Form Soc 2289 - In-Home Supportive Services Program State Administrative Review Request Response Letter To Recipient Rescinding Provider'S Third Or Fourth Violation For Exceeding Workweek And/or Travel Time Limits

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES PROGRAM
STATE ADMINISTRATIVE REVIEW REQUEST RESPONSE LETTER TO RECIPIENT
RESCINDING PROVIDER’S THIRD OR FOURTH VIOLATION FOR EXCEEDING
WORKWEEK AND/OR TRAVEL TIME LIMITS
(ADDRESSEE)
COUNTY OF:
Notice Date:
Provider Name:
IHSS Office Address:
IHSS Office Telephone Number:
To: In-Home Supportive Services (IHSS) Recipient
This notice is to inform you that the violation your provider, named above, received for
the month of _________________ has been withdrawn as of the date of this notice.
The reason for the withdrawal of this violation is because the California Department
of Social Services (CDSS) has determined that although your provider did violate the
rule(s) indicated on the SOC 2258 or SOC 2259 your provider received from the county,
the circumstances that led to your provider working the additional hours met the Exception
Criteria set by CDSS. During our review it was determined that the circumstances on the
Provider’s Right to Dispute form (SOC 2272) that was previously provided to the county
met the Exception Criteria, therefore the violation has been rescinded.
Although this violation has been rescinded, your provider could receive another violation
at a later time if he/she fails to follow the workweek and travel time limits explained in
the Provider Enrollment Agreement (SOC 846).
If you have any questions regarding this notice, you may contact your county IHSS
office at the phone number listed above.
SOC 2289 (7/16)

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Form Soc 2272b - In-home Supportive Services Program Notice To Recipient Acknowledgement Of Provider's Request For County Violation Review For Exceeding Workweek And/or Travel Time Limits Form Soc 2272b - In-home Supportive Services Program Notice To Recipient Acknowledgement Of Provider's Request For County Violation Review For Exceeding Workweek And/or Travel Time Limits Legal
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