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It records recipient identifying details, including name, telephone, and home address, and the primary contact responsible for coordinating a continuous 24-hour-a-day coverage schedule. The form also captures care provider names and contact numbers, documents how the plan ensures care for the full 24-hour period, and includes signatures and dates for the primary contact and the IHSS social worker. 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The IHSS social worker has also discussed with me the appropriateness of out-of-home care asan alternative to 24-hour-a-day Protective Supervision. |  |\n| --- | --- |\n| NAME OF CARE PROVIDER (1): | CONTACT PHONE \\#: |\n| NAME OF CARE PROVIDER (2): | CONTACT PHONE \\#: |\n| NAME OF CARE PROVIDER (3): | CONTACT PHONE \\#: |\n| Describe the implementation of the Protective Supervision 24-Hour-A-Day Coverage Plan: |  |\n\n\n| SIGNATURE OF PRIMARY CONTACT RESPONSIBLE: | DATE: |\n| --- | --- |\n| SIGNATURE OF IHSS SOCIAL WORKER: | CONTACT PHONE \\#: |\n\nSOC 825 (6/06) OPTIONAL COUNTY-USE FORM  \nState of California – Health and Human Services Agency  \nIN-HOME SUPPORTIVE SERVICES (IHSS)  \nPROTECTIVE SUPERVISION  \n24-HOURS-A-DAY COVERAGE PLAN (SOC 825)  \nINSTRUCTIONS  \nThe IHSS Protective Supervision 24-Hours-A-Day Coverage Plan (SOC 825) is an optional form for County use. The SOC 825 is intended to ensure that recipients who need Protective Supervision have the 24-hours of care needed for their health and safety 24 hours a day. The recipient’s social service worker and the IHSS care provider(s), whether a family member, friend, or no relation at all, should discuss together a plan or schedule of 24 hours a day of coverage for the recipient.  \nNAME OF IHSS RECIPIENT: Enter the full name of the IHSS recipient. RECIPIENT’S TELEPHONE NUMBER: Enter the contact telephone number for the recipient.  \nADDRESS OF IHSS RECIPIENT: Enter the recipient’s home address where the majority of the 24-hours-a-day coverage will be performed.  \nNAME OF PRIMARY CONTACT RESPONSIBLE: Enter the name of the person with primary responsibility for coordinating the recipient’s 24-Hours-A-Day Coverage Plan. PRIMARY CONTACT’S TELEPHONE NUMBER: Enter the telephone number for the primary contact responsible.  \nRELATIONSHIP TO RECIPIENT: Enter the relationship of the primary contact to the recipient,(i.e. , family member, IHSS care provider, friend, etc. ) .  \nNAME OF CARE PROVIDER(S) (1),(2),(3), and CONTACT TELEPHONE NUMBER(S): Enter the name(s) of each care provider responsible for the recipient’s care during the 24 hours a day of coverage. Enter a contact telephone number for each care provider.  \nIf more than three (3) care providers are responsible for this recipient, an additional sheet of paper can be attached with name(s) and contact telephone number(s) .  \nDescribe the implementation of the Protective Supervision 24-Hours-A-Day Coverage Plan:  \nEnter the planned schedule, or explanation of the plan in which the above provider(s) will ensure the recipient is cared for the entire 24-hour period. An additional sheet of paper can be attached if more space is needed to describe the 24-Hours-A-Day Coverage Plan. SIGNATURE OF PRIMARY CONTACT RESPONSIBLE a","cbCaioCNqAgsh6u9","https://ap.wps.com/l/cbCaioCNqAgsh6u9","pdf",137385,"English","# Instructions\n## Recipient and contact information\n## Care provider list and coverage description\n## Signatures and record retention","[{\"question\":\"What is the purpose of the IHSS Protective Supervision 24-Hours-A-Day Coverage Plan (SOC 825)?\",\"answer\":\"It helps ensure IHSS recipients who need Protective Supervision receive safe, continuous 24-hour-a-day care for health and safety. The primary contact coordinates a coverage schedule discussed with the IHSS social worker.\"},{\"question\":\"Who is responsible for coordinating the 24-hour-a-day coverage plan?\",\"answer\":\"The form identifies a primary contact responsible for arranging and coordinating the plan. The primary contact also signs and dates the form when the plan is discussed with the social worker.\"},{\"question\":\"What happens if the 24-hour-a-day coverage plan changes?\",\"answer\":\"The primary contact must immediately notify the IHSS social worker if there is any change to the coverage plan, such as hospitalization, attendance in day-care programs, or travel.\"}]","PROTECTIVE SUPERVISION 24-HOURS-A-DAY COVERAGE PLAN - SOC 825 | PDF",1790376637]