Admissions Agreement Second Spring North

Last Revised: 11/19/2025

Second Spring is a long-term Residential Care Home facility. It is designed to provide residential treatment services to individuals who have been hospitalized in psychiatric facilities. Nursing and psychiatric services are available on site as are vocational and case management services. Residents at Second Spring are expected to participate in treatment with the goal of increased independence and quality of life. Staff also receive training in trauma-informed care and co-occurring disorders treatment. Peer support is also a focus of treatment within the facility.

Second Spring is licensed by the State of Vermont as a residential care home, and as such may provide room, board, personal care, general supervision, recovery programs, vocational services, case management, and medication management. We do not provide full time nursing care. The services we provide are outlined below.

The State of Vermont regulates the services provided in a residential care home. The regulations contain much more detail about how care must be provided. You may ask staff to see a copy of those regulations if you wish.

1. Room – Under this agreement, you will be provided with a private room with a shared bath. You may bring personal possessions with you to the home as space permits unless the possessions infringe on the rights of others or create a fire or safety hazard. We have a two-bag limit on personal possessions being brought into the home upon move-in. Second Spring is an environment that fosters safety; some items, such as knives and weapons, are not permitted. A complete list of these items is included in the admission packet. Your possessions will be reviewed by staff on admission to the residence.
   
   We will hold your room for you if you are temporarily in the hospital and are expected to return here within 30 days. If we determine that we cannot hold your bed until your discharge, in collaboration with the Department of Mental Health, we will notify you 30 days prior to discharging you. If you are unable to return to pack your belongings, Second Spring staff will pack and store them for you for up to but no longer than 30 days. After 30 days we will ask your designated agency case manager to pick up your belongings for you. We may bill you or your designated agency for storage.
   
   You will be encouraged to do your personal laundry at Second Spring, and we can assist you with this if you need. We will provide you with clean bed and bath linens, as well as detergent.
2. Board – You will be provided with a nourishing, palatable, well-balanced diet that meets your daily nutritional and special dietary needs, taking into account the preferences of each resident in the home.
   • All residents will be offered support around cooking education to promote independent living skills.
   • You will be encouraged to take part in menu planning and cooking to support personal preferences and healthy cooking education.
   • We offer snacks before bed and in between meals.
   • We offer therapeutic diets if ordered by a physician.
3. Personal Care – We provide support with personal care, consistent with recovery goals and your treatment plans, as long as your needs do not exceed what we are licensed to provide. This includes:
   • Assistance with bathing and personal hygiene including shaving, combing hair, brushing teeth, shampooing, cutting hair.
   • Assistance with eating, such as cutting food.
   • Assistance with toileting, including transferring on and off the toilet, and incontinence care.
   • Assistance with dressing.
   • Assistance with movement, including assistance with walking, transporting by wheelchair, and transferring from bed to chair.
4. General Supervision and Support – General supervision, consistent with your treatment goals and recovery plan, includes:
   • Assistance in arranging necessary appointments, including providing transportation as needed.
   • Assistance in obtaining personal items, including support with shopping.
   • Assistance in obtaining medication.
   • Assistance with your schedule by reminding you about mealtimes, activities, etc.
   • Monitoring your activities to prevent harm to you and others, which may include surveying your room to ensure there are no contraband items or providing additional levels of safety supervision.
   • Assistance with managing your finances if you submit a request in writing. Finances are described in more detail below.
   • Staff will check the contents of all bags coming into the facility to check for contraband to ensure the safety of our residents and to keep you safe.
5. Transportation – As a resident of Second Spring, you will be provided regular opportunities to engage in community activities. Staff will provide transportation, activities, treatment, and medical appointments. You will not be charged for transportation to community activities or to medical appointments.
   
   If you are eligible for Medicaid, we may attempt to utilize available Medicaid transportation if appropriate. Medicaid transportation is only available for necessary medical appointments.
6. Nursing Care – State regulations prohibit us from providing full time nursing care except in limited situations. We offer the following services:
   • We have nursing staff available daily to review assessments of each resident, oversee the administration of medications, and coordinate care with physicians. On-call nursing is available 24 hours a day as needed; for example, if you become ill, need a change in your doctor’s orders, or if your ability to care for yourself appears to be deteriorating.
   • If you require hands-on care by a nurse, such as changing a dressing or catheter or receiving an injection, such care will be provided if a variance is approved by the Vermont Department of Aging and Independent Living.
7. Medication Management – All residents of Second Spring will receive medication management. Medications will be administered by the nursing staff or by delegated staff operating under the direction of our nurses. Upon admission, nursing staff will assess whether you are capable of self-administration of your medication.
8. Personal Needs – We provide the following personal needs items as part of the monthly charge: toilet paper, toothpaste, toothbrushes, soap, shampoo, combs, brushes, and general first aid supplies. You will be responsible for obtaining items not on this list. For residents who are eligible for and receive SSI, your personal needs funds are discussed in the next section of this agreement.
9. Case Management – You will be assigned a case manager at Second Spring. Your case manager will assist you with accessing your needed medical, social, and other services. They will write and review your Treatment plan with you within the first 30 days of your stay. You will be told who your case manager will be prior to your admission.

1. The monthly program fee is $825.00 due by the third day of each month. This is the standard monthly rate set by the state for individuals receiving Supplemental Security Income (SSI).
2. We ask that you notify us as soon as possible if there will be a change to your income, or if your income will cease.
3. Non-payment of charges will be cause for discharge in accordance with state regulations. We may discharge you after 30 days’ notice.
4. If you plan to move from the facility, we request that you give us a 30-day notice of your intent to do so. If you move out of the facility without notice, we may charge you up to 30 days after you leave.
5. If you are required to leave this home, either because we transfer you to another facility or because of a change in your condition which makes it impossible to remain here, we will provide you with a refund for payment made for days in which care was not provided. The refund will be provided within 30 days of discharge.
6. Residents who are eligible for SSI shall be allowed to keep, before paying program fees to the home, a minimum of $193.00 for their personal needs. If you receive income greater than the standard monthly payment for SSI, your personal needs allowance will be greater than this.
7. You will be notified in writing at least 90 days in advance of any change to the rate we ask you to pay, or a change to the services that your payment includes.
8. Second Spring may provide you with a 30-day involuntary discharge notice under the following circumstances:
   • Your care needs exceed what the home is licensed to provide or able to support.
   • Your behavior represents a threat to yourself or the welfare of staff or other residents.
   • Your discharge has been ordered by a court.
   • You haven’t paid your monthly program fees
     
     You have the right to appeal an involuntary discharge, and to ask for help with your appeal from the Long Term Care Ombudsman’s office and Disability Rights Vermont.

1. Residents retain all civil rights while residing here. State regulations list specific rights of all residents of residential care homes. This list is included in the resident guidelines, and other copies are available upon request. These rights are also posted in a public space at Second Spring. We will explain these rights before or at the time of admission.
2. If you are not satisfied with services or conditions in the home, we want you to tell us about it so we can try to resolve the concern. Our grievance procedure is included in the resident guidelines and will be reviewed with you.
3. The rules of the facility are reviewed as part of the admission process. A list of rules and protocols is included in the resident guidelines.

IV. Discharge and Transfer Rights

a. The resident’s care needs exceed those which the home is licensed or approved through a variance to provide; or
b. The home is unable to meet the resident’s assessed needs; or
c. The resident presents a threat to the resident’s self or the welfare of other residents or staff; or
d. The discharge or transfer is ordered by a court; or
e. The resident has failed to pay monthly charges for room, board and care in accordance with the admission agreement.

(2) In the case of an involuntary discharge or transfer, the manager must:
f. Notify the resident, and if known, a legal representative of the resident, of the discharge or transfer and the specific reasons for the move in writing and in a language and manner the resident understands at least 72 hours before a transfer within the home and thirty (30) days before discharge from the home. If the resident requests assistance, the notice must be sent to the Office of the Long- Term Care Ombudsman and Disability Rights Vermont. With the consent of the resident, a family member also may be notified of the pending discharge or transfer.
g. Include a statement in any legible font, size 18, that the resident has the right to appeal the home’s decision to transfer or discharge with the appropriate information regarding how to do so. iii. Include a statement in the written notice that the resident may remain in the room, unit or home during the appeal. iv. Include the name, address and telephone number of the Office of the State Long Term Care Ombudsman.
v. Place a copy of the notice in the resident’s clinical record.
w. Ensure that the facility or location to which the resident will be discharged or transferred is appropriate to meet the assessed needs of the resident. To determine whether the new facility or location is appropriate, the manager must consider the assessed needs of the resident and the ability of the proposed facility to meet those needs. The manager must take into consideration the resident’s wishes, the resident representative’s input, when appropriate, and the proximity of the proposed facility to the current home.
(2) A resident has the right to appeal the decision by the home to discharge or transfer. The process for appeal is as follows:
h. To appeal the decision to transfer or discharge, the resident or a resident representative must notify the manager of the home or the director of the licensing agency. Upon receipt of an appeal, the manager must immediately notify the director of the licensing agency.
i. The request to appeal the decision may be oral or written and must be made within 10 business days of the receipt of the notice by the resident.
j. Both the home and the resident must provide all the materials deemed relevant to the decision to transfer or discharge to the director of the licensing agency as soon as the notice of appeal is filed. The resident may submit orally if unable to submit in writing. Copies of all materials submitted to the licensing agency will be available to the resident upon request.
k. The director of the licensing agency will render a decision in writing within 10 business days of receipt of the notice of appeal.
l. The notice of decision from the director will be sent to the resident and to the home, will state that the decision may be appealed to the Commissioner, and will include information on how to do so.
m. The resident or the home will have 10 business days after the receipt of the Commissioner’s decision to file a request for an appeal with the Human Services Board by writing to the Board. The Human Services Board will conduct a de novo evidentiary hearing in accordance with 3 V.S.A. §3091.

5.3.b Emergency Discharge or Transfer of Residents
(4) An emergency transfer may only occur when one of the below criteria is met:
a. The resident’s attending licensed health care provider documents in the resident’s record that the transfer is an emergency measure necessary for the health and safety of the resident or other residents; or
b. A natural disaster or emergency necessitates the evacuation of residents from the home; or
c. The resident presents an immediate threat to the health or safety of self or others. In that case, the licensee must request permission from the licensing agency to transfer the resident immediately. Permission from the licensing agency is not necessary when the immediate threat requires intervention of the police, mental health crisis personnel, or emergency medical services. In such cases, the licensing agency must be notified on the next business day; or
d. When ordered or permitted by a court.
(4) An emergency discharge may occur only in extreme circumstances, as it eliminates the residents’ right to remain in their home during discharge planning and any appeals. An emergency discharge may only be made with less than thirty (30) days’ notice under one of the following circumstances:
e. The resident’s attending licensed health care provider documents in the resident’s record that the discharge is an emergency measure necessary for the health and safety of the resident or other residents; or
f. A natural disaster or emergency necessitates the evacuation of residents from the home and prevents timely return; or
g. The resident presents an immediate threat to the health or safety of self or others. In that case, the licensee must request permission from the licensing agency to discharge the resident.
h. When ordered or permitted by a court.
(4) The home must issue a written notice of emergency discharge to the resident as soon as a determination has been made. The notice must include the notice requirements set forth in 5.3.a (2), above, with the exception of 5.3.a.(2) iii.
(4) If a resident is transferred to a hospital for treatment, that transfer will not constitute an emergency discharge. In order to refuse to re-admit a resident after transfer to a hospital (which then becomes a discharge if not allowed to return to their home), the home must meet the requirements for an emergency discharge set forth above and must obtain approval from the licensing agency to refuse re-admission. If this occurs on a non-business day or during non-business hours, the approval request can be made on the next business day.

1. Use of a negotiated risk agreement is not prohibited or required when considering the need for an involuntary discharge of a resident. If used, the negotiated risk agreement and process must comply with Assisted Living Residence rules, section 13.7.
2. If the resident agrees to a discharge or transfer, the discharge or transfer may occur prior to the effective date of notice.
3. A home must provide sufficient preparation and orientation to residents to ensure a safe and orderly transfer or discharge from the home.
4. A home may not initiate an involuntary discharge of a resident whose care is provided and paid for under the ACCS program because of voluntary temporary, leaves from the home.
5. A home is responsible for any charges associated with disconnecting, relocating or reconnecting telephones, cable television, air-conditioning or other similar costs resulting from a home’s decision to transfer the resident or relocate the resident’s room.
6. A licensee who intends to discontinue all or part of the operation, or to change the admission or retention policy, ownership, or location of the home in such a way as to necessitate the discharge or transfer of residents, must notify the licensing agency, the Office of the State Long Term Care Ombudsman, and residents at least ninety (90) days prior to the proposed date of change. The licensee is responsible for ensuring that all residents are discharged or transferred in a safe and orderly manner. When such change in status does not necessitate the discharge or transfer of residents, the licensee must give the licensing agency and residents at least thirty (30) days prior written notice.
7. The home may include language in its admission agreement requiring residents to provide thirty (30) days’ notice when the resident intends to voluntarily leave the home. The death of a resident will not be considered voluntarily leaving the home and will not require prior notice.

Second Spring agrees to serve you under the Medicaid Assistive Community Care Services (ACCS) program, so long as you are verified as eligible and need Level III Residential Care Home Services. Second Spring charges a flat room and board rate, and your eligibility for ACCS will not affect this rate.

For as long as you are verified ACCS eligible you will be responsible for paying Second Spring directly for your program fees at the rate of $825.00 per month. You will retain a Personal Needs Allowance of at least $193.00 per month.

For as long as you maintain ACCS eligibility, Second Spring will bill the Medicaid ACCS program for your Level III care services covered by the program at the daily rate established by the Medicaid program. The home will bill the Medicaid ACCS Program at this rate for each day of service provided to you. As of the date of this agreement, that rate is $42.25 per day. A day of service is a day on which you are ACCS eligible, reside at the home, and have not been absent for the entire 24-hour day or admitted to another facility. Under the terms of the Medicaid ACCS program, the home may not ask or require you or anyone else to pay the home for days you are absent from the home.

Covered services are the following services, up to the Level III level of care: help with activities of daily living; medication assistance, monitoring, and administration; 24 hour on-site assistive therapy; restorative nursing; nursing assessment; health monitoring; case management; and routine nursing tasks. These service terms are equivalent to terms included in the Residential Care Home licensing regulations.

Second Spring agrees that your program fees, plus the funds Second Spring receives from the Medicaid ACCS program, will be the sole and complete payment to Second Spring for required services.

Second Spring requests that you immediately inform us if you become aware of a change in your Medicaid or SSI status.