ALTERNATIVE FAMILY LIVING, INC

1. CONSUMER HANDBOOK 2009 ALTERNATIVE FAMILY LIVING, INC

2. MISSION STATEMENT Our mission is to serve developmentally disabled and dual diagnosed individuals with a high degree of staff competence, quality of care and accountability.

3. ROLE AFLI is a community service provider & placement agency that serves individuals with developmental disabilities. ALTERNATIVE FAMILY LIVING, INC contracts with Lead Management Entities throughout the Western North Carolina Region. Provider services include Alternative Family Living (AFL) funded by Residential Supports or LME Family Living funds, Home Supports Services provided by family members, Home and Community Supports (HCS), Personal Care and Respite Services. AFLI specializes in the area of AFL and Respite services providing superior services and support to the communities we serve. It is also our responsibility to carry out the individual�s outcomes as written in the Plan of Care and to provide feedback of that plan to facilitate the achievement of the individual�s full potential.

4. PHILOSOPHY AFLI believes that all individuals should achieve their full potential and that all attempts should be made to maximize each individual�s independence, productivity, talents and quality of life according to his/her preference as well as support each person�s choice of living environment, learning techniques, play, work and retirement AFLI believes that each person should be empowered to make true choice in daily life by being informed of the consequences of the choices made and to afford the dignity of risk. We will provide efficient and flexible services with dedicated, competent, and supportive staff. We will adhere to moral principals, exhibit honesty, and build and maintain trust, in all endeavors of business, with the people we serve, those we work with, and those we work for. We are committed to growth and development that collaborates with people, our employees and other agencies to benefit all parties.

5. HOURS OF OPERATION Operating Office Hours for AFLI are Monday-Friday 9:00am � 1:00pm Please call the office number below during regular office hours for regular business issues. If you should have an emergency outside of office hours, please call our on- call pager at the number below. 231-9235 Mailing Address: 303 Old Hwy. 20 Alexander, NC 28701

6. IMPORTANT CONTACTS Office: 828-225-6004 Fax: 828-258-1079 � Tracy Smith Owner/ QP cell: 231-9235 tracysmith@alternativefamilylivinginc.com Resource Specialist: Melissa Gosnell 649-2308 melissasgosnell@alternativefamilylivinginc.com Data Specialist: Angela Webb 367-2714 angiewebb@alternativefamily livinginc.com Administrative Assistant367-2714gail@alternativefamilylivinginc.com �QP: Cindi Gosnell 243-6474 cindygosnell@alternativefamilylivinginc.com �For emergencies: Call the office during business hours or utilize the on-call pager after hours AFLI Beeper: 828-231-9235

7. Emergency Procedures Examples of an emergency would include: - Client incident requiring medical attention or CPR & First Aid - Client hospitalized - Use of an emergency physical restraint ( NCI approved technique) - Vehicle accident involving a client - Unavoidable instance requiring staff to not be able to work the very next day, - Staff should also inform family of client if unable to work the very next day. - For AFL�s, or Home Supports the need for emergency client placement or respite. - For family members or clients, the need for emergency placement or respite - Any other situation in which a client of ALTERNATIVE FAMILY LIVING, INC. has been placed in jeopardy or risk of harm. Employees have also received this information & emergency examples. All of us here at AFLI strive to be a supportive team for both our clients and employees. Thank you for helping us to follow these emergency protocol guidelines. Should you have any questions, please contact Tracy Smith, DCS at the above numbers.

8. CONSUMER SATISFACTION ALTERNATIVE FAMILY LIVING, INC appreciates and values you, our consumers. That is why we ask that you participate in our annual consumer satisfaction survey. This survey may be delivered to you via email, online surveys, by your assigned qualified professional, or by postal mail. The survey is anonymous, meaning you do not have to give any identifying information such as your name or social security number. All information given in the survey will be confidential and will only be reviewed by the directors and office manager. The survey rates your degree of satisfaction with us and contains general questions about the agency, the services you are receiving, and the people providing those services such as your QP, 1:1 staff, managerial availability, etc.. Completing the survey is optional, but your feedback will allow us to solve / relieve you of any issues or concerns you may have and contribute to the overall improvement of our agency. � � We have also conspicuously placed suggestion cards and boxes at our office locations. We want you to feel free to pick up a post card at any time to let us know how things are going, suggest changes which could make the services we provide better for you and / or your loved ones. We also encourage our 1:1 staff, case managers, etc. to do the same. We will be sending the surveys annually with a newsletter to keep you up to date regarding how previous suggestions have been incorporated into our business practices over the past year and how our services meet the quality you expect, along with any agency changes that would effect the services being provided to you or your loved ones.

9. YOUR RIGHTS When you receive services from ALTERNATIVE FAMILY LIVING, INC, you have many rights supported by law. Understanding your rights will help you stand up for yourself and fully participate in your care. Knowing your rights can help you: Make informed choices about your care. Resolve any problems that may occur. Know what to expect from your services providers. Become a better self advocate for your care and treatment. � A Declaration of Basic Client Rights: � Some of your basic rights � often called client rights � are in North Carolina General Statutes Article 3.122C. �It is the policy of the State to assure basic human rights to each client of a facility. These rights include the right to dignity, privacy, humane care and freedom from mental and physical abuse, neglect and exploitation.� You also have the following rights:

10. YOUR RIGHTS To be informed of your rights: �By law, you must be informed of all your rights within the first three visits to your community provider ( or within the first 72 hours if you are in a 24-hour facility). You also have the right to: Ask that printed information explaining your rights be given to you in a way that you can understand. Know what to do and whom to call if you believe someone is trying to take away your rights. To know what is expected of you: You must be told about any rules you need to follow. This information should be shared with you when you begin receiving services. If you do not receive this information, ask someone you trust to help you obtain this information. To always be treated with respect: Staff should be polite, attentive and responsive to your needs and values. To have information about you kept confidential: It is your right to receive care in your community in the least restrictive environment suitable to your individual needs.

11. YOUR RIGHTS To have information about you kept confidential: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is the federal law that protects your private health information. The HIPAA law states that medical records, treatment plans and any other information about you (including what you say or share) must be kept private. Anyone not involved in providing your care, including family members, must first obtain your or your guardian�s permission before this information is provided to them. To understand and give informed consent: When you are making a decision about your treatment, you should have the chance to know the most likely results of your decision and what other choices you have. Making decisions after considering all available options is called �informed consent.� Except during an emergency, informed consent is always your right. Before you give your approval for any service or treatment, be sure you have all of the information you need. This right is based on the idea that you are the person who best knows what works for you.

12. YOUR RIGHTS Informed consent includes being given information: To know about medication: You have the right to know the possible side effects of medication and to be free from unnecessary or excessive medication. Medication cannot be used as a punishment, discipline or for the convenience of staff. To accept or refuse services: By law, you can accept or refuse any service, medication, test or treatment. However, during an emergency situation, treatment may be necessary without your permission. To be involved in the service plan: It is your right to be involved in your service plan. You have a right to be involved in the development and review of your plan before you sign it. To make certain treatment choices: It is your right to be informed of the potential risks, benefits and alternatives to the treatment being offered to you.

13. YOUR RIGHTS To exercise your rights as a citizen: You have many rights as a citizen. These include buying or selling property, signing a contract, registering to vote, marrying or getting a divorce. Unless the court has declared you incompetent, you will always have these rights. To make advance instructions: You have the right to a written plan called an �advanced instruction for mental health treatment.� This written plan describes how you want to be cared for if you ever become unable to decide for yourself. You can also name a �health-care proxy� in your advanced instruction. This lets another person who you have identified make decisions about your care. For help in preparing these plans, you should speak with someone you trust and/or your case management agency.

14. YOUR RIGHTS To review your medical records: You will usually have the right to review information in your medical records, which includes your service plan. To see a medical care provider: If you are sick or need medical care, you have the right to receive medical treatment. To know the costs of service: Ask us if you have any questions about any costs or fees that you may be charged. AFLI does not bill any additional fees for Medicaid or CAP/MRDD Medicaid Waiver services. To be accepted for treatment: You have a right to receive age-appropriate treatment. Services cannot be denied, interrupted or reduced without good cause. If your services are denied, interrupted or reduced you can appeal the changes to your services.

15. YOUR RIGHT TO PRIVACY You have the right to be free from any unwarranted search of your person or property. At the time of admission to 24hr care, if warranted, staff may search you and/or your belongings to prevent dangerous or illegal substances from being brought into the AFL placement or respite home. The AFL home or respite home itself may be searched if dangerous or illegal substances are reasonably believed to be present, and staff may search people who are minors if warranted. Should search and seizure apply to a program for which you are receiving services, the specific procedures will be explained when you enter the program.

16. RIGHTS IN 24 HOUR CARE Consumers admitted to 24-hour residential AFL placements have important rights. However, there are times when a consumer may have some of their rights restricted based on care and treatment considerations. If you have any questions about these restrictions, you should speak to the AFLI director or your assigned Qualified Professional.

17. RIGHTS IN 24 HOUR CARE Rights of adults which CANNOT be restricted include the right to: Send and receive unopened mail. Contact a lawyer, doctor or other private professional at your own expense. Receive medical care if you are sick. Contact a client advocate. Rights of minors which CANNOT be restricted include the right to: Talk to a parent or guardian. Consult with legal counsel, private doctors or mental health, developmental disabilities, and substance abuse service providers. Contact a client advocate.

18. SUBSTANCE ABUSE RIGHTS There are special rights regarding substance abuse that are protected in federal law. Ask your LME customer service representative about specific substance abuse rights.

19. INVOLUNTARY COMMITMENTS Sometimes when a person�s illness makes it difficult for him or her to recognize the need for help, it is up to someone else who cares about the person to seek help and petition for what is called involuntary commitment petition. If you are unsure of what your rights are when you are under an involuntary commitment petition, you should ask the AFLI director or you case management agency to explain these rights to you.

20. ALL AFLI CLIENT�S RIGHTS To be treated with respect, consideration, dignity, and full recognition of his/her individuality and right of privacy. To receive care and services which are adequate, appropriate and in compliance with relevant federal and state laws. To receive upon admission and during his/her stay, a written statement of the services provided by the facility and the charges for these services. To be free of mental and physical abuse, neglect, and exploitation. Except in emergencies, to be free from chemical and physical restraint unless authorized for a specified period of time by a physician according to a clear and indicated medical reason. To have his/her personal and medical records kept confidential and not disclosed without the written consent of the individual or guardian, which consent shall specify to whom the disclosure may be made, except as required by applicable state or federal statute or regulation or by third party contract. It is not the intent of this section to prohibit access to medical records by the treating physician except when the individual objects in writing. Records may also be disclosed without the written consent of the individual to agencies, institutions or individuals that are providing emergency medical services to the individual. Disclosure of information shall be limited to that which is necessary to meet the emergency. To receive a reasonable response to his/her requests from the facility, administrator and staff. To associate and communicate privately and without restriction with people and groups of his /her own choice on his/her own or their initiative at any reasonable hour. To have access at any reasonable hour to a telephone where he/she may speak privately. To send and receive mail promptly and unopened, unless the resident requests that someone open and read the mail, and to have access at his/her expense to writing instruments, stationery and postage. To be encouraged to exercise his/her rights as a resident and citizen, and to be permitted to make complaints and suggestions without fear, coercion, or fear of retaliation. To have and use his/her own possessions where reasonable and have an accessible space equipped to lock provided for security of personal valuables. To manage his/her personal needs funds unless such authority has been delegated to another. If authority to manage personal need funds has been delegated to the ALTERNATIVE FAMILY LIVING, INC., the resident has the right to examine the account at any time. To be notified when the facility is issued a provisional license or notice of revocation of license by the North Carolina Department of Human Resources and the basis on which the provisional license or notice of revocation of license was issued. The resident�s responsible family member or guardian must also be notified. To have freedom to participate by choice in accessible community activities and in social, political, medical, and religious resources and to have freedom to refuse such participation. To receive upon admission to the ALTERNATIVE FAMILY LIVING, INC. a copy of this Policy. To contact the Governor�s Advocacy Council for person�s with disabilities (GACPD), the statewide agency designated under federal and State law to protect and advocate the rights of persons with disabilities. The contact information is as follows: http://www.gacpd.com Governor�s Advocacy Council for Persons with Disabilities 1314 Mail Service Center Raleigh, NC 27699-1314 Phone: 919-733-9250 Fax: 919-733-9173 To obtain a copy of client�s individual treatment/habilitation plan. This may be obtained from ALTERNATIVE FAMILY LIVING, INC QP or client�s case management agency. If requested, please allow AFLI 2 (two) days to copy the plan and get it to you.

21. YOUR RIGHTS ARE YOURS Use your rights to take charge of the services that you receive and your treatment. Try to learn about the many rights you have and use them in the way that is best for you. Sometimes, other people don�t know what your rights are�but do not let that stop you from using your rights. Instead, teach others about your rights. If you run into problems with your rights, ask someone to help you out. You do not have to go it alone. There are many people and supports that can help, but sometimes you have to ask for them. Remember, these are your rights, they can support and protect you and they can make your life better! Don�t be afraid to ask questions.

22. GRIEVANCE POLICY AFLI ensures that any client who feels the services provided are in adequate or disagrees with a decision regarding their support services has an effective and efficient manner to express his concerns. Every attempt will be made to resolve grievance issues at the lowest possible level of within the organization. The following grievance procedure will be followed: The client or guardian will address the concern with the management pf AFLI. The grievance is to be in writing. The issue will be resolved in a timely manner. In the event that a resolution cannot be made between client and/or guardian and AFLI in a timely manner then the issue will be referred to the QDDP for mediation In the event that a resolution cannot be made between client and/or guardian and the QDDP in a timely manner then the issue will be referred to the referring agency for mediation between the client and/or guardian and AFLI.

23. RESTRICTIVE INTERVENTION POLICY AFLI condones the use of restrictive interventions on a planned and an emergency basis. Each planned restrictive intervention will include the purposes, goals and reinforcement structure of any behavior management system that is allowed, potential restrictions or the potential use of restrictive intervention, notification regarding use of emergency restrictive intervention procedure will be explained to the individual and/or legal guardian. The legally responsible person of a minor or incompetent adult client may request Notification after any occurrence of a restrictive intervention. The competent adult client may designate an individual to receive notification, in accordance with G.S. 122C-53 after any occurrence of a restrictive intervention and of notification that provisions regarding the restriction of client rights as specified in 122C-62 Documentation that client rights have been explained to the individual before entering services with AFLI.

24. DISCHARGE POLICY Person moves out of geographic area. Person dies. All relevant goals are accomplished and there is no longer exists a need for service Person continuously refuses services after attempts by LME, Case management agency, and ALTERNATIVE FAMILY LIVING, INC. to comply with service demands and requests. Medical and /or behavioral issues occur that prevent the person from being safely served by a single staff person in the community or ALTERNATIVE FAMILY LIVING, INC.

25. DISCHARGE PROCEDURE Management will notify LME, case management agency and client of impending discontinuation of services. Attempts will be made to resolve issues related to discharge. A 30- Calendar day notice will be given unless other mutually agreed upon time arrangements are made between the LME, case management agency and AFLI. During the 30-day interval ALTERNATIVE FAMILY LIVING, INC. will cooperate with the LME, case management agency in determining an appropriate alternative placement for the client. In the event of the need for short-term placement ALTERNATIVE FAMILY LIVING, INC. will cooperate with the case mgt. agency to place the client in an existing AFL home on a temporary basis until a permanent placement can be arranged. In the event that the client and/or the client�s guardian request discharge ALTERNATIVE FAMILY LIVING, INC. likewise requires a 30- Calendar day notice unless other arrangements are agreed upon.

26. SUSPENSION / EXPULSION POLICY It is the policy of ALTERNATIVE FAMILY LIVING, INC. that clients will not be suspended from the AFL or services provided. All efforts will be made to resolve any issues that would initiate a request for suspension through the Client Rights Committee, Human Rights Committee, and with meetings with the Case Management agency. During an interim period while issues are being resolved ALTERNATIVE FAMILY LIVING, INC. will work with the client and / or guardian and case manager to provide a temporary respite location for the client. AFLI reserves the right to expel any client based on knowledge of criminal activity that leads to the harm/death of another individual or animal.

27. CONFIDENTIALITY It is the policy of ALTERNATIVE FAMILY LIVING, INC. that the referring agency is the owner of all official and unofficial client records. Any client information retained at ALTERNATIVE FAMILY LIVING, INC. is for the purpose of client progress tracking and service development. ALTERNATIVE FAMILY LIVING, INC. regards all client information as confidential and will not reveal that information to anyone other than the client, the client�s guardian, client�s care provider(s), or the referring agency. ALTERNATIVE FAMILY LIVING, INC. will only release or re-disclose information with permission from the referring agency and the client or guardian. All staff at ALTERNATIVE FAMILY LIVING, INC. are required to sign a �Assurance of Client�s Rights and Confidentiality� form before beginning work. Written Release: Consent for release of information must be in writing and is valid for 1 year from date signed. This consent an be revoked at anytime by the legal guardian or competent adult. Disclosure of client�s discharge/admission to the client�s next of kin if it is in the best interest of the client. Client may have access to information if deemed un-harmful by physician/ facility director. Legal guardian may have access to information. Internal/external client advocate may have access to confidential information. It is up to the agency to determine the information provided. Exceptions to a written release: abuse reports involuntary commitment adjudication of incompetence and appointment of guardian results of exams information to a attorney who represents facility or employee relevant to litigation of the facility any area/state facility may share confidential information to coordinate effective services anyone who is responsible for the evaluation, management or supervision of treatment imminent danger to health and safety emergency medical services: information necessary to meet emergency need index of clients served to state agencies give effect to or provide treatment to such as a physician, psychologist or qualified professional another support service. Agreement must be in writing. financial benefits; limited to financial information facility employees, students, consultants can share information to meet responsibilities specific request to physicians, psychologist who referred client next of kin/family member who has a legitimate role in therapeutic services; information provided � diagnosis, prognosis, medications and client progress research and planning

28. WEAPONS POLICY ALTERNATIVE FAMILY LIVING, INC specifically prohibits the possession of weapons by any person while receiving services from our agency. This ban includes keeping or transporting a weapon in a vehicle, in a parking area, whether public or private. If any object is found, said object will be removed and a written incident report will be issued and kept in the consumer�s file. If the agency director or QP feel that there may be a possible threat to other consumers, staff, or the community, then the consumer may be given notice and removed from services with AFLI.

29. SERVICES OFFERED ALTERNATIVE FAMILY LIVING, INC offers 1:1 services to persons with developmental disability diagnoses. We provide qualified staff persons to provide those services as specified in North Carolina & CAP/MRDD Medicaid guidelines. Services offered include: CAP- Residential Supports, Home Supports, Home & Community supports, Personal care, Respite, Enhanced personal care and respite; Family Living, Developmental Therapies, Personal Care , Personal Assistance and Respite provided through the local LME. All services are monitored by a Qualified Professional. Your QP will monitor/supervise staff members, assist in developing habilitation goals in treatment planning process, assist in explaining services, and be your liaison with the LME and case management agency. Once services begin, AFLI will do our best to match you with the right staff to provide the best quality of services.

30. OTHER HELPFUL RESOURCES Alcohol/Drug Council of NC 1-800-688-4232 www.alcoholdrughelp.org The ARC of NC 1-800-662-8706 www.arcnc.org Disability Rights NC 1-877-235-4210 www.disabilityrightsnc.org Exceptional Children�s Assistance Center (ECAC) 1800-962-6817 www.ecac-parentcenter.org Mental Health Association North Carolina, Inc. 1-888-881-0740 www.mha-nc.org/english National Council on Alcoholism and Drug Dependence, Inc. Call (Hope Line) NC CARE-LINE 1-800-662-7030 www.ncdhhs.gov/ocs/careline.htm NC care LINK www.nccarelink.gov NC Division of Health Service Regulation 1-800-624-3004 www.ncdhhs.gov/dhsr NC Mental Health Consumers Organization, Inc. 1-800-326-3842 www.ncmhcosupport.org Substance Abuse and Mental Health Services Administration (SAMHSA) 1-800-662-4357 www.samhsa.gov Veterans Services 1-800-662-7030 www.nccarelink.gov State of North Carolina Department of Health and Human Services North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services Web Address: www.ncdhhs.gov/mhddsas Email: contactdmh@ncmail.net