9. Residency Agreement

• This Agreement is made between Sunrise Care Homes (SCHs) and:

  House *

  
  
  

  SelectHaydenMcDonaldParadise ValleySunnyvale

  Select

   

  • Select
  • Hayden
  • McDonald
  • Paradise Valley
  • Sunnyvale

  Resident or Resident’s Representative *

  for:

  Resident Name *

  Date *

  DATE OF ADMISSION *

  MONTHY FEE AND SERVICES PROVIDED:

  The Fee per month for Private Room – Share Room – Master suite and basic service is:

  Monthly Room Fee *

  Supplies (Hygiene and incontinent care) $300. Service Plans $30.

  Total Monthly Fee *

  1. A room with basic furnishings, including; single bed, storage space for clothing, private storage space for personal belongings, window covers, and a bedside lamp.
  2. Use of all common areas.
  3. General housekeeping and linen and laundry service, as needed.
  4. Daily supervision during waking hours from 7:00 AM- 7:00 PM. With Awake staff during 7:00 PM-7:00 AM. (807.D.5)
  5. Three meals, plus three snacks daily.
  6. Monitoring of medications and assistance and/or administrations of medications, as directed in Resident Service Plan.
  7. Supervised activities of daily living (e.g., eating, bathing, dressing, etc.), as required.
  8. Recreational activities and supplies, including daily newspapers, current magazines, and other reading materials.
  9. Physician and all medical providers services coordination, as required.
  10. Other arrangements, as determined by the Resident, the Resident are Representative, and SCHs

  The first month’s rent is due upon move-in and is not refundable; the second month’s payment will be pro-rated, as necessary. In the event of a temporary absence from the home, 100% of all monthly payments shall continue if the resident wishes to retain his or her room. This agreement shall be on a month-to-month basis. SCHs shall provide at least 30 days’ written notice prior to the effective date of any change in a fee or charge, except when a Resident ‘s service needs change, as documented in their Service Plan.

  Additional Services at Additional Costs

  Additional fees that are not included in the monthly amount include:

  1. Service plans (required by ADHS) based on level of care (every 3, 6, 12 months)
  2. Optional beautician services: (e.g., haircuts, permanents, manicures, pedicures, etc.)
  3. Additional optional health care professionals: (e.g., podiatrist, nursing services, etc.)
  4. Off -site activities and outings

  The cost for these services may vary; however, the Resident or Resident’s Representative will be notified of the cost prior to authorization of service. Acquisition of personal care items will be the responsibility of the Resident or Resident’s Representative. Medications, special diet supplies (e.g., Ensure), and personal care items for the Resident are to be provided by the Resident or the Resident’s Representative. Personal care items for the Resident should include
  incontinence supplies, hairbrush, comb, toothbrush, toothpaste, shampoo, conditioner (if used), and any lotions the Resident uses. If these items are not provided and supplies fee decline above; the home will provide them, as needed, and the Resident or the Resident’s Representative will be charged for the items, as well as a service charge.

  Security Deposit

  In addition to the monthly costs, a security deposit in the amount of $2000,oo is due at the time that the room is held for the Resident. The Resident or the Resident’s Representative must give the SCHs 30 days’ written notice prior to intended move out, or the remainder of the month’s rent and the security deposit will be forfeited, not to exceed 30 days. This requirement will be suspended in the event of the Resident’s death, a change in health that requires immediate relocation, or in the event of abuse, neglect, exploitation, or conditions of imminent danger to life, health, or safety of the Resident by the home.
  The following deductions may be taken from the deposit:

  1. Damages to property caused by the Resident, excluding normal wear and tear
  2. Fees or charges incurred by the Resident
  3. Documented noncompliance with the Residency Agreement

  Resident Responsibilities and Obligations

  Statements will be issued monthly. Monthly fees and/or charges are due on or before the 1st (first) of the month. Payments made after the 5th of each month will be subject to a late fee of 5% per annum after the 5th. If payment is not received by the 15th day of the month , SCHs will issue written notice of intent to terminate this contract and the Resident will need to be removed from the premises within 14 (fourteen) days of the notice. At the time of move out, all amounts and fees will be due immediately. In the event that the Resident is not moved and/or the amounts due are not paid, SCHs reserves the right to have the Resident put into the care of Adult Protective Services and take legal action to collect funds owing. At that time, any costs for transportation of the Resident and/or for the collection of fees and charges, as well as the fees and charges due, shall be deducted from the security deposit. Any costs not covered by the security deposit will be included in a legal suit. The resident and/or responsible party agrees to abide by all house rules and contract rules. The resident and/or responsible party agrees to pay for any damages to SCHs’ property as a result of the resident’s direct acts or negligence. Prior to or upon admission, the Resident or the Resident’s Representative shall receive a copy of the House Rules, along with a list of the Residents’ Rights. These rules and rights shall be discussed with and signed by the Resident and/or the Resident’s Representative.

  Termination of the Residency Agreement & Additional Refund Policies

  1. 1. The Manager will terminate a Residency Agreement without notice if:
        • a. The Resident exhibits behavior that is an immediate threat to the health and safety of
        other residents and individuals in the assisted living SCHs.

  1. The Manager will terminate a Residency Agreement after Providing 14 (Fourteen) days advance written notice to the Resident or Resident’s representative for the following:
     • a. Nonpayment of fees,charges,or deposits;
     • b. The individual requires continuous. The individual requires restraints, including bed-rails.

  • i. Medical Services, Nursing Services,

  ii. Behavioral Services

• Except as noted above, the home shall not terminate a Resident’s Residency Agreement without providing the Resident or the Resident’s Representative with thirty (30) days’ written notice.
• The Resident or the Resident’s Representative may terminate the Resident’s Residency Agreement without notice due to the following, as substantiated by a government agency:
  • a. Abuse
  • b. The resident dies
  • c. Substantiated abuse, neglect, and exploitation from current provider or/and staff member.
  d. Conditions of imminent danger to the Resident’s life, health, or safety

• The Resident or the Resident’s Representative may terminate the Resident’s Residency Agreement after providing fourteen (14) days’ written notice to the SCHs for Documentation of the Homes’ failure to comply with the Resident’s Service Plan and/ or Failure to comply with Residency Agreement.
• Except as noted above, the Resident shall not terminate a Residency Agreement without providing to SCHs thirty (30) days’ written notice. Notice may be sent via email or fax
• Upon issuing notice of termination, SCHs shall provide a copy of theResident’s Service Plan, a copy of the “Freedom from TB” statement, and phone numbers and addresses of the local Area Agency on Aging and DES Long-Term Care Ombudsman.
• REFUND POLICY: SCHs shall not request or retain Security Deposit as follow:
  • a. If a Resident or the Resident’s Representative terminates residency for abuse, neglect, exploitation, or conditions of imminent danger to the Resident’s life, health, or safety (as substantiated by a governmental agency), SCHs shall not request or retain fees after the date of the resident’ s death or termination of residency.
  • b. If fourteen (14) days’ notice is given by the SCHs or the Resident or Resident’s Representative, as allowed above, SCH shall not request or retain deposit for more than fourteen (14) days from the date the written notice was received by SCHs or by the Resident or Resident’s Representative.
  • c. For reasons other than identified here, SCHs shall not request or retain deposit fee for more than thirty (30) days after the date of termination of residency.
  • d.

  SCH will NOT refund monthly fees if a resident dies at any time prior ending month and after monthly fee has been paid (this includes hospice residents)

• In the event that a Resident is not removed from a home by the date listed on the termination agreement, or by the requested date of termination by the Resident and/or the Resident’s Representative, the Resident and/or the Resident’s Representative will be in violation of this Agreement and any daily charges or costs incurred by SCHs will be deducted from the security deposit and/or billed to the Resident and/or the Resident’s Representative

Within thirty (30) days of termination of the Residency Agreement, Sunrise Care Homes shall give the Resident, the Resident’s Representative, or the Resident’s relatives the following:

A written statement that includes the disposition of the Resident’s personal property; an accounting of all fees, Resident’s personal funds, or deposits owed to the resident and an accounting of any deductions from the fees or deposits.

All fees, Resident’s personal funds, or deposits, as required by this section of the Residency Agreement.

Upon termination of the Residency Agreement, any monthly fees paid for time following the termination will be refunded on a prorated basis for the number of days beyond those which the Resident at SCHs for the particular month that the Resident paid in advance

Grievance Procedure

A Resident or the Resident’s Representative who has a complaint/grievance is encouraged to discuss it with the SCHs Assisted Living SCHs Manager. This meeting is to be held within five (5) days of a grievance request, in the event of a fourteen- (14) or thirty-day notice of termination, or prior to termination in all other cases. If the grievance is not resolved at this step, the Resident or Resident’s Representative may request a meeting with the administrator or licensee of the home. This meeting is to be held within five (5) days of a grievance request in the event of a fourteen- (14) or thirty- (30) day notice of termination, or prior to termination in all other cases. If the issue is not resolved, the Resident or their Representative may contact the DES Long-Term Care Ombudsman and/or the local Area Agency on Aging at 602-542-4446.

Changes to the Agreement

This contract is considered to be in full force and effect from the date it is signed. If any changes are to be made to this contract, the changes must be in writing and must be signed and dated by Sunrise Care Homes and the Resident and/or Resident’s Representative. If there are to be any changes in rates or services offered, the assisted living SCHs will provide a thirty- (30) day written notice of such changes unless the Resident’s service needs change, as documented in the Resident’s Service Plan as required in R9-10-711A7. If state law and/or regulations conflict with any part of this contract, only that portion of the contract will be void; the remainder of the contract will remain in full force.

I have read, or have had read to me, this Residency Agreement, and I have received a copy. I agree to all the conditions, as outlined above, and I agree to abide by this contract. I understand that this contract is legal and binding.