HRC Day Program Status Check

HRC Day Program Service Provider Survey

We will use this survey to stay in contact with you and to share information about the status of our clients during the COVID-19 Pandemic.

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* 1. Agency Name

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* 2. Vendor Number

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* 3. Program Name

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* 4. Number of Clients you currently serve

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* 5. Are your staff being paid and working with you to serve clients in remote and creative methods?

Yes

Tell us about how you are staying in contact with and supporting your clients.

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* 6. Have any of the clients served by your day program tested positive for the Corona Virus?

YES

If YES, How many, and where are they being cared for now? (eg in isolation at home, in the hospital)

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* 7. Are any of the clients that you have served considered high-risk (with medical conditions or compromised immune systems)?

Yes

If Yes, how many and where are they being cared for now? (eg in isolation at home with family? or in a licensed home?)

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* 8. Are you adequately staffed?

Yes

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* 9. Do you have any staff that are symptomatic?

Yes

If YES, how many?

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* 10. Do you have backup staff if you need them?

Yes

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* 11. Do you have ample supplies ?

Yes

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* 12. Do you serve any clients over age 65?

Yes

If yes, how many, and where are they being cared for? (eg in isolation with family, licensed home, or with supported living services)

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* 13. Have you provided training to your staff on precautions to avoid exposure to illness and communicable disease?

Yes

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* 14. Prior to the Safer At Home order and while clients were attending your program in person, have you provided training to your clients on precautions to avoid illness?

Yes

If no, do you have plans to provide this training remotely.

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* 15. Do you serve clients that have no involved family support?

Yes

If yes, how many and are they receiving support (eg from licensed home, supported living provider, etc)?

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* 16. Some of our residential service providers could experience a shortage of direct care staff at some point. Do you have any direct care staff who are background checked who might be available to work in a residential setting?

Yes

Please provide information about available direct care staff.