![]() ![]() The landlord/provider will support the individual to move to another setting and ensure a coordinated transition to the new provider.The ISC case manager will help the individual talk to the landlord/provider and tell them about their plans. The individual should work with their ISC case manager to plan the move.Any modification of the conditions above must be supported by a specific assessed need and justified in the Personal Plan.(Supports may be needed to protect the rights and privacy of others living in the home.) Individuals are able to have visitors of their choosing at any time.Individuals have access to food at any time.Individuals have the freedom and support to control their own schedules and activities.Outline the individual's rights as required under the HCBS Settings Rule including:.Outline the individual's responsibilities (i.e., maintaining his/her living space and not engaging in activities that disrupt or potentially cause harm to other residents).Share information regarding the individual's Waiver rights, as outlined on the Rights of Individuals form.In this section, share the individual's rights and responsibilities as tenant. Designate the specific unit that the individual will have (including a description of the specific bedroom). In this section, document the rent or room and board, the due date for rent or room and board and where/how the rent will be received. _ Children's Group Home Rent/Room and Board _ Community Integrated Living Arrangements (Place an X in the blank space if applicable) Type of home and community-based service provided by the landlord/provider NOTE: Are you your own guardian? _YES _ NO (Place an X in the appropriate blank space) This residency agreement is between individual/tenant _(enter tenant's name)_ or _(enter guardians' name, if applicable)_ and landlord/provider _(enter name of CILA/CLF/CGH provider name)_ located at _(enter tenant's address)_. The provider/landlord must maintain a copy in the individual's record.The person and legal representative must receive a copy.Landlords/providers must have a written agreement with people who are receiving services in Community Integrated Living Arrangements (CILA), Community Living Facilities (CLF) and Children's Group Homes (CGH) (when provided in a licensed setting). This sample residency agreement can be used to document that people have been informed of and agree to the process the landlord/provider must follow before ending services/housing. ![]()
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