THE HOME VISIT CHECKLIST

Before the Visit:

o Set up appointment by letter or phone.

o Check for current Medi-Cal eligibility in Meds.
o Prepare paperwork packet - check if income eligible or status eligible. This will tell you
what
kind of forms you will need.
o Make sure you have the Health Care Certification Form (SOC 873) for the consumer
to
complete as it is a requirement for obtaining IHSS services.
o Arrange for an interpreter, if needed.
o Have forms semi-completed before you arrive at the appointment.
o Familiarize yourself with the person's illness or diagnosis - check for contagious
diseases.
o Familiarize yourself with case. Review narrative notes from last home visit and any
notes
documenting phone calls to identify any potential issues that will need to be addressed
during the
home visit. Make notes to take with you or copy information, if necessary.
o Pay special attention to safety alelis, i.e., dogs, illegal activity expected, mental health
issues.
o Make any contacts (i.e., APS, etc.) that you feel will help you do a thorough
assessment or
answer questions that you may have.
o If indicated, get input or discuss concerns with supervisor or peers.
o Ifpossible, review timesheets or CMIPS screens to determine if the provider has been
submitting
timesheets for all authorized hours.
o Prepare a map.
During the Visit:
o Introduce yourself, show your ID.
o On entry into the home, be sure to inquire as to who is currently present in the home.
o Ask for permission to be seated. This gives them control early on and helps with
rapport
building.
o Explain the purpose of the visit.
o Observe consumer's abilities. This should begin with observing how the consumer
greets you
and continue until the interview is concluded.
o Observe environmental safety issues (i.e., throw rugs, lack of handrails, availability of
DME,
etc.).
o Conduct needs interview:
.:. Give civil rights pamphlet (pub 13).
•:. Complete Emergency Back-up plan.
•:. Review medications.
•:. Explain rights and responsibilities.
•:. All other county and state forms, if applicable.
o If the consumer is new to IHSS, inform him/her regarding the steps required to hire a
provider
and how they get paid. If this is a reassessment, check with the consumer about how
well things
are going with the provider. Make appropriate referrals to the Public Authority if the
provider
needs training or if the consumer wants to change the provider.
o Before leaving, tell the consumer what to expect next:
.:. S/he will receive a NOA.
•:. Discuss significant changes in authorization, but do not commit to a new service plan
while at the home visit.

Best Practices (not in regs):

o View all rooms in the home utilized by the consumer (if reassessing, check that
assessed chores
are being completed).
o Note DMEs that will improve the safety of the client.
o Suggest/make referrals as needed.
o Assess the need to make referrals.
Cleanse your hands immediately following every visit.
Take precautions while transporting forms that contain consumer information per your
county's policy.