Clients

We would like to thank you for choosing Cosmetic Companions for your care, hydration, and transportation needs. The information in this link is to inform you of your rights as our client and provide you with all the information required by state regulatory entities.

The Cosmetic Companion mission is to provide quality, reliable services to you. Our staff delivers the highest standards in home services. Our administrative staff coordinates all these services to provide seamless, effortless, top-notch service for you. There is always someone for you to call when you have changes or need questions answered.

At Cosmetic Companions, LLC, we collaborate with you and your family members to provide the services you need when you need them.

Our Agency maintains a client record of the services we provide. Your record is secured and its privacy protected at all times. You may request a copy of your record by sending your request to us in writing. By signing your admission documents you are authorizing our Agency to collect and maintain that record by either paper charts or electronic record.

You can contact us Monday to Friday during business hours at our office phone. After normal business hours, should you need assistance, you can call us through our answering service by calling our regular phone number which is forwarded to our on call after hours phone line. Our on call Supervisor will return your call.

Although we fully expect you to be extremely pleased with our services, if ever you should have a concern or complaint, please feel free to call our office directly at: (214) 210-9699 and the State Hotline as listed in your Client Rights.

We evaluate our Agency on an annual basis, reviewing all aspects of our services. A summary of the evaluation report is available to consumers/general public upon written request. When you are discharged from service you will receive a satisfaction survey requesting feedback on our service and programs. We hope you will take the few minutes to complete the survey and return it so that we may continue to address areas where there is an opportunity to improve. We appreciate your thanks by way of positive reviews and referrals.

Although your record is the property of our Agency, should you ever need access to your record, you may obtain copies by submitting a written request to the office that provides your services. We look forward to providing you with excellent home care service and thank you for choosing Cosmetic Companions, LLC.

Best Regards,
Diane Gibson RN,
Administrator

Guide to Safety in the Home

People of all ages have accidents. Please take a few minutes to review the safety guide; you can protect yourself and those around you by taking some precautions.

Falls are the most frequent and most serious accidents in the home. There are several things you can do to prevent falls:

• Remove throw rugs when client is relying on ambulatory aides such as walkers and canes or has a shuffling gait
• Use nonskid tape or backing on throw rugs. Tack down the edges of all carpets.
• Be sure there are firmly anchored non-slip treads, good lighting and a solid, easy-to grasp handrail that is rounded or knobbed at the end of stairs.
• Consider painting or taping the top and bottom steps so they’ll be easily noticed.
• Make sure there is a clear walkway through every room. Avoid using halls/stairways for storage.
• Be sure halls/stairways are well lit.
• Don’t walk on a freshly washed or waxed floor until it is dry.
• Wipe up any spills immediately to avoid slips.
• Avoid wearing only socks, smooth-soled shoes, or slippers on uncarpeted floors.
• In the bathroom, be sure mats are nonskid and there are treads in the tub or shower.
• Keep outdoor stairs, porches, and walkways free of wet leaves, snow, and ice.
• Make sure stairs and walkways are in good repair.

Protect Yourself and Your Family from Fire and Burns
• Don’t smoke in bed or when sleepy.
• Use portable heaters according to manufacturer’s instructions. Turn off before going to bed.
• Have your home checked if there are signs of any wiring problems.
• Check hot water temperature. Experts suggest setting hot water at 120 degrees Fahrenheit or lower.
• Keep pot handles turned away from front of stove. Use pot holders when necessary.
• Never leave unattended food cooking on the stove

Be Prepared
• Install smoke detectors and check them regularly
• Keep multipurpose fire extinguisher charged and handy
• Make a fire escape plan. Check fire exits to be sure they open easily and are free of clutter
• If you live in an area where weather conditions change suddenly, make sure you have an evacuation plan or call your city hall regarding the emergency evacuation plan. Intellectual Property rights of the trademark for Beyond Faith Consulting

NON-DISCRIMINATION/LEP STATEMENT 6.2016

Cosmetic Companions, LLC complies with applicable Federal civil rights laws and does not discriminate in hiring or admissions, on the basis of race, color, national origin, age, disability, or sex. Our Agency does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Cosmetic Companions, LLC:

 Provides free aids and services to patients with disabilities to communicate effectively with us, such as:
○ Qualified sign language interpreters.
○ Written information in other formats (large print, audio, accessible electronic formats, other
formats).

 Provides free language services to patients whose primary language is not English (LEP) such as:
○ Qualified interpreters.
○ Information written in other languages.
If you need these services, contact Diane Gibson RN.

If you believe that Cosmetic Companions, LLC has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

Agency Name: Cosmetic Companions, LLC
Agency Civil Rights Coordinator: Diane Gibson RN
Agency Address: 320 Decker Drive, Suite 100, Irving TX 75062
Agency Phone: (214) 210-9699
You can file a grievance in person or by mail or fax. If you need help filing a grievance,
Diane Gibson RN is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services, 200 Independence Avenue SW.,
Room 509F, HHH Building
1-800-368-1019, 800-537-7697 (TDD)

ADVANCE DIRECTIVES – YOUR RIGHT TO DECIDE

Under federal law, you have the right to complete an “advance directive’ which outlines one’s desire in advance on what type of treatment/care you want or do not want under special, serious medical conditions (conditions that would prevent you from telling your doctor how you want to be treated)

There are different kinds of Advance Directives, including, but not limited to those listed below.

• Living Will                                              • Health Care Surrogate/Proxy                                            • Durable Power of Attorney for Health Care
If you have executed any of these documents, please advise your Admission staff and they will make a copy of the document for our records.

If you do not currently have an advance directive in place, we encourage you to consult an attorney or the state Department of Aging for additional information and forms. If you create an Advance Directive, please advise us as soon as possible.

Our agency has adopted policies regarding the implementation of your advance directive. It includes the incorporation of the document into your record, communication of the directive to caregivers, and the assurance that the provision of your service is in no way conditional upon an advance directive or the
refusal of care.

The agency will in no way place conditions on the provision of service, or in any way discriminate against
clients, based on their right to refuse medical treatments or the creation of an Advance Directive.
Our objective is to assure that the client’s rights are respected and that any such decisions or documents
will not place conditions on the provision of service.

Our Agency Advance Directive (AD) Policy/Procedures:
1. The existence of an AD will be asked about upon admission to our agency.
2. Clients who are cognitively impaired shall have AD information provided to family or a surrogate.
3. If an AD has been executed, the client record will indicate such and efforts will be made to obtain a copy for placement in the client record.
4. At the time an AD takes effect, service will continue in compliance with said instructions to the extent permitted by law.
5. Service shall continue according to a the written plan of service and the client’s wishes unless the client’s refusal of care negates the only service being provided, at which time, after client
notification, service would cease or client would be referred to appropriate agency.
6. Clients are informed in writing in the Admission Packet, of their right to register complaints concerning AD requirements through the toll-free home care hotline in the Client Rights.

Client’s Rights and Responsibilities

These Rights and Responsibilities will be followed by all staff of Cosmetic Companions, LLC that provided services to you in your place of residence. You receive a copy of these rights upon admission to our Agency. You have the right to exercise these rights at any time without fear of reprisal or discrimination in services.

You have the right to:
1. Receive considerate and respectful service in the home at all times, be treated with dignity and have property treated with respect.
2. Receive access to service without regard to race, creed, gender, age, handicap, veteran status, sexual preference or lifestyle, or to whether or not any advance directive has been executed.
3. Be informed of organizational ownership and control and of the disciplines that will be providing you service upon request.
4. Participate in the development of and make informed decisions regarding the plan of service/plan of care, and receive an explanation, in advance, of any services proposed and the frequencies suggested in a way that is understandable to the client, changes in service, and alternative services that may be available.
5. This Bill of Rights is provided to our clients in advance of providing pre-planned service. Our clients have the right to exercise his/her rights at any time. Either you or your designated representative is authorized to exercise your rights.
6. Be informed in advance about service to be furnished and of any changes in the service to be furnished including advance notice if changes to the plan of service are occurring.
7. Receive complete written information on the plan of service, including the name of the home workers and the supervisor responsible for the services and Cosmetic Companions, LLC phone number and to be able to identify Agency staff by name badge identification.
8. Receive and access services consistently and in a timely manner in accordance with our Agency’s stated operational policy.
9. Refuse services without fear of reprisal or discrimination.
10. Be fully informed of the consequences of all aspects of service, including the possible results of refusal of services.
11. Privacy and confidentiality about one’s circumstances and about what takes place in the home (your record) is protected at all times and maintained by Cosmetic Companions, LLC.
12. Know that all communications and records will be treated confidentially and that no information will be given out without a written release from the client or family.
13. Expect that all personnel, within the limits set by the plan of service, will respond in good faith to the client’s requests for assistance in the home.
14. Receive information on Cosmetic Companions, LLC’s policies and procedures including information on charges, names and professional qualifications and supervision of personnel, hours of operation, and discontinuation of service; request a change of caregiver and ownership information.
15. Participate in the plan for discontinuation of service with the right to appeal and to be notified in advance of treatment options, transfers, when and why care will be discontinued.
16. Receive education, instructions and requirements for continuing service when the services of Cosmetic Companions, LLC are discontinued. Clients shall participate in the selection of options for alternative levels of service or referral to other organizations as indicated by the client’s need for continuing care.
17. Be referred to another provider organization if our Agency is unable to meet the client’s needs or if the client is not satisfied with the service they are receiving.
18. Have access to all bills for service regardless of whether they are paid for out-of-pocket or through other sources of payment.
19. Receive regular supervision of the home workers, the frequency of which is decided upon by you & our Agency.
20. Be free from any mental, physical abuse, neglect or exploitation of any kind.
21. Receive a clear explanation of which services provided by Cosmetic Companions, LLC are covered by third-party reimbursement and which services and equipment will be paid for by the client and of the charges which will be incurred.
22. Be advised of Agency’s policies/procedures for accessing or disclosure of your record.
23. Receive a clear explanation of the process to voice grievances about service or discontinuation of service without fear of discrimination or reprisal for doing so.
24. Appeal agency decisions regarding service, following grievance procedures. Expect to have an investigation done following a complaint regarding treatment or care. Be assured that Cosmetic
Companions, LLC shall document the existence of the complaint and the resolution or findings of the complaint.
25. Know Cosmetic Companions, LLC maintains liability insurance coverage; and be given in writing the name and telephone number of a contact person for 24 hour access to Cosmetic Companions, LLC.
26. Be fully informed about billing policies, payment procedures and any changes in the information provided on admission as they occur within 15 days from the date that Cosmetic Companions, LLC is made aware of the change.
27. Be informed orally and in writing of any changes in payment information as soon as possible, but no later than 30 days from the date that the organization becomes aware of the change.
28. Access to an interpreter if needed.
29. Our clients always have the right to express or voice complaints/grievances regarding service without fear of reprisal or discrimination.
30. State Complaint line and the reasons for calling the hotline are for asking questions or voicing
complaints about Cosmetic Companions, LLC or expressing concerns about execution of your
Advance Directive.

The TX Complaint line is 800-458-9858 – 7 AM to 7 PM.
You can also write to:
Texas Department of Aging and Disability Services
Consumer Rights and Services — Complaint Intake Unit
Mail Code E 249
P.O. Box 149030
Austin, TX 78714-9030

31. Be advised of the TX State Abuse hotlines:

Elder Abuse Hotline 800-252-5400
Child Abuse Hotline 800-252-5400

RIGHTS OF THE ELDERLY

Sec. 102.003. RIGHTS OF THE ELDERLY.  (a)  An elderly individual has all the rights, benefits, responsibilities, and privileges granted by the constitution and laws of this state and the United States, except where lawfully restricted.  The elderly individual has the right to be free of interference, coercion, discrimination, and reprisal in exercising these civil rights.

(b)  An elderly individual has the right to be treated with dignity and respect for the personal integrity of the individual, without regard to race, religion, national origin, sex, age, disability, marital status, or source of payment.  This means that the elderly individual:

(1)  has the right to make the individual’s own choices regarding the individual’s personal affairs, care, benefits, and services;

(2)  has the right to be free from abuse, neglect, and exploitation;  and

(3)  if protective measures are required, has the right to designate a guardian or representative to ensure the right to quality stewardship of the individual’s affairs.

(c)  An elderly individual has the right to be free from physical and mental abuse, including corporal punishment or physical or chemical restraints that are administered for the purpose of discipline or convenience and not required to treat the individual’s medical symptoms. A person providing services may use physical or chemical restraints only if the use is authorized in writing by a physician or the use is necessary in an emergency to protect the elderly individual or others from injury.  A physician’s written authorization for the use of restraints must specify the circumstances under which the restraints may be used and the duration for which the restraints may be used.  Except in an emergency, restraints may only be administered by qualified medical personnel.

(d)  A mentally retarded elderly individual with a court-appointed guardian of the person may participate in a behavior modification program involving use of restraints or adverse stimuli only with the informed consent of the guardian.

(e)  An elderly individual may not be prohibited from communicating in the individual’s native language with other individuals or employees for the purpose of acquiring or providing any type of treatment, care, or services.

(f)  An elderly individual may complain about the individual’s care or treatment.  The complaint may be made anonymously or communicated by a person designated by the elderly individual.  The person providing service shall promptly respond to resolve the complaint.  The person providing services may not discriminate or take other punitive action against an elderly individual who makes a complaint.

(g)  An elderly individual is entitled to privacy while attending to personal needs and a private place for receiving visitors or associating with other individuals unless providing privacy would infringe on the rights of other individuals.  This right applies to medical treatment, written communications, telephone conversations, meeting with family, and access to resident councils.  An elderly person may send and receive unopened mail, and the person providing services shall ensure that the individual’s mail is sent and delivered promptly.  If an elderly individual is married and the spouse is receiving similar services, the couple may share a room.

(h)  An elderly individual may participate in activities of social, religious, or community groups unless the participation interferes with the rights of other persons.

(i)  An elderly individual may manage the individual’s personal financial affairs.  The elderly individual may authorize in writing another person to manage the individual’s money.  The elderly individual may choose the manner in which the individual’s money is managed, including a money management program, a representative payee program, a financial power of attorney, a trust, or a similar method, and the individual may choose the least restrictive of these methods.  A person designated to manage an elderly individual’s money shall do so in accordance with each applicable program policy, law, or rule. On request of the elderly individual or the individual’s representative, the person designated to manage the elderly individual’s money shall make available the related financial records and provide an accounting of the money.  An elderly individual’s designation of another person to manage the individual’s money does not affect the individual’s ability to exercise another right described by this chapter.  If an elderly individual is unable to designate another person to manage the individual’s affairs and a guardian is designated by a court, the guardian shall manage the individual’s money in accordance with the Probate Code and other applicable laws.

(j)  An elderly individual is entitled to access to the individual’s personal and clinical records.  These records are confidential and may not be released without the elderly individual’s consent, except the records may be released:

(1)  to another person providing services at the time the elderly individual is transferred;  or

(2)  if the release is required by another law.

(k)  A person providing services shall fully inform an elderly individual, in language that the individual can understand, of the individual’s total medical condition and shall notify the individual whenever there is a significant change in the person’s medical condition.

(l)  An elderly individual may choose and retain a personal physician and is entitled to be fully informed in advance about treatment or care that may affect the individual’s well-being.

(m)  An elderly individual may participate in an individual plan of care that describes the individual’s medical, nursing, and psychological needs and how the needs will be met.

(n)  An elderly individual may refuse medical treatment after the elderly individual:

(1)  is advised by the person providing services of the possible consequences of refusing treatment;  and

(2) acknowledges that the individual clearly understands the consequences of refusing treatment.

(o)  An elderly individual may retain and use personal possessions, including clothing and furnishings, as space permits.  The number of personal possessions may be limited for the health and safety of other individuals.

(p)  An elderly individual may refuse to perform services for the person providing services.

(q)  Not later than the 30th day after the date the elderly individual is admitted for service, a person providing services shall inform the individual:

(1)  whether the individual is entitled to benefits under Medicare or Medicaid;  and

(2)  which items and services are covered by these benefits, including items or services for which the elderly individual may not be charged.

(r)  A person providing services may not transfer or discharge an elderly individual unless:

(1)  the transfer is for the elderly individual’s welfare, and the individual’s needs cannot be met by the person providing services;

(2)  the elderly individual’s health is improved sufficiently so that services are no longer needed;

(3)  the elderly individual’s health and safety or the health and safety of another individual would be endangered if the transfer or discharge was not made;

(4)  the person providing services ceases to operate or to participate in the program that reimburses the person providing services for the elderly individual’s treatment or care; or

(5)  the elderly individual fails, after reasonable and appropriate notices, to pay for services.

(s)  Except in an emergency, a person providing services may not transfer or discharge an elderly individual from a residential facility until the 30th day after the date the person providing services provides written notice to the elderly individual, the individual’s legal representative, or a member of the individual’s family stating:

(1)  that the person providing services intends to transfer or to discharge the elderly individual;

(2)  the reason for the transfer or discharge listed in Subsection (r);

(3)  the effective date of the transfer or discharge;

(4)  if the individual is to be transferred, the location to which the individual will be transferred;  and

(5)  the individual’s right to appeal the action and the person to whom the appeal should be directed.

(t)  An elderly individual may:

(1)  make a living will by executing a directive under the Natural Death Act (Chapter 672, Health and Safety Code);

(2)  execute a durable power of attorney for health care under Chapter 135, Civil Practice and Remedies Code;  or

(3)  designate a guardian in advance of need to make decisions regarding the individual’s health care should the individual become incapacitated.

Clients of Cosmetic Companions, LLC have the responsibility to:

• Notify our Agency of changes in their situation (hospitalization, symptoms, etc.).

• Follow the plan of service.

• Notify our Agency if the visit schedule needs to be changed.

• Keep appointments and notify our Agency if unable to do so.

• Advise our Agency of any issues or dissatisfaction with the service/s or the workers providing the service/s.

• Provide a safe environment for services to be provided.

• Carry out mutually agreed responsibilities.

A reasonable attempt has been made and documented that the client and family understand these rights and responsibilities which have been reviewed with the client prior to or at the start of service visit and periodically thereafter.

NOTICE OF HIPAA PRIVACY PRACTICES FOR PHI page 1 of 3

[45 CFR 164.520] OCR HIPAA Privacy December, 2002

THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION
IS PROTECTED & MAY BE USED AND DISCLOSED

We are required by law to maintain the privacy of your health information; to provide you this detailed Notice of our legal duties and privacy practices, and to abide by the terms of the Notice that are currently in effect.

You have the right to:
Advise our Agency to limit what information is utilized or shared:
 Ask our Agency not to use or share certain health information for treatment, payment, or operations. Our Agency is not required to agree to your request, and may say “no” if it would affect your care.
 If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. Our Agency will say “yes” unless a law requires us to share that information.

Choose someone to act on your behalf:
 If you have designated an individual medical power of attorney or have a legal guardian, that individual may exercise your rights and make choices about your health information.
 Our Agency will make ensure the person has this authority and can act for you before we take any action.

Obtain a list of those with whom we’ve shared information:
 You can ask for a list (accounting) of the times the Agency has shared your health information for six (6) years prior to the date you ask, who the Agency shared it with, and for what purpose.
 Our Agency will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). Our Agency will provide one accounting a year at no charge, but will charge a reasonable fee if you ask for another within 12 months.

Request confidential communications:
 You can ask our Agency to contact you in a specific way (ie. at home/work phone) or send mail to a specific address. Our Agency will comply with all reasonable requests.

Get an electronic or paper copy of your medical record:
 You can ask to see or receive an electronic or paper copy of your medical record and other health
information the Agency has about you. Ask our Agency how to do this.
 The Agency will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record:
 You can ask our Agency to correct health information about you that you think is incorrect or incomplete.

Ask our Agency how to do this.
 Our Agency may say “no” to your request, but we will explain why in writing within 60 days.

Get a copy of this privacy notice:
 You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice
electronically. Our Agency will provide you with a paper copy promptly.

For certain health information, you can tell us your choices about what we share: If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:
 Share information with your family, close friends, or others involved in your care.
 Share information in a disaster relief situation.

NOTICE OF HIPAA PRIVACY PRACTICES FOR PHI page 2 of 3

 Include your information in a hospital directory.
If you are not able to tell us your preference, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

USES AND DISCLOSURES:

For Treatment. Our Agency will use and disclose your health information in providing you with treatment/services and coordinating your care and may disclose information to other providers involved in your care. Your health information may be used by doctors involved in your care and by nurses and health aides as well as by therapists, pharmacists, suppliers of medical equipment, or other persons involved in your care.

For Payment/Billing for Services. Our Agency may use and disclose your health information for billing and payment purposes. We may disclose your health information to your representative, or to an insurance or another third party payer. We may contact your health plan to confirm your coverage or to request prior
approval for services that will be provided to you.

For Health Care Operations. Our Agency may use and disclose your health information as necessary for operating our Agency, such as management, personnel evaluation, education and training, and to monitor our quality of care. We may disclose your health information to another entity with which you have or had a relationship if that entity requests your information for certain of its health care operations or health care fraud and abuse detection or compliance activities.

To Do Research: Our Agency can use or share your information for health research.

To Comply with the law: Our Agency will share information about you if state or federal laws require it, including with the US Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

To Respond to organ and tissue donation requests: Our Agency can share health information about you with organ procurement organizations.

To Work with a medical examiner or funeral director: Our Agency can share health information with a coroner, medical examiner, or funeral director when an individual dies.

To Address workers’ compensation, law enforcement, and other government requests:
Our Agency can use or share health information about you:
 For workers’ compensation claims
 For law enforcement purposes or with a law enforcement official
 With health oversight agencies for activities authorized by law
 For special government functions such as military, national security, etc

To Respond to lawsuits and legal actions: Our Agency can share health information about you in response to a court or administrative order, or in response to a subpoena.

We will never share your information for the following purposes unless you give written permission:
 Marketing purposes
 Sale of your information
 Most sharing of psychotherapy notes
 We may contact you for fundraising efforts, but you can tell us not to contact you again

We are allowed to use or share your health information in other ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

NOTICE OF HIPAA PRIVACY PRACTICES FOR PHI page 3 of 3

To help with public health and safety issues:
We can share health information about you for certain situations such as:
 Preventing disease
 Helping with product recalls
 Reporting adverse reactions to medications
 Reporting suspected abuse, neglect, or domestic violence
 Preventing or reducing a serious threat to anyone’s health or safety

SPECIFIC USES/DISCLOSURES OF YOUR HEALTH INFORMATION
Individuals Involved in Your Care or Payment for Your Care: Unless you object, our Agency may disclose health information about you to a family member, close personal friend, or other person you identify, including clergy, who is involved in your care.

Emergencies: Our Agency may use or disclose your health information as necessary in emergency treatment situations.

As Required By Law: We may use or disclose your health information when required by law to do so.

Business Associates: Our Agency may disclose your protected health information to a contractor or business associate that needs the information to perform services for our Agency. Our business associates are committed to preserving the confidentiality of this information.

RESPONSIBILITIES OF OUR AGENCY:
Our Agency is required by law to maintain the privacy and security of your protected health information.

 We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
 We must follow the duties and privacy practices described in this notice and give you a copy.
 We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

You have the right to express concerns/complaints, without fear of retaliation, to our Agency or the US Department of Health & Human Services, regarding any act that you consider a violation of these privacy rights.
If you feel your privacy rights have been violated, Please direct concerns to our agency at:

Cosmetic Companions, LLC
Diane Gibson RN
320 Decker Drive, Suite 100, Irving TX 75062
(214) 210-9699

Our agency will never retaliate against you for filing a complaint.
Or, you can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights
by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 877-696-6775, or
www.hhs.gov/ocr/privacy/hipaa/complaints/.
For more information: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Our Agency can change the terms of this notice, and the changes will apply to all information we have about you. The new
notice will be available upon request and be posted in our office.

Client Concerns/Grievance Policy

Cosmetic Companions,
LLC

We strive to provide the highest quality services for our clients. That’s why your concerns are our concerns.

To insure that our services meet your needs, we encourage you to make us aware of any complaints or concerns. Complaints should be addressed to the Administrator who will promptly review the problem. Following that review, the Administrator will make written or verbal contact with you to assure you that the problem has or is being addressed. It is in our agency policy to address the complaint within 30 days. If at any time you feel that a situation was not resolved to your satisfaction by this process, you may contact the office at (214) 210-9699.

We appreciate your candid comments as this helps us in the process of continually working to improve our services to our many and valued clients. If you have information about unethical behavior, criminal activities, or other concerns regarding your services, please call the Administrator at the office. Your confidentiality will be protected.

The following are examples of issues that should be brought to our attention immediately

• Potential criminal violations
• Health and safety issues
• Theft and fraud
• Bribes and kickbacks
• Conflicts of interest
• Insider trading
• Breach of confidentiality of company information
• Breach of confidentiality of client records
• Antitrust laws
• Privacy of employee and client records
• Harassment or discrimination
• On-the-job substance abuse
• Billing and documentation/insurance fraud
• Violation of clients’ rights

Complaint & Grievance Process/Reporting Abuse

Clients, families, visitors, advocates Our Agency is committed to providing excellence in client service.

We will give full consideration to your issues and make an effort to resolve any issues to your satisfaction. We will provide you every opportunity to voice grievances without discrimination, fear of reprisal, or any discrimination from our Agency or its employees.

If you have any concerns at all, please:
Tell us, either verbally or in writing, the Administrator or Supervisor or any staff member you are comfortable with. They will ensure the concern is presented to the Administrator. If you call after business hours, the Administrator will be in contact with you the next business day.

The Administrator will contact you within 10 days and will help to resolve the complaint/concern to your satisfaction. They will look at all aspects surrounding the grievance, investigation, and resolution. You will be notified of the Administrator’s decision within thirty (30) days.

If you are dissatisfied with the outcome of the complaint investigation, you may request that the Administrator submit an appeal with Cosmetic Companions, LLC’s Governing Body.

You may also file a complaint with the Texas Complaint hotline at:
800-458-9858

You may file a grievance/concern with our Agency at any time without fear of reprisal.

Please contact us at:
AGENCY: Cosmetic Companions, LLC
AGENCY ADMINISTRATOR: Diane Gibson RN
AGENCY TELEPHONE: (214) 210-9699

Mandatory Reporters

You are required by the Client Abuse Statutes to report whenever you suspect there has been an instance of client abuse, neglect, mistreatment or misappropriation of a clients’ property to the appropriate state protective services agency.

Elder Abuse Hotline 800-252-5400
Child Abuse Hotline 800-252-5400

Emergency Preparedness Info Sheet

To attempt to keep all our Consumers informed and educated Cosmetic Companions, LLC wants to give you the best direction possible to be prepared. When your service began we assigned you a priority code based on your own unique situation in the home.

As your safety is of great importance to us, if you relocate during an emergency situation, please let the agency know your location: (214) 210-9699

DISASTER EMERGENCY PRIORITY CLASS

 Class I – HIGHEST- Clients in severe situations that require ongoing service to maintain safety at home.
 Class II – Clients with a great need for service .Services could be postponed for 2-3 days without adverse effects.
 Class III – Services could be postponed 3-4 days without adverse effects.
 Class IV – LOWEST-Service could be postponed for 5 days without adverse effects.

You have been assigned as priority code:  IV

During an emergency situation, Cosmetic Companions, LLC clients can expect that we will do everything
within our means to continue servicing your emergent needs.

Some of the situations that may cause us to close an office and put the emergency plan in effect are:
• Severe winter storms
• Severe weather conditions (hurricane, tornado etc)
• National Emergency status called for by the Governor
• Terrorist attack
• Pandemic threat such as Avian Influenza

In the event that we have some notification of the emergency situation, you can expect a phone call from our office explaining when we anticipate your next visit to be done and by whom. Due to your assignment of priority code 4, we are likely to postpone your scheduled visit to another day in the same week.

We advocate that all persons create at least a 3 day supply of clean drinking water, canned/nonperishable food, flashlight with extra batteries, extra blanket, 3 day supply of medication, and portable radio. Please take some time now to be sure these are in place BEFORE an emergency event should occur.

When an emergency condition occurs our office begins a specialized procedure to assure your care. The Administrator will begin notifying their staff and the phone tree continues until all employees are contacted so that everyone knows what to do and when to do it. Please refrain from calling the office unless you have a true emergency situation as our office is likely to be very busy during the time of an emergency. We will be calling you to keep you informed.