff (coordinator, nurse)

NATURE OR PURPOSE: Provide care and service receive supervision, development of POC

EQUIPMENT OPERATION: Walker, Cane, Crutches, Wheelchair, Commode, Hospital Bed, Hoyer Lift, Household appliances (i.e. vacuum, refrigerator, stove, blender, toaster, etc)

EFFECTIVE HOME CARE, LLC

POLICY AND PROCEDURE MANUAL

SPECIFIC DUTIES AND RESPONSADILITIES: In order to comply with the Americans with Disabilities Act (ADA), eachessential duty would be indicated with an "X" in the ADA box. A duty is essential if: (1) the position exists to perform thatduty; (2) it requires) specialized skills and/or expertise; (3) it can only be performed by a limited number of available employees.

 

ADA DUTIES/RESPONSABILITIES

X Preparing and serving normal therapeutic diets. Assisting patient with eating, monitors intake.

X Assisting with bathing of patient-in bed, tub, shower.

X Assisting with grooming, care of hair, including shampoo, shaving with electric razor only, and ordinary care of nails-thismeans soaking and filing nails.

X Assisting with care of teeth and mouth.

X Assisting patient on and off bedpan, commode and toilet.

X Assisting patient in transferring from bed to chair, to wheelchair and in walking with or without devices.

X Assisting patient with dressing.

X Assisting patient with self-administrated Oral medications that have been ordered by the medical practitioner.

X Taking temperature, pulse and respiration as directed.

X Use of special equipment i.e. Hoyer lift.

X Assisting, as instructed with a home exercise program including passive range of motion, turning and positioning.

X Reporting any change in patient's mental and physical condition or home situation to the nurse.

X Makin and changing bed/linens.

x Dusting and vacuuming the rooms the patient uses.

X Tidying kitchen, dishwashing.

X Tidying bedroom.

X Tidying bathroom.

X Patient's personal laundry; this may include necessary ironing and mending.

X Provides a supportive environment and ongoing reality orientation to confused patients using appropriate interpersonalbehavioral techniques.

X Assists with self-administered medications.

X Take and record temperature, pulse, respiration.x Measure and record Intake and Output.

XReinforce sterile dressing.Empty urine or ostomy bag.

X Cleanse catheter insertion site.

X Administer special skin care as directed.

X Collect stool, sputum and urine specimens using appropriate techniques.

X FUTIONS PRMISSIBLE FOR HOME HEALTH AIDES UNDER SPEACIAL CIRCUMSTANCES: If no family member is present orcapable of providing care for a special patient, the nurse may with approval of the physician, teach and closely supervise theaide in the following procedures:

FUNCTIONS PERMISSIBLE UNDER SPEACIAL CICUMTANCES: (Continued)

X Assist with changes of colostomy bag.X Reinforce dressing and change simple non- sterile dressing.

X Assist with the use of devices geared to disability to aid in daily living.

X Assist patient with prescribe exercises which the Home Health Aide has been taught by appropriate professional personnel.

X Apply prescribed ice cap or ice collar.

X Perform simple urine test for sugar, acetone or albumen and record results.

X Perform functions allowable as per: NYC DOH Approved Scope of Practice

EFFECTIVE HOME CARE, LLC

POLICY AND PROCEDURE MANUAL

THE HOME HEALTH AIDE WILL NOT PERFORM THESE FUNCTION'S UNDER ANY CIRCUMSTANCES:

1. Foley catheter irrigation.

2. Apply a sterile dressing.

3. Give enemas or remove impactions.

4. Perform gastric lavage or gavage.

5. Applications of heat in any form.

 

CUSTOMER SERVICE/INTERPERSONAL SKILL

1. Assists other employees where needed.

2.Is responsible and cooperative with patients/families, supervisors, fellow employees.

3. Maintains friendly working atmosphere.

4. Maintains appropriate attitude.

5. Maintains appropriate appearance.

6. Accepts constructive criticism as evidenced by appropriate changes in behavior.

7. Utilizes established channels of communication.

8. Recognizes, accepts and respects people as individuals.

9. Recognizes limitations and seeks assistance appropriately.

 

SPECIALIZED SKILLS AND TECHNICAL COMPETENCIES:

1. Ability to apply prosthetic devices.

2. Ability to take and record TPR and measure I&O.

3. Ability to reinforce sterile dressing and change non-sterile dressing.

4. Ability to follow the instructions related to exercise and positioning.

5. Ability to safely use the Hoyer lift.

6. Ability to- care for urinary, ostomy and Foley catheters.

7. Ability to apply warm or cold compress, ace bandage and elastic stockings.

 

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Check one physical requirement which applies to this position:

MEDIUM WORK: Exerting up to 50 pounds of force occasionally and/or up to 20 pounds of force frequently and/or up to 10 pounds of force constantly to move objects.

WORK ENVIROMENT: Patient's home.

CONFIDENTIALITY STATEMENT: Agency records are maintained in a safe and secure area with specific access availability to ensure confidentiality. Agency records, files, documents and reports are the exclusive.

Under New York City's Earned Safe and Sick Time Act (Paid Safe and Sick Leave Law), certain employees have a right to safe and sick leave. Go to nyc.gov/PaidSickLeave to learn which employees are covered by the law.

Employees who work for employers with five or more employees who work more than 80 hours a calendar year in New York City have a right to paid safe end sick leave. Employees who work for employers with fewer than five employees have a right to unpaid safe and sick leave.

Employees who work for employers who must provide safe and sick leave must receive this written notice from their employer when they begin employment or by June 4, 2018, whichever is later.

YOU HAVE A RIGHT TO SAFE LEAVE, which you can use to seek assistance or take other safety measures if you or a family member may be the victim of any act or threat of domestic violence or unwanted sexual contact, stalking, or human trafficking.

YOU HAVE A RIGHT TO SICK LEAVE, which you can use for the care and treatment of yourself or a family member.

AMOUNT OF SAFE AND SICK LEAVE:

Your employer must provide up to a total of 40 hours of safe and sick leave every calendar year. You may use any earned leave for either safe or sick leave purposes, your employer's calendar year is: Start of Calendar Year:_____ End of Calendar Year:____

RATE OF ACCRUAL:

You accrue safe and sick leave at the rate of one hour for every 30 hours worked, up to a maximum of 40 hours of safe and sick leave per calendar year.

DATE ACCRUAL BEGINS:

You begin to accrue safe and sick leave on April 1, 2014 or on your first day of employment, whichever is later.

Exception: If you are covered by a collective bargaining agreement that was in effect on April 1, 2014 f you begin to accrue safe and sick leave under City law beginning on the date that the agreement expires.

DATE SAFE AND SICK LEAVE IS AVAILABLE FOR USE:

• You could begin using sick leave on July 30, 2014 or 120 days after you begin employment whichever is later.
• You could begin using safe leave on May 5, 2018 or 120 days after you begin employment, whichever is later.

ACCEPTABLE REASONS TO USE SAFE AND SICK LEAVE:

You can use safe and sick leave to take time off from work when:

• You have a mental or physical illness, injury, or health condition; you need to get a medical diagnosis, care, or treatment of your mental or physical illness, injury, or condition; you need to get preventive medical care.
• You must care for a family member who needs medical diagnosis, care or treatment of a mental of physical illness, injury, or health condition, or who needs preventive medical care.

FAMILY MEMBERS:

The law recognizes the following individuals as “family members:"

• Any individual whose close association with the employee is the equivalent of family
• Child (biological, adopted, or foster child; legal ward; child of an employee standing in loco parentis)
• Grandchild
• Spouse
• Domestic Partner
• Parent
• Grandparent
• Child or Parent of an employee’s spouse or domestic partner
• Sibling (including a half, adopted or step sibling)
• Any other individual related by blood to the employee

ADVANCE NOTICE:

If the need is foreseeable your employer can require up to seven days advance notice of your intention to use safe orsick leave, If the need is unforeseeable, your employer may require you to give notice as soon as practicable.

DOCUMENTATION:

Your employer can require documentation if you use more than three consecutive workdays as safe or sick leave.The Paid Safe and Sick Leave Law prohibits employer from requiring the health care provider to specify the medicalreason for sick leave or requiring safe leave documentation to specify the details of any act or threat of domesticviolence or unwanted sexual contact stalking, or human trafficking. Disclosure may be required by other laws.

UNUSED SAFE AND SICK LEAVE:

Up to 40 hours of unused safe and sick leave can be carried over to the next calendar year. However, your employeris only required to let you use up to 40 hours of safe and sick leave per calendar year.

YOU HAVE A RIGHT TO BE FREE FROM RETALIATION FROM YOUR EMPLOYER FOR USING SAFE AND SICK LEAVE.

Your employer cannot retaliate against you for:

• Requesting and using safe and sick leave.
• Filing a complaint for alleged violations of the Jaw with DOA
• Communicating with any person, including coworkers, about any violation of the law.
• Participating in a court proceeding regarding an alleged violation of the law.
• Informing another person of that person's potential rights.

Retaliation includes any threat, discipline, discharger demotion, suspension, or reduction in your hours, or any otheradverse employment action against you for exercising or attempting to exercise any right guaranteed under the law.

YOU HAVE A RIGHT TO FILE A COMPLAINT.

You can file a complaint with DCA. To get the complaint form, go online to nyc.gov/PaidSickLeave or contact 311 (212-NEW-YORK outside NYC).

DCA will conduct an investigation and try to resolve your complaint. DCA will keep your identity confidential unlessdisclosure is necessary to conduct the investigation, resolve the complaint, or is required by law.

(Keep a copy of this notice and all documents that show your amount of safe and sick leave accrual and use).

Note: The Earned Safe and Sick Time Act sets the minimum requirements for Safe and sick leave. Your employer'sleave policies may already meet or exceed the requirements of the law

THE MATERIALSEFFECTIVE HOME CARE, LLC

110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235

HOME TEL: 718-806-1666 / FAX: 718-806-1506

 

Effective home care is notifying you about New York City's earned safe and sick time act (paid safe and sick leave law).

Please read and acknowledge the receipt of this notice by signing this letter below and mail it in self-stamped envelope provided for your convenience.

Effective Home Care le esta notificando acerca de las ganacias de tiempo de cuídado y enfermedad de la ciudad de Nueva York (Paid Safe and Sick Leave Law).

Por favor leer y verificar la recivida de esta carta, firme de bajo. Envie por correo en el sobre stampado.

THE MATERIALSEFFECTIVE HOME CARE, LLC

110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235

HOME TEL: 718-806-1666 / FAX: 718-806-1506

 

PHOTO IDENTIFICATION

 

As an employee of EFFECTIVE HOME CARE LLC, I acknowledge receipt of the Agency issuedphoto identification card. As required by regulation and agency policy, I agree to wear the IDwhen working.

Identification card is the property of EFFECTIVE HOME CARE, LLC and shall be returned to the agencyupon termination of employment

EFFECTIVE HOME CARE, LLC

110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235

TEL: 718-806-1666 / FAX: 718-806-1506

 

CONFLICT OF INTEREST

Employees must avoid any interest, influence. Or relationship which might conflict or appear to conflict with the best interest of EFFECTIVE HOME CARE, LLC. You must avoid any situation in which your loyalty may be divided and promptly disclose any situation where an actual or potential conflict may exist.

Examples of potential conflict situations include:

• I Having a financial interest in any business translation with EFFECTIVE HOME CARE, LLC.
• Owning or having a significant financial interest in, or other relationship with EFFECTIVE HOME CARE, LLC. Competitor, costumer or supplier.
• Accepting gifts, entertainment or other benefit of more than a normal value from EFFECTIVE HOME CARE, LLC. Competitor, costumer or supplier.

Anyone with a conflict of interest must disclose it to management and remove themselves from negotiations, deliberations or votes involving the conflict. You may, however, state your position and answer questions when your knowledge may be of assistance to EFFECTIVE HOME CARE, LLC.

EFFECTIVE HOME CARE, LLC

110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235

TEL: 718-806-1666 / FAX: 718-806-1506

 

To File: 05-18-2016

From: Human Resources Dept

Ref: Leave of absence Policy

Effective Home Care LLC has adapted Leave of Absence Policy effective immediate. This policy is based on NYS applicable Labor Law and NYS DOH regulations. As a reminder, employees are provided with one-week paid vacation per year. Any period more than one week, but not more than 90 days, will be considered Leave of Absence without pay. In this case employee must notify management of his/her plans at least 21 days in advance, unless it is an emergency situation (e.g. death in the family

If employee decides to take 90 days and more off, he/she will be subject to rehiring process and his/her tenure with the company will. be nullified and will start from date of hire.

EFFECTIVE HOME CARE, LLC

110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235

TEL: 718-806-1666 / FAX: 718-806-1506

MEMORANDUM

HHRS AND PCA'S assigned for live in case

 

Aides who assigned for live-in cases (live on premises of the patient), have to follow rules implemented by Effective Home Care LLC under New York State Labor Law.

Aides are providing care for patients on live- in case according to plan of care. They work and are receiving compensation for 13 hours of work.

Aides are getting 8 hours to sleep. However, Aides must sleep continuously for 5 (five) hours. If patient condition deteriorates to the point where aide will need to interrupt his/ her sleep, then aide must report this situation to the agency next morning, so appropriate measures can be taken to the correct problem.

Reporting must be provided by FAX or E-mail or by Texting for records keeping.

EFFECTIVE HOME CARE, LLC

110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235

TEL: 718-806-1666 / FAX: 718-806-1506

 

To: All newly hired employees

Re: 90 days probation period

 

As per Company Policy all newly hired employees will undergo 90 calendar days ofprobation period.

During this period (90 days or earlier) the Company reserves the right to terminatethe employee at Company's own discretion.

I have read and agree:

EFFECTIVE HOME CARE, LLC

110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235

TEL: 718-806-1666 / FAX: 718-806-1506

 

COMPANY MULTI-AGENCY EMPLOYMENT POLICY

 

Effective Home Care is making efforts to accommodate our caregivers, who want to work not only for our company, but for other agencies as well, without causing a conflict of working

In order to avoid conflict when we schedule the services for our patients we are asking all caregivers to notify us of employment in other agencies, name of the agency, and giving us a current schedule there. Please notify us if schedule will change in the future.

Caregivers who do not notify us of double employment and make call-in or call-out while working in the other agency and therefore violating company policy, causing conflict in schedule will be, atfirst denied payment for-that day. Caregivers who repeat the violation will be terminated.

I read and acknowledged above policy.

EFFECTIVE HOME CARE, LLC

110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235

TEL: 718-806-1666 / FAX: 718-806-1506

02/12/2018

 

To All field employees:

 

Please be advised that those employees who did not elect to receive their payrollchecks through direct deposit to their bank account are personally responsible forlost or undelivered payroll check sent by mail.

 

Effective Home Care is not responsible for lost or otherwise undelivered payrollcheck. sent by mail.

 

Please kindly sign below that you read and understood the content of this letter

EFFECTIVE HOME CARE, LLC

110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235

TEL: 718-806-1666 / FAX: 718-806-1506

 

Sexual Harassment

was trained by the Agency Effective Home Care, LLC about Sexual Harassment Prevention Policy.

I was informed about my rights and the way to report any evidence to the Agency.