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BCC Absentia 08-27-2013 Item #16D1 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. .kit 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. Lisa Can HHVS It 8/27/13 2. Jennifer B. White, ACA Office located in HHVS � � '2'1 �,� County Attorney Office Department 3. BCE ice Board of County C.XX\ tssioners �� C- Ow_ 1 4. Minutes and Records Clerk of Court's Office Cop PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact i o tt needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Lisa Carr Phone Number 252-2336 Contact/ Department Agenda Date Item was 8/27/13 Agenda Item Number - n Approved by the BCC Type of Document 2 Applications Number of Original 4 Attached /2- 0".'")-A4-1'C 4- e t"C C' Documents Attached PO number or account number if document is NJ\ to be recorded C� N �n TIM dC Sqr, i it 61/644TRiucTioNs . c../dLi'sT Initial the Yes'�olumn 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? YES✓ 2. Does the document need to be sent to another agency for additional signatures? If yes, NO (/ 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 signed by the Chairman,with the exception of most letters,must be reviewed and signed YES ✓ by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's 4{5- \n 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 YES or document or the fmal negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's YES si.nature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip should be provided to the County Attorney Office at the time the item is input into SIRE. 5 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 8/27/13 (enter date)and all changes ,.' 4 made during the meeting have been incorporated in the attached document. The j�S 'F`; g g P „itt �� , 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 BCC,all changes directed by the BCC have been made,and the document is ready for the c9. / 7 q 1,,, Chairman's signature. -- `= , / _2t_e_ct .2c:. .,11n / n .ce)vut .t,R,K,.c)),1 .1 , ./, _ . ...,_._ REQUEST FOR PROPOSAL DOCUMENTS This packet contains formats for documents considered essential, "Proposal Documents" required from all applicants for: OLDER AMERICANS FUNDS Title III B Title III E Access Services For the Period of: 1/1/2014 — 12/31/2019 CD Access Application Index ' �I'" l ;' x abr Page Number 1 Form PUR State Form 7033 3-4 2 Service Provider Summary Information 5 3 Administrative Synopsis 6-7 4 Staffing Plan/Organizational Chart 7-9 Appendix A 2 5 Confidentiality assurance/HIPAA 9-10 Appendix A 3 & A 4 6 Grievance process 10 Appendix A 5 & A 6 7 Quality Assurance/Improvement 10-12 Appendix a 7 8 Coordination Plan 12 9 Targeting/Outreach Plan 13-15 Appendix A 8 10 Training Plan 15 Appendix A 9 11 Licenses NA 12 IRS Letter See Appendix Index 13 Audited Financials See Appendix Index 14 Insurance Documents See Appendix Index 15 Service Standards 17-22 16 Administrative Assessment 23-24 17 Certification of 60 operating funds 25 18 HIPAA Compliance Assurance 26 19 Statement of No Involvement and Contract Terms and Conditions 27 20 Contract Terms and Conditions 28 21 Statement of Compliance with Service Standards and 29 Requirements 22 Certification of Debarment/suspension 30 23 Availability of Documents 31 24 Match Commitment 32-37 25 Rate Quote 38-39 26 Rate Acceptance 40 27 Unit Cost Methodology work sheets See Appendices Index Access Services 0 Appendices Index Access Services Appendices r : P S :77 4'1 41" 1"a Page Number Al Organization Chart 41-42 A2 Job Description 43-53 A3 HIPPA Regulations 54-58 A4 Release of Information 59-60 A5 Services for Seniors Grievance Procedure 61-64 A6 Notice of Adverse Actions 65-66 A7 Sample of Satisfaction Surveys 67-68 A8 Collier County Target Plan 69-70 A9 Staff Development&Training Log 71-73 A10 Senior Choices 2012 Program Monitoring Report 74-104 All IRS Letter 105-106 Al2 Audit Financials 107 On enclosed Disk Al 3 Insurance Documents 108-109 A14 Unit Cost Methodology 110 7 Access Services 1. 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 8/28/2013 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 TOLL-FREE NUMBER protest within the time prescribed in Section 10.53(5). Florida statutes shall 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 submitting a ��r' L /CJ 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 C (1, i proposal and certify that I am authorized to sign this proposal for the proposer and that the 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 AUTHORIZED SIGNATURE ANUAL) 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 and the State of Florida for price fixing relating to the particular commodities or services purchased or acquired by the State of Florida. At Leo E. Ochs, Jr., County Manager the discretion,such assignment shall be made and become effective at the time the purchasing agency tenders final payment to the proposer. AUTHORIZED SIGNATURE(TYPED)TITLE 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 proposes risk. above address,the date and time of the proposal number.Proposal prices not submitted on attached proposal price sheets when required shall be rejected. All proposals are (d) INVOICING AND PAYMENT:The contractor shall be paid upon submission of property subject to the conditions specified herein. Those not complying with these conditions are certified invoices to the purchaser at the prices stipulated on the contract at the time the subject to rejection. order is placed, after delivery and acceptance of goods, less deductions if any as 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 2. NO PROPOSAL SUBMITTED:If not submitting a proposal,respond by returning only invoices for any travel expenses shall be submitted in accordance with the rates at or below this acknowledgment form,marking it NO PROPOSAL",and explain the reason in the Payment those shall specified in Sections accordance with and 287.5.42 F.S. , which states the Penalties: space provided above. Failure to respond to a procurement solicitation without giving Payment shag rights made in Agency's responsibilities section 215.422, F.S., pe penalties tn justifiable reasons for such failure, nonconformance to contract conditions, or other time limits for ripay and the vo ces. VENDOR OMBUDSMAN:DSMAN:v interest o p providing ods pertinent factors deemed reasonable and valid shall be cause for removal of the time limits for payment c invoices. VENDOR OMBUDSMAN:vendors providing goods protinent s name from the proposal mailing list. NOTE:To qualify as a respondent, and services to an agency should be aware of the following time frames. Upon receipt, proposer must submit a"NO PROPOSAL",and it must be received no later than the an agency has five(5)working days to inspect and approve the goods and services, stated proposal opening date and hour. unless the bid specifications, purchase order or contract specifies otherwise. An agency has 20 days to deliver a request for payment (voucher). The 20 days are 3. PROPOSAL OPENING:Shall be public,on the date,location and the time specified measured from the latter of the date the invoice is received or the goods or services are on the acknowledgment form. It is the proposer's responsibility to assure that his received, inspected and approved. If a payment is not available within 40 days, a proposal is delivered at the proper time and place of the proposal opening. Proposals, separate interest penalty of.03333 percent per day will be due and payable,in addition which for any reason are not so delivered,will not be considered. Offers by telegram to the invoice amount,to the vendor.The interest penalty provision applies after a 35 or telephone are not acceptable. A proposal may not be altered after opening of the day time period to health care providers,as defined by rule. Interest penalties of less price proposals. NOTE: Proposal tabulations will be furnished upon written request than one(1)dollar will not be enforced unless the vendor requests payment. Invoices, with an enclosed,self addressed,stamped envelope and payment of a predetermined which have to be returned to a vendor,because of vendor preparation errors,will result fee. Proposal tabulations will not be provided by telephone. in a delay in the payment. The invoice payment requirements do not start until properly 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 Comptroller's 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 Assistant Cott Attorney CD 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 of a request for proposals,or developing a program for future implementation shall 11. ADVERTISING: In submitting a proposal, proposer agrees not to use the results be eligible to contract with the agency for any contacts dealing with that specific there from as a part of any commercial advertising. subject matter,and proposers must disclose with their proposal any such conflict of interest. 12. ASSIGNMENT:Any Contract or Purchase Order issued pursuant to this request for 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 7. INTERPRETATIONS/DISPUTES: An against claims by third parties resulting from the contractors breach of this contract y 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 binding unless provided in writing by the Area Agency of Aging in response to 14. FACILITIES:The Agency reserves the right to inspect the proposers facilities at a requests in full compliance with this provision. Any person who is adversely affected time with prior notice. by the agency's decision or intended decision concerning a procurement solicitation or contract award and who wants to protest such decision or intended decision shall 15. CANCELLATION: The Agency shall have the right to unilateral cancellation for file a protest in compliance with Rule 13A-1.006(3). Florida Administrative Code. refusal by the contractor to allow public access to all documents,papers,letters,or Failure to file a protest within the time prescribed in Section 120.53(5).Florida other material subject to the provisions of Chapter 119,Florida Statutes,and made Statutes shall constitute a waiver of proceedings under Chapter 120, Florida or received by the contractor in conjunction with contract. 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) Contractors 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 C 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 [ ]#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. Name: Leo E.Ochs,Jr. Signature: • �,�- Title: Collier County Manager Date: $ •\1'proved as to form and legality ,zoC 5 Assistant Coun ttorney C,A 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 A1) 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 CA 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 CA 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 1,71 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 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 j`til 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 ?tii 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. EOGe Signat a of authorized ag n y representative Approved as to form and legality 18 Assistant County rney `u __.) 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 gam-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 701B, 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 C COMCESS BETWEEN individual completing the intake will explain the eligibility criteria and reason for 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 mey 20 Ova 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) Ill-B, (X) III-E PROVIDED: X Directly To Be Subcontracted DAYS AVAILABLE: Monday-Friday HOURS 8 am-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 701B/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- tyre 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 Assistant County Atto ey 22 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 9 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. 4P1 Authorized Represent five 8/27/2013 Date Approved as to form and legality Assistant County A ►�;ey A2 25 cCI9) 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. ozvo Authorized Repres tative 8/27/2013 Date Approved as to form and legality ssistant 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 istant Count 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 Cou Attorney A5 28 4? 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. `c 8/27/2013 Authorized Represe tive Date Approved as to form and legality Assistant Coun 6' ttorney A6 29 COT' 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. Signature yc3 Date 8/27/2013 Name and Title of Authorized Individual Approved as to form and legality (Print or type) (�, — Assistant Coui��y Attorney Leo E. Ochs, Jr., County Manager Collier County Housing, Human & Veteran Services Name of Organization A7 30 c6J 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. ' 4ter(' : a 8/27/2013 Signatu Date Leo E. Ochs, Jr., County Manager Approved as to form and legality \CX_a)\-, 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 $708.33 Monthly Special Conditions: Third Party Donors: (Please identify all sources of this cash donation below) X County Government: ❑ City Government: ❑ City Government: ❑ Other: Fl 32 MATCH COMMITMENT FOR DONATION OF BUILDING SPACE [ ] Original, dated SFY: FFY: Contract Amendment# Agency Name: Program: Donor Identification:Name: Collier County Housing, Human & Veteran Services Street:3339 Tamiami Trail E, Suite 211 City: Naples State: FL Zip: 34112 Phone: 239-252-2273 Authorized Representative: Description of Space: [X ] Office [ ] Site [ ] Other Provider Owned Space: 1. Number of square feet used by project 1600 sq.ft. 2. Appraised rental value per square foot$ /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 D, jV11 Date: 8/27/2013 Signa ur- of Donor or Repr .e tative F2 Approved as to form and legality Assistant Cou Attorney 3 3 Kam' 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 0 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 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 F4 35 Cq 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 cAo 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 it 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. z 8/27/2013 Leo E. Ochs, Jr., Signature of Authorized Agency Representative Date Approved as to form and legality Assistant County"►rney 40 `. � Al Organization Chart 41 8 � g° m vms ay V yw 2 - 5E mr (o + � o °i 2, g. 0 , o g po g. 2 \ N ]i 33 8 fD \ O 8 O N' \i} �/ a^ a W g wm co m a c0 O 8 8 8 3 N p (p '� - 8g mg' m m � m n mN ^e�' O 7 0 7 C > 7C 7 m m 3 m m g m m 0 io (c m S is m 6 a 'Vd) .� gm _ d = w < o0 O3s 2g - _ '- m c 5 a 9, (f) 2 o3�K i ry' a•2 1 22 (0, N Dm 7 N 2 N (p 7C 0 7C (O m Q' 5i > > m m o \,?.-...../ N a c N O m m N W. I n G) G) 'G) I 3 u O?r > NaO 0- � _ 0 C4 n< g��r ? .m 1.1: m om O yy ( Qom - c g o�� ' � aO d a~ . N N wj m O. O CO g s as o - N a a r m.va 20 mn .N..V N O c - 3 8 K .�/ �/ w m cq PS' y n$ SE o 8 6 C b 7 a as < p (c� z: g 0 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 ier 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: l loosing. Htn at �tttd 60 Vettran Se•rti ict•s 3301 East Lamm!r.l•Health Butt •Naples.FL 34112 238 2$2 CARL(2l3) •n9 25241 0663 •2 -2` CAFt i2233)•239252RSVP(178I)•239 252 M'E FS(mod)•vettw ccatergov nethurrienst 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 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 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 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 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 A7 Sample Client Satisfaction Survey 67 Cotter County Pubic Services Division 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 3"d, 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! int, Housing, 'Littman and Ve te!ail er,ices ,, " t": 68 3301 East Lamaist 1rad•Health EitAing•Wes Ft 34112 244 2ti•CA11(22n) •249 252 t ,9(4 593)•t;i 252-t AF 11;2233)•239 252 RSVP(77137)•239-252 VETS( 7)•wax camps n ce 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 Yes 1 hour Annually Interviewing: Skills 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 Seniorchoices of Southwest Florida November 14, 2012 Mr. Fred Coyle, Chairman Board of County Commissioners 3299 Tamiami Trait 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 lhe r.ompreheosive resource for seniors ,,,tp h.,. 1-866-413-5337 S,') trxrli,1 5., '',(t R. I 1M 0111. t■t. \h r,, ;1901 (uhce 2 if,652.69fX) 1 es 23' 3 e".e 75 ANNUAL IVIC1NITORINO ASSISTANCE REPORT PROVIDER: Housing, Human &Veteran Services-Collier County Government PRIVATE NC3NPROFI 11 ORGANIZATION PUBLIC AGENCY X COUNTY GOVERNMEN I CONTACT PERSONS: Kim Grant, Interim Director Louise Pelletier, Case Management Supervisor Hoid Fahnostock, Nutrition Program Administrative Supervisor TELEPHONE: (239) 252-8443 Fax: (239) 252-2638 ADMINISTERING AGENCY. Senior Choices-Area Agency on Aging for Southwest Florida (AAA) CC)NTRACT rqui1V113E.i-t: C)AA 203.11 CCE 304.203.11 ADI 306.203.11 HCE 316/317.203.11 FUNDING PERIOD: July 1, 2011 -June 31,2012 General Revenue Proyrms January 1 2011 -December 31, 2011 OAA, FUNDING SOURCE older Americans Act Title III Community Care for the Elderly (CCE) Home Care for the Elderly(HCF) Medicaid Waiver ADA/ALE Alzheimer's Disease Initiative (ADI) TYPE: OF MCINI I()RING' X Annual Special DATE(S) OF VISIT: October 25, 2012 PARTICIPAN1 5: Senior Choices of SWFL Staff: ivonne.. Garcia Mesa, Medicaid Wavier Specialist Suzanne Clarke, Program Specialist Angela Wood, Program Specialist Senior Choices ot 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 Administrative Supervisor Debbi Mexon, Case Manger SITES VISITED: The Goodwill-Roberts Center Congregate meal site in Immokalee was visited on October 16, 2012. Satisfaction surveys were completed during two home visits on October 250 and on October 30"' six clients were visited at their homes dining a monitoring of the Home Delivered Meal route to complete surveys. Executive Summary The annual oresite lead agency monitoring of Collier County Services for Seniors (CCSS)was conducted on October 25th, 2012 at 3339 cast Tamiami Trail, Building H, Naples, Florida 34112. Collier County Services for Seniors is S division of the county government agency. There are currently 496 seniors enrolled in their programs which include nutrition (congregate meal sites and home delivered meals) and case management. They operate four congregate meal sites throughout Collier County. An rii.t,ancita v./a*, held on October 25, 2012.A geinral outline 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 petted with nonconformance file issues Two home visits were made to conduct client satisfaction interviews. The Goodwill Roberts Canter 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 MUT lityr the Home Delivered Meal (HDM) route. Senior Choices completed its programmatic monitoring on October 25, 2012 and an exit conference was held via teleconference on Octobet 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 implemented some internal changes over the past year to improve their pit/grams. 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-UP FROM PREVIOUS MONITORING VISIT There were recurring findings in both Program and Medicaid Waiver files for incorrect completion of the 701B 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 ADL/IADL sections on the 701B 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 nenconformance.s 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 701B Assessment. There are inconsistencies between the ADLJIADL 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 Rol Average Days 2011 Requests January 13 25 February 12.38 19 Mai m 143= ^w'« ' 1133 15 May w", 13.66 4 July 12.Z5 8 August 10.6 / September 16 5 2 November 8 1 December 6 2 zo 2m -� �- 'No/ u` oamu -ma o � = = � � �� � � � 2 � � ~ Quality Assurance: Collier County Services for Senior mailed satisfaction surveys to 239 clients in May 2011 There were 113, (47%) 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. All CCE (Community Care for the Elderly)vendor monitoring was completed by CCSS as agreed upon through the shared monitoring agreement. _ � --------� Senior Choices ofSvYHouUa nu/erCoun?ymv ni»oringKepurt2Ol2 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 nutrition if they are serving food. Cunentiy, the volunteers that serve food do not all receive training by the RD. This is a requirement(page 4-1 13 in manual). There were 29 Congregate and HDM client files reviewed. All files were compliant with required documents. A meal site visit was conducted at the Goodwill-Roberts Center in lmmokalee on October 16 2012. Seven meal site participants were surveyed and all expressed satisfaction 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. Howovmr, 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 1, 2012-Sept 30, 2012, 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 The standard for improvement or maintenance of Activities of Daily Living(ADL) was 58.97Y6 compared to the standard of 65% It is understood that this client base is comprised of individuals whose ability to improve performance of AD L's is affected by age. APS: Collier County Services for Seniors had two high, 19 moderate and one low risk Adult Protective Service (APS) referrals from October 1, 2011 through October 1, 2012 All APS cases were served within mandated time frames. CCSS does a good job with documentation for the High Risk referrals in ARTT and the client files, Medicaid Waiver: Aged and Disabled Adult Medicaid Waiver Program (ADA): Since the October 2011 annual monitoring. 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 The Medicaid Waiver handbook stipulates that both the _��cc�� ______��^'- ^�~'� �°��'`'- ^.,�~-,~~�~�~~��"'`~^^'° ---�s Senior Choices oUSW Florida Collier County Monitoring Report 2012 Page 80 number of units and the number of converted unites must 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 necessary, however the following were the overall issues: Assessment Summary completed incorrectly, assessment inconsistencies, Care Plan inconsistencies with annualized 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 ADLJIADL sections (total help/sometimes), 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 clienL files, both the number of units and the number of converted unites must be documented in 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 Fahneotook, Debbie Maxon, Sarah Gutuerre and Carlton Bronson fvnmCC'OS In attendance from Senior Choices of Southwest Florida were Sue Clarke, /\nge|aVVoug. |vonneGarcia'N1esa and Nicole St. /\mend. The results of the monitoring were reviewed and findings discussed. A report will be issued within �0 business days. Senior Choices of Southwest Florida wishes to thank Collier--County Services for Seniors for its cooperation and assistance during the monitoring visit. Senior Choices of SW Florida Collier County Monitoring Report 2012 Page 6 Signatures' /I , - Sue Clarke, Program Specialist Date /Li/ LL cre.k, Angela Mood, Program Specialist Date -3 hy,/, ..2/49- 1vonne Garcia Mesa, Medicaid Wavier Specialist Date WWI! Senior Choices of SW Florida Collier County Monitoring Report 2012 Page 7 82 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, X 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 X HIPPA Update training is completed annually with all staff/volunteers 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? X Are persons who are referred to the Provider by Adult Protective Services given priority services? X Are suspicions of abuse, neglect or exploitation reported to the protective service abuse registry? January 2012. 84 PROVIDER ADMINISTRATIVE REVIEW Collier County 2012 Yes No N/A Corrective Action Needed DISASTER PLANNING X Has the Provider Director submitted an updated Disaster Plan to the 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 X service provision, including: Pre-Service and In-service? Annual In-Service (6 hours required) Required Topics: X • Overview of Home and Community based care services • Relationship of case management to the community care X services system X • Use and completion of assessment instruments and care plans X • Interviewing skills and techniques January 2012 85 PROVIDER ADMINISTRATIVE REVIEW Collier County 2012 Yes No N/A Corrective Action Needed X • Record keeping procedures X • CIRTS procedures • 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 Is 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. X Provider has addressed/resolved sub-contractors services issues. Provider ensures sub contracted vendors are providing services per X Program and Services Manual standards. January 2012 86 OUTREACH/TARGETING REVIEW Collier County 2012 Yes No N/A Corrective Action Needed X The agency has established a plan to interact with Information and Referral services and available community service agencies? The agency not potential clients initiate outreach activities. X 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? X X Are targeting plans completed,analyzed and updated annually? Are Outreach Plans completed and provided to the AAA semi- X annually? January 2012 87 OUTCOME MEASURE REVIEW–Actual achievement Collier County 2012 ft Outcome M easure Standard Performance Measure 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 65 CLIENT SATISFACTION REVIEW/QUALITY IMPROVEMENT PROGRAM Collier County 2012 Yes No N/A Corrective Action Needed X 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? 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 X Do case review and home visits take place according to program standards, or more frequently, depending upon the individuall client? Is the client reassessed at least once every year, using 701 B? X X Does the case manager appropriately complete a functional assessment of clients, utilizing 701 B? 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 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 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 -- X Master Training Documentation File (on site review) Incidents Report File (copies for file)viewed on site Complaint tracking logs (copies for file) viewed on site ADA Assurance and Supporting Documentation &ADA Policies(on 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 Staffing Plan/Organizational Chart Personnel Policies Manual Functional Procedures Manual/Standard Operation Procedures Copies of any license held by agency (Day Care, Companion etc) X Affirmative Action Plan Consumer outreach/targeting plan Januury 2012 91 NUTRITION PROGRAM REVIEW Collier County Yes No N/A Corrective Action Needed Meal provided meets 1/3 RDA for individual's 51/over. When two X meals are served/day, they provide 2/3 RDA. 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 X method and are approved by licensed Dietitian/RD. — Dietitian/Nutritionist adheres to Chapter 468.509, FS, and Chapter X 64B-842, FAC. Dietitian is licensed RD. Provider's RD monitors for compliance with Chapter 64E FAC X requirements 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 X nutrition education. — RD develops food and menu standards for food service contract; X and reviews/approves menus and menu substitutions Provider maintains daily food temperature logs and menu X 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 X account for all contributions. Priority for service is given to those identified as being in greatest 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 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 Congregate meals provided are hot or other appropriate meals. Project has provided/planned for provision of shelf stable meals in X emergency 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 underf60 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 X frozen solid Frozen Solid — 93 AVAILABILITY OF DOCUMENTS/DOCUMENT REVIEW NUTRITION PROGRAM Yes No NIA Corrective Action Needed Copy of RD signed menus and cycle analysis and documentation X that they ' y t first week of use Cop y of RD license and R abi' 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 Copy of temperature logs for one month Copy of client satisfaction survey and analysis X Copy of targeting plan 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 -- . Documentation that RD has provided Nutritional Counseling X 7Y 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 X Documentation supports need for Medicaid Services X X No Billing and Claims information is correct 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 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 maintained to record and evaluate unmet X service requests/needs, in order to advocate for clients and to plan 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 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 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? January 2012 96 MEDICAID WAIVER ADMINISTRATIVE REVIEW ADA MED WAIVER Collier County October 2012 Yes No N/A Corrective Action Needed Is the client notified in writing of the termination? X 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 No assessment? X If yes, explain. 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? X If yes, explain. _ Were there any concerns relating to the Case Narratives? X No If yes, explain 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? X No Note: There was one LOC that was completed late, however the notes were very well documented to justify the reason. Were there any concerns relating to Medicaid Eligibility? X No Note: There was an eligibility that was out of date in the { October 2012 monitoring. Were there any concerns that related to the program specifics? X No Medicaid Waiver handbook requires that units as well as 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 X Assisted Living Case Managers meet case load standards Assisted Living Case Managers have Assisted Living Core Training Is the Provider a Medicaid Waiver Provider-or have they applied to be a MW Provider X This section summarizes results from Medicaid Wavier file reviews: # Reviewed: 7 ALE X 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 -......... 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? X Do case review and home visits take place at following program standards, or more frequently, depending upon the individual client? X Is the client is reassessed at least once every year, using 701 B? 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 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 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 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 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? X Do case review and home visits take place at following program standards, or more frequently, depending upon the individual client? Is the client is reassessed at least once every year, using 701B? 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, X utilizing 701 B? 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 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 X plans and/or activity plans that address physical problems, such as dental, vision and swallowing, which impede proper nutrition? Are the case managers and program coordinators developing care I 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? 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 X assessment? If yes, explain. Assessment summary completed incorrectly --------------- Were there any concerns relating to the Care Plan? X If yes, explain. Care plans need to be updated with correct annualized total Were there any concerns relating to the Case Narratives? X If yes, explain Missing documentation for receipt of services 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? 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 N/A 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 X the probability of the provider accepting the client; and an arrangement for 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 N/A 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? January 2012 104 A11 IRS Letter 105 OR/05/12 ILORIDA • DR-14 Consumer's Certificate of Exemption] R.04/11 Issued Pursuant to Chapter 212,Florida Statutes OF REVENUE UEE 4 p c. 85-80159665310-1 • 10/31/2012 10/31/2017 'c1 f •cra, ,"? . ,. Certificate Number Effective Date Expiration Date gprM + : rsa ` tit_•t •k s ` ,. This certifies that .. f • t COLLIER COUNTY BOCC b 4 g i' `°t«• k 3299 TAMIAMI TRL E STE 403 : � , NAPLES FL 34112-5748 #s t 1t '�"� 4 r x is exempt from the payment of Florida sales and use tax on real property rented,transient renta IrepertrUnted,tangible personal property purchased or rented,or services purchased. EtOIz,oA Important Information for Exempt Organizations I R.04/11 OEPAAR T I I 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(FA.C.). 2. Your Consumers Certificate of Exemption is to be used solely by your organization for your organization's customary nonprofit activities. f 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 an such taxable transactions. Note: Churches are exempt from this requirement except when they are the lessor of real property(Rule 12A-1.070,FAC.). 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 Entities." 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 ,,„.•-..I40 COLLI-1 OP ID: DO AC./"Y D 1'Z"' DATE(MMIDD/YYYY) kr.,,,��1�/lllJ CERTIFICATE OF LIABILITY INSURANCE 08/26/13 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 239-649-7933 PHONE FAX Services,Inc. (NC,No.Ext): (NC,No): 8950 Fontana Del Sol Way#200 ADDRESS: Naples, FL 34109-4374 William H.Kuhlman,CPCU,ARM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Princeton Excess&Surplus 10786 INSURED Collier County Government INSURER B:Underwriters at Lloyds Risk Management Department INSURER C:Midwest Employers Casualty Co 23612 3311 Tamiami Trail East,#D 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSR VD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 A X COMMERCIAL GENERAL LIABILITY 64A3EX000001509 10/01/12 10/01/13 DAMAGE SESO(Ea occurrence) $ Included CLAIMS-MADE OCCUR MED EXP(Any one person) $ 1,000 A X Professional Liab SIR$200,000 PER OCC 10/01/12 10/01/13 PERSONAL&ADV INJURY $ Included GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG _$ 5,000,000 POLICY X JEC7 LOC Prof. $ 5,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5,000,000 (Ea accident) $ A X ANY AUTO 64A3EX000001509 10/01/12 10/01/13 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) X SIR PER OC 200,000 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X WC STATU- 0TH- AND EMPLOYERS'LIABILITY TORY LIMITS ER Y/N C ANY PROPRIETOR/PARTNER/EXECUTIVE 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 I 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Master Certificate ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE '" —' 109 I ©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 co 0 0 a. N 0 <J 0 O CO 0 C J n O N (D 0 0 0 0 m 0 N O W N X mp jmlp o I0m � moc� mcdacminni Co. o m m a n1 C) 'R 1 v ( oiicv1.- s' ^ mq .1j� 2, 3 Im t) 0 D D m a= o,C D > .< m - = of m 1 3 Z r Z r' in 0 o CO Z CO p m v m ti m -0- N 7 N m m D D m D D ?7 o = n Q a'� Kic N x m °- o 0 D a Z Q 0 1 O 0 rn C m m' N = m m - `<�,, p) T . 'm -i 'd0 I 1 T g m,D, m m - m - d'o vlN �, m1 I-.. la of N r0 o 0ID'I 0 N C I Ia.2 �'3' 173 co X150.. *. 1 =y__. --- ° L- .- --�,. I� �, SID W I'D C CO 0 Irmo) m m o m,03 0 mim �1m 0 0'(0i 0,-1 co o', I� N;o m - m • m m ,- m m N. 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EA tot) 0 Z CD N O N N CI) A N g y 3 O _ T O (( N CD co 01 W 0 O O -, 0) ,-�' a 11 co O E9 7 a m v N d7 �.. n "co 01 A 0 N N N.3 1 W CO W 0) 0) 0 A A N V DUPARTAICNT OF Monthly and YTD Service Units with Unduplicated Client Counts PSA: 08 Provider: 81302 Location: ALL LOCATIONS t1 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? V Group g by: Location, Program, Service � rou MTH(Monthly) Unduplicated Location Program Service YTD(Year to Date) Units Provided Client Count 01 ADI CM MTH 13.75 2 I` (, `, YTD 26.00 2 �1 ea 8 CCE 3 CM MTH 968.50 163 �' YTD 2,042.00 234 -yly J I Lw x\t Wt S 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 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 c) 10PARTAIFN1 01 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 Grou b Location, Program,Service sraTeo Fnonme Group by: 9 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 Rerti. YTD 53.00 2 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'' 9 C Lip YTD 6,169.00 10 CCE ADC MTFI 760.00✓ 2 YTD 2,241.00 6 OA3B ADC MTH 640.00 r 2 YTD 736.00 3 RESF YTD 72.00– r �.. ,.ie,oed 1 07 CCE EAR MTH 419.00,E 11 —0:1-j YTD 2,285.00 14 OA3B EAR MTH 3,107.00 19 YTD 6,048.00 20 09 rcwoe,g0A3E ' GECI �� YTD 136.50 9 __ Cee 13 ADI RESP MTH 625,50/ 2 .,1 1 YTD 1,021,50 2 i' �A. CCE CHO MTH 13.00/ 1 ___(VV L YTD 13.00 1 HMK MTH 1,840.50✓ 18 YTD 3,381.00 22 PECA MTH 2,191.50✓ 20 YTD 3,968.00 24 RESP MTH 2,458.25✓ 12 YTD 4,193.50 16 OA3B CHO MTH 12.50✓ 1 YTD 43.50 3 COMP MTH 0.00 1 YTD 0.00 1 Report run–on: 08/12/2013 10:36 AM Page 2 of 5 –y mon td_services.rdf Report run by: CARRILLO Dispose of this report so that it can not be read or reconstructed pa;oni;suoaaa Jo pew aq;ou uea 1!;eLl;os voila,s!Ll;o esods10 alliNNv3 :ICq un.i podazl 1Prsaaltuas ppC-uoww 9 Jo£a1ed IAIV 9E:06 £60Z/Z6/80 :uo unJ podab E 0017171. OIA Z 1'00'0 H11A1 V03d 1.1. 00'88t7 OlA. I' A. 9Z'O2Z WAN >11A1H EIEVO 9 00'08L`Z alA 9 n00'99Y`I. 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