Todisco Sober Homes LLC
NEW RESIDENT INTAKE PACKET
APPLICATION, RULE HANDBOOK, RELAPSE PREVENTION, POLICIES & ADDITIONAL INFO.
The completed form and necessary additional information can be emailed to todiscosoberhomes@gmail.com subject “Application for Cara’s Place OR Kathy's Place"
Demographics:_
Name: Client first nameClient last name
Preferred Name:Text field
- Date of Birth: Client birthdate
- Gender: Client gender
- Contact Information: Client phone Client email
Employment:_
- EmploymentHistory
State or Federal Income/Benefits:
- Type of income/benefit (e.g. SSI, SSDI, VA benefits):Text field ____________________
- Amount: $______Text field__________________________________________
Emergency Contacts:Text field
Contact
Medication:
List current medications and dosages:Text field______________________________________ ___________________________________________________________________
- List any allergies or sensitivities: _Text field______________________
Legal Issues or DCF Involvement:Text field
- Are you currently on probation or parole? Yes/No Text field
- If yes, provide:Text field
Probation/Parole Officer and or DCF case worker Information:
- Name: __Text field_____________________________________________
- Phone: Text field______________________________________________
- Email: _________Text field______________________________________
- Court Location: ______Text field_______________________________________
- Probation/Parole Conditions: _______Text field_______________________________
- Have you been convicted of a felony? Yes/NoText field
- If yes, provide details: _____Text field_____________________________
Probation Officer Information:
- Name: ___Text field____________________________________________
- Phone: _______Text field_______________________________________
- Email: _____Text field__________________________________________
Recovery Goals:
- What are your short-term recovery goals? __Text field_____________________
- What are your long-term recovery goals? __Text field_____________________
Recovery Plan:
- Describe your recovery plan, including support groups, therapy, and other resources: Text field___________________________________________________________________
- How do you plan to maintain sobriety? ___Text field__________________________________
Additional Comments: _____Text field_____________________________________________
______________________________________________________________________
______________________________________________________________________
Todisco Sober Homes LLC
I understand that I am required to follow the rules and responsibilities of the home, including:
- No smoking inside including vapes, smoking is allowed in designated smoking areas outside &
disposed of properly in the stand-up stanchion
- No candles or incense, no use of traditional fireplaces.
- Curfew of 10 PM on weekdays (Mon-Thur) and 11 PM on weekends (Fri-Sun)
- Completing weekly assigned house chores to maintain a clean and sanitary living environment
Resident must maintain good hygiene
-
- Obtaining employment or a source of income by day 30 (45 at the latest)
- No violence or disturbing behavior, if so it will result in dismissal
- No weapons or firearms, if found it will result in immediate dismissal
- No illicit drugs or alcohol on the premises, if so it could result in immediate dismissal
- Approved visits from friends and family in common areas only
-
-
No entering other resident's bedrooms
No food in the living room or bedrooms (Kitchen only)
Attending up to 2 or more meetings weekly to align with house rules and recovery pathways
- Must attend all house meetings
Approved visitors must sign in and out
-
Submitting to random drug and alcohol testing, with a positive screening resulting in a conversation with
the house manager to discuss a relapse prevention plan, potentially leading to temporary or permanent dismissal
*GARAGE USE IS PROHIBITED, OFF LIMITS TO RESIDENTS*
*SMOKING INSIDE THE HOME IS NOT ALLOWED INCLUDING VAPES & ECIG'S*
*TODISCO SOBER HOMES LLC IS NOT LIABLE FOR ANY RESIDENT STOLEN OR DAMAGE PROPERTY*
It is suggested for residents to seek either IOP/PHP or Private therapy while in Todisco Sober Homes to enhance the success of long-term sobriety and reach recovery goals. These services
are not offered at the house however referrals can be offered.
Residents Signature: Signature
Date: Date
Todisco Sober Homes Manager or Mentor: Signature Date:Date
Todisco Sober Homes Owners: Marissa Todisco, Mario Todisco SignatureDate
Todisco Sober Homes
Cara's Place & Kathy's Place
Residents Rights
Each resident has rights that the house staff will safeguard during your stay. You have a right to:
1. Humane care in an environment that supports your recovery.
2. Be free from verbal and physical abuse.
3. Be treated with dignity and respect.
4. Choose your recovery goals.
5. Participate actively in your recovery.
6. Expect meetings with Director to occur during scheduled times and at designated locations. 7. Be given
information regarding informed consent prior to the start of your stay.
8. Receive information regarding cost.
9. Be informed of the costs, potential benefits, and potential negative consequences of living in the 1,2,3 House.
10. Confidential records that are accessible only to designated staff and which can be released to others outside of our sober
home only with your written permission except as allowed by state and federal law.
11. Be referred to subsequent services upon leaving or transfer from the house. 12. Retain personal property that does not
jeopardize your or others' safety or health. 13. Receive and send unopened mail. I will always open received mail in the presence of a staff member when requested.
14. Be seen by a private physician with the understanding that all costs will be the responsibility of the resident. 15. File a
complaint with the manager, operator or the Massachusetts Alliance for Sober Housing without fear of retaliation and to have
the complaint investigated within a reasonable amount of time. 16. Be fully informed before changes occur in these rights and responsibilities as well as changes to our policies, procedures and schedule.
17. Know the qualifications of the staff involved in your recovery.
18. Refuse to stay and to be informed of the consequences of this action
19. Request referral resources in the event of my dismissal.
20. Not to be required to perform services for us which are not included in the usual expectations of all residents I have been informed at admission of my rights as listed above.
Print Name: Text field
Residents Signature: Signature
Date: Date
Staff Signature Signature
Marissa Todisco
Mario Todisco
Todisco Sober Home Financial Agreement
Single resident Bedroom $325.00 weekly (1 available in home) Double
resident Bedroom $275.00 weekly (4 available in home)
- First and Last week's rent is due upon entry
- Weekly Rent going forward:
*Weekly Rent: $ $275 OR $325 DEPENDING ON BED (due every Friday)!
Refund Policy:
- Refunds will be issued minus any outstanding balances or damages.
Two weeks' notice of leaving the home must be given in writing to Todisco Sober Homes LLC. If notice is provided, last week's fee's will be applied to the last week or refunded. If notice is not provided last week's fee will not be refunded. Refunds will be issued 3-7 after the resident is moved out.
Payment Terms:
- Payments are due every Friday.
Payments can be made by our online payment system, PayPal, checks made payable to Todisco Sober Homes LLC or cash. Collection of Check's or Cash will be collected only by Todisco Sober Homes LLC staff. Cash will be given a receipt if requested by the resident.
-This agreement is legally binding and enforceable. Prices are subject to change; residents will be notified in advanced by writing. Any unpaid balances or back rent will be brought forth to Todisco Sober Homes' legal counsel and will be dealt with accordingly by law, including but not limited to, legal action & collections.
By signing below, I acknowledge that I have read, understood, and agreed to the terms and conditions of this financial agreement.
Resident's Signature: Signature
Date: Date
Todisco Sober Homes Marissa Todisco, Mario Todisco Signature
Date: Date
Todisco Sober Homes LLC
Relapse Policy:
Substance Use/Relapse Procedure
• You may be asked to submit to urine analysis or breathalyzer at any time.
• You will have one hour to produce a sample
•
You may not leave the house or the common areas of the house before giving
urine sample
• Refusal to give one or tampering with sample will be considered the same as if it
were a positive result and will
result in immediate permanent removal from the house.
• If a screen comes back positive, or a member has stated they have relapsed,
every effort will be made by Todisco Sober Homes to get said individual help for their current substance use if they desire.
Returning to Todisco Sober Homes is on a case by case basis upon the discretion of house manger/ owner.
Drug Testing Policy
1. Members agree to take random drug or alcohol screening if ask (refusal to take test (s) is
immediate justification for dismissal from program and home). If the screening proves
positive
the member will be asked to leave immediately and have all their things removed within 5
hours
or all items will be donated or disposed of at end of 30 days.
2. Members must avoid using food or liquids containing poppy seeds, mouthwash
containing
alcohol, and certain cold and cough medications due to drug testing.
3. No soliciting, no exchanging, or storing of drugs/alcohol for any one inside or outside of
homes.
4. Home coordinators may do drug testing but any decisions or consequences resulting
from
testing becomes the responsibility of a staff member.
5. Any submission of a urine specimen that is not your own or altered in any way is cause
for
immediate discharge from the renewal sober living program.
Todisco Sober Homes LLC
Todisco Sober Homes is not responsible for personal belongings left behind by residents after departure. However, we will make reasonable efforts to store and return left behind items to their rightful owners.
-
Procedure:
Residents are responsible for removing all personal belongings upon departure. - Items left behind will be stored for a maximum of 30 days.
- After 30 days, unclaimed items will be donated, discarded, or disposed of according to our discretion.
Residents can arrange to pick up left behind items within the 30-day period.
Prohibited Hazardous Search Policy
Being in possession of, using, sharing, buying, or selling alcohol, unauthorized medications, drugs, or misusing prescribed or over the counter medications may require immediate dismissal. All prescription and non-prescription medication(s) will require approval from owner and manager of the sober house.
You may Smoke/Vape in designated areas only.
All Weapons and explosives are strictly prohibited. Including, but not limited to knives, guns, brass knuckles, batons, stun guns, pepper spray, fireworks.
Random room and common area searches will be conducted be Owner and Manager. In
the event you are found to be in position of a prohibited item you may be asked to leave the home Immediately.
Residents Signature: Signature
Date:Date
Todisco Sober Homes LLC Medication Policy
All prescription medication must have a prescription from a licensed doctor. All non-prescribed meds will be
approved based on what over the counter medication it is, to prevent a false positive
Medications are to be listed on your application for Todisco Sober Homes.
Medications are kept in a secure lock box style bin. Each resident is provided a lock box style bin that they are responsible for to self administer medications.
The combination code is to be shared between Todisco Sober Homes Manager and the resident only.
The red sharps container is located in the home for safe disposal of any insulin or injection style medication or syringes to further ensure the safety of the staff and residents.
Residents Signature: Signature
Date:Date
TODISCO SOBER HOMES LLC GRIEVANCE POLICY
Steps to finding solution
1. try to figure it out between the 2 parties or parties involved.
2.
Go to the manager and/or owner for assistance.
3. If the issue is not resolved after attempting 1 & 2, then feel free to reach out to MASH.
Grievances can be submitted to Todisco Sober Homes Attention Marissa Todisco or Mario Todisco (owners) by email to Todiscosoberhomes@gmail.com.
Grievances can also be submitted to MASH (Massachusetts Alliance for Sober Housing) (781) 472-2624 or visit their website at https://mashsoberhousing.org/.
TODISCO SOBER HOMES - CARA'S PLACE
MASH CODE OF ETHICS
MASH certified sober home operators, staff, peer leaders, and volunteers shall value and respect each resident and put each individual's recovery and needs at the forefront of all decisions. To meet this obligation, certified operators, staff, peer leaders, and volunteers will adhere to the following principles:
1. Assess each potential resident's needs and determine whether the
level of support available within the sober home is appropriate. If a resident needs
additional support, the sober home should provide assistance and appropriate referrals.
2. Value diversity and non-discrimination.
3. Provide a safe, home-like environment that meets MASH standards.
4. Maintain an alcohol- and illicit-drug-free environment.
5. Honor individuals' rights to choose their recovery paths within the
parameters defined by the sober home.
6. Protect the privacy, confidentiality, and personal rights of each resident.
7. Provide consistent and uniformly applied rules.
8. Provide for the health, safety, and welfare of each resident.
9. Address each resident fairly in all situations.
10. Encourage residents to sustain relationships with professionals, recovery
support service providers and allies.
11. Take appropriate action to stop intimidation, bullying, sexual harassment
and/or otherwise threatening behavior of residents, staff, and visitors within
the sober home.
12. Take appropriate action to stop retribution, intimidation, or any negative
consequences that could occur as the result of a grievance or complaint.
13. Provide consistent, fair practices for drug testing that promote the
resident's recovery and the health and safety of the recovery environment and protect
the privacy of resident information.
14. Provide an environment in which each resident's recovery needs are the
primary factors in all decision-making.
15. Promote the sober home with marketing or advertising that is
supported by accurate, open, and honest claims.
16. Decline taking a primary role in the recovery plans of relatives, close
friends, and/or business acquaintances.
17. Sustain transparency in operational and financial decisions. 18. Maintain clear personal and professional boundaries.
19. Operate within the sober home's scope of service and within
professional training and credentials.
20. Maintain an environment that promotes the peace and safety of the surrounding neighborhood and the community at large.
Residents Signature:Signature Date: Date
Marissa Todisco Mario Todisco Signature
Date: Date
Todisco Sober Homes Mission Statement
The mission of Todisco Sober Homes is to give residents a safe and encouraging environment in which to practice sobriety. To offer a housing situation that provides them the time required to learn the
skills needed to effectively maintain their sobriety independently.
Todisco Sober Homes
12 Sagamore Street Lynn, MA 01902
In the event of a fire (fire extinguisher is located in kitchen) or an emergency. Residents are to make their way to the nearest exit and join together in-front of the home.
Call 911 and notify house manager immediately (Marissa 617-686-6434)
NARACN is located in the kitchen hanging on lanyard NARCAN is located on the second floor hallway hanging on lanyard NARCAN is located in the basement near laundry hanging on lanyard
Identify Opioid
Overdose
and Check for
Response
Give
NARCAN
Nasal
Spray
Call for
emergency medical
help, Evaluate,
and Support
Ask person if he or she is okay and shout name.
Shake shoulders and firmly rub the middle of their chest.
Check for signs of opioid overdose:
• Will not wake up or respond to your voice or touch
• Breathing is very slow, irregular, or has stopped
• Center part of their eye is very small, sometimes called "pinpoint pupils" Lay the person on their back to receive a dose of NARCAN Nasal Spray.
Remove NARCAN Nasal Spray from the box.
Peel back the tab with the circle to open the NARCAN Nasal Spray.
Hold the NARCAN nasal spray with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle.
NARCAN NASAL SPRAY 4mg
SEE ENCLOSED QUICK START GUIDE
LOT 90000&EXP MMM/YYYY
DO NOT TEST DEVICE BEFORE USE
Gently insert the tip of the nozzle into either nostril.
• Tilt the person's head back and provide support under the neck with your hand. Gently insert the tip of the nozzle into one nostril, until your fingers on either side of the nozzle are against the bottom of the person's nose.
Press the plunger firmly to give the dose of NARCAN Nasal Spray.
• Remove the NARCAN Nasal Spray from the nostril after giving the dose.
Get emergency medical help right away.
Move the person on their side (recovery position) after giving NARCAN Nasal Spray.
Watch the person closely.
If the person does not respond by waking up, to voice or touch, or breathing normally another dose may be given. NARCAN Nasal Spray may be dosed every 2 to 3 minutes, if available.
Repeat Step 2 using a new NARCAN Nasal Spray to give another dose in the other nostril. If additional NARCAN
Nasal Sprays are available, repeat step 2 every 2 to 3 minutes until the person responds or emergency medical help is received.
NOZZLE-
PLUNGER
HAND SUPPORTS HEAD
KNEE STOPS BODY FROM ROLLING ONTO STOMACH
MASH
Massachusetts Alliance for Sober Housing
Confidentiality Policy
The following information is considered a resident's personal information and shall be secured in locked filing cabinet, desk, or office. Only authorized persons may have access to resident information and only for official business purposes.
This information includes paperwork signed upon admittance to the house, alcohol and drug test results, medication lists, health records and correspondence, financial information, and correspondence with probation, parole or DCF staff.
In the case of a medical emergency, we reserve the right to share a resident's health information and medication list with emergency responders when relevant.
Financial Record Keeping Policy
All financial transactions involving residents, such as fees, charges, payments, and deposits, will be documented in some form of accounting system such as QuickBooks, Excel, similar software applications, paper ledger, etc.). Payments made by third parties such as parents, scholarship entities, etc. will also be documented and the name of the payor will be noted.
An accurate statement of all resident charges and payments may be requested by a resident and will be provided within one week of the date of request.
The operator shall make receipts available upon request for payments made
electronically. For payments made by cash/check/money orders the operator will provide a dated receipt for all payments specifying the days covered at time of transaction.
Infectious/Contagious Disease Policy
We are committed to maintaining, to the extent reasonably possible, a safe environment. The purpose of this policy is to prevent infection through proper Blood borne pathogens (BBP) procedures and help prevent the spread of contagious viruses and diseases through measures that focus on safety, prevention, and education. We will follow the directions of the local health department to prevent the spread of a virus or infection and to protect everyone's health. This policy is not intended to cover common illnesses, such as colds, or upper respiratory infections.
Protocol for Contagious Disease or Virus
Persons who know or have reason to believe they are infected with a contagious virus or disease must notify house leadership immediately. They also should contact their healthcare provider and follow the directions of their healthcare provider. Depending on the nature of the virus or disease, we may isolate a resident/s and ask them to use one specific bathroom and sanitize it after use with house supplied cleaning products recommended by the Centers for Disease Control (CDC). We ask the resident to isolate as much as possible for the recommended amount of time and not spend time in the common areas. Certain times will be set for the use of the kitchen (sanitizing the kitchen area after will be required). The resident may be required to wear a mask when outside of their bedroom. Other residents will be notified of the risk so they can take reasonable steps to stay safe and healthy. These requirements will remain in effect until the residents have completed their medical protocol and are believed to no longer be capable of spreading the virus or disease.
All residents are required to continue housecleaning/sanitizing and follow reasonable safety precautionsto keep everyone safe. Personal Protection Equipment (PPE) may be provided and if necessary. We reserve the right to limit access to our home to any third parties (visitors, guests, contractors, etc.) for such a time as is necessary.
Blood Borne Pathogens
We are committed to following proper procedures to ensure the safety of residents and people supporting the sober home. BBP include the following: Human Immunodeficiency Virus (HIV), the Hepatitis B Virus (HBV), and the Hepatitis C Virus (HCV). All these viruses can be transmitted from one infected person to another through blood and other bodily fluids entering through broken skin or mucous membranes (including mouth, nose, and eyes). If you feel you were exposed to a BBP please notify the house leadership.
Treat all blood and other bodily fluids such as vomit as being potentially infected with BBP. The five basic steps for cleaning up blood spills/bodily fluids are:
1. Prevent the BBP from direct contact. At a minimum gloves and mask should be
worn. 2. Contain and remove the spill. Example: use tongs whenever possible.
3. After soaking up most of the blood/fluid in a cloth, disinfect the area thoroughly. 4. All
the disposable things that have been used in the cleaning process must be packed in a
bag and labeled to prevent anyone from encountering it.
5. Apply generous amounts of sanitizers in the spill area. Ensure that the room is well-ventilated
and let the sanitizer sit in the area for a considerable period.
Wounds that have been in contact with blood or body fluids should be washed with soap and water; mucous membranes should be flushed with water. Do not apply bleach or other chemicals to the skin or any other body part. Please refer to CDC for more information.
https://www.cdc.gov/niosh/topics/bbp/default.html
Neighbor Communication Policy
All residents will be provided the appropriate contact information and be oriented to our Good Neighbor Policy to prevent or minimize conflicts with our neighbors.
If a neighbor communicates with any resident with a question or problem concerning the house, or requests the contact information of the operator, the resident will provide the neighbor with the contact information. The resident will immediately notify the operator of the nature of the conversation.
Resident Work Policy
We are committed to maintaining a safe and comfortable environment for all. The purpose of this policy is to provide guidelines concerning residents who perform paid work for the sober home operator or manager, either on the premises or outside of the house.
Any work arrangement will be subject to the following principles:
•
Paid work arrangements are completely voluntary.
• Residents do not suffer any consequences from declining work.
• Residents who accept paid work are not treated more favorably than residents who
do not.
• All qualified residents are given equal opportunity for available work. • Paid work for the operator or house mentor will not interfere with the residents' progress towards their recovery goals.
• Paid work is treated the same as any other employment situation.
• Wages are commensurate with marketplace value and at least minimum wage. •
The arrangements are viewed by most of the residents as fair.
• Paid work does not confer special privileges on residents doing the work. • Work relationships do not negatively affect the recovery environment or morale of the home.
Unsatisfactory work relationships are terminated without recrimination that
can impair recovery.
Resident Participation Policy
As part of our resident's recovery process, we strive to involve residents in governance of the house. To reach this goal/standard resident will create some rules/procedures and guidelines in consultation with the operator. Residents, not staff, will implement and enforce resident created rules/procedures. For example, house chores.
Safety Policy
To ensure our property is maintained in a safe manner we will install and maintain:
1. Functional smoke detectors in all bedroom areas and elsewhere
required by local code.
2. Functional carbon monoxide detectors on all floors and elsewhere
required by code.
3. Functional fire extinguishers in every kitchen in a clearly marked location.
We will verify that all detectors are present and are in good order monthly and will replace batteries at least once per year.
All smoke detectors will be replaced at least once every ten years.
Fire and other emergency evacuation drills take place regularly and are documented.
I attest that I have read, understand, and will implement these additional MASH standards listed in this document. I am aware the home certification inspection will include verifying that these policies have been implemented.
Sober Home Operator Marissa Todisco Mario Todisco
Sober Home Address 12 Sagamore St Lynn MA 01902
Signature of Sober Home Operator Marissa Todisco Mario Todisco
Date 8/12/24
Todisco Sober Homes LLC Non-Discrimination Disclosure
We comply with Massachusetts state law and do not discriminate against any individual based on:
-
- Race
- Color
- National origin
- Ancestry
- Creed
- Religion
- Sex
- Sexual orientation
- Gender identity
- Age
- Disability
- Genetic information
- Military service
- Veteran status
or any other protected class under Massachusetts law (M.G.L. c. 151B).
We provide equal access to residency and opportunities.
I have read over this entire packet of Todisco Sober Homes LLC Rules, Responsibilities, Codes of Ethics, Guidelines, Policies and Financial Agreement and agree to the following information included in this packet.
Residents Signature: Signature Date: Date