APPLICATION FOR EMPLOYMENT

ANTONINA HEALTH CARE is an Equal Opportunity Employer. We do not discriminate on the basis of age, race, sex, colour, religion, national origin, disability, or any other applicable status protected by state or federal law. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

Each question should be fully and accurately answered. No action can be taken on this application until all questions have been answered. Use blank paper if you do not have enough room on this application. PLEASE PRINT, except for signature on back of application. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.

(A "Yes" answer does not automatically disqualify you from employment, since the nature of the offense, date, and the job for which you are applying will also be considered.)

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Employment: List the last five years of employment history, starting with the most recent employer.

 

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CREDENTIALS/SPECIALIZED SKILLS & QUALIFICATIONS/EQUIPMENT OPERATED

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING

• I certify that the facts contained in this application are true and complete to the best of my knowledge and understand, that, if employed, falsified statements on this application SHALL BE GROUNDS FOR DISMISSAL
• I authorize a complete investigation of all statements contained herein and hereby give my full permission for the Agency to contact and fully discuss my background and history with all persons and entities listed above to give the Agency any and all information concerning my previous employment and any information they may have, and release all former employees and others listed above from all liability for any damage that may result from furnishing the same to the Agency.
• I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment processing which may include a physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.
• I understand I may be required to successfully pass a drug screening examination. I hereby consent to pre and/or post-employment drug screen as a condition of employment, if required.
• I understand that all training shifts will be paid at minimum wage. I further understand that the standard pay rate is $14 (subject to taxes, withholdings and deductions, as applicable), plus any applicable shift differential based on the client's needed level of care. The pay rate for each case will be included in the email I receive with the client's information and care plan.
• I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE BY EITHER ME OR THE EMPLOYER.

 

I have read, understand and my signature consent to these statements.

This application for employment shall be considered active for a period of time not to exceed 180 days. Any applicant wishing to be considered for employment beyond this time shall inquire as to whether or not applications are being accepted at that time.

*Please notify Antonina Health Care if any of the emergency contact information changes.

Notification and Authorization to Release Criminal

Information for Employment Purposes

Notification

The position for which I am being considered requires me to consent to a criminal background check as a condition of employment. This check includes the following: Criminal history reference searches for felony and misdemeanour convictions where I currently reside or where I have resided during the past 7 years; and National Sex Offender registry, OIG registry, Colorado DORA license verification searches.

Authorization:

I hereby authorize Antonina Health Care to conduct the criminal background check described above. In connection with this, I also authorize the use of law enforcement agencies and/or private background check organizations to assist Antonina Health Care in collecting this information. Such information will be used to determine whether the results of the background check reasonably bear on my trustworthiness or my ability to perform the duties of my position in a manner which is safe for Antonina Health Care clients, employees, and other community members.

Have you ever been convicted of a criminal offence or have any pending criminal charges against you?

This refers only to felonies and misdemeanours; you do not need to include non-criminal traffic violations or municipal ordinance violations.

To the best of my knowledge, the information provided in this Notice and Authorization and any attachments thereto are true and complete. I understand that any falsification or omission of information may disqualify me for this position and/or may serve as grounds for termination of my employment with Antonina Health Care. By signing below, I hereby provide my authorization to Antonina Health Care to conduct a criminal background check. In addition to those rights, I understand that I have a right to appeal an adverse employment decision made by Antonina Health Care based on my background check information within three business days of receipt of such notice and that a determination on my appeal will be made in seven working days from Antonina Health Care's receipt of such appeal.

I further understand that per Antonina Health Care (AHC) policy, AHC may request an explanation of any charges, arrests, etc. that show on my criminal background check. Offers of employment will be reviewed on a case-by-case basis prior to extending any offer of employment. Failure to provide an explanation will result in immediate disqualification of employment with AHC.

To the best of my knowledge, the information provided in this Notice and Authorization and any attachments thereto are true and complete. I understand that any falsification or omission of information may disqualify me for this position and/or may serve as grounds for termination of my employment with Antonina Health Care. By signing below, I hereby provide my authorization to Antonina Health Care to conduct a criminal background check. In addition to those rights, I understand that I have a right to appeal an adverse employment decision made by Antonina Health Care based on my background check information within three business days of receipt of such notice and that a determination on my appeal will be made in seven working days from Antonina Health Care's receipt of such appeal.

I further understand that per Antonina Health Care (AHC) policy, AHC may request an explanation of any charges, arrests, etc. that show on my criminal background check. Offers of employment will be reviewed on a case-by-case basis prior to extending any offer of employment. Failure to provide an explanation will result in immediate disqualification of employment with AHC.

Antonina Health Care Reference Verification

References: (Previous employers, supervisors or co-workers. NO RELATIVES)

For Office Use Only

Antonina Health Care

Health Maintenance Attendant (HMA) Job Description

Description:

• Health Maintenance Attendants provide service to individuals in their own homes and communities, who need assistance caring for themselves due to aging, illness, disability and/or other inflictions.
• Health Maintenance Attendants are responsible for ensuring that service is delivered in a caring and respectful manner, in compliance with relevant Agency policies and industry standards.
• The primary goal is to promote consumer dignity, independence, comfort, mobility and safety.
• Transporting clients in your car or their car is against agency policy and State of Colorado Program regulations and may result in disciplinary action.

Reporting Relationship:

• Reports to Supervisor/Agency Administrator and IHSS Client Responsibilities/Activities: Skilled care:

Responsibilities/Activities: Skilled care:

• Skin care and check
• Assist with self-administered medications by opening a medication bottle or pillbox to aid the consumer with obtaining the amount of the medication desired. The Attendant may read the instructions on the label to the consumer if the correct dosage is questioned.
• Vital checks including weighing client, blood pressure, blood glucose, O2 monitoring and pulse rate.
• Transferring in /out of bed or to change position by means of Hoyer, Slide Board, gait belt, stand-by, or pivot devices.
• Assist with mobility and assistive devices- cane, walker, wheelchair, etc.
• Assist with range of motion exercises.
• Assisting individual to move on/off bed pan, commode, or toilet
• Assist with toileting by administering rectal stimulation or suppository
• Empty, change and clean leg/catheter bag
• Assisting with bathing in bed, tub, shower, or with sponge bath
• Assisting with grooming to include care of hair, shaving, and ordinary care of nails, oral care
• Dressing/undressing
• Other skilled tasks specific to client and approved by IHSS RN
• Meal Preparation for specialized/prescribed diet
• Feeding client with swallowing precautions, requiring tube feedings, etc.
• Ensure client's safety and security by supervising the home environment.
• Provide companionship including social interactions, conversations, emotional reassurance and encouragement of activities that provide mental stimulation.
• Escorts clients to medical facilities and outings as specified in the care plan
• Participate with the Care Team by providing input and making suggestions.
• Ensure service is delivered in accordance with all relevant policies, procedures and practices.
• Follow the written care plan. Notify office if care plan needs updated with requested tasks.
• Observe clients and their environments and report unsafe conditions to the Supervisor including behavior, physical and/or cognitive changes and/or changes in living arrangements.
• Complete and maintain records of daily activities, observations, and direct hours of service.
• Attend orientation, in-service training sessions and staff meeting,
• Develop and maintain constructive and co-operative working relationships with others.
• Make decisions and solve problems.
• Communicate with Supervisor and co-workers.Observe. receive and obtain information from relevant sources.
• Performs other duties as required.
• Report any significant changes in condition, falls, hospitalizations, exploitation, any abuse (physical, verbal or sexual), or safety concerns within 24 hours.

Required Minimum Knowledge:

• Knowledge of personal care and home management skills.
• Knowledge of principles and processes for providing client and personal-care services. including needs determinants, meeting quality standards and evaluation of client satisfaction.
• Ability to speak, read and write English.
• Knowledge of proper body mechanics.
• Knowledge of clerical procedures such as maintaining records and completing forms.

Required Skills/Abilities:

• The ability to competently, assist clients with activities of daily living.
• The ability to be aware of other people's reactions and understanding why they react as they do.
• The ability, to establish and maintain relationships.
• The ability to actively listen.
• The ability to identify problems and determine effective solutions.
• The ability to apply reason and logic to identify strengths and weaknesses of possible solutions.
• The ability to monitor and assess themselves, clients and effectiveness of service.
• The ability to understand written and oral instructions.
• The ability to communicate information verbally in an understandable to others way.
• The ability to communicate in writing in an understandable way.
• The ability to work independently and in cooperation with others.
• The ability to determine or recognize when something is likely to go wrong. 
• The ability to suggest a number of ideas on a subject.
• The ability to perform activities that utilize the whole body.
• The ability to handle and move objects and people.
• The ability to utilize the knowledge of proper body mechanics.
• The ability to observe and recognize changes in clients.
• The ability to established and maintain harmonious relations with clients/families/co-workers.

Physical and Mental Demands: 

• Good physical and mental health.
• Physical ability to stand, walk, use hands and fingers, reach, stoop, kneel, bend, lift up to 25 Ibs, talk, hear, and see.
• Mental fortitude and stability to handle stress.
• Physical and mental ability to drive a vehicle.

Qualifications/Education:

• Minimum of high school completion.
• Current driver's license with active vehicle Insurance Coverage.
  
  

Training/Experience: 

• May require related experience 
• On-the-job training for new activities.
  
  

I have read and understand the job description and agree to fulfil the position's responsibilities

 

 

Antonina Health Care

PERSONAL CARE PROVIDER/WORKER JOB DESCRIPTION

Description:

• Personal Care Providers/Workers provide service to individuals in their own homes and communities, who need assistance caring for themselves due to aging, or illness. disability and/or other inflictions. Personal Care may include assistance with the activities of daily living, and housecleaning. laundry, meal preparation, companionship and respite.
• Personal Care Providers/Workers are responsible for ensuring that service is delivered in a caring and respectful manner, in compliance with relevant Agency policies and industry standards.
• Transporting clients in your car or their car is against agency policy and may result in disciplinary action.

Reporting Relationship: 

• Reports to Supervisor/Agency Administrator.

Responsibilities/Activities: 

• Assist with the activities of daily living and personal care including:
  -bathing -oral care -skin care -shaving (electric razor only) -dressing -feeding -positioning -transferring -ambulation -exorcise -toileting -medication reminding
• Ensure client's safety and security by supervising the home environment. 
• Teach/perform meal planning and preparation, routine housekeeping activities such as making bed/changing linens, dusting, vacuuming, washing floors, cleaning kitchen and bathroom, and laundry.
• Provide companionship including social interactions, conversations, emotional reassurance and encouragement of activities that provide mental stimulation.
• Provides respite care for families in accordance with care plans.
• Performs/assists with essential shopping/errands, which may include handling the client's money in accordance with the care plan and under the observation of the Supervisor/ Agency Administrator.
• Assists clients with following a written meal plan and encourages the maintenance of a healthy diet or speciality diet as identified on the care plan
• Escorts clients to medical facilities, errands, shopping and outings as specified in the care plan;
• Participate with the Care Team by providing input and making suggestions.
• Ensure service is delivered in accordance with all relevant policies, procedures and practices.
• Follow the written care plan. Notify office if the care plan needs updated with the requested tasks.
• Carry out duties as assigned by the Supervisor.
• Observe clients and their environments and report unsafe conditions to the Supervisor including behavior, physical and/or cognitive changes and/or changes in living arrangements.
• Complete and maintain records of daily activities, observations, and direct hours of service.
• Attend orientation, in-service training sessions and staff meetings.
• Develop and maintain constructive and cooperative working relationships with others.
• Make decisions and solve problems.
• Communicate with Supervisor and co-workers. 
• Observe, receive and obtain information from relevant sources. 
• Performs other duties as required.
• Report any significant changes in condition, falls, hospitalizations, exploitation, any abuse (physical, verbal or sexual), or safety concerns within 24 hours

Required Minimum Knowledge: 

• Knowledge of personal care and home management skills.
• Knowledge of principles and processes for providing client and personal care services. including needs determinants, meeting quality standards and evaluation of client satisfaction.
• Ability to speak, read and write English.
• Knowledge of proper body mechanics.
• Knowledge of clerical procedures such as maintaining records and completing forms.

 

Required Skills/Abilities: 

• The ability to competently, assist clients with activities of daily living. 
• The ability to be aware of other people's reactions and understanding why they react as they do.
• The ability, to establish and maintain relationships. 
• The ability to actively listen. 
• The ability to identify problems and determine effective solutions.
• The ability to apply reason and logic to identify strengths and weaknesses of possible solutions.
• The ability to monitor and assess themselves, clients and effectiveness of service.
• The ability to understand written and oral instructions.
• The ability to communicate information verbally in an understandable to others way. 
• The ability to communicate in writing in an understandable way. 
• The ability to work independently and in cooperation with others.
• The ability to determine or recognize when something is likely to go wrong. 
• The ability to suggest a number of ideas on a subject.
• The ability to perform activities that utilize the whole body.
• The ability to handle and move objects and people.
• The ability to utilize the knowledge of proper body mechanics. 
• The ability to observe and recognize changes in clients.
• The ability to established and maintain harmonious relations with clients/families/co-workers.

Physical and Mental Demands:

• Good physical and mental health.
• Physical ability to stand, walk, and use hands and fingers. reach, stoop, kneel, bend. lift up to 25 lbs. talk, hear, and see. 
• Mental fortitude and stability to handle stress.
• Physical and mental ability to drive a vehicle.
  
  

Qualifications/Education:

• Minimum of high school completion.
• Current driver's license with active vehicle Insurance Coverage.

Training/Experience:

• May require related experience
• On-the-job training for new activities.
  
  

I have read and understand the job description and agree to fulfil the position's responsibilities.

 

 

Antonina Health Care

HOMEMAKER JOB DESCRIPTION

Description:

• Homemaker provide service to individuals in their own homes and communities, who need assistance caring for themselves as a result of aging; illness; disability and/or other inflictions. Homemaking may include house cleaning, laundry, meal preparation, shopping.
• Homemakers are responsible for ensuring that service is delivered in a caring and respectful manner, in accordance with relevant Agency policies and industry standards.
• Homemaker services do not include any personal care tasks. If your client is in need of personal care please report to office immediately.
• Transporting clients in your car or their car is against agency policy and may result in disciplinary action

Reporting Relationship:

• Reports to Supervisor/Agency Administrator.

Responsibilities/Activities:

• Teach/perform meal planning and preparation, routine housekeeping activities such as making bed/changing linens, dusting, vacuuming, washing floors, cleaning kitchen and bathroom, laundry
• Provide companionship including social interactions, conversations, emotional reassurance and encouragement of activities that provide mental stimulation.
• Preforms/assists with essential shopping/errands, which may include handling the client's money in accordance with care plan and under the observation of the Supervisor/ Agency Administrator.
• Assists clients with following a written meal plan and encourages maintenance of a healthy diet or specialty diet as identified on the care plan.
• Escorts clients to medical facilities, errands, shopping and outings as specified in the care plan;
• Participate on the Care Team by providing input and making suggestions.
  Ensure service is delivered in accordance with all relevant policies, procedures and practices.
• Follow the written care plan.
• Carry out duties as assigned by the Supervisor.
• Observe clients and their environments and report unsafe conditions to the Supervisor.
• Observe clients and their environments and reports behavior, physical and/or cognitive changes and/or changes in living arrangements to Supervisor.
• Complete and maintain records of daily activities, observations, and direct hours of service.
• Attend orientation, in-service training sessions and staff meetings.
• Develop and maintain constructive and co-operative working relationships with others.
• Make decisions and solve problems.
• Communicate with Supervisor and co-workers.
• Observe, receive and obtain information from relevant sources.
• Performs other duties as required.
• Report any significant changes in condition, falls, hospitalizations, exploitation, any abuse (physical, verbal or sexual), or safety concerns within 24 hours

Required Minimum Knowledge:

• Knowledge of home management skills.
• Knowledge of principles and processes for providing client and homemaker services, including needs determinants, meeting quality standards and evaluation of client satisfaction.
• Ability to speak, read and write English.
• Knowledge of proper body mechanics.
• Knowledge of clerical procedures such as maintaining records and completing forms.

Required Skills/Abilities:

• The ability to be aware of other people's reactions and understanding why they react as they do. The ability, to establish and maintain relationships.
• The ability to actively listen.
• The ability to identify problems and determine effective solutions.
• The ability to apply reason and logic to identify strength and weaknesses of possible solutions.
• The ability to monitor and assess themselves, clients and effectiveness of service.
• The ability to understand written and oral instructions.
• The ability to communicate information verbally in an understandable to others way.
• The ability to communicate in writing in an understandable way.
• The ability to work independently and in cooperation with others.
• The ability to determine or recognize when something is likely to go wrong.
• The ability to suggest a number of ideas on a subject.
• The ability to perform activities that that utilize the whole body.
• The ability to handle and move objects and people.
• The ability to utilize the knowledge of proper body mechanics.
• The ability to observe and recognize changes in clients.
• The ability to established and maintain harmonious relations with clients/families/co-workers.
  
  

Physical and Mental Demands:

• Good physical and mental health.
• Physical ability to stand, walk, use hands and fingers, reach, stoop, kneel, bend, lift up to 25 lbs, talk, hear, and see. Mental fortitude and stability to handle stress.
• Physical and mental ability to drive a vehicle.
  
  

Qualifications/Education:

• Minimum of high school completion.
• Current driver's license with active vehicle Insurance Coverage.
  
  

Training/Experience:

• May require related experience
• On the job training for new activities.
  
  

I have read and understand the job description and agree to fulfill the position's responsibilities.

Antonina Health Care Job Acceptance Statement

Electronic Signature and Electronic Security

I understand that by providing my electronic signature, I am asserting that I have reviewed the times and tasks shown on Antonina Health Care's tracking software, caregiver application or telephony phone call. I further understand that I agree to the same disclosure that has been documented on paper care sheets.

By signing this financial document, timesheet We certify that all information is current and accurate. We understand that in case of any discrepancies or by knowingly providing false or incorrect information We accept full legal and financial responsibility. I the undersigned provider, hereby certify that I am not a member of client's family (family is defined as all persons related to client by virtue of blood, marriage, adoption or common law)

I understand the need and responsibility to maintain a high level of security regarding access to electronic information. I will not allow anyone to use my computer key/password and accept full responsibility for the security of my computer key/password. I fully acknowledge that I have read and fully understand this entire Agreement and that by signing below, I agree with and accept all the terms and conditions contained herein.

CONFIDENTIALITY OF AND PROTECTION OF PROTECTED HEALTH INFORMATION (PHI)

It is both the agencies and the employee's responsibility to ensure that every patient's health information is protected at all times. By signing below, you are indicating the acknowledgement of HIPAA and understand that a thorough orientation of the agency's policy regarding patients' protected health information will be provided upon hire. I understand that I may be handling protected health information. I understand the guidelines include enforcing the following measures to protect disclosing protected health information.

1. Protected health information will be transported in a protected travel chart when travelling. To prevent unauthorized access to information.  
2. When transmitting and receiving a fax involving Protected Health Information, I ensure that it is conducted in a private area.
3. Protected Health information will be returned to the agency or destroyed upon acknowledgement of the patient being discharged.
4. The agency had sanctions and fines for all individuals failing to comply with HIPAA rules and regulations. I pledge to make every effort to keep a patient's Protected Health Information protected at all times and abide by HIPAA rules and regulations.

I pledge to make every effort to keep a patient's Protected Health Information protected at all times and abide by HIPAA rules and regulations.

HIPPA AND CONFIDENTIALITY AGREEMENT

CONFIDENTIALITY OF CLIENT INFORMATION

By accepting employment with Agency, I agree to carefully refrain from discussing any client's condition or personal affairs with anyone outside the agency, unless expressly authorized to do so. I will not share any medical information with other clients or visitors without clear instruction provided to the agency. I acknowledge that ALL information seen or heard regarding clients, directly or indirectly, is completely confidential and is not to be discussed, even with my family or coworkers. My job as an employee requires that I govern myself by high ethical standards. Failure to recognize the importance of confidentiality is not only a breach of professional ethics but can also involve an employee in legal proceedings. I will not share any Information about clients or the agency with the media. This is essential for protection of both the client and Agency. I, further, understand that at no time am I to allow a client to endorse a check over to the home care

I have read and understood the above statement and agree to abide by these policies. I understand that a breach of the policy may result in disciplinary action and possible dismissal from employment.

CORPORATE COMPLIANCE POLICY

Acknowledgement of Receipt and Understanding

As you know, Antonina Health Care and our Staff members have always been committed to providing exceptional health care and upholding ethical conduct standards and legal compliance Our policy formally and clearly states that there is zero tolerance to any form of fraud or misconduct. Antonina Health Care believes that every employee or agent plays a key and active role in maintaining its image and reputation.

I hereby acknowledge that I have been apprised of and agree to comply with Antonina Health Care's Corporate Compliance Policy. I understand that in no way does this create an obligation or contract of employment and that I, as well as Antonina Health Care, have the right to end the employment relationship at any time.

Compliance Statement:

The Corporate statement provided is to be acknowledged and signed by EVERY Antonina Health Care employee and by every employee working on a contract basis.

EMPLOYEE SAFETY

ACCIDENTS AND INJURIES:

Antonina Health Care is concerned about employee safety and the safety of our clients. If an accident occurs, and employee MUST report it immediately to a Supervisor at Antonina Health Care no matter how minor it may seem. The Administrator will obtain details of the accident, investigate and complete the required paperwork. All accidents and incidents, WHETHER EMPLOYEE OR CLIENT- RELATED require reporting. Failure to notify Antonina Health Care of the accident or incident could result in a reduction of benefits up to and including discharge.

ACCIDENT REPORTING:

Report all accidents or near misses to your supervisor immediately. Falsification of records, including employment applications, time records or safety documentation, is not tolerated.

EMERGENCIES AND DISASTERS:

Employees, for the benefit of their own safety, must learn what to do in case of an emergency. Each employee must become familiar with Antonina Health Care's Disaster/Emergency Preparedness Plan and successfully complete mandatory Emergency Preparedness in-services.

HAZARD REPORTING:

Notify a supervisor immediately of any unsafe condition and/or practice. ALCOHOL OR ILLEGAL DRUGS: No illegal drugs or alcohol is allowed on the work site. Employees must notify their supervisor if they are taking any prescription drugs that might affect their judgment.

DRIVING:

While driving a vehicle owned by the organization or driving your own vehicle for business purposes, obey all traffic laws and signs at all times. Wear your seat belt at all times. Do not drive over the posted speed limits, and NEVER text and drive. You will not transport clients in your vehicle.

PERSONAL PROTECTIVE EQUIPMENT (PPE):

Appropriate PPE must be worn at all times. PPE will be allocated and training completed as necessary based on each job task. Training requirements and specific PPE are listed in detail in the job-specific safety rules.

The agency makes available PPE kits for field staff. It is the responsibility of staff members to utilize these kits and other safety equipment available to avoid injury and reduce exposure to possible infections.

I understand the Personal Protective Equipment (PPE) kit is available at the in accordance with my assigned job duties. 

 

CODE OF CONDUCT

All employees at Antonina Health Care have to follow the company's Code of Conduct. Antonina Health Care is committed to providing quality care to the public in their home environment. By complying with this code, we can achieve our mission together.

1. The Employee will complete scheduled visit and assignments on a timely basis. The employee will notify agency of any emergency or delays that may cause tardiness or to be absent for a visit.
2. The employee will refrain from excessive or unexcused absences.
3. The employee will notify AHC of any schedule changes, including leaving early and receive approval prior to the change.
4. The employee will respond to communications and/or messages (phone call, voicemail, text or email) from AHC in a timely manner, 4 hours during business hours is considered timely, per Employee Handbook.
5. The employee will complete required classes, orientation and educational requirements to maintain current licensure and compliance with Antonina Health Care's policy.
6. The employee will submit accurate records of employment, applications and time sheets.
7. The employees will conduct themselves in a professional manner in all interactions with supervisors, peers and clients. Licensed and certified employees will hold to the standards of their accrediting board.
8. The employee will honour client confidentiality.
9. The employees will present themselves in a professional manner by proper grooming as well as appropriate attire.
10. The employee will respect the right of the property of Antonina Health Care, other employees and clients.
11.  The employee will not engage in any of the following: a) Abuse, Negligence or Exploitation (handle any client financial affairs) b) Possession of or being under the influence of alcohol or illegal substances, c) Possession of weapons while on duty. d) Unsafe behaviours.
12. The employee will be aware of and practice safety policies and procedures.
13.  The employee will perform his/her duties as stipulated in the criteria-based job descriptions.
14.  The employee will be aware of and adhere to the fraud and abuse laws as stated in the Medicare Act.
15. The employee will refrain from use of prejudicial or offensive language and always be respectful.
16.  The employee will not ask for or accept money, goods, property or gifts from a client under any circumstances.
17.  The employee will not make or receive personal calls during visits.
18. The employee will not discuss personal affairs including pay with the client/family.
19. The employee will return any propriety materials at the end of their employment and will not disclose such information.
20. The employee will not accept direct employment from the client/family. They will direct them to the Agency office.
21. The employee will report any problem, incident or accident to the office and avoid discussion with the client.  
22. Non-skilled staff (PCP/W, HMKR) will not, under any circumstance, dispense or administer any medication to a client. (IHSS providers may with prior approval from agency)
23. The employee will notify the agency of any changes to the client's schedule including leaving early or staying longer.
24. The employee is prohibited from smoking in the presence of the client. 

The type of disciplinary action which may be taken in response to the violation of this Code of Conduct will be determined on an individual basis to include, but not limited to, the following: report incidents to licensing agencies where applicable, verbal warning, written warning, suspension without pay, demotion, probation or termination. Violation of the Medicare Fraud and Abuse Laws may result in fines of up to $25,000- and 5-years imprisonment.

I have read and agree to comply with the above Rules of Conduct.

ACKNOWLEDGEMENT OF RECEIPT OF EMPLOYEE HANDBOOK

 

ANTONINA HEALTH CARE POLICIES AND PROCEDURES

I understand that copies of Antonina Health Care's policy and procedure manuals are available and that it is my responsibility to read, understand and comply with all applicable policies including personnel policies. It is also my responsibility to comply with periodic changes and revisions. I have read and agree to comply with Antonina Health Care's Policy and Procedure on Abuse, Neglect and Exploitation and will be bound by the policy.

I understand that only the Antonina Health Care has the authority to admit clients and will supervise with appropriate personnel all services provided at the Company's discretion.

As a caregiver, I will carry out treatment according to the client's care plan, report any change in condition, falls, hospitalization, etc., at minimum, on a bi-weekly basis. I understand that it is my responsibility to obtain client signatures at the end of each scheduled visit. If I fail to obtain a signature, I will notify AHC immediately with an explanation. I will participate in developing and reviewing care plans, periodic client evaluations, care conferences, discharge planning and schedule coordination. I will provide services within the geographical area covered by Antonina Health Care. I will attend required staff meetings, in-service trainings and other training required for my position with Antonina Health Care.

I understand that I must remit documentation of services performed prior to payment for those services and that payroll procedures require timely and accurate completion of documentation to be submitted prior to receiving payment for services provided.

I understand that all information, both written and verbal, regarding client and employee health conditions is strictly confidential and is governed by HIPAA regulations. The presence of a communicable or venereal disease; testing, results or known infection HIV, AIDS, Hepatitis, Tuberculosis: information regarding child abuse, mental health, drug or alcohol abuse is protected under specific law. All information in connection with the examination, care or provision of services to any client will not be disclosed without the individual's written consent except as may be necessary to provide services as required by law. Information may be used in statistical or other summary form or for clinical purposes only if the individual's identity is not disclosed. I understand that violation of the client/employee confidentiality is subject to civil and criminal penalties.

I affirm that I have auto insurance coverage as required by State of Colorado law and by Antonina Health Care. I agree to keep auto insurance in full force on any vehicle I use for the conduction of Antonina Health Care business during the term of my employment. Antonina Health Care has the right to request proof of insurance at any time during my employment. I understand I am required to comply with all Antonina Health Care requirements and all Federal, State and local laws.

I understand that my employment at Antonina Health Care is "at-will" meaning that both the Company and I have the right to end my work relationship with the Company without advance notice for any reason. I also understand that information concerning my employment is outlined in the Employee Handbook which I acknowledge I have received (online copy) and am expected to read.

Antonina Health Care

HCBS/IHSS PROVIDER MANDATORY 20 HRS TRAINING

All direct care staff training is completed online through Relias Learning. Below are the listed modules in our New Hire Training Plan. All trainings must be completed within 30 days of hire.

• Antonina Health Care New Hire Orientation (AHC Orientation) 4h
• Advance Directives (REL-ALL-0-ADVDIR) .5h
• Caregiver Conduct-Regulations, Co-workers and Families (REL-SC-HH-CCRCF) 1h
• Communicating with People with Dementia (REL-SRC-0-CPD) 1h
• Corporate Compliance: The Basics (REL-ALL-0-CCTB) .5h
• Cultural Diversity in Home Health (REL_SC_HH_CULDIV) .5h
• Customer Service in Home Health (REL-ALL-0-CSERV) .5h
• Duties of a Caregiver (REL-PAC-0-CTCP) 1h
• Effective Communication (REL-PAC-0-CCRCF) .25h
• Food Safety in the Home (REL-SC-HH-FS-S) .5h
• Handling Aggressive Behaviors (REL-SRC-0-HAB) .5h
• HIPAA and Social media for Home Health (REL-SC-HH-HIPAASM) .5h
• Investigating Employee Accidents in Home Health (REL-SC-HH-IEA) .5h
• Orientation for Home-Based Services: Infection Control and Patient Care (REL-SRC-0-OHSICPC) 1.5h
• Orientation for Home-Based Services: Safety and Compliance (REL-SRC-0-OHSSC) 1.5h
• Preventing Harassment in the Workplace for Home Health Staff (REL-SC-HH-PHW-S) .5h
• Preventing Slips, Trips and Falls (REL-ALL-0-PSTF) .25h
• Preventing, Recognizing, and Reporting Abuse (REL-SRC-0-PRRA) .75h
• Protecting Patient Rights in Home Health (REL-SRC-0-PPRHH) .5h
• Understanding the Meaning Behind Behaviors (REL-SRC-0-UMBB) .5h
• Employee Handbook (Includes policies & procedures, code of conduct & Orientation)

I understand that I may be assigned additional training as part of training and/or disciplinary action, I further understand, I may elect to voluntarily complete any courses provided by Relias.

I acknowledge understanding that my employment may be terminated if the above training is not completed within 30 days of the date of hire. I understand that it is my responsibility to remain compliant with State and Federal program regulations to continue my employment with Antonina Health Care.

 

Antonina Health Care Orientation Check List

NON-SKILLED ORIENTATION REVIEW

Antonina Health Care, LLC

INITIAL COMPETENCY ASSESSMENT: Personal Care Provider/Worker & Homemaker

Form must be completed prior to services delivery to a client.

Skills/ Procedures                                                 Competency Completion Summary

ANTONINA HEALTH CARE DRUG-FREE WORKPLACE POLICY EMPLOYEE ACKNOWLEDGEMENT

Notification of Designated Providers of Injured Workers

To: All Employees

From: Antonina Health Care Date: 4/27/2020

Subject: Designated Medical Providers for Work-Related Injuries and Illnesses

All employees must obtain treatment of work-related injuries and illnesses from one of the following medical providers:

1. Name: WorkWell Occupational Medicine Address: 2550 S Parker Rd, Suite 150 City, State & Zip: Aurora, CO 80014 Phone: 720-512-4408

2. Name: Concentra Medical Center-Cherry Creek Address: 875 S Colorado Blvd City, State & Zip: Denver, CO 80246 Phone: 303-388-3627

3. Name: Concentra Medical Center-Denver North Address: 420 E 58th Ave, Suite 111 City, State & Zip: Denver, CO 80216 Phone: 303-292-2273

4. Name: Concentra Medical Center- South Academy Address: 2322 S Academy Blvd City, State & Zip: Colorado Springs, CO 80916 Phone: 719-390-1727

In the event of a life- or limb-threatening emergency, the injured employee will be sent to the nearest emergency medical facility. One of the medical providers designated above must provide all follow-up care.

If an unauthorized medical provider treats an employee, the employee will be responsible for payment for said treatment.

I have read and am fully aware of the organization's policy regarding medical treatment for work-related injuries and illnesses. I further understand that I must immediately report any work-related injury to my supervisor. 

All employees must sign below, acknowledging this policy.

ANTONINA HEALTH CARE

WAGE PAYMENT ELECTION AND CONSENT FORM

For Fully Electronic Bundle

EMPLOYEE INFORMATION

WAGE PAYMENT ELECTION

Direct Deposit (indicate amount of deposit to each account type and provide account number)

Wisely Pay by ADP card (indicate amount of deposit)

 

I confirm my authorization to be paid through the Wisely Pay by ADP card is fully voluntary. I acknowledge I have received and read the Wisely Pay card Fee Schedule, Cardholder Agreement, and Privacy Notice. I understand that to use the Wisely Pay card, I will need to accept and agree to the Cardholder Agreement and pay the fees as indicated on the Fee Schedule by activating my Wisely Pay card. By electing a Wisely Pay card as my wage payment choice, I am consenting to provide my personal information to ADP to enrol in and request a Wisely Pay card. IMPORTANT INFORMATION ABOUT APPLYING FOR A NEW PREPAID CARD ACCOUNT - To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

CONSENT TO DEPOSIT WAGES

I authorize my employer (or its payroll service provider) to initiate credit entries each pay date to deposit my pay (either net or a portion thereof) into the checking, savings or Wisely Pay card account selected in this election and consent (the "Account" If funds to which I am not entitled are deposited to my Account, I authorize my employer (or its payroll service provider), to initiate any action to reverse or correct an erroneous credit entry to my Account and to direct the bank to return said funds to my employer (either directly or through its payroll service provider), to the extent permitted by applicable law. I will review my pay statement to ensure that my wages are being deposited correctly into my Account each payroll period. I understand that I can change my election at any time by contacting my employer and that this authorization replaces any previous authorizations and will remain in full force and effect until my employer (or its payroll service provider) has received written notification from me of its termination and my employer (or its payroll service provider) and the bank has had a reasonable opportunity to act on said termination.

CONSENT TO ELECTRONIC PAY STATEMENTS

I agree to receive and access all of my pay statements on or before each regular payday electronically on www.myADP.com, a secure website, rather than receiving a paper statement. I understand that I may retain a copy of the pay statement by saving it to my computer or by printing a hard copy of it. I understand that I should not save my statement to a public computer as others may see my statement. (Note: Your statements will remain on the secure website for 3 years. If you want to retain a copy for a longer period, you must either print a copy or save an electronic copy.

I understand that Antonina Health Care, as of September 1, 2019, will no longer provide any paper pay statements. I understand that my only access to my pay statements is electronically by using the secure website, www.myADP.com. Antonina Health Care is going green.

Return this completed application form via fax to (720) 500-5647, email to admin@antoninahealth.com (PDF format only) or deliver/mail to:

Antonina Health Care

1241 S Parker Rd,

Suite 201 Denver, CO 80231

ANTONINA HEALTH CARE

CAREGIVER SKILLS TEST 2022

Mark the Correct True or False Answer. 

Please circle the most appropriate answer; there may be more than one per question.  

CONFIDENTIALITY AND NON-COMPETITION AGREEMENT

The Agency requires that the Employee avoid disclosure of confidential information to anyone outside of the Agency and refrain from engaging in unfair competition.

The Employee agrees to refrain from prohibited competition with the Agency and to maintain the confidentiality of information regarding employees, clients, and the Agency business.

The Employee will have access to information not generally made available to the public, such as identity of clients, pricing, computer-related programs, etc. The Agency prohibits the utilization of this information for any purposes other than for the Agency's own benefit and prohibits disclosure or unauthorized use during employment or at any time thereafter of any confidential information pertaining to Agency administration and/or projects, or outside investigations of the Agency. The employee is prohibited from disclosing any defaming information regarding Agency personnel and/or personnel incidents related to any violations of the personnel policies.

During the course of employment and for a twelve month period thereafter the Employee is prohibited from engaging in any of the following: induce any employee of the Agency to resign, encourage any client or entity to discontinue any relationship with the Agency, solicit any client of the Agency (current and within the past twelve month period), enter into competitive employment or seek to provide competitive services while employed within twenty-five miles of any office of the Agency, or solicit referrals or opportunities from any referral source.

Upon termination of employment or at the request of the Agency, the Employee is required to return all the Agency's property including keys, client records, forms, manual, ID badge, etc. to the Agency and will not retain copies. Failure to return a key will result in a $25.00 charge and failure to return an ID badge will result in a $150.00 charge deducted from the paycheck.

Violation of this agreement will result in termination and any additional remedy available to the Agency including legal action to remedy all damages including loss of profits, cost of replacing and training employees improperly solicited for competitive employment, etc. suffered by the Agency. Employees will be required to reimburse the Agency for all legal fees, costs, and other expenses.

This agreement is in effect during the Employee's employment and for twelve months thereafter. It does not modify the right of the Employee to resign at any time or of the Agency to terminate employment without prior cause, notice or liability and does not modify any other Agency policy.