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Backup Documents 08/27/2013 Absentia BCC ABSENTIA BACK-UP DOCUMENTS August 27, 2013 2013 EXECUTIVE SUMMARY APPROVED IN BOARD'S ABSENCE ITEM #16F1, TO BE RATIFIED ON SEPTEMBER 10, 2013: APPROVAL OF THE FOLLOWING DOCUMENTS BY THE COUNTY MANAGER IS SUBJECT TO FORMAL RATIFICATION BY THE BOARD OF COUNTY COMMISSIONERS. IF THE DECISION BY THE COUNTY MANAGER IS NOT RATIFIED BY THAT BOARD, THE DOCUMENT(S) SHALL BE ENFORCEABLE AGAINST COLLIER COUNTY ONLY TO THE EXTENT AUTHORIZED BY LAW IN THE ABSENCE OF SUCH RATIFICATION BY THAT BOARD. A. RECOMMENDATION TO APPROVE SUBMITTAL OF THE OLDER AMERICANS ACT APPLICATION FORGRANT RENEWAL TO THE AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC., DBA SENIOR CHOICES OF SOUTHWEST FLORIDA (SENIOR CHOICES), AND IF AWARDED, WILL PROVIDE GRANT FUNDS IN THE ESTIMATED AMOUNT OF $923.226 ANNUALLY, FOR A PERIOD OF SIX YEARS. B. RECOMMENDATION TO APPROVE NINE (9) RELEASES OF LIEN FOR THE DISASTER RECOVERY INITIATIVE PROGRAM LOANS AS THE TERMS AND CONDITIONS OF THE 5 YEAR AFFORDABILITY PERIOD HAVE BEEN MET. C. RECOMMENDATION TO REJECT SOLICITATION (ITB) #13-6125, NORTH COLLIER REGIONAL PARK WATER SLIDE TOWER PAINTING AND RENOVATION. Page 1 August 27,2013 (BCC Ratification on September 10, 2013) ampeUals s ueUrnsgD o --- .. . - -jh 1- '' .A(:),` 1-.\-..j-1. 7-7;.-4-1:R-. 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Page Number HIPPA Regulations 40-43 II Services for Seniors Grievance Procedure 44-48 III Samples of Satisfaction Surveys 49-52 IV Job Descriptions 53-64 V Unit Cost Methodology 65 3 Cq SERVICE PROVIDER SUMMARY INFORMATION PAGE PSA: 8 ORIGINAL SUBMISSION [X ] REVISION [ ] 1. PROVIDER INFORMATION: 2. GOVERNING BOARD CHAIR: Executive Director: Georgia A.Hiller,Esq.Chairwoman Kimberley Grant 3299 Tamiami Trail E.,Ste.303 3339 Tamiami Trail E,Ste.211 Naples,FL 34112 Naples,FL 34112 (239)252-8602 (239)252-2273 Name of Grantee Agency: Legal Name of Agency: Collier County Board of County Commissioners 3. ADVISORY COUNCIL CHAIR: (if applicable) Housing,Human and Veteran Services {Name/Address/Phone} Mailing Address 3339 Tamiami Trail E.,Suite 212 Naples,FL 34112 Telephone Number: [239]252-2273 4. TYPE OF AGENCY/ORGANIZATION: 5. PROPOSED FUNDING PERIOD:January 1, 2014— NOT FOR PROFIT: _PRIVATE December 31, 2019 x PUBLIC A. NEW APPLICANT_ PRIVATE FOR PROFIT _ B. CURRENT CONTRACTOR x 6. FUNDS REQUESTED: [x]OAA Title IIIC-1 [x]OAA Title IIIC-2 7. SERVICE AREA: [x]Single County Collier []Multiple Counties(please list 8. ADDRESS FOR PAYMENT OF CHECKS ITEM#: [x]#1 []#2 9. CERTIFICATION BY AUTHORIZED AGENCY OFFICER: I hereby certify that the contents of this document are true, accurate and complete statements. I acknowledge that intentional misrepresentation or falsification may result in the termination of inancial assistance. Name: Leo E. Ochs, Jr. Signature: Title: County Manager Date: 3 ".4'') 11 Approved as to form and legality Assistant County Att ey 4 CA I. rurc otale roan 1UJJ: SUBMIT PROPOSAL TO: AREA AGENCY ON AGING Area Agency on Aging for Southwest Florida REQUEST FOR PROPOSAL 15201 N.Cleveland North Fort Myers,FL 33903 CONTRACTUAL SERVICES Telephone Number:239/652.6900 Acknowledgment Page 1 of PROPOSALS WILL BE OPENED: September 3,2013 PROPOSAL NO. _106 Pages and may not be withdrawn within 30 days after such date and time AGENCY MAILING DATE: HAND DELIVERED 8/28/2013 PROPOSAL TITLE: Collier County Senior Nutrition Program FEDERAL EMPLOYER IDENTIFICATION NUMBER OR S.S. NUMBER 59-6000558 VENDOR NAME Collier County Housing,Human and Veteran Services REASON FOR NO PROPOSAL VENDOR MAILING ADDRESS 3339 Tamiami Trail E.,Suite 211 POSTING OF PROPOSAL TABULATIONS CITY-STATE-ZIP Naples,FL 34112 Proposal tabulations with recommended awards will be posted for review by interested parties AREA CODE TELEPHONE NUMBER 239-252-2273 at the location where proposals were opened and will remain posted for a period of 72 hours. Failure to file a protest within the time prescribed in Section 10.53(5). Florida statutes shall TOLL-FREE NUMBER n/a constitute a waiver of proceedings under chapter 120.Florida Statutes.Posting will be on or about December 15,2006. I certify that this proposal is made without prior understanding,agreement,or connection with any corporation,firm,or person C submitting a proposal for the same contractual services,and is in all respects fair and without collusion or fraud.I agree to ■10 e---w .'// abide by all conditions of this proposal and certify that I am authorized to sign this proposal for the proposer and that the AUTHORIZED SIGN•UUR(ANUA proposer is in compliance with all requirements of the request for Proposal, including but not limited to, certification requirements,in submitting a proposal to an agency for the State of Florida,the proposer offers and agrees that if the proposal is accepted,the proposer will convey,sell,assign or transfer to the State of Florida all rights,title and interest in and to all Leo E. Ochs,Jr.,County Manager causes of action it may now or hereafter acquire under the Anti-trust laws of the United States and the State of Florida for price AUTHORIZED SIGNATURE(TYPED)TITLE fixing relating to the particular commodities or services purchased or acquired by the State of Florida. At the discretion,such assignment shall be made and become effective at the time the purchasing agency tenders final payment to the proposer. GENERAL CONDITIONS SEALED PROPOSALS: All proposal sheets and this original acknowledgment form (c) MISTAKES: Proposers are expected to examine the conditions, scope of work, must be executed and submitted in a sealed envelope. (DO NOT INCLUDE MORE proposal prices,extensions,and all instructions pertaining to the services involved. THAN ONE PROPOSAL PER ENVELOPE.) The face of the envelope shall contain, Failure to do so will be at the proposer's risk. in addition to the above address,the date and time of the proposal number.Proposal prices not submitted on attached proposal price sheets when required shall be (d) INVOICING AND PAYMENT: The contractor shall be paid upon submission of rejected. All proposals are subject to the conditions specified herein. Those not property certified invoices to the purchaser at the prices stipulated on the contract at complying with these conditions are subject to rejection. the time the order is placed,after delivery and acceptance of goods,less deductions if any as provided. Invoices shall contain the contract number, purchase order 1. EXECUTION OF PROPOSAL: Proposal must contain a manual signature of number and the contractors'Federal Employer Identification Number. An original authorized representative in the space provided above. Proposal must be and three(3)copies of the invoice shall be submitted. The final payment shall not typed or printed in ink. Use of erasable ink is not permitted. All corrections to be made until after the contract is complete unless the Agency has agreed prices made by proposer must be initialed.The company name and F.E.I.D.or otherwise. Invoices for fees or other compensation for services or expenses social security number must appear on each pricing page of the proposal as submitted for contractual services shall be submitted in detail sufficient for a proper required. pre-audit and post-audit thereof and invoices for any travel expenses shall be submitted in accordance with the rates at or below those specified in Sections 2. NO PROPOSAL SUBMITTED: It not submitting a proposal, respond by returning only this acknowledgment form, marking it"NO PROPOSAL", and accord 1 and 28ection F.S. Interest which states Payment shall be made in explain the reason in the space provided above. Failure to respond to a accordance with section 215.422,F.S.,which states the contractors'rights and the procurement the reason the without provided Agency's responsibilities concerning interest penalties and time limits for payment of giving justifiable reasons for such failure, invoices. VENDOR OMBUDSMAN: vendors providing goods and services to an nonconformance to contract conditions, or other pertinent factors deemed agency should be aware of the following time frames. Upon receipt,an agency has reasonable and valid shall be cause for removal of the proposer's name from five(5)working days to inspect and approve the goods and services,unless the bid the proposal mailing list. NOTE:To qualify as a respondent, proposer must specifications, purchase order or contract specifies otherwise.An agency has 20 submit a"NO PROPOSAL", and it must be received no later than the stated days to deliver a request for payment(voucher).The 20 days are measured from proposal opening date and hour. the latter of the date the invoice is received or the goods or services are received, 3. PROPOSAL OPENING: Shall be public, on the date, location and the time inspected and approved. If a payment is not available within 40 days,a separate specified on the acknowledgment form. It is the proposers responsibility to interest penalty of.03333 percent per day will be due and payable,in addition to the assure that his proposal is delivered at the proper time and place of the invoice amount,to the vendor.The interest penalty provision applies after a 35 day proposal opening. Proposals,which for any reason are not so delivered,will time period to health care providers, as defined by rule. Interest penalties of less not be considered. Offers by telegram or telephone are not acceptable. A than one (1) dollar will not be enforced unless the vendor requests payment. proposal may not be altered after opening of the price proposals. NOTE: Invoices, which have to be returned to a vendor, because of vendor preparation Proposal tabulations will be furnished upon written request with an enclosed, errors,will result in a delay in the payment. The invoice payment requirements do self addressed, stamped envelope and payment of a predetermined fee. not start until properly completed invoice is provided to the agency. A Vendor Proposal tabulations will not be provided by telephone. Ombudsman has been established within the Department of Banking and Finance. The duties of this individual include acting as an advocate for vendors who may be 4. PRICES,TERMS AND PAYMENT:Firm prices shall be proposed and include experiencing problems in obtaining timely payment(s)from the agency. The Vendor all services rendered to the purchaser. Ombudsman may be contracted at (904) 488-2924) or by calling the State (a)TAXES: The Area Agency on Aging does not pay Federal Excise and Sales Comptroller's Hotline, 1-800-848-3792. The Area Agency On Aging review the taxes on direct purchases of services. See tax exemption number on face conditions and circumstances surrounding non-payment and unless there is a bona of purchase order or agreement form. This exemption does not apply to fide dispute, the Area Agency on Aging may in writing authorize the contract purchases of services in the performance of contracts for the improvement supplier to reject and return purchase orders from said agency until such time as the of state-owned real property as defined in Chapter 192,Florida Statutes. agency complies with the provisions of Section 215,422,F.S. (b)DISCOUNTS:Cash discount for prompt payment shall not be considered in (e) ANNUAL APPROPRIATIONS: The Area Agency on Aging performance and determining the lowest net cost for proposal evaluation purposes. obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. Approved as to form and legality (-:)■ e.-,�/l---- 5 Assistant Cou Attorney g 5. CONFLICT OF INTEREST: The award hereunder is subject to the provisions of 10. LEGAL REQUIREMENTS: Applicable provision of all Federal, State, Chapter 112,Florida Statutes. Proposers must disclose with their proposal the name county and local laws, and of all ordinances, rules, and regulations shall of any officer, director, or agent who is also an employee of the Area Agency On development,submittal and evaluation of all proposals received in response Aging or any of its agencies. Further,all proposers must disclose the name of any hereto and shall govern any and all claims and disputes which may arise Area Agency On Aging employee who owns,directly or indirectly,an interest of five between person(s) submitting a proposal response hereto and the Area (5%) or more in the proposer's firm or any of its branches. In accordance with Agency of Aging, by and through its officers, employees and authorized Chapter 287, Florida Statutes, no person or firm receiving a contract that has not representatives, or any other person, natural: or otherwise, and lack of been procured pursuant to Section 287.057)20 or(3)to perform a feasibility study of knowledge by any proposer shall not constitute a cognizable defense the potential implementation of a subsequent contract participating in the drafting of against the legal effect thereof. a request for proposals,or developing a program for future implementation shall be 11. ADVERTISING: In submitting a proposal, proposer agrees not to use the eligible to contract with the agency for any contacts dealing with that specific subject matter,and proposers must disclose with their proposal any such conflict of interest. results there-from as a part of any commercial advertising. 6. AWARDS:As the best interest of the Agency may require,the right is reserved to 12. ASSIGNMENT: Any Contract or Purchase Order issued pursuant to this reject any and all proposals or waive any minor irregularity or technicality in proposals request for proposal and the monies which may become due hereunder are received. Proposers are cautioned to make no assumptions unless their proposal not assignable,except with the prior written approval of the purchaser. has been evaluated as being responsive. 13. LIABILITY:On any contract resulting from this proposal the proposer shall 7. INTERPRETATIONS/DISPUTES: Any questions concerning conditions and specifications shall be directed in writing to this office for receipt no later than ten(10) hold and save the Area Agency on Aging, its officers, agents and days prior to the proposal opening. Inquiries must reference the date of proposal employees harmless against claims by third parties resulting from the opening and proposal number. No interpretation shall be considered binding unless contractors breach of this contract or the contract's negligence. This provided in writing by the Area Agency of Aging requirement does not apply to contracts between governmental agencies. P 9 Y 9 Y g' g in response to requests in full compliance with this provision. Any person who is adversely affected by the agency's decision or intended decision concerning a procurement solicitation or contract award 14. FACILITIES:The Agency reserves the right to inspect the proposer's and who wants to protest such decision or intended decision shall file a protest in facilities at a time with prior notice. compliance with Rule 13A-1.006(3). Florida Administrative Code. Failure to file a protest within the time prescribed in Section 120.53(5).Florida Statutes, shall 15. CANCELLATION:The Agency shall have the right to unilateral cancellation constitute a waiver of proceedings under Chapter 120,Florida Statutes. for refusal by the contractor to allow public access to all documents,papers, letters, or other material subject to the provisions of Chapter 119, Florida 8. GOVERNMENTAL RESTRICTIONS:In the event any governmental restrictions may Statutes, and made or received by the contractor in conjunction with be imposed which would necessitate alteration of the material quality of the services contract. offered on this proposal prior to their completion,it shall be the responsibility of the successful proposer to notify the purchaser at once,indicating in his letter the specific 16. PUBLIC RECORDS:Any material submitted in response to this Request for regulation which required an alteration.The Agency reserves the right to accept any Proposal will become a public document pursuant to Section 119.07,F.S. such alteration,including any price adjustments occasioned thereby,or to cancel the This includes material,which the responding proposer might consider to be contract at no further expense to the Agency. confidential of a trade secret. Any claim of confidentiality is waived upon submission,effective after opening pursuant to Section 119.07,F.S. 9. DEFAULT: Failure to perform according to this proposal and/or resulting contract shall be cause for your firm to be found in default which event any and all re- procurement costs may be charged against your firm. Any violations of these stipulations may also result in: a) Contractor's name being removed from the Division of Purchasing vendor mailing list. b)All Agencies being advised not to do business with the contractors without written approval of the Division of Purchasing. NOTE: ANY AND ALL SPECIAL CONDITIONS AND SPECIFICATIONS ATTACHED HERETO WHICH VARY FROM THESE GENERAL CONDITIONS SHALL HAVE PRECEDENCE. 6 C RESPONSE TO RFP SPECIFICATIONS Q1. Administrative Information: a. Brief synopsis of your business / agency's background and qualifications to provide Nutrition Services: The Collier County Department of Housing, Human and Veteran Services has demonstrated a record of managerial and technical experience to effectively administer this grant program. The Department is the arm of County government that serves Collier County's very low, low and moderate income residents, including the senior population by providing access to health care, developing volunteer services with retirees, assisting with affordable homeownership and other housing opportunities, maintaining safe and decent housing and independent living for seniors, utilizing federal and state grants to build safe, livable and healthy communities and to meet the government mandates of human services in Collier County. Housing, Human and Veteran Services (HHVS) successfully administers a number of federal and state grants including, Community Development Block Grant, HOME, Department of Elder Affairs, Safe Havens Visitation and Safe Exchange Program, State Housing Initiative Partnership and Disaster Recovery Initiative programs. Under the direction of Kimberley Grant and Kristi Sonntag, the department holds years of experience in grant administration. In addition, the Nutrition Services program manager has successfully operated the program for 5 years. The Department has been the Lead Agency for DOEA programs for over 30 years and provides excellent case management and assistance to Collier County's frail elderly. In addition to providing case management, personal care and homemaking services, HHVS has administered the Collier County Nutrition Program (Nutrition Program) for five years. During this time, the department doubled the clientele receiving home delivered meals and operates at capacity. Opening two additional congregate sites in recent years, our expanded congregate meal sites serve even more seniors. In a previous monitoring, Senior Choices noted our Golden Gate congregate meal site as the "flagship" site in the entire PSA. By providing hot nutritious meals to needy, isolated, low-income and often times non-English speaking seniors; clients are receiving one-third to two thirds of their daily nutritional needs. Also, the Nutrition Program provides meals to over 120 of Collier County's most frail home bound seniors in the community through the home delivered meals program. We select the most at-risk clients from the Senior Choices waitlist ensuring that we are helping those most in need. If we are unable to provide meals due to funding we refer clients to Meals on Wheels. If they can't accept the client we make every effort to add them to our service. All Nutrition Program clients also receive monthly nutrition education as well as have the opportunity to complete an annual satisfaction survey. Meals are provided on a weekly basis at a time that is convenient to the client. Accommodations are made for doctor appointments or other situations that may interfere with their delivery. We encourage clients to call us for any assistance needed and are often able to direct them to other resources for 7 0 utility assistance, food pantries, transportation, and medical services coordinated by our case management staff. Any clients who are in need of services beyond home delivered meals are referred to Senior Choices or to another community resource. Clients are assessed annually for program compliance and updating records. The Nutrition Program now operates four (4) congregate meal sites that are in areas of the most economic need. Serving over 135 clients weekly, the sites are accessible via public transit or para-transit. In addition to hot meals, each meal site provides activities which strive to engage participants, reduce loneliness and isolation and stimulate their minds. This program encourages seniors to stay active physically and mentally by getting out into the community and meeting new friends, playing games like bingo, and being educated on health topics as well as other senior related information. We hope to reduce hunger, isolation, depression and inactivity to one of the most at-risk populations through the increase in available services and activities, thus reducing the need for other community services such as in-home health care or nursing home services. Activities include bingo, mah jongg, dominoes, jazz bands, quilting, health and nutrition talks and more. HHVS maintains partnerships with senior minded groups and agencies to provide these activities. Although Collier County is known as an affluent community, seniors, ages 60 and older, are often in danger of poor nutrition and loneliness and isolation. The Nutrition Program also serves as a resource for information to many seniors in need of other services such as one on one nutrition counseling, registering for food stamps, finding a food pantry, housing assistance, bus or emergency transportation, and referrals to the Elder Helpline for additional in-house services like home-care or water and electric bill assistance. Many of our seniors don't have family or neighbors looking in after them and our site coordinators may be the only person keeping tabs on their welfare. b. Staffing Plan for Nutrition Program: Collier County Housing, Human and Veteran Services seeks to provide services for functionally impaired elderly persons in a community care, continuum of care service system, which is designed to allow for Collier County seniors to age in place, with purpose, security, and with dignity. Staff is respectful and allow for seniors to also age in an elder friendly environment. Currently, the nutrition program employs 4.50 full time employees (See Job description in Appendix IV). The staffing pattern is described below: The Director of the Department has a Master's Degree in Business Administration and has the authority over all administrative operations of the department. This individual is responsible for the administration of the Services for Senior's programming and lead agency functions and ensures that it is managed in accordance with DOEA requirements. The Director has over 8 years experience working in Collier County Government. The Supervisor of Food Programs oversees the day-to-day operations and scheduling of the four congregate meal sites as well as the home delivered meals. The Supervisor of Food Programs supervises four (4) part time meal site coordinators who are charged with daily meal site operations and one (1) case manager assistant. Both have a working knowledge of the nutrition program administered by this agency and thus are able to access and 8 0 authorize other resources/services available to eligible clients while working under ServSafe guidelines. The nutrition services program also employs Experience Works individuals, and R.S.V.P. volunteers to staff the meal sites. Each site has a trained supervisor on location at all times. The Supervisor of Food Programs maintains current ServSafe certification and attends bi- annual nutrition education training, conducts NPCR's, provides bi annual food safety training to all staff, new employee food safety training, and ensures all staff is current on fire safety training and conducts annual safety reviews of sites. The Supervisor of Food Programs also orders congregate and home delivered meals, ensures all sites are in compliance at all times and conducts annual satisfaction surveys from all clients. To support the Supervisor of Food Programs HHVS also employs a Grant Coordinator, who performs professional and financial duties for the Services for Seniors program. The employee works closely with the fiscal component of the Services for Seniors program and provides data entry into the Client Information Resource Tracking System (CIRTS). Additional responsibilities include receiving invoices for vendor's services and provide billing data to Senior Choices for payment to the respective vendors. In addition, the Grant Coordinator provides oversight for the services and contribution reports that report the number of units and the amount of funds expended to date and variance from current spending patterns. This information is reviewed by program and fiscal staff on a regular/weekly basis to ensure appropriate spending patterns associated with client needs are being established for both the current individuals and new clients associated with the service. Fiscal staff communicates information to the Grants Coordinator in order to maintain the requirements of grants associated with the lead agency responsibilities. The Grant coordinator is supported by a Manager/Federal and State Grants with extensive experience in grant and contract management as well as a social services background. The Nutrition Program directly provides nutrition education, outreach services and meals. The lead agency contracts with a Registered Dietician for nutritional counseling services and authorizing use of nutritional education, menus and meal data cycle analysis. The Services for Seniors program utilizes the Limited English Proficiency program as well as nutrition staff members for translation with the clients that don't speak English. There is a case manager assistant available for home bound client assessments and speaking to clients on the telephone. The case manager assistant aide has over one year of experience working with clients in Collier County and assists clients weekly. Q2. Client Targeting and Outreach: Targeting Goals: For the 2014 OAA contract year, this agency expects to provide service to 250 total (unduplicated) clients annually. • Of these clients, we anticipate that 200 (80%) clients will be 60+ below poverty level minority clients. 9 0 • 80 clients will be 60+ below poverty level non-minority clients. • Additionally, we expect to provide service to 3 clients living in the rural area of our county. Our plan to meet the above targeting goals is as follows: HHVS continues to expend funding for the congregate meal program by cultivating relationships with other senior oriented groups, churches, food pantries and stores. We have opened two additional sites since we began in 2007 adding an additional 200 episodic clients to our base. We attend expos whenever the opportunity exists. We have flyers at all Collier County parks and community centers. Through community networking, we can continue to serve the needy senior population of Collier County. We will distribute flyers, menus and activity calendars to appropriate senior-frequented establishments. The home delivery program serves approximately 120 clients daily and is at capacity. We also partner with the following agencies: Senior Choices Guadalupe Social Services Marion Fether Clinic/ Immokalee Horizons Clinic/Naples Salvation Army The Society of St. Vincent de Paul Naples Community Hospital and its satellite facilities Physician's Regional Medical Center Collier County Social Services Cancer Alliance of Naples The Alzheimer's Support Network Sheriff's Senior Services Division Collier County Sheriff's Office Senior Services Unit The Parkinsons' Association The Shelter for Abused Women and Children Cypress Run and Bromelia House in Immokalee Experience Works Collier County University of Florida Extension Lee County University of Florida Extension These and many other agencies and entities figure into the department's outreach plan, along with maintaining a continuous presence at senior centers, public events, presentations, speaking engagements, interagency councils, and community centers, and by utilizing our public information staff. Case managers are also active in various community organizations which create even more opportunity for outreach. Collier has a slightly older population than the state average and many more retirees arriving each year. The county is also seeing a huge growth in the number of immigrants from Mexico, Latin America, and Haiti. The growing Hispanic community makes up 25.6 percent of the population with many of those first-generation immigrants speaking only their native language. As a result, there is significant linguistic isolation (English not spoken in the home), particularly in the areas of Golden Gate City and Immokalee. The 10 c10 department has outreach for this population and access to a network of translators for multiple languages. Both the informational website and informational brochures are available in Spanish. HHVS addresses the needs of the BPL (below poverty level) elder population by providing for nutritional needs and nutritional counseling, facilitating access to transportation services, assistance with prescription and medical care costs, in-home personal and housekeeping care, emergency alert systems, caregiver support, day care for dementia patients, and more, with outreach with and through networks it has created and fostered for many years. HHVS continues to strive to meet the needs of Collier's most frail and vulnerable populations, thus meeting the target goals for Collier County. Q3. Client Confidentiality Safeguards: (Specify procedures and training efforts. Include copy of privacy notice) HHVS is committed to providing confidentiality for all clients receiving, or waiting to receive, services from OAA and other programs that we administer. Our networks have restricted access to further ensure confidentiality of our clients. CCHHVS has and follows a Health Insurance Portability and Accountability Act (HIPAA) Standard Operating Procedure which has been attached to the Master Documents (Appendix I). All employees are cognizant of the Health Insurance Portability and Accountability Act of 1996 and have signed a Confidentiality Agreement. Employees are trained in HIPAA regulations and are knowledgeable of how to contact the Privacy Officer in the Department should a client request information regarding the privacy practices. HHVS staff is careful with client information when dealing with other agencies. Only that information which needs to be shared in order to provide the best service and ensure the clients safety is given out on a need to know basis. All Services for Seniors staff is considered in the circle of need to know. Client files are kept in lockable file cabinets. The intake information for the waiting list and other files relating to clients, are in lockable file cabinets as well. Closed files are maintained for the mandated five years in locked filing cabinets or off-site storage. After the time is up, they are shredded. Files can only be accessed by authorized nutrition staff. Access to CIRTS is safeguarded by individual passwords that are initiated and changed periodically by the Senior Choices of Southwest Florida. When services are available to meet the client's needs, staff members of HHVS explains the process of authorizing services to the client and obtains a signed Release of Information form. This release gives the staff permission from the client to give pertinent data to the service provider agency so that services can be arranged and provided. This release also allows the staff to access other services and resources on behalf of the client. All HHVS clients are notified of their right to privacy of protected health information. Services for Seniors clients, upon receipt of the Notice of Privacy Practices, signs a 6.40 statement confirming receipt of this notice. This confirmation is maintained in the client's file. Q4. Grievance Procedures / Process for Reducing or Terminating Services: (Include copy of material given to clients, procedures and method of determining which clients will receive reductions or termination of services.) At the time of enrollment through completing the required assessment, staff will explain the Grievance Procedure to the client. A copy of the Grievance Procedure, as well as the "Minimum Guidelines for Recipient Grievance Procedures Applicable to All Adverse Actions Deemed Terminations, Suspensions, or Reductions in Service" is given to the client. The client signs the Grievance Procedure confirming this procedure has been explained and is maintained in the client's file. When a client files a grievance and requests to implement the appeal process, the supervisor references this document and includes a copy of the signed form in the correspondence to the client. CCHHVS has a Standard Operating Procedure for the Seniors Program related to the Grievance Procedure. A copy of the Standard Operating Procedure, Grievance Procedure and the Minimum Guidelines are included in the Master Documents (Appendix II). If a client is being considered for reduction of service, the supervisor will consider the impact of the reduction. If the client will be put "at risk" and no non-DOEA service is available to offset the risk, then no reduction will be made. If the client is able to absorb the change and/or the services is available through another source, the client will be given ten (10) days notice in order to "grieve" the decision. This same process will also be applied to the termination of service. If the client requests a reduction or termination of service on their own, the ten (10) day rule and the right to grieve will not apply. Notification of any adverse actions (such has reducing or terminating services) is completed by sending a letter to the client at least 10 days in advance of any action with information related to the Grievance Procedure. If the client chooses to implement the Grievance Procedure, services cannot be reduced or terminated during this process. All actions taken are to be documented clearly by the coordinator or Supervisor in the client's case narratives and all correspondence maintained in their files. Q5. Plan For Coordination Between aging network providers: (Include plan for sending/receiving referrals, sharing clients, coordination of services Eligible home bound clients are acquired through the wait list established by Senior Choices. Any clients who contact nutrition staff directly are referred to Senior Choices. They are then contacted by a nutrition staff member to schedule an appointment. After an assessment has been completed, Meal vendor is contacted and instructed to add the client to the home delivery meal route list. Congregate clients can initiate enrollment by calling the nutrition program directly or walking in at their local meal site if funding is available; otherwise they would be referred to Senior Choices. Meal vendor is then instructed to send a meal on behalf of the client. Any clients that appear to need additional services are referred to a local resource. Case managed clients who qualify for meals can be referred to the nutrition program by their case manager. Case managers and the supervisor work together in enrolling, discontinuing, placing on hold, resuming, adding and reducing meals for clients. 12 0 Q6. Plan to Maintain Quality Control and Monitor Client Satisfaction: (Describe both internal and external methods to assure quality services and process for determining consumer satisfaction. Include sample satisfaction surveys. Include procedures for handling client complaints grievances and unusual incidents.) Housing, Human and Veteran Services has developed both internal and external methods to assure quality services and to determine client satisfaction. All meal sites are monitored on a quarterly basis for program compliance. For new clients, a two week follow up is given. Annual satisfaction surveys are distributed to all participants and results are reviewed carefully. When presenting new menu items, meal site coordinators verbally query participants for their satisfaction and randomly on meals that are served on every menu cycle. Clients are encouraged to attend semi-annual Advisory Council meetings to express areas of concern, likes and dislikes, questions and comments. Home delivered routes are monitored quarterly for cleanliness, use of appropriate holding equipment; verification that clients are actually receiving meals and to ensure meals are at proper temperatures. External effectiveness is also evaluated through both programmatic and contractual grantor monitoring. Through this process we are notified of any deficiencies and suggestions for corrective actions. As a proactive measure, this agency initiates an annual satisfaction survey to each client we serve. The feedback is invaluable in providing what we do well and areas needing improvement. The survey also allows clients to voice areas of need and what other community resources might better fulfill their needs. All clients are surveyed annually and receive contact information through the monthly nutrition education they receive. All complaints are noted, addressed and followed up on, as applicable. Meals complaints are addressed with the vendor at time of occurrence and during the annual monitoring. Program complaints are addressed by either assessing and correcting said issue or asking client if they have a suggestion. Grievances are guided by the grievance procedure (attached). Unusual incidents, dealt with on an individual basis, are documented and followed up with if necessary. If changes need to be made or situations need to be addressed polices will be followed Every effort is made to accommodate clients' needs and preferences. As a result of the above, the Collier County Nutrition Program maintains a high level of accountability. We are committed to using these various tools to provide an effective program servicing the nutritional needs of Collier County's elderly. Sample of satisfaction surveys (Appendix Ill). Q7. Please provide a list of Meal Site locations: Golden Gate Community Center 4701 Golden Gate Parkway Naples, FL 34116 239-252-4195 East Naples Community Park 3500 Thomasson Dr. Naples, FL 34112 239-774-2956 13 0 Roberts Center 905 West Roberts Ave. Immokalee, FL 34142 239-657-2823 Goodlette Arms 950 Goodlette Road N. Naples, FL 34102 239-252-2233 Service Delivery (SD) a. Description of Service Delivery and Coordination Plan: (Provide one sheet for each of the services that you propose to provide) Nutrition Services: Congregate Meals Congregate Meals Screening Home Delivered Meals Outreach Nutrition Education Nutrition Counseling Home Delivered Meal Screening and Assessment 14 S SERVICE DELIVERY AND COORDINATION SERVICE: Congregate Meals SITE LOCATION/S: (If different from Summary Page; provider may attach a list of sites.) FUNDING: X III-C-1, ❑ III-C-2, PROVIDED: Directly X To Be Subcontracted DAYS AVAILABLE: Goodlette Arms Monday, Wednesday, Friday except Holidays. All other sites Monday-Friday except for Holidays HOURS AVAILABLE: 8:30 am- 1:00 pm at Roberts Center; 11:00 am- 1:00 pm East Naples, Golden Gate Community and 11:00 a.m. - 12:00 p.m. at Goodlette Arms. ACTIVITIES INCLUDED: Provide a noontime meal (Roberts Center includes breakfast) to eligible clients at 4 sites following all regulations regarding safe food handling, temperatures, and minimum RDA compliance. The meal site coordinator completes the 701C. Educational, nutritional and physical activities and programs are coordinated by the Housing, Human and Veteran Services Dept. M-F from 11-1 in Naples (Goodlette Arms provides their own activities) and 9-12 in Immokalee. COORDINATION Clients who walk in will be provided a guest meal and then information will be METHODS USED TO obtained by the Meal Site Coordinator to complete the assessment. Clients will be ASSURE CLIENT required to sign in and pre-register for meals to avoid over and under-ordering. CIMS CHOICE, SERVICE and CIRTS are checked to verify clients are not already receiving home delivered AUTHORIZATION meals. AND AVOIDANCE OF DUPLICATION OF SERVICE. COMMUNICATION Clients interested in meals can call or stop by a meal site. If there is availability, client PROCESS BETWEEN can enroll; otherwise client is referred to the Elder Helpline to get on the wait list. AGENCY, PROVIDER Client waitlist is checked monthly when funds are available to add clients. Once an &CLIENT opening becomes available, client can be enrolled. USE OF PROGRAM INCOME-HOW WILL IT BE USED TO Meals are provided free, however clients have the option of making a donation and INCREASE these monies will be used to provide more meals. AVAILABILITY OF SERVICE? APPLICANT, PLEASE COMPLETE: We will provide the a ve se ice in all areas of the county or counties we propose to serve. N----k60 ' Signature of authorize• a. •ncy epresentative SDI 7 Approved as to form and legality �A �� 15 �s,sis`tant Co Attorney C® SERVICE DELIVERY AND COORDINATION SERVICE: Congregate Meals Screening SITE LOCATION/S: (If different from Summary Page; provider may attach a list of sites.) FUNDING: M III-C-1, ❑ III-C-2 PROVIDED: x Directly To Be Subcontracted DAYS AVAILABLE: Monday - Friday HOURS AVAILABLE: 8:30 am- 1:00 pm at Roberts Center; 11:00 am- 1:00 pm East Naples, Golden Gate Community and 11:00 a.m. - 12:00 p.m. at Goodlette Arms. ACTIVITIES Interviewing clients and potential clients through the use of standard screening INCLUDED: assessment instruments (701C) and processing necessary paperwork to determine need/eligibility for meals. Service will be performed by meal site coordinator, supervisor or case manager assistant. COORDINATION METHODS USED TO All clients will be given choice when available. Potential clients and existing clients ASSURE CLIENT receive screening annually to confirm their needs and eligibility. Any indication from CHOICE, SERVICE client or staff that client's needs have changed may result in referral to case AUTHORIZATION management staff. Client files include all required paperwork and signed documentations. CIMS and CIRTS are checked to see if client is already receiving AND AVOIDANCE OF services in another program/territory. DUPLICATION OF SERVICE. COMMUNICATION PROCESS BETWEEN All paperwork will be kept up to date and communicated to all staff and providers AGENCY, PROVIDER including service authorizations, terminations and updated assessment information. &CLIENT USE OF PROGRAM INCOME-HOW WILL IT BE USED TO N/A INCREASE AVAILABILITY OF SERVICE? APPLICANT, PLEASE COMPLETE: We will provide the above service in all areas of the county or counties we propose to serve. Signature of authorized •ency representative SD1 Approved as to form and legality 16 Assistant unty Attorney CD SERVICE DELIVERY AND COORDINATION SERVICE: Home Delivered Meals SITE LOCATION/S: (If different from Summary Page; provider may attach a list of sites.) FUNDING: ❑ III-C-1, Fl III-C-2 PROVIDED: Directly x To Be Subcontracted DAYS AVAILABLE: Monday—Friday HOURS AVAILABLE: 8:00 am—5:00 pm (frozen) ACTIVITIES Delivery of frozen home delivered meals to frail and homebound clients throughout INCLUDED: Collier County. All regulations regarding meal delivery times, temperatures and RDA compliance and quarterly monitoring will be strictly adhered to. COORDINATION METHODS USED TO Home delivered meals clients are assessed and referred to Senior Choices, case ASSURE CLIENT managers, case management supervisor, nutrition staff, or the supervisor and a CHOICE, SERVICE service authorization completed. Clients will receive home delivered meals the AUTHORIZATION following week; however same day meal service will be possible if necessary. Frozen meals are offered to clients who receive this service. Most clients will receive AND AVOIDANCE OF either 5 or 7 meals a week but clients with an extreme need can be considered for 14 DUPLICATION OF meals. The Supervisor of Food Programs coordinates and oversees meal routes SERVICE. which are all positioned county wide. The assessor will complete the Client Evaluation Form for Frozen Meals to determine their ability to safely utilize the frozen choice. A Service Order/Change Order for case managed clients will be completed and forwarded to the supervisor when a change is needed. CIMS and CIRTS are checked to see if client is already receiving services in another program/territory COMMUNICATION The nutrition staff or dietician will inform the case manager or supervisor immediately PROCESS BETWEEN of problems, changes or health issues noticed in clients.Client waitlist is checked AGENCY, PROVIDER monthly when funds are available to add clients. Once an opening becomes &CLIENT available, client can be enrolled. USE OF PROGRAM INCOME—HOW WILL IT BE USED TO N/A INCREASE AVAILABILITY OF SERVICE? APPLICANT, PLEASE COMPLETE: We will • ovide the ..ove ervice in all areas of the county or counties we propose to serve. Sign. ure of authorized :genc representative / SD1 Approved as to form and legality erkmd Assistant C unty Attorney SERVICE DELIVERY AND COORDINATION SERVICE: Home Delivered Meals Screening and Assessment SITE LOCATION/S: (If different from Summary Page; provider may attach a list of sites.) FUNDING: ❑ III-C-1, M III-C-2 PROVIDED: x Directly To Be Subcontracted DAYS AVAILABLE: Monday- Friday HOURS AVAILABLE: 8 am-5 pm ACTIVITIES Upon the noting on the wait list that the client is next to be seen based on the priority INCLUDED: score, a nutrition staff member will arrange for and complete a home visit. The client is assessed with the OAA portion of the 701A. IIIC clients must be screened and assessed annually. Case managed clients who also receive home delivered meals are assessed annually by their case manager. COORDINATION At the time of the home visit the staff member will apprise the client of available METHODS USED TO resources and screen for eligibility for other programs not part of the nutrition program. If the client chooses to receive services through the Services for Seniors ASSURE CLIENT program, the client and staff member will determine needed services and resources CHOICE, SERVICE available. AUTHORIZATION The provider for the meal service is discussed with the client and the assessor will AND AVOIDANCE OF explain the procedure while reasonably accommodating all the clients' requests. DUPLICATION OF Authorization is sent to the agency to provide said service. CIMS and CIRTS data SERVICE. base will be checked to ensure client is not already receiving any meals services through HHVS. COMMUNICATION Communication is open between the sites/providers and CCHHVS to ensure that the PROCESS BETWEEN appropriate service is being provided to each person. Communication between the AGENCY, PROVIDER client and CCHHVS is always open to address any service provision issues, to assure satisfaction with service and to assure the clients' needs are being met. The &CLIENT nutrition program has a dedicated phone line for all meal clients to call for information. USE OF PROGRAM INCOME-HOW WILL IT BE USED TO N/A INCREASE AVAILABILITY OF SERVICE? APPLICANT, PLEASE COMPLETE: We il�ide tfb,e a• e s , e in all areas of the county or counties we propose to serve. Signature of authorized .,gen- y representative SDI Approved as to form and legality 18 ssistant Cou Attorney SERVICE DELIVERY AND COORDINATION SERVICE: Nutrition Counseling SITE LOCATION/S: (If different from Summary Page; provider may attach a list of sites.) FUNDING: ❑ M Ill-C-1, Fj III-C-2 PROVIDED: Directly x To Be Subcontracted DAYS AVAILABLE: Monday-Friday by appointment or published presentation HOURS AVAILABLE: 8 am-5 pm or by appointment ACTIVITIES Individualized advice and guidance to elders at nutritional risk due to history, dietary INCLUDED: intake, medication use or illness. Counseling will be provided at congregate meals sites either by group or individually and by phone or home visit for homebound clients. Counseling will be conducted by our nutrition consultant, who is a Registered Dietician. COORDINATION METHODS USED TO Although nutritional counseling will be primarily utilized by nutrition services clients, ASSURE CLIENT case management staff may refer high risk clients not receiving meals who could CHOICE, SERVICE benefit. A nutrition counseling referral will be filled out by the case management staff AUTHORIZATION and forwarded to the nutrition consultant to initiate the service. AND AVOIDANCE OF DUPLICATION OF SERVICE. COMMUNICATION The nutrition consultant notifies the supervisor immediately of problems, health PROCESS BETWEEN issues or decline of the client. Clients who qualify for NUCO will receive service if AGENCY, PROVIDER they would like to receive it. Clients not eligible but still interested in NUCO will &CLIENT receive service if funds are available. USE OF PROGRAM INCOME-HOW WILL IT BE USED TO N/A INCREASE AVAILABILITY OF SERVICE? APPLICANT, PLEASE COMPLETE: We will provide the above service in all areas of the county or counties we propose to serve. ' _- e' -4'e 0 Signa ure of authorized a ncy epresentative SDI Approved as to form and legality Vi er9G4:31 Assistant Co my Attorney 19 G C, SERVICE DELIVERY AND COORDINATION SERVICE: Nutrition Education SITE LOCATION/S: (If different from Summary Page; provider may attach a list of sites.) FUNDING: M III-C-1, M III-C-2 PROVIDED: X Directly X To Be Subcontracted DAYS AVAILABLE: Monday-Friday or by appointment HOURS AVAILABLE: 8 am—5 pm or by appointment or published presentation ACTIVITIES A program of regularly scheduled presentations is provided in a group setting at the INCLUDED: meal sites done by or overseen by our nutrition consultant. Activities include preparation of visual aids and printed handouts. Talks at meal sites and guide materials are also used to train staff in the nutrition program. Nutrition material such as brochures, newsletters or pamphlets will be delivered to home meals clients through mail delivery. Clients and caregivers may call the nutrition staff to discuss. COORDINATION METHODS USED TO Although nutrition education is primarily utilized by nutrition services clients our sites ASSURE CLIENT are open to and can accommodate clients from all programs. Services for Seniors CHOICE, SERVICE staff members can encourage all clients to participate. Any senior interested in only AUTHORIZATION nutrition education is welcome to come to any of our sites as a guest. All meal clients receive nutrition education on a monthly basis. Signature sheets and meal route lists AND AVOIDANCE OF are checked to ensure clients are not double billed. DUPLICATION OF SERVICE. COMMUNICATION Nutrition consultant notifies case manager or supervisor immediately with any PROCESS BETWEEN concerns, health issues or client decline. All clients added for meals receive this AGENCY, PROVIDER service. Once service has been provided documentation is sent to Senior Choices &CLIENT verifying who received Nutrition Education for the month and what the topic was. USE OF PROGRAM INCOME—HOW WILL IT BE USED TO N/A INCREASE AVAILABILITY OF SERVICE? APPLICANT, PLEASE COMPLETE: We will provide the above service in all areas of the county or counties we propose to serve. Signature of authorized ag,en'y representative / Approved as to form and legality SD1 20 ssistant Co my Attorney 40 SERVICE DELIVERY AND COORDINATION SERVICE: Nutrition Outreach SITE LOCATION/S: (If different from Summary Page; provider may attach a list of sites.) FUNDING: Fi III-C-1, 171 III-C-2 PROVIDED: x Directly To Be Subcontracted DAYS AVAILABLE: Outreach is scheduled whenever there is an opportunity to present information for the elderly to appropriate individuals HOURS AVAILABLE: See above ACTIVITIES Outreach efforts are targeted to all elders in the community with special efforts to INCLUDED: reach those in low income, minority or less accessible areas. This includes participation in health fairs, senior expos, exhibits and other activities where seniors would be present. It also includes speaking engagements, distribution of brochures, news articles, web site information and participation in local interagency organizations and groups that includes professionals or service providers who have regular contact with seniors. COORDINATION Efforts are made to reach areas of greatest social and economic needs, METHODS USED TO neighborhoods with large numbers of low income, minority elderly and also rural ASSURE CLIENT areas. The goal is to identify service needs and link potential participants to CHOICE, SERVICE appropriate and available resources. Coordinated publicity via various media outlets, AUTHORIZATION local community papers and speaking opportunities at neighborhood events or AND AVOIDANCE OF churches will be coordinated among key staff in the nutrition program area, services DUPLICATION OF for seniors and the public services division. SERVICE. COMMUNICATION Constant communication through staff meetings, memos, calendars and flyers will PROCESS BETWEEN keep agency, provider and client informed of outreach efforts and potential program AGENCY, PROVIDER participation. &CLIENT USE OF PROGRAM INCOME-HOW WILL IT BE USED TO N/A INCREASE AVAILABILITY OF SERVICE? APPLICANT, PLEASE COMPLETE: We will provide the abo e service in all areas of the county or counties we propose to serve. Signature of authorized -.e cy epresentative Approved as to form and legality � 21 ssistant C my Attorney Nutrition Assurances: In accordance with the nutrition requirements of Title III-C of the Older Americans Act Janet Calderwood R.D., L.D./N (Name of Nutrition Consultant) will provide Nutrition Consultation for the congregate / home delivered meals program of Collier County Housing, Human and Veteran Services (Name of Provider) Janet Calderwood R.D., L.D./N (Name of Nutrition Consultant) is a registered/licensed dietitian whose current registration number from the Commission on Dietetic Registration is: 926084 and/or whose license number from the Florida Department of Professional Regulation is: , or whose qualifications the Area Agency's nutrition consultant or the Department of Elder Affairs has approved. The Nutrition Consultant Agreement for Services and a current resume of the Nutrition Consultant will be included in the proposal at the beginning of each bid cycle and updated when there is a staff change. Collier County Housing, Human and Veteran Services. (Name of Provider) also agrees that all menus will be submitted to Senior Choices prior to their use and after the Provider's RD / LDN has reviewed, approved and signed the menus. This approval will assure that each meal complies with the current Dietary Reference Intake/Adequate Intake (DRI/AI) and Dietary Guidelines For Americans, published by the Secretary of Health and Human Services and the Secretary of Agriculture, based on the documentation of a computerized assisted nutrient analysis. l (3 Project Director Signature Date Menus: Address special menus for both congregate and home delivered meals, choice of meals and/or provider for home delivered meals. Al 22 Statement of Compliance with Service Standards and Requirements: I, Leo E. Ochs, Jr. have read and understand the requirements and standards for the services included in this Request for Proposal for which my agency/company, Collier County Housing, Human and Veteran Services, is bidding. I hereby issue this statement of assurance that this agency/company is in compliance with and is able to meet all of the requirements and standards noted in both the Department of Elder Affairs July 2013 Client Services Manual and the Home and Community Based Services Handbook for services included in this proposal. 8/27/2013 Authorized Represent ve Date Approved as to form and legality Assistant Co ty Attorney A2 23 HIPAA Compliance Assurance: I, Leo E. Ochs, Jr. , as an authorized representative of Collier County Housing, Human and Veteran Services , hereby issue this statement of assurance that this agency/company has determined that: [X] it is considered a "covered entity" and is in compliance with and is able to meet all of the requirements of the Health Insurance Portability and Accountability Act of 1996. [ ] it is not considered a "covered entity," but will comply with the intent of the Act in the areas of privacy, security and billing. Authorized Represe Kati e 8/27/2013 Date Approved as to form and legality Assistant Cou ty Attorney A3 24 Certification (signed statement) of availability of 60 days operating funds: I, Leo E. Ochs, Jr. , as an authorized representative of Collier County Housing, Human and Veteran Services, certify that this firm has and maintains sufficient funds to continue operating at current levels for a minimum of 60 days. � C•- Authorized Repre tative 8/27/2013 Date Approved as to form and legality Assistant Coun Attorney A4 25 Statement of No Involvement and Contract Terms and Conditions: STATEMENT OF NO INVOLVEMENT I, Leo E. Ochs, Jr., as an authorized representative of Collier County Housing, Human and Veteran Services, certify that no member of firm nor any person having interest in this firm has been awarded a contract by the Department of Elder Affairs on a noncompetitive basis to: (1 ) develop this Request for Proposal; (2) perform a feasibility study concerning the scope of work contained in this RFP; or (3) develop a program similar to what is contained in this RFP. • � Authori ed Represent., i 'e 8/27/2013 Date Approved as to form and legality CA SLR ssistant Count Attorney A5 26 \ ^ j CONTRACT TERMS AND CONDITIONS I, Leo E. Ochs, Jr., as an authorized representative of Collier County Housing, Human and Veteran Services , certify that this firm agrees to all the terms and conditions of the contract as set forth in this Request For Proposal. p Authorized Repre 8/27/2013 Date Approved as to form and legality ssistant Coun ttorney A6 27 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION CONTRACTS/SUBCONTRACTS This certification is required by the regulation implementing Executive Order 12549, Debarment and Suspension, signed February 18, 1986. The guidelines were published in the May 29, 1987 Federal Register (52 Federal Register, pages 20360-20369). (1) The prospective recipient certifies, by signing this certification, that neither he nor his principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in contracting with the Department of Elder Affairs by any federal department or agency. (2) Where the prospective recipient is unable to certify to any of the statements in this certification, such prospective recipient shall attach an explanation to this certification. Signature (. Date [ Leo E. Ochs, Jr., County Manager Name and Title of Authorized Individual Approved as to form and legality (Print or type) �. Assistant Coun ; ttorney Collier County Housing, Human and Veteran Services Name of Organization A7 28 ADMINISTRATIVE ASSESSMENT OF POTENTIAL PROVIDERS Agency: Collier County Housing, Human and Veteran Services Date: 8/23/2013 Address: 3339 Tamiami Trail E. Suite 211 No. of employees: 40 Naples, FL 34112 No. of locations of business: 1 Director/Owner' s Name: Kimberley Grant Administrative Assessment: An assessment of your organizations managerial, financial, and administrative capabilities will be made on the basis of your response. If any response is other than "yes" or"no", please reference the appropriate question and give your response on a separate page. This information must be completed and returned with the response to our Request for Proposal. Fl 29 ADMINISTRATIVE ASSESSMENT CHECKLIST YES NO OTHER 1 Procurement Are written purchasing policies for procurement of supplies, equipment, x construction, and other services on file? 2 Accounting a. Are financial reports prepared monthly for internal management purposes? x b. Does an independent auditor perform a certified audit annually? x c. Are basic books of accounting maintained? x (1) General ledgers x (2) Project ledgers x (3) Accounts receivable/cash x (4) Accounts payable/cash Disbursement journal x d. Is there adequate segregation of duties among personnel in the accounting x functions listed below? (1) Is payroll prepared by someone other than the timekeepers and persons who x deliver paychecks to employees? (2) Are duties of the bookkeeper separate from cash-related functions? x (3) Is the signing of checks limited to those authorized to make disbursements x and whose duties exclude posting and recording of cash received? (4) Are personnel performing disbursement functions excluded from the x purchasing, receiving, inventory, and general ledger services? (5) Are accounting records retained for a period of 5 years? x (6) Does Provider maintain adequate liability insurance coverage? x 3 Personnel a. Are personnel policies in writing and approved by appropriate authority? x b. Are job descriptions provided to all employees at time of initial employment? x c. Are job descriptions on file for all positions? x d. Is each staff member appraised on performance, at least annually? x e. Are staff members asked to review and comment on their evaluations? x Fl 30 \ r MATCH COMMITMENT OF CASH DONATION [X ] Original, dated 8/23/2013 SFY: FFY: 14 Contract Amendment# Agency Name: Collier County HHVS Program: X III-C-1,X III-C-2, Donor Identification: Name: Collier County Housing Human and Veteran Services Street: 3339 Tamiami Trail E, Suite, 211 City: Naples State: FL Zip: 34112 Phone: 239-252-2273 Authorized Representative: Leo E. Ochs, Jr., County Manager Total Amount # Payments Amount/Payment Contribution Period $30,693.39 12 $2,557.78 Jan. 1- Dec. 31, 2014 Special Conditions: Third Party Donors: (Please identify all sources of this cash donation below) ❑ County Government: ❑ City Government: ❑ City Government: ❑ Other: Donor Certification: I hereby certify intent to make the cash donation set forth above for use in the specified program during the program's upcoming funding period. This cash is not included as contribution for any other State or Federally assisted program or any Federal contract and is not borne by the Federal government directly or indiretly under any federal grant or contract. X � Date: S � Signatu`r of Donor or Repre tative F2 Approved as to form and legality 31 Assistant County Tn,rney MATCH COMMITMENT FOR DONATION OF BUILDING SPACE [ ] Original, dated SFY: FFY: Contract Amendment# Agency Name: N/A Program: ❑ III-C-1, ❑ III-C-2, Donor Identification: N/A Name: Street: City: State: Zip: Phone: Authorized Representative: Description of Space: [ ] Office [ ] Site [ ] Other Provider Owned Space: 1. Number of square feet used by project sq.ft. 2. Appraised rental value per square foot $ /sq.ft. 3. Total value of space used by project (1x2) $ Donor Owned Space: 1. Established monthly rental value $ 2. Number of months rent to be paid by donor months 3. Value of donated space (1x2) $ Special Conditions: Donor Certification: The space being donated is owned and 'donated' by: I hereby certify intent to donate use of the space set forth above for the program specified above during the program's upcoming funding period. This space is not being used as match for any other State or Federal program or contract. X Date: Signature of Donor or Representative F3 32 MATCH COMMITMENT OF SUPPLIES [ ] Original, dated SFY: FFY: Contract Amendment# Agency Name: N/A Program: ❑ III-C-1, ❑ III-C-2, Donor Identification: N/A Name: Street: City: State: Zip: Phone: Authorized Representative: Description of Supplies: The below described supplies are committed for use by the project for the period of: (From) (To) Computation of Value: Value to be claimed by project: $ Special Conditions: Donor Certification: I hereby certify intent to donate these supplies for the program specified above during the program's upcoming funding period. These supplies are not being used as match for any other State or Federally assisted program or contract. X Date: Signature of Donor or Representative F4 33 MATCH COMMITMENT OF EQUIPMENT [ ] Original, dated SFY: FFY: Contract Amendment#_ Agency Name: N/A Program: ❑ III-C-1, ❑ III-C-2, Donor Identification: N/A Name: Street: City: State: Zip: Phone: Authorized Representative: Description of Equipment: The below described equipment is committed for use by the project for the period of: (From) (To) Acquisition Description of Item Number Cost Value to Protect* 1. 2. 3. 4. 5. Total Value Claimed: *Items that are currently owned by the Grantee or are loaned or donated to the project are valued at an annual rate of 6-2/3 percent of the acquisition value. Donor Certification: This equipment is not included as a contribution for any other State or Federally Assisted program or contract and costs are not borne by the Federal Government directly or indirectly under any Federal grant or contract except as provided for under: (cite the authorizing Federal regulation or law if applicable). X Date: Signature of Donor or Representative F5 34 �1. MATCH COMMITMENT OF IN-KIND CONTRIBUTION OF SERVICES BY STAFF OF SERVICE PROVIDER OR STAFF OF OTHER ORGANIZATIONS [ ] Original, dated SFY: FFY: Contract Amendment# Agency Name: N/A Program: ❑ III-C-1, ❑ III-C-2, Donor Identification: N/A Name: Street: City: State: Zip: Phone: Authorized Representative: Descriptions of Positions: Position Hourly Rate or # Hours Value to Title Service Annual Salary Worked Proiect* 1. $ $ 2. $ $ 3. $ $ Total - $ *Value to project = (# of hours worked) x (Hourly rate) or (Annual Salary _ 2080 hrs) x (# of hours worked) Donor Certification: These services are not included as match for any other State or Federally Assisted program or contract and costs are not borne by the Federal Government directly or indirectly under any Federal grant or contract except as provided for under: (cite the authorizing Federal regulation or law if applicable). It is certified that the time devoted to the project will be performed during normal working hours. X Date: Signature of Donor or Representative F5 35 MATCH COMMITMENT OF IN-KIND VOLUNTEER PERSONNEL AND TRAVEL [ ] Original, dated SFY: FFY: Contract Amendment# Agency Name: N/A Program: ❑ III-C-1, ❑ III-C-2, Donor Identification: N/A Name: Street: City: State: Zip: Phone: Authorized Representative: The volunteer staff positions identified below will be filled by local volunteers who will be recruited, trained and supervised as an ongoing activity of our agency. We will maintain volunteer records to document individual volunteer activity. Describe Volunteer Effort: Equivalent # of Value Position Title Hourly Rate Hours to Project 1 $ $ 2 $ $ 3 $ $ TOTAL VALUE TO AGENCY $ Equivalent Hourly Rates were determined by: [ ] Rates for comparable positions within own agency. [ ] State Employment Service estimate of rates for type of work. [ ] Rates for comparable positions within other local agencies. ESTIMATED X RATE PER MILE = VALUE MILEAGE Donor Certification: I hereby certify that commitments have been received from individual volunteers or groups sufficient to provide the volunteer hours and travel identified above. X Date: Signature of Agency Official Name: F7 36 Acceptance of Service Rates In accordance with the contract requirements of Title IIIB and Title IIIE and Title IIIC of the Older Americans Act and this bid document Collier County Housing, Human and Veteran Services Agrees to provide the service proposed in this proposal for the approved contracted rates. 8/27/2013 Signature of Authoriz=: Agency Representative Date Approved as to form and legality Assistant C4inity Attorney F8 37 SERVICE UNIT RATE QUOTE Proposed Service Proposed Rate/s* Congregate Meals Total Unit cost $ 9.84 90% Reimbursement Rate $ 8.86 Home Delivered Meals Total Unit cost $ 9.77 90% Reimbursement Rate $ 8.79 Outreach Total Unit cost $ 4.80/per person 90% Reimbursement Rate $ 4.32/per person Nutrition Education Total Unit cost $ 1 .80 90% Reimbursement Rate $ 1 .62 Nutrition Counseling Total Unit cost $ 58.89 90% Reimbursement Rate $ 53.00 38 (7- SERVICE UNIT RATE QUOTE Proposed Service Proposed Rate/s Congregate Meal Screening Total Unit cost $ 31.11 90% Reimbursement Rate $ 28.00 Home Delivered Meals Screening and Assessment Total Unit cost $ 50.00 90% Reimbursement Rate $ 45.00 *Based upon current PSA 8 rates. 39 (,r) Appendix HIPPA (Notice of Privacy Practices) 40 Collier County Housing,Human&Veteran Services Department Standard Operating Procedures Health Insurance Portability and Accountability Act (Updated July 12, 2013) Purpose: The purpose of this policy is to ensure that all clients will be notified of their rights to privacy of protected health information, as required by the Health Insurance Portability and Accountability Act of 1996(HIPAA)Privacy Rule. Description: All clients will be given a copy of the Notice of Privacy Practices,which will explain how their health information may be used. Procedures: Staff: 1. All staff will read and become familiar with CMA 5207, SANCTIONS FOR FAILURE TO COMPLY WITH HIPAA POLICIES sign a Confidentiality form annually. New employees shall review CMA 5207 and complete the Confidentiality form with 10 business days of the commencement of employment. 2. Staff are not to share any Personal Health Information(PHI)of a client unless on a need to know basis. 3. Faxes are to be sent with cover sheets containing the confidentiality statement. 4. Emails with specific client information should be encrypted. ISPs in general are not encrypted. CIRTS is an encrypted system. 5. New employees shall complete training on HIPAA and the Standard Operating Procedures within 30 days of the commencement of employment. All other employees will receive this training annually. Training shall be conducted by the Department HIPAA Privacy Officer. 6. 7. The Department Privacy Officer shall be responsible for obtaining executed Business Associate Agreements from Business Associates. A standard Business Associate Agreement, approved as to legal sufficiently by the County Attorney's Office, shall be made available by the HIPAA Privacy Officer for use by affected County entities. The HIPAA Privacy Officer shall have the authority to execute the document on behalf of the County. The Department Privacy Officer shall obtain Business Associate Agreements at the commencement of new vendor Agreements or in accordance with the requirements set forth under Federal Law. Offices: 1. A copy of the Notice of Privacy Practices is displayed in the lobby. 2. Client related information and files are in lockable cabinets in secured offices after hours and on weekends. 3. A second key is kept in a case in the over-head cabinet at the Administrative Secretary's desk. 4. Schedules open to public view should not show client identifiable information. 41 5. Documents put in the file holders on the doors should have identifiable information turned in toward the door. 6. Place items face down on the Case Manager's chair or desk if that Case Manager is not in the room. If a Case Manager is conducting a home-visit,care should be given to PHI that is transported in a vehicle placing items face down so as not to be seen or revealed. 7. All records containing client information must be kept for seven years. 8. Computer monitors shall be placed in a manner that shall prevent intentional or inadvertent viewing by non essential parties.Verbal discussions of client PHI shall be avoided in public areas and shall be confined to private areas whenever possible. Social Services Program: 1. Clients are given an Intake form upon arrival to the office. 2. New clients will be given a copy of the Notice of Privacy Practices(NPP). 3. The Case Manager will explain the NPP and obtain the client's signature of receipt. 4. The client will sign the Authorization/Consent form indicating their receipt of the NPP. 5. The clients will be provided a copy of their signed Authorization/Consent form. 6. The original of the signed Consent is kept in the client's file. 7. Files should be re-filed immediately after the notes are completed. 8. Specific authorization does not have to be given by the client if the transaction is related to treatment or payment(see the NPP under Treatment). 9. Information can be shared with the family of a client provided the client has signed a release of information for the specific family member. Services for Seniors: 1. New clients will be given a copy of Notice of Privacy Practices.A signed receipt of the notice is maintained in the client's record. 2. The original signed consent form will be kept in the file.The client signs this form annually. 3. A copy of the Consent will be given to the client. 4. All faxes to any Vendor or the Senior Choices of Southwest Florida(AAA)will have a cover sheet with the confidentiality statement. 5. All emails will have the confidentiality statement(now available on Desktop). 6. CIRTS transactions are encrypted and are HIPAA compliant. 7. Care Plans do not need to be sent to Vendors for Chore only clients. 42 8. We are considered a Treatment entity and do not need specific authorization to access resources in the course of providing for the client's best interest over and beyond the Authorization. 9. Do not share information with anyone except on a need to know basis. All staff in the HHVS office are considered in the circle of need to know and need to comply by annually signing the HHVS Policy on Confidentiality; staff agree to protect all clients' HIPAA and confidential information. Miscellaneous: 1. If the client has a complaint or concern then they are to be referred to the Privacy Officer Assistant. 2. The clients have the right to request: ❑ Access to their records ❑ Amendments to their records ❑ Restriction to access of their records 3. The client has the right to file a complaint about the privacy policies. 4. The client's legal representative has the right to access the client's information in lieu of the client. 43 Appendix II Service for Seniors Grievance Procedure r County Public Services Division Housing,Human&Veteran services SERVICES FOR SENIORS GRIEVANCE PROCEDURE Collier County Services for Seniors staff endeavors to provide quality service to each of our clients.In the event of client disagreement with this agency's client care decisions; the following grievance procedure is available to all clients: Step 1: Discuss with your Case Manager the problematic issue. If resolution at this level does not meet your expectations: Step 2: A formal meeting*between the client,Case Manager,and Case Management Supervisor will be arranged.If resolution following this meeting is not acceptable: (*Phone conferences may be substituted) Step 3: A formal meeting between client, Case Management Supervisor,and Department Director will take place. If resolution following this meeting is not acceptable: Step 4: A written request by the client for a formal hearing with the Case Management Supervisor, Department Director,and Public Services Administrator will take place at the office of the Public Services Administrator. A written response detailing the date and time of this hearing will be sent to the client within 2 weeks of receipt of the client's request. Final determination of appropriate action on this level will be determined at this hearing. Address requests for this meeting to: Public Services Administrator 3339 Tamiami Trail East,Rm 217 Naples,FL 34112 Step 5: This decision may be appealed to the Area Agency on Aging by written request to: Senior Choices of Southwest Florida—Executive Director 15201 N.Cleveland Ave.,Suite#1100 North Fort Myers,FL 33903 Please be aware the case notes and any pertinent correspondence with the clients will be referenced throughout this process. If any part of this procedure requires further clarification,please call the Case Management Supervisor at 239-252-2696 Signature below confirms receipt of the"Minimum Guidelines for Recipient Grievance Procedures". Client Signature Date Cm Initials Client Signature Date Cm Initials Housing. Human and Veteran Servrces ar 3301 ERNI Tynan tad•Hoek aiTnp•Napbs,21 341t2 239 262 ORE Vt73)•2392S2OE t •27a 252-caFtivn).239,252RSP(Ti ►•ne-2524EFS PUP vow callagov.flogutensmiciek 45 MINIMUM GUIDEUNES FOR RECIPIENT GRIEVANCE PROCEDURES APPUCABLE TO ALL ADVERSE ACTIONS DEEMED TERMINATIONS, SUSPENSIONS OR REDUCTIONS IN SERVICE Medicaid Waiver clients have the right to request a fair hearing from the Department of Children and Families(DCAF)Office of Appeal Hearings in addition to or as an alternative to these procedures. NOTICE TO THE RECIPIENT OF ADVERSE ACTION TO BE TAKEN AND EXPLANATION OF THE GRIEVANCE PROCEDURES FOR REVIEWING THAT DECISION • The recipient must be informed by the decision maker of the action, in writing,no less than 10 calendar*days prior to the date of the adverse action will be taken. (Prior notice is not applicable where the health and safety of the individual is endangered If action is not taken Immediately; however, notice must be made as soon thereafter as practicable.) • Services cannot be reduced or terminated, nor any adverse action taken during the 10 day period. • The Notice must contain: • A statement of what action is intended to be taken; • The reason for the intended action; • An explanation of: 1. The individual's right to a grievance review if requested in writing and delivered within 10 calendars days of the Notice postmark (assistance in writing, submitting and delivering the request must be offered and available to the Individual); 2. In Medicaid Waiver actions,the individual's right to request a fair hearing from DCAF; 3. The Individual's right,after a grievance review,for further appeal; 4. The right to seek redress through the courts if applicable; a statement that current benefits will continue if a grievance review is requested, and will continue until a final decision is made regarding the adverse action; and a statement that the individual may represent himself/herself or use legal counsel,a relative,a friend,or other qualified representative in the requested review proceedings. • All records of the above activities must be preserved in the client's file. GRIEVANCE REVIEW PROCEDURE UPON TIMELY RECEIPT OF A WRITTEN REQUEST FOR REVIEW • Within 7 calendar*days of the receipt of a request for review,the provider must acknowledge receipt of the request by a written statement delivered to the requester.This statement must also provide notice of: o the time and place scheduled for the review; 1 46 o the designation of one or more impartial reviewers who have not been involved in the decision at issue; o the opportunity to examine, at a reasonable time before the review, the individuars own case record,and to a copy of such case record at no cost to the individual; o the opportunity to informally present argument,evidence,or witnesses without undue interference at a reasonable time before or during the review; o a contact person for any accommodations required under the Americans with Disabilities Act; and assistance, if needed, in order to attend the review; and the stopping of the intended action until all appeals are exhausted. • All grievance reviews must be conducted at a reasonable time,date and place by one or more impartial reviewers who have not been directly involved in the initial determination of the action in question. • The reviewer(s)must provide written notification to the requester,within 7 calendar*days after the grievance review,stating: o the decision,the reasons therefore in detail; o the effect of the decision has on current benefits, if favorable; or the circumstances regarding continuation of current benefits until all appeals are exhausted; o the individual's right to appeal an adverse decision to the Area Agency on Aging by written request within 7 calendar* days,except in decisions involving the professional judgment of a legal assistance provider; o the availability of assistance in writing, submitting and delivering the appeal to the appropriate agency; o the opportunity to be represented by himself/herself or by legal counsel,a relative,a friend or other qualified representative; o for legal assistance service appeals, the individual's right to file a grievance with the Florida Bar regarding complaints related to the actual legal representation provided. PROCEDURE FOR APPEALS OF A GRIEVANCE REVIEW DECISION UPON TIMELY RECEIPT OF A WRITTEN APPEAL TO THE AREA AGENCY ON AGING • Within 7 calendar*days of the receipt of a notice of appeal of a grievance review decision,the AAA must acknowledge receipt of the notice of appeal by a written statement delivered to the appellant. This statement must also provide notice of: o the time and place scheduled for the appeal; o the designation of one or more impartial AAA officials who have not been Involved in the decision at issue; o the opportunity to examine at a reasonable time before the appeal the individual's own case record to date,and to a copy of such case record at no cost to the individual; o the opportunity to informally present argument,evidence,or witnesses without undue interference during the appeal; 2 47 o assistance,if needed,in order to attend the appeal; o and the stopping of the intended action until all appeals are exhausted. • All appeals of grievance reviews must be conducted at a reasonable time,date and place by one or more Impartial AAA officials who have not been directly involved in the initial determination of the action in question. • The designated AAA official(s) must provide written notification to the requested within 7 calendar'days after considering the grievance review appeal,stating: o the decision,and the reasons therefore in detail; o the effect the decision has on current benefits, if favorable, or the circumstances regarding continuation of current benefits until all appeals are exhausted; o the individual's right to appeal,if applicable. • Except for Medicaid Waiver actions,the decision of the AAA shall be the final decision;and the availability of assistance in requesting a fair hearing, including a notice regarding accommodations as required by the ADA. • All records of the above activities must be preserved and remain confidential.A copy of the final decision must be placed in the client's file. *In computing any period of time prescribed or allowed by these guidelines,the last days of the period so computed shall be included unless it is a Saturday,Sunday or legal holiday,in which event the period shall run until the end of the next day which is neither a Saturday,Sunday or legal holiday. 3 48 Appendix III Sample of Satisfaction Surveys 49 Housing, Collier County Nutrition Services Human and Participant Satisfaction Survey - October 2012 Veteran ervices GGCC - Golden Gate of Collier County 1. Has your participation in the Collier Nutrition Program helped you feel less isolated? YES NO If Yes, How: 2. If you were depressed before coming, has your participation helped you feel less depressed? YES NO N/A If Yes, How: 3. In the time since you have been participating would you say that your emotional well being has improved? YES NO N/A If Yes, How: 4. In the time since you have been participating, have you learned more about good nutrition and healthy eating? YES NO 5. How long have you been eating at the Golden Gate site? 6. Is the staff friendly and helpful? YES NO 7. Are you happy with the selection of food? YES NO 8. Do the meals you receive taste good? YES NO 9. Are you happy with the activity programs?YES NO 10. What other activities would you like to see? Please list: 11. Are you happy with the amount of time you spend here? YES NO Additional comments, suggestions, ideas: Client Name: (OPTIONAL) Thank you for responding.! Coder County Public Services Divi Housing,Human&Veteran Services 50 Housing, in Collier County Nutrition Services Human and Participant Satisfaction Survey - October 2012 Veteran ervices IMMK - Immokalee of Collier County 1. Su participacion en el Programa de Nutricion Collier le ha ayudado a sentirse menos aislado? SI NO En caso afirmativo, iComo?: 2. 45u participacion le ha ayudado a sentirse menos solo? SI NO En caso afirmativo, e.Como?: 3. Si estdbas deprimido antes de venir, su participacion le ha ayudado a sentirse menos deprimido? SI NO N / En caso afirmativo, c.Como?: 4. En el tiempo transcurrido desde que ha estado participando usted diria que su bienestar emocional ha mejorado? SI NO N / En caso afirmativo, e.Como?: 5. En el tiempo transcurrido desde que han participado, ha aprendido mds sobre Ia buena nutricion y Ia alimentacion saludable? SI NO 6. t,Cudnto tiempo ha estado comiendo en el sitio Goodlette Arms? 7. Es el personal amable y servicial? SI NO 8. LEstd satisfecho con Ia seleccion de los alimentos? SI NO 9. e.Las comidas que recibe tienen buen sabor? SI NO 10. c.Estd satisfecho con Ia cantidad de tiempo que pasa aqui? SI NO Otros comentarios, sugerencias, ideas: Nombre del Cliente: (OPCIONAL) Gracias por responder! 51 Housing, Human and Veteran §ervices of Collier County Collier County Housing, Human and Veteran Services Home Delivered Meals 2012 Satisfaction Survey We continue to make efforts to provide our clients with healthy meals and educational materials. To help us better understand your needs and satisfaction with current services, please complete the following questions and return in the stamped envelope provided by October 26th. We appreciate your participation in the annual survey! 1. The person who delivers my meals is friendly. Yes No 2. My meals arrive at an appropriate time. Yes No What time do the meals arrive? Is this too early? Yes No 3. I am happy with the number of meals I get each week. Yes No 4. I have better knowledge of good nutrition and healthy eating habits since I began receiving meals. Yes No 5. I am happy with the selection of meals I receive. Yes No 6. My meals taste good to me. Yes No 7. I would like to receive Nutrition Counseling/ speak to a dietician to give advice on diet (if eligible). Yes No COMMENTS Name (optional) Phone Colter C cy Housng,Human&Veteran Services 52 Appendix IV Job Descriptions 53 Class Code: 15598 Pay Grade: 17 COLLIER COUNTY, FLORIDA CLASSIFICATION SPECIFICATION CLASSIFICATION TITLE: SUPERVISOR -FOOD PROGRAMS PURPOSE OF CLASSIFICATION The purpose of this classification is to supervise the congregate meal site program or home delivery meal program. This includes monitoring health and safety regulation per USDA, Older American's Act Guidelines, Community Development Block Grant Guidelines,supervising all meal personnel,and ensuring program compliance with federal,state and local rules and regulations. ESSENTIAL FUNCTIONS The following duties are normal for this position. The omission of specific statements of the duties does not exclude them from the classification if the work is similar, related, or a logical assignment for this classification. Other duties may be required and assigned. Supervises, directs, and evaluates assigned staff, processing employee concerns and problems, directing work, counseling, disciplining, and completing employee performance appraisals; conducts interviews and makes hiring recommendations. Coordinates daily work activities; organizes, prioritizes, and assigns work; monitors status of work in progress and inspects completed work; confers with assigned staff, assists with complex/problem situations, and provides technical expertise. Ensures adherence to meal service rules and regulations by following federal, state and county guidelines; maintains and remains current on all local sanitation and health laws, client confidentiality, and HIPAA rules and regulation; maintains and confirms proper cleaning and maintenance schedules are prepared and carried out. Ensures meals are delivered on time; oversees the delivery of food, maintenance of temperature logs for submission to grantor agency. Ensures the quality and the quantity of meals delivered meets federal, state, local standards, and meal program guidelines while understanding and maintaining compliance for meal reimbursement and menu planner documentation. Ensures all sites meet current state, local licensure, certification and safety requirements for the provision of services and proper facilities/equipments are available onsite for storage and readily available for serving. Prepares and submits reports/logs to grantor agencies monthly, quarterly, semi annually, annual and as on as needed basis. 54 Maintains all certifications for food safety (Sery Safe), client assessments (Department of Elder Affair, 701B training). Ensures each site is fire and safety inspected annually. Ensures meals served meet meal pattern requirements and time restrictions for the meal service; meals must be served in the quantity and portion of each required component to ensure senior's nutrient and energy needs are met. Ensures service eligibility for Older Americans Act Programs. Reassures the program income, via donations, are accomplished per the grantor and County compliance guidelines. Organizes and conducts monitoring of vendors to ensure compliance with the program. Coordinates monitoring by grantor agency and provides input on programs and modification of existing programs. Provides information and assistance to the community by responding to request from the public regarding available services. Answers inquiries from the public. Assess community service gaps by identifying and reporting unmet needs, analyzes service delivery and offers constructive comments or suggestions to Senior Choices. Develops a delivery strategy based on the most effective use of available resources, analyzes how service delivery can be provided most successfully and provides leadership and advocacy in the community on aging issues. Ensures service preference and assessment of individual needs by providing services to eligible clients with the greatest economic and/or social needs. Gathers and provides information in the current areas of service available in the community from both public and private agencies and organizations to refer services including food stamps and emergency transportation. Manages service provider activities by having clearly written operating procedures, ensures retention of records per the record's retention guidelines. Checks onsite operations to ensure that site personnel maintain all program required records. Coordinates and works with other County Departments such as Purchasing, Risk Management, Facilities, HR Fleet, IT Parks and Recreation and Office Management Budget to ensure all program requirements are met. Works directly with accounting/fiscal staff to ensure that all meals and the number of clients served are reported timely and accurately to the grantor agency. Assists fiscal staff with review, approval, and clarification of vendor invoices as needed. Reviews the financial reports monthly with fiscal staff and projects the meal quantity based on funding availability. Assists in staying within budget and projected meal participation. 55 Provides information and assists Purchasing Department with solicitations for new vendor contracts and existing vendor contracts. Plans and implements procedures for providing meal services during a natural disaster. Checks on clients for safety. Inspects and reassures the sites are safe for normal operations and meals are delivered to clients after the emergency event. Assist in preparation of Board of Collier County Executive Summaries and Request for Proposal to Senior Choices, agreements, leases, Memorandums of Understanding. Prepares and reports operational data to the grantor agency and department and adheres to all reporting and recordkeeping procedures. Provides information and assists in agreements, leases, Memorandums of Understanding, etc. Assists in preparation of the grant applications for funding sources. Creates and enforces that the established procedures for meal accountability/service are followed. Establishes measures and performance reports. Plans for nutrition services by establishing measurable objectives in relation to the targeted individuals to be served, services to be provided and plans for monitoring progress, and volunteer resources. Documents and reports of unusual incidents. Has written procedures to investigate, report, and record. Responds to unusual incidents in accordance with all federal, state and local laws and regulations. Ensures all clients have the opportunity to voluntarily and confidentially contribute to the cost of the service. Ensures all eligible clients are offered nutrition counseling by a Registered Dietitian and all home delivered clients are evaluated for frozen meals. Collects data, compiles reports and utilizes the information to perform efficiently, effectively and to prevent future issues. Prepares and submits memos and documentations for updates, changes, or requests to Senior Choices. Ensures sites take corrective action on any issues and creates procedures to prevent reoccurrences. Ensures new meal services are in place by conducting client follow ups. Coordinates and ensures completion of needed repairs. Assist in the cleaning of kitchen, equipment,tables and storeroom to ensure safe working procedures when short staffed and to keep site and equipment in good working condition. Assists in meal preparation, serving of high quality, nutritious, cost effective meals following standardized procedures and in accordance to the established menu when short staffed. Works directly with Park Supervisors, Goodwill Industries, and other facilities to schedule the use of the amenities for senior meal sites. Assists in marketing meal programs through creation/distribution of brochures, handouts and signage. Also develops displays for outreach events and marketing materials/giveaways. 56 Participates in short term and long range planning for the meal program and assists in goal setting by preparing target plan and customer surveys annually for meal programs. Ensures all staff is training in food safety, programs compliance and office procedures. Performs neighborhood outreach in specific senior areas. Coordinates with Registered Dietitian to provide required trainings and approvals. Reviews departmental publications and meets with public organizations to educate and inform the citizens. Represents meal program at events. Prepares and distributes monthly nutrition education for all meal participants. Conducts public meetings and individual meetings in order to determine the nutrition needs of seniors in the community; plans and organizes events at the facilities. Directs and organizes outreach for the program at EXPOs at the meal sites and different locations. Ensures that socialization opportunities are available to the meal clients. Orders and maintains supplies for sites. Manages the maintenance of department files and records. Ensures automated and manual records are kept up to date. Prepares records for storage, microfilming and/or destruction as appropriate. Operates a personal computer,telephones,copiers and other general office equipment as necessary to complete essential functions, to include the use of word processing,spreadsheet,database,or other system software. ADDITIONAL FUNCTIONS Organizes and maintains office workspace and ensures adequate inventory of office supplies. Performs other related duties as required. In the event of a declared state of emergency,employees in this classification may be called to work during days or hours other than those for which they are regularly scheduled. MINIMUM QUALIFICATIONS High school diploma or GED; supplemented by three years of responsible clerical and customer service experience; or any equivalent combination of education,training, and experience which provides the requisite knowledge, skills, and abilities for this job; may be required to obtain a Serve Safe Certification. Must possess and maintain a valid Florida Driver's License with any applicable endorsements and maintain eligibility requirements and endorsement(s)to drive a County vehicle as provided in CMA 5805.Fingerprinting required. PERFORMANCE APTITUDES Data Utilization: Requires the ability to review, classify, categorize, prioritize, and/or analyze data. Includes exercising discretion in determining data classification, and in referencing such analysis to established standards for the purpose of recognizing actual or probable interactive effects and relationships. Human Interaction: Working with others to coordinate the programs and/or resolve typical problems associated with the responsibilities of the job. 57 Equipment,Machinery,Tools,and Materials Utilization: Requires the ability to operate,maneuver and/or control the actions of equipment,machinery,tools,and/or materials used in performing essential functions. Verbal Aptitude: Requires a level of comprehension and expression to read, understand, write, and speak involved with advisory data and information associated with financial statements, eligibility guidelines, product specifications, marketing surveys,consumer reports and laws. Mathematical Aptitude: Requires the ability to perform addition, subtraction, multiplication, and division; the ability to calculate decimals and percentages;the ability to utilize principles of fractions;and the ability to interpret graphs. Functional Reasoning: Requires applying an understanding of specific learned, rational system(s) and interpreting a variety of instructions furnished in oral,written,diagrammatic and/or schedule form.. Situational Reasoning: Requires the ability to exercise judgment, decisiveness and creativity in situations involving evaluation of information against measurable or verifiable criteria. Leadership: Customer Service: Financial Accountability: ADA COMPLIANCE Physical Ability: Requires mildly heavy physical effort involving regular and, at times, sustained lifting, carrying, pushing, or pulling 12 to 20 pounds of weight and occasionally 20 to 50 pounds of weight. Sensory Requirements: Some tasks require the ability to perceive and discriminate sounds and visual cues or signals. Some tasks require the ability to communicate orally. Environmental Factors:Essential functions are regularly performed without exposure to adverse environmental conditions. Collier County is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the County will provide reasonable accommodations to qualified individuals with disabilities and encourages both prospective and current employees to discuss potential accommodations with the employer. 58 Class Code: 15655 Pay Grade: 7 COLLIER COUNTY, FLORIDA CLASSIFICATION SPECIFICATION CLASSIFICATION TITLE: PARKS AND RECREATION ASSISTANT PURPOSE OF CLASSIFICATION The purpose of this classification is to provide assistance in the execution of Parks and Recreation programs in one or more of the following areas:community center aide,babysitting/childcare,park attendant,after-school counseling,gymnasium,or fitness. ESSENTIAL FUNCTIONS The following duties are normal for this position. The omission of specific statements of the duties does not exclude them from the classification if the work is similar, related, or a logical assignment for this classification. Other duties may be required and assigned. Greets patrons; meets and assists the public at front desk; provides customer service. Answers the telephone and provides information as requested. May assists with office functions: gives out beach stickers,boat ramp stickers, and registration forms; hands out equipment; reserves meeting rooms and playing fields; registers participants for programs. Takes rental payments or program fees; verifies cash deposits; operates cash register. Sells tickets to and/or registers patrons for special events. Explains Parks and Recreation programs. Delivers equipment and supplies. Inspects equipment for safety; makes minor repairs to equipment. Orders and/or procures supplies for job tasks. Assists with County-wide and departmental special events; distributes flyers for special events; decorates for special events. Ensure the cleanliness of offices and community center facilities:cleans,vacuums,and/or waxes floors;dusts fixtures and furniture; cleans counters;empties trash;freshens bathrooms;stocks supplies;maintains grounds;sweeps and blows debris;cleans windows. 59 Sets up tables and chairs. Changes letters on marquee. Watches children whose parents are participating in programs at community centers; plays with children; entertains children with music,movies,reading,and activities;feeds infants bottles;provides snacks;contacts parents if children are disruptive. Disinfects toys; cleans furniture and bathroom in daycare area; organizes arts and crafts, toys on shelves, games, and activities; ensures safety of daycare area. Reviews reservation book and calendar of events. Prepares programs for afterschool,preschool,and summer camp. Provides first aid assistance to patrons as needed. Develops,plans,and implements afterschool program:monitors children at school sites prior to bus arrival;provides fair,consistent discipline; monitors children to ensure safety; mentors children; communicates with parents; takes and records attendance; maintains sanitary conditions;organizes program supplies. Participates in sports activities with children at the gymnasium, including basketball, football,volleyball, and soccer;plays games; supervises children in drop-in program;supervises park activities;sets up gymnasium for athletic events. Instructs fitness classes;monitors the use of equipment;provides personal training;assists patrons with exercises and stretching. May operate one or more of the following pieces of equipment:computer,blood pressure machine,exercise equipment,copier,golf cart,gas powered blower,floor scrubber,buffer,hand tools,cleaning equipment,cash register,adding machine,or other equipment as necessary to complete essential functions. ADDITIONAL FUNCTIONS Runs errands as requested. Performs other related duties as required. In the event of a declared state of emergency, employees in this classification may be called to work during days or hours other than those for which they are regularly scheduled. MINIMUM QUALIFICATIONS High school diploma or GED; six months of experience in customer service; or any equivalent combination of education, training, and experience which provides the requisite knowledge, skills, and abilities for this job. Must possess and maintain First Aid and CPR certifications. May be required to obtain instructor certifications for teaching fitness classes. Fingerprinting required. PERFORMANCE APTITUDES Data Utilization: Requires the ability to compile, assemble, copy, record and/or transcribe data according to a prescribed schema or plan. Includes judging whether readily observable functional, structural or compositional characteristics are similar to or divergent from prescribed standards,procedures or routines. Human Interaction: Requires the ability to exchange information for the purpose of clarifying details within well-established policies,procedures and standards. 60 Equipment, Machinery, Tools, and Materials Utilization: Requires the ability to start, stop, operate and monitor the functioning of equipment,machinery,tools,and/or materials used in performing essential functions. Verbal Aptitude: Requires the ability to utilize a wide variety of reference and descriptive data and information. Mathematical Aptitude: Requires the ability to perform addition,subtraction,multiplication, and division.May include counting, recording of counts,and basic measuring. Functional Reasoning: Requires the ability to carry out instructions furnished in written, oral,or diagrammatic form. Involves semi-routine standardized work with some latitude for independent judgment concerning choices of action. Situational Reasoning: Requires the ability to exercise judgment, decisiveness and creativity in situations involving a variety of generally pre-defined duties which are often characterized by frequent change. Leadership: Customer Service: Financial Accountability: ADA COMPLIANCE Physical Ability: Tasks require the ability to exert very moderate physical effort in light work, typically involving some combination of stooping, kneeling, crouching and crawling, and which may involve some lifting, carrying, pushing and/or pulling of objects and materials of moderate weight(12-20 pounds). Sensory Requirements: Some tasks require the ability to perceive and discriminate colors or shades of colors, sounds, and visual cues or signals. Some tasks require the ability to communicate orally. Environmental Factors: Performance of essential functions may require exposure to adverse environmental conditions, such as dirt, dust, pollen, odors, wetness, humidity, rain, temperature and noise extremes, machinery, electric currents, or rude/irate customers. Collier County is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the County will provide reasonable accommodations to qualified individuals with disabilities and encourages both prospective and current employees to discuss potential accommodations with the employer. 61 Code: 15593 Pay Grade: 12 COLLIER COUNTY, FLORIDA CLASSIFICATION SPECIFICATION CLASSIFICATION TITLE: CASE MANAGER ASSISTANT PURPOSE OF CLASSIFICATION The purpose of this classification is to provide assistance to case managers who conduct a client centered series of activities which includes planning, arranging for, and coordinating appropriate medical assistance services for an eligible client. Employees in this classification assist case managers in assessing the needs of clients, and arranging and coordinating services/resources through county, state, and federal programs. These programs include ones offered through the area agency on aging and/or provided by the Collier County Board of County Commissioners. ESSENTIAL FUNCTIONS The following duties are normal for this position. The omission of specific statements of the duties does not exclude them from the classification if the work is similar, related, or a logical assignment for this classification. Other duties may be required and assigned. Completes eligibility assessment of clients; assists case managers in developing a care plan to meet the service needs of the client;arranges and coordinates needed services for clients;provides follow-up with clients' as needed. Maintains federal,state,and County mandated client records;prepares reports;writes letters and correspondence. Contacts and advocates with other community agencies on clients'behalf. Assists in crisis interventions. Provides information and referral for the general public and agencies;receives,processes,and tracks referrals. Completes telephone intakes; develops and maintains CIRTS client tracking systems for active clients; develops and maintains information and referral database. Represents departmental interests at community meetings;attends seminars and in-service training. Tracks all client contacts of contact on behalf of client. Provides interviews to walk-in clients. Reviews and implements new and changing program requirements. Arranges for access to medical care. 62 Operates a computer, printer, calculator, facsimile machine, copier, telephone, cellular telephone, automobile, pager, or other equipment as necessary to complete essential functions,to include the use of word processing, spreadsheet, CIRTS database, or other system software. ADDITIONAL FUNCTIONS Enters data into CIRTS network;answers the telephone;mails requested information;makes copies. Maintains client files. Obtains holiday gifts and food for clients. Performs other related duties as required. MINIMUM QUALIFICATIONS The position requires the ability to observe clients,record information,conduct client interviews,assist case managers in implementing treatment plans,employ problem-solving techniques,handle crisis intervention matters,and use proper referral procedures. Applicants must have effective communication skills,a strong sense of responsibility,and the ability to manage time effectively.Must demonstrate experience with direct contact with elders and individuals who are vulnerable to exploitation or mistreatment;and the ability to display patience,understanding,and a strong desire to help others. A high school education with proven leadership ability,either from previous experience or as a volunteer as an assistant to Human Services, Social Work,Gerontology,Psychology,Nursing,or closely related field;one year of experience in social services related work;or any equivalent combination of education,training,and experience which provides the requisite knowledge,skills,and abilities for this jobMust possess and maintain a valid Florida Driver's License with any applicable endorsements and maintain eligibility requirements and endorsement(s)to drive a County vehicle as provided in CMA 5805. Fingerprinting required. PERFORMANCE APTITUDES Data Utilization: Requires the ability to evaluate, audit, deduce, and/or assess data using established criteria. Includes exercising discretion in determining actual or probable consequences and in referencing such evaluation to identify and select alternatives. Human Interaction: Requires the ability to apply principles of persuasion and/or influence over others in coordinating activities of a project,program,or designated area of responsibility. Equipment, Machinery, Tools, and Materials Utilization: Requires the ability to operate, maneuver and/or control the actions of equipment,machinery,tools,and/or materials used in performing essential functions. Verbal Aptitude: Requires the ability to utilize a wide variety of reference,descriptive,and/or advisory data and information. Mathematical Aptitude: Requires the ability to perform addition, subtraction, multiplication, and division; the ability to calculate decimals and percentages;the ability to utilize principles of fractions;and the ability to interpret graphs. Functional Reasoning: Requires the ability to apply principles of rational systems; to interpret instructions furnished in written, oral, diagrammatic, or schedule form; and to exercise independent judgment to adopt or modify methods and standards to meet variations in assigned objectives. 63 Situational Reasoning: Requires the ability to exercise judgment, decisiveness and creativity in situations involving the evaluation of information against sensory,judgmental, or subjective criteria, as opposed to that which is clearly measurable or verifiable. Leadership: Customer Service: Financial Accountability: ADA COMPLIANCE Physical Ability: Tasks require the ability to exert light physical effort in sedentary to light work,but which may involve some lifting, carrying, pushing and/or pulling of objects and materials of light weight (5-10 pounds). Tasks may involve extended periods of time at a keyboard or work station. Sensory Requirements: Some tasks require the ability to perceive and discriminate sounds, odor, and visual cues or signals. Some tasks require the ability to communicate orally. Environmental Factors: Performance of essential functions may require exposure to adverse environmental conditions, such as odors,temperature extremes,traffic hazards,bright/dim lights,or disease. Collier County is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the County will provide reasonable accommodations to qualified individuals with disabilities and encourages both prospective and current employees to discuss potential accommodations with the employer. 64 Appendix V ➢ Unit Cost Methodology: Personnel Allocations (pages 1 -11 ) Supporting Budget Schedule (pages 1 -4) ➢ Service Costs Report Personnel Allocations (pages 1 -12 Supporting Budget Schedule (pages 1 -6) Vendor Cost (pages 1 -8) 65 CD D N _O W 0 C) 4) O C C) O N_ C 2. 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TI co O EA E9 Q (D N cn j 0 n O 0 . -co N N N al 0) 0 O A A N 4: V DITA0.BIENT Or Monthly and YTD Service Units with Unduplicated Client Counts PSA: 08 Provider: 81302 Location: ALL LOCATIONS ,1 Program: ALL PROGRAMS Service: ALL SERVICES ELDER Start Date: 0110112013 End Date: 06/3012013 Fiscal Begin Date: 07/01/2012 AFFAIRS Include Zero Unit? Y Include Aggregate? Y Group by: Location, Program, Service MTH(Monthly) Unduplicated Location Program Service YTD(Year to Date) Units Provided Client Count 01 ADI CM MTH 13.75 2 (` YTD 26.00 2 �to - CCE 3 CM MTH 968.50 163 YTD 2,042.00 234 < UJi[u c,\c)..,, ,.: .)11<<A5 SCSM MTH 0.00 1 YTD 1.00 2 HCE BASI MTH 85.00 18 YTD 174.00 22 CMV YTD 83.00 16 RESV YTD 46.00 2 SCSM MTH 6.00 1 YTD 12.00 4 SCSV MTH 48.00 12 YTD 89.00 17 0301 CNML MTH 16,249.00 196 YTD 33,689.00 231 NTED MTH 551.00 1 YTD 1,083.00 1 NTSC MTH 115.50 89 YTD 202.25 150 OTR MTH 20.00 1 YTO 20.00 1 O3C2 HDM MTH 14,261.00 30 YTD 30,492.00 134 HDMF MTH 0.00 103 YTD 0.00 103 NTED MTH 670.00 1 YTD 1,409.00 1 SCAS MTH 244.25 77 YTD 287.50 87 OA3B CM MTH 265.75 49 YTD 455.50 56 INSC MTH 43.00 19 YTD 134.00 51 SCAS MTH 35.00 8 YTD 79.00 17 TRS MTH 1,184.00 1 YTD 2,355.00 1 OA3E ADC MTH 127.00 1 YTD 203.25 1 DPRESP MTH 348.00 11 YTD 718.75 12 RESF MTH 5,136.00 13 YTD 6,600.00 14 SCAS MTH 34.00 9 Report run on: 08/12/2013 10:36 AM Page 1 of 5 mon_ytd_services.rdf Report run by: CARRILLD Dispose of this report so that it can not be read or reconstructed DI PA RTAI ENT or Monthly and YTD Service Units with Unduplicated Client Counts . 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PUR State Form 7033: SUBMIT PROPOSAL TO: AREA AGENCY ON AGING Area Agency on Aging for Southwest Florida REQUEST FOR PROPOSAL 15201 N.Cleveland Ave. CONTRACTUAL SERVICES Fort Myers,FL 33903 Acknowledgment Telephone Number:2391652.6900 Page 1 of PROPOSALS WILL BE OPENED: September 3,2013 PROPOSAL NO. 151_Pages and may not be withdrawn within 30 days after such date and time AGENCY MAILING DATE: Hand Delivered on 812812013 PROPOSAL TITLE: Collier County Services for Seniors FEDERAL EMPLOYER IDENTIFICATION NUMBER OR S.S. NUMBER 59-6000558 VENDOR NAME Collier County Housing,Human and Veteran Services REASON FOR PROPOSAL VENDOR MAILING ADDRESS 3339 Tamiami Trail E.Suite 211 POSTING OF PROPOSAL TABULATIONS CITY-STATE-ZIP Naples FL 34112 Proposal tabulations with recommended awards will be posted for review by interested parties at the AREA CODE TELEPHONE NUMBER 239-252-2273 location where proposals were opened and will remain posted for a period of 72 hours. Failure to file a protest within the time prescribed in Section 10.53(5).Florida statutes shall constitute a waiver of TOLL-FREE NUMBER proceedings under chapter 120.Florida Statutes.Posting will be on or about December 15,2006. I certify that this proposal is made without prior understanding,agreement,or connection with any corporation,firm,or person submitting a proposal for the same contractual services,and is in all respects fair and without collusion or fraud.I agree to abide by all conditions of this proposal and certify that I am authorized to sign this proposal for the proposer and that the proposer is in compliance with all requirements AUTHORIZED SIGNATURE ANUAL) of the request for Proposal,including but not limited to,certification requirements,in submitting a proposal to an agency for the State of Florida,the proposer offers and agrees that if the proposal is accepted,the proposer will convey,sell,assign or transfer to the State of Florida all rights,title and interest in and to all causes of action it may now or hereafter acquire under the Anti-trust laws of the United States Leo E. Ochs,Jr., County Manager and the State of Florida for price fixing relating to the particular commodities or services purchased or acquired by the State of Florida. At the discretion,such assignment shall be made and become effective at the time the purchasing agency tenders final payment to the AUTHORIZED SIGNATURE(TYPED)TITLE proposer. GENERAL CONDITIONS SEALED PROPOSALS: All proposal sheets and this original acknowledgment form must (c) MISTAKES:Proposers are expected to examine the conditions,scope of work,proposal be executed and submitted in a sealed envelope. (DO NOT INCLUDE MORE THAN ONE prices,extensions,and all instructions pertaining to the services involved. Failure to do PROPOSAL PER ENVELOPE.) The face of the envelope shall contain,in addition to the so will be at the proposers risk. above address,the date and time of the proposal number.Proposal prices not submitted (d) INVOICING AND PAYMENT:The contractor shall be paid upon submission of property on attached proposal price sheets when required shall be rejected. All proposals are certified invoices to the purchaser at the prices stipulated on the contract at the time the subject to the conditions specified herein. Those not complying with these conditions are order is placed, after delivery and acceptance of goods, less deductions if any as subject to rejection. provided. Invoices shall contain the contract number,purchase order number and the 1. EXECUTION OF PROPOSAL: Proposal must contain a manual signature of contractors'Federal Employer Identification Number. An original and three(3)copies authorized representative in the space provided above. Proposal must be typed or of the invoice shall be submitted. The final payment shall not be made until after the printed in ink. Use of erasable ink is not permitted. All corrections to prices made by contract is complete unless the Agency has agreed otherwise. Invoices for fees or proposer must be initialed.The company name and F.E.I.D.or social security number other compensation for services or expenses submitted for contractual services shall must appear on each pricing page of the proposal as required. be submitted in detail sufficient for a proper pre-audit and post-audit thereof and invoices for any travel expenses shall be submitted in accordance with the rates at or 2. NO PROPOSAL SUBMITTED:If not submitting a proposal,respond by returning only below those specified in Sections 112.061 and 287.058, F.S. Interest Penalties: this acknowledgment form,marking it"NO PROPOSAL",and explain the reason in the Payment shall be made in accordance with section 215.422, F.S.,which states the space provided above. Failure to respond to a procurement solicitation without giving contractors'rights and the Agency's responsibilities concerning interest penalties and justifiable reasons for such failure, nonconformance to contract conditions, or other time limits for payment of invoices. VENDOR OMBUDSMAN:vendors providing goods pertinent factors deemed reasonable and valid shall be cause for removal of the and services to an agency should be aware of the following time frames. Upon receipt, proposers name from the proposal mailing list. NOTE:To qualify as a respondent, an agency has five(5)working days to inspect and approve the goods and services, proposer must submit a"NO PROPOSAL",and it must be received no later than the unless the bid specifications, purchase order or contract specifies otherwise. An stated proposal opening date and hour. agency has 20 days to deliver a request for payment (voucher). The 20 days are measured from the latter of the date the invoice is received or the goods or services are 3. PROPOSAL OPENING:m n Shall be is on the date,responsibility and to time assure specified received, inspected and approved. If a payment is not available within 40 days, a on proposal acknowledgment form. It is the proposers lac of re proposal on lto to assure tpo his separate interest penalty of.03333 percent per day will be due and payable,in addition which is any reason at the proper not d time and place of be c nsie opening. Proposals,telegram to the invoice amount,to the vendor.The interest penalty provision applies after a 35 or tel for any are not arc not sl delivered, alll not bocbe altered considered. Offers en telegram day time period to health care providers,as defined by rule. Interest penalties of less or telephone are not acceptable.Proposal l proposal may be furnished al upon opening request the than one(1)dollar will not be enforced unless the vendor requests payment. Invoices, with an enclose. NOTE:addressed,Passed, tabulations lol ee and upon careen request which have to be returned to a vendor,because of vendor preparation errors,will result wieh an enclosed,self addressed,stamped envelope and eayment of a predetermined in a delay in the payment. The invoice payment requirements do not start until properly fee. Proposal tabulations will not be provided by telephone. completed invoice is provided to the agency. A Vendor Ombudsman has been 4. PRICES, TERMS AND PAYMENT: Firm prices shall be proposed and include all established within the Department of Banking and Finance. The duties of this services rendered to the purchaser. individual include acting as an advocate for vendors who may be experiencing (a) TAXES: The Area Agency on Aging does not pay Federal Excise and Sales taxes on problems in obtaining timely payment(s)from the agency. The Vendor Ombudsman direct purchases of services. See tax exemption number on face of purchase order or may be contracted at(904)488-2924)or by calling the State Comptrollers Hotline, 1- agreement form. This exemption does not apply to purchases of services in the 800-848-3792. The Area Agency On Aging review the conditions and circumstances performance of contracts for the improvement of state-owned real property as defined surrounding non-payment and unless there is a bona fide dispute,the Area Agency on in Chapter 192,Florida Statutes. Aging may in writing authorize the contract supplier to reject and return purchase (b) DISCOUNTS: Cash discount for prompt payment shall not be considered in orders from said agency until such time as the agency complies with the provisions of determining the lowest net cost for proposal evaluation purposes. Section 215,422,F.S. (e) ANNUAL APPROPRIATIONS:The Area Agency on Aging performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. Approved as to form and legality 3 Assistant Cod Attorney y 5. CONFLICT OF INTEREST: The award hereunder is subject to the provisions of 10. LEGAL REQUIREMENTS:Applicable provision of all Federal, State,county and Chapter 112, Florida Statutes. Proposers must disclose with their proposal the local laws,and of all ordinances,rules,and regulations shall development,submittal name of any officer,director,or agent who is also an employee of the Area Agency and evaluation of all proposals received in response hereto and shall govern any On Aging or any of its agencies. Further,all proposers must disclose the name of and all claims and disputes which may arise between person(s) submitting a any Area Agency On Aging employee who owns,directly or indirectly,an interest of proposal response hereto and the Area Agency of Aging,by and through its officers, five(5%)or more in the proposers firm or any of its branches. In accordance with employees and authorized representatives, or any other person, natural; or Chapter 287,Florida Statutes, no person or firm receiving a contract that has not otherwise,and lack of knowledge by any proposer shall not constitute a cognizable been procured pursuant to Section 287.057)20 or(3)to perform a feasibility study defense against the legal effect thereof. of the potential implementation of a subsequent contract participating in the drafting 11. ADVERTISING: In submitting a proposal, proposer agrees not to use the results of a request for proposals,or developing a program for future implementation shall there-from as a part of any commercial advertising. be eligible to contract with the agency for any contacts dealing with that specific subject matter,and proposers must disclose with their proposal any such conflict of 12. ASSIGNMENT:Any Contract or Purchase Order issued pursuant to this request for interest. proposal and the monies which may become due hereunder are not assignable, 6. AWARDS:As the best interest of the Agency may require,the right is reserved to except with the prior written approval of the purchaser. reject any and all proposals or waive any minor irregularity or technicality in proposals received. Proposers are cautioned to make no assumptions unless their 13. LIABILITY:On any contract resulting from this proposal the proposer shall hold and proposal has been evaluated as being responsive. save the Area Agency on Aging, its officers, agents and employees harmless against claims by third parties resulting from the contractor's breach of this contract 7. INTERPRETATIONS/DISPUTES: Any questions concerning conditions and or the contract's negligence. This requirement does not apply to contracts between specifications shall be directed in writing to this office for receipt no later than ten governmental agencies. (10) days prior to the proposal opening. Inquiries must reference the date of proposal opening and proposal number. No interpretation shall be considered 14. FACILITIES:The Agency reserves the right to inspect the proposers facilities at a binding unless provided in writing by the Area Agency of Aging in response to time with prior notice. requests in full compliance with this provision. Any person who is adversely affected by the agency's decision or intended decision concerning a procurement solicitation 15. CANCELLATION: The Agency shall have the right to unilateral cancellation for or contract award and who wants to protest such decision or intended decision shall refusal by the contractor to allow public access to all documents,papers,letters,or file a protest in compliance with Rule 13A-1.006(3). Florida Administrative Code. other material subject to the provisions of Chapter 119,Florida Statutes,and made Failure to file a protest within the time prescribed in Section 120.53(5).Florida or received by the contractor in conjunction with contract. Statutes shall constitute a waiver of proceedings under Chapter 120, Florida Statutes. 16.PUBLIC RECORDS:Any material submitted in response to this Request for Proposal 8. GOVERNMENTAL RESTRICTIONS: In the event any governmental restrictions will become a public document pursuant to Section 119.07, F.S. This includes may be imposed which would necessitate alteration of the material quality of the material,which the responding proposer might consider to be confidential of a trade services offered on this proposal prior to their completion, it shall be the secret. Any claim of confidentiality is waived upon submission, effective after responsibility of the successful proposer to notify the purchaser at once,indicating in opening pursuant to Section 119.07,F.S. his letter the specific regulation which required an alteration.The Agency reserves the right to accept any such alteration,including any price adjustments occasioned thereby,or to cancel the contract at no further expense to the Agency. 9. DEFAULT: Failure to perform according to this proposal and/or resulting contract shall be cause for your firm to be found in default which event any and all re- procurement costs may be charged against your firm. Any violations of these stipulations may also result in: a) Contractor's name being removed from the Division of Purchasing vendor mailing list. b) All Agencies being advised not to do business with the contractors without written approval of the Division of Purchasing. NOTE: ANY AND ALL SPECIAL CONDITIONS AND SPECIFICATIONS ATTACHED HERETO WHICH VARY FROM THESE GENERAL CONDITIONS SHALL HAVE PRECEDENCE. 4 CAn 2. SERVICE PROVIDER SUMMARY INFORMATION PAGE PSA: 8 ORIGINAL SUBMISSION [X ] REVISION [ ] 1. PROVIDER INFORMATION: 2. GOVERNING BOARD CHAIR: Executive Director: {Name/Address/Phone} {Name/Address/Phone} Georgia Hiller,Chairperson Kim Grant,Director 3299 Tamiami Trail,East 3339 Tamiami Trail,East Harmon Turner Building F Suite 211 3rd Floor Naples,FL 34112 Naples FL 34112 Legal Name of Agency: Collier County Board of County Commissioners Housing,Human and Veteran Services Name of Grantee Agency: Mailing Address 3339 Tamiami Trail,East 3. ADVISORY COUNCIL CHAIR:(if applicable) Suite 211 {Name/Address/Phone} Naples,FL 34112 Telephone Number:[239]252-2273 4. TYPE OF AGENCY/ORGANIZATION: 5. PROPOSED FUNDING PERIOD: 01/01/2014-12/31/2019 A. New Applicant NOT FOR PROFIT: PRIVATE X PUBLIC B. Continuation X . PRIVATE FOR PROFIT 6. FUNDS REQUESTED: [X]OAA Title IIIB [X]OAA Title IIIE 7. SERVICE AREA: [X]Single County Collier County [ ]Multi-county: List: 8. ADDRESS FOR PAYMENT OF CHECKS ITEM#: [X ]#1 [ 1#2 9. CERTIFICATION BY AUTHORIZED AGENCY OFFICER: I hereby certify that the contents of this document are true,accurate and complete statements. I acknowledge that intentional misrepresentation or falsification may result in the termination of financial assistance. L67/* Signature: Name: Leo E.Ochs,Jr. g I Title: Collier County Manager Date: Approved as to form and legality 5 Assistant County.attorney �t� Proposal Requirements Q1. Synopsis of your business/agency's background and qualifications: (Provide a description of qualifications and prior experience performing tasks similar or relevant to those required in this RFP. The discussion should include a description of the applicant's background and relevant experience that qualifies it to provide the services required by this RFP.) For more than thirty-nine (39) years, the Collier County Housing, Human and Veteran Services Department, Services for Seniors program (CCSS), has been the lead agency in Collier County in providing elder services. The Services for Seniors program has an excellent reputation in providing service delivery to our vulnerable elderly population. The funding that is received from the Federal Older American Act grant enables the Services for Seniors program to continue to provide quality services to the elderly who want to remain living independently in their homes. The high quality of service to this county's elderly is attested by the 2012 programmatic and contractual monitoring results earned by this program. Additional programs in the Housing, Human and Veteran Services Department also include Social Services, RSVP (Retired and Senior Volunteer Program), Affordable Housing and a variety of Federal/State Grants. As part of Collier County Government, the department is one of several within the Public Services Division. These departments include the University Extension Services, Domestic Animal Services, Library Department, Museum Department, and Parks and Recreation Department. The Housing, Human and Veteran Services Department partners with these other sister departments to provide high quality senior services in a variety of community settings. In addition, an enhancement of this agency's effective coordination of service is demonstrated by the high visibility and recognition within Collier County. Our reputation as a quality community resource for elder care is demonstrated by the active role the program serves in Collier County's community social service network. To address the social needs of seniors in the community, the department provides and participates in senior activities throughout the year, as well as special events such as Senior Expos held throughout the County. This year's County Senior Expo event was held at the Golden Gate Community Center, which is also where one of our four congregate meal sites is located. The department is also a participating member in the Alzheimer's Support Group, Collier County Council on Aging, the Sheriff's Council, and the Naples and Immokalee Interagency Councils. This year the Services for Seniors program staff were instrumental in participating in the planning of the future Collier County Senior Resource Center. CCSS is an active member of the Leadership Coalition on Aging-Collier County (LCA). The LCA has taken the lead with achieving the goal of securing a senior center site. CCSS was instrumental in the planning of Collier County's first Annual Conference on Aging held in Naples, FL. In conjunction with LCA, CCSS participated in the Florida Gulf Coast University's senior needs assessment and participated in local Focus Groups to meet with seniors to determine the specific needs of Collier County seniors. CCSS is active in state-wide elder support organizations such as the Florida Council on Aging, the Florida Association of Service Providers, the Community Care for the Elderly Coalition, and the Florida Association of County Human Service Administrators. 6 CA The Collier County Board of County Commissioners consistently provides strong support in this agency's operations and believes in our mission of improving the lives of Collier County's elderly residents. Strong board support allows this agency access to financial resources as well as support resources. The County's legal department assists with approval of contractual documents and policies. The Finance division of the Clerk of Courts acts as the agency's bookkeeper and auditor, allowing our fiscal office the necessary time to monitor and track performance standards. The Purchasing Department acts as this agency's agent for cost savings in acquiring vendor services and products. The Human Resources Department ensures our ability to meet high personnel standards, which translates to premium client care. Because of the availability of these valuable operational resources,the grantor agency can be assured that quality and accountability will always be maintained. The Services for Seniors program staff has over 70 years of combined experience in providing case management as well as over 20 years experience with fiscal delivery of case management services. The philosophy of the program has been to employ individuals who have the skills, dedication, education, and experience to link individuals to the most beneficial service that is also the least restrictive. Assisting individuals to live independently has been the stalwart of the program throughout its operation. Our services assess an individual's situation in order to determine what is necessary to either maintain or improve his or her health, family, social, or medical status to remain in the least restrictive setting possible. As services are delivered, the quality and quantity of the services are carefully measured to ensure outcome measures are consistent with and on target with the Department of Elder Affairs statewide outcome and output measures. Case managers also provide advocacy ensuring that their best interests are upheld both by the service delivery system and the community at large. Our services assist the client in meeting or exceeding self-sufficiency and functioning, and helping protect individuals from abuse, neglect, and exploitation. Our case managers interact frequently with the client's caregiver or family member ensuring quality communication is provided to coordinate care with these most important individuals in the client's life. Finally, program integrity is maintained through balanced caseloads of no more than 70 clients per case manager. It is important to note that the entire staff of Collier County Services for Senior's exceeds training and certification requirements of the grantor agency and the Florida Department of Elder Affairs. In Collier County, the focus is on providing elders with support that enhances their quality of life and utilizes resources to maintain independence and maximum capacity. Q2. Organizational Chart/s: (Please provide a copy of the organizational chart that directly relates to the division that will provide services under OAA programs) (See Appendix Al) Q3. Job Descriptions& Position Qualifications: (See Appendix A2) The staff of Collier County Government Services for Seniors program provide services for functionally, impaired elderly persons in a community care, continuum of care service system, which is designed to allow for Collier County seniors to age in place, with purpose, security, and with dignity. Staff is respectful and allow for seniors to also age in an elder friendly environment. With this in mind, the staffing pattern is described below: The Director of the Department has a Master's degree in Business Administration and has the authority of the overall administrative operations of the department. This individual is responsible for the 7 CA administration of the Services for Seniors program and Lead Agency functions and ensures that it is managed in accordance with DOEA requirements. The Director has over 25 years experience combined in the private and government sectors of administration. The organization is supported by an Operations Coordinator, who provides clerical and administrative support involving preparing operational and administrative forms, reports, records and summaries; entering data and retrieving information from department databases and assisting callers and/or visitors. Collier County Services for Seniors is also supported by an Accounting Supervisor with a Master's degree in Business Administration who supervises the accounting staff performing the professional and technical accounting and financial duties for the Services for Seniors Program which includes a Grant Accountant with a Bachelors of Science degree and an Accounting Technician with over 11 years of fiscal experience in these programs. The Fiscal section provides accounting services and oversight, as well as data entry into the Client Information Resource Tracking System (CIRTS). Additional services are provided by the Grant Coordinator, who is responsible for review and approval of invoices, preparation of service agreements, assurance of vendor compliance with established policies and procedures, and provision of various program and fiscal data sets to Senior Choices of Southwest Florida. In addition, the Grant Accountant provides oversight for the services and contribution reports that report the number of units and funds expended to date, and variance information detailing current spending patterns. This information is reviewed by program and fiscal staff on a regular basis to ensure appropriate spending patterns associated with care plans are being established for both the current individuals and new clients associated with the service. Fiscal staff and program staff work together on a daily basis in order to maintain the requirements of the grants' expenditures and service delivery associated with the lead agency responsibilities. The Case Management Supervisor has a Master's degree in community mental health services and 35 years experience in assisting adults and families accessing community resources. The Case Management Supervisor is responsible for assigning new cases, managing the wait list, and ensuring maximum productivity levels are met for the three (3) Case Managers. The Case Management Supervisor reviews and monitors client assessments and client care plans to ensure that policies regarding the prioritization, determination of the type of services, and the level of service of each client are met through arranging and coordinating services/resources through county, state, and federal programs. The case managers currently maintain an average client case load of 65. These caseload sizes fluctuate due to attrition and funding limitations; however, to date the program staff has been able to manage the service delivery associated with the lead agency functions. In addition, the Case Management Supervisor manages referrals associated with the Senior Choices Elder Helpline, Adult Protective Services referrals and Community Comprehensive Assessment and Review for Long Term Care Services (CARES) referrals. The Services for Seniors program provides case management services and no other direct services. The Lead Agency contracts for in home services with area home health agencies, emergency alert response vendors, medical supply vendors and adult day care providers. The Case Managers have a working knowledge of all programs administered by this agency and thus are able to access and authorize other resources/services available to eligible clients. The case 8 management staff has been resourceful and innovative in providing services above and beyond what the grant provides with donations from local churches, and the private and public sector. Of the three (3) full time case managers, one (1) case manager is bilingual in Spanish and English. In addition, HHVS has a total of thirty-five (35) employees and 35% of the staff is bilingual in English/Spanish and 52% of the staff is bilingual in English and another language. The staff is always willing to assist clients with translation and conveying their requested needs and questions. HHVS has initiated a Limited English Program (LEP) policy and has the ability to utilize web based verbal/written translation assistance for many languages. All HHVS Services for Seniors' forms have been translated to Spanish and will complete the process of the forms being translated into Creole by December 2013. Spanish and Creole are the two most prevalent primary languages that the County's seniors utilize fluently. Q4. Synopsis of your business/ agency's Client Confidentiality Safeguards (Specify procedures and training efforts. Include copy of privacy notice) Collier County Housing, Human and Veteran Services Department (CCHHVS) is committed to providing confidentiality for all clients receiving, or waiting to receive, services from OAA and other programs that we administer. CCHHVS has and follows a Health Insurance Portability and Accountability Act (HIPAA) Standard Operating Procedure. Clients are also required to sign a release of information form in order for staff to share client health information with service providers. (See Appendix A3, A4) All employees are cognizant of the Health Insurance Portability and Accountability Act of 1996 and have signed a Confidentiality Agreement. Employees are trained in HIPAA regulations and are knowledgeable of how to contact the Privacy Officer in the Department should a client request information regarding the privacy practices. The Services for Seniors staff are careful with client information when dealing with other agencies. Only that information which needs to be shared in order to provide the best service and ensure the clients safety is given out on a need to know basis and with the proper release of information from the client. All Services for Seniors staff are considered in the circle of need to know. Client files are kept in locked file cabinets. The intake information for the waiting list and other files relating to clients, are in locked file cabinets as well. Closed files are maintained for the mandated six years in locked filing cabinets. After the time is up, files are securely shredded. Access to CIRTS is safeguarded by individual passwords that are initiated and changed periodically by Senior Choices of Southwest Florida and registered with the Florida's Department of Elder Affairs. In addition, Collier County Information Technology Department installs firewalls for each staff computer that is password protected. When services are available to meet the client's needs, a Case Manager explains the process of authorizing services to the client and obtains a signed Release of Information form. This release gives the Case Manager permission from the client to give pertinent data to the service provider agency so that services can be arranged and provided. This release also allows the Case Manager to access other services and resources on behalf of the client. 9 CAO All CCHHVS clients are notified of their right to privacy of protected health information. Services for Seniors clients, upon receipt of the Notice of Privacy Practices, sign a statement confirming receipt of this notice.This confirmation is maintained in client files. (See Appendix A3, A4) Q5. Grievance Procedures/ Process for Reducing or Terminating Services (Include copy of material given to clients, procedures and method of determining which clients will receive reductions or termination of services). Case managers set up an appointment to complete the Client Home Visit and Assessment and during the assessment, the case manager will explain the Grievance Procedure to the client. A copy of the Grievance Procedure, as well as the "Minimum Guidelines for Recipient Grievance Procedures Applicable to All Adverse Actions Deemed Terminations, Suspensions, or Reductions in Service" is given to the client. The client signs the Grievance Procedure confirming this procedure has been explained and is maintained in the client's file. When a client files a grievance and requests to implement the appeal process, the Case Manager references to this document and includes a copy of the signed form in the correspondence to the client. Collier County Housing, Human and Veteran Services Department have a Standard Operating Procedure for the Seniors Program related to the Grievance Procedure. A copy of the Standard Operating Procedure, Grievance Procedure and the Minimum Guidelines are contained in the Appendix (See Appendix A5). If a client is being considered for reduction of service, the case manager will consider the impact of the reduction. If the client will be put "at risk" and no non DOEA service is available to offset the risk, then no reduction will be made. If the client is able to absorb the change and/or the service is available through another source, the client will be given ten (10) days notice in order to "grieve" the decision. This same process will also be applied to termination of service. If the client requests a reduction or termination of service on their own,the ten (10) day rule and the right to grieve will not apply. Notification of any adverse actions (such as reducing or terminating services) is completed by sending a letter to the client at least 10 days in advance of any action with information related to the Grievance Procedure. If the client chooses to implement the Grievance Procedure, services cannot be reduced or terminated during this process. All actions taken are to be documented clearly by the case manager or case management supervisor in the client's case narratives and all correspondence maintained in their files. A Standard Operating Procedure for the Notification of Adverse Actions has been included in the Appendix. (See Appendix A6). Through the policies and procedures that are in place, every effort is made by Services for Seniors' staff to work with the client to resolve any concerns or issues without any additional intervention and to minimize the impact on the client as a result of any necessary adverse actions. Q6. Plan to Maintain Quality Control and Monitor Client Satisfaction (Describe both internal methods to assure quality services and process for determining consumer satisfaction. Also include procedures for handling client complaints, grievances and unusual incidents.) . The Services for Seniors program through the County's Office of Management and Budget/Grant Management Office, has the ability to monitor monthly budget activity and monthly and quarterly 10 ,,c� performance measures and compares it to prior year's activities. The internal reports generated compare client cost and suggest cost saving strategies. The program also prepares monthly unit cost worksheets that not only isolate unit cost variances but also identifies areas where cost savings may be necessary to ensure the grant spending will provide client services through the budget year allocation. The fiscal staff maintain spreadsheets that are reviewed daily to keep apprised of the fluctuations in spending. The contracted agencies are given an orientation by the grant coordinator upon the award of the contract with directions on due dates, timely submittal of invoices and the means to tally the costs. Fiscal staff reviews the costs regularly with case management staff. Program effectiveness is determined in several ways. Internally, outcome measures are an excellent tool in determining how effective we are doing our job. The outcome measures report is completed quarterly through the report section of DOEA's CIRTS web based data information system. The quarterly reports are submitted to Senior Choices for analysis and review with the case management supervisor for program changes if necessary to better serve the client. Quantitative outcomes provide a level of expectations that, at a minimum, are our measure of successful achievement of our program's goals. This agency uses the CIRTS web based data system through monthly review of "turnaround" reports. Internally, case managers routinely check with clients to assess service needs and monitor their progress. The case management supervisor makes random checks regarding file documentation and care plans to assure fulfillment of appropriate client care and grantor program requirements. Formal county procedures are in place, which evaluate this agency's performance through legal reviews, internal audits, and annual independent audits. In addition, Services for Seniors staff complete CCE, ADI, HCE, and OAA service delivery statistics, ADA and ALE HCBS Waiver statistics and other data and report to Area Agency on Aging of Southwest Florida and the Department of Elder Affairs in accordance with reporting requirements established by the Department. A report/invoice system is developed that track and enter data related to unit's service provided into CIRTS. Services are reported on a weekly basis to permit staff to verify correctness of information before data entry. External effectiveness is also evaluated through both programmatic and contractual grantor monitoring. Through this process we are notified of any deficiencies and suggestions for corrective actions. As a proactive measure, this agency initiates an annual satisfaction survey (Appendix A7) to each client we serve. The feedback is invaluable in providing what we do well and areas needing improvement. The survey also allows clients to voice areas of need and what other community resources might better fulfill their needs. The case management supervisor contacts all clients that have written on the annual survey that they would like to speak to a supervisor directly. The case management supervisor contacts the client directly to review the complaint and works diligently to resolve any reasonable issues the client is experiencing. This may include unusual circumstances that a client needing emergency services because their caregiver has been hospitalized, or an in home health agency terminating their services because of the client's behavior. CCSS maintains good relations with all the OAA Senior Choices contracted vendors and communicates the client complaints to the contracted vendor to ensure that client satisfaction is achieved with their services. CCSS maintains a Complaint Log and every client complaint are logged in by the case manager. The case management supervisor reviews each complaint and resolves any problems that occur with the senior, the vendor and the service. The case management supervisor submits the complaint log to Senior Choices quarterly. Accordingly, Services for Seniors case managers prepare a plan of care for each eligible client in a coordinated effort with the client, and/or caregiver using the approved DOEA format. The plan addresses all client needs and considers both formal and informal resources to provide the needed services. Clients are given the option to accept or decline the care plan and in the cases of denial are provided the opportunity to follow the grievance procedure outlined elsewhere in this application. Clients are also provided the opportunity to choose amongst multiple vendors of service when such opportunities are available and the client's choice of vendor is documented within the case file. In addition, case managers monitor the quality of services delivered to the client and outlined in the plan. Q7. Plan For Coordination Between aging network providers include plan for sending/receiving referrals, sharing clients, coordination of services) Collier County Services for Seniors Program (CCSS) coordinates with the Senior Choices 'Elder Helpline for the receipt of client referrals. The Elder Helpline updates their information on an annual basis to confirm availability of certain resources. When the caller presents as an appropriate referral for the services administered by the Services for Seniors program, a referral is taken and emailed to the case management supervisor. Both the case manager and the case management supervisor receive the referral via email. The case management supervisor documents the referrals and assigns the referral to one of the three case managers and assignments are directed to geographic location and/or cultural/language preference in Collier County. The specific case manager assigned to the referral enables the process to be efficient as possible in meeting perspective clients as by DOEA required time line. The case manager will make contact to the potential client and/or care giver and set up a home visit so the case manager can explain the services available, the possible wait list for services and possible co payment schedule depending on which grant contract under which the client will receive services. After completing the home visit and 701B assessment, the case manager submits the information to the CIRTS data entry staff and completes a Triage Request for Services form which includes a score which is generated by the CIRTS assessment and is submitted to the case manager supervisor. The Triage form will be emailed to Senior Choices' designated Program Specialist who presents the case to the Triage Committee for review. Approval for services will be determined by the Risk and Priority scores from the 701B assessment tool. If a client is not approved for services, client will be placed on a wait list which the case manager will update every 6 months unless the case manager is notified from the client and/ or family member of any significant client changes. When a client is approved for services, the case manager will verify with the client the vendor choice form that was completed during the initial assessment. If client is unable to choose a vendor, the case manager will choose the contracted vendor from the provider rotation list. Services for Seniors staff maintain wait list referrals in locked filing cabinets. Staff meetings are held every two weeks, both case managers and fiscal staff are in attendance. Staff discuss individual client cases, the client services delivered and the current status of surplus/deficits. Specific client care plans are reviewed and new referrals are assigned for home visit assessments. CCHHVS utilizes a centralized system for inputting assessment information and billing data which assures accurate overview of the total grant budget spending. 12 Q8. Client Targeting and Outreach: (include a synopsis of how you intend to address the OAA targeting requirements: Low income, rural, minority, non English speaking. Actual Target plans and reports will be required annually) (See Appendix A8) GOAL: The2012-2013 Services for Seniors Target Plan is to increase services to Collier County's Hispanic and African American population. Currently, we have provided services to 24% of the Hispanic population and will increase services to 26% by December 31, 2013. We have provided services to 16% of the African American senior population and the goal is to increase service by 3% serving a total of19% of African American seniors. Services are needed in these two groups of seniors due to their isolation and the increasing cultural and socio-economic changes of living in Southwest Florida. PLAN: CCSS provided OAA Ill B services to approximately 961 seniors in 2012 which was a 2% increase from 2011. Our 2013 goal is to assist 977 Seniors and we will continue to target the following populations: 1. Individuals who are 60+ in age 2. Persons living below Poverty Level 3. Minority persons living below Poverty Level 4. Persons living alone 5. Minority persons with limited English Characteristic 2013 60+served 977 BPL 402 Living Alone 478 Minority 359 Minority BPL 258 Low income Minority with Limited English 91 Target Areas AREA POPULATION Golden Gate City,Naples Hispanic population The Estates, Naples Hispanic population Immokalee&N.Naples Hispanic,African American& Low-income housing Haitian populations Goodlette Arms Apartments Naples FL Mixed population Haitian Baptist Church Immokalee FL Haitian population 13 cA 0 During 2012, CCSS met with Goodlette Arms Apartment residents and staff located in Naples FL and with the residents at both Garden Lakes and Summer Glen Apartments in Immokalee FL. All three apartment complexes have elderly, low-income senior populations that we provide services to once referred and approved by Senior Choices. In 2013, CCSS participated in the Collier County Senior Expo Fair and provided information and eligibility requirements to the public in the community of Golden Gate City. We attended both the Immokalee and Naples Interagency program spotlights. We participated in the staff and caregiver meetings at the Alzheimer's Support Network, presented at the League of Women's Voters monthly meeting and were the spotlight speaker at the Leadership Coalition on Aging monthly meeting. During 2013 to help assist CCSS in achieving their goals for target areas, we will continue to participate in the following community agencies' meetings and develop new partnerships with the following agencies: Immokalee Naples Immokalee Interagency Meeting Naples Interagency Meeting Guadalupe Soup Kitchen Golden Gate Senior Expo I HOPE Community Foundation Alzheimer's Support Network Marion Fether Health Clinic Staff Meeting Neighborhood Health Plan Haitian Baptist Church Leadership Coalition on Aging Roberts Center for Seniors Senior Congregate Meal Sites Catholic Charities Goodlette Arms Apartments CCSS participated in the Hunger and Homeless Coalition's Annual Get Help Clinic, 01/24/13 in Naples FL. Program information was distributed to 60 individuals who reside in Collier County. We will continue to partner with the Collier County RSVP (Retired Seniors Volunteer Program) with annual service days, and volunteer appreciation luncheon to present the CCSS programs. We continue to participate in the Collier County' Homeless Coalition and Migrant Farm Worker's Staff Information Meetings to share the message of our services and target those in most need. Collier County Services for Seniors' staff continue to face unique challenges in serving our Seniors in the Naples Golden Gate Estates and Immokalee, although rural, but not designated as rural areas, are geographically spread out where services are not easy to access and there is limited medical transportation. Target Plan: OA3EG For the 2012 OAA contract year, CCSS provided OAA IIIEG services to approximately 10 seniors which is a 2% increase from 2011. CCSS was able to expend 100% of their grant in assisting seniors who are grandparents and the main caregiver to their grandchild or grandchildren. For 2012, CCSS assisted over 13 grandchildren with the expenses of after school program and summer camp. Presently, for 2013, we have been successful in expending our IIIEG funding by assisting 8 grandparents and 15 grandchildren with summer camp expenses. Target Plan: OA3E For the 2012 OAA contract year, CCSS provided service to 38 clients. In 2011, CCSS served a total of 17 seniors; this was an increase of 50%. In 2012, CCSS was able to assist Seniors and their caregivers with facility respite stays, which included day care that provided much needed rest for clients' 14 caregivers. OAA3E assisted with seniors' medical supplies and gas cards for family to take clients to their specialized medical appointments where there were no other available means of transport to date, CCSS has served 16 seniors to date with facility respite stays, in home services and medical supplies; CCSS has exceeded our 2013 goal of serving 15 seniors. CCSS will continue to target, minority, low-income and low-income minority that speak limited English. Q9. Training: Include plan for Pre, In-service and Annual training of Agency staff including DOEA required trainings CCSS provides an in depth in-service training program and participates in all Senior Choices/DOEA required program trainings. During the CCSS 2012 Annual Program Monitoring completed on site, CCSS was in full compliance of the DOEA and PSA 8 required training for Services for Seniors case managers. In 2012, CCSS staff received over 40 hours of training. In 2013 to date, CCSS staff has received 25 hours of training which includes DOEA required training topics including the overview of community care services, the detailed training of the completion of client assessment forms for determining client eligibility, writing care plans completely with cost allocations, CIRTS data entry, case management- interviewing skills/techniques and file record keeping procedures. CCSS received training on the overview of state and county community agencies and how to interface and partner when providing services to Seniors. The CCSS Training Plan will also encompass the Aging Network Overview, Alzheimer's disease, and Caregiver Training. CCSS is an active member on the Leadership Coalition on Aging- Collier (LCA) and was instrumental in planning and organization of the first Annual Collier County Aging conference in Naples, April 2013. The conference included workshops: Issues on Aging community panel, Dementia/Depression, Care giving Concerns and Geriatric Pharmacology. The CCSS attends the Florida Council on Aging Conference annually, which encompasses three full days of Workshops on specialized elder topics and DOEA information. In addition, CCSS participated in the Department of Elderly Affairs (DOEA) pilot program of the new 701B assessment tool review in the final version of the assessment that was instituted this July 2013. CCSS also participates in monthly staff safety trainings per the County's safety requirements through the Risk Management Department. (See Appendix A9) Q10. Documentation of satisfactory prior performance: [ X ] Continuation Bidder Documentation of Effective Management/Service Quality. (Provide copies of reports from funding agencies other then the AAASWFL for prior 12 months. If Monitoring Reports indicate program management and /or service delivery problems, please provide response to the report, plan of correction and explain in detail the steps taken to avoid recurrence.) or [ ]New Bidder Documentation of Effective Management/Service Quality. (Provide documentation in form of official reports and / or service evaluations indicating ability 15 to effectively manage agency operations, provide quality services and staff requests promptly. Include: a description of the services delivered; the contract period; and the name, address, and telephone number of the contact person for each of the contracting agencies as well as copies of any monitoring reports, corrective actions and/or other relevant information, including monitoring report response and/or plan of correction.) For more than thirty-nine (39) years, the Collier County Housing, Human and Veteran Services Department, Services for Seniors program has been the lead agency in Collier County for providing case management of elder services. CCSS has received the grant allocations based on prior experience and excellent customer service. Funding from the Federal Older American's Act has established a reputation of excellence in service delivery system provided by this agency for that entire period of time. The high quality of service to this county's elderly is attested to by the excellent programmatic and contractual monitoring results earned by this program. (See Appendix A10) CCSS was commended in the 2012 Program Monitoring for the internal restructuring with the hiring of a grant coordinator and for implementing an internal quality control of client file reviews. CCSS file review error rate was 1.6% and to date it is .08%, both below the <2.0% DOEA/Senior Choices' error rate. In 2012, with 46 files reviewed, there were only three (3) priority errors and zero (0) risk scores noted. CCSS was commended for the service and documentation of the Adult Protective Services (APS) referrals being completed and recorded within the mandated time frames. CCSS is the lead case management agency in Collier and receives grant funding from the Community Care for the Elderly, Home Care for the Elderly and the Alzheimer's Disease Initiative. CCSS Nutrition provides home delivered meals and manages four (4) congregate meal sites in Collier County. Collier County Human Services program partners with both the Homeless Coalition and Direct Assist Collier non-profit agencies so that additional services can be secured for seniors when grant funding is not available. During 2012-2013, CCSS case managers were able to assist two clients by securing donated labor and supplies to completely remodel a senior's bathroom and another senior's home to have central air conditioning installation. Also, this past year, CCSS case managers were able to secure $26,400 in donations of supplies and medical equipment to give to seniors in Collier County. CCSS is a member of the Naples Interagency Council and respected by other providers. CCSS is the authority on securing services and assistance for seniors when services have not been available or when seniors were ineligible for grant funded services. CCSS participates at several ongoing annual speaking venues to assist seniors in securing services and to understand the referral process, available services and eligibility requirements. These presentations were completed at the Alzheimer Support Network and Avow and Vitas Hospices. Q11. Copies of state/ local licenses to provide services: 1 Copy of Current License (State and/or County), if applicable, to provide service in each county covered by Proposal should be included. Q12. IRS determination letter granting tax-exempt status (if applicable): On file with Senior Choices of Southwest Florida. 16 Q13. Bound audited financial statement with management letter or current financial statement: If the AAA has the most current (within 12 months) Audited Financial statement on file it does not need to be submitted. (Where management letter cites concerns or problems, provide copy of response as well.) On file with Senior Choices of Southwest Florida. Q14. Assurance of Sufficient Insurance Coverage: (Indication of type and amount will suffice for purpose of this RFP. Chosen Providers must submit verification from Insurance Company following notification of selection): HHVS will submit insurance verification following notification of award. Service Delivery 1. Description of Service Delivery and Coordination Plan: (Provide one sheet for each of the services that you propose to provide. If a service is provided under more than one funding source, only one description is needed.) Access Services: • Case Management • Case Aide • Intake • Screening and Assessment • Transportation 17 SERVICE DELIVERY AND COORDINATION SERVICE: Case Management SITE LOCATION/S: (If different from Summary Page; provider may attach a list of sites.) FUNDING: X III-B, ❑ III-E PROVIDED: X Directly To Be Subcontracted DAYS AVAILABLE: Monday-Friday; On call on weekends via HHVS cell phone. HOURS AVAILABLE: 8am-5pm,on call after hours via cell phone ACTIVITIES A Case Manager will assess applicants for OAA programs,who are 60 years old and INCLUDED: older and who are frail and possibly eligible for Florida Medicaid. CCSS will provide case management and coordinate all service delivery including linking them with an array of community based services and resources. The Case Manager is responsible for arranging services,developing the care plan,and monitoring the quality of the service provided. The Comprehensive Assessment Tool (701B)will be completed with a well-developed care plan. The Case Manager assesses the client face to face annually and bi-annually with additional visits/contacts to assess the client's status,satisfaction with services and to monitor services semi-annually. Clients will be apprised of their right for grievance if services are reduced or terminated. The Case Manager will serve as a link between the client's noted needs and the client remaining independent as long as possible. COORDINATION After completing an intake on the individual and a service is determined to be METHODS USED TO available,a Case Manager will conduct a home visit to determine the needs and choices ASSURE CLIENT of the client. Providers for the particular services are reviewed with the client and the CHOICE,SERVICE Case Manager will explain that the choice of the client is respected. If the client does AUTHORIZATION not wish to make a choice then the Case Manager will assign the vendor based on a AND AVOIDANCE OF rotation system accessible on the computer and available to all Case Managers. An DUPLICATION OF authorization is sent to the agency to provide the needed service authorizing said SERVICE. service. COMMUNICATION The aide and the client both sign the vendor printed daily service form,which PROCESS BETWEEN documents the provided service and time. The daily,authorization,and the summary AGENCY, PROVIDER of service provision are reviewed weekly to reconcile service provision and services &CLIENT authorized. Although HIPAA restricts the exchange of information,the Case Manager can monitor services the client is receiving to avoid the client's duplicating service. USE OF PROGRAM INCOME-HOW WILL IT BE USED TO N/A INCREASE AVAILABILITY OF SERVICE? APPLICANT, PLEASE COMPLETE: We will provide the above service in all areas of the county or counties we propose to serve. --0C-e Signat e of authorized ag=n y representative Approved as to form and legality 18 Assistant Coifnty V Bey SERVICE DELIVERY AND COORDINATION SERVICE: Case Aide SITE LOCATION/s: (If different from Summary Page; provider may attach a list of sites.) PROVIDED: x Directly To Be Subcontracted DAYS AVAILABLE: Monday-Friday HOURS AVAILABLE: 8am -5pm FUNDING: (X) III-B, (X) III-E ACTIVITIES The Case Aide provides assistance to the Case Manager and to the client by INCLUDED: arranging and coordinating client services. The services are an adjunct to the Case Management and enhance the timeliness of the Lead Agency response to the needs of the client. Case Aide is trained and can enter CIRTS program and billing data. COORDINATION The Case Aide and Case Manager will confer about the needs of a client. The METHODS USED TO Case Aide can access specific program and community resources to facilitate the ASSURE CLIENT needed assistance and allow the Case Manager the time to provide more in-depth CHOICE,SERVICE attention to clients. The Case Management Supervisor will monitor Case Aide AUTHORIZATION assignments to ensure the most appropriate use of time is employed. Case AND AVOIDANCE OF Managers and Case Aide staff will confer with the Case Management Supervisor to DUPLICATION OF assure that the appropriate staff is assigned in completing the duties of these two SERVICE. roles. COMMUNICATION The Case Aide works under the direction of a Case Manager and the Case PROCESS BETWEEN Management Supervisor and follows the HHVS-Services for Seniors program's AGENCY,PROVIDER established policies for case management to ensure communication between &CLIENT agency, provider and client. USE OF PROGRAM INCOME-HOW WILL IT BE USED TO N/A INCREASE AVAILABILITY OF SERVICE? APPLICANT, PLEASE COMPLETE: We will provide the above service in all areas of the county or counties we propose to serve. Signat of authorized age, • rep esentative Approved as to form and legality Assistant C " Attorney 19 0 SERVICE DELIVERY AND COORDINATION SERVICE: Intake SITE LOCATION/S: (If different from Summary Page; provider may attach a list of sites.) PROVIDED: X Directly To Be Subcontracted DAYS AVAILABLE: Monday-Friday FUNDING: (X) III-B, ❑ III-E HOURS 8am -5 pm AVAILABLE: ACTIVITIES The intake function is provided to prioritize clients for services and to evaluate their needs for services.The 701-B form is completed which allows the Case Manager to obtain essential INCLUDED: information in order to assist in screening for eligibility and appropriate service referrals.The client information is then prioritized through CIRTS to be placed on the waiting list.This system of prioritization through the Intake allows staff to provide service to the neediest clients first. COORDINATION Because the grantor agency has centralized the initial contact through the Elder Helpline, METHODS USED TO most initial contacts are through that resource.With the creation if this centralized referral ASSURE CLIENT and information services, CCSS receives referrals for individuals who need a more thorough CHOICE,SERVICE assessment than the intake. Once the case manager contacts the elderly person, completes AUTHORIZATION the 701 B, and determines that s/he may be eligible for OAA or other program services based AND AVOIDANCE OF on the information received,the individual prioritizes the person for a home visit and DUPLICATION OF screening and assessment(SCAS), based on the"priority score"obtained from the CIRTS Turnaround report. SERVICE. COMMUNICATION If the individual does not appear to meet eligibility requirements for any funded program,the individual completing the intake will explain the eligibility criteria and reason for PROCESS BETWEEN determination. Other community resources are explained to the individual seeking services AGENCY, PROVIDER and the staff member completing the initial screening will provide this referral information. &CLIENT Records of this referral are kept and the individuals are provided with an opportunity to file a grievance to appeal the decision of ineligibility. USE OF PROGRAM INCOME-HOW WILL IT BE USED TO N/A INCREASE AVAILABILITY OF SERVICE? APPLICANT, PLEASE COMPLETE: We will provide the above service in all areas of the county or counties we propose to serve. Signature of authorized ag cy representative Approved as to form and legality Assistant CoUnty)4tprney 20 t�v� SERVICE DELIVERY AND COORDINATION SERVICE: Screening and Assessment SITE LOCATION/S: (If different from Summary Page; provider may attach a list of sites.) FUNDING: (X) III-B, (X) III-E PROVIDED: X Directly To Be Subcontracted DAYS AVAILABLE: Monday-Friday HOURS gam-5 pm AVAILABLE: ACTIVITIES Upon the noting on the wait list that the client is next to be seen based on the priority score,the Case INCLUDED: Manager will arrange for and complete a home visit. The client is assessed with the OAA portion of the 701 B(plus the caregiver section for 3E)and a care plan is developed detailing the services to be provided. IIIB clients must be screened and assessed annually. Clients who receive congregate meals are screened and assessed annually. If the client receives only the meals,the SCAS is completed through the meal site. Otherwise the Case Manager completes the 701 B/OAA sections. COORDINATION At the time of the home visit the Case Manager will apprise the client of available resources and screen METHODS USED TO for eligibility for other programs not part of the CCSS programs. If the client chooses to receive services ASSURE CLIENT through CCSS,the client and Case Manager will determine needed services and the client is told of the CHOICE,SERVICE available vendors and told of their right to"choice". Providers for the particular services are reviewed with the client and the Case Manager will explain that AUTHORIZATION the choice of the client is respected. If the Client does not wish to make a choice then the Case AND AVOIDANCE OF Manager will assign the vendor based on a rotation system accessible on the computer and available to DUPLICATION OF all Case Managers. An authorization is sent to the agency to provide the needed service authorizing said service. If the SERVICE. client/caregiver needs respite then the Case Manager coordinates the system of service delivery and coordinates the payment to the vendor.Several Assisted Living Facilities(ALF's)in Collier County cooperate with CCSS through the 3E program. COMMUNICATION Communication is open between the sites/providers and CCSS to ensure that the appropriate service is PROCESS BETWEEN being provided to each person. Communication between the client and CCSS is always open to address any service provision issues,to assure satisfaction with service and to assure the client's needs AGENCY,PROVIDER are being met.Case Managers have voice mail services to take messages from clients or providers &CLIENT when they are out of the office. USE OF PROGRAM INCOME-HOW WILL IT BE USED TO N/A INCREASE AVAILABILITY OF SERVICE? APPLICANT, PLEASE COMPLETE: We will provide the above service in all areas of the county or counties we propose to serve. Signs ure of authorized ag- f re resentative Approved as to form and legality Assistant County Att ey 21 CA SERVICE DELIVERY AND COORDINATION SERVICE: Transportation SITE LOCATION/s: (If different from Summary Page; provider may attach a list of sites.) PROVIDED: Directly X To Be Subcontracted DAYS AVAILABLE: FUNDING: (X) III-B, (X) III-E HOURS AVAILABLE: ACTIVITIES Collier County Services for Senior's staff will work through the Local Coordinating INCLUDED: Board (LCB) for contract transportation services. Clients will be able to access the meal sites by using the available transportation provided through Collier County ATC/Para transit. Access to medical care and necessary shopping for those who are unable to drive is facilitated by the transportation available. COORDINATION METHODS USED TO Collier County Services for Senior's subcontracts with ATC/Para transit, the Collier ASSURE CLIENT County designated LCB transportation provider, to provide transportation to and CHOICE,SERVICE from meal site visits under OAA. Applications are provided by Case Managers or AUTHORIZATION referred to Collier Area Transit for assistance in completing the application. AND AVOIDANCE OF An OAA/meal site client has their transportation arranged through the meal site. DUPLICATION OF SERVICE. COMMUNICATION Each month the transportation records are sent to the Housing, Human and PROCESS BETWEEN Veteran Services Accountant who will then reconcile the transportation records with AGENCY,PROVIDER the meal site records of who received meals and who accessed the transportation. &CLIENT USE OF PROGRAM INCOME—HOW WILL IT BE USED TO N/A INCREASE AVAILABILITY OF SERVICE? APPLICANT, PLEASE COMPLETE: We will provide the above service in all areas of the county or counties we propose to serve. Signature of authorized ncy representative Approved as to form and legality 22 Assistant County AttoMey Administrative Assessment Checklist: ADMINISTRATIVE ASSESSMENT OF POTENTIAL PROVIDERS Agency: Collier County Housing Human & Veteran Services Date: August 30, 2013 Address: 3339 Tamiami Trail East, Suite 211, Naples FL 34112 No. of employees: 40 . No. of locations of business: 1 Director/Owner'sName: Kim Grant . Administrative Assessment: An assessment of your organizations managerial, financial, and administrative capabilities will be made on the basis of your response. If any response is other than "yes" or "no", please reference the appropriate question and give your response on a separate page. This information must be completed and returned with the response to our Request for Proposal. 23 v ADMINISTRATIVE ASSESSMENT CHECKLIST YES NO OTHER 1 Procurement Are written purchasing policies for procurement of supplies, equipment, X construction, and other services on file? 2 Accounting a. Are financial reports prepared monthly for internal management purposes? X b. Does an independent auditor perform a certified audit annually? X c. Are basic books of accounting maintained? X (1) General ledgers X (2) Project ledgers X (3) Accounts receivable/cash X (4) Accounts payable/cash Disbursement journal X d. Is there adequate segregation of duties among personnel in the accounting X functions listed below? (1) Is payroll prepared by someone other than the timekeepers and persons X who deliver paychecks to employees? (2) Are duties of the bookkeeper separate from cash-related functions? X (3) Is the signing of checks limited to those authorized to make X disbursements and whose duties exclude posting and recording of cash received? (4) Are personnel performing disbursement functions excluded from the X purchasing, receiving, inventory, and general ledger services? (5) Are accounting records retained for a period of 5 years? X (6) Does Provider maintain adequate liability insurance coverage? X 3 Personnel a. Are personnel policies in writing and approved by appropriate authority? X b. Are job descriptions provided to all employees at time of initial employment? X c. Are job descriptions on file for all positions? X d. Is each staff member appraised on performance, at least annually? X e. Are staff members asked to review and comment on their evaluations? X Al 24 Certification (signed statement) of availability of 60 days operating funds: I, Leo J Ochs, Jr. , as an authorized representative of Collier County Housing, Human & Veteran Services certify that this firm has and maintains sufficient funds to continue operating at current levels for a minimum of 60 days. fs Authorized Represent ive 8/27/2013 Date Approved as to form and legality Assistant County A ;y, ey A2 25 (119) HIPAA Compliance Assurance: I, Leo E. Ochs, Jr. , as an authorized representative of Collier County Housing, Human & Veteran Services, hereby issue this statement of assurance that this agency/company has determined that: [ X ] it is considered a "covered entity" and is in compliance with and is able to meet all of the requirements of the Health Insurance Portability and Accountability Act of 1996. [ ] it is not considered a "covered entity," but will comply with the intent of the Act in the areas of privacy, security and billing. Authorized Repres tative 8/27/2013 Date Approved as to form and legality istant Coun ttorney A3 26 Statement of No Involvement and Contract Terms and Conditions: STATEMENT OF NO INVOLVEMENT I, Leo E. Ochs, Jr. , as an authorized representative of Collier County Housing, Human & Veteran Services, certify that neither any member of this firm nor any person having interest in this firm has been awarded a contract by the Department of Elder Affairs or the Area Agency on Aging for Southwest Florida on a noncompetitive basis to: (1) Develop this Request for Proposal; (2) Perform a feasibility study concerning the scope of work contained in this RFP; or (3) Develop a program similar to what is contained in this RFP. Authorized Represent. - 8/27/2013 Date Approved as to form and legality A sistant Con Attorney A4 27 CONTRACT TERMS AND CONDITIONS I, Leo E. Ochs, Jr. , as an authorized representative of Collier County Housing, Human & Veteran Services , certify that this firm agrees to all the terms and conditions of the contract as set forth in this Request For Proposal. Authorized Represe - ive 8/27/2013 Date Approved as to form and legality Assistant Coun Attorney A5 28 Statement of Compliance with Service Standards: I, Leo E. Ochs, Jr., have read and understand the requirements and standards for all services to be coordinated or provided directly for which my agency / company, Collier County Housing, Human & Veteran Services is applying and would be held responsible. I hereby issue this statement of assurance that this agency / company is in compliance with and is able to meet all of the requirements and standards noted in Department of Elder Affairs Home and Community Based Services Handbook (2009) for services included in this proposal. 8/27/2013 Authorized Represe tive Date Approved as to form and legality Assistant Coun 6• ttorney A6 29 ^4 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Contracts/Subcontracts: CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION CONTRACTS/SUBCONTRACTS This certification is required by the regulation implementing Executive Order 12549, Debarment and Suspension, signed February; 18, 1986. The guidelines were published in the May 29, 1987 Federal Register (52 Fed. Reg., pages 20360-20369). (1) The prospective recipient certifies, by signing this certification, that neither he nor his principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in contracting with the Department of Elder Affairs by any federal department or agency. (2) Where the prospective recipient is unable to certify to any of the statements in this certification, such prospective recipient shall attach an explanation to this certification. ‘'''"t`i2s Signature ' — 0 ' S - Date 8/27/2013 Name and Title of Authorized Individual Approved as to form and legality (Print or type) Cr `Assistant Cottaty Attorney Leo E. Ochs, Jr., County Manager Collier County Housing, Human & Veteran Services Name of Organization A7 30 ,OD) AVAILABILITY OF DOCUMENTS The undersigned hereby gives full assurance that the following documents are maintained in the administrative office of the provider and will be filed in such a manner as to ensure ready access for inspection by the AAA or its designee(s) at any time. The Provider will furnish copies of these documents to the AAA upon request. 1. Current Board Roster 2. Articles of Incorporation 3. Copy of most recent IRS Form 990 (if not-for-profit): 4. Corporate By-Laws 5. Advisory Council By-Laws and Membership 6. Current Equipment Inventory 7. Bonding / Insurance Coverage Verification 8. Staffing Plan a. Position Descriptions b. Pay Plan c. Organizational Chart 9. Personnel Policies Manual 10. Financial Procedures Manual 11. Operational Procedures Manual 12. Interagency Agreements 13. Affirmative Action Plan 14. Outreach Plan 15. Americans With Disabilities Act Assurance and supporting documentation 16. Unusual Incident File 17. Co-Pay Contribution System 18. Civil Rights Compliance Documentation CERTIFICATION BY AUTHORIZED AGENCY OFFICIAL: I hereby certify that the documents identified above currently exist and are properly maintained in the administrative office of the Provider. Assurance is given that the AAA or its designee(s) will be given immediate access to these documents, upon request. 8/27/2013 Signatur Date Leo E. Ochs, Jr., County Manager Approved as to form and legality 31 Assistant County Atf ey Match COMMITMENT OF CASH DONATION [ ] Original, dated SFY: FFY: Contract Amendment# Agency Name: Collier County Housing, Human Program: OAA 3B &Veteran Services Donor Identification: Name: Collier County Housing, Human &Veteran Services Street:3339 Tamiami Trail E, Suite 211 City: Naples State: FL Zip: 34112 Phone: 239-252-2273 Authorized Representative: Total Amount # Payments Amount/Payment Contribution Period $8,500.00 12 $708.33 Monthly Special Conditions: Third Party Donors: (Please identify all sources of this cash donation below) X County Government: ❑ City Government: ❑ City Government: ❑ Other: Fl 32 � 1 MATCH COMMITMENT FOR DONATION OF BUILDING SPACE [ ] Original, dated SFY: FFY: Contract Amendment# Agency Name: Program: Donor Identification:Name: Collier County Housing, Human &Veteran Services Street:3339 Tamiami Trail E, Suite 211 City: Naples State: FL Zip: 34112 Phone: 239-252-2273 Authorized Representative: Description of Space: [X] Office [ ] Site [ ] Other Provider Owned Space: 1. Number of square feet used by project 1600 sq.ft. 2. Appraised rental value per square foot$ /sq.ft. 3. Total value of space used by project (1x2) $ Donor Owned Space: 1. Established monthly rental value $ 2. Number of months rent to be paid by donor months 3. Value of donated space (1x2) $ Special Conditions: Donor Certification: The space being donated is owned and `donated' by: I hereby certify intent to donate use of the space set forth above for the program specified above during the program's upcoming funding period. This space is not being used as match for any other State or Federal program or contract. X - Date: 8/27/2013 Signalur of Donor or Repr -e tative F2 Approved as to form and legality )_C Assistant Cou Attorney 33 MATCH COMMITMENT OF SUPPLIES [ ] Original, dated SFY: FFY: Contract Amendment# Agency Name: Program: Donor Identification: N/A Name: Street: City: State: Zip: Phone: Authorized Representative: Description of Supplies: The below described supplies are committed for use by the project for the period of: (From) (To) Computation of Value: Value to be claimed by project: $ Special Conditions: Donor Certification: I hereby certify intent to donate these supplies for the program specified above during the program's upcoming funding period. These supplies are not being used as match for any other State or Federally assisted program or contract. X Date: Signature of Donor or Representative F3 34 MATCH COMMITMENT OF EQUIPMENT [ ] Original, dated SFY: FFY: Contract Amendment# Agency Name: Program: Donor Identification: N/A Name: Street: City: State: Zip: Phone: Authorized Representative: Description of Equipment: The below described equipment is committed for use by the project for the period of: (From) (To) Acquisition Description of Item Number Cost Value to Project* 1. 2. 3. 4. 5. Total Value Claimed: *Items that are currently owned by the Grantee or are loaned or donated to the project are valued at an annual rate of 6-2/3 percent of the acquisition value. Donor Certification: This equipment is not included as a contribution for any other State or Federally Assisted program or contract and costs are not borne by the Federal Government directly or indirectly under any Federal grant or contract except as provided for under: (cite the authorizing Federal regulation or law if applicable). X Date: Signature of Donor or Representative F4 35 c,� MATCH COMMITMENT OF IN-KIND CONTRIBUTION OF SERVICES BY STAFF OF SERVICE PROVIDER OR STAFF OF OTHER ORGANIZATIONS [ ] Original, dated SFY: FFY: Contract Amendment# Agency Name: Program: Donor Identification: N/A Name: Street: City: State: Zip: Phone: Authorized Representative: Descriptions of Positions: Position Hourly Rate or # Hours Value to Title Service Annual Salary Worked Project* 1. $ $ 2. $ $ 3. $ $ Total - $ *Value to project = (# of hours worked) x (Hourly rate) or (Annual Salary T 2080 hrs) x (# of hours worked) Donor Certification: These services are not included as match for any other State or Federally Assisted program or contract and costs are not borne by the Federal Government directly or indirectly under any Federal grant or contract except as provided for under: (cite the authorizing Federal regulation or law if applicable). It is certified that the time devoted to the project will be performed during normal working hours. X Date: Signature of Donor or Representative F5 36 CA MATCH COMMITMENT OF IN-KIND VOLUNTEER PERSONNEL AND TRAVEL [] Original, dated SFY: FFY: Contract Amendment# Agency Name: Program: Donor Identification: N/A Name: Street: City: State: Zip: Phone: Authorized Representative: The volunteer staff positions identified below will be filled by local volunteers who will be recruited, trained and supervised as an ongoing activity of our agency. We will maintain volunteer records to document individual volunteer activity. Describe Volunteer Effort: Equivalent # of Value Position Title Hourly Rate Hours to Project 1 $ $ 2 $ $ 3 $ $ TOTAL VALUE TO AGENCY $ Equivalent Hourly Rates were determined by: [ ] Rates for comparable positions within own agency. [ ] State Employment Service estimate of rates for type of work. [ ] Rates for comparable positions within other local agencies. ESTIMATED X RATE = VALUE MILEAGE PER MILE Donor Certification: I hereby certify that commitments have been received from individual volunteers or groups sufficient to provide the volunteer hours and travel identified above. X Date: Signature of Agency Official Name: F6 37 SERVICE UNIT RATE QUOTE Proposed Service Proposed Rate/s Case Management Total Unit cost $ 50.00 90% Reimbursement Rate $ 45.00 Case Aide Total Unit cost $ 27.78 90% Reimbursement Rate $ 25.00 Intake (EHEAP ONLY) Total Unit cost $ 27.78 90% Reimbursement Rate $ 25.00 Screening and Assessment Total Unit cost $ 50.00 90% Reimbursement Rate $ 45.00 Transportation Total Unit cost $ 100% Cost 90% Reimbursement Rate $ 90% Cost 38 0 III-E Respite — Day Care Total Unit cost $ 11 .12 90% Reimbursement Rate $ 10.00 Day Care Sitter Total Unit cost $ 13.34 90% Reimbursement Rate $ 12.00 Ill EG — Child Day Care Total Unit cost $ 16.67 90% Reimbursement Rate $ 15.00 Screening and Assessment Total Unit cost $ 50.00 90% Reimbursement Rate $ 45.00 Specialized Medical Equipment, Service & Supplies Total Unit cost $ 100% Cost 90% Reimbursement Rate $ 90% Cost *Based upon current PSA 8 Rates 39 c,� Acceptance of Service Rates In accordance with the contract requirements of Title IIIB and Title IIIE of the Older Americans Act and this bid document Collier County Housing, Human and Veteran Services Agrees to provide the service proposed in this proposal for the approved rates. �; 8/27/2013 Leo E. Ochs, Jr., Signature of Authorized Agency Representative Date Approved as to form and legality Assistant County Ate racy 40 Al Organization Chart 41 ( L \ /P \ m 3 cFm c m g 2 d � v m s o 2 o d a G Q -d N _ {O ?'d m r y N N � J co 7. a w U r ' q C)co c d -' chi CO 01 ro 0 m w'N m y d $ v i6@ is - 82 16 "= 160— 16 � 33-y C) 0 (dam d w d 133 d d tb d d ��1, -. B o > > > Sa my=y m � toR I' g. Io2 m N N O N d CD IDd. a a I I W a N ? A m �m < S' > - C a� C) 3 _ i 2 .o. E m m c 5'a a $ U'a o 3..-,c- a- � p 8'S' zd E E Z N � n 0 O-. N \d / 5. N I_ 3 0 g D D d ip� nC oy � D$ Dd coR � 3 R� f3 o 3 N = _ 'p 2S n W 7 P.1 S,d % O`$'' .� fD c _ �N d o 5 01 F. S� }5 v g a pfd 2. ca O to a k d I 3 3 3 7J y -1', a.r ^c 3 N c r p o.� m =W o w 0E. C)<�+ 0�()E _ m N - d0?.7d Li O ii EC o65 t1�oCg g.- ochg N5 a.ID 4 ova o fi3o N6z p d E. d 3 0 b N d a m o 0 a �� a 1� 0)w N j 0 F, " tp� la 0 N 'O.� I ,a..3. - C U � N N d g F.d ^01 d o '.j. a c o q a N a G w <p g �� a gZ' .oi3 W Jj v c \ 7 N 42 A2 Job Descriptions 43 Code: 15593 Pay Grade: 12 COLLIER COUNTY, FLORIDA CLASSIFICATION SPECIFICATION CLASSIFICATION TITLE: CASE MANAGER ASSISTANT PURPOSE OF CLASSIFICATION The purpose of this classification is to provide assistance to case managers who conduct a client centered series of activities which includes planning, arranging for, and coordinating appropriate medical assistance services for an eligible client. Employees in this classification assist case managers in assessing the needs of clients, and arranging and coordinating services/resources through county, state, and federal programs. These programs include ones offered through the area agency on aging and/or provided by the Collier County Board of County Commissioners. ESSENTIAL FUNCTIONS The following duties are normal for this position. The omission of specific statements of the duties does not exclude them from the classification if the work is similar, related, or a logical assignment for this classification. Other duties may be required and assigned. Completes eligibility assessment of clients;assists case managers in developing a care plan to meet the service needs of the client;arranges and coordinates needed services for clients;provides follow-up with clients' as needed. Maintains federal, state,and County mandated client records;prepares reports;writes letters and correspondence. Contacts and advocates with other community agencies on clients' behalf. Assists in crisis interventions. Provides information and referral for the general public and agencies;receives,processes, and tracks referrals. Completes telephone intakes; develops and maintains CIRTS client tracking systems for active clients; develops and maintains information and referral database. Represents departmental interests at community meetings;attends seminars and in-service training. Tracks all client contacts of contact on behalf of client. Provides interviews to walk-in clients. Reviews and implements new and changing program requirements. Arranges for access to medical care. Operates a computer, printer, calculator, facsimile machine, copier, telephone, cellular telephone, automobile, pager, or other equipment as necessary to complete essential functions, to include the use of word processing, spreadsheet, CIRTS database, or other system software. 44 ADDITIONAL FUNCTIONS Enters data into CIRTS network;answers the telephone;mails requested information;makes copies. Maintains client files. Obtains holiday gifts and food for clients. Performs other related duties as required. MINIMUM QUALIFICATIONS The position requires the ability to observe clients,record information,conduct client interviews, assist case managers in implementing treatment plans,employ problem-solving techniques,handle crisis intervention matters,and use proper referral procedures. Applicants must have effective communication skills,a strong sense of responsibility,and the ability to manage time effectively.Must demonstrate experience with direct contact with elders and individuals who are vulnerable to exploitation or mistreatment;and the ability to display patience,understanding,and a strong desire to help others. A high school education with proven leadership ability,either from previous experience or as a volunteer as an assistant to Human Services, Social Work, Gerontology,Psychology,Nursing,or closely related field; one year of experience in social services related work;or any equivalent combination of education,training,and experience which provides the requisite knowledge, skills,and abilities for this job. Must possess and maintain a valid Florida driver's license.Fingerprinting required. PERFORMANCE APTITUDES Data Utilization: Requires the ability to evaluate, audit, deduce, and/or assess data using established criteria. Includes exercising discretion in determining actual or probable consequences and in referencing such evaluation to identify and select alternatives. Human Interaction: Requires the ability to apply principles of persuasion and/or influence over others in coordinating activities of a project,program, or designated area of responsibility. Equipment, Machinery, Tools, and Materials Utilization: Requires the ability to operate, maneuver and/or control the actions of equipment,machinery,tools,and/or materials used in performing essential functions. Verbal Aptitude: Requires the ability to utilize a wide variety of reference, descriptive, and/or advisory data and information. Mathematical Aptitude: Requires the ability to perform addition, subtraction, multiplication, and division; the ability to calculate decimals and percentages;the ability to utilize principles of fractions;and the ability to interpret graphs. Functional Reasoning: Requires the ability to apply principles of rational systems; to interpret instructions furnished in written, oral, diagrammatic, or schedule form; and to exercise independent judgment to adopt or modify methods and standards to meet variations in assigned objectives. Situational Reasoning: Requires the ability to exercise judgment, decisiveness and creativity in situations involving the evaluation of information against sensory,judgmental, or subjective criteria,as opposed to that which is clearly measurable or verifiable. Leadership: Customer Service: Financial Accountability: 45 ADA COMPLIANCE Physical Ability: Tasks require the ability to exert light physical effort in sedentary to light work, but which may involve some lifting, carrying, pushing and/or pulling of objects and materials of light weight (5-10 pounds). Tasks may involve extended periods of time at a keyboard or work station. Sensory Requirements: Some tasks require the ability to perceive and discriminate sounds, odor, and visual cues or signals. Some tasks require the ability to communicate orally. Environmental Factors: Performance of essential functions may require exposure to adverse environmental conditions, such as odors,temperature extremes,traffic hazards,bright/dim lights, or disease. Collier County is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the County will provide reasonable accommodations to qualified individuals with disabilities and encourages both prospective and current employees to discuss potential accommodations with the employer. 46 Code: 15595 Pay grade: 18 COLLIER COUNTY, FLORIDA CLASSIFICATION SPECIFICATION CLASSIFICATION TITLE: CASE MANAGER PURPOSE OF CLASSIFICATION The purpose of this classification is to provide case management, which is a client centered series of activities including planning, arranging for, and coordinating appropriate community- based services for an eligible client. Employees in this classification assess the needs of clients and arrange and coordinate services/resources through County, State, and Federal programs. ESSENTIAL FUNCTIONS The following duties are normal for this position. The omission of specific statements of the duties does not exclude them from the classification if the work is similar, related, or a logical assignment for this classification. Other duties may be required and assigned. Completes eligibility assessment of clients; develops a care plan to meet the service needs of the client; arranges and coordinates needed services for clients; provides follow-up with clients as needed. Maintains federal, state, and county mandated client records; prepares reports; writes letters and correspondence. Contacts and advocates with other community agencies on client's behalf Assists in crisis interventions; provides clients and families with short term counseling. Provides information and referral for the general public and community agencies; receives, processes, and tracks referrals. Develops and maintains client tracking system for active clients; develops and maintains information and referral database. Complies with each program's requirements. Reviews and implements new and changing program requirements. Represents departmental interests at community meetings; attends seminars and in-service training classes. Provides interviews for clients and schedules home visits. Tracks all client contacts on behalf of client. 47 Provides interviews to walk-in clients to assess their needs. Arranges access to medical care for clients. Operates a computer, printer, calculator, facsimile machine, copier, telephone, cellular telephone, automobile, pager, or other equipment as necessary to complete essential functions, to include the use of word processing, spreadsheet, database, or other system software. ADDITIONAL FUNCTIONS Enters date into computer; answers the telephone; mails requested information; makes copies. Maintains client files. Performs other related duties as required. In the event of a declared state of emergency, employees in this classification may be called to work during days or hours other than those for which they are regularly scheduled. MINIMUM QUALIFICATIONS Bachelor's degree in Human Services, Social Work, Gerontology, Psychology, Nursing, or closely related field; three years of experience in social services related work; or any equivalent combination of education, training, and experience which provides the requisite knowledge, skills, and abilities for this job. Must possess and maintain a valid Florida driver's license. Must possess and maintain certifications that may be required for a particular program. Fingerprinting required. PERFORMANCE APTITUDES Data Utilization: Requires the ability to evaluate, audit, deduce, and/or assess data using established criteria. Includes exercising discretion in determining actual or probable consequences and in referencing such evaluation to identify and select alternatives. Human Interaction: Requires the ability to apply principles of persuasion and/or influence over others in coordinating activities of a project, program, or designated area of responsibility. Equipment, Machinery, Tools, and Materials Utilization: Requires the ability to operate, maneuver and/or control the actions of equipment, machinery, tools, and/or material used in performing essential functions. Verbal Aptitude: Requires the ability to utilize a wide variety of reference, descriptive, and/or advisory data and information. Mathematical Aptitude: Requires the ability to perform addition, subtraction, multiplication, and division; the ability to calculate decimals and percentages; the ability to utilize principles of fractions; 48 and the ability to interpret graphs. Functional Reasoning: Requires the ability to apply principles of rational systems; to interpret instructions furnished in written, oral, diagrammatic, or schedule dorm; and to exercise independent judgment to adopt or modify methods and standards to meet variations in assigned objectives. Situational Reasoning: Requires the ability to exercise judgment, decisiveness and creativity in situations involving the evaluation of information against sensory,judgmental, or subjective criteria, as opposed to that which is clearly measurable or verifiable. Leadership: Customer Service: Financial Accountability: 49 COLLIER COUNTY, FLORIDA CLASSIFICATION SPECIFICATION CLASSIFICATION TITLE: SUPERVISOR-CASE MANAGEMENT PURPOSE OF CLASSIFICATION The purpose of this classification is to provide supervision, evaluation, training, and delegation of work to Case Managers, and intake staff. This position is responsible for the review and monitoring of client assessments and client care plans to ensure that policies regarding the prioritization, determination of the type of services, and the level of service of each client are met through arranging and coordinating services/resources through county, state, and federal programs. These programs include ones offered through the area agency on aging and/or provided by the Collier County Board of County Commissioners. ESSENTIAL FUNCTIONS The following duties are normal for this position. The omission of specific statements of the duties does not exclude them from the classification if the work is similar, related, or a logical assignment for this classification. Other duties may be required and assigned. Supervises case management staff, and case manager assistant(s). Reviews client care plans and client case records to assure completeness, accuracy and timeliness. Authorizes service delivery for clients, tracks service level expenditures, and recommends service level increases and decreases to ensure that client goals and target service levels are met. Coordinates and monitors service delivery with subcontracted community service providers and resolves problems as identified. Resolves problems between the case manager and client or caregivers. Assists caregivers and family members in obtaining training and counseling as appropriate. Develops and coordinates information and referral relationships with other community agencies. Assures that all service provisions are followed as prescribed by federal, state, and county policies. Assures that all data entry and reporting requirements are met as specified by program funding sources. 50 Develops and implements training plan for staff. Maintains client caseload and assigns client caseloads to case management staff. Develops client caseload coverage plan for staff vacancies. Recommends employee selections and implements employee disciplinary actions as appropriate. Develops and implements Seniors Program policies, procedures, goals, and objectives which establish contract compliance; establishes methods for the provision of all services; monitors programmatic achievement of established goals. Represents Seniors Program and/or the Department of Human Services on task forces as necessary; serves as primary Seniors Program programmatic liaison with state designated Area Agency on Aging in conjunction with Human Services Director and Human Services Grant Manager. Performs other duties as may be required. Reviews and implements new and changing program requirements. Arranges for access to medical care. Operates a computer, printer, calculator, facsimile machine, copier, telephone, cellular telephone, automobile, pager, or other equipment as necessary to complete essential functions, to include the use of word processing, spreadsheet, CIRTS database, or other system software. ADDITIONAL FUNCTIONS Enters data into CIRTS network; answers the telephone; mails requested information; makes copies. Maintains client files. In the event of a declared state of emergency, employees in this classification may be called to work during days or hours other than those for which they are regularly scheduled. MINIMUM QUALIFICATIONS The position requires the ability to supervise case managers. Applicants must have effective communication skills,a strong sense of responsibility,and the ability to manage time effectively. Must demonstrate experience with direct contact with elders and individuals who are vulnerable to exploitation or mistreatment; and the ability to display patience, understanding,and a strong desire to help others. 51 A bachelor's degree in Human Services, Social Work, Gerontology, Psychology,Nursing,or closely related field with proven leadership ability,and three years of experience in human services. Must possess and maintain a valid Florida driver's license. Fingerprinting required. PERFORMANCE APTITUDES Data Utilization: Requires the ability to evaluate, audit, deduce, and/or assess data using established criteria. Includes exercising discretion in determining actual or probable consequences and in referencing such evaluation to identify and select alternatives. Human Interaction: Requires the ability to apply principles of persuasion and/or influence over others in coordinating activities of a project, program, or designated area of responsibility. Equipment, Machinery, Tools, and Materials Utilization: Requires the ability to operate, maneuver and/or control the actions of equipment, machinery, tools, and/or materials used in performing essential functions. Verbal Aptitude: Requires the ability to utilize a wide variety of reference, descriptive, and/or advisory data and information. Mathematical Aptitude: Requires the ability to perform addition, subtraction, multiplication, and division; the ability to calculate decimals and percentages; the ability to utilize principles of fractions; and the ability to interpret graphs. Functional Reasoning: Requires the ability to apply principles of rational systems; to interpret instructions furnished in written, oral, diagrammatic, or schedule form; and to exercise independent judgment to adopt or modify methods and standards to meet variations in assigned objectives. Situational Reasoning: Requires the ability to exercise judgment, decisiveness and creativity in situations involving the evaluation of information against sensory,judgmental, or subjective criteria, as opposed to that which is clearly measurable or verifiable. Leadership: Customer Service: Financial Accountability: ADA COMPLIANCE Physical Ability: Tasks require the ability to exert light physical effort in sedentary to light work, but which may involve some lifting, carrying, pushing and/or pulling of objects and materials of light weight (5-10 pounds). Tasks may involve extended periods of time at a keyboard or work station. Sensory Requirements: Some tasks require the ability to perceive and discriminate sounds, odor, and visual cues or signals. Some tasks require the ability to communicate orally. Environmental Factors: Performance of essential functions may require exposure to adverse environmental conditions, such as odors, temperature extremes, traffic hazards, bright/dim lights, or disease. 52 Collier County is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the County will provide reasonable accommodations to qualified individuals with disabilities and encourages both prospective and current employees to discuss potential accommodations with the employer. 53 A3 HIPPA Regulations 54 Collier County Housing, Human & Veteran Services Department Standard Operating Procedures Health Insurance Portability and Accountability Act Updated July 12,2013 Purpose: The purpose of this policy is to ensure that all clients will be notified of their rights to privacy of protected health information, as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule. Description: All clients will be given a copy of the Notice of Privacy Practices, which will explain how their health information may be used. Procedures: Staff: 1. All staff will read and become familiar with CMA 5207, SANCTIONS FOR FAILURE TO COMPLY WITH HIPAA POLICIES sign a Confidentiality form annually. New employees shall review CMA 5207 and complete the Confidentiality form with 10 business days of the commencement of employment. 2. Staff are not to share any Personal Health Information (PHI) of a client unless on a need to know basis. 3. Faxes are to be sent with cover sheets containing the confidentiality statement. 4. Emails with specific client information should be encrypted. ISPs in general are not encrypted. CIRTS is an encrypted system. 5. New employees shall complete training on HIPAA and the Standard Operating Procedures within 30 days of the commencement of employment. All other employees will receive this training annually. Training shall be conducted by the Department HIPAA Privacy Officer. 6. The Department Privacy Officer shall be responsible for obtaining executed Business Associate Agreements from Business Associates. A standard Business Associate Agreement, approved as to legal sufficiently by the County Attorney's Office, shall be made available by the HIPAA Privacy Officer for use by affected County entities. The HIPAA Privacy Officer shall have the authority to execute the document on behalf of the County. The Department Privacy Officer shall obtain Business Associate Agreements at the commencement of new vendor Agreements or in accordance with the requirements set forth under Federal Law. Offices: 55 1. A copy of the Notice of Privacy Practices is displayed in the lobby. 2. Client related information and files are in lockable cabinets in secured offices after hours and on weekends. 3. A second key is kept in a case in the over-head cabinet at the Administrative Secretary's desk. 4. Schedules open to public view should not show client identifiable information. 5. Documents put in the file holders on the doors should have identifiable information turned in toward the door. 6. Place items face down on the Case Manager's chair or desk if that Case Manager is not in the room. If a Case Manager is conducting a home- visit, care should be given to PHI that is transported in a vehicle placing items face down so as not to be seen or revealed. 7. All records containing client information must be kept for seven years. 8. Computer monitors shall be placed in a manner that shall prevent intentional or inadvertent viewing by non essential parties.Verbal discussions of client PHI shall be avoided in public areas and shall be confined to private areas whenever possible. Social Services Program: 1. Clients are given an Intake form upon arrival to the office. 2. New clients will be given a copy of the Notice of Privacy Practices (NPP). 3. The Case Manager will explain the NPP and obtain the client's signature of receipt. 4. The client will sign the Authorization/Consent form indicating their receipt of the NPP. 5. The clients will be provided a copy of their signed Authorization/Consent form. 6. The original of the signed Consent is kept in the client's file. 7. Files should be re-filed immediately after the notes are completed. 56 8. Specific authorization does not have to be given by the client if the transaction is related to treatment or payment (see the NPP under Treatment). 9. Information can be shared with the family of a client provided the client has signed a release of information for the specific family member. Services for Seniors: 1. New clients will be given a copy of Notice of Privacy Practices. A signed receipt of the notice is maintained in the client's record. 2. The original signed consent form will be kept in the file. The client signs this form annually. 3. A copy of the Consent will be given to the client. 4. All faxes to any Vendor or the Senior Choices of Southwest Florida (AAA) will have a cover sheet with the confidentiality statement. 5. All emails will have the confidentiality statement (now available on Desktop). 6. CIRTS transactions are encrypted and are HIPAA compliant. 7. Care Plans do not need to be sent to Vendors for Chore only clients. 8. We are considered a Treatment entity and do not need specific authorization to access resources in the course of providing for the client's best interest over and beyond the Authorization. 9. Do not share information with anyone except on a need to know basis. All staff in the HHVS office are considered in the circle of need to know and need to comply by annually signing the HHVS Policy on Confidentiality; staff agree to protect all clients' HIPAA and confidential information. Miscellaneous: 1. If the client has a complaint or concern then they are to be referred to the Privacy Officer Assistant. 2. The clients have the right to request: ❑ Access to their records ❑ Amendments to their records ❑ Restriction to access of their records 57 3. The client has the right to file a complaint about the privacy policies. 4. The client's legal representative has the right to access the client's information in lieu of the client. 58 A4 Release of Information 59 Coltie-r County Public Services Division Housing, Human&Veteran Services SERVICES FOR SENIORS RELEASE OF INFORMATION I, , hereby give my consent to release to the Collier County representative the following types of information pertinent to decisions concerning the furnishing of home care and related services: • Information about my physical condition, treatment rendered, medical and hospital records, or any other material or information related to my medical history. • Such social and economic information as may be needed to assist me satisfactorily. I also authorize the release of information to agencies and persons as deemed necessary by the Housing, Human and Veteran Services Department. Such information may be used by Collier County Housing, Human and Veteran Services to obtain assistance for me or my family from other agencies or organizations within the community. I also understand that while I will not necessarily be refused service by failure to sign this form, refusal to provide needed information may make it difficult to arrange services to help me. If I believe I have been unfairly denied program services, or if information is wrongfully used, I will be entitled to a fair hearing. A photocopy of the original of this Authorization for Release of Information shall be as valid as the original signed authorization. Client signature: Date: Cm Intl's: I hereby acknowledge that I have reviewed a copy of the Collier County Housing, Human and Veteran Services Department Notice of Privacy Practices and have been provided an opportunity to receive a copy. Client signature: Date: Cm Intl's: I hereby confirm I am not a relative of an employee nor am I a current or former employee of Collier County Housing, Human and Veteran Services Department or former county department serving social, senior or housing programs. Client signature: Date: CM Intl's: Ilottsing, .ifol IN/nail and 60 Veteran n Sery ict 3301 E:.asl Tarmarni Tral•Math Elurlj •Naples,FL 34112 239.253-GAIT V2(3) •239 252 HOW(1%314 252 CM t X223 )•239 262 RSVP WV)81)•al 2b2-VE lb omri•www ctittergov nctburnaamtwel A5 Grievance Procedure 61 MINIMUM GUIDELINES FOR RECIPIENT GRIEVANCE PROCEDURES APPLICABLE TO ALL ADVERSE ACTIONS DEEMED TERMINATIONS, SUSPENSIONS OR REDUCTIONS IN SERVICE Medicaid Waiver clients have the right to request a fair hearing from the Department of Children and Families(DCAF)Office of Appeal Hearings in addition to or as an alternative to these procedures. NOTICE TO THE RECIPIENT OF ADVERSE ACTION TO BE TAKEN AND EXPLANATION OF THE GRIEVANCE PROCEDURES FOR REVIEWING THAT DECISION • The recipient must be informed by the decision maker of the action, in writing, no less than 10 calendar*days prior to the date of the adverse action will be taken. (Prior notice is not applicable where the health and safety of the individual is endangered if action is not taken immediately; however, notice must be made as soon thereafter as practicable.) • Services cannot be reduced or terminated, nor any adverse action taken during the 10 day period. • The Notice must contain: • A statement of what action is intended to be taken; • The reason for the intended action; • An explanation of: 1. The individual's right to a grievance review if requested in writing and delivered within 10 calendar* days of the Notice postmark (assistance in writing, submitting and delivering the request must be offered and available to the individual); 2. In Medicaid Waiver actions,the individual's right to request a fair hearing from DCAF; 3. The individual's right,after a grievance review,for further appeal; 4. The right to seek redress through the courts if applicable; a statement that current benefits will continue if a grievance review is requested, and will continue until a final decision is made regarding the adverse action; and a statement that the individual may represent himself/herself or use legal counsel,a relative, a friend,or other qualified representative in the requested review proceedings. • All records of the above activities must be preserved in the client's file. GRIEVANCE REVIEW PROCEDURE UPON TIMELY RECEIPT OF A WRITTEN REQUEST FOR REVIEW • Within 7 calendar*days of the receipt of a request for review,the provider must acknowledge receipt of the request by a written statement delivered to the requester. This statement must also provide notice of: o the time and place scheduled for the review; 1 62 o the designation of one or more impartial reviewers who have not been involved in the decision at issue; o the opportunity to examine, at a reasonable time before the review, the individual's own case record,and to a copy of such case record at no cost to the individual; o the opportunity to informally present argument,evidence, or witnesses without undue interference at a reasonable time before or during the review; o a contact person for any accommodations required under the Americans with Disabilities Act; and assistance, if needed, in order to attend the review; and the stopping of the intended action until all appeals are exhausted. • All grievance reviews must be conducted at a reasonable time,date and place by one or more impartial reviewers who have not been directly involved in the initial determination of the action in question. • The reviewer(s)must provide written notification to the requester,within 7 calendar*days after the grievance review,stating: o the decision,the reasons therefore in detail; o the effect of the decision has on current benefits, if favorable; or the circumstances regarding continuation of current benefits until all appeals are exhausted; o the individual's right to appeal an adverse decision to the Area Agency on Aging by written request within 7 calendar* days, except in decisions involving the professional judgment of a legal assistance provider; o the availability of assistance in writing, submitting and delivering the appeal to the appropriate agency; o the opportunity to be represented by himself/herself or by legal counsel, a relative, a friend or other qualified representative; o for legal assistance service appeals, the individual's right to file a grievance with the Florida Bar regarding complaints related to the actual legal representation provided. PROCEDURE FOR APPEALS OF A GRIEVANCE REVIEW DECISION UPON TIMELY RECEIPT OF A WRITTEN APPEAL TO THE AREA AGENCY ON AGING • Within 7 calendar* days of the receipt of a notice of appeal of a grievance review decision,the MA must acknowledge receipt of the notice of appeal by a written statement delivered to the appellant. This statement must also provide notice of: o the time and place scheduled for the appeal; o the designation of one or more impartial AAA officials who have not been involved in the decision at issue; o the opportunity to examine at a reasonable time before the appeal the individual's own case record to date,and to a copy of such case record at no cost to the individual; o the opportunity to informally present argument,evidence,or witnesses without undue interference during the appeal; 2 63 o assistance,if needed,in order to attend the appeal; o and the stopping of the intended action until all appeals are exhausted. • All appeals of grievance reviews must be conducted at a reasonable time,date and place by one or more impartial AM officials who have not been directly involved in the initial determination of the action in question. • The designated AAA official(s) must provide written notification to the requested within 7 calendar*days after considering the grievance review appeal,stating: o the decision,and the reasons therefore in detail; o the effect the decision has on current benefits, if favorable, or the circumstances regarding continuation of current benefits until all appeals are exhausted; o the individual's right to appeal,if applicable. • Except for Medicaid Waiver actions,the decision of the AAA shall be the final decision;and the availability of assistance in requesting a fair hearing, including a notice regarding accommodations as required by the ADA. • All records of the above activities must be preserved and remain confidential.A copy of the final decision must be placed in the client's file, *In computing any period of time prescribed or allowed by these guidelines, the last days of the period so computed shall be included unless it is a Saturday,Sunday or legal holiday,in which event the period shall run until the end of the next day which is neither a Saturday,Sunday or legal holiday. 3 64 A6 Notice of Adverse Actions 65 Collier County Housing, Human and Veteran Services Department Standard Operating Procedures Notification of Adverse Actions; Reductions, Suspensions, Terminations of Benefits/Services Effective September 1, 2007 Purpose: To describe the process of reducing,suspending or terminating client benefits or services. Description: Proper notification is required when an adverse action affecting a client's benefits or services is intended to be taken by the agency. Procedures: 1. The client must be informed by the decision maker of the action, in writing, no less than 10 calendar days (not including a Saturday, Sunday or legal holiday) prior to the date the adverse action will be taken. 2. Services cannot be suspended, reduced, or terminated, nor any adverse action taken during the 10 day period. 3. The notice must contain a statement of what action is intended to be taken, the reasons for the intended action and an explanation of the following: A. the clients' right to a grievance review within the 10 day notification period. B. in Medicaid Waiver actions, the clients' right to request a fair hearing from the Department of Children and Families. C. The clients' right, after a grievance review, for further appeal. D. a statement that the current services/benefits will continue if a grievance review is requested and will continue until a final decision is made regarding the adverse action. E. a statement that the client may represent himself/herself or use legal counsel, a relative or friend, or other qualified representative in the requested review proceedings. 4. Client provided a copy of the "Collier County Services for Seniors Grievance Procedure" and "Minimum Guidelines for Recipient Grievance Procedures Applicable to all Adverse Actions Deemed Terminations, Suspensions or Reductions in Services". 66 Al Sample Client Satisfaction Survey 67 Co ze-r County Public Services Doman Housing, Human & Veteran Services 2013 Services for Seniors Satisfaction Survey Date: June 2013 Please take a few minutes to answer the following questions. You may provide us with your name at the end if you choose. PLEASE RETURN THIS FORM IN THE ENVELOPE PROVIDED BY JUNE 3rd THANK. YOU. 1. Are you satisfied with the help you receive from Services for Seniors and your Case Manager? Very Satisfied Satisfied Not Satisfied Please circle the name of your case manager: Debbi Maxon Carlton Bronson Polly Currie Sara Gutierrez Louise Pelletier 2. Do you feel that he/she returns your calls and responds to your requests in a timely manner? YES NO Comments about your case management services: 3. If you are receiving in home services, which Agency is providing the services? Agency: 4. What is your level of satisfaction with the agency's work? Very Satisfied Satisfied Not Satisfied Comments: 5. If you or your family member attends Adult Day Care, such as Care Club, please circle your level of satisfaction with the program. Very Satisfied Satisfied Not Satisfied Comments: 6. What services, if any, could be improved or added? Comments: 8. Would you like a supervisor to call you about your comments? Yes No Name: Phone: Thank you for responding! !lousing, fa Human and 'e[ei°ttiS r "ic t 111111111=0110100110..//eiblIONIMOMMIlt, 3301 Est 1m>marru INN•Health Bu i •Naples Ft,34112 149 2;*2 t..:AR1 1214i •2351;52 .(4,43)•749 75.7 CM t` -' )•719 252 RSVP(ttr3ti•249 252-V€IS(• •rt•vow*ctotttet9ov ae37rurnk ,sr A8 Collier County Target Plan 69 PSA 8 - COLLIER TARGET PLAN 2013 Characteristic 2013 2014 2015 2016 2017 2018 60+ served 977 997 1017 Minority 359 366 373 402 410 418 BPL 258 268 272 Minority BPL 488 498 508 Living Alone Rural N/A Low income 91 93 95 Minority with Limited English 70 A9 Staff Development & Training Log 71 STAFF DEVELOPMENT AND TRAINING PROGRAM DEPARTMENT: Collier County Housing, Human & Veteran Services Date EMPLOYEE TOPIC In service Length of Anticipated Training Training 01/19/12 Bronson,C APS —ARTT Yes 2 hours Annually Maxon, D. Currie, P. Pelletier, L. 02/16/12 Bronson,C Interviewing: Skills Yes 1 hour Annually Maxon, D. & Techniques Currie, P. Pelletier, L. 04/19/12 Bronson,C Alzheimer's Disease Alzheimer's 1 hour Annually Maxon, D. Initiative Training Support Currie, P. Network Pelletier, L. 05/17/12 Bronson,C Aging Network Yes 1.5 hours Annually Maxon, D. System and Currie, P. Community Resources Pelletier, L. Gutierrez, S. 2012 Bronson, C. Community Yes 1 hour Annually Maxon D. Resources Trainings each Currie, P 1/19/12 Disaster session Pelletier, L. Preparedness- 8 hours Assisting Seniors total 2/16/12 Coping Skills at Work 3/22/12 ADT Emergency Alert System 4/1/12 Ethical Issues 06/21/12 Bronson, B. Universal Precautions Yes 1 hour Annually Maxon, D. Pelletier, L. Currie, P. 72 7/18/12 Pelletier, L. EHEAP/Fuel Assistance No/AAA 2 hours As Bronson, B Needed Gutierrez, S. Maxon, D. Currie, P. 7/20/12 Gutierrez, S. EHEAP/Fuel Assistance Yes 2 hours As Maxon, D. Needed Currie, P. 7/20/12 Maxon, D. Hurricane Preparedness/ Yes 1 hour As Currie, P. CM Assist to Seniors Needed Pelletier, L. Bronson, C. Gutierrez, S 8/02/12 Maxon, D. Collier 3 hours Annually Currie, P American Red Cross County/ Pelletier, L. First Aid/CPR/AED Risk Mgmt Bronson, B. Gutierrez, S. 8/24/12 Maxon, D. Yes 1 hour As Currie, P Collier County First Aid needed Pelletier, L. Precautions Bronson, B. Gutierrez, S. 9/21/12 Maxon, D. Yes 1 hour Annually Currie, P Substance Abuse Issues in the Pelletier, L. Elderly Population Bronson, B. Gutierrez, S. 10/19/12 Maxon, D. Client Incidents, Complaints, & Yes 2 hours Annually Currie, P Grievances Pelletier, L. Bronson, B. Differentiation& Documentation 73 A 1 Senior Choices 2012 Program Monitoring Report 74 7,,, s • , ... 7S en choices (:).f Southwest Florida November 14, 2012 Mr. Fred Coyle, Chairman Board of County Commissioners 3299 Tamiami Trail East Naples, Florida 34112 Dear Commissioner Coyle: Senior Choices of Southwest Florida contracts with Collier County Services for Seniors as its Lead Agency in Collier County. Collier County Services for Seniors provides access, in-home, and nutrition services. Funding utilized includes the State of Florida's Community Care for the Elderly, The Alzheimer's Disease Initiative, Home Care for the Elderly, the Federal Older Americans Act and Emergency Home Energy Assistance Programs. Senior Choices recently conducted an on-sight programmatic monitoring of your Lead Agency. The purpose of our visit was to determine program compliance with state and federal regulations and to review quality of services provided. I have attached a copy of our most recent review of your agency. I would encourage you to note the comments reported and contact our office should you have any difficulties with the report. Thank you for your efforts in helping us better serve the older adults of our area, Sincerely, -.(..-- --— -= Leigh E Wade Executive Director Enclosures CC. Kimberley Grant, Social Services Director Louise Pelletier, Case Management Supervisor The::othprenensive reSOUrCe for S,V0101"5 10,1,0 100, I 4366-4113-5347 N :,-,,I t, ,,,,,. 4,,, I I fit} Not.k, ' \ix,,,, I I 1 40111 Y (,ii.,- .2 i)t",.2:6900 I ax 239 0,'.6),9 75 ANNUAL MONITORING ASSISTANCE REPORT PROVIDER: Housing, Human &Veteran Services-Collier County Government PRIVATE NONPROFI I ORGANIZATION PUBLIC AGENCY X COUNTY C3C1VERNMF IV I CONTACT PERSONS: Kim Grant, Interim Director Louise Pelletier, Case Management Supervisor Heidi Fahnestock, Nutrition Program Administrative Supervisor TELEPHONE. (239) 252-8443 Fax: (239) 252-2638 ADNIINIS r ERING AGENCY. Senior Choices-Area Agency on Aging for Southwest Florida (AAA) PONITRACITNIJIVIBEI-2: ()AA 203.11 OCE 304 203.11 ADI 306 203.11 HCE 316/317.203 11 FUNDING PERIOD: July -I, 2.011 -June 31.2012 General Revenue Proyrailis January 1 2011 - December 31, 2011 OAA JRC:F Older Americans Act title III Community Care for the Elderly (CCF) Home Care for the Elderly(HCF) Medicaid Waiver ADA/ALE Alzheimer's Disease Initiative (A01) OF ()R11\11";- _X Annual _ Special DATE(S) OF VISIT: October 25, 2012 PAR-nc:IPAN1 5: Senior Choices of SWFL Staff: Ivonne Garcia Mesa. Medicaid Wavier Specialist Suzanne Clarke, Program Specialist Angela Wood, Program Specialist Senior Choices of SW Florida Collier County Monitoring Report 2012 Page 1 76 Collier County Staff: Kim Grant, Interim Director Louise Pelletier, Case Management Supervisor Heidi Fahnestock, Nutrition Program Admitiisttative Supervisor Debbi Maxon, Case Manger SI'r ES VISITED: The Goodwill•Roberts Center Congregate meal site in Immokalee was visited on October 10,,2012. Satisfaction surveys were completed during two home visits on October 25" and on October 30"' six clients were visited at their homes during a monitoring of the Home Delivered Meal route to complete surveys. Executive Summary The annual on-site lead agency monitoring of Collier County Services for Seniors (CCSS)was conducted on October 25th, 2012 at 3339 East Tamiami Trail, Building H, Naples, Florida 34112, Collier County Services for Seniors is a division of the county government agency. There are currently 496 seniors enrolled in their prograrris which include nutrition (congregate meal sites and home delivered meals) and case management. They operate four congregate meal sites throughout Collier County. An enhance meeting was held on October 25, 2012. A general outlin e. of the monitoring schedule, follow up from the previous monitoring, client visits and assignments were reviewed at this meeting The monitoring team reviewed 51 client files; there was significant improvement for this monitoring period with rionconforitiatice file issues Two home visits were made to conduct client satisfaction interviews. The Goodwill Roberts Center Congregate meal site in Immokalee was visited on October 16, 2012 and the GA Foods driver was accompanied by a Senior Choices team member on October 30th to moreitor the Home Delivered Meal (HDM) route. Senior Choices completed its programmatic monitoring on Cio-tc.)ber 25, 2012 and an exit conference was held via teleconference on October 31, 2012 Collier County Services for Seniors continues to be an advocate for seniors in Collier County by utilizing various community resources when funding is not available. POSITIVE/ NOTEWORTHY ACTIVITIES Collier County Services for Seniors implemerited some internal changes over the past year to improve their programs. A new grant coordinator has been hired and is focused on compliance issues, additional staff is now trained in CIRTS and outreach efforts have increased. In addition, the case management supervisor has conducted internal audits of the files which have proven to be effective as evidenced by the low nonconformance rate for file reviews over the past year. Senior Choices of SW Florida Collier County Monitoring Report 2012 Page 2 77 FOLLOW-LAP FROM PREVIOUS MONITORING VISIT There were recurring findings in both Program and Medicaid Waiver files for incorrect completion of the 701 B assessment. Nutrition documentation, outreach billing, CIRTS Care Plans for nutrition clients and overdue nutrition assessments was also an issue. Nutrition documentation, outreach billing, CIRTS Care Plans for nutrition clients and overdue nutrition assessments are now in compliance and no longer a concern for this monitoring period. However, even though non conformance issues have improved in both Program and Medicaid Waiver files, there are still some concerns regarding the completion of the ADUIADL sections on the 701 B assessment. PROGRAM COMPLIANCE Administrative: All administrative program documentation is found to be in order and in compliance with the monitoring requirements. File Documentation: Throughout the year, Senior Choices of Southwest Florida conducts a quarterly review of a random sampling of client files to monitor data accuracy, program compliance, file requirements, care plan and case management activities. The files reviewed from January 2012 to October 2012 had a total of 49 nonconformances from the 46 files reviewed. There were only three priority errors and no risk score errors noted. In July of 2012, they were removed from corrective action for program files due to a consistent low nonconformance rate. Although the overall file review during this monitoring period was good, there are still some concerns about ongoing nonconformance issues on the 7010 Assessment. There are inconsistencies between the ADL/IADL sections on the 701 B assessment and what is written in the narratives or on the summary. Additional internal training is recommended. Prioritization and ARC outsourced functions: Collier County Senior Services is responsible for the outsourced ARC functions of: OAA Title III C—Nutrition Programs, OAA Title III E National Family Caregiver Program, and Adult Protective Services High Risk referral response. Collier County Senior Services has received 123 General Revenue and Older Americans referrals for 701 B assessments from the ARC between January 1, 2012 and December 31, 2012. The Average processing time for the non-Medicaid referrals from date of notice to receipt of completed request for services has been 11.18 calendar days. Senior Choices of SW Florida Collier County Monitoring Report 2012 Page 3 78 Non Waiver Client 2011 Tracking m^ Average Days 2011 Requssts�� January 13 25 [ February 1238 | 19 March 28 ^w'« 11.33 15 May L 12.13 / 10 /""~ zaas * �� | /«* 12.75 » August 10.6 7�� September 16 z 2 October 5 2 November 8 1 December 6 2: 2e ,� 0,~ m - I 1 ' = = � � �� 5 � � � � � ~ = 75� . � � 2 27, Quality Assurance: Collier County Services for Seniors mailed satisfaction surveys to 239 clients in May 2011 There were 113. (47Y6) surveys completed and returned The overall results indicated that their clients are satisfied with the services they are receiving through CCSS. There were two clients visited at their homes during this monitoring period. Both were satisfied with the services they were receiving from CCSS and their vendors. A|| CCE (Communi(yConafortheE|dedy) vendormonitur|ngvvauoomp|*tedby CCSS as agreed upon through the shared monitoring agreement. _=�,��=�=�`=��=��----------��=�='~~~~'` '�~~�~~�~~`^`�~-~^^^` ~ `- ~` Senior Choices of SW Florida Collier County Monitoring Report 2012 Page 4 79 Nutrition Compliance: Since the las monitoring period, all issues for follow up have been corrected. However, there is a compliance issue regarding volunteer training. All staff and volunteers must be trained yearly in food safety and nutritio n if they are seniing food. Currently, the volunteers that serve food do not all receive ining by the RD. This is a requirement(page 4-113 in manual). There were 29 Congregate and HUM client files reviewed. All files were compliant with required documents. A meal site visit was conducted at the Goodwill-Roberts Center in Immokalee on October 16 2012 Seven meal site pa�icipantswere surveyed and nUexpressed sodafaction'with the meal program, however, three participants reported that they were not always satisfied with the quality and taste of the meals. A Senior Choices team member also participated in a HDM route on October 30th, 2012 by accompanying a GA Foods driver during a frozen meal delivery route. The driver was compliant with all guidelines and all participants reported satisfaction with the home delivered meals program. However, a few did have concerns about the lack of constantly with food quality and taste These concerns were discussed during the exit meeting. Outcome Measures: For the period of January i. 2012-Smpt3O. 2O12. CCSS performance results of outcome measures achieved or exceeded standards in seven of nine measures One of the outcome categories had no measureable outcomes to compare. lheatandardhurimprovennen\ormain0snanoeufAcbvd/es of Daily Living(ADL) was 58.97% compared to the standard of 65%. It is understood that this client base is comprised of individuals whose ability to improve performance of A[)L's is affected by age. APS' Co|Uer �oun�� Semioea�nrSeninrnhadtwohigh. 19 moderate andune |ovv APS: nik Adult Protective Service (APS) referrals f rom October 1, 2011 through October 1 2012 All APG cases were served vvithinmandated dnneframes. CCSS does a ' good job with documen1ahonfor the High Risk referrals in ARTT and the client o files. Medicaid Waiver: Aged and Disabled Adult Medicaid Waiver Program (ADA): Since the October 2011 annual monituring. CCSS has had three file reviews. These were completed in February, June and October 2012. The agency was not placed on corrective action during this monitoring period. The Medicaid Waiver specific areas of concern are that the quarterly reviews are being inaccurately documented on the Care Plan, various forms are out dated (provider choice hospice agreement, and eligibility) and narratives did not convert the minutes to units.itn. The Medicaid Waiver handbook stipulates that both the Senior Choices oiSW Florida Collier County Monitoring Report 2012 Pagc 5 80 number of units and the number of converted unites mus be documented in the narrative. Medicaid Assisted Living Waiver(ALW): Seven files were reviewed for CCSS during this monitoring period for the Assisted Living Waiver Program The files all met the Med Waiver requirements No Corrective Action is neoeuomry, however the following were the overall issues: Assessment Summary completed incorrectly assessment inconsistencies Care Plan inconsistencies vvi(hannualized'Care Plan costs form, and documentation of receipt of services. CIRTS Data Integrity: No issues noted with CIRTS data integrity. ISSUES FOR FUTURE FOLLOW-UP There are assessment inconsistencies between ADLIIADL sections (total he|p/aomedmos), narratives, and Assessment Summary with Medicaid Waiver and Program files. All staff and volunteers must be trained yearly in food safety and nutrition if they are serving food In the ADA Medicaid Waiver client files, both the number of units and the number of converted unites must be documented fl the narrative. CORRECTIVE ACTION There is no corrective action for this monitoring. EXIT INTERVIEW An exit interview was held via teleconference on October 31, 2012 with Louise Pelletier, Heidi Fahneotouk. Debbie yNaxon. Sarah /�utuerpa and CarbunBronson 0nmCC'8S In attendance from Senior Choices of Southwest Florida were Sue Clarke, Angela Wood, |vonne (�ancim'W1eoa. and Nicole SL ��mend. The results of the m—nito'mgv,ova — vi�wadand �odingodiocusood Anapo�x*iUbeissued vvithin~0bueineond � Sonio/�huimaoof8ou�hweutF|oridawishmnUothmnk 30 days. 1i Collier County Gemioeofor Seniomfor�n000pena on and assistance during the monitoring visit. Senior hoices of SW Florida Collier County Monitoring Report 2012 Page 6 81 Signatures. > / , L - / / . ' / Sue'Clarke, Program Specialist Specialist Date Angela\Med, Program Specialist Date -1— 6 �� r / r� c~^�/ °_ ~~' ^ Medicaid VVaver0peo�|�t u�*m Senior Choices of SW Florida Collier County Monitoring Report 2012 Page 7 PROVIDER ADMINISTRATIVE REVIEW Collier County 2012 Yes No N/A Corrective Action Needed GENERAL PROVIDER ADMINSTRATION Does the Provider operate at an optimum level to meet the needs of X older persons within available resources? Are Computer operators able to access, input data and retrieve X information and reports from the computer system and there is at least one additional trained computer operator? Is there a procedure for responding to emergencies, accidents or X unusual incidents? Is a listing of services and activities posted in a conspicuous location, where applicable Has the Provider developed cooperative mechanisms to refer X consumers to alternate programs where supportive services are available, prior to accessing DOEA funded services? Have satisfactory procedures been established and implemented to X assure the protection of the Civil Rights of all participants in the provider's programs in compliance with the Civil Rights Act of 1964? Have satisfactory procedures been established to enable the X participation of handicapped persons in compliance with the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990? ._..____............... Does the Provider have adequate tools, supplies, materials and X equipment to perform the required tasks? HIPPAA/CONFIDENTIALITY Have satisfactory procedures been established to protect the confidentiality X of records that include an older person's name and personal information and to obtain and record the individual's informed consent prior to the release of personal information? The minimum requirement for safeguarding files and records is a locked file or cabinet. HIPAA training is completed with all new staff/volunteers X January 2012 83 PROVIDER ADMINISTRATIVE REVIEW Collier County 2012 Yes No NIA Corrective Action Needed HIPPA Update training is completed annually with all staff/volunteers X PUBLICITY Has the Provider developed innovative methods of increasing public X awareness of programs?CCSS Is a government agency Does the Provider maintain a publicity file? X Are AAA and DOEA acknowledged in documents that originate with X the provider?(Government Agencies are exempt) Are there regular publicity efforts in the community regarding the X Provider's services and activities? CCSS is a government agency DONATIONS/CO-PAYMENTS Are efforts being made to collect donations? X Have satisfactory procedures been established to mobilize public and X private sector support,to the extent feasible, in order to obtain donations of goods, services, or funds; and to obtain and utilize voluntary contributions for services from recipients? Are all eligible persons offered an opportunity to contribute regardless X of age, handicap or volunteer status? Do the consumer files and financial documentation indicate correct X calculation for Copayments? APS/ABUSE Is the Provider providing prompt and appropriate services to Adult X Protective Services high-risk referrals in a timely manner? Are persons who are referred to the Provider by Adult Protective X Services given priority services? Are suspicions of abuse, neglect or exploitation reported to the X protective service abuse registry? January 2012 84 PROVIDER ADMINISTRATIVE REVIEW Collier County 2012 Yes No N/A Corrective Action Needed DISASTER PLANNING Has the Provider Director submitted an updated Disaster Plan to the X Area Agency on Aging? X Do emergency plans covering various events exist, (severe weather, fire, domestic events etc) Has the provider staff been trained as to their responsibilities during X an emergency? Does the Provider have a realistic, coordinated evacuation plan to X assure the safety of older persons in the event of an emergency? STAFF TRAINING Does the provider offer appropriate training opportunities to staff and X volunteers? Are there lines of supervision,job qualifications and assignment of all functional tasks have been established and clearly communicated to X all staff, both paid and volunteer, and written job descriptions are available to all staff? Is training provided for all staff(paid and volunteer) in all aspects of service provision, including: Pre-Service and In-service? X Annual In-Service (6 hours required) Required Topics: • Overview of Home and Community based care services X • Relationship of case management to the community care X services system • Use and completion of assessment instruments and care plans X X • Interviewing skills and techniques January 2012 85 PROVIDER ADMINISTRATIVE REVIEW Yes No N/A Corrective ��|Uer�ommt��f� Action Needed -- - ---------- — ' - --- X ---�-- • Record keeping procedures X • C!RTGpnocadunaa • Overview of the aging network,AAA, DCF,AHCA, DOEA and X the relationship to the community care service system • Case manager training regarding responsibilities and X resource development techniques • Interagency coordination and informal network development X training X Do records reflect training received? FACILITY Have all applicable safety, health and operating licenses/inspections X been obtained and are current? X Are facilities safe, comfortable, do not impede walking, and are designed to meet the special needs of the elderly? Is furniture comfortable and suitable to the needs of the elderly? X X |e the Center easy accessibility for the handicapped via ramps special parking spaces, water fountains, restrooms, vehicle, etc? SUB CONTRACTS ---------- --- — -- X -- Provider has monitored all vendor sub contracts per manual requirements and has provided reports to the AAA. --- �{ Provider has addressed/resolved subcontractOrS services issues. X Provider ensures sub contracted vendors are providing services per Program and Services Manual standards. January 2012 86 OUTREACH/TARGETING REVIEW Collier County 2012 Yes No N/A Corrective Action Needed The agency has established a plan to interact with Information and X Referral services and available community service agencies? X The agency not potential clients initiate outreach activities. Outreach activities conducted to reach target group individuals, are one to one contact, used to identify their service needs and X encourage their use of available resources?(Groups only) Current funded clients are not counted as Outreach X recipients. Are satisfactory procedures established to assist older persons X located during outreach activities to link them with the appropriate service agency, either directly or through I &R services? Is there access to a comprehensive community resource file? Are targeting plans completed, analyzed and updated annually? X Are Outreach Plans completed and provided to the AAA semi- X annually? January 2012 87 OUTCOME MEASURE REVIEW—Actual achievement Collier County 2012 # Outcome Measure Standard Performance Result Percentage of Customers who are at imminent risk 1 of nursing home placement who are served with 90% 100% community based services. Percent of Adult Protective Services(APS)who are 2 in need of immediate services to prevent further 97% 100% harm who are served within 72 hours. Percentage of elders assessed with high or 3 moderate risk environments who improved their 79.3% NA environment score. Percentage of new service recipients with high risk 66% 83.33% 4 nutrition scores whose nutritional status improved. Percentage of new service recipients whose 5 Activities of Daily Living (ADL) assessment scores 65% 58.97% maintained or improved. Percentage of new services recipients whose 6 Instrumental Activities of Daily Living (IADL) 62.3% 74.36% assessment scores has been maintained or improved. Percentage of family and family-assessed 7 caregivers who self report they are very likely to 89% 97.94% provide care. Percent of caregivers whose ability to continue to 8 provide care is maintained or improved after on 90% 99% year of service intervention (as determined by the caregiver and the assessor). -- — Average time in Community Care for the Elderly 9 (CCE) Program for Medicaid Waiver Probable 2.8 months 1.87 months customers decreases January 2012 2S i5 CLIENT SATISFACTION REVIEW/QUALITY IMPROVEMENT PROGRAM Collier County 2012 Yes No N/A Corrective Action Needed Is an annual client satisfaction survey completed? X Are the results of the annual client satisfactions survey analyzed? X Is the analysis used to improve services? X Do satisfactory procedures exist to objectively resolve service X complaints and evaluate the quality of services, including services provided to handicapped older persons Does the Provider attempt self-evaluation and improvement, including X Quality Improvement initiatives related to services and client interactions? January 2012 89 FILE REVIEW PROGRAM Collier County 2012 Yes No N/A Corrective Action Needed Is pertinent information documented in the case record and updated x when conditions change or following periodic contacts with the client Do case review and home visits take place according to program X standards, or more frequently, depending upon the individual client? Is the client reassessed at least once every year, using 701B? X Does the case manager appropriately complete a functional X assessment of clients, utilizing 701 B? X Does the case manager obtain an authorized release of information form? Do case managers make appropriate referrals to the Medicaid X Waiver programs? (MW Eligible report) Is a single care plan and confidential file developed for each client? Is the care plan, developed with the client and important others, contains a description of the client's needs, goals to be achieved, X possible barriers to attaining the goal, anticipated service outcomes and the agencies and people involved and responsible for service provision. Does the case narratives record and evaluate unmet service requests/needs, in order to advocate for clients and to plan for future X service provision? Are the case managers and program coordinators developing care X plans and/or activity plans, which address physical problems? Are the case managers and program coordinators developing care X plans and/or activity plans which focus on assisting consumers maintain or improve their abilities to perform ADL's and IADL's? Do the case managers recognize environmental deficits when X completing the environmental section of the comprehensive assessment? Do they subsequently make appropriate referrals to modify correctable hazards? Are any changes in the care plan discussed with the client or X caregiver and are signed and accepted by the client or caregiver? January 2012 90 AVAILABILITY OF DOCUMENTS/DOCUMENT REVIEW Collier County 2012 Yes No N/A Corrective Action Needed The following documents were available to and verified by the Program Specialist during Monitoring: Publicity Examples—press releases and publications(copies for file) X CCSS is a government agency Master Training Documentation File(on site review) X Incidents Report File (copies for file)viewed on site X Complaint tracking logs (copies for file) viewed on site X ADA Assurance and Supporting Documentation&ADA Policies(on X site review) Client Grievance Procedures (copies for file) None since 2010 X Client Satisfaction Surveys(completed and blank form); analysis, X (copies for file) Active Client List Sorted by City for Disaster(on site review) X Current listing of case managers with current case load numbers X (copy for file) Quality Improvement Program (on site review) Emergency Procedures/Disaster Manual (on site reveiw X Staffing Plan/Organizational Chart X Personnel Policies Manual Functional Procedures Manual/Standard Operation Procedures X Copies of any license held by agency(Day Care, Companion etc) X Affirmative Action Plan X Consumer outreach/targeting plan January 2012 91 NUTRITION PROGRAM REVIEW Collier County Yes No NIA Corrective Action Needed Meal provided meets 1/3 RDA for individual's 51/over. When two meals are served/day, they provide 2/3 RDA. X Potentially hazardous foods are held and transported in a method that ensures hot food temperatures are 140 degrees F or higher and cold food temperatures are 41 degrees F or lower. (Chapter 64E-11, X FAC) Menus developed use the computer assisted nutrient analysis method and are approved by licensed Dietitian/RD. X Dietitian/Nutritionist adheres to Chapter 468.509, FS, and Chapter 64B-842, FAC. Dietitian is licensed RD. X Provider's RD monitors for compliance with Chapter 64E FAC requirements X RD trains staff and volunteers in areas of nutrition, food service X management and sanitation. Partial: volunteers aren't being trained by RD. RD assists in determining participants' satisfaction and coordinates nutrition education. X RD develops food and menu standards for food service contract; and reviews/approves menus and menu substitutions X Provider maintains daily food temperature logs and menu substitution logs. Menus are approved by a Florida RD at least 4 weeks prior to use, are dated and posted in a conspicuous location in each meal site X and are kept on file for one year. Provider solicits voluntary and confidential contributions, which may include food stamps. Project is authorized to accept food stamps. X Not authorized to accept food stamps. Contributions are used either to increase the number of meals served, facilitate access to such meals or to provide supportive X services related to nutrition services There are standard procedures established to safeguard and account for all contributions. X Priority for service is given to those identified as being in greatest X economic/social need, especially low-income minority individuals. Documentation assures provision is made for special menus as X needed for health, religious, or ethnic reasons. 92 NUTRITION PROGRAM REVIEW Collier County Yes No N/A Corrective Action Needed Have satisfactory procedures been established to locate and inform X individuals with the greatest economic or social needs and low income minority individuals regarding supportive and nutrition programs? Congregate Meals: Meals are provided 5 or more days a week. One site is open just X three days_per week. _ Meal sites are established strategically, in as close proximity to eligible individuals' residences as feasible, utilizing multipurpose X senior centers, or other appropriate community facilities. Meal sites: 1) are accessible; 2)meet applicable fire, health, safety and sanitation requirements (annual sanitation inspections X documented); and 3) have adequate equipment. Provider maintains quarterly site inspection documentation using the X Meal Site Checklist and follows up on areas of concern. Documentation indicates congregate meal clients are eligible to receive meals. Eligible: [Age 60+years, or spouse of a participant X aged 60+, or handicapped/disabled living in housing facility for the elderly where meals are provided, or a volunteer during meal hours.] Transportation to meal sites is arranged or provided, when needed. X X Congregate meals provided are hot or other appropriate meals. Project has provided/planned for provision of shelf stable meals in emer•ency and weather related emergency situation. Home Delivered Meals: There is written documentation that the participants have been assessed as eligible for HDM. Observation supports eligibility X determination. Eligible: aged 60+, or under 60 if person is spouse of home-bound recipient, disabled, living at home with participant, or elder at risk X with physical, emotional or behavioral condition making congregate dining inappropriate. _ All hot home delivered meals for the noon meal are delivered no X earlier than 10:30 AM and no later than 2:30 PM. Frozen weekly Food is individually packaged, packed in insulated carriers and transported under conditions that ensure temperature control during X delivery; hot and cold food is packaged/packed separately. Frozen meals are delivered at a maximum of 20 degrees F, or frozen solid Frozen Solid X 93 AVAILABILITY OF DOCUMENTS/DOCUMENT REVIEW NUTRITION PROGRAM Yes No N/A Corrective Action Needed Copy of RD signed menus and cycle analysis and documentation X that they were received by the first week of use Copy of RD license and RD liability insurance X Facility checklist signed by RD or documentation of RD monitoring Chapter 64E requirements X__-,--_, Copies of training logs X Copies of menu substitution items with RD signature X Copy of temperature logs for one month X Copy of client satisfaction survey and analysis X Copy of targeting plan X List of sites and locations for Congregate Meals X Copy of HDM temp logs for one month Frozen X Copy of annual Nutrition Education Plan Copies of Nutrition Education materials-with RD signature X Copies of forms used X I Documentation that RD has provided Nutritional Counseling X 747 MEDICAID WAIVER ADMINISTRATIVE REVIEW ADA MED WAIVER Collier County October 2012 Yes No N/A Corrective Action Needed Agency is following Medicaid Waiver standards X Is the Provider a Medicaid Waiver Provider-or have they applied to X be a MW Provider This section summarizes results from Medicaid Wavier file reviews: X #Reviewed: 33 ADA Files contained required Forms/Forms are current X No Note: Some of the eligibility,fair hearing, and provider choice forms were out of date. Client contact was completed following required standards X No Note: A few quarterly contacts were too early. CIRTS Data was correct Documentation supports need for Medicaid Services X Billing and Claims information is correct X No Note: Numerous claims were billed at different units that the narratives show. MEDICAID WAIVER ADMINISTRATIVE REVIEW ADA Yes No N/A Corrective Action Needed Is pertinent information documented in the case record and updated x when conditions change or following periodic contacts with the client? Do case review and home visits take place at following program X standards, or more frequently, depending upon the individual client? January 2012 95 MEDICAID WAIVER ADMINISTRATIVE REVIEW ADA MED WAIVER Collier County October 2012 Yes No N/A Corrective Action Needed Is the client is reassessed at least once every year, using 701B? X Does the case manager complete a functional assessment of X clients, utilizing 701B? The assessment determines the client's level of functioning, existing resources and service needs. Does the case manager obtain an authorized release of information X form? Do case managers make appropriate referrals to the Medicaid Waiver programs? X Is a single care plan and confidential file developed for each client? The plan, developed with the client and important others, contains a X description of the clients needs, goals to be achieved, possible barriers to attaining the goal, anticipated service outcomes and the agencies and people involved and responsible for service provision. Are adequate records maintained to record and evaluate unmet service requests/needs, in order to advocate for clients and to plan X for future service provision? Are the case managers and program coordinators developing care plans and/or activity plans that address physical problems, such as X dental, vision and swallowing, which impede proper nutrition? Are the case managers and program coordinators developing care plans and /or activity plans which focus on assisting consumers X maintain or improve their abilities to perform ADL's and IADL's? Do the case managers recognize environmental deficits when X completing the environmental section of the comprehensive assessment? Do they subsequently make appropriate referrals to modify correctable hazards? Are any changes in the care plan discussed with the client or caregiver and are signed and accepted by the client or caregiver? X Does the case record reflect adequate documentation on reasons X for reduction or termination? Was the decision to discontinue service made with the client and caregiver's involvement? X January 2012 96 MEDICAID WAIVER ADMINISTRATIVE REVIEW ADA MED WAIVER Collier County October 2012 Yes No NIA Corrective Action Needed Is the client notified in writing of the termination? X Is the provider using turnaround reports for data review and correction to maintain CIRTS data integrity? X Were there any concerns relating to the comprehensive No assessment? If yes, explain. X Note: The assessment shows gaps when the assessment summary shows "no gaps." If a client is "Total Help" and is not receiving services, then there should be a gap in the assessment summary. Were there any concerns relating to the Care Plan? If yes, explain. X Were there any concerns relating to the Case Narratives? No If yes, explain X Narratives do not state the number of units being billed. Were there any concerns relating to the Grievance/Fair Hearing X Procedures? if yes, explain. Were there any concerns relating to the Level of Care? No Note: There was one LOC that was completed late, however the X notes were very well documented to justify the reason. Were there any concerns relating to Medicaid Eligibility? No Note: There was an eligibility that was out of date in the X October 2012 monitoring. Were there any concerns that related to the program specifics? No Medicaid Waiver handbook requires that units as well as X minutes/hours be listed in the case narratives.Collier was unaware of this requirement but will implement it from this point forward. January 2012 97 MEDICAID WAIVER ADMINISTRATIVE REVIEW ALW MED WAIVER Collier County 2012 Yes No N/A Corrective Action Needed Agency is following Medicaid Waiver standards X Assisted Living Case Managers meet case load standards X Assisted Living Case Managers have Assisted Living Core Training X Is the Provider a Medicaid Waiver Provider-or have they applied to X be a MW Provider This section summarizes results from Medicaid Wavier file reviews: # X Reviewed: 7 ALE Files contained required Forms/Forms are current X Client contact was completed following required standards X CIRTS Data was correct X Documentation supports need for Medicaid Services X Billing and Claims information is correct X FILE REVIEW MEDICAID WAIVER Yes No N/A Corrective Action Needed Is pertinent information documented in the case record and updated x when conditions change or following periodic contacts with the client? Do case review and home visits take place at following program X standards, or more frequently, depending upon the individual client? Is the client is reassessed at least once every year, using 701B? X January 2012 98 MEDICAID WAIVER ADMINISTRATIVE REVIEW ALW MED WAIVER Collier County 2012 Yes No N/A Corrective Action Needed Agency is following Medicaid Waiver standards X Assisted Living Case Managers meet case load standards Assisted Living Case Managers have Assisted Living Core Training X Is the Provider a Medicaid Waiver Provider-or have they applied to X be a MW Provider This section summarizes results from Medicaid Wavier file reviews: # X Reviewed: 7 ALE X Files contained required Forms/Forms are current Client contact was completed following required standards X CIRTS Data was correct X Documentation supports need for Medicaid Services X Billing and Claims information is correct X FILE REVIEW MEDICAID WAIVER Yes No N/A Corrective Action Needed Is pertinent information documented in the case record and updated x when conditions change or following periodic contacts with the client? Do case review and home visits take place at following program X standards, or more frequently, depending upon the individual client? IIs the client is reassessed at least once every year, using 701B? X January 2012 99 MEDICAID WAIVER ADMINISTRATIVE REVIEW ALW MED WAIVER Collier County 2012 Yes No N/A Corrective Action Needed Does the case manager complete a functional assessment of clients, utilizing 701 B? The assessment determines the client's level of X functioning, existing resources and service needs. Does the case manager obtain an authorized release of information form? X Do case managers make appropriate referrals to the Medicaid X Waiver programs? Is a single care plan and confidential file developed for each client? The plan, developed with the client and important others, contains a X description of the client's needs, goals to be achieved, possible barriers to attaining the goal, anticipated service outcomes and the agencies and people involved and responsible for service provision. Are adequate records are maintained to record and evaluate unmet service requests/needs, in order to advocate for clients and to plan X for future service provision? Are the case managers and program coordinators developing care plans and/or activity plans that address physical problems, such as X dental, vision and swallowing, which impede proper nutrition? Are the case managers and program coordinators developing care plans and/or activity plans which focus on assisting consumers X maintain or improve their abilities to perform ADL's and IADL's? Do the case managers recognize environmental deficits when X completing the environmental section of the comprehensive assessment? Do they subsequently make appropriate referrals to modify correctable hazards? ...................... Are any changes in the care plan discussed with the client or X caregiver and are signed and accepted by the client or caregiver? Does the case record reflect adequate documentation on reasons for X reduction or termination? Was the decision to discontinue service made with the client and X caregiver's involvement? Is the client notified in writing of the termination? X January 2012 100 MEDICAID WAIVER ADMINISTRATIVE REVIEW ALW MED WAIVER Collier County 2012 Yes No NIA Corrective Action Needed Is the provider using turnaround reports for data review and X correction to maintain CIRTS data integrity? Were there any concerns relating to the comprehensive assessment? X If yes, explain. Assessment summary completed incorrectly Were there any concerns relating to the Care Plan? If yes, explain. Care plans need to be updated with correct X annualized total Were there any concerns relating to the Case Narratives? If yes, explain Missing documentation for receipt of services X Were there any concerns relating to the Grievance/Fair Hearing Procedures? X If yes, explain. Were there any concerns relating to the Level of Care? X Were there any concerns relating to Medicaid Eligibility? X Were there any concerns that related to the program specifics? X January 20t2 101 CASE MANAGEMENT Collier County 2012 Yes No NIA Corrective Action Needed Does the Case Manager understand Medicaid Waiver financial and X functional eligibility criteria? Does the Case Manager refer all potentially eligible consumers for further X evaluation of eligibility for community programs? Case Management staff have been trained/certified on assessment and care X plan forms with at least an 80% passing score(Sarah scheduled 11/2012) Case Managers meets the requirements to provide case management per X DOEA standards Are Case Managers referring caregivers to supportive services, such as X caregiver training and support groups and promoting caregiver attendance? Is the Case Manager knowledgeable of all formal and informal community X resources in order to coordinate services for clients, including other providers of Case Management and community programs? Do the Case Managers know program eligibility guidelines and ensure that X clients are added to programs following ARC requirements. Case Managers Case Loads average 60-70 clients(if more then 100 a x waiver from AAA is required) Does the Case Manager make use of other agency intervention to assist X clients not eligible for provider services,e.g.,volunteers? Are needed services arranged for the clients in a timely manner? X Is a standard procedure for referral and communication with service providers used, including: an overview of the client's needs;a discussion of the probability of the provider accepting the client; and an arrangement for X amounts, duration, and frequency of services? Does the Case Manager conduct follow-up contacts on service X arrangements and referrals within two weeks following such arrangements to assure that services have begun? Does the Case Manager assure that all agencies serving the client know X when services from any agency are planned to change, or are terminated, due to changes in the client's condition? Are Case managers knowledge of activities that may be considered X "billable"as part of Case Management Does Case Manager Supervisor ensure Program and Services Manual X requirements are completed? January 2012 102 CASE AIDE Collier County 2012 Yes No N/A Corrective Action Needed Is there documentation that all Case Aides have completed Training X and are Certified on DOEA assessment tools? Service is used to gather information conduct follow-ups on X individuals waiting for services and/or application assistance for EHEAP. Staff providing this service have graduated from high school (or GED X &job experience approved by AAA.) Case Aide Records are kept. Documents are signed and kept in the X case record. INTAKE Yes No N/A Corrective Action Does the Intake worker direct clients to other sources of help as X needed? Is there documentation that all Intake workers have completed X Training and are Certified on DOEA assessment tools? _-........... Staff providing this service have graduated from high school(or X GED&job experience approved by AAA.) Ianuary 2012 103 INTAKE (EHEAP APPLICATIONS) ALL CASE MANAGERS Collier County 2012 Yes No N/A Corrective Action Is there documentation that all EHEAP Intake workers have X completed Training and are Certified on DOEA assessment tools? Is there documentation that all EHEAP intake workers have X completed EHEAP training? SCREENING/ASSESSMENT Yes No NIA Corrective Action Staff performing this service have bachelor's degree. New staff hired x has degree &two years experience in social service programs (or year for year related job experience or combination education/experience substitution approved by AAA.) This service is used to gather information to reassess currently active x clients to determine the need and eligibility for OAA services. Is there documentation that all Intake workers have completed X Training and are Certified on DOEA assessment tools? I January 2012 104 A 1 1 IRS Letter 105 09/05/12 t' R,UA i[onsumer's Certificate of Exemption • R R-1 DEPARTMENT Issued Pursuant to Chapter 212,Florida Statutes OF REVENUE 85-80159665310-1 ' 10/31/2012 10/31/2017 't�Jx a t ' Certificate Number Effective Data Expiration Date ' This certifies that • >s f • COLLIER COUNTY BOCC 3299 TAMIAMI TRL E STE 403 rr , ;) NAPLES FL 34112-5748{ ; �Ao'1 is exempt from the payment of Florida sales and use tax on real property rented,transient renta 'Ffsinted,tangible personal property purchased or rented,or services purchased. ctoRIon Important information for Exempt Organizations R.04111 DEPARTMENT OF REVENUE 1. You must provide all vendors and suppliers with an exemption certificate before making tax-exempt purchases. See Rule 12A-1.038,Florida Administrative Code(F.A.C.). 2. Your Consumer's Certificate of Exemption is to be used solely by your organization for your organization's customary nonprofit activities. 3. Purchases made by an individual on behalf of the organization are taxable,even if the Individual will be reimbursed by the organization. 4. This exemption applies only to purchases your organization makes. The sale or lease to others of tangible personal property,sleeping accommodations,or other real property Is taxable. Your organization must register, and collect and remit sales and use tax on such taxable transactions. Note: Churches are exempt from this requirement except when they are the lessor of real property(Rule 12A-1.070,F.A.C.). 5. It is a criminal offense to fraudulently present this certificate to evade the payment of sales tax. Under no circumstances should this certificate be used for the personal benefit of any individual. Violators will be liable for payment of the sales tax plus a penalty of 200%of the tax,and may be subject to conviction of a third-degree felony. Any violation will require the revocation of this certificate. 6. If you have questions regarding your exemption certificate,please contact the Exemption Unit of Account Management at 800-352-3671. From the available options,select"Registration of Taxes,"then"Registration Information,"and finally"Exemption Certificates and Nonprofit Entitles." The mailing address is PO Box 6480, Tallahassee,FL 32314-6480. 106 Al2 Audit Financials This is a 426 page document on the enclosed disk. 107 A13 Insurance Documents 108 l-� COLLI-1 OP ID: DO A��RL� DATE(MM/DD/YYVY) AC CERTIFICATE OF LIABILITY INSURANCE DATE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 239-649-1444 CONTACT Insurance and Risk Management NAME: Services,Inc. 239-649-7933 PHONE FAX (A/C,No,Ext): (NC,No): 8950 Fontana Del Sol Way#200 E-MAIL Naples,FL 34109-4374 ADDRESS: William H.Kuhlman,CPCU,ARM INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Princeton Excess&Surplus 10786 INSURED Collier County Government Underwriters at Lloyds Risk Management Department INSURER B 3311 Tamiami Trail East,#D INSURER C:Midwest Employers Casualty Co 23612 Naples,FL 34112 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADDL SUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DDY/YYYY) (MM/DDS) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 A X COMMERCIAL GENERAL LIABILITY 64A3EX000001509 10/01/12 10/01/13 pREM SESO(Ea occu ence) $ Included CLAIMS-MADE OCCUR MED EXP(Any one person) $ 1,000 A X Professional Liab SIR$200,000 PER 0CC 10/01/12 10/01/13 PERSONAL&ADV INJURY $ Included GENERAL AGGREGATE $ 5,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 5,000,000 POLICY X JE LOC Prof. $ 5,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 5,000,000 A X ANY AUTO 64A3EX000001509 10/01/12 10/01/13 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NAUTON- WNED PROPERTY DAMAGE OS O (Per accident) $ X SIR PER OC 200,000 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION $ T AND EMPLOYERS'LIABILITY X TORY LIMITS E R C ANY PROPRIETOR/PARTNER/EXECUTIVEY/N EWC008555 10/01/12 10/01/13 E.L.EACH ACCIDENT $ 3,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) SIR$600,000 E.L.DISEASE-EA EMPLOYEE $ 3,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 3,000,000 B Property N13NA01740 04/01/13 04/01/14 Primary 25,000,000 5%Wind&Hail Ded REPLACEMENT COST/SPECIAL AOP Ded. 50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Self Insured Retention included within limits of liability. Nothing in this certificate shall constitute a waiver of the sovereign immunity provision of the Florida Statute 768.28. CERTIFICATE HOLDER CANCELLATION MASTCEI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Master Certificate THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I 1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Appendix 14 ➢ Unit Cost Methodology: Personnel Allocations (pages 1 -11 ) Supporting Budget Schedule (pages 1 -4) Service Costs Report Personnel Allocations (pages 1 -12 Supporting Budget Schedule (pages 1 -6) > Vendor Cost (pages 1 -8) 110 + tO - A N + » .T .Z] Z a ° c Q v m Co 3 a n a H H G u _ m v. 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N Cr) E • N o 0 • co y m- �' 01 0) 0) 01 w [1 Ef) EA ° o c o o o CD m m Cn 01 O CD O COO Q A O a N CC)) (0 CO N C N C) 7 o Efl N EA v C) N Cn � � O ▪ O 03 cp Cn CO -I W '• n O O - 0 co -A co Cn to• EA EA co • N COO C N W Cn co in A -I O O N Eft Efl _ W C) C) cm co �I N A in 00 U1 -1=. 0) -I EA N -co o j rn cr1 en co W rye EA EA EA 0 N CO CO v 0 O O A A Ooo W O co 01 (T i v , , v N W W W 01 O CC) O O O A A Eft EA EA m W W W m N N A A 01 "'' N CO - 0 -CO N D N NJ W N N NJ W W CO O i _ N W co O co W O O O O (A EA EA CO 00 CO I (T �I A A A CT 01 K (71 A CD NJ v a N ■ ■ NJ CO CO O COO iv - O 01 W co 0 OAO (NT 01 to) EA EA W '' (D W 0 A A Co A Z A A I I I , O OD O O 0 W O) W co > EA EA EA N o CO CT CD Co n C CD A A A (n Cn g <CD 01 O 0 a s < CO A A CO N N CD a A O (D CO CT O CO 7 (r CO i - i i j a O O < o D NJ O N O O CD (L] O V) 5. EA O in 3. O Cu O 0)7:1 n O A A N m O- o C 'co co m o v cn o rn o o 0 0 °o °o °o ,-�� 0 m CD o EA EA EA a m v co CT N A -, N N N m P -" - N O T v OO A A A W 01 CJ1 N CO CO j 03 -4 N O O in O O O O O O O O O O O - O EA EA NJ NJ A A -I A (T CD O 0 W CO N r CO 01 .03 O p CO O 01 W J EA EA _ N O_ CO NJ O O W 0) O (n Cn O O O EA EA CT N 00 00 N A O Cn A ■I W N 0) CO N CO O A EA Efl N • N- W CO v v 000 CO A N) ✓ (0 Oa)) Q) Efl Eft N �I W 0) (D CD O) Q) (n c1 rn -� O 0 EA EA.--. o v m (o c cD cn (� 0 0 rn a o W J co 0 m 6 a a v - - < a D 3. Efl Efl (D (D v v g. A N O N i N (n O a ry N (n W O '0 c O O p) -�,,. O T7 CD O EA EA d. O 7 O Cn v n W Cn N NJ N (n W 0 W O) O O A A NJ —V orturm ENT OF Monthly and YTD Service Units with Unduplicated Client Counts PSA: 08 Provider: 81302 Location: ALL LOCATIONS Program: ALL PROGRAMS Service: ALL SERVICES ELDER Start Date: 01/01/2013 End Date: 06/30/2013 Fiscal Begin Date: 07/01/2012 AFFAIRS Include Zero Unit? Y Include Aggregate? Y Group by: Location, Program, Service MTH(Monthly) Unduplicated Location Program Service YTD(Year to Date) Units Provided Client Count 01 ADI CM MTH 13.75 2 YTD 26.00 2 CCE J CM MTH 968.50 163 0 . YTD 2,042.00 234 SCSM MTH 0.00 1 YTD 1.00 2 HCE BASI MTH 85.00 18 YTD 174.00 22 CMV YTD 83.00 16 RESV YTD 46.00 2 SCSM MTH 6.00 1 YTD 12.00 4 SCSV MTH 48.00 12 YTD 89.00 17 03C1 CNML MTH 16,249.00 196 YTD 33,689.00 231 NTED MTH 551.00 1 YTD 1,083.00 1 NTSC MTH 115.50 89 YTD 202.25 150 OTR MTH 20.00 1 YTD 20.00 1 03C2 HDM MTH 14,261.00 30 YTD 30,492.00 134 HDMF MTH 0.00 103 YTD 0.00 103 NTED MTH 670.00 1 YTD 1,409.00 1 SCAS MTH 244.25 77 YTD 287.50 87 OA3B CM MTH 265.75 49 YTD 455.50 56 INSC MTH 43.00 19 YTD 134.00 51 SCAS MTH 35.00 8 YTD 79.00 17 TRS MTH 1,184.00 1 YTD 2,355.00 1 OA3E ADC MTH 127.00 1 YTD 203.25 1 DPRESP MTH 348.00 11 YTD 718.75 12 RESF MTH 5,136.00 13 SCAS YTD 6,600.00 34.00 14 MTH 9 0 00 Report run on: 08/12/2013 10:36 AM Page 1 of 5 mon_ytd_services.rdf Report run by: CARRILLD Dispose of this report so that It can not be read or reconstructed Gl.PAR7 MENTOF Monthly and YTD Service Units with Unduplicated Client Counts PSA: 08 Provider: 81302 Location: ALL LOCATIONS Program: ALL PROGRAMS Service: ALL SERVICES ELDER Start Date: 01/01/2013 End Date: 06/30/2013 Fiscal Begin Date: 07/01/2012 AFFAIRS STATE OF FLORIDA Include Zero Unit? Y Include Aggregate? Group g ate? Y Grou by: Location, Program,Service � MTH(Monthly) Unduplicated Location Program Service YTD(Year to Date) Units Provided Client Count YTD 34.00 9 OA3EG DCC MTH 583.14 8 YTD 583.14 8 SCAS MTH 14.00 7 YTD 14.00 7 OA3ES SCSM MTH 29.00 7 YTD 75.00 12 02 CCE HMK MTH 19.00/ 1 YTD 53.00 2 Rt.P....k PECA MTH 138.00. 1 YTD 210.00 3 RESP MTH 698.00/ 5 YTD 1,568.00 6 OA3B HMK MTH 674.00✓ 6 YTD 1,346.00 24 PECA MTH 90.00/ 1 YTD 172.00 10 RESP MTH 104.00/ 1 YTD 184.00 1 05 ADI RESF MTH 3,485.00 f 9 ' YTD 6,169.00 10 �� CCE ADC MTH 760.00/ 2 YTD 2,241.00 6 OA3B ADC MTH 640.00 i 2 YTD 736.00 t( 3 RESF YTD 72.00— r: <<.,r'. tcr3 1 07 CCE EAR MTH 419.00/ 11 ` k j YTD 2,285.00 14 OA3B EAR MTH 3,107.00'' 19 YTD 6,048.00 20 09, rt , ,,uOA3E ‘ r .c,- GEC! YTD 136.50 9 13 ADI RESP MTH 625.50/ 2 YTD 1,021.50 2 � �A, CCE CHO MTH 13.00 r 1 %_A i YTD 13.00 1 HMK MTH 1,840.50/ 18 YTD 3,381.00 22 PECA MTH 2,191.50 v 20 YTD 3,968.00 24 RESP MTH 2,458.25." 12 YTD 4,193.50 16 0A38 CHO MTH 12.50✓ 1 YTD 43.50 3 6.` COMP MTH 0.00 1 42-- YTD 0.00 1 Report run on. 08/12/2013 10:36 AM Page 2 of 5 mon_ytd_services.rdf Report run by: CARRILLD Dispose of this report so that it can not be read or reconstructed orrormENT or ��K��hU�� U� ��^�� UU�~�� it� UU��8��U^ Client Monthly - -YTD Service Units with _ _ ~` -_-- _ - Counts "v- PSA: 08 Provider: 81302 Location: ALL LOCATIONS Program: ALL PROGRAMS Service: ALL SERVICES ELDER start Date: 0101C2013 End Date: 06/30/2013 Fiscal Begin Date: 07/01/2013 AFFAIRS Include Zero Unit? Y Include Aggregate? Y Group by: Location, Program, Service MTH(Monthly) Unduplicated Location Program Service Units Provided Client Count HMK MTH 3.202.0O/ 39 YTD 8.207.50 45 PECA MTH 1,115.75/ 15 YTD 2,251.25 19 RESP MTH 484.25^ 4 ------ YTD 910.75 5 17 0A3B LEG MTH-- ' 143.00 1 -------� -,---�--- --~ YTD 143.00 1 �' ~� ` 0A3EG LEG YTD 900 1 � -J^"'" 0A3EG LEG MTH 8.00 1 YTD 26.00 1 ` ----- ------�—'—� MTH -- 1880 6 Q ' i YTD 26.00 7 `�t,u.��` CCE SCSM MTH 197.00 47 YTD 369.00 56 0A36 SCSM MTH 79.00 27 YTD 134.00 33 24 CCE RESP YTD 16.00 ^.J;.'1^ �0'°\ 1 1\"1 `^� u RESP YTD 179,00 1 -~---------A3E ---- CTSG YTD 18.50 1 28 p . -� ��_ -_Y`^.� r_v�`"~^~^�� ^~'~~~ INSC YTD 15.00 12 J - 'CCE ---- � EAR MTH 974.00/ 8 Lj YTD 97480 8 36 CCE HMK MTH 40.00/ 2 1 ' I- YTD 252.00 2 ,�``F�^ � ` PECA MTH 80.00/ 4 YTD $74.00 5 RESP MTH 12375 V 5 YTD 1.03825 6 0A313 HMK MTH 32.00 1 YTD 32.00 1 PECA MTH 15.00 1 YTD 17.00 2 RESP MTH 59.25 1 YTD 125.25 1 38 CCE HMK MTH 350.50 v 8 � L� ( YTD 906.50 8 / w�'� `�/�\�A� PECA MTH 50180/ 9 YTD 981.50 10 RESP MTH 1.408.00" 5 YTD 2.780.00 5 0A3B HMK MTH 23D25" 4 YTD 488.00 11 --.I PECA MTH ODO~' 2 YTD 144.00 3 �. ;, __-_________�� --____--�_-_� _____-�_-_ --_______-_� ' Report run on 08/12/201810:36AM Page 3 of 5 m*un_ytd_oorvmmn.rd/ Report run by: CARRILLD Dispose of this report so that It can not be read or reconstructed DLPARTMENT OF Monthl and YTD Service Units with Undu • licated Client Counts PSA: 08 Provider: 81302 Location: ALL LOCATIONS Program: ALL PROGRAMS Service: ALL SERVICES ELDER Start Date: 01/01/2013 End Date: 06/30/2013 Fiscal Begin Date: 07/01/2012 AFFAIRS STATE OF FLORIDA Include Zero Unit? Y Include Aggregate? Y Group by: Location, Program,Service MTH(Monthly) Unduplicated Location Program Service YTD(Year to Date) Units Provided Client Count _ . RESP MTH 221.50 7 3 YTD 691.00 5 491ie.01; CW4,,,ax. ADC YTD 31.00-- (,,A,,L, ol,,,, 1 ....,t 42 CCE HMK YTD 142.2 1 4 , PECA YTD 49.00 1 i'At P"o eA . RESP YTD 108.00 0 J.04t. 1 viol OA3B HMK YTD 0.00 3 PECA YTD 0.00 1 RESP YTD 0.00 3 47 " - OA3B , EAR MTH 96.00 1 C ' A ' • c., • ,ttlt OA, , VMZIAR_LID ,Y.TD 96.00 1 51-' - CCE HMK MTH 272.00., 4 Vr: YTD 332.00 4 -0 \Irvte,.... PECA MTH 438.00, 3 YTD 575.00 3 RESP MTH 1,009.00, 6 YTD 1,653.00 6 OA3B HMK MTH 278.00 vi 5 YTD 486.00 5 PECA MTH 274.50, 6 YTD 417.00 6 RESP MTH 77.00 ez. 1 YTD 89.00 1 OA3E RESP MTH 0.00 v- 1 YTD 0.00 1 52 CCE HMK YTD 49.00 1 PECA YTD 212.00 ' 04.11t, 1 ,) , RESP YTD 204.25 1 _ .. 54 0A313 t SCSM MTH 7.00 2 t-, ;Le,\. YTD 9.00 2 57 ,J" t..- 0A38 EAR MTH 263.00 2 CsiN° YTD 447.00 2 ADI RESP MTH 124.00/ 1 *.k.)64,0 Titt.A.A. YTD 124.00 1 CCE HMK MTH 223.25,, 5 YTD 300.25 5 PECA MTH 434.50/ 6 YTD 471.50 6 RESP MTH 1017.50/ 7 YTD 1,205.50 7 0A3E3 HMK MTH 417.75 v 6 YTD 521.75 7 PECA MTH 327.75/ 5 °QI YTD 327,75 / 5 -9N RESP MTH 743.25 / 6 60 Report run on: 08/12/2013 10:36 AM Page 4 of 5 mon_ytd_services.rdf Report run by: CARRILLD Dispose of this report so that it can not be read or reconstructed 1 . , --1) _.,_... . _ ihi_ Ac). ,. ,AKii. 77;41,q, u uai _.___--, -a--ij_ . m113.51 s •am3eu2ts s‘ueuutsg3 xoJ uoudo �� ago.ioj iipeoi sr 4uauinoop ago pue`apeur uaaq aneq Opg 0114 Al papoa.np sausgo Its`3011 Iou sr"y/ atp.Aq panoadds UOISIOn atp.si ruaumaop patioe1s agr rem 2m1Ju0n,iauto1is JO sisi1 •6 aur(.su p •aigeatidde ii'sa2uego alp pa,taptaa set!0011;o s,,fauJogy,C;unoD rot uondo g �� aq j luamnaop pagaelpe aq4 ut palerodaoaul uaaq aneq 2ui;aam aq;2uunp apem iou.sr y/ri sa�uuga❑e pue(Nap.raaua) £I/LZ/8 uo Dag aql Ai pano.idde SUM luamnaop aq j •8 ;saugpeap.inoif;o a.iense ag •pagginu are suouos s,OOg atl4 ro mug atut4 S j utsrta°s tng1inn aasssgeiiei or 2utprenuoj a.nnbai pue anuisuas amp ats sruamnoop autos r\ -mils o;tn Indut st utari agp aum atir re aotw0 Xaurony itrunop agi or papinoid aq pings diis 2uunor&t114 pug 4uaumoop ieut uo otp`(uoc4daox0 ue are s4osrjuoo autos)saseo 4souu ui •L •pannbar are siet3nn pus am1suSts f-S3A mueuur_sgj ago 0.0gm 2tnneotpur saWsd a4sudordde ago uo pooeid are sgs4„grog u !S„ •9 •aigsogdds sr ranatioigm amp 4oer4no pa4er4oSou Fug atp.o 4uatunoop S3A atp jo ienordde 33g jo o4ep oun se parorua uaaq sal a4sp min anueuais s‘usuuteg3 oqj, •S prsog ago o4 31r0ij ago pue uetuns1O Dog ago 4daoxa soprsd raii4o iie pur 0otu30 10 (,N -S3-k s,Xaurouy X4unop ago icq popgcur uaaq aneq suotstnar pus g2no.np-0)IU4s ua4ntrMpue11 iiy •b •Catuony iclunoJ amp aogJO alp.Aq i S3A pau.Ots pus pamatnar aq 4snur`sra44ai Isom jo uot4daoxa 0114 pm`uetuusgJ ago iCq pawls aq or snuaumoop iiy) •XouatoJJns ie ai.o3 paist1itn/pau2is uaoq oil 4uaumoop IEQ12t1O •£ wogs patinae LIE uo(auogd`.ssoippy`.1iouagy:atusiq)uojreuuo3tri 4ounro3 ago aptnord /i ON `sod(ji Lsannuats Ieuotltppe roJ/Collage ragloue or runs aq or paau 4uatunoop ago saoG •Z „71 S3A Lam-gals ieut2uo s‘uetunego ago annboi 4uaumoop 044 saoQ •I (aigeotiddy (feting) -4 •34eudordds loN)y/N saA Si ranagot11M`uumloo aigeotiddy ioN 0114 ur«y/N„)ITEM ro utunio so aril emus .LSI any a8 SAIOI.LD7 Li/ u a� i / paprooar aq or ')\,(U sr ivaamoop 3t raqumu 4un000E ro raqumu Od patioeuy sivatunooQ a,,p i 2,1}.,‘, •(,I;C? 7/ pagoslly V Isut2!O Jo raquirq suor4eotiddy Z 4uatunoou jo ad,CZ Q (7)1 OOg 0114 kg Panorddy ragtunl�I moll Epua�y £i/LZ/8 sEM umaii a1EQ Epuo y 4uauIUEdoa /4oe2uoJ 9££Z-ZSZ .aqumN auogd z' D ss1I Burs,Cteutud Jo aurEN uo�yeturo3rn 2Ulssiw ro ieuo�ytppe�o3 eys yoeyuoo oy paau Cew`anoge saassarppe — alp Jo auo Juana alp ui papaau ! 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OZ,LADS SLAT L}II130Q 'IVNIORi0 'I'IV ANN IAIODDV OIL dIrIS 910.1.9011 1SI'DID HD sixamtaaoa 'IVAIIDDIO ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW**ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. Wendy Klopf HHVS rk 08/28/13 2. 3. County Attorney Office County Attorney Office cp.92 s 113 4 County Manager County Managers Office 5. Minutes and Records Clerk of Court's Office PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to_contact staff for additional or missing information. Name of Primary Staff Wendy Klopf,HHVS Phone Number 252-2901 Contact/ Department Agenda Date Item was 08/27/2013 ■ Agenda Item Number 16.D.2 Approved by the BCC Type of Document Release of Liens Number of Original Nine(9) Attached Documents Attached PO number or account 121-138755-884200-34540.7 all items to be number if document is recorded under this line item to be recorded INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature? WK ✓ 2. Does the document need to be sent to another agency for additional signatures? If yes, WK ✓ provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be WK signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's WK Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the W N document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's WK signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip WK ✓ should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 08/27/2013 and all changes made during WK ✓ the meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the WK �. BCC,all changes directed by the BCC have been made,and the document is ready for the 0.. Chairman's signature. I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12 Prepared by: Wendy Klopf Collier County Housing,Human&Veterans Services Dept 3339 E.Tamiami Trail,Building H,#211 Naples,FL 34112 THIS SPACE FOR RECORDING RELEASE OF LIEN KNOW ALL MEN BY THESE PRESENTS: That Collier County, whose post office address is 3299 E. Tamiami Trail, Naples, Florida 34112, the owner(s) and holder(s) of a certain Lien executed by Daysi Companione to Collier County, executed on September 25, 2008 and Recorded in Official Records Book 4397, Page 1828, of the Public Records of Collier County, Florida, which is hereby acknowledged does remise, release, quitclaim, exonerate and discharge from the lien and operation of the said agreement, that certain portion of the premises conveyed by said lien, more particularly described in the aforementioned Lien. The undersigned is authorized to and does hereby release this Lien with respect to the above-named property, and consents to this Lien being forever discharged of record with respect to said property. ...mil.rg ." BOARD OF COUNTY COMMISSIONERS, • 'tnee (si MD - ,, COLLIER COUNTY, FLORIDA. a (print na = Approved in absentia per Resolution 2000-149 a 4. _ n on August 27, 2013 fitness-ignature) By: �� S�- -J 0 e_ 7L z---y k-/—c? ii Leo E. Ochs, Jr.,Coun na (print name) e. STATE OF FLORIDA) COUNTY OF COLLIER) The foregoing instrument was acknowledged before me this -EI.`day of Q, vs{ , 2013, by Leo E. Ochs, Jr., as County Manager, on behalf of Collier County, who is personalty known to me. / [N I • -'"". 14`*;r'•, A.MEET _ , ir� / • Mabry Pub1k•S1 a of Florida Signa .re of Notary Public— tate of lorida My Com .Expires Jun 23,2017 -;'- d Commiufon I FF 11935 \N (� `•N` Bonded Through Notional Nobly Assn. Irk\U T\ Print Commissioned Name of Notary Public Approved as to form and legality: Jennifer A. Belpedio Assistant County Attorney Prepared by: Wendy Klopf Collier County Housing,Human&Veterans Services Dept 3339 E.Tamiami Trail,Building H,#211 Naples,FL 34112 THIS SPACE FOR RECORDING RELEASE OF LIEN KNOW ALL MEN BY THESE PRESENTS: That Collier County, whose post office address is 3299 E. Tamiami Trail,Naples,Florida 34112,the owner(s)and holder(s)of a certain Lien executed by Novella Williams to Collier County, executed on March 7 2008 and Recorded in Official Records Book 4396, Page 2081,of the Public Records of Collier County, Florida, which is hereby acknowledged does remise, release, quitclaim, exonerate and discharge from the lien and operation of the said agreement,that certain portion of the premises conveyed by said lien, more particularly described in the aforementioned Lien. The undersigned is authorized to and does hereby release this Lien with respect to the above-named property, and consents to this Lien being forever discharged of record with respect to said property. ■ Ilbasi n ia sJ BOARD OF COUNTY COMMISSIONERS, . itnes si.? re, COLLIER COUNTY, FLORIDA. (pr'• na I •) Approved in absentia per Resolution 2000-149 i on August 27, 2013 ?Z� ..0 (/L"cl Cr-yam i ess(signature) By: 'a CT All, . 41•■ J o i i e l(.�v--c? '4'7 Leo : Ochs,Jr., Coun Ma age (print name) STATE OF FLORIDA) COUNTY OF COLLIER) The foregoing instrument was acknowledged before me this2-_+L day of P. , 2013, by Leo E. Ochs, Jr., as County Manager, on behalf of Collier County, who is persona0 known to me. [NO ' .. 4114 VIRGINIA A.NEET e &,_ ?(A):: e •'*r, Notary Public•stat,of Florida Sign re of Notary Public—State of Florida �r..11-....t.:� My Comm. ExpNaa Jun 23, 2011 ' Commission i ff 11938 \(�` r..q'� �� €.°�.� Bondea'n,ough National Notary Assn 0 Y Y Print Commissioned Name of Notary Public Approved as to form and legality: CJ,-R----(4 ,e_d. ND Jennifer A. Belpedio Assistant County Attorney Prepared by: Wendy Klopf Collier County Housing,Human&Veterans Services Dept 3339 E.Tamiami Trail,Building H,#211 Naples,FL 34112 THIS SPACE FOR RECORDING RELEASE OF LIEN KNOW ALL MEN BY THESE PRESENTS: That Collier County,whose post office address is 3299 E. Tamiami Trail, Naples, Florida 34112, the owner(s) and holder(s) of a certain Lien executed by Geraldine Prather to Collier County, executed on September 30, 2008 and Recorded in Official Records Book 4396, Page 2071, of the Public Records of Collier County, Florida, which is hereby acknowledged does remise,release, quitclaim,exonerate and discharge from the lien and operation of the said agreement,that certain portion of the premises conveyed by said lien, more particularly described in the aforementioned Lien. The undersigned is authorized to and does hereby release this Lien with respect to the above-named property, and consents to this Lien being forever discharged of record with respect to said property. BOARD OF COUNTY COMMISSIONERS, itness (s -' COLLIER COUNTY, FLORIDA. 'p -(print . e) Approved in absentia per Resolution 2000-149 on August 27, 2013 /esature) ,, By: ? ,� L e=`/--q Leo . Ochs, Jr.,Cou Ma,ager (print name) STATE OF FLORIDA) COUNTY OF COLLIER) The foregoing instrument was acknowledged before me this�°14L-day of -)5k 2013, by Leo E. Ochs, Jr., as County Manager, on behalf of Collier County, who is personalty known to me. SF�AAL A. `� 7itgK#PM $C-St*S f POtidat •s My Como.EspNts Jun-23.2017 Signat re of Notary Public—2(u2 e of Florida Commission 0 FF 1193$ Bonded Through National NU Mtn. YkrcV.\A-\ Print Commissioned Name of Notary Public Approved as to form and legality: Jenne r A. Belpedio Assistant County Attorney Prepared by:Wendy Klopf Collier County Housing,Human&Veterans Services Dept 3339 E.Tamiami Trail,Building H,#211 Naples,FL 34112 THIS SPACE FOR RECORDING RELEASE OF LIEN KNOW ALL MEN BY THESE PRESENTS: That Collier County, whose post office address is 3299 E. Tamiami Trail, Naples, Florida 34112, the owner(s) and holder(s) of a certain Lien executed by Lori Sidbury to Collier County, executed on May 30, 2008 and Recorded in Official Records Book 4396, Page 2075,of the Public Records of Collier County, Florida, which is hereby acknowledged does remise, release, quitclaim,exonerate and discharge from the lien and operation of the said agreement,that certain portion of the premises conveyed by said lien, more particularly described in the aforementioned Lien. The undersigned is authorized to and does hereby release this Lien with respect to the above-named property, and consents to this Lien being forever discharged of record with respect to said property. NiLt !- I ---_ BOARD OF COUNTY COMMISSIONERS, itness ': 111.1e) COLLIER COUNTY, FLORIDA. &k. . fir c/V- (printna e) Approved in absentia per Resolution 2000-149 on August 27, 2013 il. ness(signature) By: �� ti/ e, /1 r �U{ �4 11 Leo . Ochs,Jr., Cou• .nager (print name) STATE OF FLORIDA) COUNTY OF COLLIER) The foregoing instrument was acknowledged before me thisZ_4Lday of C:344 o5-f , 2013, by Leo E. Ochs, Jr., as County Manager, on behalf of Collier County, who is personally known to me. /� COI A.NEST 1 -�;� c� ('- �..(� =aP` N.+b` Notary PONS.SW of Florida 1 Sign ure of Notary Public–State of Florida My Comm.Expires Jun 23, 2017 1 3:%v,.:�� Commission•FF 11938 \(/ cC\ (\ 1, '`` 9onded Through Miami Notary Assn 1 f \Y1\Q 'r )• ems\ Print C�issioned Name of Notary Public Approved as to form and legality: 0,..` �� Jenn er A. Belpedi Assistant County Attorney Prepared by:Wendy Klopf Collier County Housing,Human&Veterans Services Dept 3339 E.Tamiami Trail,Building H,#211 Naples,FL 34112 THIS SPACE FOR RECORDING RELEASE OF LIEN KNOW ALL MEN BY THESE PRESENTS: That Collier County,whose post office address is 3299 E. Tamiami Trail, Naples, Florida 34112, the owner(s) and holder(s) of a certain Lien executed by Abraham and Lacmita Prudent to Collier County, executed on June 6,2008,and Recorded in Official Records Book 4396, Page 2073, of the Public Records of Collier County, Florida, which is hereby acknowledged does remise,release, quitclaim,exonerate and discharge from the lien and operation of the said agreement,that certain portion of the premises conveyed by said lien, more particularly described in the aforementioned Lien. The undersigned is authorized to and does hereby release this Lien with respect to the above-named property, and consents to this Lien being forever discharged of record with respect to said property. BOARD OF COUNTY COMMISSIONERS, itnes (si_I at e) r, COLLIER COUNTY, FLORIDA. (print e) Approved in absentia per Resolution 2000-149 on August 27, 2013 • ness(signature) By: ,.i, Leo' . Ochs,Jr., ounnZager (print name) STATE OF FLORIDA) COUNTY OF COLLIER) The foregoing instrument was acknowledged before me this 2-9-kAA day of 0\ vsk , 2013, by Leo E. Ochs, Jr., as County Manager, on behalf of Collier County, who is personally known to me. [N• i'-i IRGINIA A. _ JL A duo+•c -Stitt d RMItM Signa .re of Notary Public—State o Florida • it4•I My umn, F toff es Jun 23,2017 . ,tiron # FF119311 ...„' s jai Wary Aua. Print Commissioned Name of Notary Public Approved as to form and legality: Jennifer A. Belpedio Assistant County Attorney Prepared by: Wendy Klopf Collier County Housing,Human&Veterans Services Dept 3339 E.Tamiami Trail,Building H,#211 Naples,FL 34112 THIS SPACE FOR RECORDING RELEASE OF LIEN KNOW ALL MEN BY THESE PRESENTS: That Collier County, whose post office address is 3299 E. Tamiami Trail,Naples,Florida 34112,the owner(s)and holder(s)of a certain Lien executed by Justino and San Juana Martinez to Collier County, executed on September 19, 2008 and Recorded in Official Records Book 4396, Page 2079, of the Public Records of Collier County, Florida, which is hereby acknowledged does remise,release, quitclaim, exonerate and discharge from the lien and operation of the said agreement,that certain portion of the premises conveyed by said lien, more particularly described in the aforementioned Lien. The undersigned is authorized to and does hereby release this Lien with respect to the above-named property, and consents to this Lien being forever discharged of record with respect to said property. 0 ` 1111-■ L BOARD OF COUNTY COMMISSIONERS, fitness �- � COLLIER COUNTY, FLORIDA. ( rinri e) � Approved in absentia per Resolution 2000-149 i on August 27, 2013 r� C.�,eiZ7�i vc_ /- itne nature B g T (..,. % ys Gi b Q ( we?<-/ Leo E. Ochs,Jr.,Cou ' onager (print name) STATE OF FLORIDA) COUNTY OF COLLIER) The foregoing instrument was acknowledged before me this Z944......_day of Cl\. ..)s-t , 2013, by Leo E. Ochs, Jr., as County Manager, on behalf of Collier County, who is personally known to me. — ek' ' N" P ' �.0NA A.MEET _ �L - �s„ 1A.eit Notary Public•St of Florida Sign- ure of Notary Public State o Florida• My Comm.Expires Jun 23,2017 1 Commission•FF 1I93$ 41'S Bonded Through National Notary Assn. V \r°�k r\A 4 .\ • _ _ _ _ _ ♦ Print Comtnissioned Name of Notary Public Approved as to form and legality: Jennt er A. Belpedio Assistant County Attorney Prepared by: Wendy Klopf Collier County Housing,Human&Veterans Services Dept 3339 E.Tamiami Trail,Building H,#211 Naples,FL 34112 THIS SPACE FOR RECORDING RELEASE OF LIEN KNOW ALL MEN BY THESE PRESENTS: That Collier County, whose post office address is 3299 E. Tamiami Trail, Naples, Florida 34112, the owner(s) and holder(s) of a certain Lien executed by Jose and Yolanda Hernandez to Collier County, executed on June 6, 2008 and Recorded in Official Records Book 4397, Page 1826, of the Public Records of Collier County, Florida, which is hereby acknowledged does remise,release, quitclaim, exonerate and discharge from the lien and operation of the said agreement,that certain portion of the premises conveyed by said lien, more particularly described in the aforementioned Lien. The undersigned is authorized to and does hereby release this Lien with respect to the above-named property, and consents to this Lien being forever discharged of record with respect to said property. ____ BOARD OF COUNTY COMMISSIONERS, a • 4 _ i,t COLLIER COUNTY, FLORIDA. (print naive Approved in absentia per Resolution 2000-149 on August 27, 2013 1e- � CC c�z7ez�c._ tnes�s'gnature) By: ._aa,1� �J (4,,-,7`` 0 G, ,,,'cz <7 Le E. Clichs,Jr.,Co Manager (print name) ) STATE OF FLORIDA) COUNTY OF COLLIER) The foregoing instrument was acknowledged before me this2If&day of Q,ucvs , 2013, by Leo E. Ochs, Jr., as County Manager, on behalf of Collier County, who is personally known to me. : � VIRGINIA A.NEST ik NoMry Public-State o1 Florida Signat e of Notary Public- tate of lorida My C010M.Expires Jun 23. 2017 0.4• CaflMnission#►FF 11938 /` `C\`� ''.;',�`. 101wTtrcough Nafional Notary A>sn V Print Com issioned Name of Notary Public Approved as to form and legality: CAS 4_ c�� Jennirer A. Belpedio Assistant County Attorney Prepared by: Wendy Klopf Collier County Housing,Human&Veterans Services Dept 3339 E.Tamiami Trail,Building H,#211 Naples,FL 34112 THIS SPACE FOR RECORDING RELEASE OF LIEN KNOW ALL MEN BY THESE PRESENTS: That Collier County, whose post office address is 3299 E. Tamiami Trail, Naples, Florida 34112, the owner(s) and holder(s) of a certain Lien executed by Patricia Couture to Collier County, executed on May 27,2008 and Recorded in Official Records Book 4396, Page 2077, of the Public Records of Collier County, Florida, which is hereby acknowledged does remise,release, quitclaim,exonerate and discharge from the lien and operation of the said agreement,that certain portion of the premises conveyed by said lien, more particularly described in the aforementioned Lien. The undersigned is authorized to and does hereby release this Lien with respect to the above-named property, and consents to this Lien being forever discharged of record with respect to said property. I .ma BOARD OF COUNTY COMMISSIONERS, itne 11.7 ur- COLLIER COUNTY, FLORIDA. La (print na ;) Approved in absentia per Resolution 2000-149 on Aug .t 27, 2013 • W ess(signature) 1 By: ♦ i Aar A7 Leo E. Ochs,Jr.,Co ty nager (print name) STATE OF FLORIDA) COUNTY OF COLLIER) The foregoing instrument was acknowledged before me this -1L-day of quel ost , 2013, by Leo E. Ochs, Jr., as County Manager, on behalf of Collier County, who is personall known to me. [N '!1. ' WINO A.MEET t 081iwy Mk•Stale of Florida ignat. e of Notary Public—St e of Florida ••' Yy Cons.Exyiru Jea 23.201 Commission 9 FF 11938 c\ •,''�� r tended Through National Notary Assn. V\ \Y\\Q Print Cothmissioned Name of Notary Public Approved as to form and legality: Jennirer A. Bel p iio Assistant County Attorney Prepared by: Wendy Klopf Collier County Housing,Human&Veterans Services Dept 3339 E.Tamiami Trail,Building H,#211 Naples,FL 34112 THIS SPACE FOR RECORDING RELEASE OF LIEN KNOW ALL MEN BY THESE PRESENTS: That Collier County,whose post office address is 3299 E. Tamiami Trail, Naples, Florida 34112, the owner(s) and holder(s) of a certain Lien executed by Ben Davison and Amanda Davison to Collier County, executed on July 1,2008 and Recorded in Official Records Book 4516, Page 334, of the Public Records of Collier County, Florida, which is hereby acknowledged does remise, release, quitclaim, exonerate and discharge from the lien and operation of the said agreement, that certain portion of the premises conveyed by said lien, more particularly described in the aforementioned Lien. The undersigned is authorized to and does hereby release this Lien with respect to the above-named property, and consents to this Lien being forever discharged of record with respect to said property. tk BOARD OF COUNTY COMMISSIONERS, itness(st na ` COLLIER COUNTY, FLORIDA. .rint na' ) Approved in absentia per Resolution 2000-149 / on August 27, 2013 OF itness(signature) By: % / e / C u- ✓ v',7 1 Leo . Ochs,Jr., County . aver (print name) STATE OF FLORIDA) COUNTY OF COLLIER) The foregoing instrument was acknowledged before me this 2'94 .day of \3\ ■SaC , 2013, by Leo E. Ochs, Jr., as County Manager, on behalf of Collier County, who is personally known to me. [Nr :11.,7..: • IARGIN1AA.NEET It: 4 NMM Public•State of Florida Signa re of Notary Public— tate of Florida My Comm.Expires Jun 23.201/ Commission•FF 11930 (� , Bonded Through National Notary bill. �Yq\Y1\c3� Print Commissioned Name of Notary Public Approved as to form and legality: CA- Jennifer A. Belpedio Assistant County Attorney