Section 1 – Organization and Administration
Legal and Regulatory Compliance
Disclosure of Ownership and Management
Professional Standards and Principles
Governing Body Responsibilities and Requirements
Conflict of Interest
Administrator
Lines of Authority
Services Provid
Clinical Manage
Collection and Transmission of OASIS Data
Reporting Negative Agency Outcomes
services furnished under written agreement/contract
Waived Tests
Attachment
Governing Body Members roster
Governing Body Orientation checklist
Conflict of Interest Attestation Statement
Designation of Alternate Administrator
Organizational Chart
Designation of Alternate Clinical Manager
Contractor/Provider Agreement
Annual Contractor Evaluation
Section 2 – PROGRAM AND SERVICE OPERATIONS
Description of Care and Services
Patient Rights and Responsibilities
Reporting and Investigating Abuse and Neglect
Patient Grievances and Complaints
Patient Confidentiality and Protected Health Information
Advance Directives
Emergency Care and Resuscitation
Ethical Issues
Communication and Language Barriers
Provision of Patient-CEntered Care
Agency Compliance Program
Supervisor and Nursing Availability
Approved Treatments and Procedures
Attachment
Patient Rights and Responsibilities
Sample Complaint Log
Sample Complaint Report
Notice of Privacy Practices
Compliance Reporting Poster
Section 3 – Fiscal Management
Agency Budget Plan
Capital Expenditure Plan
Financial Management and Business Practices
Financial Records Retention and Review
Disclosure of Rates for Care and Services
Attachment
Care and Service Rates
Section 4 – Human Resource ManagemenT
Personnel File Management
Verification of Credentialing
TB Screening and Vaccination Policies
Job Description
Driver’s License and MVR Checks
Background Checks
Employee Handbook and Personnel Policies
Annual Performance Evaluations
Orientation
Competency Assessment
Continuing Education and In-Service Requirements
Home Health Aide Training, Competency, and Supervision Requirements
Personal Care Attendants
Training for Waived Testing
Specialty Training and Certification for Nurses
Attachment
Personnel File Checklist             Â
Sample Job Descriptions
Administrator
Clinical Manager
Registered Nurse
Licensed Practical/Vocational Nurse
Physical Therapist
Physical Therapist Assistant
Occupational Therapist
Occupational Therapist Assistant
Speech-Language Pathologist
Medical Social Worker
Home Health Aide
Quality Assurance Coordinator/QAPI Coordinator
acknowledgement Of receipt of Employee Handbook
Sample Performance Evaluations
Administrator
Clinical Manager
Registered Nurse
Licensed Practical/Vocational Nurse
Physical Therapist
Physical Therapist Assistant
Occupational Therapist
Occupational Therapist Assistant
Speech-Language Pathologist
Medical Social Worker
Home Health Aide
Quality Assurance Coordinator/QAPI Coordinator
Sample Competency Assessments
Registered Nurse
Licensed Practical/Vocational Nurse
Physical Therapist
Physical Therapist Assistant
Occupational Therapist
Occupational Therapist Assistant
Speech-Language Pathologist
Medical Social Worker
Home Health Aide
Sample Annual Education/Inservice Agenda
Section 5 – Provision of Care and Record Management
Patient Record Requirements
Storage and Access of Patient Records
Initial Assessment and Plan of Care Development
COMPREHENSIVE ASSESSMENTS
Therapy and Medical Social Work Services Assessments
Drug Regimen Review and Medication Management
First Dose in the Home Setting
Plan of Care Requirements
Written Instructions for Patients and Caregivers
Care Coordination
Transfer/Discharge Criteria and Process
Verbal Orders
Changes in Patient Condition
Skilled Professional Services
Home Health Aide Services
Patient and Caregiver Education
Referral and Acceptance Process
Face-to-Face Encounter and Certification
Credential Verification for Physicians and
Allowed Practitioners
Outpatient Services
Attachment
drugs and solutions approved for home administration
patient referral and acceptance process policy revision flow sheet
Home health referral and admission availability assessment tool
Physician and Allowed Practitioner License Verification
Section 6 – QUALITY OUTCOMES AND PERFORMANCE IMPROVEMENT
Quality Assessment and Performance Improvement  (QAPI) plan
Oversight and approval of the QAPI Program
Incidents and Occurrences Reporting and Documentation
Safe Medical Device Reporting
OASIS Data Reports
Attachment
Agency QAPI Plan
Annual QAPI Report
Sample Incident/Occurrence Report
Sample Incident Log
Section 7 – RISK MANAGEMENT: INFECTION CONTROL, SAFETY and emergency preparedness       Â
Infection Control Program
Exposure Control and Standard Precautions
Tuberculosis Screening and Prevention Plan
COVID-19 Standard
Employee and Patient Infection Control Training
Employee and Patient Infection Control Tracking
Bloodborne Pathogens Standard
Employee Personal Safety Education
Basic Home Safety
Office and Workplace Safety Plan
Hazardous Waste and Materials Use, Storage, and Disposal
Hazard Communication Standar
Incident and Occurrence Reporting for Personnel
Point-of-Care Laboratory Testing: PT/INR
Point-of-Care Laboratory Testing: Blood glucose monitors
Emergency Preparedness
Safe Use of Equipment and Supplies
Experimental Therapies and Clinical Research
Workplace violence prevention plan
Attachment
Agency TB Screening Assessment
Employee TB Screening Assessment
Patient Infection Log
Employee Infection Log
Fire Drill Log
Annual Office Environment Assessment
Incident/Occurrence Log
Incident/Occurrence Report
EMERGENCY PREPAREDNESS PLAN
RISK FACTORS FOR WORKPLACE VIOLENCE
WORKPLACE VIOLENCE PREVENTION PROGRAM ASSESSMENT CHECKLIST