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State-operated group homes

Policy samples for comprehensive services

Table of contents

1.000 Mission Statement
2.000 Program Management
3.000 Rights
4.000 Health
5.000 Safety

Title Section Page
Mission Statement including:

Program Goals, Objectives;
Relationships with Neighborhoods;
Relationships with Facilities
Revised 12/1/01

1.000 1
Program Management

Enhanced Residential for Medical Homes

Form: Enhanced Residential Activity Preferred List
Form: Enhanced Residential Schedule of Activities
Form: Enhanced Residential Weekly Totals
New Policy 11/21/00

2.001 1-2
Entry/Residential Support Plan

OAR 309-049-0190
Revised 12/1/01

2.002 1-4

Exit/Transfer

OAR 309-049-0190(4)
Revised 11/3/98

2.003 1-3
Individual/Family Involvement

OAR 309-049-0207
Revised 4/8/99

2.004 1
Non-Retaliation

OAR 309-049-0210(2)
Revised 4/10/97

2.005 1
Personnel File Requirements

OAR 309-049-0095
Form: Employee File Checklist, 5/02
Form: Pre-Inservice Training Record, 12/01
Form: Yearly Staff Training Record, 12/01
Form: Temporary CPR/First Aid Certification Documentation, 12/01
Form: Hepatitis B Immunization Series Designation Form, 12/01
Form: Tuberculosis and Hepatitis B Sign-off, 12/01
Form: Mandatory Abuse Reporting Notice, Revised 8/02
Revised 5/14/02

2.006 1-2
Personnel Policy - Abuse

OAR 309-049-0095(3)
Form: Mandatory Abuse Reporting Notice, Revised 8/02
Abuse Reporting and Protective Services Rule
(OAR 309-040-0200 through 309-040-0209, adopted 1/30/97) 1-16
Revised policy 11/23/99, added form 12/1/01

2.007 1
Payment of Personal Property Claims

ORS179.210-179.240
Form: Property Damage Claim Form, 11/02
New policy 11/1/02

2.008 1
Rights

   
Behavior Intervention

OAR 309-049-0165, OAR 309-049-0170
Form: Behavior Support Plan Data Form, 10/00
Tool: Consulting Psychologist Communication Log, 12/01
Tool: Daily/Monthly Behavior Graphs, 12/01
Tool: Two Year Behavior Record, 12/01
Revised policy 4/10/97, added forms 12/1/01

3.001 1-5
Complaints and Grievances

OAR 309-049-0160
Form: Client Grievance Report Form, 12/01
Revised 4/10/97

3.002 1-2
Confidentiality of Records

OAR 309-049-0155(1)
Revised 12/01/01

3.003 1
Confidentiality of HIV Records

OAR 309-049-0075(2)
Revised 4/10/97

3.004 1
General

OAR 309-049-0150
Form: Rights Sign-Off Form for Individual & Guardian, 12/01
Revised 4/10/97

3.005 1-7
Individual Money Management

OAR 309-049-0180
Form: Income and Expense Account Record, 12/01
Form: Transaction Slips, 12/01
Revised 5/14/02

3.006 1-5
Informed Consent

OAR 309-049-0150(2)(a)
Revised 4/10/97

3.007 1
Personal Property

OAR 309-049-0185
Form: Personal Property List, 12/01
Revised 12/01/01

3.008 1-2
Physical Restraint

OAR 309-049-0170
Form: Incident Report Form (3 pages), Revised 5/01
Revised 5/14/02

3.009 1-2
Health

   
180-Day Medication Review

OAR 309-049-0075(10b)
Tool: 180-Day Medication Review form, 5/02
Revised 5/14/02

4.001 1
Food and Nutrition

OAR 309-049-0080
Revised policy 10/15/01, Forms removed 12/1/01

4.002 1-2
Infection Control

OAR 309-049-0075
Revised 11/3/98

4.003 1-4
Medical Services, Medical Administration

OAR 309-049-0075(3)(5)(6)(8)
Form: Medical Administration Record, 5/95
Form: Addendum to Physician Orders, 10/01
Medication Administration Procedures Manual (21 pages)
Revised policy 11/1/02

4.004 1-7
Medical Services, Emergency Medical Procedures

OAR 309-049-0075
Revised 12/01/01

4.005 1
Medication Administration, Controlled Medication Count

OAR 309-049-0075(3)(5)(6)(8)
Form: Medication Count Sheet, 10/01
Revised 2/24/98

4.006 1-2
Individual Care

OAR 309-049-0075(1)(3)(4)(5)(6)(7)(9)
Form: Addendum to Physician Orders, 12/01
Form: Annual Menstruation Record, 10/01
Form: Balancing Form,10/01
Form: Influenza Immunization Informed Consent, 10/01
Form: Immunization Record, 10/01
Form: Medical History, 10/01
Form: Medication Count Sheet for Controlled/Narcotic Medications, 10/01
Form: Progress Notes, 10/01
Tool: Physician's Visit/Orders, 12/01
Form: Psychotropic Drug Record, 10/01
Form: Registered Nurse Communication Log, 10/00
Form: Seizure Calendar, 12/01
Tool: Seizure Protocol, 12/01
Tool: Seizure Report, 12/01
Revised 5/14/02

4.007 1-2
Medical Services, Nurse-Client Relationship

OAR 309-049-0075
Revised 10/15/01

4.008 1-3
Medical Services, Nursing Care/Level of Care

OAR 309-049-0075(14)(15)
Guidelines for Weighing
Form: Monthly Weight, 10/00
Form: Weight Chart, 10/01
Revised 12/30/97

4.009 1
Medical Services, Medication Disposal

OAR 309-049-0075(11)
Form: Drug Disposal Sheet, 12/01
Revised 12/1/01

4.010 1-2
Medical Services, Pharmacy, Adverse Effect Safeguard

OAR 309-049-0075(12)
Revised 12/1/01

4.011 1-2
Self-Administration

OAR 309-049-0075(12)
Sample Individual Self-Administration of Medications
Program (2 pages), 4/99
Revised 4/10/97

4.012 1-2
Safety

   
SOCP Safety Committee and Program

OAR 437-001-0760, OAR 437-001-0765
New policy 5/31/01

5.001 1-4
Bloodborne Pathogens Exposure Plan

OAR 309-049-0075, OAR 437-002-1910.1030
Form: Significant Exposure Information, 10/01
Form: Universal Precautions, 10/01
Revised 12/10/02

5.002 1-5
Emergency Plan

(Fire/Explosion/Earthquakes/Flooding, Injury,
Illness, Death, Missing Resident)
OAR 309-049-0120(1)(2)
Revised 5/31/01

5.003 1-6
Evacuation Drills

OAR 309-049-0130
Form: Fire Drill Record, 10/01
Revised 10/15/01

5.004 1-2
Incident Reports and Emergency Notification

OAR 309-049-0110
Form: Incident Report Form (3 pages), Revised 5/01
Form: Medication Administration/Documentation Irregularity Report
Revised policy 5/14/02

5.005 1-3
Individual Summary Sheet

OAR 309-049-0105
Form: Individual Summary Sheet, 12/01
Revised 4/10/97

5.006 1
Personal Protective Equipment (PPE)

OAR 437-002-1910.132 - 138
New policy 5/31/01

5.007 1-4
Safety Review

OAR 309-049-0120(3)
Form: Safety Checklist (2 pages), 3/02
Revised 10/15/01

5.008 1
Training

OAR 309-049-0095(2)
Form: Core Competencies (initial, 30-day, 90-day), 8/02
Form: Transfer Core Competencies, 8/02
Form: Yearly Cumulative Training Record, new 1/03
Form: Instruction Record, new 1/03
Revised policy 4/22/03

5.009 1-2
Vehicles and Drivers

OAR 309-049-0115
Revised 12/1/01

5.010 1
Zero-Lift Policy

New Policy 12/1/01

5.011 1-2
Oregon Administrative Rule - 24-Hour Residential Services
for Individuals with Developmental Disabilities

Cover page, Table of Contents i-viii, rule
(OAR 309-049-0030 through 309-049-0225,
adopted 10/16/98, 43 pages)

 



 
Page updated: September 22, 2007

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