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ATTACHMENT A

NDIS PRACTICAL DESIGN FUND PROJECT FINAL REPORT

Agreement Id 2-2GCCELQ Schedule Id: 2-2GHFMN

Final Report Attachment: Description of Key Activities

Further details of the key activities are:

HR&SS engaged a project manager to undertake the project in January 2013. A Steering Group was established, comprising senior staff of the Housing Resource and Support Service. The group met regularly to oversee the project. A project action plan was developed and implemented. An assessment of the Activity was undertaken by the Steering Committee to ensure compliance with the National Statement on Ethical Conduct in Human Research A reference group comprising two people with disabilities, a disability team leader, case manager and the project manager met regularly to discuss the parameters of the project, provide advice

regarding the approaches to running focus groups, identified possible service providers and service users to consult, venues and provided feedback regarding the progress of the project. The project manager researched legal and compliance requirements The project manager corresponded with 68 service provider organisations providing services to people with a broad range of disabilities. The purpose of the project was outlined, copies of their

service agreements were requested if available and they were invited to participate in the project through focus groups or one to one consultation with staff and/or clients. The project manager corresponded with 5 peak organisations outlining the purpose of the project and inviting participation from their members. Peak organisations forwarded the details of the

project to their members. Approximately ten members made contact individually with the project manager and agreed to participate in the consultation. The project manager received, reviewed and collated the contents of 12 service agreement templates provided by disability organisations. The majority of service providers stated they did not

have service agreements with clients in place. Some were in the process of developing one and others intend to develop one in the near future. A few did not share their agreements due to intellectual property issues.

The following disability organisations were willing for their service agreements to be included in the project. The Housing Resource and Support Service acknowledges the valuable contribution of these organisations:

Alpha Autism Inc. Baptcare Jewish Care Moira Independence Australia Radius Disability Services Vista Milparinka (2) Independent Rehabilitation Services Independent Disability Services –formerly Housing Resource and Support Service

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The project manager undertook face to face consultations, focus group meeting and telephone consultations with executive, middle management and direct care staff from a range of service providers regarding their perceptions of what was needed to be included in best practice service agreements and undertook the same process with a range of people with disabilities who are service users and/or their carers.

Based on the feedback from the service users and providers draft service agreement templates were developed and as well as a list of the participants’ suggestions. The reference group reviewed these and a revised template was circulated to interested participants for comment.

The Information Access Group created an Easy English version of the Service Agreement template. The NDIS Final Performance report was prepared and included a draft template of a service agreement, an Easy English version of the agreement, a collated list of contents from a number of

agreements currently used by service providers, a proposed contents checklist for use by clients and service providers in the preparation of service agreements and an appendix of copies of a selection of the service agreements collected for the project.

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ATTACHMENT B

NDIS PRACTICAL DESIGN FUND PROJECT FINAL REPORTAgreement Id 2-2GCCELQ Schedule Id: 2-2GHFMN

Final Report Attachment: Summary of Achievements

Of the 73 organisations contacted 12 provided their existing service agreements for review under this project. Most clients and service providers acknowledged the importance of having written agreements with clients There were common themes in the existing agreementsThere was considerable variation in the size, layout and content of the agreements

Key features of best practice in service agreements: Fairness - a balance of rights and obligations of the parties Clearly and completely identifies what services are being provided Is understandable Protects the rights of both parties Clearly identifies what will be required to successfully fulfil or complete the agreement Identifies agreement conditions such as :

Timeliness of delivery Time and method of payment Required level of service quality

Includes any special arrangements Includes a procedure for resolving disputes in a timely and cost-effective manner Protects confidential information Has a fair and timely process for varying the agreement Provides a clear statement of how the agreement can be terminated in the event of default or other specified events and then what is to be

done by the parties Provides a regular (at least annual) quality assurance/evaluation of the progress of the service agreement Avoids using complex language and includes a glossary explaining difficult terminology.

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Protects confidential information and the privacy of the client.

Recommended Approach to Drawing up Service Agreements

The majority of clients and several service providers recommended that it should be the client who initiates the development of a service agreement with a provider. This was felt to be in keeping NDIS’s goal regarding client choice and control in making decisions about the disability services and supports they use. The majority of people with disabilities who participated in the project expressed frustration about the lack of choice, control and flexibility they have in the types and delivery of the services they receive. They also strongly advocated for some form of redress when their provider failed to provide the agreed service.

The recommended process for drawing up service agreements is as follows:1. The client and the client’s NDIS planner develop the client’s support plan2. The planner provides the client with information about the service providers in the client’s locality. 3. The client choses a service provider.4. The planner gives the client a checklist of mandatory and discretionary items for inclusion in the service agreement and explains the

purpose of service agreements (See Attachment Proposed Content Checklist ) 5. The client with or without the planner selects the items that are important to him/her to have included in their agreement.6. The client negotiates and signs the agreement with the service provider once its terms are acceptable to both parties.

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ATTACHMENT C

INDIVIDUAL SERVICE AGREEMENT

Between

Name of Client/Participant

And

Name of Service Provider

Next Review Date:

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Service Provider Details, Logo and ABN

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Table of Contents

1. Glossary of terms2. Purpose of agreement3. Description of Services4. Client Rights and Responsibilities/Statement of Expectations5. Complaints and Disputes6. Service Fees7. Quality Assurance/Evaluation8. Review and Audits9. Signatures10. List of Schedules

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1. Glossary of Terms

Advocacy: Representing the concerns and interests of clients and carers, speaking on their behalf, and providing training and support to enable them to represent themselves.

Advocacy services: Services specialising in the representation of people with a disability, their views and interests.

Agency: The National Disability Insurance Scheme Launch Transition Agency has been established by the Australian Government to implement the first stage of a National Disability Insurance Scheme (NDIS). The name of the scheme is Disability Care Australia. The Agency will work to ensure improved support for people with a disability, their family and carers, and to deliver the first stage of an NDIS.

Agreement: A document that sets out the rights and obligations of service clients and service providers. The agreement may cover a variety of issues relating to service provision, including care, fees and charges, the rights and responsibilities of the service provider and care recipient, and any extra services.

Assessment: Ongoing process beginning with first client contact and continuing throughout the intervention and maintenance phases to termination of contact. The major goals of assessment are (a) identification of vulnerable or likely cases; (b) diagnosis; (c) choice of optimal treatment; and (d) evaluation of the effectiveness of the treatment. Assistive technology: Specialised equipment that enhances an individual’s participation and independence in their daily lives. Examples of assistive technology include speech generating devices and communication aids, computers, powered mobility equipment, specialised wheelchair seating and walkers.

Carer: A person who provides any informal ongoing assistance, in terms of help or supervision, to persons with disabilities. Assistance to a person in a different household relates to 'everyday types of activities', without specific information on the activities. Where the care recipient lives in the same household, the assistance is for one or more of the following activities:

cognition or emotion communication health care housework meal preparation mobility paperwork property maintenance self care transport.

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Communication aids and devices: help people with complex communication needs communicate, by supporting or replacing their speech. There are high technology options which use computers and specialised software and include speech generating devices. These allow an individual to produce or select messages for communication. Low technology options include simple technologies, communication boards or communication books. These options show pages of pictures and/or letters and words that a person with complex communication needs can point to in order to communicate (also see PODD communication books).

Community-based supports: Services or supports within communities that can be used by everyone. Eg. this might be a health service or home cleaning.

Community access: A service which supports people to go to local places and community activities such as social groups, libraries and general community services.

Complaints Policy: A document that talks about the steps a service will take when a person makes a complaint about them. It also talks about what the person who is making the complaint has to do.

Day services: provide daytime support for people in their communities. Activities vary between day service centres as they’re based on individuals’ choices and interests and include swimming, art and music programs and woodwork.

Disability Act 2006 : talks about the rules and guidelines that disability services have to follow. The Act talks about things like the rights and responsibilities of people with disabilities and rules for services. (Applies to Victoria only)

Disability Support Register: is a system that records information about a person's support needs. This helps keep track of who needs what so that when services and resources become available, they can be given to people in a way that is fair and happens more quickly.

Easy English: An Easy English document is one that is written in simple and plain language so that it is easy to understand. More documents that are produced by the Government are now being offered in Easy English.

Evaluation: The process used to describe the process of measuring the value or worth of a program or service.

Formal Supports: are those that people pay for. Formal supports might be community-based (like paying for house-cleaning through a local council) or might be disability specific (like paying for a support worker).

Guardian: A person who has been given the legal power to make important personal decisions on behalf of another adult. This might include decisions about where the person should live or what kind of health care and services the person should have.

Independent living training service: provides support to people who want to gain skills and confidence in a range of activities, which will allow them greater independence and control in their day-to-day lives.

Informal supports: Supports offered by family and friends and others in the community.

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Local Area Coordinators (LAC): work to increase community inclusion and support people with disabilities. They connect participants with mainstream services and local, community based supports and help participants to realise their plan by building individual and informal support capacity. They provide information to those people who are not eligible as participants of NDIS about other appropriate services.

Outcome: A measurable positive change in the well-being of a participant supported through NDIS which is attributable to the interventions or services they have received.

Participant: a person with a disability who is eligible to receive care and support through the National Disability Insurance Scheme and who is utilising, or who has utilised, a service.

Planner: A NDIS Planner works with participants to identify support needs including access to mainstream supports and community life to enable a good life and enable progress with the participant’s goals and aspirations.

Policies and Procedures Manual: talks about how a service should run. It should also have information available about how the service will respond in certain situations such as when someone makes a complaint.

Power of Attorney: A document by which a person appoints someone else, usually a trusted family member or friend, to act as their agent with authority to deal with and manage their property and other financial affairs.

Registered Disability Service Providers are agencies that are funded by DHS to provide services for people with a disability. These services must follow the guidelines in the Disability Act 2006. A list of all registered services can be found on the Department website. It is called the Register of Disability Service Providers. (Applies to Victoria only)

Residential Care: is provided to people with a disability who cannot live independently at home and who have been assessed as needing this care.

Respite: Respite care services help carers take breaks from their caring role. A range of respite care services are available, including respite in the person's home, in a day care centre in the community or in a residential facility. Respite can be provided by family members, friends, neighbours or trained workers.

Self-determination: The entitlement of people to have control over their destiny and to be treated respectfully – it is founded in International Rights law.

Service provider: Organization, business or individual that offers service to others in exchange for payment.

Support Plan Review: Is the process of looking at a current support plan to see if there need to be any changes. This should happen at least every three years, or a participant can ask NDIS to have a review at any time.

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2. Purpose of agreement

The purpose of this agreement is to document a personalised and self directed support arrangement between (Client’s Name) and (Service Provider’s Name) which provides the service user the flexibility and authority to determine his/her chosen supports to achieve his/her potential /aspirations and control his/her own life. (Service Provider’s Name) agrees to provide the services or support outlined in this Individual Service Agreement. Any changes to the services and/or support listed in this agreement will require prior authorisation from all parties.

3. Description of ServicesThe Service Provider offers a range of service types that can be used singly or in a range of combinations to suit the client. (Name of Service Provider) will provide details of services, costs, policies, and procedures and other relevant information as an attachment to this service agreement by way of Schedules.

4. Client rights and responsibilitiesWhilst accessing services outlined in this Agreement as a client of (Service Name), I (Client’s Name)

Have the right to nominate, in writing, an advocate or guardian, who will act in my interests and accept the responsibilities imposed under this agreement Have the right to be treated with dignity and respect and to have my choices and aspirations supported as far as is reasonably possible Have the right to determine the type and range of activities that I wish to participate in Have the right to request services in accordance with my support plan, provided the request is also in accordance with all applicable legislation Have the right to participate in the development of my support plan acknowledging that the cost of supports arising from that plan must be able to be met within the funding available for this

support (unless I have other income sources). Any support plan will be reviewed annually or can be reviewed upon request by me or (Name of Service) at any time. Have the right to privacy and confidentiality and in keeping with the Health Records Act2001, to request access to any health information kept by (Name of Service Provider).

As a client or family member I (Client’s Name) will: Treat staff and other clients with courtesy and consideration at all times Respect the needs and opinions of all clients and staff Keep the Service informed of any changes in my personal life such as where I live and any changes in medication. Work cooperatively with (Name of Service Provider) regarding issues arising during the development and delivery of support and activities covered by this agreement Pay all fees owing by the due date Adhere to the budgetary requirements of my service plan. Provide the Service with 2 months advance notice of intention to leave the service. Participate in the development and regular review of my support plan

Responsibilities of (Name of Service Provider)

In agreeing to provide this support arrangement (Name of Service Provider): Will respect the rights of the client to determine the range and types of activities they wish to participate in Will work cooperatively and in line with the principle of least restrictive alternative with the client and the activities they have chosen to undertake Will prepare a support plan with the client that outlines the activities they will undertake and the support to be provided by (Name of Service Provider). A copy of the support plan will be

provided to the client (and his or her guardian or advocate where applicable). Will treat information about the client and their activities as private and confidential in line with the client’s wishes and with privacy legislation. Will be responsible for ongoing liaison with the relevant funding body regarding the development and operation of the support arrangement. Will be responsible for the management and reporting of funding. Will respect the right of the client to determine the range and type of activities they wish to participate in Will receive, where applicable on behalf of the client, their allocated funding, and provide advice and reports as to the client’s budget and any income and expenditure at least quarterly and

upon request at any time.

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Will advise the client of any sector-wide or (Name of Service Provider) developments that may affect the way support is provided. Will provide the client with 2 months notice of intention to cease service provision.

5. Complaints and Disputes

(Name of Service Provider) recognises that clients and their carers have a right to provide feedback to our staff, management and Board of Directors to raise suggestions, resolve grievances and commend good performance and encourages all clients to speak up when they are not happy.

If the client has a complaint (Name of Service Provider’s) Complaints Policy will be followed. A copy of our Complaints Policy will be provided with this service agreement.

The Disability Act 2006 requires that (Name of Service Provider) must:

Have a clear process for managing complaints about our services Ensure the people we support know how to raise a complaint; and Report every year to the Disability Services Commissioner about the number of complaints we receive and how we managed these complaints

6. Service FeesAttached to this service agreement is the cost proposal for services decided by the client and family. Variations may be negotiated depending on the client’s choice and needs and availability of service/supports required.

Method of Payment for ServicesPayment can be made from the funding body direct to (Name of Service Provider)

Or

Payment can be made to an Intermediary (third party who facilitates funds for and on behalf of the Client/Advocate)Services to be invoiced monthly to Client/Advocate who will then forward Invoice to Intermediary for payment to (Name of Service Provider). Invoices will be payable within fourteen (14) days.

Or

Direct payments from Client/AdvocateServices to be invoiced monthly to Client/Advocate by (Name of Service Provider) and will be payable within fourteen days.

If for some reason the fees cannot be paid for a particular period, the client or family or carer is required to contact the (Manager Name of Service Provider) or delegate with an explanation as to the problem and negotiate ways for this to be resolved.

7. Quality Assurance/Annual EvaluationTo monitor the quality of the outcomes relevant to the aim of this service agreement, the client with his/her representatives and (Name of Service Provider) will participate in a quality assurance process at least annually. Each party will independently complete a quality/evaluation document attached to the agreement as Schedule… . A consultative meeting will then be held to discuss any issues arising or changes that might be requested.

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8. Review and AuditsRecognising that (Name of Service Provider) has a legal obligation to participate in government- initiated reviews and audits the client and his/her representatives agree to co-operate to the extent reasonably necessary for these to take place subject to discussion of the relevance of the audit to the client’s situation.

9. Service Agreement Signatures

Client’s Signature confirming the support arrangement and service agreement with (Name of Service Provider):

I, ___________________________understand, accept and agree to the information outlined in this Service Agreement and Schedule(s) _________________________

Name: _____________________________Signature: _______________________Date___________

OR Family Member/Administrator’s signature:

I, __________________________ as family member/administrator for ________________ understand, accept and agree to the information outlined in this Service Agreement and Schedule(s)______________________________________________________

Name:_________________________Signature_______________________________Date_________

Relationship to the person accessing this support arrangement:______________

Agreement accepted and signed on behalf of (Name of Service Provider)

Name:_______________________Signature:___________________________Date______________

10. LIST OF SCHEDULES- (Mandatory /Discretionary)

A. Client Support PlanB. Service Provider Complaint Procedure (Mandatory)C. Service Provider Privacy Policy (Mandatory)D. Provision of Mandatory Information By Service Provider E. Service Provider RatesF. Details of Services Provided to ClientG. Service Agreement Quality Assurance/Evaluation DocumentH. SignaturesI. Etc.

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ATTACHMENT D

NDIS PRACTICAL DESIGN FUND PROJECT


PROPOSED CONTENT CHECKLIST FOR USE IN THE PREPARATION OF SERVICE AGREEMENTS BETWEEN CLIENTS AND THEIR SERVICE PROVIDERS

CHECK BOX SERVICE AGREEMENT CONTENTPurpose of AgreementService Provider’s Vision and MissionDefinitions/GlossaryClient personal detailsClient emergency informationClient contact listDescription of servicesService variation and cancellation processHolidays and Short Breaks NoticeClient to provide equipment that meets safety requirementsService StandardsRights and responsibilities of clientRights and responsibilities of service providerProcess of redress for failure by either party to abide by the agreementComplaints and disputes procedureRequirement to include mandatory informationPrivacy and Confidentiality statementType of Support FundingService feesMethod of payment for servicesNegotiation of fee arrearsPeriod of notice for termination of service agreementReview DateSignatures

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ATTACHMENT E



COLLATED CONTENTS OF REVIEWED DISABILITY SERVICE AGREEMENTS

COVER PAGEIndividual Service /Hosting Agreement between Agency Name and Client/Consumer/Supported Person’s NameNext Review DateName, address, phone numbers, web address

TABLE OF CONTENTSContentsPurpose of agreementDefinitionsGeneral Client detailsClient Personal and Emergency informationIntroductionDescription of ServicesClient Rights and ResponsibilitiesAgency’s Rights and ResponsibilitiesComplaints and DisputesQuality Assurance/Annual Evaluation (Milparinka) SignaturesReview DateSchedules/Attachments

INDIVIDUAL SERVICE AGREEMENT

Purpose of agreement (Radius)Definitions (Milparinka)

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Aim of agreement is to help individual and family to plan more flexibly in allocating funding to support changes in individuals routines as he continues his journey towards independence (Milparinka host agency)General client details (Independence) (Alpha Autism)Client Personal and Emergency Information (Baptcare)Client Contact list (Baptcare)Type of Support Funding-e.g. as detailed within the Individual Support Plan (VISTA)

Introduction-Who we are values, missionDescription of Services (Radius)Service Variation (Radius p4) What will Milparinka doWhat will the individual/representative doRights and Responsibilities of clients (Alpha Autism p3/4)Rights/Obligations and Responsibilities AgencyTime frames Service standards and consequences when these are not met.Provision of information s 89 (applies in Victoria)

Informed consent formComplaints Process (Complaint FORM attached as a Schedule)/Disputes and GrievancesReview and Audit (Milparinka)Acknowledgement of documents received and agreed to between the parties e.g. consent to release of consumer informationISP

Declaration and Signatures-Supported Person’s or Representative’s SignatureAgency Representative6 month review dateExpiry date

Schedule for In-Home Care Clients:Client Rights and ResponsibilitiesReimbursement for Activity Related expensesTermination of Support ArrangementWritten Notice 4 weeksRequest for additional servicesCancellation or Shortening of ShiftsHolidays and Short BreaksProvision of adequate equipmenteziTrackerFunding administrationPayment of invoices (Provided on a fortnightly basis, payment within 14 days of receiptProcess when non-paymentDispute of invoice amount

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Schedule for Residential Clients:Clients Rights and ResponsibilitiesTermination of Support AgreementHolidays and Short BreaksAgency Responsibilities

Schedule for clients living in housing supported by the AgencyClient responsibilitiesAgency’s responsibilitiesSchedule for Case Mangement and Outreach Support ClientsClient Rights and ResponsibilitiesPsychology and Counselling ClientsClient Rights and ResponsibilitiesChoice of Psychologist/CounsellorConfidentiality and Privacy

Consent to release of Client information –noted and signed as written or verbalAppointments

Schedule for Recreation ClientsClient rights and responsibilities

Schedule of Fees/Charges/RatesCost Proposal Method of paymentNon-payment of feesDetails of intermediaryDirect payments Fee Details, Rate Total PayablePayment frequencySpecial considerationsPerson/agency responsible for payment of invoiceDetails of payment arrangements

OTHER

Data Collection QuestionnaireProcess/Steps (Baptcare p8)Consent to Release of Consumer Information (Baptcare)Informed consent form (Independent Rehab Services)

Questions of a personal nature Physical contact Risks related to therapy

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Research Third Party Presence Substituted consent We need to know (e.g medical conditions) Electronic information Health Information Consent to video recording/photography

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ATTACHMENT G

NDIS PRACTICAL DESIGN FUND PROJECT FINAL REPORT


Final Report Attachment:

Easy Read Version of Service Agreement Template

Individual service agreement

This agreement is between

[Your name, the client]

and

[The name of your service provider, the service provider].

[the name, contact details, logo and ABN of the service provider]

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Easy Read version

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How to use this document

This is an easy-to-read version of an Individual Service Agreement.Some words are written in bold. We explain what these words mean in the Word list on page xx.You can ask for help with this document. A family member or support person may be able to help you.It is important that you understand everything in this document before you sign it.Make sure you also understand all the other information you get with this document. There is a list of this information on page 18.

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What’s in this document?

What’s this document about? 28

Your individual service agreement 29

What can you expect? 29

What can [the service provider] expect of you? 32

What about the money? 32

How do I pay for the service? 34

What if I want to make changes to this agreement? 35

Making sure this agreement works well 37

What if there’s a problem? 38

Making this agreement 39

Other information with this agreement 42

Word list 44

Where can I get more information? 46

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What’s this document about?

This document is about you and your service provider agreeing on the kind of services and support you will receive. A service provider is a person or an organisation that offers paid services and support to people with a disability.You can choose the service provider who bests meets your needs and helps you live in the way you want to.This document is called an individual service agreement. We explain more about this on the next page.

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Your individual service agreement

This agreement is just for you and [the service provider]. It’s not for anyone else. It is called an individual service agreement. It explains what you can expect of [the service provider]. And it explains what [the service provider] can expect of you.This agreement describes the service and support that [the service provider] will provide for you.This includes:

what the service is

how the service will work

the cost of the service

the rules that apply.

[The service provider] will give you all this information with this agreement. There is a list of the information you will get from them on page 18.If you want to, you can choose a person who can:

help you with this agreement

sign this agreement for you.

This person is called a nominee. Your nominee should be someone you trust, like a family member, friend or support person. If you choose a nominee you must write a letter telling [the service provider] who your nominee is.

What can you expect?

When you use services from [the service provider]:

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They will treat you kindly and with respect.

They will support you to live your life in the way you want to, as far as possible.

They will help you put together a support plan.

A support plan is a document that says:

you are in charge of your life

you decide what you want in your life

you choose the activities you want to take part in

how [the service provider] will help you do this.

You will get a copy of your support plan. If you have a nominee, they will also get a copy of the support plan.

You and [the service provider] will look at your support plan at least once each year.This is called a review.The review is to make sure you are still happy with the way the support plan is going.

You can review your support plan more often if either you or [the service provider] want to do this.

[The service provider] will keep your information safe and private.They will only tell someone else this information if you allow them to, or if the law says they have to.

You can ask to see any health information [the service provider] has about you.

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[The service provider] will tell you about any changes to your support.For example, they will tell you:

• if the laws about your support change

or

• if the government makes changes.

If [the service provider] wants to stop your service they will tell you about this at least 2 months before they want to stop.

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What can [the service provider] expect of you?

When you, your family or your nominee use services from [the service provider], you all agree that:

You will always treat the staff and other clients with kindness and respect. You will listen to them and care about their needs and opinions.

You will tell [the service provider] about any important changes in your life. This might include:

• moving house

• a change to any medicines you take.

You will work with [the service provider] to:

• put together your support plan

• review this plan.

You will talk to [the service provider] about any problems you are having with the service. You will work together with [the service provider] to fix these problems. There is more information

about this on page 14.

You will pay [the service provider] by the date shown on the bills from them. There is more information about this on page 10.

If you want to leave the service, you will let [the service provider] know at least 2 months before you want to go.

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What about the money?

The money you receive to pay for the services and support you need is called funding. The organisation that provides this money is called a funding body. The funding body may be the government or another organisation. It’s important that the services you use don’t cost more than your funding money. If you choose services that cost more than your funding money, you will need to pay these extra costs from other money you have.

When you put together your support plan, you also make a budget.A budget is a plan of how you will spend your money. It shows the money that you receive and how you will use it.You and [the service provider] need to follow the budget in your support plan.

We explain how you can pay for the services on the next page.

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How do I pay for the service?

[The service provider] decides how much the service costs.With this service agreement you will receive a cost proposal.This explains how much you need to pay [the service provider].If you are not happy with the cost of the service, or if you want to change the cost, you must talk to [the service provider].

There are 3 ways you can pay [the service provider]:Your funding body pays [the service provider], using your funding money.If this happens, [the service provider] will make sure you know about:

how much money they have received

how the money is being used

how your budget is going.

They will do this at least 4 times each year.They can do this more often if you ask them to.

You pay [the service provider] yourself, using your funding money.You will receive a bill every month from [the service provider].

You need to pay the bill by 14 days after the day you receive it.

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You (or your nominee) choose a person or organisation to look after your funding money for you.

The funding body will send your funding money to this person or organisation.You will receive a bill every month from [the service provider].

You need to give this to the people who look after your funding money.They will pay [the service provider].They need to pay the bill by 14 days after the day you receive it.

If ever a bill cannot be paid on time, the person who pays the bill must talk to [the service provider] about why this happened.They will need to discuss how to fix this problem.

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What if I want to make changes to this agreement?

You (or your nominee) can ask to make changes to this agreement. [The service provider] can also ask to make changes to this agreement. If you want to make a change, you must first talk about it with [the service provider].You decide together to make the change.In the same way, if [the service provider] wants to make a change, they must talk to you about it first. You must say yes to any change before it is made.

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Making sure this agreement works well

It’s important that you and your service provider are happy with the way this agreement is working. Each year, you will both complete a form that talks about how things are going.

You may also need to meet to talk about how things are going.Or you may need to meet to talk about any changes that you or [the service provider] want to make.

Sometimes, the government will need to look closely at the services you use, to see how well they are working. This is called an audit. You and your nominee will need to take part in an audit if the government asks you to.

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What if there’s a problem?

You and your nominee have the right to tell [the service provider] what you think about their service.It’s important that [the service provider] knows how you feel about their service. They need to know what is working well and what is not working well.

If you are not happy with something you should tell [the service provider] about this.The complaints policy you receive with this agreement explains how to tell [the service provider] if there is a problem with the service.

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Making this agreement

You, or your nominee, will sign the agreement on the next page to say:

you understand it

you agree to everything in it

you will do the things it says.

The agreement includes all the information in the list on page 18.[The service provider] will also sign the agreement on page 17 to say that they agree to everything.

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You read and sign here:

I, [your name], understand and agree to everything in this agreement .

Your name

________________________________________

Your signature

________________________________________

Date_______ / _______ / _______

Or:

I, [your nominee’s name], as nominee for [your name], understand and agree to everything in this agreement .

Nominee’s name

________________________________________

Relationship of nominee to you

________________________________________

Nominee’s signature

________________________________________

Date_______ / _______ / _______

Your service provider reads and signs here:I, [name], accept this agreement for [name of service provider]Name of person

________________________________________Name of service provider

________________________________________Signature

________________________________________

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Date_______ / _______ / _______

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Other information with this agreement

With this agreement [the service provider] will give you a copy of:

your support plan

their complaints policy.

Other information [the service provider] should give you with this agreement includes:

[the service provider]’s privacy policy

details of any information about you that the law says [the service provider] must tell the government

their cost proposal – this is information about how much their service costs

details of the services that this agreement is about.

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Word list

AuditAn audit is when the government wants to look closely at the services you use to see how well they are working.

BudgetA budget is a plan of how you will spend your money. It shows the money that you receive and how you will use it.

Complaints policyA complaints policy tells you how to tell the service provider if there is a problem.

Cost proposalA cost proposal tells you how much you will need to pay the service provider for the services that you decide to buy from them.

FundingFunding is the money you receive to pay for the services and support you need.

Funding bodyThe funding body is the organisation that provides the funding money to pay for the services and support you need. This may be the government or some other organisation.

Individual service agreementAn individual service agreement is an agreement between you and your service provider. The agreement:

describes how the service provider will support you

explains all the important information about the service or support

explains your rights and responsibilities when you use their service.

NomineeA nominee is a person you choose who acts for you.

Privacy policyA privacy policy tells how an organisation will keep information about you safe and private.

ReviewWhen you and your service provider look at your support plan each year to make sure you are still happy with it.

Service providerA service provider is a person or an organisation that offers paid services and support to people with a disability.

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Support planYour support plan describes how you want to live your life and how your service provider will help you do this.

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Where can I get more information?

This Easy Read document was created by the Information Access Group using custom images.Service providers may reuse these images for the purpose of sharing this Easy Read Individual Service Agreement with their clients.Service providers may also like to include images or photographs from their own service, perhaps including recognisable places and people.

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ATTACHMENT H



SUGGESTED ANNUAL SERVICE AGREEMENT QUALITY ASSURANCE EVALUATION

A copy each to be to be completed by the Client and the Service Provider

How do you rate performance against the Service Agreement for the period DD/MM/YY to DD/MM/YY according to the following statements?

StronglyDisagree

Disagree Neutral Agree StronglyAgree

The roles and responsibilities of the Service Provider were carried out satisfactorilyThe roles and responsibilities of the client and his/her family were carried out satisfactorilyAll decisions regarding (Client’s name) incorporated his/her wishes as far as possibleOpen and reciprocal communication was maintained between (Name of Client and his/her family and (Name of Service Provider) during the periodThe selection and employment of support workers for (Name of client) was performed jointly by (Name of Service Provider) and (Name of Client and/or their Representative)An audit of the funding allocations was made. The client and/ his representatives were provided with an approved copy of the auditThe quality of the services delivered was satisfactoryThe client’s issues were responded to promptly by the service provider

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The service provider’s requests were responded to promptly by the clientThe client was treated with dignity and respectThe service provider was treated with dignity and respect

1. If any of your ratings above were “Strongly Disagree” or “Disagree” could you please explain?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. What did you like most about the Agreement?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. What other ideas would you like included in the Agreement?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. In what ways did the support plan enhance or prohibit the client from achieving his/her ambitions?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Other comments

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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