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Business Name:
The Crossroads Home Care
Street Address: 3519
W. Sahuaro Dr.
City/State/Zip: Phoenix,
AZ 85029
Telephone Number: (602)
283-5020
After Hours Number:
(480)
375-5552
Fax Number: (602)
674-5259
E-mail Address:
info@thecrossroadshc.com
Web Site:
www.thecrossroadshc.com
Counties in which services
are provided: Maricopa
To go to
Member Information about their business, click on topic below:
Hours of Operation
Ownership and
Verification Information
Additional Member Information
Membership Category
Home Care Services Offered
Other Home Care
Services Offered
Member’s
Employment Information and Practices
Scheduled Hours of Operation
Office:
Hours/Days: 8:00 am to 5:00 pm
Service Hours -
Days/Evenings/Nights: Days, Evenings,
and Overnight
Weekends: Yes - 24/7
Office Staff
Availability: After Hours On- Call Supervisor - 24/7
A.
Ownership
-
The name and type of
entity (corporation, association, governmental unit, person or
partners) legally responsible for operating the business is a:
Limited Liability Corporation
2.
State License #
3.
Federal ID # On file with the
Association
4.
State Tax ID # On file with the Association
5.
The names, titles and addresses of all officers,
directors, owners and managerial
employees, and the percent of ownership if proprietary.
|
Names of Officers,
Directors,
Owners, and Managerial
Employees
|
Title (President, Director, Partner, Stockholder, etc.) |
Address
(Street, City, Zip)
|
Percent of
Ownership (if proprietary) |
|
Thomas R. Cross |
Owner/CEO |
3519 W. Sahuaro Drive
Phoenix, AZ 85029
|
51% |
|
Kristine A. Cross |
Owner/COO |
3519 W. Sahuaro Drive
Phoenix, AZ 85029 |
49% |
|
|
|
|
|
6. A Certificate of Good Standing for the corporation to
do business in the State of Arizona from the Arizona Corporations Commission
is on file with the Association. This certificate was valid as of the day of
the Member's application.
7. List the name of
the business, corporation’s, or LLC’s Agent(s):
8. Other office locations: N/A
9. The owner of Crossroads Home Care have owned and operated a Non-Medical Home
care business since April of 2009.
(Back to the Top)
Additional Member
Information
|
Yes ____ No
U |
Have any of
the Member’s Officers, Directors, Owners, or Managerial Employees ever
been convicted of any criminal offense, other than a minor
traffic violation? |
|
Yes
____ No
U |
Are any of the Member’s
Officers, Directors, Owners, or Managerial Employees licensed or
certified in any capacity of health or home care? |
| Yes____ No
U |
Have any of the Member’s
Officers, Directors, Owners, or Managerial Employees had their
license/certification ever revoked or suspended or any other
disciplinary action taken against them by a licensing body? |
|
Yes ____ No
U |
Have the owners or
principals of the Member’s business been involved, had interest in, or
owned a Non-Medical Home Care business, or other health care business,
that has either shut down its operations or went out of business? |
(Back to the Top)
B.
Membership Category
U
Business Members - Those who are exclusively engaged in the
Non-Medical Home Care industry.
(Back to the Top)
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Homemaker Services |
|
Yes
U
No _____ |
Housekeeping or Home Management |
|
Yes
U
No _____ |
Light house cleaning |
|
Yes
U
No _____ |
Sweeping, vacuuming, mopping |
|
Yes
U
No _____ |
Laundry |
|
Yes
U
No _____ |
Ironing |
|
Yes
U
No _____ |
Washing dishes and utensils |
|
Yes
U
No _____ |
Bagging garbage and taking it out |
|
Yes
U
No _____ |
Making beds and changing linens |
|
Yes
U
No _____ |
Assisting client organizing household routines |
|
Yes
U
No _____ |
Assisting with reading and writing tasks as
requested (not financially related) |
|
Yes
U
No _____ |
Assisting with organizing household
efficiently |
|
Yes
U
No _____ |
Assisting with correcting safety issues |
|
|
|
Yes
U
No _____ |
Meal Preparation |
|
Yes
U
No _____ |
Assisting with menu planning where appropriate |
|
Yes
U
No _____ |
Preparing and serving meals using sanitary
meal preparation practices |
|
|
|
|
Yes
U
No ____ |
Transportation/Shopping |
|
Yes
U
No ____ |
Accompanying a client on trips to obtain
health care services or other necessary items or services. |
|
Yes
U
No ____ |
Caregiver drives client’s vehicle for such
trips. |
|
Yes U
No ____ |
Caregiver drives personal vehicle for such
trips. |
(Back to the Top)
|
Yes
U
No _____ |
Home Care Aide Tasks (Complete Hands-on
assistance)
Bathing/Showering/Bed
Baths
Dressing/Undressing
Personal Hygiene
Toileting/Peri Care
Transfers
Ambulation
Medication Monitoring
|
|
Yes
U
No _____ |
Home Care Aide Tasks (Limited Hands-on
assistance)
Bathing/Showering/Bed Baths
Dressing/Undressing
Personal Hygiene
Toileting/Peri Care
Transfers
Ambulation
Medication Monitoring
|
|
Yes
U
No _____ |
Home Care Aide Tasks (No Hands-on assistance/
Stand-By Only)
Bathing/Showering/Bed Baths
Dressing/Undressing
Personal Hygiene
Toileting/Peri Care
Transfers
Ambulation
Medication Monitoring
|
|
Yes ___
No
U |
Registered Nursing
Services
|
|
Yes ___
No
U |
Hospice
Services |
|
Yes ___
No
U |
Medical Social Services |
|
Yes ___ No
U |
Licensed Practical Nursing Services |
|
Yes ___ No
U |
Nutritional Services by a Dietitian |
|
Yes ___
No
U |
Occupational Therapy |
|
Yes ___
No
U |
Speech Therapy |
|
Yes ___
No
U |
Physical Therapy |
|
Yes ___
No
U |
Respiratory Therapy |
|
Yes ___
No
U |
Medical Supplies and Equipment Accompanied |
(Back to the Top)
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Yes
U
No _____ |
The Member has provided verifiable evidence of
current workers' compensation coverage as required by the State of
Arizona. (This policy expires: 06/01/2011). |
|
Yes
U
No _____ |
The Member has provided verifiable evidence of
liability insurance coverage for all its employees.
(This policy expires: 06/02/2011). |
|
Yes
U
No _____ |
The Member has provided verifiable evidence of
a bond against theft for its employees. (This
policy expires: 07/31/2011). |
|
Yes
U
No _____ |
Does the Member classify its Caregivers as
"Employees?" (If so, the business maintains a payroll process which
includes reporting of employment, wages, collecting state and federal
withholding payroll taxes, and the payment of these taxes and all other
state and federal payroll taxes to the appropriate governmental
institutions.) |
|
Yes ____
No U |
Are the Caregivers working for the Member
considered private contractors or self employed individuals? |
|
Yes ____
No U |
Are private contractors or self-employed
individuals ever referred to clients or potential clients by the Member? |
|
Yes
U
No _____ |
Does the business have and perform criminal
background checks for all individuals who have direct contact with
clients in their homes or in the community? |
|
Yes
U
No _____ |
Does the Member have and perform criminal
background checks for all managerial officials, supervisors, office
personnel and volunteers? |
|
Yes
U
No _____ |
Does the Member operate the business from a
commercial office space, in a commercially zoned area or from a private
residence zoned for commercial use? |
|
Yes
U
No _____ |
Does the Member enter into
a written service agreement with each client to provide home care
services, signed by the client’s financially responsible person and by
the company or business organization? |
|
Yes
U
No _____ |
Does the Member have an abuse prevention plan
for each vulnerable adult receiving services from your company? |
|
Yes
U
No _____ |
Does the Member require your Caregivers to
have clean driving records and provide a copy of the Caregiver’s DMV
driving record? |
|
Yes
U
No _____ |
Does the business obtain at least two positive
references from two previous employers in the past five years for each
Caregiver applicant? |
|
Yes
U
No _____ |
Does the Member validate home making and home
care skills of Caregivers through demonstration and written
questionnaires? |
|
Yes
U
No _____ |
Does the Member require all caregivers to read
and write English? |
|
Yes
U
No _____ |
Does the Member require its Caregivers to
maintain current CPR and First Aide certification and have policies in
place to ensure these are updated on a timely basis? |
|
Yes
U
No _____ |
Does a Staff Person of the Member conduct a
face to face interviews with Caregiver applicants, in English, that
covers employment history, experience, training issues, skill knowledge,
and employment preferences? |
|
Yes
U
No _____ |
Have all personnel in the Member’s business,
who require direct contact with clients, had tuberculosis screening
performed at least annually? |
|
Yes
U
No _____ |
Has every individual who provides direct care
or manages services in the Member’s business been oriented to the home
care duties and skill requirements necessary in order for him or her to
perform his or her duties as a care provider? |
|
Yes
U
No _____ |
The Member has a client problem resolution
and/or client complaint process policy in place that promptly addresses
and resolves problems, issues or conflicts? |
|
Yes ____
No U |
Does the Member drug test all new employees?
Employees sign agreement of drug policy and agree to testing if
required. |
|
Yes
U
No _____ |
Does the Member have an established on-going
policy and practice that randomly drug tests current employees? |
(Back to the Top)
|
Yes
U
No _____ |
Does the Member perform any type of evaluation
or assessment prior to providing care for a client? |
|
Yes
U
No _____ |
Does the Member require a
deposit from the customer in order to perform services?
Payment is due by credit
or debit card, money order or cashiers check, in advance, monthly or
weekly. If client expires or cancels services, unused portion of payment
is refunded by check to client, or if client expires, to the next of
kin.
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Yes ____ No
U
Yes ____ No
U
Yes ____ No
U
Yes ____ No
U
Yes
U No___
Yes ____ No
U
|
Does the Member have any of the following fees :
a. Set-up/Start-up fees? Amount Charged:
b. Administrative fees? Amount Charged:
c. Cancellation fees? Amount Charged:
d. Client Visit fees? Amount Charged: $.55
per mile (Mileage- if client is transported in caregiver's vehicle)
e. Managerial fees? Amount Charged:
$_________________
|
| Yes ____
No
U |
Does the Member have a minimum amount of
hours, whether per day, per week, or per month, or minimum charge that
is required before for the business will provide services? If Yes, what
are those minimum hours and/or minimum charges?
*However, we inform clients that we will make every effort to staff a
case with minimal hours, but that we cannot guarantee that we will be
able to staff the case. but there is no minimum hours requirement. |
|
Yes ____ No
U |
Does the Member have a business policy on a
client canceling services? Please indicate issues such as amount of
notice required, any penalties, and etc.?
No. This agency promotes individuality and choice. we do however, if
services are cancelled suddenly or abruptly, reserve the right to not
take the assignment again in the future. We will try to find the reason
for the cancellation, and if it's a quality issue or caregiver issue, we
will attempt to resolve and re-staff the assignment. |
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