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Incident Report 

    SPECIAL INCIDENT REPORT 
    State Requirement, ALL Instructors/Education Consultants must create an incident report here within 4 days if the client is missing.  If a client has not been seen for 5 days or on the 5th consecutive day of an UNPLANNED absence the Instructors/Education Consultants must report here immediately. If a Instructors/Education Consultants has not reported the client missing then the Instructors/Education Consultants will be reported to Adult Protective Services for negligence and client abandonment. The Instructors/Education Consultants may also be faced with disciplinary actions or termination. If a law suit results from the Instructors/Education Consultants negligence then the Instructors/Education Consultants will cover all legal charges and fee's or fines applicable. 
    HOW TO RESPOND TO AN INCIDENT: 
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    Things To Remember When A Special Incident Occurs

    Insure: the safety of the consumer
    Notify : ACRC, CCL, APS/Ombudsman, Police, 
    Family, DHS, or coroner as required         
    Check: for completeness of information on  incident report
    Inquire: into inconsistencies
    Document: details
    Explore: causes of the incident
    Note: necessary additions or corrections to SIR             
    Track: SIR follow-up and completion


    STAFF INFORMATION 

    Please add your Job title. If you are in training please put Consultant in Training; if you are an intern please indicate.
    In California, an employee may not work for a period of more than five hours per day without a meal period of not less than thirty minutes, except that if the total work period per day of the employee is no more than six hours, the meal period may be waived. A second meal period of not less than thirty minutes is required if an employee works more than ten hours per day, except that if the total hours worked is no more than 12 hours. If you have waved the first meal you may NOT wave the second meal period. If hours worked are less than 3.5 hours there are no rest periods required. If the hours worked are 3.5 hours to 6 hours there are one to 10 minutes paid rest period. If there are over 6 hours of hours worked up to 10 hours there are two 10 minute paid rest periods. IF there are over 10 hours worked up to 14 hours there are three 10 minute paid rest periods. As a result if you select no you may not come back and ask for compensation for the meal missed.
    Instructor Weekly Schedule
    (please fill it out Weekly Schedule 
    ​it is required if your schedule is not filled out then it will be noted that you are not working this week and therefore did not return in a leave request. 

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    CLIENT  INFORMATION 

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    Clients with asterisk (*) are non-active. 108 = Parenting. 520 = ILS. Dates are expiration POS dates.
    NOTE: All final notes must be complete by the 31st of each month. Otherwise, we are not able to back pay for notes. Unfortunately, if you have not turned in your billing before the end of the month we can not pay for these hours unless approved by management in writing.
      SERVICE INFORMATION

    Please input case managers names here based on Regional Center. Please double check your work to make sure you have the case manager correct. The case managers with asterisk (*) are the ones who speak Spanish.
    B Behavior Counselor observation, client statements. 1. Subjective data about the client—what are the client’s observations, thoughts, direct quotes? 2. Objective data about the client—what does the counselor observe during the session (affect, mood, appearance)? I Intervention Counselor’s methods used to address goals and objectives, observation, client statements. 3. What is the counselor’s understanding about the problem? 4. What are the counselors’ working hypotheses? 5. What was the general content and process of the session? 6. Was homework reviewed (e.g., journal, reading assignments – if any)? 7. What goals, objectives were addressed this session? R Response Client’s response to intervention and progress made toward tx plan goals and objectives 8. Client’s response to the treatment plan, what needs revision? 9. What is the client’s current response to the treatment plan? P Plan Document what is going to happen next 10. What in the treatment plan needs revision? 11. What is the counselor going to do next? 12. When is the next session date? ABBREVIATIONS DX- Diagnosis SX- Symptoms BX-Behavior RX- Medication HX-History TX-Treatment TXP-Treatment Planning SOP-Scope of Practice SOC-Scope of Competence ID- Information D/A-Drug and Alcohol Sf A- Substance Abuse ETOH- Alcohol CLEV- Clinical Evaluation 911- Crisis HD- Human Diversity L-Law E-Ethics REF- Referral DR-Doctor PSY- Psychiatrist or Psychologist GP- Group Dir-Director Coun-Counselor MOB-Mother of Baby FOB-Father of Baby Pmob-Paternal Mother of Baby Fmob Paternal Father of Baby
    Max file size: 20MB
    Before any millage can be paid proof must be provided.
    Max file size: 20MB
    For the protection of our clients we ask that you upload a current photo. In the case of an emergency we will have updated images of what our clients look like. Clients have already signed a document stating that they agree to have their photos taken

    Statement of facts of the incident who, what, when where, why.
    What immediate and short-term things were done to keep the individual safe, or what immediate medial care was provided, or any other actions that wee taken including what was done or is being to determine the cause of the incident so that an appropriate prevention plan can be implemented. Who did what? What are the expected outcomes?
    What is being done to make sure this does not happen again? Include future appointments, consultations, training, policy changes, individual service plan changes; who will be responsible for implemetion the dates by when they will occur, how and where the outcomes will be documented.
    I certify that by typing and providing my first and last name or initials in the bellow consultant E-Signature slot under penalty of perjury that the above information and any information pertaining to clients or hours work that have been turned into LeBlanc Consulting by me for myself, or for anyone affiliated with LeBlanc Consulting is accurate. I agree that any misrepresentation here with my hours or by billing for more hours will lead to immediate termination. Otherwise I may face prosecution and be required to pay back monies that are inaccurately billed for as well as any legal cost to pursue this matter. I  agree and understand that If I am not claiming mileage now that I am not entitled to come back at a later date and claim millage. I know if I am falsely claiming mileage or hours worked that this is fraud and can be pursued in the court of law. I agree that I am in the right mind and body when I am submitting my documentation and when I saw the client.  I understand that any false misrepresentation of the clients, LeBlanc Consulting or the Regional Center of the East Bay can lead to prosecution and is subject to a law suit and paying legal fees.   I certify that the consumer(s) listed above was/were provided the service as authorized for the stated periods, and that no additional charges were made to other parties. These claims are submitted under penalty of perjury in accordance with the terms and conditions below.
    1. The Provider agrees and shall certify under penalty of perjury that all claims for service provided to Regional Centers have been provided to the consumer(s) by the Provider.
    2. The services were, to the best of the Provider's knowledge, provided in accordance with the consumer's written Individual Program Plan.
    3. The Provider shall also certify that all information submitted to the Regional Center is accurate and complete.
    4. The Provider understands that payment of these claims will be from the federal and/or state funds and any falsification or concealment of a material fact may be prosecuted under federal and/or state laws.
    5. The Provider agrees to keep for a minimum period of five years from the date of service, a printed and/or electronic representation of all records which are necessary to disclose fully the extent of services furnished to the client.
    6. The Provider agrees to furnish these records and any information regarding payments claimed for providing the services, on request, within the State of California, to the California Department of Healthcare Services; Medi-Cal Fraud unit; California Department of Developmental Services; California Department of Justice; Office of the State Controller; U.S. Department of Health and Human Services, or their duly authorized representatives.
    7. The Provider also agrees that services are offered and provided without discrimination based on race, religion, color, national or ethnic origin, sex, sexual orientation, age, or physical or mental disability.
    8. The Provider agrees that they are in compliance with Welfare and Institutions Code Section 4514, Health Insurance Portability and Accountability Act (HIPAA), and all other applicable state and federal statutes and regulations regarding confidentiality of consumer information.
    Did you double check your work? If you did not double check your work and you submit a note with mis information such as putting 1pm-2pm and you actually worked 5 hours the 5 hours the lesser will paid. It is up to you to double check your work, It takes time for the IT department to pull your note back up. This menu will NOT allow you to return once the note has been completed. Incompetent notes will not be accepted, honored or paid. Please submit with care and caution.
    Type your first and last name so that we can identify who you are. Your signature should contain your full first and last name. Please do not put your initials. Please be sure that your note is complete. Once you turn in the note you will not be able to go back and make changes. By accessing this information, I agree that I am the rightful person qualified to use this system by LeBlanc Consulting and that no one other than me is currently using this system. I agree that I have permission to access this system by LeBlanc Consulting and that I agree to use this system responsibly. This page contains confidential information and by using this web page and entire website I have agreed to company secrecy and the legal use of this private information for the sole purposes of Le Blanc Consulting only. I agree to not copy this information in any way or form such as rewording or changing the documents to meet the needs of any other company. I agree to not compete with LeBlanc Consulting under any circumstances for the length that this company is in operation or vendored with the Regional Centers. Therefore, by submitting this document this serves as my official no compete clause and I agree to company secrecy. I know and agree that this is my official no compete clause which I sign every time I log into the computer. I agree to use this system responsibly. I agree to professional secrecy and this is my formal non disclosure acknowledgement. If I am found to use this information or any of the information thereof it can be punishable by termination or possible suit in the court of law. I agree that if I misuse this information which may lead to a case in the court of law will be my sole responsibility to pay for all attorney and court fees for myself and LeBlanc Consulting. I agree that if I have questions about this system that I will contact LeBlanc Consulting Information technology department to get those questions answered and I will not consult with an entity outside of LeBlanc Consulting. The direct contact time log/progress notes are to be typed immediately upon entering a client's home to assist in the retention of important and sometimes critical information, only submit the contact log as you are leaving the client's home otherwise your hours will look short in the computer system. Be sure to start filling out the note as you are communicating with the client as the computer times the amount of time you have spent at the client's home and can pinpoint your location as well. As you are going through the lesson plan use the tools on our database. I agree that I will log into the system when i enter the client's home since I know that the system allows us to see how long you are logged into the client IP address at their home. I agree that if I log onto this computer system from anywhere other than the client's home that this may be grounds for termination and I may be terminated without notice. I am aware that If I do not bill at the time of services, my hours may not be paid. I am aware that that maximum hours I can work with clients is based on their service agreement and I shall not go over the amount of hours permitted daily unless approved by a supervisor. I agree that If I go beyond those hours provided within the service agreement without permission for a supervisor that I may not get paid. I am also aware that parenting hours are 20 per month and ILS hours are 40 hour per month per client depending on how the service agreement is written, however I will check with my supervisor to see if any of my client hours have been used so that I do not go over their allowed hours per month. I agree that if I go over the client hour that it may not be paid. ​PLEASE READ BEFORE FILLING OUT THIS NOTE: If you are hired with LeBlanc Consulting you are considered a contract employee until your 90 day probation period is up. After your 90 day probation period then you are considered permanent. At this point LeBlanc Consulting will issue an ID Badge. The ID Badge is to be used simultaneously with this computer login system. Log into the computer as you arrive to the client's home,no later than 1-5 hours after services are provided. If the note is NOT filled out in it's entirely then you will not be paid for services you are stating that you rendered. If you submit a note with the same information from the last time you saw the client(cutting and pasting information) then the note will not be paid, if you submit all of your notes late or at the last minute (on the 30th and or its more than 5 days late) you will not be paid. If you state you saw the client and did not actually see the client and you are paid, then you will have to reimburse LeBlanc Consulting for the monies paid to you. If LeBlanc Consulting discovers that you have not seen your client which causes the company to lose the purchase orders for that client then LeBlanc Consulting has the right to request the fees for the remainder of contracted POS. Any mistakes were made where you were paid more than what you worked, or if you falsely claimed hours that you did not work, or if you quit your job with LeBlanc Consulting the Company reserves the right to obtain its funds for up to 5 years from the date of services. If you refuse to repay the moneys for the fraudulent claims then a letter will be sent to collections. After 3 collection attempts (3 months) A Lawsuit will be filed on the behalf of LeBlanc Consulting to obtain the money paid to you. If there is a special incident please file a special incident report immediately & our office and we will send it over to RCEB, or CPS.
Submit progress note
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​We Provide Services 24/7
Administrative Office Hours: 
Monday - Friday 7:00am-7:00pm 
Saturday & Sunday by Appointment Only

​We operate on Pacific Standard Time.
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Contact us:

Toll FREE: 1(800) 707-1852
North Bay Office: 1(707) 654-8488 
North Bay Cell: 1(707) 727-9100
East Bay Office:  1(510) 275-3679
East Bay Cell: 1( 510) 241-9115
South Bay Cell: 1(831) 313-7902
Golden Gate Cell: 1(415) 630-0112

E-mail: [email protected]
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Please Note: If you have questions, please feel free to contact us and we would be happy to speak with you. Le Blanc consulting reserves the right to refuse services and admission to our programs. Tours and Open house can be reserved by clicking here The information presented in this website is for informational use only.  It is not intended to diagnose or treat any medical condition. Please consult a health practitioner before embarking on any health protocol. Moreover, LeBlanc Consulting is not responsible for any problems, issues, or technical difficulties related to downloading or accessing any information on this website. This web site is designed for your general information only. The information presented on this website should not be construed to be formal Therapeutic Counseling sessions or advice nor the formation of a Therapist/client relationship. Furthermore, the hiring of a Professional is an important decision and should not be based solely upon any form of advertisements. Before you decide to hire, please feel free to review our degrees and certification by contacting us for more information about our qualifications and experience. 

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Mandated Reporter Notice:  All Instructors,Caregivers and staff affiliated with Le Blanc Consulting are considered Mandated Reporters. California Law, under section WIC 15630(a) of the Welfare & Institution Code provides for mandatory reporting of physical abuse, neglect, self neglect, sexual abuse, mental suffering, financial abuse, isolation, abandonment or abduction of a dependent adult when:1) The victim reports abuse has occurred or has knowledge of abuse. 2) You observe the incident. 3) when an injury or condition reasonably leads one to suspect that abuse has occurred. Any signs of abuse will be reported to Child Protective Services or Adult Protective Services. 

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