02/24/1988 AgreementI
BAY SHORE MANOR
A/K/A MONROE COUNTY HOME
ADULT CONGREGATE LIVING FACILITY
FOR THE ELDERLY - LEVEL II
A G R E E M E N T
This agAeement en-tened into thus 24th day o� February
19__U_, by and between the County ob Monroe, State o6
Ftonida, heAe%naitetc ca ted "County", and Grace D. s; nc l a; r
heAei.na6ta caned "Resident", and William H. Gaiser
heAe.ina6teA caQted "Respon/s.ibte Panty",
WI TN ESS ETH:
WHEREAS, the Au ident desiu u to u6 e the 6aci.Q,ity o6 the County
known a6 the MonAoe County Home, a/k/a Bay Shone Manors and,
WHEREAS, the County hays reviewed the appt icati.on o6 the taident �oA
admis scion to the Monroe County Home and ha.6 deteJcm.ined that the neis.ident is
eUg.ibte Got adtniz,.ion to said home, now, theAe6otce,
In cons.idmation ob the mutual. cov enant6, pAomiz eta and pAen" es
heAein contained, the pattie6 agree as bottow6:
A. BAY SHORE MANOR
1. To burnish room, board, tinenz, pAes ibed medicines
and geneAat peAsonat carte.
2. To aAAange boA the tAaysbeA ob the te/s.ident to the
hozpitol ob the Aezident'z choice when otdeAed by the
attending physician on the heatth o6 the tes ident
Aequi&e,s same, and to .immedi.atee.y notiby any
Aesponzibte paAty (ate de6ignated heAein) o6 zuch ttans6a.
3. To maize Aebun6 on a pets diem bcv iz in accotcd with date
o6 dus c.haAg e 6Avm the home. Rebund6 cannot be made at,
.bong a-s petvsona2 betongingts remain .in the tez ident',s
Room. Rebunds cannot be made as .bong as theAe aAe
outstanding expendituAe,6 bot seAv.ice6 Aeceived by the
Aes,ident.
4. In the event ob ceo.6uAe ob the bacitity 6oA any Aea>son,
a pro -Awed peA diem tebund ahatt be made .in accord
with date o6 ctoswte. within .even (7) days.
5. OtheA: To pay 8G% of balance after M di carp
and AARP for lst 14 days of hospital carp.
and 80% of balance after Medicare and HARP '
for physician services.
6. To reimburse resident ten ($10) dollars per
month for personal spending money.
B. THE RESIDENT OR RESPONSIBLE PARTY
1. To ptov.ide Such peu ona.L clothing and e4 6 ects a�
needed oA dai ed by the to ident.
2. To pay the montht y Aate agreed upon and such
chahga as determined by the Montoe County Home
to be nece�szah.y bot the opencation oA the home.
3. That, upon ceAti6.ication by a phyt6.ic%an otc the
adm.in iztAatm o� the home, the tce6ident is no
tongeA capable o6 meeting the AequiAement6 boA
occupancy .in ttis bac Zity, the tca ident, next o6
kin, tegat tcepke6entative otc agenw acting on the
Aes.ident'.s behaiL , wi.?.Q. have to maize aAAangementts
6oA the immediate tkary b eA to an apptoptu.ate /6ac itity.
In the event a Aetr.ident has no Amon to Aeptuent
h,im/heA, this bacct ty shaU oumist Aes ident in
contacting an apptopA i.ate Social. S eAv.ice Agency b M
placement. AppZicant agteu to vacate the tacit ty
within bonny -eight (48) houtus a6tet dusquat i, ication.
4. To comet y with aU tequi tements " set 6 otcth .in the
appt ication made by the tes ident.
5. To comp.ty with a2,e. tuita and tegutationz eistabWhed
by the County boA opmation and contAot ob 6a,id home.
G. Agtea, i6 not paying the maximum Aate, to pay
.incicea, e in .income dut ing the coutur e ob tes idency,
up to the maximum Aate..
7. OtheA: To pay AARP premiums
C. FINANCIAL ARRANGEMENTS
The to ident and/ot tupon,6 ibte panty agtem to pay to the
County $ 407.00 , peA month a6 tent bm use ob the bac titim.
PAYMENT WILL BE FROM THE FOLLOWING SOURCES:
1. Petr6onat bund6 ob Aes,ident
2. Retspons.ibte patuty Witt pay
3. UneaAned ,income ob Aesident
witt pay:
Soc%.at Secututy
Civic SeAv.ice Annuity
V.A. Pension
OtheA
$ 407.00
2
D. STANDARD ADMISSION WAIVER
The County, through its emptoyees, has agreed to exencv6 e such
Aea6onabte cane towaAd the Ae-s ident ass his on hen known condition may nequiAe.
Howev etL, tW home is ,in no s ens e an .i"uneA ob hits on hen .5 ab ety oA wetbane
and ",sump no t ab.i e%ty as .such.
The management ob this home wcU not be Aapons.ibte boA any
vatuabtu oA money debt .in the poue.6.6.ion ob this peAzon white he oA she is
a Resident ob tins home.
E. TERMINATION
Ib Resident iz absent bAom the home in excest6 ob bounteen (14)
continuous days, such absence shatt automatically tehminate tW agreement
and the nes.ident shaU Aemove atQt ob W oA hen pAopeAty oA beeong.ings
.immed,aiety. Ib tes ident baiz to remove dame, the rLn ident does heAeby
authorize the County to Aemove da,id pAopenty oA betongingd and deeiveA dame
to te6pon,6 ibte panty.
F. MEDICAL SERVICES
The partied agree that Monroe County dha t not be Aespons.ibte bon
oA a-,dume any tmponz.ibit ty boA payment ob any medicat oA hospitae setcv.icm
unZelsd d peci4 icaUy agreed to by the paAtia oA thei t AepALa entativ a at the
time ob the tendetr i.ng ob d ervice.
G. DURATION OF AGREEMENT
E.i theA panty may teAminate this agreement on thirty (30) days
wAitten notice. Othutwis e, it w.i Pt Remain. ,in eb b ect unfit a dib b eAent
agreement .ins executed. Howevetc., thi6 does not mean that a tLa ident w,itt be
botLced to Remain in the bac City aga.indt W /hen w.itt bm any .length ob time.
SIGNTRE OF RESIDENT
WITNESSES AS TO RESIDENT 1
/ r
MG RES N I B L RTy
WITNESSES AS TO RESPONSIBLE P y
3
r
DATE: 3
APPROVED:
S ijMutce o Repne.6 en a tiv e
of Monnoe'County Home a/k/a
Bay Shone Manors
Stignatutce a Executive
DiAectotc--Monnoe County
Sociat Setcvices
ig n tce a �Cou�nty
Adminti.5ttcatott
Thi6 iz to cetti6y that thi6 Admi6zion Agtceement a6 appAoved by
the County Home and the County Adminizts zatotc ways tcati6ied by the
Monnoe County BoaAd o6 County Commi6,sionetcz at xheiA meeting
head on the 1.c4 day aU--^*4, G,l- , 19�_•
4�,� 1 19,
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Sig tuts a e C atitcman
Montcoe Cou zy BoaAd o6
County Commi66ionvus
n
MONROE COUNTY HOME JUNIOR COLLEGE ROAD KEy WEST, FLORIDA
i
AfMISSION CPITEPIA. AND POLICIES
The Monnoe County Home, A.dut,t CongAegAate Living Fac ix'ity 6oA the E.LdeAty,
Levet II, heAeinaAtet Ae6eAAed to ah the Faai,P y, is eicevized through the
State o6 Ftotrida Depatetment o�) Heafth and Rehab.it tat.ive SeAvices, hene.in-
a6teA Ae6med to as HRS, and operated by the Board o6 County Commisb.ionvo
o� Monnoe County, Ftoxc da. The Facitity a govetcned in accordance with the
Aequi ementt6 ob ChapteA 400, PaAt II, F.-oAida Statu.eh and the PuEes and Regu-
tat.ions ass adopted by the Boated o{ Montcoe County Commits ione z hereinabten
u6eAAed to aS County, contained henei,n.
Re/s ident o6 Monroe County, Ftotci.da, z xty (60) yeaA6 o6 age or otdete, ambutatony,
in recusonabte health, .in need o� a home and having no 6amity able to meet theite
needa, able to carte 6oA them5e2ves to a cetctain degree and not .in need o6 nutus.ing
carte, convatescant cane, temporary of emergency shetten zha e be eli.g.ibze �oA
admi,s,s ion to the baciZ ty in accordance with the teAms and conditions contained
herein.
Appticationz are accepted on a non-dfzcAim.inatory baud's .ine'euding but not
Zi,mdted to sex, eotm, race oA etceed. The 6ac,itity 6hati provide a homed ke
atmotspheAe (Room and board), peJcsonat �seAv.ieeis and a eompnehens.ive program to
meet day to day needts o� the ambutatory aged on an .indiv.iduat basis - conducive
to group tiv,ing. PeA6onat SeAviceis meant s eAv.ices , in addition to housing and
hood seAv.ice which .inctude but are not Limited to: peAzonat zsistanee with
bathing, dreszing, ambutation, housekeeping, 5upeAvbs.ion, emotionae seeuX ty,
and any other Aeiated /sehvices which the 6acit ty may de6ine. Pmonae setcv.ice
does not .inetu de m ed ieat s e/tvic es .
ELIGIBILITY AND ADMISSION POLICIES
The ac6 , ,s.ion o4 each te6 ident to thdls jac,iL ty .shaft be undeA the supen-
vdls.ion o6 the Adm.ini sttLator 06 the Fae i P icy within the con6inets o6 the bottow.ing
geneAae poticie/s:
(1) A )L"ident/apptieant must:
(a) Not have a communicabY-e disease in a tran s -
6 erabt e s tag e.
(b) Have a ehetst x-nay oA shin test (TB) within
ninety (90) days ptc,io k to admi,5,sion to the
6 acit ty.
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(c) Be a Aesident o6 Rlontoe County, Ftotu.da 6oA at .least
one (1) yeaA and 6uAwushveA.i6.ication o6 same.
(d) Futuiizh pnoo6 o6 need 6oA the 6acif-ity and that thetce is
no 6ami y able to meet tWA needs {m adequate cane.
(e) FutcnZsh wn,itten medical examination {um a ticetised
phy,sici.an (6otcm w,iU be 6uAnizhed) which shaU ceAti6y that
.theiA medical condition is such that they w,iU meet the Ae-
gUit ement,s o6 the 6ac,i�y and that seAv.ices beyond that -
aAe petcmitted in the 6acieity arse not AeguiAed.
(6) Be ambulatotcy - that is the condition o6 being phys icaUy
and emoti.ona ty able to aA 6e 6Aom a hotitizonta.l oA 'Sitting
pos-i Lion, and in an em(?Agency to exit the building to a point
of satiety. This would .include tho,6e .individuaP-s who may be
able to ambulate with the assistance o6 pusthetic devices
,such as cAutche/s, walk.eAz oA wheel cha t6.
(g) Be sixty (60) yeatus o� age oA otdeA and 6uAnZsh age veAi6.i-
cation by ei theA pupeA .identi% ication, documents, oA by
in6oAmat.ion 6Aom othvL public agencies Such as the Social
SecuA ty AdminustAat%on.
(h) FuAnizh pAoo6 o6 ho.5p.itatization and medical -in/suAance
which is equal to oA b etteA than cov eAo_g e o 6 5 eAed by MedicaAe.
(�) Execute a wtr i tten conttcac i with this Aaci ity at the time o6
admiz,s ion, oA p)Lim thetceto, between the 6ac —y and the
Aes.ident oA his designee oA Zegat AepALaentative. A copy
oU contAact to be executed is attached heLeto and made a
paAt thetc o6.
(2) THE ADMINISTRATOR SHALL:
(a) Maintain a wAitten Aecmd ,in the ka ident',s peAzonat
{rile o 4 aP 1. 4 i.nanc%al at Aang ement6 with the tes.ident, hip
next o6 kin, oA.5powsoA, with copies executed by and �uAni6hed
to each patchy. This shaU .include detailed ,LecoAds o6 any
6unds oA pmopeAty held 6oA the Aes.ident 6oA sa6e keeping ,in
accoAdance with Chaptetc 400 F.S. PatLt II.
(1) The 6ac tity my hold pmonat 6unds 6oA the Aes ident
not to exceed $100.00.
(2) The 6acil-i ty shall not accept any othetc. 6unds oA
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pnopenty except as .6ei 6oAth .in 1 above.
(b) A/sse/ss no additi.onat change, expewsm on o,then
6inanciat i.ab.i.Piti.e/s in exce6,s o6 the wtoviz ions
inceuded .in the admi/s s ion cont,%act.
(c) DeteAm.ine and .inceude a6 a minimum, the 6oU.owing
pnovi,s ions and s eAvice/s .in the basic adm,iz/sion contAact
with each Aezident, next o6 kin oA AponsoR:
(1) The da ty, weeUy, oA montht y Rate, and Re6und
pnovision 6oR unused pontionz theneo6.
(2) A ti. sting o6 z env.ices to be pAov.ided.
(3) Sociat componentz appnopniate to the needs o6 the
Residents .
(d) App.ey the 6 o Uowing nes tR.ictio n/s to admits s io n and,
netewti.vn o6 n'ersidentz
1. A Aesident who man%6eSt/ such degnee ob behay.ion that
he ,cs a dang eh to h,ims e e oA others, on whose b ehay.ioA
.us so unacceptable oR disturbing as to .inteA6e)Le with
the adequate cane oA com6olt o6 otheA Residents .in the
6ac i e ity shaU not be admitted oA nLetained, and shaU
be Removed 6Aom the 6ac,LC ty.
2. No te,6ident shaP.2 possess on consume atchotic beveAages
oA any eontutted substance in the 6acitity without h is
phys.icia.n's ondeA.
3. No Resident shaU be head .in the 6aciLity against hi6
Witt, unP-ess undeA Count OAdeA.
4. No Resident shaU be admitted to on Aetained in a 6ac Uty
who tequ,i)Lm services beyond those the 6ac Uty i5 ticensed
to pAov.ide. This 6aci t ty may not pnov.ide nwEs,i.ng cage un-
.less 6oR a temponaky i Uness , not to exceed seven (7) days.
5. A resident absent 6Rom this 6acit.ity in excess o6 6ouhteen
(14) days, due to ho/sp.i ia.Pization oA abandonment shaee be
tenm.inated as a Aes.ident .in this 6aci.Y.i ty. Such Ae/s.ident
may Ae-appty bon admi&s.ion 6oUow,ing the same pAoeedune as
that o6 a new apptieant.
(3) The monthty Hate 6oA appt i.eants/Aez idents shoU. be adjusted to the
ab-it ty o6 the app,Pi.cant/Ae5ident to pay. AppXi.cants/Aes.ident�s with
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incomes .tees .titan the maximum
may
be a lowed to
pay that
amount as the. - monthtu, hate,
th,iswoad
inceude
any ,ineAeasm
,in theiA .income duAing the eouue oU theiA ,Le�sidency, up to the
maximum Rate.
(a) The monthly basic Aate shae.2 be established at the
beginning ob the 6izcat yeah and shaet pAevait
thAough out the yeah.
(b) MonthXy Aatez .shaY,e be Aeviewed and admended by the
Board o� MonAoe County Comm,im ioans.
(c) When Appt i.cant/ Res.id ent Aeee c:v n income and has
assets Zes�s than the maximum monthtu Aate, suppte-
mental. Suppoht wiU be accepted 6Aom the,i t 6amity,
oth eA ous s ins Lance agencies oA Ae.pA s entati.v es .
(d) I6 theAe 16 no 6upptementae support avaieabte, each
apptieant/Aaident wiU then be conzideAed on an in-
div,iduae basis .
(e) AU Aes,idents except those paying the. maximum Aate oA
those who do have otheA assets oA te6ouAca, wile. be
Aeimbuued ten (10.00) dottau pets. month by the County
6oA theit peAsona,i use.
(4) Upon eeAtic ication by the Adm.in istALatoA o6 the 6acie ity with the
eoncuAAanee o{ the 1=xecutive DiectoA o6 the MonAoe County DepaAt-
ment o6 Soci.ae Services, that aU ctciteAia and tequ,cA.ement6 set
6nth heAe in have been complied with and/oA met, .the appe i.cant shaU
be admitted to the 6aciUty. Subject to adequate �aciU ies being
avaieabte and execution o6 the admission agAeement by .the ka ident
and the County.
OPEPATIONAL STANDARDS
The 6aci.lity sha t o66eA cease supeAv.is,ion and t i,ving conditions as -its
necessaA.y to the condition o� the A,uident. This inceudes supeAv,is,ion oA
d.,ietts as to quality and quantity, wateh6utnes6 oveA the geneAae health,
satiety and wee.2 being o6 A.ez de;A6. TheAe shaU be a daity awaALeness ob the
Residents by designated lsta66 o6 the 6aeiUty as to the apparent we.0 being
o� the individuals with su6�icient pAov.is,ion 6oA contacting the Resident's
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physic i.a.n, i6 the Aesident has not atAeady done so, at any time ,theAe
appeaAz to be s-ign.i6icant deviation 6Aom his noAmat appeatuance on
state o5 heaPth and weU being. AppupA.iate notice ob such ,instances
shall be AecoAded .in the personae tecoAds o6 the .ind.iv.idua2..
WAitten agrceements between the 6aci?ity and each o6 its Aes.idents 6haU
pAov.ide that, upon ceAtiAication by a physician that .the Aes,ident .is no
.tongeA capatbZe o6 meeting the Aequitements Got occupancy .in this 6acit ty,
the Aes.id_ent, next o6 kin, .tegat AepAes entativ e, otc agency acting on the
Aes.ident's behat6, wi e be noti6ied that the Aes.ident w,iU have to maze
atcAang em ents 6oA .cmm ed.iat e scans b en to an ap pAo p k iat e caAe s etti.ng . In
the event a Aes.id ent has no p e u o n to AepAn ent him, this 6 aci.e it y s ha t
be tesponz ib.te 6oA Ae�mae to an appAopAi.ate soc%at setcvice agency 6oA
p.tacement.
The admission o4 a tezident to this 6acieity and his pAesence theAein shate
not con6 eA on the 6aci t ty, .its adm.in-is tA,atoA, empto yeeis oA tepAes entati.v es
any authoA ty to manage, use oA dispose o6 any pupeAty o6 the Resident;
noA shall such admission oA ptesence conjjeA on any o6 such petusons any
authoA,ity oA tesponz ibit ty 6otc the peronae a66a u o6 the ies.ident,
except what may be necessaAy 6oA the sa6e and ondetcty management ob the
6ac%Q.ity otc �oA the satiety oA the tcez ident.
This �aci,eity, adm.inisttcato,,t, emptoyee otc tceptr.e/sentative theheo6, may
not act as the coutct appointed guardian, tAustee, oA conseAvatoA botc any
Aes.ident o6 the jacit ty oA any o4 such Resident's pAopetcty.
This 6ac,i.Pity sha t be oAganized on a ptco4ess.ionaZ basis consistent with
good business practices.
This 6aci pity shaU be Aespons.ibte 4otc ptwv,iding s etcv.ices 6oA tces.idents as
Aequ,iAed consistent with the Zevet o6 svLvices o66vred.
This baciUty shall emp.toy oA othe&vi6e a&Aange 6oA .the seAv.ice o6 such
peAsonnet as atce Aequ,itced to pAopetey sta66 the 6acit ty.
AIMINISTRATIVE STANVARiS
This 6acit ty shaU be undeA the contAot o6 an adm.in.istAatoA.
(1) The �aciP.ity oA its dity designated AepAes entatc:ve shaU
maintain the 6oteow-ing wtc i tten Aecmds and any otheA Aecot d
Aequi.ted by the County oA HRS in. a rtace,- 6oian -an d-s ys,tem
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ondi.natity emptoyed in good business ptca.ctices.
(a) An ac6nimion and dischatcge tcegistetc tiisting
nameis oS na.identi6 and date ac6n,itted, identi.6y.ing
in6oAmati.on about each, the place 6Lom which ,the
tce.,s dent wall admitted; the date and heason 6oA
duschaAge, adequate .identi6icat.ion o6 the 6ac.cuty
to which the tces.ident .us dub chatcg ed on tAmiz 6 enned.
(b) A pets onat jit e 6oA each Aes,ident consisting ob ,
apptwpt late data, .including .ident.i6.ication o6 next
o6 kin, and aU data Aequiked 6oA. the Hotiida
Cetti6.icate of Death. Det" o� the tce6etvLaZ,
admis,s.ion, peAtinent non-med.icat and medicat .in-
6otrmation conceAing the uz ident �shaU be main-
tained with the genewt 6.uscat -Aecotcd o6 each,
,including copses o6 aU agneement6 on contAact,6,
account kecoA& and a cu.rtcent .inventoAy o6 peuonal
ptc.opeAty held bon sa6e-keeping.
(c) A jaci t ty accident/incident Aeco kd 6it e, containing
a clean des c option o6 each accident/.incident and
any otheA incident .invotv.ing hazardous on deb.iant
behav,io,t o6 a tes.ident on 6ta66 membeA with names
o6 .in dividuaZ6 .involved, des ctt i.ptio n o6 m edicat on
other s eAvices pnov.ided and the steps taken .i6 any
to prevent neculvcance.
(d) Petrsonnel tecond o6 each sta66 member. This record
w,i.P2 be kept updated and contain o>tig,inat emptoyme.ni
apptication with nejenences 6unn.v5hed.. _
(e) A tecord ob pehsonnel potic%e6, .including statements
ob pot i..cies and work assignments bon each position.
(J) A necotc.d o6 monthty 6 tc.e dAiPX6, indicating the date,
ho u,t and g en enal des cA iptio n o6 each dA i,Q l , the extent
ob the sta66 .involved and the name o6 peuon in charge.
(g) F.inanciat tcecotcd6 which identi6y a2t .income ob the
6 ac,i.l-it y by source and des cn ib,ing a.2.1, exp en ditutce6 by
category �n such a manners as to be auditabte by basic
accounting pnoceduna.
e
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FINANCIAL STANDARDS
The administrator o6 this 6acitity shaU maintain Uiscae records in
accordance with the tequi)Lements o6 Chapter 400, F.S. Pant II. There
,shaU be a recognized system o6 accounting used ,to aceuratety re6tect
detai,bs o6 .the business. The Jacitity shaU:
(1) Be adm,inusteAed on a sound 6.inanc i.ae basis cons.c5,tent
with good bu�sines.6 practices.
(2) Sped% y its re6und pot icin as pant ob the adinis s ion
contract.
(3) Speciby that no administrator, eo"uttant, sta66 member
or repres enta tiv e s ha t :
(a) Pay any eommisb.ion, bonus, rebate or gri ttui'ty
to any organization, agency, phy.6ician, zta�j
or other. peson Aor retie AaP. o6 any resident to
the 6acitity.
(b) Request or accept any renumeration, rebate, g.iSt
bene6it or advantage o6 any 6orm 6rom any vendor
or other suppti.er because o6 the putechase, rentae
or toan o6 equipment, 5upp.e ies or s eAv.ices 6or the
6acitity or resident not consistent with noAmae
busines,s proaetice.
PERSONNEL STANDARDS
The administrator ob this {acitity .shaU operate the 6acitity .in accordance
with .the ex fisting Monroe County Petusonnee PoZicies and Procedures.
DIETARY STANDARDS
This 6acie i ty 6haU have written pot ieies and procedures SwL providing proper
nutAitionae care o6 its to ident6 -
(1) The 6oteotving requ,U ements shaU be met:
(A) The administrator or a person designated by the
adm.inustr.ator shaU be kesponzibte 6or the totae
di.etcAy setev.ice and the day to day .5uperv,cs.ion o6
dietary seAv.ice. The designated petuson shaU be
re,spon,s ibte 6orcoordinating dietary services with
other sekv.ices; deve.eop.ing work asz-ignment.6.
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The pmon daignated by ,the admiii,istAatoA shaU
peA6oAm his/het duties in a safe and s.an taty
rVInnn eA .
(B) Thnapeuti.e diets as pA.esenibed bci .the physician
s h_a,e e be in ,the te,5ident',s ,Lecotd and s elcv ed as
oAdeAed.
(C) FeguXat diets shaU meet nuttci,t-ionat needs o6
Aesident,s in aeeotdanee with .the cu"ent recommended
V etaAu Attowance o6 the Food and Nu,ttiti,on Boatd,
Nat(.onaX ReseaA.eh CounciX., adjusted 'oA age, sex,
and activity. TheAapeuti.c diets sha t meet these
nub i tionae standaAcs to the extent ,that ,is med cagey
poss ibt e.
(D) The dietary allowance shae.e be met by the uses ob
standaA,i.zed Aeci.pes o66eA%ng a vaAiety 06 Goods
adapted to the Good hab,i is , pAe� enences and physieae
abZUt.%es o6 the Ataidents .
(F) An up to date ma.nuae app tov ed by HRS shaU be used
as the standard_ Ae6etcenee in ptann.ing tegu&IL and
theA.apeuti.e diets .
(F) Dated menus shaU be planned at .least one week in
advance {oA Aegu.eat and therapeutic diets; and
coAtected as served and kept on 6iZe 6ok six months.
Supptia o6 non-peA,ishabte Good to meet nuttiti.onae
needs o6 A.esidents 6oA one (1) week petci.od shaU be
on hand.
(G) Food shade be selcved attAa_etiveey at sa6e and
paeatabte tempehatuAes . AU. tesidents s haU be en-
eo uAag ed to ea'. at tabt es in dining oAeas . A, s uppt y
oU appnopt ate eating ware shaU be on hand .to serve
ate Aesident/s .
(H) A.tt matteA/s peA,tai.ning to Good seuice shaU eompey
with the puv,isions o4 Chaplet 10-13, Ftoti.da San itaAy
Code.
-9-
RIGHT TO NEARING
Any app.-icant who Zs d iss at z 6-ied with ,the decision tcendened by ,the
DepaA ment 06 Montcoe County Social SeAviCes, has the Aight to nequest
a tcev.iew o6 theZ% case by ,the Social Setcv.icu Execu.ti.ve Ditcectm TW
tcev.iew shaU be done within 6.ive (5) woA ling days a6ten ,the tequnt is
tceceived 6tcom the appti.cant. 16 the D.itc.ectotc's tcev.iew does not 'Laotve
the app.ii.cant's compta,int, .the appti.cant then has the tight to kequetst
a Fadtc. Heating.
FAIR HEAPING PROCEDURE
Within ten (10) wotcFii.ng days a6tetc a complaint .is t<ece,ived 6tcom an
app.iicant, a heatLi.ng witt be head .in .the o66.ice o6 the County Adm.inistkatotc.
The putcpose o6 tW heaAi.ng w,cU be to aLeow the app.-icant a 6aiv oppotrtunity
to voice his/het comptaa.int be6otce a heaAi.ng committee. Th.iscomm,c ttee wilt consist
o6 the
County AdmiaistmtoA, the
Cterch
o6 the Boatcc{
o6 Alon,toe
County
CommZss.ionetus
and one
(1) County CommZss.ionm
The
6.inat decision
shaU be
made by
the heatci.ng
committee within ten (10) days and a copy o6 same shaU be 6uknZshed to the
app.Pi.cant by United States Mail otc peuona.2 de.ei.veAy.
As o6 this date, I have head the Admission C)Litetc.ia and Pot.ic.ies:
A-� lj;Ja�
ti nature oj ReziZlEnt
V�.c es s
es s
'?, 2 3 , C98
a e
. z3���
Date
Wc;23)(f
Date