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Click ‘Get Form’ to open the ihss supervision form in the editor.
Begin by entering the full name of the IHSS recipient in the designated field. This is crucial for identifying who requires supervision.
Next, input the recipient’s telephone number and home address where care will be provided. Accurate information ensures effective communication and service delivery.
Fill in the name and contact number of the primary contact responsible for coordinating care. Specify their relationship to the recipient, such as family member or friend.
List up to three care providers along with their contact numbers. If more are needed, you can attach an additional sheet.
Describe how the 24-hour coverage plan will be implemented, detailing schedules or arrangements for care. Use additional space if necessary.
Finally, ensure that both the primary contact and IHSS social worker sign and date the form to validate it.

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What are the maximum hours for protective supervision for IHSS?

After you submit your application for protective supervision, your county IHSS office will contact you to schedule an assessment. Generally, the county must process your application and mail you a notice of action within 30 days from when you completed the application.

How long does IHSS take to approve protective supervision?

Protective Supervision is an additional IHSS service for individuals with severe mental impairments who need constant supervision to stay safe. Its not about helping with physical tasksits about providing non-medical observation to prevent injury due to unsafe behaviors such as: Running into traffic.

How many hours is protective supervision in California?

Protective Supervision Programs: If the person is proven to be non-severe then they will receive 195 hours per month. If the person is proven to be severe then they will receive 283 hours per month.

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