Supported living referral

REQUEST FOR PROPOSAL
All Level 1 Waiver Providers
Michael Null, Service and Support Administration Assistant Director
Susan Vecchio, Service and Support Administrator
June 6, 2013
Client: # 362
This person is a twenty four year old verbal female who requires less
than 24-hour supervision. She requires physical assistance in areas
including safety, personal income, and community access. The family
requests visual supervision while in the community. She enjoys shopping
at the mall, going to movies and going out to eat, karaoke, bowling,
swimming, picnics, dances and walks in the park. She currently resides
with her parents and brother and is in need of services to be provided
primarily in the community

DEADLINE
TO RESPOND:
Per HCBS waiver - Free Choice of Provider Rule 5123:2-9-11, verbal or
written response required within two (2) working days following initial
contact by SSA or receipt of this RFP (Responses due by 6/11/2013).
Verbal response at 440-918-5068 to be followed by written response to
the attention of Susan Vecchio, SSA at 9350 Progress Parkway., Mentor;
or by fax 440-918-5125.

FUNDING
SOURCE:
Level 1 Waiver

PER DIEM:
Total Available in Plan = $5,000.00.
Agency 15 minute unit: $4.75 Individual 15 minute unit: $4.11
SERVICE
HOURS NEEDED: Services to be provided as follows: Avg 4 hours/week, on Saturday
DAY
PROGRAM:
Society for Rehab, Thurs-Friday 8:30 am - 3:30 pm (including
transportation)
DIAGNOSES:
Moderate Mental Retardation, Downs Syndrome, Farsighted
CURRENT
MEDICATION:
Loestrine, Celexa

GUARDIANSHIP: This individual is her own guardian.

PROVIDER
REQUIREMENT: A provider would need to be able to deliver all ISP services as
determined at the ISP meeting.

SERVICE AREAS: Social skills, leisure/recreation, and transportation

CHOICE &
OPTIONS:
Encourage individual to make choices for leisure activities. This
individual enjoys music and singing, going out to the mall, park to eat,
shopping, bowling and swimming.

PERSONAL
INCOME:
Family will maintain benefits and assist with personal income needs.

HOUSING:
This individual currently resides with her parents and brother and will
need services provided in the community

COMMUNITY
MEMBERSHIP:
Provide opportunities for social outings in the community. As
previously mentioned, this individual enjoys shopping, going to the
movie theatre, and eating at restaurants and going to the mall and the
park to name a few.
Routine home and community safety training. Requires staff assistance
to maintain safety.
Family will schedule, monitor and follow-up on all routine and
emergency medical needs and appointments (including Primary Care
Physician, dentist and ophthalmologist).

Source: http://www.lakebdd.org/services/documents/362june6.pdf