DISCLOSURE STATEMENT
Fedelta Home Care provides assistance to guardians, care managers, trust officers, power of attorney and health care representatives, and family members with supportive services for their clients and loved ones through the following activities:

Services offered:
Medical Attendant*
Pick up client from home (private home, facilities, adult care homes)
Transport to medical appointments (doctor, dentist, eye, specialists)
Attend medical appointment
Take detailed notes
Obtain after visit summary
Provide detailed narrative to responsible party

Social/Recreational Outing*
Pick up client from home (private home, facilities, adult care homes)
Escort to activity of client/responsible parties’ choice
Restaurants         Concerts
Shopping  Park
Bowling         Church
Movies         Zoo
Scenic drives Travel
Provide companionship and supervision during outing
Provide detailed narratives to responsible party

Other Services available (see separate disclosure statements):
In-home care services including personal care and medication management, from four to 24-hour shifts are provided through our in-home care agency.  Information available through a separate disclosure statement.
Care Management Services are provided to assist clients, families, and fiduciaries with the coordination of all aspects of client care, including assessments, care plans, medical advocacy, placement, and more. All Care Managers, at minimum, hold an advanced degree in Social Work.

COVID policies
All cars are sanitized after each outing per CDC guidelines
Clients ride in the back for social distancing whenever possible
A/C and/or fan are set for outside air and depending on weather, windows are open  
Employees wear masks during the outing if requested by client
Masks and gloves are available for client’s use
We are unable to transport clients showing active symptoms of COVID

Charges for Services    

Medical/social outings - Mon through Fri:     $60.00 per hour - minimum 2 hours

Medical/social outings - Sat and Sun:            $70.00 per hour - minimum 2 hours

2 persons or more:                                            Hourly rate reduced 25% per person

Gas surcharge - Sedan:                                     $2 every 50 miles or portion thereof

Gas surcharge - Wheelchair van:                     $4.50 every 50 miles or portion thereof

Infection control - supplies and cleaning:      $4 per outing

Time to sanitize cars after outing will be billed
Clients will be charged one and one-half (1 ½) times the applicable rates set forth above for services provided on the following Holidays:  New Year’s Day, Memorial Day, July 4th, Labor Day, Thanksgiving Day, and Christmas Day.  All hours of service provided during the 24-hour period from 12:01 AM until midnight on the Holiday will be charged at the Holiday rate.

Time starts when the employee leaves the office until they return to the office

9955 SE Ash Street, Portland, OR 97216

Starting Services:
Responsible party provides:  
Detailed profile on the client including demographics, likes/dislikes, allergies, relevant medical history and medications as well as permissible activities.
 Billing information
 Picture of client
 Request for wheelchair van
 Details on time and place of outings as well as any special instructions

Billing
Unless otherwise specified, Medical or occasional Outings will be billed within 48 business hours of services.  Regularly scheduled Social Outings will be billed twice monthly on the 15th and last day of each month. Payment is due upon receipt of the bill and the Client has 10 days to remit payment before any interest or penalties may be applied.  
Payments later than 30 days will be charged 1.5% fee on unpaid balances charged monthly.
Clients and/or responsible parties will be given a 10 day written notice of increase in rates.

Cancellation Policy
Services must be canceled at least twenty-four hours prior to the start of shift. If not, the client will be charged for one hour or total care associate time, whichever is greater.  

Refund Policy
If either we or a Client become aware of a situation where the Client was billed at an incorrect rate or for services not provided, or if the Client overpaid for any reason, or if there is a valid reason for an adjustment for billing that was paid, we will reflect a credit in the appropriate amount on the next billing, or, if the Client requests it, we will promptly issue a refund check.  Clients must notify us by in writing of a request for a refund.

Termination of Services
We reserve the right to terminate services with 30 days written notice that will specify the reason(s) for termination with the following exceptions:
We reserve the right to terminate services to a Client immediately with a verbal or written notice when the continuation of service to a client may place our Employees in an unsafe or inappropriate situation.  (Verbal notices will be followed by an email or written notice)
We reserve the right to terminate services to a Client on 48 hours’ notice if the client has failed to pay for past services rendered after reasonable collection efforts.  
Client has the right to terminate Services at any point with no notice. Clients will still be responsible for fees for any services provided but not yet paid.

Company Cars
All company cars have dash cameras and GPS systems installed. The cameras record “harsh” events such as speeding, hard braking,  accidents, or distracted driving. The client might show up in the video feed, however there is no audio.

Client Reimbursement for stolen, broken, or misappropriated client property or funds
Clients are responsible for securing valuable and cherished items or removing them from the home before services begin. It is strongly encouraged that valuables be locked up for safekeeping.
Client (or responsible party) must disclose any valuable possessions that are kept in the home, whether secured or not. It is recommended that the client (or responsible party) photograph each item and note its location and value. Should anything disappear, these detailed records will be available to help corroborate and guide an investigation.
Client must report suspected breakage, theft or misappropriation to the caregiver’s supervisor within the greater of 24 hours or the next business day of learning of the issue.
Client must provide verification of the value of stolen/broken funds or property.
Client must provide reasonable evidence of property being broken or stolen by an Agency caregiver.
Client must be willing to file police report for stolen property or funds
All above terms met, the Agency will reimburse the client for stolen or broken items at replacement cost.

Alternate forms of this disclosure statement may be available at client  request.

Procedures for filing a grievance or complaint with the Agency.
You may file a grievance or complaint if you feel your rights have not been properly recognized and protected.  Clients may file a written grievance or complaint with Pegasus Social Services detailing the issue and requested resolution to the IHC Administrator, Pegasus Social Services, PO Box 92094 Portland, OR, 97292

Procedure to file a complaint with the State of Oregon
You may file a complaint with the Oregon Health Authority, Health Care Regulation and Quality Improvement, at 800 NE Oregon St, Ste 305, Portland OR  97232. Telephone number 971-673-0540; Fax 971-673-0556. The complaint application form is available online at www.healthoregon.org/hcrqi

Notice of State’s Right to examine Client Record
The State of Oregon has the right to examine Clients’ records as part of its regulation and evaluation of the agency.

Contacting Fedelta Home Care
Our business hours are Monday through Friday from 8:30 AM until 5:00 PM.
Limited phone service after business hours are also available.  


* If excessive personal care services are necessary, the client will need to be brought into services under In-Home Care.