Loading...
HomeMy WebLinkAbout09-02-09ANNUAL REPORT OF GUARDIAN OF THE PERSON co - ; ~ ~ 1j ~ :~ ' ~~ --- L' , "D rs r - ~.; N COURT OF COMMON PLEAS OF -- '~ Cumberland COUNTY, PENNSYLVANIA `- ~ ~ f ~ ~ ' ~ ? ~~ ` ORPHANS' COURT DNISION ~ _~ w ~ , , .~- - to Estate of Nicole Hlavac , an Incapacitated Person No. 06-0608 I. INTRODUCTION Dana and Rose Hlavac ,was appointed ®Plenary Limited Guardian of the Person by Decree of J. Oler J,~ dated 8/31/06 A. This is the Annual Report for the period from September 1 2008 to August 31 2009 (the "Report Period"); or B. This is the Final Report for the period from to (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: 2. The Guardianship was terminated by the Court by Decree of J., dated For a Final Report, omit Sections II through IV. Form G-03 rev. 10. /3.06 Page 1 of 4 Estate of Nicole Hlavac II. PERSONAL DATA Age of the Incapacitated Person: 21 III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: 905 Charleston Green Malvern, PA 19355 B. The Incapacitated Person's residence is: an Incapacitated Person Date of Birth: 08/24/1988 © own home /apartment nursing home boarding home /personal care home ~ Guardian's home /apartment © hospital or medical facility relative's home (name, relationship and address) other: Group Home C. The Incapacitated Person has been in the present residence since July 10, 2009 If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: 9 Oak Ridge Road, Carlisle, PA 17015 (Home of Mother) Nicole turned 21 this year transitioned from Education to Adult MH/MR services. Form G-03 rev. !0.!3.06 Page 2 of 4 Estate of Nicole Hlavac an. Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: Melmark 2600 Wayland Road Berwyn, PA 19312 (i.e., Melmark manages the group home) IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: Nicole has profound intellectual delays with diagnosis including: ADD/ADHD, CP, Autism and OCD due to a rare genetic defect. B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: Nicole is in a vocational program at Melmark. The program includes supports for Nicole's speech and behavior needs. V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: ~ continue ~ be modified ^ be terminated Estate of Nicole Hlavac an Incapacitated Person The reasons for the foregoing opinion are: While Nicole is learning job skills and making progress towards independent communication, she remains unable to handle her own affairs and is dependent on others for her care and safety. B. During the past year, the Guardian of the Person has visited the Incapacitated Person 8 times with the average visit lasting 39 hours, 41 minutes. The report of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. 8/31 /09 Dare /~. ~ l Srgrxnure of Guardian of the Person Rose Hlavac Name of Guardian of the Person (type or print) 9 Oak Ridge Road Address Carlisle, PA 17015 crry, stare, ztp 717-258-5666 Telephone Form G-03 rev. 10.13.06 Page 4 of 4 Supplement to Annual Report of Guardian of the Person Person: Nicole Hlavac; Docket Nbr: 06-0608 Following are the details regarding visits to Niki during the September 1, 2007 to August 31, 2008 timeframe. Trip Visit Visit Duration Number Start End (Hrs Notes 1 9/28/08 9/28/08 5 Visit, switch seasonal clothes, Hair Cut, Sho ,Dinner 2 11 /26/08 11 /29/08 68 Niki home for Thanksgiving; Picked Niki up in Philly about 7 p.m. anal returned back to Phil! about 4 .m. 3 12/21/08 12/27/08 170 Niki home for Christmas; Picked Niki up in Philly about 1 p.m. and dropped her off about 3 .m. 4 2/21/09 2/21/09 6 Switch Seasonal clothes; Sho 5 4/10/09 4/12/09 46 Niki home for Easter ;Picked Niki up in Philly about 7 p.m. and returned back to Phil! about 5 .m. 6 6/12/09 6/12/09 8 Niki's Graduation; lunch and haircut 7 6!28/09 6/28/09 7 Niki's Birthday -Took her shopping and out to dinner 8 7/30/09 7/30/09 7 Attended Niki's IPP mtg at 10 a.m. and then had House Warmin Part until ? .m. Total visits = 8 Total hours = 317 Average Per Visit: 39 hrs and 41 minutes