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Agenda 09/10/2019 Item #16D 4 (Request for Proposal - OAA & AAASWFL)
09/10/2019 EXECUTIVE SUMMARY Recommendation to approve a submittal of a Response to the Older American Act Grant Services Request for Proposal, after the fact, to the Area Agency on Aging for Southwest Florida, Inc., for a 6-year period. OBJECTIVE: To apply for a grant to provide services to Collier County's frail and elderly residents through the Older American Act (OAA) program. CONSIDERATIONS: The OAA program is a federally funded program offering a variety of in-home and community-based services. This grant is received from the Florida Department of Elder Affairs (DOEA) and is managed by the Area Agency on Aging (AAA). This grant enables the County’s Services for Seniors (CCSS) Program to provide in-home services to seniors and their caregivers so that they ca n remain in their homes and live with independence and dignity. All OAA services must be centered and delivered with the goal of providing elder consumers the support and assistance needed so that they may remain in the least restrictive environment. Community and Human Services Division (CHS) currently administers a six-year OAA contract which expires on December 31, 2019. The current grant contract where Collier County is a qualified Lead Agency began on January 1, 2013. On May 6, 2019, a notice of fund ing was received from AAA. The purpose of the Request for Proposal (RFP) was to solicit applications from qualified agencies/organizations interested in providing services to the 60+ population within Collier County and other functions required by law as a n OAA service provider. The OAA service provider is a key component of the publicly funded long-term care system and its performance has a highly significant impact on the lives of the individuals it services and the local, regional, and statewide fiscal s ustainability of the long-term care system. The RFP response was due on July 9, 2019, which required an after -the-fact approval. Collier County CMA #5330 authorizes the County Manager to approve the submittal of grant applications with subsequent Board action at the next available Board meeting to ratify the approval as “after -the-fact.” The County Manager’s office approved the submission of the grant application on June 28, 2019. It is anticipated that AAA will provide notice of the contract award by Au gust 26, 2019, and should CHS be awarded the grant, CHS will bring the notice of award to the Board for approval. Should it again be awarded to the County, the new grant contract will be for a 6 -year contract period with annual contracts and annual fiscal allocations. Collier County Services for Seniors will be responsible to respond to the needs of seniors and to manage the spending authority for the OAA programs. All associated vendor contracts procured through this process will be renewed for five (5) ad ditional years, contingent upon satisfactory performance, Collier County’s award and availability of funds. If awarded, the operations for the OAA programs will commence on January 1, 2020. An authorizing resolution is being brought forth as part of the grant requirement. FISCAL IMPACT: There is no Fiscal impact at this time. Funding is provided by the Federal Department of Elder Affairs passed through AAA via annual contracts for each individual grant program. The OAA program requires a ten percent (10%) match and has historically been funded by a combination of Human services Grant Fund (707) carry forward (as available), required vendor match and the General Fund (001). For the current grant award, the County has received funding in the amount of $1,23 5,199, and the current match requirement is $131,992.89. A budget amendment will also be brought to the Board at a future meeting after award. 16.D.4 Packet Pg. 1370 09/10/2019 GROWTH MANAGEMENT IMPACT: There is no Growth Management impact. LEGAL CONSIDERATIONS: The Board will have the opportunity to accept or reject the funds if the grant is approved. Accordingly, this Office has no issue with respect to the legality of this request, which is appropriate for Board action and requires a majority vote for Board action. -JAB RECOMMENDATION: Recommendation to approve the submittal of a Response to the Older American Act Grant Services Request for Proposal, after the fact, to the Area Agency on Aging for Southwest Florida, Inc., for a 6-year period. Prepared By: Hilary Halford, Senior Grant & Housing Coordinator, Community & Human Services Division ATTACHMENT(S) 1. [LINKED] 01 Combined w_bookmarks FINAL signed edited AAASWFL RFP 2019 applciation (PDF) 2. Scanned After-the-Fact Approval001 (PDF) 3. Resolution (PDF) 16.D.4 Packet Pg. 1371 09/10/2019 COLLIER COUNTY Board of County Commissioners Item Number: 16.D.4 Doc ID: 9558 Item Summary: Recommendation to approve the submittal of a Response to the Older American Act Grant Services Request for Proposal, after the fact, to the Area Agency on Aging for Southwest Florida, Inc., for a 6-year period. Meeting Date: 09/10/2019 Prepared by: Title: – Community & Human Services Name: Hilary Halford 07/09/2019 11:14 AM Submitted by: Title: Manager - Federal/State Grants Operation – Community & Human Services Name: Kristi Sonntag 07/09/2019 11:14 AM Approved By: Review: Community & Human Services Kristi Sonntag CHS Review Completed 07/24/2019 2:37 PM Community & Human Services Maggie Lopez Additional Reviewer Completed 07/25/2019 1:20 PM Public Services Department Kimberley Grant Level 1 Reviewer Completed 08/12/2019 3:03 PM Public Services Department Todd Henry Level 1 Division Reviewer Completed 08/13/2019 2:48 PM Grants Erica Robinson Level 2 Grants Review Completed 08/19/2019 10:44 AM County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 08/19/2019 4:12 PM Public Services Department Steve Carnell Level 2 Division Administrator Review Completed 08/22/2019 8:16 AM County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 08/22/2019 9:19 AM Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 08/23/2019 4:37 PM Budget and Management Office Ed Finn Additional Reviewer Completed 08/26/2019 5:03 PM Grants Therese Stanley Additional Reviewer Completed 08/29/2019 11:11 AM County Manager's Office Leo E. Ochs Level 4 County Manager Review Completed 08/29/2019 11:20 AM Board of County Commissioners MaryJo Brock Meeting Pending 09/10/2019 9:00 AM 16.D.4 Packet Pg. 1372 c,t["rcounw ffice of Management & Budget TO: Leo E. Ochs, Jr., County Manager CC:Hilary Halford Senior Grant Coordinator - CHS FROM: Therese Stanley Manager - OMB Grants Compliance DATE: June27,2019 4// RE County Manager review and approval for the submittal of the Request for Proposal for Lead Agency Designation to the Area Agency on Aging of Southwest Florida (ATFI9- 016) The Collier County Community and Human Services Division is submitting a Request for Proposal for Lead Agency Designation to the Area Agency on Aging of Southwest Florida (AAA) in order to provide uninterrupted services to Colliery County Services as an Older American Acts (OAA) service provider. This designation is required is be renewed at least once every six years through a competitive procurement process. The Lead Designation allows the County to receive available funding from the State of Florida Department of Elder Affairs through the AAA. The OAA program requires a 10% match and is historically funded by Human Services Grant Fund 707 carry forward (as available), required vendor match and/or the General Fund (001). For the current grant award, the County has received funding in the amount of $1,235,199 and the current match requirement is $131,993. The notice of funding was received from the AAA on May 06, 2019. The OAA application is due July 09, 2019. Due to this expedited schedule, we are asking for your approval to submit the application, followed by After the Fact approval by the Board of County Commissioners at the September 10,2019 BCC meeting. Once you have reviewed the application, please sign an the box above and in the areas marked throughout the application and call me for pickup at 239-252- 2959. Thank you, and please let me know if you have any questions regarding this request Grant Application Reviewed and Approved by After-the-Fact Approval by the BCC is required at the September 10, 2019 BCC meeting County a nager,orde4Z (date) 3299 TamiamiTrail East, Suite 201 . Naples, Florida 34112-5746 ' 239-252-8973 ' FAX 239-252{828 16.D.4.b Packet Pg. 1373 Attachment: Scanned After-the-Fact Approval001 (9558 : Approval of After-the-Fact RFP submittal to the area Agency on Aging) c,Rff* couttw REQUEST # 19-012Ofrce of Maneenrent & Budget REQUEST FOR AFTER THE FACT APPROVAL OF GRANT APPLICATION Submit all requests to: OMB Grants Compliance Offlce FEDERAUSTATE AGENCY PROGRAI\4 NAME Area Agency on Aging ol Southwest Fbnda Older Ameri@ns Acl (OAA) Sedi@s Requ6t lor Prcposal CFDA# / CSFA#: DATE REQUESTED 05n3h9 DIVISION: community & Human seMces REQUEST MADE BY: FUNDING ANNOUNCEIVlENT DATE:05/06/19 SUBMISSION DEADLINE 07,09119 NEXT AVAIL. BCC IqEETING DATE:09/10h9 CMA 5330 Policy - (Check One) E (a) the grant is announced and the application is due within one month or less and the deadline has been missed for the next available Board of County Commissioners meeting; n (b) Division commitments to emergency situations or events b€yond normal operations prohibit staff from having time to develop application in coordination with Grant Compliance Office; or E (c) The Board of County Commissioners is not in session for a few weeks at a time (e.9. summer break). The Board of County Commissioners must approve all grant applications, even those applications that do not require a signature and are submitted online or require an individual other than the Chairman of the Board to sign. The most common reason for an exception is when a grant application's deadline precedes the agenda meeting deadline for Board approval, In this case, the project or program manager must contad the Ol,lB Grants Compliance Office to request or discuss options for emergency submittals or an after-the-fact approval. Over usage or unjustifiable reliance on the after-the-fact process is not acceptable and the County Manager has the right at any point to disapprove the submittal of an application. 1, Choose one exception to CMA 5330 below. 2. Provide additional justification within this box (date you became awar€ of tunding opportunity, etc.) 3. Attach a copy of the funding notification to this request. The funding announcement was available on 5i6l2019 giving the department 44 working days to complete this application. An intent to submit is required no later than June 1 1, 2019. As the guidelines to this RFP show, this application is lengthy and extensive and will be difficult to complete as required within the 44 day time frame and would be impossible lo have ready by the June 25th BCC meeting. A copy of the funding notification is attached. Because the guidelines require 5 executed hard copies to be delivered to N. Fort Myers on the day of the July I BCC meeting it is requested that the after-the-fact be for the September 10, 2019 meeling in the fall. Requirements and Timeline Once the Grants Compliance Office receives your request and a copy of the funding notification, you will be contacted with an initial approval. No later than three business days prior to submittal, the Division must provide a complete application as will be submitted to the grantor agency and a draft Executive Summary, for review and County Manager approval prior to submittal. OMB will prepare the County Manager's Memorandum of Approval (CM l.4emo) on behalf of the Division. The Division is required to obtain formal Board approval at the Board meeting date identified in the OMB written approval as well as attach a copy of the CM Memo to the Board action, Division Staff Signature I have read and understand the Requirements and l-lmeline Section of my After the Fact Request. I have included a copy ofthe Funding Announcement and any other accompanying information. f{rk"+/r/kr/ sr' Grant and Housins coordinator OMB Grants Accountant Reviewo/a OMB Grants Compliance Manager Approval FYIT v2 I I I I 16.D.4.b Packet Pg. 1374 Attachment: Scanned After-the-Fact Approval001 (9558 : Approval of After-the-Fact RFP submittal to the area Agency on Aging) 16.D.4.cPacket Pg. 1375Attachment: Resolution (9558 : Approval of After-the-Fact RFP submittal to the area Agency on Aging) 16.D.4.cPacket Pg. 1376Attachment: Resolution (9558 : Approval of After-the-Fact RFP submittal to the area Agency on Aging) Tab # —Cover Letter 1 CAle'r COU14tyINTRODUCTION Service Provider Summary Information Sheet/Application Update Table of Contents 2 Public Services Department - Community&Human Services Division p,1.A. PROGRAM MODULE -General Requirements 3 1. Needs Assessment 4 AAASWFL 2. Targeting Outreach and Prioritization 5 RFP -2019-01 2.A. 2020 CHS Target and Education Plan 6 2.13.III.E. Services 7 3. Service Delivery System and Coordination 8 4. Eligibility and assessment/Reassessment Process 9 5. Services 10 6. Process for Handling and Reporting Adverse Incidents, Consumer 11 Complaints, and Grievances 7. Quality Assurance 12 8. Goals, Objectives and Performance Measures 13 9. Reporting 14 10. Disaster Preparedness 15 11. Client Confidentiality 16 12. Description of Service Delivery 17 II.A. Congregate and Home Delivered Nutrition Services (Sections 1-7) 18 II.B.1 — Personnel Allocation Worksheet & 11. B.2 Unit cost Worksheet 19 II.13.3 — Supporting Budget Schedule by Program Activity 20 II.13.4-9 — Match Commitments 21 11.13.10 - Availability of Documents 22 II.B.11 — Managing Unit Achievement Letters 23 11.13.12 — SPA Contract Module Review Checklist 24 SPA APPENDIX (Tabs A -Z) 25 For the period of: ATTACHMENTS (i -vii) 26 January 1, 2020 - December 31, 2025 ,8-'r Public Services Department Community & Human Services Division July 9, 2019 Becky MacKenzie, Director of Programs and Planning Area Agency on Aging for Southwest Florida 15201 North Cleveland Avenue, Suite 1100 North Fort Myers, Florida 33903 Re: Response to the Older American Act Grant Services Request for Proposal Dear Ms. MacKenzie, Community and Human Services is proud to submit to the Area Agency on Aging the attached response to your RFP for the Older American Act Grant Services. For over 38 years Collier County Public Services Department, Community and Human Services Division, has been the designated lead agency for Services for Seniors' to serve frail elderly clients. Our program works diligently to ensure dignified and independent living for those served. Over the past 38 years we have experienced tremendous growth in the program and annually serve 165 seniors in our in-home program, 190 seniors in our congregate meals program and 90 seniors in our home delivered meals program. We are proud of the service we provide and the quality of vendors who deliver services to our most vulnerable residents. Traditionally our program receives excellent programmatic and fiscal reviews by AASWFL and not to mention outstanding client satisfaction ratings. For example, in 2018 the Collier County Senior Services Programs (CCSS) received a 92% client satisfaction rating. In addition, the 2018 CCSS-AAA File Review had an error rate of .25%, well below the 2.00% allowable error rate and lowest rate to date. CCSS was also found to be 100% compliant with DOEA guidelines for serving new clients and all DCFS/APS case referrals. These are just a few of our recent achievements in the CCSS Programs and with continued support we can continue to provide vital services to the seniors of Collier County. On behalf of the Collier County Community and Human Services please find enclosed the above reference RFP solicitation response. Thank you for your consideration. If you have any questions or comments concerning this submission, please call me at (239)252-2486. Si�fely, ("_ - /I ` Cristi Sonntag Director, Community a Human Services Division ENCLOSURES 14 Community & Human Services Division • 3339 Tamiami Trail East, Suite 211 • Naples, Florida 34112-5361 239 -252 -CARE (2273) - 239-252-CAFt (2233) • 239-252-4230 (RSVP) • wsvv.colliergov.neUhumanservices 1. PROVIDER INFORMATION: 2, OVERNING BOARD CHAIR: Executive Director: William L. McDaniel, Jr. Kristi Sonntag, Director Tamiami Trail East 3339 Tamiami Trail East, Suite 211 Naples, Florida 34112 Naples, Florida 34112 Legal Name of Agency: Name of Grantee Agency: Collier County Board of County Commissioners Community & Human Services Division Mailing Address: 3339 Tamiami Trail East, Suite 211 Naples, Florida 34112 3. ADVISORY COUNCIL CHAIR: (if applicable) [Name/Address/Phone] Telephone Number: 239-2522486 4. TYPE OF AGENCY/ORGANIZATION: 5. PROPOSED FUNDING PERIOD: 1/1/20 —12/31/20 Not for profit: ❑ Private O Public A. New Applicant ❑ B. Continuation ❑x Private for profit: : ❑ 6. FUNDS REQUESTED: O OAA Title IIIB 19 OAA Title III — Cl OAA Title III — C2 9 OAA Title IIIE © OAA Title IIIEG 9 OAA Title IIIES 7. SERVICE AREA: © Single County ❑ Multiple Counties List County/Counties: COLLIER COUNTY 8. ADDRESS FOR PAYMENT OF CHECKS: Item: 41 ❑X # 2 ❑ See address above 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. l Name: Leo Ochs ,ri Signature: Title: County Manager Date: July 9, 2019 Approved as to form and legality Page 3 of 33 AAASWFL RFP — 2019 — 01 SPA Format As.;istant County Moinvy Service Provider Application Update Table of Contents PAGE I. A. Service Provider Summary Information Tab 2 II. A. Program Module - General Requirements 1. Needs Assessment Tab 4/Pg.4 2. Targeting Tab 5/ Pg.8 3. Service Delivery System and Coordination Tab 8/Pg.12 4. Eligibility and Assessment/Reassessment Process Tab 9/Pg.14 5. System for Consumer Targeting Prioritization Tab 5/Pg.8 6. Services Tab 10/Pg.15 7. Process for Handling and Reporting Adverse Incidents, 7. Commitment of In -Kind Contribution of Equipment Consumer Complaints and Grievances Tab 11/Pg.17 8. OAA Subcontract Monitoring Schedule Tab 'G' 9. Quality Assurance Tab 12/Pg.18 10. Goals, Objectives, and Performance Measures Tab 13/Pg. 21 11. Reporting Tab 14/Pg. 22 12. Disaster Preparedness Tab 15/Pg. 23 13. Client Confidentiality Tab 16/Pg. 27 14. Description of Service Delivery Tab 17/Pg. 29 15. Nutrition Provider Documentation Tab 18/Pg. 31 16. Legal Provider Documentation N/A 17. Organizational Chart Tabs'V' &'W' II. B. Contract Module -General Requirements 1. Personnel Allocations Worksheet Tab 19 2. Unit Cost Worksheet Tab 19 3. Supporting Budget Schedule by Program Activity Tab 20 4. Commitment of Cash Donation Tab 21 5. Commitment for Donation of Building Space N/A 6. Commitment of In -Kind Contribution of Supplies N/A 7. Commitment of In -Kind Contribution of Equipment N/A 8. Commitment of In -Kind Contribution of Services N/A 9. Commitment of in -Kind Volunteer Personnel and Travel N/A 10. Availability of Documents Tab 22 Page 2 of 33 AAASWFL RFP - 2019 - 01 SPA Format Title III -13 Supportive and Access Services Collier County Provider Summary Information For more than thirty-eight (38) years, the Collier County Human and Community Services Division (CHS), Services for Senior Program, has been the lead agency in Collier County for elder services. For over eleven (11) years CHS has been providing congregate meals and home delivered meals in Collier County to seniors. Funding from the Federal Older American's Act has established a reputation of excellence in service delivery system provided by this agency. 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. Additional programs in the Community and Human Services Division also include a Social Services program offering medical and prescription services, Retired and Senior Volunteer Program (RSVP), Affordable Housing and Federal/State Grants. As part of Collier County Government, the division is one of several within the Public Services Department. These divisions include the University Extension Services, Domestic Animal Services, Library Division, Museum Division and Parks and Recreation Division. The Community and Human Services Division partners with other County departments to provide high quality senior services in a variety of community settings. The primary service CHS provides to Collier County seniors is to assist seniors in remaining self-sufficient and independent and to help protect seniors from abuse, neglect and exploitation. 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. The Manager of Senior program is the Collier County Community Liaison for senior issues and attends community events supporting seniors' needs and promoting CHS senior services. To address the social needs of seniors in the community, the Services for Senior program provides and participates in senior activities throughout the year, as well as special events such as Senior Expos which provide information and referral information to seniors. 1 CHS is in the final stage of completing a Collier County website with quick and concise informational access specifically for information that seniors need including legal advice, housing, and the AAA program. CHS is a participating member in the Alzheimer's Support Group, the Leadership Coalition on Aging, Hunger and Homeless Coalition, and the Immokalee Interagency Council. Over the last four (4) years, the program was instrumental in the development of the two Senior Centers, the Naples Senior Center and the Golden Gate City Senior Center in Naples, FL. This program is also active in state-wide elder support organizations such as the Florida Council on Aging, the Florida Association of Service Providers and the Florida Association of County Human Service Administrators. 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 this 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 Division acts as this agency's agent for cost savings in acquiring vendor services and products. The Human Resources Division 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 has over 100 years of combined professional experience in providing case management as well as over 38 years of experience with fiscal delivery of case management services. The philosophy of the program has been to employ individuals who have the skills, knowledge, education, and experience to link individuals to the most beneficial services that is also the least restrictive. Assisting individuals to live independently has been the stalwart of the program throughout its inception. CHS currently serves over four hundred (400) seniors in Collier County, providing in home services and nutrition services. Our skilled PA staff assess an individual's situation 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. We currently serve 138 seniors with in- home and respite services and 280 seniors in the nutrition program. Over the last 5 years, CHS has served over a total of 600 seniors with in home and nutrition services. As services are delivered, the quality and quantity of the services are carefully measured to ensure outcomes measures are consistent 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 seek to 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 meet and 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 supports that enhance their quality of life and uses resources to their maximum capacity. 3 II.A. Program Module — General Requirements 1. Needs Assessment Collier County is a unique county due to its cultural diversity, large geographic area and transient elderly tourist population. Collier County 2018 Population Profile listed below is compiled from the Florida Department of Elder Affairs 2018 Profile of Older Floridians: (See SPA Appendix A) Total population: 363,996 (100%) Over 60 years of age: 129,830 (35.7) 65+ 103,610 (28.5) 70+ 77,152 (21.2) 75+ 50,990 (14.0) Although Collier is not listed as a rural community, but rather an urban area, the total geographic area consists of 2305 square miles which encompasses rural communities outside of the city of Naples including the towns of Immokalee, Goodland, Ave Maria and specific geographic sections which include Golden Gate Estates, Golden Gate City and Orange Tree. The population by Race and Ethnicity in Collier County: White Black Hispanic Total Racial/ Hispanic Minorities Medically Underserved (65+) 95.7% 3.3 8.6 12.6 4.4% 23,317 seniors Population by Financial Status in Collier County: Below Poverty 7.5% Below 125% of Poverty 10.2 Minority Below Poverty 2.8 Minority Below 125% 3.7 Collier County's population of residents 60 years and older is growing and is 0 being reported as 35.7% of the county's population. The Services for Seniors program works closely with the Area Agency on Aging of Southwest Florida (AAA) in reviewing the Elder Helpline's state wait list for seniors in need of in- home services and nutrition. CHS utilizes research and data from the latest two research studies, the ALICE Report (The United Way Alice Project 2018) and the Leadership Coalition on Aging: Naples Area Senior Needs Assessment (FGCU 2012) to assess the needs of not only the seniors we serve but to monitor the needs of seniors that these studies have identified and in what geographic areas they reside in Collier County. FGCU is completing an updated study on their 2012 study with results being published in 2019. CHS is an active member in the Collier Senior Resources- Leadership Coalition on Aging of Collier County (LCA). This is the sole senior coalition in the County and the membership roster includes dedicated agencies who work with Collier County seniors. Members of the LCA include, Meals of Hope, Harry Chapin Food Bank, Naples Community Hospital, Healthcare Network of SWFL, the Jewish Family & Community Services, Avow Hospice, Catholic Charities of Collier County, Parkinson's' Association of SWFL, Goodlette Arms Senior Apartments and several home care agencies and senior volunteer agencies. Through the Coalition, CHS can utilize a network of senior agencies and organizations dedicated to the care and concerns of Collier County seniors. LCA was instrumental in working with Collier Health Care Network in recruiting three physicians to Collier County that specialize in Gerontology. CHS participates on the Advocacy and Annual Conference committees and was instrumental in the creation, design and implementation of Collier Counties two senior centers, the Naples Senior Center and the Golden Gate Senior Center. In addition, LCA has hosted six annual conferences enlisting professionals who work with seniors to participate and attend cutting edge topics on senior issues and how to address the senior population needs in Collier County. Most recently, CHS participated in the LCA sponsored Forum on Senior Health Equity Group where the needs of seniors during a disaster were specially addressed due to the ongoing issues that occurred to our senior population during Hurricane Irma in 2017. 5 Collier County reviews the state wait list weekly in the CIRTS data base and priority is based on the 7015 telephone assessment score and Priority Score and Rank that is completed with the senior and Elder Helpline staff. Priority scores determine the greatest need the senior has and those seniors are placed are placed on a waiting list by County. Services for Seniors team of program, grant and fiscal staff review available grant funding monthly and it is determined the total number of client referrals we can request from Client Services at AAA. Referrals are provided to CHS based on the priority scores and rank for seniors waiting for services in the OAA program. The senior population that CHS serves includes seniors that are White, Hispanic, African American and Haitian. CHS will continue to focus on the special needs of our seniors who are homebound and need in home assistance, nutrition services, transportation and medical care. The aging full-time population in Collier County is growing rapidly and as well as the seniors' specific needs for assistance as evident in the large number of seniors waiting for services in the Florida DOEA-CIRTS system. CHS communicates and works closely with the Collier County Sheriff's Advocacy Office, social service agencies including Salvation Army, Catholic Charities, St. Vincent de Paul and the Jewish Family & Community Services. The local ministries assist seniors with donations and volunteers who assist with transport and home repairs, including handicap ramps. As services are delivered, CHS is careful to analyze that our measures and outcomes are consistent with and on target with the DOEA statewide report. CHS Target Plan strategizes in parallel to the DOEA 2018 Targeting Report - Collier. (See SPA Appendix A) CHS' ability to accept referrals and provide services on a countywide basis has the proven record of being the only lead agency in Collier County in case management for thirty- eight (38) years. The eligibility criteria for the CCE, HCE and ADI Programs, has been determined by the Department of Elder Affairs. For CCE and HCE, individuals 60 years or older and for ADI, individuals 18 years of age or older. The individual must have a need of assistance and the risk of long-term facility placement without in home care services in place. The Emergency Home Energy Assistance for the Elderly Program (EHEAP) provides assistance for home energy emergencies to qualified low-income households with at least one person 60 years or older with a household of a past due utility bill. Once the Services for Seniors Manager receives the referrals from Client Services AAA, the Manager prints out the 7015 referrals and contacts and screens the referral on the telephone with the Individual and/or their family contact. Once the individual agrees they would like assistance, the Manager assigns the referral to a case manager who will contact the individual/family member to set up a home visit to complete the DOEA 7016 assessment. (See SPA Appendix B) 2.Targeting Outreach and Prioritization CHS works closely with the Alzheimer's Support Network, Goodlette Arms Apartments -the only low-income County Senior Housing, the Collier County Sheriff's Office (CCSO), Avow Hospice, Veterans' Services and the Parks and Recreation Departments where the latter hosts 2 of our 4 congregate meal sites. CHS is recognized and respected in Collier County as a support and resource to seniors and other agencies. CHS assists agencies, senior, caregivers and staff in making referrals to the AAA Elder Helpline for seniors to receive assistance. Collier County has initiated a 3-1-1 Communication Center which is a section of the Communication and Customer Relations Division. Collier 311 is responsible for providing residents and visitors ease of access to the full scope of government services. The system provides said access through a website, mobile application and a call center. Through 311, CHS receives numerous phone calls requesting information about services for seniors in Collier County. CHS is a member of the Hunger and Homeless Coalition of Collier County and meets with community social service agencies bi-monthly to keep the coalition informed of service information and referral assistance to senior programs. CHS participated in the Integrated Community Paramedicine Roundtable which included Naples Community Hospital, Emergency Management, Collier County Fire & Rescue and the "charette" focused on strategies in lowering senior (911) emergency calls, the care of our elderly in attaining mental health services and solutions to the rise of Emergency Room overcrowding, medication management, and lack of no hospital discharge planning. CHS is an active member in the following senior affiliations: Florida Council on Aging (FCOA), Florida Association of Aging Service Providers (FAASP) and the Community Care of the Elderly State Coalition. CHS attends all the LCA quarterly Empowerment Series which provides information to seniors and their caregivers on current topics, previous series included Elder Abuse, Theft Identity, Senior Housing and Navigating the Medicare system. At the Series event, CHS staff discuss with participants their specific needs, the AAA referral process and documents these contacts in the CHS Annual Target Plan. This D year CHS was present at the FCOA-AAA Senior Summit held at Avow Hospice. This public forum invites seniors to express their opinions and focuses on how to enlist their help with local legislation to maintain current state services for seniors. Recently, CHS was invited to partner with the Florida Department of Health to assist us in our targeting goals in reaching out to as many seniors in Collier County and informing them of our in-home services, EHEAP and nutrition programs. The Florida Department of Health applied and received a $5000. grant to assist an agency who works in the community promoting services to seniors without the negative language of describing seniors as old and frail but to positively reframe seniors' status to "age friendly". The" Age Friendly Initiative" included CHS meeting with Florida's Department Health's Director of Community Promotion and our age friendly collaboration included the following goals to target seniors who are minorities, minorities. below poverty level and limited English proficiency and living alone: • The printing of the Services for Seniors laminated flyers in three languages, (English Spanish and Creole) and the distribution of the flyers at all the Collier County Libraries, Museums, and Park & Recreation facilities. • The Services for Senior Information Sheet was mailed to 518 Collier County primary care providers. (See SPA Appendix C) • The Naples Daily News digital ad ran from April 20 -May 20, 2019. The ad was seen 52,593 times in 30 days. • Radio spots ran May 20 -June 6, 2019 on WAVY 101.1 FM weekly, 30 seconds long, twice a day. Prioritization addressed in 2.A section System for Consumer Targeting Prioritization. E 2.A 2020 CHS Target and Education Plan First Quarter January— March CHS will meet with local social service agencies to include: St. Vincent De Paul, Salvation Army, Guadalupe Center, David Lawrence Center, Catholic Charities of Venice, Senior Friendship Health Center. Participate on the Greater Naples Leadership Social Services Day. Second Quarter April —June CHS will meet with the local ministries to include: St. Elizabeth Seton Catholic Church, Guadalupe Center- Catholic Charities, Covenant Church, Stephen Ministries of the Naples United Church of Christ, Emmanuel Lutheran Church in Naples and the Immokalee Haitian Baptist Mission. Third Quarter July -Sept Participate in Collier Senior Expos, Medical Health Fairs, LCA Empowerment Lectures, Our Lady of Guadalupe Church Immokalee, Immokalee Haitian Free Methodist Church. Fourth Quarter October— Dec Alzheimer's Support Network monthly community presentation and staff meeting, Lighthouse of Collier, Harry Chapin Food Bank, Immokalee Interagency Meeting, Collier League of Women Voters, Goodlette Arms Senior Apartments. In addition to being known as a main source of resources and information in the community, CHS is responsible in educating the community and residents about the growing needs and available resources for seniors in Collier County. CHS informs the community regarding the large number of seniors who are on state wide waiting list to receive in home services. Other issues CHS educates the community during presentations the shortage of senior low income and affordable housing, transportation, food insecurity and lack of income to pay for medications. CHS' goal when we educate the community on senior issues are how the community can create solutions and make new partners rather than rely on only state and federal funding. 10 2.6 III E Services CHS maintains a strong focus on serving low income seniors and their caregivers in working with other dementia focused agencies particularly when the seniors are not able to afford respite services, i.e., Alzheimer's Support Network, the Collier County Sheriff's Office, and the Leadership Coalition on Aging. CHS can assist seniors and caregivers with emergency and non -emergency respite facility stays and have a vendor contract with Arden Courts of Lely Palms in the event a caregiver cannot care for their family member and/or needs to leave the senior alone and has no additional assistance; CHS can provide in home respite by any of the contracted in home vendors when the senior is unable to stay at a facility or the senior can attend CHS' newly contracted adult day care at Shifting Sands Adult Day Center when day respite is needed and the senior is mobile to travel. Also, funding assists seniors and their caregivers with material aid (shower chairs, commodes) specialized medical equipment (hospital beds, left chairs) and medical/nutritional supplies (diapers, Ensure) since these supplies are a great expense for our low-income seniors and the supplies are delivered directly to the seniors' homes. CHS partners with Collier County Parks & Recreation Division in assisting senior grandparents who are responsible for raising their grandchildren and paying for summer camp costs and afterschool programming. Since CHS is able to cover costs with an interdepartmental contract, the grandparents do not have to pay up front nor be reimbursed for costs incurred in caring for their grandchildren. CHS receive referrals from the Parks & Recreation Division, CCSO Youth Resource Center and the Grandparent Support groups. During 2018, CHS assisted 7 grandparents and 11 grandchildren with summer camp expenses. (See SPA Appendix T) 11 3. Service Delivery System and Coordination CHS presents quarterly in general informational meetings and staff meetings with the Alzheimer's Support Network (ASN) to assist seniors diagnosed with Dementia and their caregivers with support services that include facility respite, in home respite, adult day care and nutrition services. CHS can assist seniors and caregivers with emergency and non -emergency respite facility stays and have a vendor contract with Arden Courts of Lely Palms in the event a caregiver cannot care for their family member. The 2018 Targeting Report shows 18% of active clients having a diagnosis of dementia and 19% of seniors are waiting for services. (See SPA Appendix A) The ASN is the leading agency in Collier County assisting seniors with dementia and their family members with support, education and services. CHS assists their members who are not active with CHS with services of respite and applying for services through the Elder Helpline. CHS refers seniors to the Collier County Veterans' Services for exploration of VA benefits, material aid and in-home services. Many seniors living alone, 39% of our active seniors and 40% of seniors not enrolled, are targeted through the housing developments in Immokalee and in Naples. Outreach is made with contacting and meeting the residents and staff of three senior apartment residences: Bromelia Place, Summer Glen, Esperanza Place Apartments in Immokalee, FL and Goodlette Arms Apartments in Naples, FL; all the residents residing in the above complexes are on low income rental plans. In addition, referrals are made to the Agency and Disability Resource Center from the CHS office and the case management staff for additional information which includes SHINE for Medicare counseling, Home & Community based care, long term care with DCF -CARES, Health & Wellness, Dementia education/support and Elder Abuse. CHS assists seniors with securing transportation through the Collier Area Transit's Paratransit shuttle. This service enables Collier County seniors and adults with disabilities who are unable to take the fixed route public bus service due to physical health and/or medical issues. CHS assists seniors with the completion of the application and attaining a medical confirmation that the senior meets the criteria for this transportation service. (See SPA Appendix D) 12 Seniors make reservations and pay for each individual ride; this service is available door to door. Grant Funding to seniors enrolled in the OAA Grant may be eligible for this service with no cost to the senior. Since CHS -Services for Seniors is a division of Collier County government and a resource to the public, the Division receives on an average of 360 phone calls per month requesting information about senior services that include but not limited to Social Security, Medicare/Medicaid, housing, medical, transportation, etc. CHS provides seniors with a list of resources with specific information in relation to their inquiries of assistance. (See SPA Appendix E) 13 4. Eligibility and Assessment/Reassessment Process CHS requests Wait Listed Referrals from the AAASWFL and Initial assessments ae completed with the client and the case manager within fourteen (14) days. Six months later, a care plan review is completed with client, and the case manager initials page one pf the care plan. At this time, the care plan is reviewed, and updates are noted and at any time the senior and/or the family can request additional services or an increase in services. Whether it is an Initial Assessment or annual assessment, the case manager will discuss with the client if there have been any significant changes in the client's life with medical conditions, physical and/or mental health. Changes can include the physical and/or the mental health of the caregiver is there is one, or changes in the client's finances and housing. All assessments and updates are entered into CIRTS timely and efficiently as is evident when the CIRTS monthly reports are run for overdue assessments and sent monthly to AAASWFL with detailed explanations. When CHS receives referrals from outside agencies, direction is provided to call the AAASWFL Elder Helpline and the ADRC for additional services and assistance i.e., Medicare/Medicaid counseling, longterm cares program, caregiver support, training, exercise programs, dementia assessments. Depending on the senior's needs, CHS can provide respite, supplies, equipment when there is a caregiver involved with the senior through the OAA3E funding and home delivered meals through the OAA3C2 funding. CHS provides additional resources to seniors not enrolled with CHS with other agencies for medical referrals, mental health support, donations, senior centers, exercise, volunteering, and visiting companions. 14 5. Services a. Description of Service Delivery (17 Services) (See SPA Appendix F) b. Services CHS will offer directly: Case Management c. Services CHS will subcontract: Homemaking Personal Care Medical Transportation CHORE, Enhanced CHORE Supplies, Medical Equipment Home Delivered Meals, Congregate Meals Nutritional Counseling and Education d. Action plan to be followed for the selection of subcontractors: CHS works in partnership with the Collier County Procurement Services Division taking the lead in receiving new and existing subcontractor bids and the selection process. CHS develops the scope of the subcontract services required and all proposals are submitted online via the County Procurement Services Online Bidding System bidsync.com. Once a vendor is selected, the CHS Senior Grant Coordinator coordinates in partnership with the senior fiscal and program team, routine vendor partnership meetings to address performance measures, timely submitted invoices and to assist with needed corrective action. e. CHS Monitoring Unit samples vendor's employees Level 2 Background screening results during the annual vendor monitoring to ensure subcontractors' employees are background screened and fingerprinted and are cleared to work with CHS seniors. CHS -Services for Seniors program does not utilize volunteers currently in 15 assisting our program's function since case management is a specific, professionally trained service. Collier County would not be able to use volunteers for positions that are currently funded by Collier County. In the future, CHS would like utilize volunteers to provide a range of services to assist our seniors with shopping, companionship and the completion of household tasks. We would secure background checks, fingerprinting and personal liability. Our seniors do benefit from Volunteers that are utilized by other community program that CHS works with in serving our seniors which includes the Retired Senior Volunteer Program (RSVP) which is included in the CHS division. f. The CHS Grants' Compliance Unit (GCU) conducts on-site vendor services monitoring activities for vendors providing client services under the OAA grant funded activities. These annual monitoring activities are conducted in accordance with grantor agency regulations and forwarded to the grantor agency. GCU Programmatic staff conduct an on-site review of the vendor files, following the desk review and monitoring checklist, provided by the AAA. GCU fiscal staff also utilize the monitoring tool provided by the AAA to complete the fiscal review of sampled invoices. Once the monitoring visits are conducted, GCU staff complete the monitoring tools and prepare monitoring results letters, which are shared with each vendor and AAA. Should any vendor be identified as noncompliant, GCU prepares a corrective action plan, outlining required remedial steps to bring the vendor back into compliance. (See SPA Appendix G) g. Subcontract Monitoring Tool (See SPA Appendix G) 16 6. Process for Handling and Reporting Adverse Incidents, Consumer Complaints, and Grievances CHS has three separate Standard Operating Procedures for Reporting Adverse Incidents, Documenting and reporting Complaints, and the Grievance Procedure. (See SPA Appendix H) a. Adverse Incidents: The CHS policy and procedure states that each client served by CHS and the AAASWFL that has an incident in their home, will have an Incident Report completed and a copy is placed in the Client File and sent to AAA and the service provider. The service provider completes their agency form and CHS will complete an internal form before sending the entire incident packet to AAASWFL consistent with Chapter 415, F.S. and acceptable by the AAASWFL. The case manager will document the Incident on the CGS monthly Incident Log and the Manager will review and document that follow-up was completed and the plan to resolve the incident will be documented on the Incident Log and on the case narratives of the Client File. If there is any question as to what determines an Incident that should be documented, CHS will contact AAASWFL for guidance and determination. b. Consumer Complaints: CHS staff are required to document, report and address all complaints made to them by a client and/or a vendor. Case managers document all complaints on the monthly Complaint Log and every effort is made by the case manager and the manager to resolve the complaint. All follow-up will be documented on the log and in the case narratives in the Client File. c. Grievance Procedure: Each client served by CHS and the AAASWFL has the right and ability to grieve any decision made by the Lead Agency (CHS) regarding or affecting his/her services. During the initial Assessment and every annual assessment following, case managers review the Grievance Policy with the client and they are asked to sign the Services for Seniors Grievance Procedure and receive a copy of the signed form in addition to the form: Minimum Guidelines for recipient grievance procedures applicable to all adverse actions deemed terminations, suspensions or reduction in service. 17 7. Quality Assurance A. To ensure services provided to clients are satisfactory and provided with professionalism and care and in compliance to the service authorization between CHS and the contracted vendor, all services will be monitored for quality assurance by the CHS Case Manager, Senior Program Manager, Grant Coordinator and the CHS Monitoring Unit in accordance to the DOEA Manual. (See SPA Appendix 1) B. CHS as the lead case management agency in Collier County collaborates with the three other lead agencies in PSA 8 for the annual CCE and ADI vendor monitoring that includes seven (7) counties. All the CCE/ADI vendors provide OAA services. The Senior Nutrition Program is included in the Joint Monitoring and the lead agencies that provide senior nutrition collaborate on the monitoring of the food vendor; currently the other leads and CHS have the same food vendor. C. The quality assurance process results directly drive not only problem solving, but long-term improvement. Collier County has several Quality Improvement initiatives that include: 1. Ongoing Vendor Partnership Meetings for constructive feedback between CHS and the vendors. 2. Vendor solicitations included rate increases for in home services and respite facility stays. 3. Provide additional TA and support to vendor for program and fiscal guidance D. Annual Survey: Collier County has recently implemented a new Customer Satisfaction system and software system, Qualtrics, that collects the satisfaction survey data and sends quarterly data reports to each Manager for tracking rather than the annual surveys. Surveys are completed with all enrolled seniors during home visits and annual assessments. Nutrition clients who receive home delivered meals complete the survey during the annual 19 meal assessment and congregate meal clients complete the survey at the meal sites. E. Every CHS staff has a link to the Services for Seniors' Customer Satisfaction Survey that is printed on each County email. An annual review of the data/comments from the annual CHS Client Satisfaction Survey. Manager contacts clients who want to talk to a manager and receives feedback and assesses complaints and if with vendor, manager addresses the issues/comments directly with the vendors. F. Consumer Satisfaction: CHS takes great pride in the services that are delivered to our senior clients. Every effort is made to accommodate the client, caregiver and family when providing case management, in-home services, adult day care, facility respite and supplies/equipment. Every client complaint is documented on the Complaint Log and in the Client case narrative notes. Both the case manager and manager contact the client personally; the manager contacts the vendor and informs the vendor of the client dissatisfaction and if unable to resolve the issue, the case manager assigns another contracted vendor from the vendor rotation list if the client is unable to choose and to ensure client satisfaction. The Manager formally meets with the vendor who has not been able to accommodate/address the client complaint. (See SPA Appendix U) G. File reviews: CHS maintains an internal Client File Review quarterly and AAA completes a quarterly CHS file review as part of the CHS annual monitoring site visit. H. Internal controls: Collier Collier has implemented a department, Corporate Compliance and Internal Review in 2018. This division facilitates seamless, high-quality Internal Control services toward achieving quality services for each division's objectives in operations, reporting and compliance in the present and in the future, and includes grant compliance. 19 In Service Staff Training for case manager includes a minimum total of twenty-six (26) hours annually, exceeding the minimum six hours required by DOEA. The training is sponsored by Collier County University and the County's Risk Management Department. In addition, AASWFL provides the lead agencies annually with one full day of training for 7 hours and quarterly trainings at 4 hours each session. All training includes the minimum standard requirements that include: HIPAA, Aging Network, Record Keeping, APS Records, Community Care Services, CIRTS documentation, and Caregiver and Coordination Training. CHS attends a series of annual conferences which include the Florida Council on Aging, Southwest Florida, and the Leadership Coalition on Aging. (See SPA Appendix J) go 8. Goals, Objectives and Performance Measures (See SPA Appendix K) CHS is required to submit to AAASWFL a quarterly CIRTS Outcome Measures Reports that exhibits improvements, maintenance and no improvements when services are provided to the client and the caregiver. Every quarter, the CHS Manager and Case Managers review the Outcome Measures Report and strategize how to increase and maintain the client's performance scores with additional services and/or community resources. The Outcome Measures Reports that are reviewed include: 1. APS (Adult Protective Services) Referrals Receiving a Service Other Than Case Management Within 3 Days of the Referral Date 2. Environment Outcome Report 3. ADL Outcome Report (Activities of Daily Living) 4. IADL Outcome Report (Instrumental Activities of Daily Living) 5. Caregiver and Assessor Ability to Continue to Provide Care 21 9. Reporting CHS Case Managers are responsible for entering the 701B Assessment and the Nutrition Supervisor is responsible for the 701A and 701C assessments into CIRTS at the time the assessment is being completed with the client face to face. The 701B will reviewed in 6 months during the semi-annual assessment/ care plan review. At any time, all assessments can be updated due to any client and caregiver changes that would impact their service level. The Case Manager is responsible for entering the Care Plan and Enrollment data in CIRTS within 48 hours to ensure timely billing for case management hours and service units. CHS utilizes DOEA CIRTS reporting to maintain operations as the lead agency. CIRTS reporting provides CHS with the number of clients served and the amount of services that are being provided. Outcome Measures are vital in providing the data that displays the client's ranking and priority scores have decreased with the services in place and provided by CHS. CHS runs the following CIRTS reports monthly on the tenth (10th) of the following month, The following reports that are run monthly: Assessment Due, Incomplete Assessment, Assessment Inconsistencies, Outcome Measures, Current Active Clients by Program or Provider, and Priority Ranking for APCL Clients. CHS' Fiscal Department runs seven (7) additional reports listed in the Standard Operating Procedure: CIRTS Reporting. CHS adheres to the policies and procedures implemented by the AAASWFL to ensure timely and accurate reporting. (See SPA Appendix L) Corrections and exemptions are reviewed by the Manager with each Case Manager. NPA 10. Disaster Preparedness (See SPA Appendix M) Collier County CHS has three (3) Emergency Plans: a. Community & Human Services Emergency Response Plan: Outlines specific staff responsibilities within the CHS division in preparation of disaster. b. Collier County Case Management and Disaster Housing Plan: Outlines a broad collaborative casework and management approach needed in response through longterm recovery. c. The Collier County Emergency Action Plan: one is for Building H where CHS is located and the second is for the Collier County Risk Management Standard Operating Procedure: Outlines an Emergency Action Plan that will assist in the attainment of the Incident Objectives and is part of the Government Location emergency response plan. d. Collier County CHS maintain two staff lists that are imperative to the Division during a disaster when the Director would implement staff Assignments. CHS Emergency Coordinating Officers: Kristi Sonntag, CHS Division Director Louise Pelletier, Mgr., Sr. Programs & Social Services Maggie Lopez, CHS Accounting Supervisor Lisa Oien, Senior Grant Coordinator 1. CHS Staff Emergency Assignment Plan: Each staff person is listed with a Pre -Emergency, During Event, and Post -Emergency assignment coordinated by the Division Director. A written formal request is to be completed if any staff requests an exemption from Disaster assignments. The request is reviewed and approved by the Division Director and Human Resources. 2. Alert Collier: The new Collier County's Bureau of Emergency Services emergency notification system, a web -based system where all Collier 23 County employees register their contact information and disaster assignments. This system notifies employees and residents with system alerts for any threats and/or impending disasters that threaten the community's safety. Alerts include: severe weather, evacuations, power outages, boil water notices and missing persons. 3. CHS Staff Emergency Contact Information: CHS maintains an employee emergency list that is and updated monthly with their address, telephone and emergency contact. A. Alternate CHS Site During Disaster: Collier County CHS Office and staff will relocate to the Collier County Emergency Management Building, (EOC), 8075 Lely Cultural Parkway in Naples, FL. CHS maintain a formal seat at the Collier County Bureau of Emergency Services (BES) and is the central command center that has 46 departments and agencies represented during a disaster at the Center. Specific coordination is generated between agencies, the Emergency Information Phone Bank and the Special Needs Shelter/Registry. In addition, all agencies and departments that have a formal seat utilize the Continuity of Operations Plan (COOP) to enter contact information for all County vendors relating to emergencies. All designated disaster staff receive quarterly training in ow to update information and to communicate in the Collier County web -based software system, Web EOC, for the management of information related to a specific County wide disaster, 4. Contact & Coordination Efforts for Clients Coordination for Special Needs Clients: Collier County maintain a Special Needs Registry in collaboration with the State of Florida which is updated annually in the event of an incident and/or disaster. Collier County and the Collier County Health Department provides special medical sheltering and/or transportation to a special needs shelter for critical care patients who need supervision/medical attention and who cannot stay in a traditional shelter. z0 Annually, CHS case managers and staff discuss with senior clients and seniors at large whether they would like to register for a special needs shelter placement and/or renew their annual application. The CHS case manager and staff submit the applications to the Emergency Management for registration. In the event of an upcoming incident/disaster, the case manager contacts the senior to verify their shelter plans and if they need transportation to the shelter, so the best plan can be developed to assist the senior to stay in a safe environment. Pre -Disaster: Prior to the announcement and/or knowledge of a disaster, the senior case managers, the senior nutrition supervisor and the senior program manager are required to download the CHS enrollment list which contains their address, phone number and contact person information so that each client will be contacted personally by telephone and/or in person to confirm their specific disaster plans and what they will need assistance with if a Disaster occurs, i.e., medications, shelter registration, transportation, food. Depending on the demand and scope of senior clients' needs, the manager may have to enlist other CHS staff to assist with the seniors' pre -emergency needs. The manager notifies the subcontracted vendors who provide in home services when services will be placed on hold; dates are confirmed by the service modifications forms sent by email, to the vendor. The Senior Nutrition vendor will be notified to cease the delivery of hot congregate meals to the four meal sites and frozen home delivered meals to clients' homes. Manager will request shelf stable meals for the Clients who will remain in their home and in place during the disaster. During the Disaster Phase: CHS Coordinating Officers are present in 12 hour shifts at the EOC Building coordinating post -disaster plans and providing information and support to any person/senior who contacts the Emergency phone banks for assistance. CHS coordinates with the other 36 agencies to assisting seniors with, transportation, evacuation to 25 the special needs shelter, medications, delivery of oxygen tanks, generators, food supplies. Post Disaster Phase: Senior services' case managers, senior nutrition supervisor and the manager, will call or visit every enrolled senior that was staying in place during the Disaster. All client will receive a home visit to verify the senior is safe and the home is habitable and what the senior needs to stay in the home. If the senior and the home displays risk, relocation may occur. Vendors can be contacted to resume in home services and food delivery depending on the extent of the disaster damage. Other CHS staff will continue to interface and take shifts answering the Phone Bank and coordinating services, rescue and other issues related to disaster damage. 26 11. Client Confidentiality CHS ensures and maintains the responsibility of consumer information confidentiality by all employees, service providers as required by state and federal laws. CHS Manager meets with each employee in the CHS Division to provide an in- service training on the confidentiality of information for the senior clients that are served. Each employee is required to read and acknowledge the CHS Standard Operating Procedure on the Health Insurance Portability and Accountability Act (HIPAA), sign the Collier County CHS Policy on Confidentiality, read the Collier County CMA #5207 Sanctions for Failure to comply with HIPAA and complete the Personal Information/HIPAA training on the County's HR site, Collier University annually. (See SPA Appendix N) a. HIPAA CHS complies with all the requirements of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The State Department of Elder Affairs (DOEA) and CHS recognize that each is a Business Associate of the other under the terms of HIPAA. CHS agrees to the terms written in the Program and Services Contract. Recently. CHS maintains an encrypted email in Outlook and all client information is protected. Invoice and accounting information is sent to all subcontractors in an encrypted format where vendors have a one-time password to open the protected email. When communicating email information containing client information, the CIRTS Client ID# is the preferred identifier. (See SPA Appendix N) b. Social Security Number Disclosure CHS complies as a service provider with all the requirements of the Social Security number confidentiality and security measures as required by Section 119.07 (5) F.S. (See SPA Appendix O) c. E -Verify Requirements CHS as a provider complies with all the requirements pursuant to Executive Order Number 11-116 and applicable AAASWFL Instruction Memorandums (IM) related to the requirements to utilize the U.S. Department of Homeland Security's E -Verify system to verify the 27 employment of all new employees hired by CHS. Collier County Human Resources Division oversees the entire screening and new hire process with all new County employees. (See SPA Appendix P) d. Background Screening CHS complies with all requirements pursuant to Chapter 2010-114, Laws of Florida (L.O.F.), Sections 430.0402 and 435.01(2) Florida Statutes and applicable AAASWFL Instruction Memorandum (IM). Collier County's CMA 5390 details the process of Level II Background screening and Fingerprinting of potential employees. Fingerprint records are sent to the Florida Department of Law Enforcement (FDLE) for a state Florida background check and to the Federal Bureau of Investigation for the national background check. Once the results are received, these confirmations are sent to the DEOA. DEOA sends a confirmation clearance letter to Collier County confirming the employee is cleared to begin employment at CHS per direction of DOEA Programs and Services Handbook, Appendix E, Background Screening Clearinghouse Instructions (See SPA Appendix Q). Collier County Facilities Management verifies the receipt and monitors all future required fingerprint and Level II screenings and notifies Director and employee when fingerprint screening. All employees receive a 5 -year re -screen to ensure continued compliance. PW 12. Description of Service Delivery (See SPA Appendix F) Currently, CHS — Services for Seniors is the lead case management agency in Collier County. In addition to case management, CHS will offer the following services: • Homemaking which includes laundry, cleaning, shopping assistance, meal preparation • Personal Care which includes assistance with bathing, dressing and medical transportation • Respite (Facility Based) • Respite (In -Home) • Adult Day Care • Chore • Chore(Enhanced) • Emergency Alert Response • Material Aid • Specialized Medical Equipment and/or Service • Monthly Supplies (Incontinent supplies, nutritional supplements • Skilled Nursing CHS will directly provide the case management services, please see the Description of Service Form for each service the CHS will provide and will subcontract. CHS has subcontractor contracts with all vendors that are three-year contracts with (2) one-year renewals. CHS completed the process of developing a new subcontractor bid and selection process with the Collier County Procurement Services Division in 2018-19. CHS developed the scopes of the subcontract services required and all proposals were submitted online via the County Procurement Services Division Online Bidding System, bidsync.com. The CHS Grant Coordinator developed a selection committee from Collier County employees who work in other division as well as CHS staff. The selection committee scored and ranked the proposals based upon their responses to the Request for Proposal (RFP). Vendors were notified of their award with the agreed upon rates and payments. Final contracts were developed with each vendor and 29 vendor partnership meetings were set up to explain to the vendors their contracts, services rendered and the proper submission of invoices for payments. CHS's vendors who provide direct care are required to have employees/volunteers complete a level 2 background screening. During the annual vendor monitoring, CHS' Monitoring Unit verifies the documentation that the vendor's employees have completed their background screening. CHS as the lead agency in Collier County collaborates with three (3) lead agencies in the PSA 8 for the annual CCE/ADI vendor monitoring that includes seven (7) counties. The timeline for the vendor monitoring occurs from April through June and reports are submitted to AAA by June 301h of the same month. 30 11 A. Congregate and Home Delivered Nutrition Services 1. NUTRITION EDUCATION SCHEDULE The Nutrition Education Scheduled curriculum is planned by CHS's contracted Licensed Dietician/Nutritionist. The LD/N researches materials and develops a nutrition education plan for a 6 -month period, twice a year. The LD/N facilitates a Train the Trainer with nutrition program staff bi-annually. Documentation of the training includes the training sign in sheet, list of topics and materials to be distributed. Meal Site Coordinators facilitate Nutrition Education with clients on days with the highest reservation count to ensure maximum participation. Documentation of Nutrition Education for monitoring purposes includes date and length of the presentation, name and title of presenter, copies of the curriculum, number of persons in attendance, in addition to a sign in sheet. C2 clients receive a monthly mailing with Nutrition Education handout. Documentation of C2 Nutrition Education includes the current client mailing list, copies of the curriculum, date of the mailing and the staff responsible for the mailing. Participation in Nutrition Education is recorded in CIRTS monthly by client, as a unit of service. a. List and describe all OAA III C-1 Lesson Topics and scheduled dates (see SPA Appendix R) b. List and describe all OAA III C-2 Lesson Topics and scheduled dates Same Nutrition Education schedule and curriculum for C-2 lesson as C-1 (see SPA Appendix R) 2. NUTRITION COUNSELING Individuals found to be at high nutritional risk (scoring 5.5 or higher on the 701C) are given the opportunity to receive Nutrition Counseling. The goal being the client would improve his/her nutrition risk level. Qualifying clients will then sign a consent for nutritional counseling to authorize the referral to the contracted Licensed Registered Dietician (LD/N). The LD/N contacts the client to schedule 31 a face to face counseling session. For C1 clients, Nutrition Counseling takes place at the meal site or at the client's home. C2 clients receive this service in their homes. Case Managed clients of CHS Services for Seniors, who are not enrolled in C1 or C2 may also be referred for Nutritional Counseling. The LD/N will keep applicable written records that may include nutrition assessment, counseling plan, dietary orders, nutrition advice, progress notes and recommendations to the client. Documentation of counseling will be directed to CHS. Participation in Nutrition Counseling is recorded in CIRTS as a unit of service. 3. NUTRITION PROVIDER TRAINING AND CERTIFICATION Nutrition service providers shall ensure that training will be provided for both paid and volunteer staff. Training and certifications must be maintained in accordance with the standards of nutrition service provision as outlined in the DOEA Programs and Services Handbook and all applicable DOEA Notices of Instruction and AAASWFL Instruction Memorandum. a. All new nutrition staff and volunteers receive safe food handling training by a Certified Food Protection Manager. CHS has two Certified Food Protection Managers on staff to ensure proper procedures are being followed. See attachment II.A.14.c for Outline of Food safety Training. Documentation of training is evident by training sign -in sheet and copies of curriculum. In addition, annual food safety training is conducted by the LD/N for all nutrition staff. Food safety topics are included in the Train the Trainer for Nutritional Education. 32 4. NUTRITION PROVIDER MEAL SITE REVIEW a, The Nutrition Provider Compliance Review tool is completed 4 times a year (quarterly) at each congregate meal site to ensure compliance with food safety, food sanitation and service standards. CHS's Nutrition Program Supervisor maintains the NPCR monitoring schedule. The Nutrition Program Supervisor conducts the NPCR twice a year. The Licensed Dietician/Nutritionist and Case Manager Assistant conduct the NPCR once a year. The Nutrition Program Supervisor reviews each completed NPCR for completeness and immediately addresses any items that are out of compliance. NPCR's are forwarded to AAA after completion. NPCR's are also reviewed during CHS's Internal Controls. The Nutrition Provider Compliance Review tool is completed 4 times a year (quarterly) at each congregate meal site to ensure compliance with food safety, food sanitation and service standards. CHS's Nutrition Program Supervisor maintains the NPCR monitoring schedule. The Nutrition Program Supervisor conducts the NPCR twice a year. The Licensed Dietician/Nutritionist and Case Manager Assistant conduct the NPCR once a year. The Nutrition Program Supervisor reviews each completed NPCR for completeness and immediately addresses any items that are out of compliance. NPCR's are forwarded to AAA after completion. NPCR's are also reviewed during CHS's Internal Controls. 33 5. NUTRITION PROVIDER PUBLIC INFORMATION AND ADVISORY COUNCIL PLANS a. In the past, the Senior Nutrition Program has utilized newspaper, tv, flyers and brochures to advertise services. Staff also attends Interagency meetings, Advisory Councils and Senior Expos to inform the community of the Nutrition Program. Staff will continue to utilize these methods. In addition, we ensure that our services are posted on all related referral websites. b. Advisory Council meetings are held twice a year (June and December) at each congregate meal site. Meeting dates and times are posted in advance at each site. Documentation of these meetings include sign in sheets, agenda and meeting notes. The Nutrition Program Supervisor reviews meeting notes and addresses any concerns. Menu feedback and recommendations are forwarded to the food vendor for consideration. In addition, the annual client satisfaction survey data report is reviewed by the Nutrition Supervisor and the Manager; recommendations are made, and the Nutrition Supervisor contacts the client to understand resolve the dissatisfaction. 34 6. NUTRITION CONSULTATION AGREEMENT/NUTRITION ASSURANCES A. In accordance with Section 339(1) of the OAA which requires each nutrition project to be established and administered with the advice of dieticians (or individuals with comparable expertise), and Section 339(2)(F) which requires compliance with applicable state or local laws regarding safe and sanitary handling of food, equipment, and supplies used in the storage, preparation, service, and delivery of meals to elderly nutrition program participants. Janet Calderwood LD/N will provide Nutrition Consultation for the nutrition project of CHS. Janet Calderwood is a registered/licensed dietitian whose current registration and license numbers are: Commission on Dietetic Registration: 926084 Florida Department of Professional Regulation is ND4440. All nutrition providers funded through OAA must submit the following documents with their completed Service Provider Application Update: B. Nutrition Consultant Agreement for Services with defined responsibilities as outlined inthe DOEA Programs and Services Handbook which include but are not limited to: • Monitoring of Food Service, to ensure compliance with FAC Chapter 64E-11, Florida Administrative Code • Training Staff and volunteers in areas of nutrition, food service management and sanitation Assist in developing participant's satisfaction surveys 35 C. Nutrition Consultant Contact Information (address, e-mail, and phone number): Janet Calderwood : 0 REFr Bonita Springs, FL 34135 janetcalderwood@yahoo.com (239)248-6191 CHS assures that the meals provided through the project comply with the Dietary Guidelines for Americans and all applicable DOEA nutrition requirements. All meals must comply with the Dietary Guidelines for Americans and provide a minimum of 33 1/3 percent of Dietary Reference Intake/Adequate Intake (DAI/AI) for a moderately active age 70+ female, as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences. D. Holiday closing schedule - The State of Florida recognizes the holidays listed below for employees. Nutrition Program Service Providers must receive prior written authorization from the AAASWFL for any additional planned closing dates. Also, providers must ensure that planned holiday closings do not result in the closure of a congregate meal site for more than four (4) consecutive days, including weekend days. o New Year's Day o Martin Luther King, Jr. Day o Memorial Day o Independence Day o Labor Day o Veterans Day o Thanksgiving Day o Friday after Thanksgiving o Christmas Day 36 E. To accommodate clients during holiday closures, shelf stable meals may be offered when available through the contracted food vendor. Clients are also referred to other community food resources. Clients are made aware of meal site closures in advance and closures are noted on the monthly menu posted at each site. In the event of a disaster with unexpected closures, CHS has a disaster plan policy in place. (See SPA Appendix M) 37 FLORIDA Di RTMENT OF ELDER AFFAIRS SIMPLIFIED UNIT COST METHODOLOGY 11.6.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources) BUDGET YEAR: January 1, 2020 - December 31, 2020 RECIPIENT NAME: Collier County % Increased by: 3% ,�Y }-1 � '^ -r � '' ss '� r- s Y .. Xl' 3e. % '`"".' 'x.»r�:,. +fi•' '�i.N��`-.r, .. `r.') w� a �'..�s� ,r��,„�,r' xl n` 5'^J � �.�,,•:. :�� S �,y ,xz.a _ 'a ` y _.r�� ..�� "� �- � �;:,,x :x..a ,• ."T ��' s 1 N �3� ;x -� ��--: >h .s Yy t%.( �,"". z; OTHER i.,'.,s,.. � -: ����, �.. Aquino Luque, Blanca Senior Accountant 86,231.00 2,586.93 88,817.93 2,080.0 88.0 96.0 120.0 16.0 1,760.0 -STAFF POSII�ION DESGRIPTIpN 68,826.00 2,064.78 70,890.78 �iOURS��,110URS 88.0 LEA. E LFAd/E 16.0 1,760.0 ��.�. � � � � � < ,lI�A�E� ; .�.INCREA`S � B�E1pOET 2,080.0 88.0 96.0 160.0 TIME t ��OUR��. Aguilar, Hilda Parks & Recreation Assistant 18,b42.14 bb6.26 19,091JAU 1,300.0 - - - - 1,300.0 Aquino Luque, Blanca Senior Accountant 86,231.00 2,586.93 88,817.93 2,080.0 88.0 96.0 120.0 16.0 1,760.0 Blanco, Lori Case Manager 68,826.00 2,064.78 70,890.78 2,080.0 88.0 96.0 120.0 16.0 1,760.0 Bronson, Carlton Case Manager 82,836.00 2,485.08 85,321.08 2,080.0 88.0 96.0 160.0 16.0 1,720.0 Carrillo Aparicio, Dora Accountant 91,224.00 2,736.72 93,960.72 2,080.0 88.0 96.0 160.0 16.0 1,720.0 Castorena, Margo Operations Analyst 114,176.00 3,425.28 117,601.28 2,080.0 88.0 96.0 160.0 16.0 1,720.0 Chouinard, Marco Case Manager 77,040.00 2,311.20 79,351.20 2,080.0 88.0 96.0 160.0 16.0 1,720.0 Chronis, Sharon Grants Support Specialist 51,836.08 1,555.08 53,391.16 2,080.0 88.0 96.0 80.0 16.0 1,800.0 Diaz, Ana Accounting Technician 75,274.00 2,258.22 77,532.22 2,080.0 88.0 96.0 160.0 16.0 1,720.0 Evans, Bonnie Case Manager Assistant 54,606.34 1,638.19 56,244.53 2,080.0 88.0 96.0 80.0 16.0 1,800.0 Garcia, Ivonne _ Case Manager 78,850.00 2,365.50 81,215.50 2,080.0 88.0 96.0 120.0 16.0 1,760.0 Vacant Parks & Recreation Assistant 18,542.14 556.26 19,098.40 1,300.0 - - - - 1,300.0 Hernandez, Elizabeth Operations Analyst 76,595.00 2,297.85 78,892.85 2,080.0 88.0 96.0 120.0 16.0 1,760.0 Jeanlys, Nouchely Parks & Recreation Assistant 14,834.10 445.02 15,279.13 1,040.0 - - - 1,040.0 Kemner, Cynthia Grants Compliance Supervisor 98,773.80 2,963.21 101,737.01 2,080.0 88.0 96.0 120.0 16.0 1,760.0 Klopf, Wendy Grants Coordinator 91,610.00 2,748.30 94,358.30 2,080.0 88.0 96.0 160.0 16.0 1,720.0 Lopez, Maggie Accounting Supervisor 102,344.36 3,070.33 105,414.69 2,080.0 88.0 96.0 120.0 16.0 1,760.0 Maxon, Debbie Case Manager 99,257.00 2,977.71 102,234.71 2,080.0 88.0 96.0 200.0 16.0 1,680.0 Mesa, Nancy Senior Accountant 97,448.00 2,923.44 100,371.44 2,080.0 88.0 96.0 160.0 16.0 1,720.0 Mordaunt, Danielle Food Programs Supervisor 78,863.48 2,365.90 81,229.38 2,080.0 88.0 96.0 120.0 16.0 1,760.0 Pelletier, Louise Senior Program and Social Service 97,194.34 2,915.83 100,110.17 2,080.0 88.0 96.0 160.0 16.0 1,720.0 Rubbo, Michelle Operations Coordinator 62,122.92 1,863.69 63,986.61 2,080.0 88,0 96.0 120.0 16.0 1,760.0 Silva, Anita Parks & Recreation Assistant 41,906.00 1,257.18 43,163.18 2,080.0 88.0 96.0 120.0 16.0 1,760.0 Sonntag, Kristi Division Director 129,438.00 3,883.14 133,321.14 2,080.0 88.0 96.0 160.0 16.0 1,720.0 Suter, Glenda Parks & Recreation Assistant 17,058.63 511.76 17,570.39 1,196.0 - - - - 1,196.0 48,516.0 1,848.0 2,016.0 2,880.0 336.0 TOTAL WAGES 1,825,429.33 54,762.88 1,880,192.21 PERCENTAGE OF WAGES 100.0% TOTAL HOURS 41,436.00 PERCENTAGE OF HOURS 1 100.0% Appendix Vlb - Unit Cost Methodlogy Worksheet.xls (II.B.1. Personnel Allocations) Page 1 of 6 6/26/2019, 2:25 PM FLORIDA Dl ,RTMENT OF ELDER AFFAIRS SIMPLIFIED UNIT COST METHODOLOGY II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources) BUDGET YEAR: January 1, 2020 - December 31, 2020 RECIPIENT NAME: Collier County % Increased by: 3°% Case Management Col r : F CURl2EN7 Aguilar, Hilda Parks & Recreation Assistant 18,542.14 556.26 19,098.40 Aquino Luque, Blanca Senior Accountant 86,231.00 2,586.93 88,817.93 Blanco, Lori Case Manager 68,826.00 2,064.78 70,890.78 Bronson, Carlton Case Manager 82,836.00 2,485.08 85,321.08 Carrillo Aparicio, Dora Accountant 91,224.00 2,736.72 93,960.72 Castorena, Margo Operations Analyst FRO T'), 'PROPOSED % OF Chouinard, Marco Case Manager % OF 2,311.20 WAGE % OF Grants Support Specialist 51,836.08 1,555.08 53,391.16 , Accounting Technician 75,274.00 2,258.22 77,532.22 Evans, Bonnie Case Manager Assistant 54,606.34 STAFF POS#TION, ES RIP710N WAGE )Ni AAS BiIDGES TIME HR/UNIT WAGE COST TIME HR/UNIT COST TIME r y Operations Analyst 76,595.00 2,297.85 78,892.85 Jeanlys, Nouchely Parks & Recreation Assistant 14,834.10 445.02 15,279.13 Kemner, Cynthia Grants Compliance Supervisor Aguilar, Hilda Parks & Recreation Assistant 18,542.14 556.26 19,098.40 Aquino Luque, Blanca Senior Accountant 86,231.00 2,586.93 88,817.93 Blanco, Lori Case Manager 68,826.00 2,064.78 70,890.78 Bronson, Carlton Case Manager 82,836.00 2,485.08 85,321.08 Carrillo Aparicio, Dora Accountant 91,224.00 2,736.72 93,960.72 Castorena, Margo Operations Analyst 114,176.00 3,425.28 117,601.28 Chouinard, Marco Case Manager 77,040.00 2,311.20 79,351.20 Chronis, Sharon Grants Support Specialist 51,836.08 1,555.08 53,391.16 Diaz, Ana Accounting Technician 75,274.00 2,258.22 77,532.22 Evans, Bonnie Case Manager Assistant 54,606.34 1,638.19 56,244.53 Garcia, Ivonne Case Manager 78,850.00 2,365.50 81,215.50 Vacant Parks & Recreation Assistant 18,542.14 556.26 19,098.40 Hernandez, Elizabeth Operations Analyst 76,595.00 2,297.85 78,892.85 Jeanlys, Nouchely Parks & Recreation Assistant 14,834.10 445.02 15,279.13 Kemner, Cynthia Grants Compliance Supervisor 98,773.80 2,963.21 101,737.01 Klopf, Wendy Grants Coordinator 91,610.00 2,748.30 94,358.30 Lopez, Maggie Accounting Supervisor 102,344.36 3,070.33 105,414.69 Maxon, Debbie Case Manager 99,257.00 2,977.71 102,234.71 Mesa, Nancy Senior Accountant 97,448.00 2,923.44 100,371.44 Mordaunt, Danielle Food Programs Supervisor 78,863.48 2,365.90 81,229.38 Pelletier, Louise Senior Program and Social Service 97,194.34 2,915.83 100,110.17 Rubbo, Michelle Operations Coordinator 62,122.92 1,863.69 63,986.61 Silva, Anita Parks & Recreation Assistant 41,906.00 1,257.18 43,163.18 Sonntag, Kristi Division Director 129,438.00 3,883.14 133,321.14 Suter, Glenda Parks & Recreation Assistant 17,058.63 511.76 17,570.39 TOTAL WAGES PERCENTAGE OF WAGES TOTAL HOURS PERCENTAGE OF HOURS 1,825,429.33 54,762.88 1,880,192.21 0.00% 30.00% 0.00% 0.00% 100.00% 5.79% 0.00% 95.60% 6.63% 0.00% 0.00% 0.00% 0.50% 0.00% 25.00% 100.00% 25.00% 0.00% 0.71% 0.00% 68.06% 0.14% 0.00% 25.00% 0.00% 528.0 1,720.0 99.6 1,720.7 114.0 8.8 440.0 1,720.0 440.0 12.3 1,17.0.6 2.4 430.0 8,406.5 20.3% 26,645.38 93,960.72 6,809.11 51, 039.28 5,140.39 394.46 25,434.25 94,358.30 26,353.67 715.65 68,134.98 88.94 33,330.29 432,405.43 0.00% 0.00% 0.00% 99.03% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 99.63% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 98.75% 0.00% 0.00% 0.74% 0.00% 0.00% 0.00% 0.00% 1,703.3 84,493.47 1,753.5 80,915.00 1,659.0 100, 956.78 12.7 740.82 5,128.5 12.4% 267,106.06 95.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 5.00% 0.00% 92.97% 0.00% 98.92% 0.00% 0.00% 0.00% 0.00% 0.00% 51.00% 1.27% 0.00% 95.85% 0.00% 99.59% Appendix Vlb - Unit Cost Methodlogy Worksheet.xls (11.6.1. Personnel Allocations ) Page 2 of 6 6/26/2019, 2:25 PM FLORIDA D( RTMENT OF ELDER AFFAIRS SIMPLIFIED UNIT COST METHODOLOGY II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources) BUDGET YEAR: January 1, 2020 - December 31, 2020 RECIPIENT NAME: Collier County % Increased by: Meals C1 WAGE HR/UNIT I COST Aguilar, Hilda Parks & Recreation Assistant 18,542.14 556.26 19,098.40 1,235.0 18,143.48 Aquino Luque, Blanca Senior Accountant 86,231.00 2,586.93 88,817.93 - - Blanco, Lori Case Manager 68,826.00 2,064.78 70,890.78 - - Bronson, Carlton Case Manager 82,836.00 2,485.08 85,321.08 - - Carrillo Aparicio, Dora Accountant 91,224.00 2,736.72 93,960.72 - - Castorena,Margo Operations Analyst 114,176.00 3,425.28 117,601.28 - - Chouinard, Marco Case Manager 77,040.00 2,311.20 79,351.20 - - Chronis, Sharon Grants Support Specialist 51,836.08 1,555.08 53,391.16 - - Diaz, Ana Accounting Technician 75,274.00 2,258.22 77,532.22 - - Evans, Bonnie Case Manager Assistant 54,606,34 1,638.19 56,244.53 90.0 2,812.23 Garcia, Ivonne Case Manager 78,850.00 2,365.50 81,215.50 - - Vacant Parks & Recreation Assistant 18,542.14 556.26 19,098.40 1,208.6 17,755.79 Hernandez, Elizabeth Operations Analyst 76,595.00 2,297.85 78,892.85 - - Jeanlys, Nouchely Parks & Recreation Assistant 14,834.10 445.02 15,279.13 1,028.8 15,114.11 Kemner, Cynthia Grants Compliance Supervisor 98,773.80 2,963.21 101,737.01 - - Klopf, Wendy Grants Coordinator 91,610.00 2,748.30 94,358.30 - - Lopez, Maggie Accounting Supervisor 102,344.36 3,070.33 105,414.69 - - Maxon, Debbie Case Manager 99,257.00 2,977.71 102,234.71 - - Mesa, Nancy Senior Accountant 97,448.00 2,923.44 100,371.44 - - Mordaunt, Danielle Food Programs Supervisor 78,863.48 2,365.90 81,229.38 897.6 41,426.99 Pelletier, Louise Senior Program and Social Service 97,194.34 2,915.83 100,110.17 21.8 1,271.40 Rubbo, Michelle Operations Coordinator 62,122.92 1,863.69 63,986.61 - - Silva, Anita Parks & Recreation Assistant 41,906.00 1,257.18 43,163.18 1,687.0 41,371.91 Sonntag, Kristi Division Director 129,438.00 3,883.14 133,321.14 - - Suter, Glenda Parks & Recreation Assistant 17,058.63 511.76 17,570.39 1,191.1 17,498.35 TOTAL WAGES 1,825,429.33 54,762.88 1,880,192.21 155,394.25 PERCENTAGE OF WAGES 100.0% 8.3% TOTAL HOURS 7,359.9 PERCENTAGE OF HOURS 17.8% Appendix Vlb - Unit Cost Methodlogy Worksheet.xis (11.6.1. Personnel Allocations ) Page 3 of 6 6/2612019,2:25 PM FLORIDA D( RTMENT OF ELDER AFFAIRS SIMPLIFIED UNIT COST METHODOLOGY 11.6.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources) BUDGET YEAR: January 1, 2020 - December 31, 2020 RECIPIENT NAME: Collier County % Increased by: (12) (26) Appendix Vlb - Unit Cost Methodlogy Worksheet.xls (11.6.1. Personnel Allocations ) Page 4 of 6 6/26/2019, 2:25 PM 3% Congregate Meals (Screening) C1 Home Delivered Meals C2 " 4 ` CURRENT Pt2flPOS�D PROPOS�D % OF WAGE % OF WAGE STAFF 1?OStTfONDC�t1P?IQN_ 1/AC�Ik3SEa. Bl1GET = w TIME HR/UNIT COST TIME HR/UNIT COST Aguilar, Hilda Parks & Recreation Assistant 18,542.14 556.26 19,098.40 4.50% 58.5 859.43 0.00% - - AquinoLuque,Blanca Senior Accountant 86,231.00 2,586.93 88,817.93 0.00% - - 0.00% - - Blanco, Lori Case Manager 68,826.00 2,064.78 70,890.78 0.00% - - 0.00% - - Bronson, Carlton Case Manager 82,836.00 2,485.08 85,321.08 0.00% - - 0.00% - - Carrillo Aparicio, Dora Accountant 91,224.00 2,736.72 93,960.72 0.00% - - 0.00% - - Castorena,Margo Operations Analyst 114,176.00 3,425.28 117,601.28 0.00% - - 0.00% - - Chouinard, Marco Case Manager 77,040.00 2,311.20 79,351.20 0.00% - - 0.00% - - Chronis, Sharon Grants Support Specialist 51,836.08 1,555.08 53,391.16 0.00% - - 0.00% - - Diaz, Ana Accounting Technician 75,274.00 2,258.22 77,532.22 0.00% - - 0.00% - - Evans,Bonnie Case Manager Assistant 54,606.34 1,638.19 56,244.53 1.15% 20.7 646.81 80.00% 1,440.0 44,995.62 Garcia, Ivonne Case Manager 78,850.00 2,365.50 81,215.50 0.00% - - 0.00% - - Vacant Parks & Recreation Assistant 18,542.14 556.26 19,098.40 6.50% 84.5 1,241.40 0.00% - - Hernandez, Elizabeth Operations Analyst 76,595.00 2,297.85 78,892.85 0.00% - - 0.00% - - Jeanlys, Nouchely Parks & Recreation Assistant 14,834.10 445.02 15,279.13 0.00% - - 0.00% - - Kemner, Cynthia Grants Compliance Supervisor 98,773.80 2,963.21 101,737.01 0.00% - - 0.00% - - Klopf, Wendy Grants Coordinator 91,610.00 2,748.30 94,358.30 0.00% - - 0.00% - - Lopez, Maggie Accounting Supervisor 102,344.36 3,070.33 105,414.69 0.00% - - 0.00% - - Maxon, Debbie Case Manager 99,257.00 2,977.71 102,234.71 0.00% - - 0.00% - - Mesa, Nancy Senior Accountant 97,448.00 2,923.44 100,371.44 0.00% - - 0.00% - - Mordaunt, Danielle Food Programs Supervisor 78,863.48 2,365.90 81,229.38 3.85% 67.8 3,127.33 41.73% 734.4 33,897.02 Pelletier, Louise Senior Program and Social Service 97,194.34 2,915.83 100,110.17 0.00% - - 1.07% 18.4 1,071.18 Rubbo, Michelle Operations Coordinator 62,122.92 1,863.69 63,986.61 0.00% - - 0.00% - - Silva, Anita Parks & Recreation Assistant 41,906.00 1,257.18 43,163.18 4.15% 73.0 1,791.27 0.00% - - Sonntag, Kristi Division Director 129,438.00 3,883.14 133,321.14 0.00% - - 0.00% - - Suter, Glenda Parks & Recreation Assistant 17,058.63 511.76 17,570.39 0.00% - - 0.00% - - TOTAL WAGES 1,825,429.33 54,762.88 1,880,192.21 7,666.24 79,963.83 PERCENTAGE OF WAGES 100.0% 0.4% 4.3% TOTAL HOURS 304.5 2,192.9 PERCENTAGE OF HOURS 0.7% 5.3% Appendix Vlb - Unit Cost Methodlogy Worksheet.xls (11.6.1. Personnel Allocations ) Page 4 of 6 6/26/2019, 2:25 PM FLORIDA Di RTMENT OF ELDER AFFAIRS SIMPLIFIED UNIT COST METHODOLOGY II.8.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources) BUDGET YEAR: January 1, 2020 - December 31, 2020 RECIPIENT NAME: Collier County % Increased by: 3% Nutrition Education Outreach Screening/Assessr Aguilar, Hilda F'arKS & Kecreatlon Assistant 16,042.14 00b.2b 19,UUb.4U Aquino Luque, Blanca Senior Accountant 86,231.00 2,586.93 88,817.93 Blanco, Lori Case Manager 68,826.00 2,064.78 70,890.78 Bronson, Carlton Case Manager 82,836.00 2,485.08 85,321.08 Carrillo Aparicio, Dora Accountant 91,224.00 2,736.72 93,960.72 Castorena, Margo Operations Analyst 114,176.00 3,425.28 117,601.28 PROPOSED Case Manager 77,040.00 2,311.20 79,351.20 Chronis, Sharon Grants Support Specialist 51,836.08 1,555.08 53,391.16', Diaz, Ana 6URREN f PftOPOSEb 2,258.22 % OF Evans, Bonnie WAGE % OF 1,638.19 WAGE % OF Case Manager STAFF Pfi81T10NDS RIPTION AGES r INC EASES BUD ET TIME HR/UNIT COST TIME HR/UNIT COST TIME HR/UNIT � ., w.� 14,834.10 _.?? �. , Kemner, Cynthia Grants Compliance Supervisor 98,773.80 2,963.21 101,737.01 Klopf, Wendy Grants Coordinator 91,610.00 Aguilar, Hilda F'arKS & Kecreatlon Assistant 16,042.14 00b.2b 19,UUb.4U Aquino Luque, Blanca Senior Accountant 86,231.00 2,586.93 88,817.93 Blanco, Lori Case Manager 68,826.00 2,064.78 70,890.78 Bronson, Carlton Case Manager 82,836.00 2,485.08 85,321.08 Carrillo Aparicio, Dora Accountant 91,224.00 2,736.72 93,960.72 Castorena, Margo Operations Analyst 114,176.00 3,425.28 117,601.28 Chouinard, Marco Case Manager 77,040.00 2,311.20 79,351.20 Chronis, Sharon Grants Support Specialist 51,836.08 1,555.08 53,391.16', Diaz, Ana Accounting Technician 75,274.00 2,258.22 77,532.22 Evans, Bonnie Case Manager Assistant 54,606.34 1,638.19 56,244.53 Garcia, Ivonne Case Manager 78,850.00 2,365.50 81,215.50', Vacant Parks & Recreation Assistant 18,542.14 556.26 19,098.40 Hernandez, Elizabeth Operations Analyst 76,595.00 2,297.85 78,892.85 Jeanlys, Nouchely Parks & Recreation Assistant 14,834.10 445.02 15,279.13 Kemner, Cynthia Grants Compliance Supervisor 98,773.80 2,963.21 101,737.01 Klopf, Wendy Grants Coordinator 91,610.00 2,748.30 94,358.30 Lopez, Maggie Accounting Supervisor 102,344.36 3,070.33 105,414.69 Maxon, Debbie Case Manager 99,257.00 2,977.71 102,234.71 Mesa, Nancy Senior Accountant 97,448.00 2,923.44 100,371.44 Mordaunt, Danielle Food Programs Supervisor 78,863.48 2,365.90 81,229.38 Pelletier, Louise Senior Program and Social Service 97,194.34 2,915.83 100,110.17 Rubbo, Michelle Operations Coordinator 62,122.92 1,863.69 63,986.61 Silva, Anita Parks & Recreation Assistant 41,906.00 1,257.18 43,163.18 Sonntag, Kristi Division Director 129,438.00 3,883.14 133,321.14 Suter, Glenda Parks & Recreation Assistant 17,058.63 511.76 17,570.39 TOTAL WAGES 1,825,429.33 54,762.88 1,880,192.21 PERCENTAGE OF WAGES 100.0% TOTAL HOURS PERCENTAGE OF HOURS Appendix Vlb - Unit Cost Methodlogy Worksheet.xls (II.B.1. Personnel Allocations) Page 5 of 6 U.bu ro 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.62% 0.00% 0.53% 0.00% 1.08% 0.00% 0.00% 0.00% 0.00% 0.00% 1.55% 0.00% 0.00% 0.00% 0.00% 0.41% 27.3 'Jb.49 351.13 101.70 164.53 1,259.06 4.9 71.69 68.0 0.2% 2,043.59 0.1% u.0u ro 0.00% 10.49% 0.00% 0.00% 0.00% 0.66% 0.00% 0.00% 0,00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.29% 0.00% 0.00% 0.00% 0.00% 184.6 11.4 5.0 201.0 0.5% 7,436.44 523.72 290.32 8,250.48 0.4% u.u0 ro 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 13.23% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.09% 0.00% 1.87% 0.00% 0.00% 0.00% 0.00% 0.00% 238.1 143.10'1 272.6 0.7% 6/26/2019,2:25 PM FLORIDA D� RTMENT OF ELDER AFFAIRS SIMPLIFIED UNIT COST METHODOLOGY 11.6.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources) BUDGET YEAR: January 1, 2020 - December 31, 2020 RECIPIENT NAME: Collier County % Increased Aguilar, Hilda Parks & Recreation Assistant 18,542.14 556.26 19,098.40 Aquino Luque, Blanca Senior Accountant 86,231.00 2,586.93 88,817.93 Blanco, Lori Case Manager 68,826.00 2,064.78 70,890.78 Bronson, Carlton Case Manager 82,836.00 2,485.08 85,321.08 Carrillo Aparicio, Dora Accountant 91,224.00 2,736.72 93,960.72 Castorena, Margo Operations Analyst 114,176.00 3,425.28 117,601.28 Chouinard, Marco Case Manager 77,040.00 2,311.20 79,351.20 Chronis, Sharon Grants Support Specialist 51,836.08 1,555.08 53,391.16 Diaz, Ana Accounting Technician 75,274.00 2,258.22 77,532.22 Evans, Bonnie Case Manager Assistant 54,606.34 1,638.19 56,244.53 Garcia, Ivonne Case Manager 78,850.00 2,365.50 81,215.50 Vacant Parks & Recreation Assistant 18,542.14 556.26 19,098.40 Hernandez, Elizabeth Operations Analyst 76,595.00 2,297.85 78,892.85 Jeanlys, Nouchely Parks & Recreation Assistant 14,834.10 445.02 15,279.13 Kemner, Cynthia Grants Compliance Supervisor 98,773.80 2,963.21 101,737.01 Klopf, Wendy Grants Coordinator 91,610.00 2,748.30 94,358.30 Lopez, Maggie Accounting Supervisor 102,344.36 3,070.33 105,414.69 Maxon, Debbie Case Manager 99,257.00 2,977.71 102,234.71 Mesa, Nancy Senior Accountant 97,448.00 2,923.44 100,371.44 Mordaunt, Danielle Food Programs Supervisor 78,863.48 2,365.90 81,229.38 Pelletier, Louise Senior Program and Social Service 97,194.34 2,915.83 100,110.17 Rubbo, Michelle Operations Coordinator 62,122.92 1,863.69 63,986.61 Silva, Anita Parks & Recreation Assistant 41,906.00 1,257.18 43,163.18 Sonntag, Kristi Division Director 129,438.00 3,883.14 133,321.14 Suter, Glenda Parks & Recreation Assistant 17,058.63 511.76 17,570.39 TOTAL WAGES PERCENTAGE OF WAGES TOTAL HOURS PERCENTAGE OF HOURS 1,825,429.33 54,762.88 1,880,192.21 100.0% Appendix Vlb - Unit Cost Methodlogy Worksheet.xls (11.8.1. Personnel Allocations ) Page 6 of 6 C2 I Screening/Assessment WAGE I % OF COST TIME 7,440.59 96.10 1,518.99 9,055.68 0.5% 0.00% 0.00% 0.68% 0.00% 0,00% 0.00% 0.00% 0.00% 0.00% 0.37% 0.00% 0.00% 0,00% 0.00% 0.00% 0.00% 0.60% 0.00% 0.00% 0.22% 0.00% 0.00% 0.00% 0.00% H R/UNIT WAGE COST 580.18 300.50 613.41 220.24 1,714.33 0.1% Non-DOEA Services & Activities % OF TIME HR/UNIT WAGE COST 0.00% - - 70.00% 1,232.0 62,173.44 89.51% 1,575.4 63,454.46 0.29% 4.9 244.84 0.00% - - 94.21% 1,620.4 110,792.17 99.34% 1,708.7 78,828.03 4.40% 79.3 2,351.83 93.37% 1,606.0 72,391.59 0.00% - - 0.00% 0.00% - - 99.50% 1,751.2 78,498.39 0.00% - - 75.00% 1,320.0 76,302.76 0.00% - - 75.00% 1,320.0 79,061.02 0.55% 9.3 567.39 99.29% 1,707.7 99,655.69 0.00% - - 28.35% 487.6 28,381.82 99.86% 1,757.6 63,898.04 0.00% - - 75.00% 1,290.0 99,990.86 0.00% 916,592.33 48.7% 32.1 I 17,470.1 0.1% 42.2% 6/26/2019, 2:25 PM FLORIDA DEPA1, ENT OF ELDER AFFAIRS SIMPLIFIED UNI- COST METHODOLOGY 11.8.2. UNIT COST WORKSHEET (All Funding Sources) BUDGET YEAR: January 1,2020- December 31, 2020 RECIPIENT NAME: Collier County (Service Reference) (1) (6) (7) (e) 1101 1111 (12) 1171 vvagus Fringe Travel Education/Training Communications & Postage Utilities Printing & Supplies Advertising Insurance Maintenance & Repair Space Costs Equipment Program Supplies Depreciation Food & Food Supplies Other In -Kind Services In -Kind Supplies I, I vv,JVv.Uo „PngrYear Propgsed'., >,,..,z*w 0.0% 0.00 0.00 0.0% 0.00 1,551.00 1.0% Congregate Emergency 1.0°% 3,173.99 4,921.50 1.0% Management& Adult Day Care 1.0% Child Day Care Chore Crisis Congregate Meals Alert "� `''" "' �'x 6,290.63 1.0% BueTTOY;1Yjs General Cost Pool 1.0% Management y 1.0% 4,748.06 Meals C1 1.0°% 252.50 12,803.64 Gosfs ?018' Decrease 688,254.13 12.3°% . 773,229.09 136,520.61 10.6% 151,054.79 188,459.16 11.9% (Screening) C1 Response 56.1% 59,250.00 289,37383 8.8% 314,863.62 21,564,18 19.9% 23,692.25 207,049,46 11.0°% 229,743.54 3,341.35 11.0% vvagus Fringe Travel Education/Training Communications & Postage Utilities Printing & Supplies Advertising Insurance Maintenance & Repair Space Costs Equipment Program Supplies Depreciation Food & Food Supplies Other In -Kind Services In -Kind Supplies I, I vv,JVv.Uo U.0I%0 1,000, 1 V4.4I 0.00 0.0% 0.00 0.00 0.0% 0.00 1,551.00 1.0% 1,566.51 3,142.56 1.0°% 3,173.99 4,921.50 1.0% 4,970.72 12,848.69 1.0% 12,977.18 1.0% 0.00 2,275.00 1.0% 2,297.75 6,290.63 1.0% 6,353.54 20,607.60 1.0% 20,813.68 4,701.05 1.0% 4,748.06 250.00 1.0°% 252.50 12,803.64 9.7% 14,040.00 688,254.13 12.3°% . 773,229.09 136,520.61 10.6% 151,054.79 188,459.16 11.9% 210,937.86 37,950.00 56.1% 59,250.00 289,37383 8.8% 314,863.62 21,564,18 19.9% 23,692.25 207,049,46 11.0°% 229,743.54 3,341.35 11.0% 3,374.76 - 0.0% 30,550.00 156,482.70 11,0% 158,047.53 65245.94 11.1% - 72,490.25 0.00 0.0% 2,308.70 26,321.78 1.0% 26,585.00 0.00 0.0% 0.00 4,019.83 3.0% 4,140.42 16,050.00 0.0% 16,050.00 131,689.23 32.0% 173,808.66 34,243.13 55.5°% 53,248.34 0.00 0.0% 0.00 7,898,266A8 4,9 4,760;SS1 Service Subcontract Allowance (input subcont. amount if <$25,000 or up to $25,000/per contract) Service Subcontract Adjustment TOTAL COSTS: BY SERVICE Budgeted In -Kind Valuation Total Costs Less In -Kind by Service Number of Billing Units (estimated) UNIT COST (Actual Cost) LESS IN-AfNI!AfJYlbO irPlbgj SIJ fYlethodu 4JL,4Uo.4J 1,566.51 1,350.94 12,977.18 2,297.75 1,057.09 252.50 212.00 2,971.87 30,550.00 - 1,154.35 6,740.68 3,397.16 33,947:161 25,000.00 5,550.00 3,397.16 - - 36,882.46 331,716.08 8,243.83 2,444 3,400 383 411401 --100,3tl4.Le l,Ooe.L4 - 1,823.05 - 1,031.72 3,939.00 - 1,770.55 20,813.68 - 139,098.57 2,826.16 - - 3,989.26 - - 2,977.00 24.00 - - - 15,311.49 240.00 `'.. 1,031.72 347,94101: 6.98 - 13,870.51 209.02 - 128,054.22 14,040.00 1,560.00 14,040.00 246.91 1,261.78 396,977.40 9,375.78 19,078.74 24.00 - 15,311.49 - 1,560.00 222.91 1,261.78 381,665.91 9,375.78 173518.74 10 24 28,781 335 13,000 FLORIDA DEPA� =NT OF ELDER AFFAIRS SIMPLIFIED UNI i .,OST METHODOLOGY II.B.2. UNIT COST WORKSHEET (All Funding Sources) BUDGET YEAR: January 1, 2020 - December 31, 2020 RECIPIENT NAME: Collier County 1261 1291 1351 1341 1461 I4l1 1491 1411 1s1, wages Fringe Travel Education/Training Communications & Postage Utilities Printing & Supplies Advertising Insurance Maintenance & Repair Space Costs Equipment Program Supplies Depreciation Food & Food Supplies Other In -Kind Services In -Kind Supplies In -Kind Volunteers 1,1bV,3U9.U8 b.61 "A 1,880,192.21 0.00 0.0%° 0.00 0.00 0.0% 0.00 1,551.00 1.0% 1,566.51 3,142.56 1.0% 3,173.99 4,921.50 ,.. Home 12,848.69 1.0% 12,977.18 44,420.45 1.0% 0.00 2,275.00 Respite ,. "..' rHisforical -s 3'- a IncreAse/ 1?ropaseds: Delivered Homemaker MATE Nutrition Occupational Other Outreach Personal Care (Facility 12,803.64 '9.7% 14,040.00 BU(�got Tatals. 12.3% 773,229.09 136,520.61 Education Therapy 188,459.16 11.9% !. 210,937.86 37,950,00 LINE ITEM'EXPE,NS F Gosts 2018 Dlcrease M- Meals C2 21,564.18 19.9% 23,692.25 207,049.46 11.0% 229,743.54 3,341.35 Based) 3,374.76 - 0.0% .� h 156,482.70 11.0% 158,047.53 65,245.94 11.1% 72,490.25 0.00 0.0% 2,308.70 wages Fringe Travel Education/Training Communications & Postage Utilities Printing & Supplies Advertising Insurance Maintenance & Repair Space Costs Equipment Program Supplies Depreciation Food & Food Supplies Other In -Kind Services In -Kind Supplies In -Kind Volunteers 1,1bV,3U9.U8 b.61 "A 1,880,192.21 0.00 0.0%° 0.00 0.00 0.0% 0.00 1,551.00 1.0% 1,566.51 3,142.56 1.0% 3,173.99 4,921.50 1.0% 4,970.72 12,848.69 1.0% 12,977.18 44,420.45 1.0% 0.00 2,275.00 1.0% 2,297.75 6,290.63 1.0% 6,353.54 20,607.60 1.0% 20,813.68 4,701.05 1.0% 4,748.06 250.00 1.0% 252.50 12,803.64 '9.7% 14,040.00 688,254,13 12.3% 773,229.09 136,520.61 10.6% 151,054.79 188,459.16 11.9% !. 210,937.86 37,950,00 56.1% 59,250.00 289,37383 '8.8% 314,863.62 21,564.18 19.9% 23,692.25 207,049.46 11.0% 229,743.54 3,341.35 1.0% 3,374.76 - 0.0% 30,550.00 156,482.70 11.0% 158,047.53 65,245.94 11.1% 72,490.25 0.00 0.0% 2,308.70 26,321.78 1.0% 26,585.00 0.00 0.0% 0.00 4,019.83 3.0% 4,140.42 16,050.00 0.0% 16,050.00 131,689.23 32.0% 173,808.66 34,243.13 55.5% 53,248.34 0.00 0.0% 0.00 Service Subcontract Allowance (input subcont. amount if <$25,000 or up to $25,0001per contract) Service Subcontract Adjustment Total Modified Direct Costs TOTAL COSTS BY SERVICE Budgeted In -Kind Valuation Total Costs Less In -Kind by Service Number of Billing Units (estimated) 19,9w.83 135.13 232,315.24 39,357.90 47,257.00 175,765.05 115,438.17 90,427.95 9,171.90 2,043.59 _ - 59,129.30 548.60 31,498.00 26,642.80 1,154.35 6,440.99 151.16 - -10,090.31 - 46,007.50 19,529.45 19,529.45 277,247,57 469,8$`1.64+.. 14,504.25 44,420.45 161,809.40 369,453.69 2,043.59 - - 8,250.48 - - 4,748.06 - - - - - - - - - - 226,336.66 - - 25,884.65 - - - - 44,470.69 59,250.00 14,520.35 53,949.99 260.58 - - - - - - - - - - 21,492.65 - 297.92 - - - - - - 42,904.00 6,498.00 41.22 - - - - 44,675.76 25,000.00 219.36 - - - - 341,979.24 34,250.00 PM 115,438.17 90,427.95 5,087.20 2,043.59 _ - - 8,250.48 87,579.76 31,498.00 302,989.85 480,046.74 6,440.99 2,499.31 -. - -10,090.31 449,088.96 72,771.941 19,529.45 46,007.50 - - - - - 42,904.00 6,498 00 283,460.40 434,039.24 6,440.99 2,499.31 - - 10,090.31 406,184.96 66,273.94 31,550 19,250 6 1,540 - - 148 17,300 6,000 PM FLORIDA DEP/ ENT OF ELDER AFFAIRS SIMPLIFIED UNI, .,OST METHODOLOGY II.B.2. UNIT COST WORKSHEET (All Funding Sources) BUDGET YEAR: January 1, 2020 - December 31, 2020 RECIPIENT NAME: Collier County 1531 1541 (551 f/ri4�Fil�:S11 (G91 vvages I,1bu,4u9.u0 0.017. Fringe 0.00 0.0% Travel 0.00 jal Sry�ediclald Education/Training 1,551.00 1.0% Communications & Postage 3,142.56 1.0% Utilities Respite (in- ScreeninglAs Screening/As Skilled 1.0°% Advertising gram-.. Tp' al"P Non-DOEA �-<- a -7 ,HistoNcal Increase/IJ-116 =„- 6,290.63 1.0% Space Costs Nursing 1.0% Transportation Or Services & .x 227,057.01 673,163.87 Home) sessment C2 sessment 16,898.86 Equipment, 7,485.13 .r ,:.... �, '^ Costar,, ' 4,027,703.95 r Services $ (0.00) Activities 214 38 444 1,067 77 _ "nia Services & vvages I,1bu,4u9.u0 0.017. Fringe 0.00 0.0% Travel 0.00 0.0% Education/Training 1,551.00 1.0% Communications & Postage 3,142.56 1.0% Utilities 4,921.50 1.0% Printing & Supplies 12,848.69 1.0°% Advertising 1.0% Insurance 2,275.00 1.0% Maintenance & Repair 6,290.63 1.0% Space Costs 20,607.60 1.0% Equipment 4,701.05 1.0% Program Supplies 26,321.78 1.0% Depreciation 0.00 0.0% Food & Food Supplies 4,019.83 3.0% Other 16,050.00 0.0% In -Kind Services 131,689.23 32.0% In -Kind Supplies 34,243.13 55.5% In -Kind Volunteers 0.00 0.0% Service Subcontract Allowance (input subcont. amount if <$25,000 or up to $25,000/per contract) Service Subcontract Adjustment TOTAL COSTS BY SERVICE ;. Budgeted In -Kind Valuation Total Costs Less In -Kind by Service Number of Billing Units (estimated) 1,uau,l9z.n 0.00 0.00 1,566.51 3,173.99 4,970.72 12,977.18 0.00 2,297.75 6,353.54 20,813.68 4,748.06 252.50 14,040.00 773,229.09 151,054.79 210,937.86 59,250.00 314,863.62 23,692.25 229,743.54 3,374.76 30,550.00 158,047.53 72,490.25 2,308.70 - 26,585.00 0.00 4,140.42 16,050.00 173,808.66 53,248.34 0.00 9,ubrr.a6 1,n4a3 418.90 303,809.95 82,707.60 116,664.25 116,664.25 24,320.60 71,614.00 58,420.55 585,746.10 10,551.24 3,104.64 2,545.92 157,786.95 34.20 4,1,18.8u - 26,287.08 - - - 6,120.32 1,804.00 - - 18,407.40 - 18,04(1,90". 202,481.43 x+,120.82 1,168.50 24,958.78 - 15,067.50 132,828.17 - 531,194.40 916,592.33 1,823.05 4,970.72 5,296.45 20,813.68 4,748.06 14,040.00 773,229.09 151,054.79 210,937.86 59,250.00 314,863.62 23,692.25 229,743.54 3,374.76 30,550.00 158,047.53 72,490.25 2,308.70 26,585.00 4,140.42 15,838.00 173,808.66 53,248.35 Check for Total Costs (0.00) (0.00) 0.00 (0.00) 0.00 (0.00) (0.00) (0.00) 0.00 MIR (0.00) (0.00) (0.00) (0.00) 18,99/,GZ 4,1,18.8u 34g.29 682.88_', 75532.42 1,364,81 f 204396.69] 0.00 130,034.55 9,474.58 1,714.33 2,972.50 69,653.26 6,120.32 916,592.33 744,777.87 11,587.37 )2,096.62 18,702.86 '< 218,013.85 7,485.13 :x,1,120,989.02 .' 4,254,760.95 71,614.00 - - 1,804.00 18,407.40 - - 227,057.01 673,163.87 11,587.37 2,096.62 16,898.86 199,606.44 7,485.13 13120,989.02 4,027,703.95 $ (0.00) 29,350 214 38 444 1,067 77 _ "nia 6/26/2019, 2:36 PM C 0 N M T O O O O U Q E U O m U � OO 0 O O O =o o U U o a Z W C3 Lij m W Q J ❑ z ❑ 7 J z Q W Q�aa �(nm W x K W W U 0 w M (p I- n W C7 ❑ m C �Q (@jmUU❑ W U a o m m m a m m F- Z f ci a X = LL .Q _ 06 C 0 N M T O O O O v c 9 = E U O m U � OO T N ❑o O O O =o o U U o rn N N Z W 0Jz�~� Lij m @ Q T @ ❑ z ❑ C @ @ Q Z J z Q W Q�aa �(nm E o m E K W W ¢Ua(L 0 w M C r o n O O O O O O O O O N OO O O O O O O O N r n N N C @ f .Q _ 06 N O N M O O) N M O O O O O O O O O O O O O O O N r O) O @ @ N N W o@ N CJ Q O . 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Match Commitment of Cash Donation Agency Name: Collier County Government Donor Identification: Name: Community and Human Services of Collier County Street: 3339 East Tamiami Trail, Building H, Room 211 City: Naples State: FL Zip: 34112 Phone: 239 252-4228 Authorized Representative: Kristi Sonntag, Director Total Amount # Payments Amount/Payment Contribution Period Special Conditions: Donor Certification: $452,119.39 26 $17,389.21 1/1/20 —12/31/20 None I hereby certify intent to make the cash donation set forth above for use in the specified program during the program's upcoming funding period. This cash is not included as match for any other State or Federally assisted program or contract and is not borne by the federal government directly under any federal grant or contract. Signature of Donor or } January2M Page Z of K Approved as to form and legality � t Assistant Count ttorncy 0 H. B. 5. Match Commitment for Donation of Building Space Agency Name: Collier County Government Donor Identification: Name: N/A Street: City: State: Zip: Phone: Authorized Representative: Description of Space: [ ] Office [ ] Site [ ],Other Provider Owned Space: 1. Number of square footage used by project: —sq/ft 2. Appraised rental value per square foot: $ 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: mos. 3. Value of donated space (1x2): Special Conditions: Donor Certification: 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. Signature of Donor or Representative: Date: January2018 Page 27 & 32 II. B. 6. Match Commitment of Supplies Agency Name: Collier County Government Donor Identification: Name: N/A Street: City: State: Zip: Phone: Authorized Representative: The below described supplies are committed for use by the project for the period of: Description of Supplies: Computation of value method: Value to be claimed by project: $ Donor Certification: These supplies are not included as contributions for any other State or Federally assisted program or contract and 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). Signature of Donor or Representative: Date: I 1 January 2018 Page 28 of 32 II. B. 7. Match Commitment of Equipment Agency Name: Collier County Government Donor Identification: Name: N/A Street: City: State: Zip: Phone: Authorized Representative: The below described equipment is committed for use by the project for the period of: Item Description Number Acquisition Cost Value to Proiect* 1. 2. 3. 9 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 match for any other State or Federally assisted program or contract and 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). Signature of Donor or Representative: Date: January 2018 Page 29 of 32 IL B. 8. Match Commitment of In -Kind Contribution of Services by Staff of Service Provider or Staff of Other Organizations Agency Name: Collier County Government Donor Identification: Name: N/A Street: City: State: Zip: Phone: Authorized Representative: The personal services described below are committed for use by the project for the period of: Description of Positions: Position/Title Service Hourly Rate or #Hours Value Annual Salary Worked to Proiect 1. 2. 3. 4. TOTAL - $ " Value to project = (# of hours provided) x (hourly rate of annual salary). Donor Certification: It is certified that the time devoted to the project will be performed during normal working hours. These services are not included as match for any other State or Federally assisted program or contract and 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). Signature of Donor or Representative: Date: January2018 Page 30 of 32 II. B. 9. Match Commitment of In -Kind Volunteer Personnel And Travel f Agency Name: Collier County Government Donor Identification: 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: Position Title Equivalent # of Value to Hourly Rate Hours Project 1. N/A $ 2. $ 3. $ 4. $ 5. $ 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 Mileage X Rate per mile = Value Donor Certification: I certify that commitments have been received from individual volunteers or groups sufficient to provide the volunteer hours and travel as identified above. Signature of Agency Official: Date: January 2018 Page 31 of 32 II. B. 10. AVAILABILITY OF DOCUMENTS The undersigned hereby gives assurance that the following documents are maintained in the administrative office of the provider and are accessible for review by the AAA. a. Current Board Roster b. Articles of Incorporation and Corporate By -Laws c. Advisory Council By -Laws and Membership d. Corporate fee documentation e. Insurance and Bonding Verification f. Staffing Plan (i.e. Position Descriptions, Pay Plan, Organizational Chart with staff names) g. Personnel Policies Manual h. Financial and Purchasing Procedures Manual i. Operational Procedures Manual j. Affirmative Action Plan k. Targeting Plan and documentation of activities I. Americans With Disabilities Act Assurances and Policies m. Staff Development and Training Plan (i.e. schedule, agendas, handouts, sign in sheets) n. Unusual Incident File o. Service. subcontracts and subcontractor monitoring reports p. Co Payment System (i.e. Policies and Procedures for CCE and AD[) q. Civil Rights Compliance documentation r. Confirmation of successful completion of the Level II background checks of required staff s. E -Verify Resolution t. Volunteer documentation (Le. hours, assignments, training) u. Quality Assurance documentation (client satisfaction surveys and compiled results) v. Safety/Licensure compliance (annual fire inspection reports of administrative offices and agency buildings with SGR funded services and licensure documentation if applicable.) w. Interagency agreements x. Conflict of Interest Policy y. Current equipment inventory z. Documentation of match commitments aa. Detailed documentation supporting contract expenditures and units of service bb. Client files cc. Subcontractor Affidavit of Compliance CERTIFICATION BY AUTHORIZED AGENCY OFFICIAL: identified above currently exist and are available for review upon request. ite Name and Title of Author' ed Indiv II.B.11 Managing Unit Achievement Levels CHS -Services for Seniors program is required by contract to manage unit achievement levels and service dollars to avoid having a wait list and a surplus of funds at the end of the contract year. We will ensure that 100% of the projected deliverables are performed and that active clients will receive services throughout the contract period. Currently, Service for Seniors case managers authorize each service for a client with a formal Service Authorization form that is provided to the vendor and the CHS Grant Coordinator. The Coordinator tracks all the service and the units on a cost allocation/vendor spreadsheet. The Grant Coordinator receives the vendor invoices and reconciles the invoice with the authorized units on the spreadsheet. Any invoice discrepancies are returned to the vendor for corrections. Monthly, the CHS Fiscal staff meet to review current and projected spending and complete and submit the Lead Agency's Lead Spending Report to AAA. This report confirms CHS' spending allocation and determines how many additional clients CHS will be able to serve the in the following month or to maintain our current client caseload and service spending level. Service Provider Application Update Table of Contents PAGE I. A. Service Provider Summary Information Tab 2 11. A. Program Module - General Requirements 1. Needs Assessment Tab 4/Pg.4 2. Targeting Tab 5/ Pg.8 3. Service Delivery System and Coordination Tab 8/Pg.12 4. Eligibility and Assessment/Reassessment Process Tab 9/Pg.14 5. System for Consumer Targeting Prioritization Tab 5/Pg.8 6. Services Tab 10/Pg.15 7. Process for Handling and Reporting Adverse Incidents, Consumer Complaints and Grievances Tab 11/Pg.17 8. OAA Subcontract Monitoring Schedule Tab 'G' 9. Quality Assurance Tab 12/Pg.18 10. Goals, Objectives, and Performance Measures Tab 13/Pg. 21 11. Reporting Tab 14/Pg. 22 12. Disaster Preparedness Tab 15/Pg. 23 13. Client Confidentiality Tab 16/Pg. 27 14. Description of Service Delivery Tab 17/Pg. 29 15. Nutrition Provider Documentation Tab 18/Pg. 31 16. Legal Provider Documentation N/A 17. Organizational Chart Tabs 'V' &'W' II. B. Contract Module -General Requirements 1. Personnel Allocations Worksheet Tab 19 2. Unit Cost Worksheet Tab 19 3. Supporting Budget Schedule by Program Activity Tab 20 4. Commitment of Cash Donation Tab 21 5. Commitment for Donation of Building Space N/A 6. Commitment of In -Kind Contribution of Supplies N/A 7. Commitment of In -Kind Contribution of Equipment N/A 8. Commitment of In -Kind Contribution of Services N/A 9. Commitment of in -Kind Volunteer Personnel and Travel N/A 10. Availability of Documents Tab 22 Page 2 of 33 AAASWFL RFP - 2019 - 01 SPA Format Collier County Older Floridian Profile/Demographics A (� Co ier County Public Services Depadrnent Priority Waitlist Process B Community & Human Services Divislon Services for Seniors Bilingual Fliers & Consumer Information Sheet C CAT Connect Shared -Ride Application Form D Collier County Services for Seniors Resource List E Service Delivery (By Service) Descriptions F OAA Subcontract Monitoring Schedule G SPA Standard Operating Procedures: Services for Seniors Client Incident H APPENDIX Standard Operating Procedures: Quality Assurance I 2018 Staff Development Training Program J Goals, Objectives and Performance Measures K Standard Operating Procedures: CIRTS Reporting L Collier County CHS Emergency Response Plan: Revised June 2018 M Standard Operating Procedures: Health Insurance Portability and N Accountability Act Collier County CHS Services for Seniors Release of Information Form O Employment Eligibility Verification Depart. of Homeland 1-9 Form P CMA 5390: Fingerprint/Background Checks Q Nutrition Education Plan January -December 2019 R Site Information S Standard Operating Procedures: Title IIIE National Family Caregiver T Sur cort Proaram Collier County CHS Service for Seniors Client Satisfaction Survey U Collier County Board of County Commissioners Organizational Chart V Collier County Public Services /CHS Division Organizational Chart W Case Manger Verification Log 2018-19 X Profile of Older Floridians Collier County Unless otherwise noted, the data presented refers to individuals age 60 and older. All Ages 363,996 100.0% !Under 18 67,058 18,4% IUnder60 234,166 64.3% Total Hispanic 11,228 8.6% 118-59 167,108 45.9% 60+ 129,830 35.7% 65+ 103,610 28.5% 70+ 77,152 21.2% 75+ 50,990 14.0% 80+ 29,635 8.1% 85+ '' 14,539 4.0% Source: Office of Economic and Demographic Research (EDR), 2017 Population by Gender Male 59,665 46.0% Female 70,165 54.0% I Source: EDR, 2017 English Proficiency With Limited English Proficiency' 6,826 Source: DOEA calculations based on EOR and 2011-2015 American community Survey (ACS) Special Tabulation on Aging tabulated for AoA 250,000 200,000 150,000 a E z 100,000 50,000 0 167,108 173,263 129,830 137,232 );LDER AFFAIRS White 124,198 95.7%j Black 4,253 ' 3.3% Other Minorities 1,379 1.1% Total Hispanic 11,228 8.6% White 10,759 8.3% Non -White: 469 0.4% Total Non -Hispanic 118,602 91.4% 1 Total Racial and Hispanic Minorities 16,391 ' 12.6% Source: EDR, 2017 Below Poverty Guideline 9,764 7.5% 5eiow 1GJ%o. or --13,175 >.:1uZpo 3overty Guideline Minority Below 3,607\ 2.8% 7overty Guideline Minority Below 125% of 4,82 7overty Guideline Source: DOEA calculations based on EDR and 2011-15 3.7% data 215,904 192,165 191,331 172,513 69,410 78,880 88,336 _.. 24.738. v 33,826. 2018 2020 Year 2030 2040 --*-<18 18-59 -k--60+ -K-85+ Source: Office of Economic and Demographic Research, 2017 1 rI,D1;12 AFFAIRS Profile of Older Floridians Collier County Unless otherwise noted, the data presented refers to individuals age 60 and older. 80 r r 70 60 50 c A u 40 N a 30 20 10 0 2018 2020 Year 2030 2040 Aged Dependency Ratio (65+) Youth Dependency Ratio (0-17) Source: Office of Economic and Demographic Research, 2017 Living With Own 3,795 Grandchildren* Grandparent Responsible 804 for Own Grandchildren* Grandparent Not Responsible 2,991 for Own Grandchildren* Not Living With Own 126,035 Grandchildren* -Grandchildren Under Age 18 Source: DOEA calculations based on EDR and 2011-15 ACS data 413 or Fdorl Qtamn Participants 4,755 Potentially Eligible 13,178 1 Participation Rate 36.1% Source: Florida Department of Children and Families, 2017 (Rural (Yes/No) NOI Source: Rural Economic Development initiative Notal Medically Underserved" 23,317 Living in Areas Defined as Having Medically 23,317 Underserved Populations 'I. Living in Medically 0 Underserved Areas Source: DOH and U.S. HHS, Data as of 8/07/2018 a Population 60+ Living Alone - Female ■ Population 60+ Living Alone - Male ounce: DOEA calculations based on EDR and 2011-15 ACS data 2 Profile of Older Floridians Collier County Unless otherwise noted, the data presented refers to individuals age 60 and older. jElder Registered Voters (60+) 110,189 (Registered Voters (All Ages) 202,833 Source: FL Department of State, 2017 Florjda-Driv�ees License !Elder Drivers (60+) 130,235 Drivers (All Ages) 312,2831 Source: FL Department of Highway Safety & Motor Vehicles as of 07/08/2018 28,242 16,670 Source: U.S. Department of Veterans Affairs, 2016 Below 50% Area Median Income (65+)5. Elder Households 61,065 Percent of All Households 13.2% Source: The Shimberg Center for Housing Studies, 2017 !Single Elders Owner without Mortgage 4,314 Renter, one bedroom 5,131 Owner with Mortgage $36,024 Elder Couple 4,474 Total Age 45-64 Age 65-84 Age 85+ Source: U.S. Department of Veterans Affairs, 2016 Below 50% Area Median Income (65+)5. Elder Households 61,065 Percent of All Households 13.2% Source: The Shimberg Center for Housing Studies, 2017 !Single Elders Owner without Mortgage $22,884 Renter, one bedroom $24,768 Owner with Mortgage $36,024 Elder Couple 4,474 Owner without Mortgage $33,564 Renter, one bedroom $35,448 Owner with Mortgage $46,704 Source: Wider Opportunities for Women Elder Economic Security Standard'" Index (Elder Index), Data as of 7/28/2018 E LDi"2 AR -All2s Disability Insurance (OASDI) 90,452 Beneficiaries Percent OASDI Beneficiaries 87.3% Source: DOEA calculations based on EDR and the U.S. social Security Administration data, 2017 2012-2016 $59,783 I Source: U.S. Census Bureau, 2012-2016 American Community Survey 5 -Year Estimates lWith One Type of Disability' 15,543 ,With Two or More Disabilities 13,089 Total With Any Disability Hearing 13,341 Vision 4,629 Cognitive 6,424 Ambulatory 15,709 Self -Care 4,474 Independent Living 11,021 With No Disabilities 101,198 Probably Alzheimer's Cases (65+) a 14,309 Source: DOEA calculations based on EDR, 2011-15 ACS data, and Alzheimer's Disease Facts and Figures Report, 2017 Medical Doctors Licensed 950 Limited License 17 Critical Need Area License 9 Restricted 0 Medical Faculty Certification 1 Public Health Certificate 0 Licensed Podiatric Physicians 39 Licensed Osteopathic Physicians ` 109 Licensed Chiropractic Physicians 118 Licensed Registered Nurses 4,208 Source: Florida Department of Health, 2017 2018 Projections Profile of Older Floridians Collier County Unless otherwise noted, the data presented refers to individuals age 60 and older. SNF Beds 959 Community Beds 755 Sheltered Beds 204 Veterans' Affairs Administration Beds - ' Other Beds 79.1% SNFs With Beds 15 Community Beds 11 Sheltered Beds 4 Veterans' Affairs Administration Beds Other Beds SNFs With Community Beds 11 Community Bed Days 275,575 Community Patient Days 218,106 Medicaid Patient Days 108,327 Occupancy Rate 79.1% Percent Medicaid 49.7% Home Health Agencies Agencies 36 Medicaid Certified Agencies 3 j Medicare Certified Agencies 13 Homemaker & Companion Service Companies �E..nies Facilities 1 ,Capacity 60 Source for Page: AHCA, 2017 f'I DE'R AFFAnts rota) Beds 2,227 OSS Beds9 18 Non -OSS Beds 2.209 32 Facilities with ECC License10 14 Facilities with LMH License 11 4 Facilities with LNS License 12 8 Adult Family Care Homes Homes 41 Beds 15 Facilities 15 Operating Rooms 30 ,i Recovery Beds 76 Hospitals 6 Hospitals with Skilled Nursing Units 0 Hospital Beds 1,051 Skilled Nursing Unit Beds " 0 Medicaid Eligible - All Ages 44,856 60+ Medicaid Eligible 6,176 Dual Eligible - All Ages 6,565 60+ Dual Eligible 5,192 4 i Projections ELDER 11 ARIPAZA Profile of Older Floridians Collier County Unless otherwise noted, the data presented refers to individuals age 60 and older. Elder Needs Index (All Factors) 4.93-11,00 11.01 - 15.11 IN 15.12 - 20,87 20,88 - 31.33 ■ 31.34 - 53.40 Elder Needs Index The Elder Needs Index (ENI) Is a composite measure that includes: (1) the percentage of the 60 and older population that is age 85 and older; (2) the percentage of the 55 and older population who are members of racial or ethnic minority groups; (3) the percentage of the 65 and older population with one or more disability; and (4) the percentage of the 55 and older population living below 125% of the Federal Poverty Level. The Index Is an averaged score that indicates senior citizens' overall level of risk for a probable need of social services within a geographic area. It is not a percentage of the area's population. The green areas of the map represent current conservation land such as national parks, state forests, wildlife management areas, local and private preserves. The blue areas of the map represent current water features such as lakes, streams, rivers, and coastlines. Complete maps available at http://eideraffairs.state ft us/doeo%ni home.php Source: Florida Department of Elder Affairs using U.S. Census Bureau, 2012-16 ACS data Office of Economic & Demographic Research (EDR) FL Division of Emergency Management (Shelters) U.S. Census Bureau, American Community Survey Florida Housing Data Clearinghouse U.S. Census Bureau, Quick Facts County Chronic Disease Profile Agency for Health Care Administration (AHCA) 2018 Projections I E iD�RArrAIRs Profile of Older Floridians "" °"' Collier County Unless otherwise noted, the data presented refers to individuals age 60 and older. 1 Those who report speaking English "Not well" or "Not at all" are defined as having Limited English Proficiency (LEP) in this profile. ' Total Minorities = (60+ Population) - (White Non -Hispanic 60+) 3 A "dependency ratio" is commonly depicted as a ratio of workers to non -workers. Rather than using labor -force participation rates, which fluctuate, a stable dependency ratio can be estimated by using the number of individuals in the population who fall into age groups generally aligned with school -aged kids, working age adults, and retired seniors. For this graphic, working age adults (defined as 18-59) were compared to minors (age 0-17)(youth dependency ratio) and seniors (age 65+)(aged dependency ratio). Some of the potential implications of a higher dependency ratio include labor shortages, lower tax revenues, higher government spending, higher taxes, and pressure to raise retirement age. 4 Medically Underserved Areas/Populations are areas or populations designated by Health Resources & Services Administration(HRSA) as having too few primary care providers, high infant mortality, high poverty or a high elderly population. 5 Households age 65 and older paying more than 30 percent of income for housing costs (including utilities) and have an income below 50 percent of the area median income 6 Wider Opportunities for Women Elder Economic Security Standard TM Index (Elder Index) measures how much income �- retired older adults require to meet their basic needs without public or private assistance. The Elder Index measures basic expenses for elders age 65+ living in the community, not in institutions. Annual expenses include: housing, including utilities, taxes, insurance; food; transportation; health care, based on good health; and miscellaneous. Data found at http://www.basiceconomicsecurity.org/El/ 7 With One Type of Disability: 60+ people who have only one type of disability 6 Probable Alzheimer's Cases = (65-74 Population x 0.036596) + (75-84 Population x 0.169158) + (85+ Population x 0.427599) Alzheimer's by Age in 2017 Alzheimer's Disease Facts and Figures Report used to develop calculation can be found at https://www.alz.org/getmedia/4d0840b6-Obaa-4b97-8a0e-1775cfbf44a4/statesheet florida 9 OSS Beds: Optional State Supplementation Beds. Optional State Supplementation (OSS) is a cash assistance program. Its purpose is to supplement a person's income to help pay for costs in an assisted living facility, mental health residential treatment facility, and adult family care home. It is NOT a Medicaid program. to ECC License: Extended Congregate Care License. The ECC license is a specialty license that enables a facility to provide, directly or through contract, services beyond those permissible under the standard license, including acts performed by licensed nurses, and supportive services defined by rule to persons who otherwise would be disqualified from continued residence in a facility licensed under this part. 11 LMH License: Limited Mental Health License. Any facility intending to admit three or more mental health residents must apply for and obtain a limited mental health license from AHCA's Assisted Living Unit before accepting the third mental health resident. 12 LNS License: Limited Nursing Services License, The LNS license is a specialty license that enables a facility to provide a select number of nursing services. 13 Florida Registered Voters: Totals reflect the number of active registered voters in Florida on 03/20/2018 o.o��Io M U-) N N O W co co co NIN • o+. o \ \ \ O \ O p U 0 of 00'd' CO O Nm NIt N N O d' N , j O O 0(M00 W W N N N 0 M �0 0 1CO-0 0O 0 of N CO O Nm NIt N N O d' N , j N M N h 0 of N CO _ rn N N O N N , j N J p O N ' m� a �a� °0 r-fa'� N J dam N t A J F- a) m `o w o 5 a a` Lo AreaAgency on Aging Inn BOU HN CY FLU fl,UA POLICY TITLE: PRIORITY WAITLIST PROCESS DATE ADOPTED: MARCH 26, 2019 DATE REVISED: MAY 3, 2019 President/CEO Approval Signature: 7&ua,� czlz %._. The Area Agency on Aging for Southwest Florida (AAASWFL) is responsible for completing a 701S Priority Screening Assessment of clients seeking access to Department of Elder Affairs (DOER) funded programs, in accordance with its current edition of the Programs and Services Manual. These funded programs are for the Statewide Medicaid Managed Care Long -Term Care Program (SMMC LTC) and State and Federal grant funded programs other than SMMC LTC. 1. PROGRAM ACTIVATION PROTOCOL FOR AAASWFL A. Based on priority score of their statewide standardized 701 S Screening Assessment, the Department of Elder Affairs will send to AAASWFL at the beginning of each month, the names of those clients who are released for processing for SMMC LTC. B. 7015 PRIORITY SCREENING ASSESSMENT AND REASSESSMENT PROCESS, AAASWFL: 1) AAASWFL provides a 701 S Priority Screening Assessment to clients seeking access to the Department of Elder Affairs' (DOEA) funded programs in accordance with its current edition of the Programs and Services Manual. Those clients who complete the assessment are put on a statewide Assessed Prioritized Consumer List (APCL). a) Those who qualify for state and federal funded programs Community Care for the Elderly (CCE), Home Care for the Elderly (HCE), Alzheimer's Disease Initiative (ADI) and funding through the Older Americans Act are assigned a priority score according to their statewide standardized 701 S Priority Screening Assessment. b) If program funding is not available, the AAASWFL will place the client on the appropriate Assessed Priority Consumer Lists (APCL). Clients may be placed on the APCL for all programs for which they qualify. c) The ADRC will conduct a reassessment for all APCL clients on an annual basis as required by the Department of Elder Affairs Programs and Services Manual. AAASWFL Priority Waitlist Process Page 1 of 6 Policy No. A-012 Rev. 001 7) Any exceptions to the above mentioned waitlist releases will be handled on a case by case basis by the AAASWFL. (Example: Client needs one -time - only pest control service that is not covered under their current funding source). Any requests for these one -time -only exceptions should be requested through ClientServices0aaaswfl.org. B. AAASWFL RELEASE PROCESS: 1) AAASWFL will acknowledge receipt of this request within 24 business hours of receipt.* 2) AAASWFL will begin referring name(s) to the Lead Agency within three (3) business days upon receipt of the request,* and repeat this process until the referral request list is satisfied. The AAASWFL will run a report in CIRTS to AAASWFL Priority Waitlist Process Page 2 of 6 Policy No. A-012 Rev. 001 -� Arga Agency on Aging ,. � FPq BP UTIfWEBT FlP%IUA 2. PRIORITY WAITLIST ACTIVATION PROTOCOLS FOR STATE AND FEDERALLY FUNDED PROGRAMS (OTHER THAN SMMC LTC) A. LEAD AGENCY REQUEST PROCESS: 1) Lead Agencies must send an email request for all services under CCE, HCE, ADI and OA3B programs except if the only service provided under OA3B is: a) TRS -Transportation b) EARS — Emergency Alert c) SCSM — Specialized Medical Equipment Services 2) The Lead Agency is responsible for ensuring funds are available in the appropriate program in order to serve additional clients. a) To request a release, the Lead Agency is to email Client Services at ClientServices@aaaswfl.org and include the following information: i. Grant funding source for which activation is sought (CCE, HCE, ADI or OA313); and li. Number of clients requested 3) Any modifications to requests and/or approvals, must be documented and transmitted to AAASWFL via email to ClientServicestaaaaswfl.ora. 4) Lead Agencies are not permitted to contact APCL clients until authorized to do so by AAASWFL (except for non -case managed, budgeted services). 5) Lead Agencies are not permitted to change any APCL enrollment code for CCE, ADI, or HCE unless the client has been released to the lead agency by AAASWFL for that specified funding source. For OA313, Lead Agencies are only permitted to change APCL enrollments without prior authorization for the following services; TRS, EARS, and SCSM. 6) Clients who are receiving non -case management OAA services cannot be ACTV for other OAA case managed services without being released by the AAASWFL. (Example; opening non -case managed services does not allow Lead Agency to receive case managed services.) 7) Any exceptions to the above mentioned waitlist releases will be handled on a case by case basis by the AAASWFL. (Example: Client needs one -time - only pest control service that is not covered under their current funding source). Any requests for these one -time -only exceptions should be requested through ClientServices0aaaswfl.org. B. AAASWFL RELEASE PROCESS: 1) AAASWFL will acknowledge receipt of this request within 24 business hours of receipt.* 2) AAASWFL will begin referring name(s) to the Lead Agency within three (3) business days upon receipt of the request,* and repeat this process until the referral request list is satisfied. The AAASWFL will run a report in CIRTS to AAASWFL Priority Waitlist Process Page 2 of 6 Policy No. A-012 Rev. 001 Area Agency on Aging � FOO BOOTHW BST RLOgIp� produce a list of clients (based on priority) for release, to ensure highest- ranking clients are served accordingly and based on criteria of the federal and state grant funding requirements. a) The AAASWFL will then contact the client to confirm they are still in need of services and still eligible under the current available funding source. b) AAASWFL will try to call the client three (3) times on three (3) different days. If a client is unable to be contacted after the third attempt, AAASWFL will send a letter stating we have been trying to reach them and to please contact our office. These attempted calls and the date the letter is sent will be noted in REFER. The AAASWFL will mark TALO in CIRTS (Terminated APCL Lost Contact) untillunless client contacts AAASWFL — then case can be reopened. c) AAASWFL will then move on to the next client. 3) AAASWFL will provide eligible clients to the Lead Agency using the client's first and last initials and the client's CIRTS ID number. C. LEAD AGENCYACTIVATION RESPONSIBILITIES: 1) Upon receiving an AAASWFL referral, the Lead Agency shall: a) Contact the client and ensure that a 701 B assessment is completed and that the client becomes active within 14 working days. b) Once requested release is received from AAASWFL, lead agency will change client status in CIRTS from APCL to TAAS. This will ensure client is no longer on the waiting list while determining eligibility. c) If client is found not eligible, declines services, or lead agency is unable to contact client, the lead agency is to close enrollment with appropriate termination code and notify AAASWFL via email at ClientServices(&aaaswfl.org that they have closed enrollment, with reason for closure. d) Lead Agency must notify AAASWFL (ClientServices(aaaswfl.org) to confirm completion of the 701 B with the date of completion, if they were not able to contact the client, or if services were not implemented and the reason why (for example, client refused services). e) Update CIRTS within the required contractual timeframes. "The data must be entered into the CIRTS database before the Contractor submits their Request for Payment and Receipts and Expenditure Reports to the Agency." The AAASWFL timeframe for billing is the 9th -11th of each month (depending on funding source). f) Develop a Care Plan that provides services needed to maintain a client safely in the community in the least restrictive, most cost-effective manner. AAASWFL Priority Waitlist Process Page 3 of 6 Policy No. A-012 Rev. 001 Area Agency on Aging am FOR SOUTHWEST FLORIDA g) Assure that all relevant CIRTS information is updated as required by contract. 3. OTHER AAASWFL/LEAD AGENCY RESPONSIBILITIES In accordance with HIPAA rules, the Lead Agency is not permitted to access any client information on the Accessed Prioritized Consumer List for any purpose other than providing services to clients through funding provided by AAASWFL. A. CIRTS ENROLLMENT SCREEN RESPONSIBILITIES: 1. The Lead Agency will change appropriate enrollment to active status and notify the AAASWFL via email at ClientServicesCa.aaaswfl.orp that client is receiving services. 2. For active clients receiving services through the Lead Agency where the client's situation has changed (e.g„ admitted to nursing home, moved out of area, passed away) and who do not need services any longer: a) the Lead Agency is to close the Active status in CIRTS. b) The Lead Agency is to notify the AAASWFL via email at ClientServices(o)aaaswfl.orq so that AAASWFL can close the APCL enrollment. c) The AAASWFL is responsible for managing the CIRTS documentation for APCL clients who are deceased. B. LEAD AGENCY CLIENT REFERRAL PROCESS: 1. Each Lead Agency will refer to the Helpline all clients seeking information and referral about resources available to older adults, adults with disabilities, and their caregivers. 2. There are times when a Lead Agency is providing services to those in their county for OAA non -registered services and/or Non -Departmental Funding (NDP) services. 3. The Lead Agency should refer that new client to the AAASWFL Helpline in order to see if they qualify for any publicly -funded long term care services. 4. Client can call the Helpline directly at 866-413-5337. 5. Lead Agency can complete the AAASWFL Referral Form and fax to 239-652- 6910 (see Attachment A). C. MEDICAID PROBABLE CLIENTS: 1. According to the contract between AAASWFL and the respective Lead Agencies, the Lead Agencies who have CCE ACTV clients that are not on APCL for SMMC LTC and but believe they should be because of financial AAASWFL Priority Waitlist Process Page 4 of 6 Policy No. A-012 Rev. 001 Area Agency on Aging aw FOR SOUTHWEST FLORIDA and/or physical conditions must refer these clients back to the ADRC/AAASWFL. 2. The Lead Agency must send an email to ClientServices aa)aaaswfl.ora and write "Medicaid Probable" in the subject line. 3. Medicaid Probable definition (Note: Lead Agencies have asked us for a definition of this. AAASWFL asked DOFA for this definition on 3-21-19. Once we receive a response we will update this section.) 4. If appropriate, AAASWFL will add the client to SMMC LTC enrollment waitlist. 5. AAASWFL will follow up with the lead agency via email with the outcome. D. SERVING AN ACTIVE CLIENT IN A DIFFERENT FUNDED PROGRAM 1. Case -managed services received by clients must be under the funding source for which they are enrolled and as authorized by the AAASWFL. 2. If an active client in one program is in need of services provided by another DOFA funded program for which he or she is waitlisted, the Lead Agency must seek prior authorization from AAASWFL via email at ClientServices a0aaaswfl.orp. 3. If the client is not yet waitlisted in the additional program, the Lead Agency will refer the client to the AAASWFL Helpline for enrollment and follow procedures. The Helpline phone number is: 1-866-413-5337. E. LEAD AGENCY SERVING CIRTS REGISTERED CLIENTS UNDER NON-DOEA (NDP) PROGRAMS: 1. When Lead Agency DOER -funded program budgets cannot support adding services for active clients, they may choose to use their own Non- DOEA Program funds (NDP). The following describes the procedures that must be followed for providing such services to clients registered in CIRTS: a) The Lead Agency shall: I. Update the client's Care Plan; ii. Record client NDP activation in CIRTS; iii. Record service provision under NDP in CIRTS monthly; iv. Adhere to procedures of contacting AAASWFL via email at ClientServices0aaaswfl.org when seeking to transfer services to a DOEA program; and v. If surplus funding is available in a DOFA program at year end, the Lead Agency may, under the direction of AAASWFL Fiscal Department at contract close-out, reclassify NDP services to the AAASWFL Priority Waitlist Process Page 5 of 6 Policy No. A-012 Rev. 001 Area Agency on Aging FOR SOUTHWEST FLOHIOA program in which the client is actively receiving services as additional funding permits. NOTE: The AAASWFL may modify these procedures as needed, and will notify the Lead Agencies of the changes by sending a Notice of Instruction. * These timelines may be adjusted during emergency situations and/or if internet outages prevent AAASWFL from responding accordingly. The Lead Agencies will be notified when these types of situations occur for an extended period of time. AAASWFL Priority Waitlist Process Page 6 of 6 Policy No. A-012 Rev. 001 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA REFERRAL FORM E Fax To: From: Subject: Date: Pages (Inc. cover): Information: Information: f Area Agency on Aging FOR SOUTHWEST FLORIDA "fir..-:,'?..XMffRglnpihli6WE.I,I1TYAwWk9Cgi1N„`3 Important IF All Referral forms MUST include a signature on the Client Consent section and/or HIPAA Authorization section to be accepted. Forms received without required signatures will not be accepted. Client Needs Assistance with: ❑ Information and Referral - information about community services available for adults with disabilities, seniors, and their caregivers. ❑ Referral for MIPPA Programs - (Low Income Subsidy and/or Medicare Savings Program) ❑ Intake and Screening - to be assessed for funded services for in-home and ALF (DOEA form 701 S telephone screening) ❑ Referral for Under -60 Medicaid Waiver Screening HELPLINE FAX: 239-652-6910 N� Area Agency on Aging for Southwest Florida area agency on aging ` Referral Form -:V6- ron SOUTHWEST PLOMDA Agency/Service Provider: Worker name: Worker email address: Date: Phone: Fax: Client name: Client address: Zip Code: County: Client phone: Alternate phone: Person to be contacted: Best time to call: Language Spoken: Situation/Notes: Is the client currently receiving any services? If yes, what services? ❑ Yes ❑ No Have any other referrals already been given? If yes, what referrals? ❑ Yes ❑ No Does the client have capacity toconsent? ❑ Yes ❑ No (If yes, client must sign consent section. If no, Authorized Representative must complete HIPAA privacy section.) Client Notice of Consent By signing this document, you (the client) confirm you are aware of and are authorizing a referral for information or assistance to be submitted on your behalf, and allow Area Agency on Aging for Southwest Florida staff to contact you directly regarding this request: Client Name: Client Signature: HIPAA Privacy Authorization Form Authorization for Use or Disclosure of Protected Health Information I hereby authorize the Area Agency on Aging for Southwest Florida to use and/or disclose my Protected Health Information (PHI) pertaining to the waitlist and waitlist screening process and other related information and/or referral services to my authorized representative. Client's Name: Client's Signature: Authorized Representative's Name: Authorized Representative's Signature: Relationship to Client: Date: If Authorized Representative holds Power of Attorney for the client, please provide a copy of the executed Power of Attorney along with this completed HIPAA form. Please Fax completed form to 239-652-6910 Revised 312019 Community & Human Services Division Services for Seniors Standard Operating Procedures Waitlist Prioritization Process Purpose: To determine a process for prioritizing eligible clients in the Services for Seniors program. Description: The Division of Community and Human Services (CHS) places clients on a waidist when program funding is not available and places clients on the appropriate wait list for programs for which they qualms. Clients will be added once availability is determined. Procedure: A. CHS as a lead agency will send an email request to the Area Aging on Aging of Southwest Florida (AAASWFL) who is responsible for maintaining the PSA 8 DOEA wait list, requesting activation release for new clients at ClientServicesLc aaaswflorg. (see AAA Priority Waitlist Process Policy) and include the following information: a. Grant funding source for which activation is sought (CCE, HCE, ADI or OA313; and b. Number of clients requested. c. The following exception if the only service provided under OA3B is: i. TRS -Transportation ii. EARS -Emergency Alert iii. SCSM- Specialized Medical Equipment Services B. CHS will be responsible for ensuring funds are available in the appropriate program to serve additional clients. C. Any modifications to requests and/or approvals will be documented and transmitted to AAASWFL via email. D. If an active client in one program needs services provided by another DOEA funded program for which he or she is waitlisted, CHS will seek prior authorization from AAASWFL via email. a. If the client is not waitlisted in the additional program, CHS will refer the client to AAASWFL Helpline for enrollment and follow procedures. The Helpline phone number is 1-866-413- 5337. The case manager can use the AAA Referral Form and obtain a client signature before sending to AAA. Community & Human Services Division Services for Seniors Standard Operating Procedures Waitlist Prioritization Process E. If DOEA funded program budgets cannot support adding services for active clients, CHS may choose to use other non-DOEA (NDP) funds to provide services. The following describes the procedure that must be followed for providing such services to clients registered in CIRTS: i. Update the client Care Plan; ii. Record client NDP activation in CIRTS iii. Record service provision under NDP in CIRTS monthly; iv. Adhere to procedures of requesting permission from AAASWFL via email when seeking to transfer services to a DOEA program and v. If surplus funding is available in a DOEA program at year end, CHS may under the direction of AAASWFL Fiscal Department at contract close-out, reclassify NDP services to the program which the client is actively receiving services as additional funding permits. F. For Nutrition Services: Potential clients are provided the AAA's Elder Helpline (1-800-413-5337) to complete the 7015 telephone screening. The 701S generates a score that determines where the client will be placed on the Wait List. When funding is available, the Nutrition Program Supervisor directly accesses the wait list in CIRTS by running the report "Assessed Prioritized Consumer List". a. First Level: Clients with the highest nutrition score will be placed first on the waiting list based on the score generated by the 701 S assessment. b. Second Level: If several Wait List clients have the same priority risk score, the next deciding factor is income. Although income is not a determining factor for eligibility, those with the lowest income should receive the service before those with higher incomes. c. Third level: If a client's priority score and income are the same, the client who has been on the waitlist for a longer period will be served first. Community & Human Services Division Services for Seniors Standard Operating Procedures Waitlist Prioritization Process The Nutrition Supervisor will maintain a spreadsheet system with client names, nutrition score, date added to waitlist and, when enrolled, first day of service L; ICT y Public Services Department Community & Human Services Division Collier County Community & Human Services Services for Seniors program has been providing support services to Collier County's older adults for the past 30 years through funding from the Area Agency on Aging of Southwest Florida including Federal and State Grant Funding. The Collier County Services for Seniors Program is a comprehensive program offered to qualified adults age 60+ and older, 18+ adults who have dementia, who need services to remain independent, want to continue to live in their own homes and need family support. Services that are provided include: Homemaking Bathing, Dressing Grocery Shopping Medical Transportation Skilled Nursing Medical Alert System Respite Medical Supplies/Nutritional Supplements Senior Nutrition Program provides Home Delivered Frozen Meals to aging adults and serves Four (4) Congregate Meal Sites in East Naples, Goodlette Arms, the Golden Gate Senior Center and Roberts Center in Immokalee, FL. Our staff continue to provide quality services to our aging population in Collier County. Our dedicated staff work diligently to serve our senior clients with contracted in-home services so that they can remain independent and provide nutritional nourishment to maintain their physical strength. Call: Elder Helpline 1-866-413-5337 The EHEAP Program (Emergency Home Energy Assistance Program) assists aging adults 60+ with their electric bill. For a household to meet the age requirement, at least one member of the household must be 60+. Call Community & Human Services 239-252-2273. Our staff will continue to provide quality services to our senior citizen population in Collier County. Our dedicated staff work diligently to serve our senior clients in providing contracted in- home services so that they can remain independent as long as possible in their own homes and provide nutritional nourishment to maintain their physical strength. Community &Human Services Division • 3339 Tamiami Trail East, Suite 211 Naples, Florida 34112-5361 239 -252 -CARE (2273) + 239 -252 -CAFE (2233) - 239-252-4230 (RSVP) - vwrw.colliergov,neUhumanservices Homemaking Bathing, Dressing Grocery Shopping Medical Transportation Skilled Nursing Medical Alert System Respite Medical Supplies Nutritional. Supplements C® rev u�y Public Services Department Community & Human Services Division Colne County EQUAL HOUSING OPPORTUNITY z z Servicios domesticos Banar, Vestir Comprar comida Transportation medica Enfermeria especializada Sistema de alerta medica Cuidado de Relevo Provisiones medicas Suplementos nutricionales ®miler unty IN Public Servims DepartmentHEALTH Community & I iuman Services Mision ITY Calfier Cnunf�=- OPPORTUNITY \ \ \ it fir. a S .. ; e „a m a i� awn Menoje Benyen, abiye Fe maket Transpotasyon medikal Enfimye kalifye Sistem Avetisman Medikal Relev Founiti medikal Sipleman nitrisyonel Co ew ugggo ta Public Services Community EQUAL HOUSING CG4�y $i Human Services Divisionember rnmw OPPORTUNITY t0l* - COLLIE RAREATRANSIT CAT Connect Shared -Ride Application Form 8300RadioRoad, Naples, FIor! da34104 CAT Connect is a public transportation shared -ride door-to-door service that is ONLY available for individuals who do not have access to any other means of transportation, including the Collier Area Transit (CAT) bus service (fixed route). The CAT Connect program provides transportation service through the Florida Department of Transportation for eligible individuals through several funding programs, including the American with Disability Act (ADA) and Florida Commission for the Transportation Disadvantaged (TD). CAT Connect can be used for medical appointments, work, school and other trips depending on the funding program the individual qualifies under. The information requested on this application is intended to help us determine the funding program you qualify for. The qualification guidelines for each program are shown below. If you are unsure whether you qualify, have any questions, or need assistance completing this application, please call our Customer Service Department at (239) 252-7272 or the CAT office at (239) 252-7777. For TTY/TDD devices call (800) 955-1339. For MEDICAID TRANSPORTATION please call (877) 254-1055. Eligibility Criteria ADA TD • Your trips origin and destination are • Your trips origin or destination must within the ADA corridora reside outside the ADA corridor but within • You have a recognized disability Collier County. verified by an accepted medical • You have a physical or mental disability, professional income status, or age; that prevents you • Unable to Utilize CAT Fixed Route to transport yourself or to purchase transportation; • Or you are a Pre-school child who is handicapped or high-risk or at -risk. • Eligibility is a functional determination of the applicant's ability to use the CAT bus service (fixed route), and not simply a medical or psychiatric diagnosis. • The ADA certification process may involve a telephone interview and/or a personal functional assessment to determine if and how the applicant's transit needs can be met. CAT Connect will pay for the functional assessment as well as provide transportation to and from the evaluation, if necessary. The in-person assessment begins with a one-on-one interview, designed for an applicant to provide details regarding his/her travel skills and abilities. During the interview, the assessor determines whether the applicant can safely participate in the functional assessment process. A mobility assessment focuses on each applicant's functional and cognitive abilities. Through assessments, an evaluator can determine environmental, architectural, and personal Rev -Feb 2017 CAT Connect— Shared Ride Public Transportation Application -Page 1 barriers that may impact an applicant's ability to safely and independently access public transportation. i All applicants will be notified of the outcome of their application. PROCESSING OF THIS APPLICATION CAN TAKE UP TO 21 CALENDAR DAYS. The 21 day period begins AFTER a complete application is received. Travel Trainina is a FREE service that is offered and creates opportunities for community access by teaching you how to use the CAT bus service (fixed route). The Travel Trainer will work with you in either an individual or small group setting to teach you the travel skills needed to get to your destination safely and independently. The Travel Trainer will work with you until you are capable and confident to travel your route on your own. REMEMBER WHEN COMPLETING THIS APPLICATION! 1. Type or PRINT legibly, ILLEGIBLE. INCOMPLETE AND/OR UNSIGNED APPLICATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED. THIS WILL CAUSE A DELAY IN YOUR ELIGIBILITY DETERMINATION. 2. To confirm disability THE MEDICAL VERIFICATION SECTION IS REQUIRED and must be completed by an accepted medical professional (see list on top of Medical Verification form). 3. PROOF OF INCOME IS REQUIRED IF A REDUCED CO -PAY IS REQUESTED. Acceptable types of proof of income are pension benefit statements, unemployment benefits, or current paystubs. 4. Complete all sections of the application requested, return all information requested, and sign where indicated. Note: All CAT bus service (fixed route) vehicles are wheelchair accessible and equipped with wheelchair lifts. Therefore, use of a wheelchair does not automatically justify use of paratransit service. Bus operators or automatic systems announce major streets and intersections and/or all vehicles are equipped with automated enunciators. Rev -Feb 2017 CAT Connect— Shared Ride Public Transportation Application -Page 3 OFFICE USE ONLY - DO NOT WRITE IN THIS SPACE Date Received: Initial Reviewer: `eview Start Date: Final Reviewer: ❑ New Application:\ ❑ Approved El Re -certification: I ❑ Denied TD ❑ $1.00 ❑ $3.00 ❑ $5.00 ❑ $7.00 PCA Needed: ❑ YES ❑ NO Assessment: Date ADA Approval: TD Approval: Conditional /Temporary: > ❑ Temporary ❑ Conditional: ❑ Permanent ADA ❑ $1.00 ❑ $3.00 ❑ $0.00 Senior Service Funding Source: ❑ ADA ❑ TD TT Requested: ❑ YES ❑ NO Customer ID#: SECTION 1 —GENERAL INFORMATION (PLEASE PRINT) f, ❑ Check here if you are a current Paratransit rider J Check here if you currently receive Medicaid or any program that would pay for transportation. Date of Birth:—/—/. Sex: ❑ Male ❑ Female Last Name: First Name: M. 1. Street Address: Apt.#: City: State: Zip Code: Home Phone: Cell Phone: Email: Name of Subdivision, Building Complex Name, and/or Facility Name Is a gate code required for entry? ❑ YES ❑ NO Code Number Mailing Address (if different from above): Is this a ❑ Nursing Home ❑ ACLF/ALF ❑ Boarding Home Does the facility you live in have a vehicle to transport residents? INWA=6�ookila7 Rev -Feb 2017 CAT Connect — Shared Ride Public Transportation Application -Page 4 Have you ever been transported by this facility? ❑ YES ❑ NO f )o you require materials or correspondence in an alternative format? If so, please specify; ❑ Large Print ❑ Audio ❑ Computer ❑ Other If the applicant received assistance completing this application, please specify; Name: Relationship: Phone: Do you authorize this person to assist you with future travel arrangements? ❑ YES ❑ NO List additional persons that are authorized to assist you with travel arrangements in the future: Emergency Contact: Name and telephone number of someone we can call in an emergency. Name: Relationship: Home Cell P TRAVEL INFORMATION 1. How do you currently travel to appointments or to other activities such as grocery shopping? 2. Have you ever used the Collier Area Transit's bus service? ❑ YES ❑ NO t NOTE: CAT Connect offers travel training services to teach individuals how to use the CAT bus service. Participation in travel training will not affect your eligibility for ADA Paratransit service. ❑ Check here if you are interested in receiving additional information on travel training. MOBILITY INFORMATION All Collier Area Transit's buses are wheelchair accessible. Therefore, use of a wheelchair does not automatically justify use of Paratransit service. 1. Please check the appropriate mobility aid(s) or equipment listed below that you use to assistyou when you travel. ❑ Powered scooter/wheelchair ❑ Walker ❑ Cane Other (soecifv): ❑ Applicant special accommodation for transport: ❑ Oxygentank ❑ Manual wheelchair ❑ ServiceAnimal f NOTE: CAT Connect will transport all mobility devices measuring up to 48 inches in length, 30 inches in width, and between 800 to 1000 pounds in weight when occupied. Rev -Feb 2017 CAT Connect— Shared Ride Public Transportation Application -Page 5 COMMON DESTINATIONS ist the doctors, medical facilities or other locations you visit on a regular basis and how you currently .,avel to those appointments. a. Doctors Name/Medical Facil Phone b. Doctors Name/Medical Facil Phone Nu Address c. Other non-medical desti we d. Other non-medical destination Address SECTION 2 - TD APPLICANTS OR REDUCED CO -PAY NOTE: Proof of income is required. Please submit with completed application. I. In order to determine if you qualify as Transportation Disadvantaged (TD), please answer the following: # of persons in your household $ Total Annual Household Income 2. How many personal vehicles are owned or used by members in your household? ❑ 0 ❑ 1 ❑ 2 or more 3. Are these vehicles available for use? If not, please state why: NOTE: Acceptable types of proof of income are pension/social security benefit statements, unemployment benefits, bank statements or current paystubs. Rev -Feb 2017 CAT Connect — Shared Ride Public Transportation Application -Page 6 SECTION 3 - ALL APPLICANTS .tPPLICANT CERTIFICATION I understand the information contained in this application will be kept confidential and shared only with professionals involved in evaluating my eligibility for Paratransit Shared -Ride Service. I certify the information provided in this application is true and correct. I understand that providing false or misleading information or making false statements on behalf of others constitutes fraud and is considered a felony under the laws of the State of Florida. I authorize the professional(s) listed to release information to CAT CONNECT Program about my disability and its effects on my ability to travel on the COLLIER AREA TRANSIT bus service (fixed route). I understand that I may revoke this authorization at any time with written notice to CAT CONNECT Program. THIS APPLICATION MUST BE SIGNED Signature of applicant: Date: If Applicant is unable to sign this form, he/she may have someone sign and certify on applicant's behalf. Proxy Signing for Applica _ tint Name: Relationship to applicant: MAIL APPLICATION TO: OR FAX APPLICATION TO: WHEN COMPLETED, PLEASE CAT Connect Program CAT OPERATIONS CENTER 8300 RADIO ROAD NAPLES, FL 34104 (239)252-4464 Rev -Feb 2017 CAT Connect — Shared Ride Public Transportation Application -Page 7 MEDICAL VERIFICATION (Must be completed by accepted medical professional) FOR ADA OR if you are aaDlvina for TD due to a medically verified Dhvsical or coanitive ondition, impairment, or disability: A Medical Verification Form must be completed and signed by a licensed medical professional. Accepted medical professionals include: • Medical Doctor • Audiologist • Registered Nurse • Doctor of Osteopathic Medicine • Ophthalmologist • Physical Therapist • Doctor of Chiropractic • Psychologist • Licensed Practical Nurse • Occupational Therapist - Licensed and Registered Dear Medical Professional: In order to process this applicant's request for CAT Connect eligibility, we require this form be completed. Only licensed medical professionals having knowledge of the applicant's functional ability to use the Collier Area Transit (CAT) bus service (fixed route) should complete this form. CAT Connect is the shared -ride door-to-door service and CAT is the fixed route bus service. All CAT bus service (fixed route) vehicles are wheelchair accessible and equipped with wheelchair lifts. Therefore, use of a wheelchair does not automatically justify use of paratransit service. Bus operators or automatic systems announce major streets and intersections, and/or all vehicles are equipped with automated enunciators. Thank you for your assistance. Contact information: CAT Connect Program Customer Service Phone: (239) 252-7272 or (239) 252-7777 Fax: (239) 2524464 or (239) 252-5753 Email: goCATbus@colliercountyfl.gov Additional information can be found on our website www.goCATbus.com Rev -Feb 2017 CAT Connect— Shared Ride Public Transportation Application -Page 8 MEDICAL VERIFICATION - ADA & TD DISABILITY APPLICANTS (MUST BE COMPLETED BY MEDICAL PROFESSIONAL) APPLICANT'S NAME: Date of Birth: I I 1. What are the disability/ies or health conditions that affect the applicant's ability to use the Collier Area Transit bus service (fixed route)? 2. Does this person require a Personal Care Attendant (PCA) while traveling? 0 Yes 0 No 3. How long has this disability been present? Is the disability 0 permanent, 0 temporary or 0 progressive? If temporary, how long? 4. Please describe any other medical conditions this person has at this time and severity, in detail, including any restrictions, limitation, and prognosis 5. How long have these conditions been present? Is condition 0 permanent, 0 temporary or 0 progressive? 6. Is this person able to: 0 Yes 0 No Communicate addresses, destinations, and phone numbers? 0 Yes 0 No Read and/or monitor time? 0 Yes 0 No Ask for, understand, and follow instructions? 0 Yes 0 No Deal with unexpected situations or changes in routine? 0 Yes 0 No Safely and effectively travel through crowded or complex facilities? In signing, I acknowledge that, to the best of my knowledge, the information in this evaluation form is true and correct. I understand that providing false or misleading information could result in the re- examination of the eligibility status of the applicant as well as prosecution to the maximum extent allowed by the laws of the state of Florida. Print or type Name and Title: State of Florida License Number: Business City: State: hone Number: Code: Rev -Feb 2017 CAT Connect — Shared Ride Public Transportation Application -Page 9 Collier County Services for Seniors Resources Parkinson's Assoc of SW Florida (239) 417-3465 Area Agency on Aging of SW Florida (239) 652-6900 Elder Helpline (866) 413-5337 SHINE Medicare Counseling (866) 413-5337 Social Security & Medicare Office: 2659 Professional Circle, Naples FL 34119 (800) 772-1213 Medicaid: www.mvflorida.com/accessflorida/ (866) 762- 2237 DCF Food Stamps: www.mvflorida.com/accessflorida/ Florida Dept of Health: (239) 252-8200 Florida Senior Legal Hotline (888) 895-7873 Elder Abuse Hotline (800) 962-2873 Volunteer -Retired Seniors Volunteer Program (RSVP) 239-252-4230 Collier Area Transit (CAT) (239) 252-7777, 252-7272 AARP (888) 227-7669 Emergency Home Energy Assistance for the Elderly (EHEAP) (239) 252-2273 f Alzheimer's Support Network (239) 262-8388 Long Term Care Ombudsman Program (888) 831-0404 Senior Centers: The Naples Senior Center (239)325-4444 The Golden Gate Senior Center (239)252-4541 Senior Friendship Medical Center (239) 566-7425 Florida Public Guardian Office: Patrick Webber (239) 417-1040 Collier County Courthouse: Probate Help (239) 252-8140 Emergency Special Needs Disaster Registration: (239) 252-3608 Lighthouse of Collier, Center for Blindness/Vison Loss (239) 430-3934 Naples Lions Club -Hearing /Vision Assistance (239) 353- 4800 Nutrition Services Collier County Services for Seniors Congregate Meal Sites/Frozen Meals Delivery (239) 252-2233 Meals on Wheels- St. Vincent de Paul (239) 775-0443 Food Pantries Harry Chapin (239) 334-7007 Catholic Charities (239) 455-2655 New Hope Ministries (239) 348-0122 Salvation Army Naples (239) 775-9447 Tree of Life Church (239) 530-2200 Jewish Family & Community Services of SW FL (239) 325- 1 St. Vincent de Paul (239) 775-1667 Cremation/Burial Services Community & Human Services 239-252-2273 I. Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Service: Adult Day Care Program: OAA a. Subcontractor Will your agency provide this service directly? ❑ Yes ® No If your agency will subcontract this service, list all subcontractors below: See SPA Appendix -List of Subcontractors Subcontractor(s) Shifting Sands Adult Day Care Center Business Name: Shifting Sands Adult Day Care Center Address: 28410 Bonita Crossings Blvd. Phone Number:239-405-7009 License Number (if applicable): #9427 Contract Start/End Date: May 5 — September30, 2019 Anticipated Monitoring Date: June 2020 b. Site Location See Appendix List of Subcontractors For Congregate, Adult Day Care, and Facility Respite sites, the OAA Site Information Form must be utilized. This document is included Attachment I. c. Days and Hours of Operation; Monday -Friday, 6:30 am -6 pm. d. Activities Describe the specific activities your agency will provide under this service. Adult day care is a facility -based program of therapeutic social and health activities provided to seniors who have functional impairments and require supervision for their personal safety. Services are provided in a protective, community-based environment. e. Training Requirements: Describe the orientation and annual in-service training required of direct service staff providing this service. The contracted agency is licensed by the State of Florida, AHCA and its' employees have completed the Home Health Aide Certification, Alzheimer's Disease Training certification and HIV/AIDS certification. Program Income/Voluntary Contributions: • Describe for this service the procedure for informing OAA clients of voluntary contributions NA • Describe for this service the voluntary contribution collection methods NA. • Include a plan for ensuring program income contributions will be obtained and identifyways that your agency can increase contributions. NA I. Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Service: CHORE a. Subcontractor Program: M Will your agency provide this service directly? ❑ Yes M No If your agency will subcontract this service, list all subcontractors below: See SPA Appendix -List of Subcontractors Subcontractor(s) Business Name: Address: Phone Number: License Number (if applicable): Contract Start/End Date: Anticipated Monitoring Date: b. Site Location See Appendix List of Subcontractors c. Days and Hours of Operation; Monday -Friday, 8am-5pm, unless Client has a specific need that warrants weekend coverage d. Activities Describe the specific activities your agency will provide under this service. CHORE is defined as the increased performance of a request that exceeds routine house or yard tasks including jobs as seasonal cleaning, a deep cleaning, yard work, lifting and moving furniture including appliances and heavy objects; household repairs which do not require a permit or specialist and household maintenance. e. Training Requirements: Describe the orientation and annual in-service training required of direct service staff providing this service. The contracted agency is licensed by the State of Florida, AHCA and its' employees have completed the Home Health Aide Certification, Alzheimer's Disease Training certification and HIV/AIDS certification. f. Program Income/Voluntary Contributions: • Describe for this service the procedure for informing OAA clients of voluntary contributions NA Describe for this service the voluntary contribution collection methods NA. Include a plan for ensuring program income contributions will be obtained and identifyways that your agency can increase contributions. NA I. Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Service: Case Program: OAA Management a. Subcontractor Will your agency provide this service directly? ® Yes ❑ No Contract Start/End Date: January 1, 2020 — December 31, 2021 Anticipated Monitoring Date: November 2019 b. Site Location: c. Collier County Community & Human Services -Services for Seniors 3339 Tamiami Trail East Suite 211 Naples, FL 34112 d. Days and Hours of Operation; Monday -Friday, (On Call 24/7) Monday -Friday 8am-5PM Office Hours e. Activities Describe the specific activities your agency will provide under this service. Case management is a client centered service that assists individuals in identifying physical and emotional needs and issues through an interview and assessment process; discussing and developing a care plan for services which addresses the individual's needs; arranging and coordinating agreed upon services. Case management is a service for actively enrolled clients that provides continuing support and addresses the changing needs of the client. f. Training Requirements: Describe the orientation and annual in-service training required of direct service staff providing this service. Case managers and manager will receive annual and quarterly case management trainings per year as directed by AAA of SWFL. In addition, Collier County provides all employees 24-32 hours of safety and administrative training annually. g. Program Income/Voluntary Contributions: • Describe for this service the procedure for informing OAA clients of voluntary contributions NA Describe for this service the voluntary contribution collection methods NA. Include a plan for ensuring program income contributions will be obtained and identify ways that your agency can increase contributions. NA I. Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Service: Emergency Program: Alert Response a. Subcontractor •:: Will your agency provide this service directly? ❑ Yes ® No If your agency will subcontract this service, list all subcontractors below: See SPA Appendix -List of Subcontractors Subcontractor(s) Business Name: Address: Phone Number: License Number (if applicable): Contract Start/End Date: Anticipated Monitoring Date: b. Site Location See Appendix List of Subcontractors For Congregate, Adult Day Care, and Facility Respite sites, the OAA Site Information Form must be utilized. This document is included Attachment c. Days and Hours of Operation: Monday -Sunday, 2417 d. Activities Describe the specific activities your agency will provide under this service. The emergency alert/response service is a community based electronic surveillance system which monitors the frail homebound senior by means of an electronic communication link with a response system. The device can be ordered as a necklace model or as a watch worn on the wrist. The client must have the device on to be effective as an emergency alert system. e. Training Requirements: Describe the orientation and annual in-service training required of direct service staff providing this service. The contracted agency is required to provide only employees that have completed a Background Level II screening when entering a client's home. Generally, the equipment is mailed directly to the client's residence. Program Income/Voluntary Contributions: • Describe for this service the procedure for informing OAA clients of voluntary contributions NA • Describe for this service the voluntary contribution collection methods NA. • Include a plan for ensuring program income contributions will be obtained and identifyways that your agency can increase contributions. NA Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Service: Enhanced CHORE a. Subcontractor Will your agency provide this service directly? If your agency will subcontract this service, See SPA Appendix -List of Subcontractors Subcontractor(s) Business Name: Address: Phone Number: License Number (if applicable): Contract Start/End Date: Anticipated Monitoring Date: b. Site Location See Appendix List of Subcontractors Program: OAA list all subcontractors below: Days and Hours of Operation; Monday -Friday, 8am-5pm, unless Client has a specific need that warrants weekend coverage d. Activities Describe the specific activities your agency will provide under this service. Enhanced CHORE is defined as the increased performance of a request that exceeds routine house or yard tasks including jobs as seasonal cleaning, a deep cleaning, yard work, lifting and moving furniture including appliances and heavy objects; household repairs which do not require a permit or specialist and household maintenance. Enhanced CHORE is requested when the task(s) will require more than one aide to complete the task(s). e. Training Requirements: Describe the orientation and annual in-service training required of direct service staff providing this service. The contracted agency is licensed by the State of Florida, AHCA and its' employees have completed the Home Health Aide Certification, Alzheimer's Disease Training certification and HIV/AIDS certification. Program Income/Voluntary Contributions: • Describe for this service the procedure for informing OAA clients of voluntary contributions NA • Describe for this service the voluntary contribution collection methods NA. • Include a plan for ensuring program income contributions will be obtained and identifyways that your agency can increase contributions. NA Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Service: Respite- Facility a. Subcontractor Will your agency provide this service directly? If your agency will subcontract this service, See SPA Appendix -List of Subcontractors Subcontractor(s) Business Name: Address: Phone Number: License Number (if applicable): Contract Start/End Date: Anticipated Monitoring Date: b. Site Location See Appendix List of Subcontractors Program: OAA -I IIE ❑ Yes M No list all subcontractors below: For Congregate, Adult Day Care, and Facility Respite sites, the OAA Site Information Form must be utilized. This document is included Attachment c. Days and Hours of Operation; Monday -Sunday 24/7. d. Activities Describe the specific activities your agency will provide under this service. Facility based respite care is the provision of relief, rest and/or emergency care for a primary caregiver from the continuous supervision/care of a senior who has limited physical and mental impairment and requires 24/7 supervision and care. The respite care is provided at a licensed facility that provides 24/7 care for a specified period. e. Training Requirements: Describe the orientation and annual in-service training required of direct service staff providing this service. The contracted agency is licensed by the State of Florida, AHCA and its' employees have completed the Home Health Aide Certification, Alzheimer's Disease Training certification and HIV/AIDS certification. Program Income/Voluntary Contributions: Describe for this service the procedure for informing OAA clients of voluntary contributions NA Describe for this service the voluntary contribution collection methods NA. Include a plan for ensuring program income contributions will be obtained and identifyways that your agency can increase contributions. NA Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Service: Homemaking Services a. Subcontractor Will your agency provide this service directly? If your agency will subcontract this service, See SPA Appendix -List of Subcontractors Subcontractor(s) Business Name: Address: Phone Number: License Number (if applicable): Contract Start/End Date: Anticipated Monitoring Date: b. Site Location Program: OAA ❑ Yes ® No list all subcontractors below: See Appendix List of Subcontractors For Congregate, Adult Day Care, and Facility Respite sites, the OAA Site Information Form must be utilized. This document is included Attachment I. c. Days and Hours of Operation; Monday -Friday, 8am-5pm, unless Client has a specific need that warrants weekend coverage d. Activities Describe the specific activities your agency will provide under this service. Homemaking service is defined as the accomplishment of specific home management duties including housekeeping, laundry, cleaning refrigerators and floors, assistance with budgeting and paying bills, meal planning and preparation, shopping assistance and routine house -hold activities by a trained homemaker. e. Training Requirements: Describe the orientation and annual in-service training required of direct service staff providing this service. The contracted agency is licensed by the State of Florida, AHCA and its' employees have completed the Home Health Aide Certification, Alzheimer's Disease Training certification and HIV/AIDS certification. f. Program Income/Voluntary Contributions: Describe for this service the procedure for informing OAA clients of voluntary contributions NA Describe for this service the voluntary contribution collection methods NA. Include a plan for ensuring program income contributions will be obtained and identifyways that your agency can increase contributions. NA Service Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Material Aid Program: OAA -1113E, (MATE) 1113ES a. Subcontractor Will your agency provide this service directly? If your agency will subcontract this service, See SPA Appendix -List of Subcontractors Subcontractor(s) Business Name: Address: Phone Number: License Number (if applicable): Contract Start/End Date: Anticipated Monitoring Date: b. Site Location See Appendix List of Subcontractors c. Days and Hours of Operation; Monday -Friday, 8am-5pm d. Activities ❑ Yes M No list all subcontractors below: Describe the specific activities your agency will provide under this service. Goods or surplus food, clothing, smoke detectors, eyeglasses, hearing aids. Repair, purchase and installation of any household appliance or home repair that will assist the person and is necessary for the health, safety or welfare of the person. If service/product exceed $500., prior approval from AAA with two quotes is required. e. Training Requirements: Describe the orientation and annual in-service training required of direct service staff providing this service. NA -This service has no face to face contact with seniors. f. Program Income/Voluntary Contributions: • Describe for this service the procedure for informing OAA clients of voluntary contributions NA Describe for this service the voluntary contribution collection methods NA. Include a plan for ensuring program income contributions will be obtained and identifyways that your agency can increase contributions. NA Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Service: Personal Care a. Subcontractor Will your agency provide this service directly? If your agency will subcontract this service, See SPA Appendix -List of Subcontractors Subcontractor(s) Business Name: Address: Phone Number: License Number (if applicable): Contract Start/End Date: Anticipated Monitoring Date: Program: a.. ❑ Yes ® No list all subcontractors below: b. Site Location See Appendix List of Subcontractors For Congregate, Adult Day Care, and Facility Respite sites, the OAA Site Information Form must be utilized. This document is included Attachment I. c. Days and Hours of Operation; Monday -Friday, 8am-5pm, unless Client has a specific need that warrants weekend coverage. d. Activities Describe the specific activities your agency will provide under this service. Personal care is assistance with eating, dressing, personal hygiene and other activities of daily living. This service may include assistance with meal preparation, housekeeping chores to include bed making, dusting and vacuuming essential to the health and welfare to the client. Personal care includes accompanying the client for physician visits and medical transport that does not require special assistance. e. Training Requirements: Describe the orientation and annual in-service training required of direct service staff providing this service. The contracted agency is licensed by the State of Florida, AHCA and its' employees have completed the Home Health Aide Certification, Alzheimer's Disease Training certification and HIV/AIDS certification. Program Income[Voluntary Contributions: • Describe for this service the procedure for informing OAA clients of voluntary contributions NA • Describe for this service the voluntary contribution collection methods NA. • Include a plan for ensuring program income contributions will be obtained and identifyways that your agency can increase contributions. NA I. Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Service: Respite, In- Program: OAA-IIIE Home a. Subcontractor Will your agency provide this service directly? ❑ Yes ® No If your agency will subcontract this service, list all subcontractors below: See SPA Appendix -List of Subcontractors Subcontractor(s) Business Name: Address: Phone Number: License Number (if applicable): Contract Start/End Date: Anticipated Monitoring Date: b. Site Location See Appendix List of Subcontractors For Congregate, Adult Day Care, and Facility Respite sites, the OAA Site Information Form must be utilized. This document is included Attachment I. c. Days and Hours of Operation; Monday -Friday, 8am-5pm, unless Client has a specific need that warrants weekend coverage d. Activities Describe the specific activities your agency will provide under this service. In -Home respite care is the provision of relief or rest for a for a primary caregiver from constant, continued supervision and care of a senior that physical and/or mental impairments that requires 24/7 supervision. e. Training Requirements: Describe the orientation and annual in-service training required of direct service staff providing this service. The contracted agency is licensed by the State of Florida, AHCA and its' employees have completed the Home Health Aide Certification, Alzheimer's Disease Training certification and HIV/AIDS certification. f. Program Income/Voluntary Contributions: Describe for this service the procedure for informing OAA clients of voluntary contributions NA • Describe for this service the voluntary contribution collection methods NA. • Include a plan for ensuring program income contributions will be obtained and identifyways that your agency can increase contributions. NA Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Service: Skilled Nursing Program: OAA a. Subcontractor Will your agency provide this service directly? ❑ Yes ® No If your agency will subcontract this service, list all subcontractors below: See SPA Appendix -List of Subcontractors Subcontractor(s) Business Name: Address: Phone Number: License Number (if applicable): Contract Start/End Date: Anticipated Monitoring Date: b. Site Location See Appendix List of Subcontractors For Congregate, Adult Day Care, and Facility Respite sites, the OAA Site Information Form must be utilized. This document is included Attachment I. c. Days and Hours of Operation; Monday -Friday (On Call 24/7) Monday -Friday 8am-5pm d. Activities Describe the specific activities your agency will provide under this service. Skilled nursing includes home nursing and medication management. This service may include checking client's vitals for glucose levels and blood pressure. Medication management includes screening and education regarding the client's prescribed and OTC medications. This service includes packaging pill boxes and understanding the importance of a medication specific time schedule. e. Training Requirements: Describe the orientation and annual in-service training required of direct service staff providing this service. The contracted agency is required to provide only nurses that are license in the State of Florida and have completed the Alzheimer's Disease Training and HIV/AIDS certification. f. Program IncomeNoluntary Contributions: • Describe for this service the procedure for informing OAA clients of voluntary contributions NA Describe for this service the voluntary contribution collection methods NA. Include a plan for ensuring program income contributions will be obtained and identifyways that your agency can increase contributions. NA Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Service: Specialized Medical Equipment, Services & Supplies a. Subcontractor Will your agency provide this service directly? If your agency will subcontract this service, See SPA Appendix -List of Subcontractors Subcontractor(s) Business Name: Address: Phone Number: License Number (if applicable): Contract Start/End Date: Anticipated Monitoring Date: b. Site Location See Appendix List of Subcontractors c. Days and Hours of Operation; Monday -Friday, 8am-5pm d. Activities Program: OAA -1113E, 1113ES ❑ Yes ® No list all subcontractors below: Describe the specific activities your agency will provide under this service. Specialized medical equipment, services and supplies include the following: adaptive devices or services that enable seniors to increase their ability to perform activities of daily living. This service can include walkers, bedside rails, commodes, touch lamps, adaptive eating equipment, glasses. Supplies may include diapers, bed pads, hygiene products, medical services, dental visits, pharmaceutical payment and nutritional supplements. These services shall only be provided if it cannot be purchased through Medicare, Medicaid or other third parties e. Training Requirements: Describe the orientation and annual in-service training required of direct service staff providing this service. NA -This service has no face to face contact with seniors. f. Program Income/Voluntary Contributions: Describe for this service the procedure for informing OAA clients of voluntary contributions NA Describe for this service the voluntary contribution collection methods NA Include a plan for ensuring program income contributions will be obtained and identifyways that your agency can increase contributions.NA H. Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Service: Congregate Program: C1 Meals a. Subcontractor Will your agency provide this service directly? ❑ Yes IN No If your agency will subcontract this service, list all subcontractors below: Subcontractor(s) Business Name: GA Foods Address: 12200 32nd Court North, Saint Petersburg, FL 33716 Phone Number: 1-800-852-2211 License Number (if applicable): n/a Contract Start/End Date: 5/14/2019-5/13/2024 Anticipated Monitoring Date: October 2019 b. Site Location East Naples Community Park 3500 Thomasson Dr. Naples, FL 34112 (239) 252-4864 Golden Gate Senior Center 4898 Coronado Parkway Naples, FL 34116 (239)252-4195 Goodlette Arms 950 Goodlette Road North Naples, FL 34102 (239)451-9923 Immokalee Roberts Center 905 Roberts Ave. Immokalee, FL 34142 (239) 657-1504 c. Days and Hours of Operation All sites are open Monday through Friday, except for holidays. East Naples Community Park, Golden Gate Senior Center & Goodlette Arms are open from 9am-1 pm. Immokalee Roberts Center is open from 8am-12:30pm and serves breakfast at 8:30am in addition to lunch. d. Activities CHS has been providing congregate meals for 10 years to seniors in areas of Collier County with the most economic need. The goal of the congregate meal program is to reduce hunger, isolation, depression and inactivity to at risk seniors in our community. All meals provide a minimum of 1/3 of the dietary reference intake/adequate intake (DRI/AI) for a moderately active 70+ female as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences. CHS's contracted Licensed Dietician/Nutritionist approves the menu before implementation to ensure meal compliance. Menus are visibly posted at each site. All Nutrition staff are trained in food safety by a Certified Food Safety Manager before handling meals to ensure proper procedures are followed. Meal temps are recorded at delivery and before serving. In 2018, 198 unduplicated seniors participated in CHS's congregate meal program. The program currently serves an average of 600 meals per week at four locations. We currently have 197 active clients receiving meals. There are 26 seniors on the waitlist, who will be added as funding becomes available. Seniors with the highest nutritional risk score will be added first. Nutrition staff complete the 701C assessment with clients to ensure eligibility prior to participating in the program. Clients that receive a 5.5 or higher nutrition risk score are referred to Nutrition Counseling with a Licensed Dietician /Nutritionist. Nutrition Education is offered monthly to all participating clients. Clients are encouraged to participate in bi-annual Advisory Council meetings. Activities such as bingo and bone builders are also offered at the meal sites. Bus passes (at no cost to the client) are available to clients in need of transportation to the meal sites. All services provided are documented in CIRTS by the Nutrition Program Supervisor, monthly by individual client. e. Training Requirements: • DOEA 701C Congregate Meals Assessment training (for Meal Site Coordinators) • Annual Food Safety training (all Nutrition staff) • Annual Fire Safety training (all Nutrition staff) • Bi -Annual Nutrition Education Train the Trainer (all Nutrition staff) f. Program Income/Voluntary Contributions: • Describe for this service the procedure for informing OAA clients of voluntary contributions. • Meal Site staff explain to new C1 clients that there is no fee for meals, however donations are accepted. All contributions shall be voluntary and the participant's ability or willingness to contribute shall have no effect on his/her enrollment in the program. New clients are shown where the locked donation box is located at each site. The donation box has a sign posted stating, "Thank you for your contribution. Please remember you do not have to donate to eat." Describe for this service the voluntary contribution collection methods. • The collection of contributions shall ensure the participant's confidentiality. Staff will not discuss a participant's contribution with the individual, another participant or a staff member. The donation box is displayed to not allow the value of the contribution to be determined. • Include a plan for ensuring program income contributions will be obtained and identify ways that your agency can increase contributions. • A locked box is made available at each site to collect contributions. Only the Nutrition Supervisor and Case Manager Assistant have access to the lock box key. The Nutrition Supervisor or Case Manager assistant retrieve the contributions along with the Meal Site Coordinator for that site and count the contributions together and prepare the deposit slip, The contributions are logged In the CHS F Deposit Log Book and monies with attached deposit slip are deposited in the CHS safe. Fiscal then processes the contributions. II. Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Service: Home Delivered Meals a. Subcontractor Program: C2 Will your agency provide this service directly? ❑ Yes ® No If your agency will subcontract this service, list all subcontractors below: Subcontractor(s) Business Name: GA Foods Address: 12200 32nd Court North, Saint Petersburg, FL 33716 Phone Number: 1-800-852-2211 License Number (if applicable): n/a Contract Start/End Date: 5/14/2019-5/13/2024 Anticipated Monitoring Date: October 2019 b. Site Location n/a For Congregate, Adult Day Care, and Facility Respite sites, the OAA Site Information Form must be utilized. This document is included Attachment I. c. Days and Hours of Operation: Deliveries are made Monday through Friday 8am-5pm d. Activities CHS has provided frozen delivered meals to frail and homebound seniors for 10 years. All meals provide a minimum of 1/3 of the dietary reference intake/adequate intake (DRI/AI) for a moderately active 70+ female as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences. In 2018, the Nutrition Program served 161 unduplicated clients. The C1 program currently has 110 clients, averaging 900 meals delivered weekly. This program currently has 42 clients on the waitlist. The Nutrition Program Supervisor refers to the waitlist in CIRTS when adding new C2 clients. Clients with the highest priority score are added first. Clients on the waitlist have already completed at minimum a telephone screening (701S) and are already determined eligible for home delivered meals. Clients with the highest priority score are added first. Nutrition staff make an appointment to complete the 701A assessment at the client's home. Client meets directly With the client or client's caretaker. Staff completes a client evaluation form for frozen delivered meals to ensure client has the physical and mental capability to properly prepare the meals. The number of meals authorized are between 5 to 14 meals per week, which are determined by the client's individual need. Clients that receive a 5.5 or higher nutrition risk score are referred to Nutrition Counseling with a Licensed Dietician /Nutritionist. Staff also refers clients to other services and programs when other needs are determined. After initial assessment, clients are assessed annually. Home delivered meals are documented monthly in CIRTS by individual client. e. Training Requirements: • DOEA 701A Home Delivered Meals Assessment training (Case Manager Assistant & Nutrition Program Supervisor) • Annual Food safety Training (all nutrition staff) • Annual Fire Safety Training (all Nutrition staff) • Bi -Annual Nutrition education Train the Trainer (all Nutrition staff) f. Program Income/Voluntary Contributions: • Describe for this service the procedure for informing OAA clients of voluntary contributions. • Nutrition staff explain to new C2 clients that there is no fee for meals, however donations are accepted. All contributions shall be voluntary and the participant's ability or willingness to contribute shall have no effect on his/her enrollment in the program. C2 clients receive Nutrition Education monthly via mail. The Nutrition Education is accompanied by a letter. On the letter it states, "We encourage you to send in your voluntary donations made payable to BCC. Remember any money donated goes right back into the nutrition program to help provide meals for collier County's home bound elders. Please be advised that donations should only be mailed in. Do not give a donation or gift of any kind to the driver who delivers your meals." • Describe for this service the voluntary contribution collection methods. Clients are instructed to mail in any voluntary donation made payable to BCC, to 3339 Tamiami Trail East, Suite 211, Naples, FI 34112. • Include a plan for ensuring program income contributions will be obtained and identify ways that your agency can increase contributions. • The contributions are mailed to the Manager of Services for Seniors. The donation is logged in the CHS Deposit Log Book and monies with attached deposit slip are deposited in the CNS safe. Fiscal then processes the contributions. II. Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Service: Nutrition Program: C1 & C2 Counseling a. Subcontractor Will your agency provide this service directly? ❑ Yes ® No If your agency will subcontract this service, list all subcontractors below: Subcontractor(s) Business Name: Janet Calderwood Address: 27800 Old 41 Rd., Bonita Springs, FL 34135 Phone Number: (239) 248-6191 License Number (if applicable): 926084 Contract Start/End Date: 1/1/19-12/31/19 Anticipated Monitoring Date: 4/25/19 b. Site Location (This service is performed at a meal site for C1 clients and in the home for C2 clients) East Naples Community Park 3500 Thomasson Dr. Naples, FL 34112 (239) 252-4864 Golden Gate Senior Center 4898 Coronado Parkway Naples, FI 34116 (239)252-4195 Goodlette Arms 950 Goodlette Road North Naples, FI 34102 (239)451-9923 Immokalee Roberts Center 905 Roberts Ave. Immokalee, FL 34142 (239) 657-1504 c. Days and Hours of Operation All sites are open Monday through Friday, except for holidays. East Naples Community Park, Golden Gate Senior Center & Goodlette Arms are open from 9am-fpm. Immokalee Roberts Center is open from 8am-12:30pm and also serves breakfast at 8:30am. d. Activities C1 & C2 clients found to be at high nutritional risk (scoring 5.5 or higher on the 701 C) are given the opportunity to receive Nutrition Counseling. The goal being the client would improve his/her nutritional risk level. Qualifying clients will then sign a consent for nutritional counseling to authorize the referral to the contracted Licensed Registered Dietician (LD/N). The LD/N contacts the client to schedule a face to face counseling session. For C1 clients, Nutrition Counseling takes place at the meal site or at the client's home. C2 clients receive this service in their homes. Case Managed clients of CHS Services for Seniors, who are not enrolled in C1 or C2 may also be referred for Nutritional Counseling. The LD/N will keep applicable written records that may include nutrition assessment, counseling plan, dietary orders, nutrition advice, progress notes and recommendations to the client. Documentation of counseling will be directed to CHS. Participation in Nutrition Counseling is recorded in CIRTS as a unit of service. e. Training Requirements: • This service is conducted license number 926084. by a Licensed Dietician/Nutritionist, f. Program Income/Voluntary Contributions: • Describe for this service the procedure for informing OAA clients of voluntary contributions. Nutrition staff explain to new C1 & C2 clients that there is no fee for Nutritional Counseling, however donations are accepted. All contributions shall be voluntary and the participant's ability or willingness to contribute shall have no effect on his/her enrollment in the program. New C1 clients are shown where the locked donation box is located at each site. New C2 clients are informed that they may mail their donation. Describe for this service the voluntary contribution collection methods. The collection of contributions shall ensure the participant's confidentiality. Staff will not discuss a participant's contribution with the individual, another participant or a staff member. For C1 clients the donation box is displayed to not allow the value of the contribution to be determined. C2 clients can mail in their donation. • Include a plan for ensuring program income contributions will be obtained and identifyways that your agency can increase contributions. • For C1 clients there is a locked box is made available at each site to collect contributions. Only the Nutrition Supervisor and Case Manager Assistant have access to the lock box key. The Nutrition Supervisor or Case Manager assistant retrieve the contributions along with the Meal Site Coordinator for that site and count the contributions together and prepare the deposit slip. C2 clients can mail in their donations to the Manager of Services for Seniors. The contributions are logged in the CHS Deposit Log Book and monies with attached deposit slip are deposited in the CHS safe. Fiscal then processes the contributions. Contributions are utilized to expand services for the C1 & C2 programs. II. Description of Service Delivery (By Service). This page must be completed for each service funded through OAA. Service: Nutrition Education a. Subcontractor Program: C1 & C2 Will your agency provide this service directly? ® Yes ® No The Nutrition Education curriculum is developed by the contracted Licensed Dietitian/Nutritionist. The LD/N trains the CHS Nutrition staff bi- annually. The CHS Nutrition staff directly provide the service to the clients. If your agency will subcontract this service, list all subcontractors below: Subcontractor(s) Business Name: Janet Calderwood Address: 27800 Old 41 Rd., Bonita Springs, FL 34135 Phone Number: (239) 248-6191 l License Number (if applicable): 926084 Contract Start/End Date: 1/1/19-12/31/19 Anticipated Monitoring Date: 4125/19 b. Site Location East Naples Community Park 3500 Thomasson Dr. Naples, FL 34112 (239)252-4864 Golden Gate Senior Center 4898 Coronado Parkway Naples, FI 34116 (239)252-4195 Goodlette Arms 950 Goodlette Road North Naples, FI 34102 (239)451-9923 Immokalee Roberts Center 905 Roberts Ave. Immokalee, FL 34142 (239) 657-1504 c. Days and Hours of Operation All sites are open Monday through Friday, except for holidays. East Naples Community Park, Golden Gate Senior Center & Goodlette Arms are open from 9am-fpm. Immokalee Roberts Center is open from 8am-12:30pm and serves breakfast at 8:30am. d. Activities • Nutrition Education curriculum is planned by CHS's contracted Licensed Dietician/Nutritionist. The LD/N researches materials and develops a culturally sensitive nutrition education plan for a 6 -month period, twice a year. The LD/N facilitates a Train the Trainer with nutrition program staff bi-annually. Documentation of the training includes the training sign in sheet, list of topics and materials to be distributed. Meal Site Coordinators facilitate Nutrition Education with C1 clients on days with the highest reservation count to ensure maximum participation. Documentation of Nutrition Education for monitoring purposes includes date and length of the presentation, name and title of presenter, copies of the curriculum, number of persons in attendance, in addition to a sign in sheet. C2 clients receive a monthly mailing with Nutrition Education handout. Documentation of C2 Nutrition Education includes the current client mailing list, copies of the curriculum, date of the mailing and the staff responsible for the mailing. Participation in Nutrition Education is recorded in CIRTS monthly by client, as a unit of service. e. Training Requirements: • Bi -Annual Nutrition Education Train the Trainer (all Nutrition staff) f. Program Income/Voluntary Contributions: • Describe for this service the procedure for informing OAA clients of voluntary contributions. • Meal Site staff explain to new C1 & C2 clients that there is no fee for Nutrition Education, however donations are accepted. All contributions shall be voluntary and the participant's ability or willingness to contribute shall have no effect on his/her enrollment in the program. New C1 clients are shown where the locked donation box is located at each site. New C2 clients are informed that they may mail any voluntary contribution. • Describe for this service the voluntary contribution collection methods. • The collection of contributions shall ensure the participant's confidentiality. Staff will not discuss a participant's contribution with the individual, another participant or a staff member. The donation box is displayed to not allow the value of the contribution to be determined. C2 clients can mail in their donation • Include a plan for ensuring program income contributions will be obtained and identifyways that your agency can increase contributions. • A locked box is made available at each site to collect contributions. Only the Nutrition Supervisor and Case Manager Assistant have access to the lock box key. The Nutrition Supervisor or Case Manager assistant retrieve the contributions along with the Meal Site Coordinator for that site and count the contributions together and prepare the deposit slip. The contributions are logged in the CHS Deposit Log Book and monies with attached deposit slip are deposited in the CHS safe. C2 clients can mail in their donations to the Manager of Services for Seniors. The contributions are logged in the CHS Deposit Log Book and monies with attached deposit slip are deposited in the CHS safe. Fiscal then processes the contributions. Contributions are utilized to expand services for C1 & C2 programs. OAA Subcontract Monitoring Schedule Include information on all OAA funded Subcontracts County: COLLIER COUNTY Date: 06/18/2019 II.A.4.a SUBCONTRACT MONITORING SCHEDULE Include all OAA Funded Subcontractors and Vendors Subcontractor or Vendor Date of Program Service Fiscal//Admin. Visit Programmatic A BETTER HEALTH CARE APRIL CCE, ADI, PECA, HMK, RESPITE, BOTH 1 OA3B, OA3E HN ALMOST FAMILY APRIL CCE, ADI, PECA, HMK, RESPITE, BOTH 2 OA3B HN ALWAYS THERE APRIL CCE, ADI, PECA, HMK, RESPITE, BOTH 3 OA3B HN ARDEN COURT APRIL OA3B ADC, RESF BOTH 4. HEALTH FORCE APRIL CCE, ADI, PECA, HMK, RESPITE BOTH 5 OA3B HOME INSTEAD SOUTH APRIL CCE PECA, HMK BOTH 6. JANET CALDERWOOD APRIL C1, C2 CNM, HDM BOTH 7. PHILLIPS APRIL CCE EARS BOTH 8. VIP AMERICA APRIL CCE, ADI, PECA, HMK, RESPITE BOTH 9 OA3B GAFOODS OCTOBER C1,C2 MEALS BOTH 10. 11. 12. 13. 14. 15. VENDOR MONITORING Vendor: 'grvices Provided: -aad Agencies Covered by Report: Date of Review: General Standards Yes No Part NIA Comments 1 License is current, if required. 2 Vendor complies with state registration requirements / background screening, if applicable to service. 3 Staff training; Training logs are maintained. Annual Training Plan Training logs were reviewed. Topics included and evidenced; a. Annual Client confidentiality and Annual HIPAA review 4 Clients report satisfaction with service/s received from this Vendor. (From completed Client Service Review forms.) 5 Complaint logs are maintained and clients are given the opportunity to request a worker change if dissatisfied with service. (reviewed by monitor and samples are held at Lead Agency with monitoring back up documents) 6 Case Managers indicate client complaints are minimal / addressed quickly. 7 Staff in direct contact with clients do not handle money unless permitted by the service provided (minimual requirement is workers are trained upon hire). a) Policy has been reviewed and is acceptable b. Policy has been reviewed and needs some revision. 8 Incident Reports are appropriate, timely, and on file. a. Reports are sent to the Lead Agency. SERVICE STANDARDS Yes No Part NIA Comments 9 Agency appears to comply with law/ Department of Elder Affairs Service's Handbook. 10 Vendor has and follows written HIPAA policies/procedures. 11 Vendor carries contractually required proof of the following; Workman's Compensation: ACORD expiration: $100,000.00 each accident Commercial General Liability Insurance: $1,000,000 Per Occurrence Bodily Injury Liability and Property Damage Professional Liability Insurance: $ 1,000,000.00 coverage Business Auto Policy: (Business vehicles owned, hired, non -owned, and employee non -ownership) $ 300,000.00 Per Occurrence Combined Single Limit Bodily Injury and Property Damage Liability Agency ACORD names Lead Agencylies as'Additional Insured'? Vendor has current Certificate of Insurance that complies with contractual requirement. VENDOR MONITORING Vendor: irvices Provided: 'ead Agencies Covered by Report: Date of Review: General Standards Yes No Pad N/A Comments Fiscal Standards Yes No Pad N/A Comments 18 Vendor has completed and submitted the Civil Rights 12 Compliance Questionnaire for the fiscal year. b. are generally accurate, 14 Vendor maintains written policies and procedures for Obtain copy. 19 systems management. Procedures are in place to If Vendor has submitted late or inaccurate invoices during the fiscal year being reviewed, provide a brief narrative of what happened, when it happened, and what steps/measures maintain system security and routinely back-up of data per were/are taken to prevent this from happening in the future 21 Vendor complies with single -audit requirement (if applicable). Chapter 44-4.070, FAC or as subsequently amended. A review of the immediate past year's monitoring report has 15 been completed, any/all corrective actions cited have been addressed satisfactorily? Regarding Debarment, Suspension, and Ineligibility; 16 confirmation DUNS# using www.sams.gov has been made, Vendor may conduct business. (affach copy to final report) 17 Are there any significant or trending issues with this vendor that need to be addressed. Fiscal Standards Yes No Pad N/A Comments 18 Vendor invoices; a. are submitted timely, b. are generally accurate, c. copylies of Fiscal Monitoring Statements are attached. 19 If Vendor has submitted late or inaccurate invoices during the fiscal year being reviewed, provide a brief narrative of what happened, when it happened, and what steps/measures were/are taken to prevent this from happening in the future 21 Vendor complies with single -audit requirement (if applicable). updated 212019 Collier County Community and Human Services Division Standard Operating Procedures Services for Seniors Client Incident Procedure Purpose: A report needs to be filed with CCSS and the Area Agency on Aging of SW Florida when a client has an incident in their home which requires medical attention, law enforcement and/or serious follow-up while the contracted vendor is present. Description: Each client served by CCSS and the Area Agency on Aging for Southwest Florida that has an incident in their home, will have an Incident Report completed and a copy will be kept in the Client File, and sent to AAA and the Service Provider. Procedure: 1. When the Case Manager is made of aware that an incident has occurred to the CCSS client in their home, CM will request the Service provider to complete the Vendor's Incident/Occurrence Report. 2. The case manager will speak to the vendor and client and get a full verbal report before completing the Collier County Services for Seniors Incident Report. Case notes and any pertinent correspondence with the client and vendor will be referenced throughout the process. The case manager will log the Incident on the CCSS Incident Log, provide all the information to the Manager. The Manager will review the Incident and document comments/findings. The Manager will email the Incident Log and a copy of the Incident Report to AAA SW Florida. A copy of the report will be placed in the Client's file. 4. The case manager will be responsible will follow up and resolve any issues that pertain to the incident under the supervision of the Manager. June 22, 2018 � � \ � \ � � \ « a� • j!� � R,(\\ a j) . .:per » § ƒ)� j p ; \ j ,t \ INCIDENT REPORT COLLIER COUNTY SERVICES FOR SENIORS DATE: CONSUMER: SUBJECT: STAFF: Please refer to the attached case notes regarding the consumer identified above. This incident report and supporting documents have been copied to: Manager Signature ❑ Area Agency on Aging FISER VICE PROVIDER: ❑ CONSUMERS FILE: Collier County Services for Seniors Date C= l 4 a r C n 14 )f t INCIDENT REPORT COLLIER COUNTY SERVICES FOR SENIORS DATE: CONSUMER: SUBJECT: STAFF: Please refer to the attached case notes regarding the consumer identified above. This incident report and supporting documents have been copied to: Manager Signature ❑ Area Agency on Aging FISER VICE PROVIDER: ❑ CONSUMERS FILE: Collier County Services for Seniors Date Collier County Community and Human Services Division Standard Operating Procedures Documenting and Reporting Complaints Purpose: To describe the process of documenting and reporting complaints from clients andlor vendors. Description: Services for Seniors staff are required to document, report and address all complaints made to them by clients and/or vendors. Procedure: 1. Upon receiving a complaint, the Case Manager will contact the parties (client, provider, etc...) involved within 7 calendar days to gather facts and discuss the situation and possible resolutions. 2. The Case Manager will work with the client and/or vendor to resolve the issue which led to the complaint. When needed, the Case Manager may develop a resolution independently based on the Lead Agency's policies and procedures. However, when appropriate, the Case Manager may facilitate the process of resolving the issue(s) between the client and vendor. 3. The complaint is recorded in the clients file with the facts gathered from the contacts/discussions and what actions have or will be taken to address the complaint. 4. The Case Manager then records an entry on the "Complaint Log" and submits the log to the Manager for review. The Complaint Log is then submitted to the Area Agency on Aging for Southwest Florida by the Manager monthly. 5. The Case Manager completes follow-up on the complaint as he/she determines necessary and records the follow-up accordingly. Follow- up should be should be completed within 7 calendar days of receipt. The resolution will be documented both in the case narrative and on the Complaint Log. In the event a vendor or other service provider needs to be changed, the resolution may take longer to complete. 6. The reporting of complaints is discussed at every program staff meeting and is an ongoing agenda item. 7. Should a complaint be filed due to the suspicion/accusation of the HIPAA standards, the grievance shall be immediately reported to the HIPAA Privacy Officer. The Privacy Officer must investigate the complaint within 7 calendar days to determine if there was a HIPAA violation and the Client file will note that the issue was referred to the Privacy Officer and the results of the investigation and what if any corrective action was taken. Updated 02/21/19 Collier County Community and Human Services Division Standard Operating Procedures Documenting and Reporting Complaints 8. The CHS Division Director will be notified immediately if a HIPAA violation occurred concerning a client and their personal information. 9. The Manager emails all written complaints monthly to the Area Agency on Aging Program Specialist for review. 10. Any complaint reported against a contracted vendor will be addressed by the CCSS Manager to the Director of the vendor agency promptly and will request a verbal plan to avoid future complaints against the vendor's performance. CCSS will ensure vendor monitoring reports will reflect trending complaint issues with specific vendors that complaints have been filed against during the monitoring year. Updated 02/21/19 Collier County Community and Human Services Division Standard Operating Procedures Services for Seniors Grievance Procedure Purpose: To describe the process of informing clients of their right to grieve or formalize a disagreement with this agency's client care decisions. Each recipient will be notified within 10 calendar days in writing, of actions that will neither reduce, suspend or terminate his1her current level of services. Description: Each client served by the Area Agency on Aging for Southwest Florida has the right and ability to grieve any decision made by the Lead Agency regarding or affecting his/her services. The procedure and process to be followed by the Lead Agency and the client is provided below: Procedure: A. Lead Agency: 1. At the Initial Assessment, and again at the Annual Assessment, the client is notified by the assigned Case Manager of his/her right to file a grievance in the event of a disagreement with the Case Manager/Lead Agency: a. The client is asked to sign and date the Collier County Services for Seniors Grievance Procedure confirming he/she has been made of aware of this right and provided a copy of the procedure and the "Minimum Guidelines for Recipient Grievance Procedures Applicable to all Adverse Actions Deemed Terminations, Suspensions, or Reductions in Service". The Case Manager initials this signed form. b. A copy of the Grievance Procedure and Minimum Guidelines are given to the client for his/her records. c. The signed and dated Grievance Procedure and a copy of the Minimum Guidelines are filed in the client's record. 2. As the Grievance Procedure and/or Minimum Guidelines are modified or revised by the Lead Agency or DOEA, the client is asked to sign and date the new document. 3. If/when the Case Manager is made of aware of the client's desire to file a grievance, the Case Manager will send a copy of the Grievance Procedure and Minimum Guidelines to the client if the client does not already have an up-to-date copy. 4. In addition to the Grievance Procedure, clients sign and date this form annually confirming they are aware of their right to request a hearing regarding any actions affecting their eligibility. 5. Case notes and any pertinent correspondence with the client will be referenced throughout this process. Updated April 5, 2018 Collier County Community and Human Services Division Standard Operating Procedures Services for Seniors Grievance Procedure 6. Grievances alleging a violation of PHI/HIPAA will be immediately reported to the Division Director and to the HIPAA Privacy Officer. The Privacy Officer must investigate to determine if there was a HIPAA violation and the Client file will note that the issue was referred to the Privacy Officer and the results of the investigation and what if any corrective action was taken. B. Client: 1. The Grievance Procedure is as follows: Step 1: Discuss with your Case Manager the problematic issue. If resolution at this level does not meet your expectations: Step 2: A formal meeting* between the client, Manager of Senior Programs will be arranged within 7 calendar days. If resolution following this meeting is not acceptable: (*Phone conferences may be substituted) Step 3: A formal meeting between client, Manager and Division Director will take place with 7calendar days. If resolution following this meeting is not acceptable: Sten 4: A written request by the client for a formal hearing with the Manager, Division Director and Public Services Administrator will take place at the office of the Public Services Administrator. A written response detailing the date and time of this hearing will be sent to the client within 14 calendar days of receipt of the client's request. Final determination of appropriate action on this level will be determined at this hearing. Address requests for this meeting to: Public Services Administrator, 3339 Tamiami Trl. E., Bldg H, Naples, FL 34112 Step 5: This decision may be appealed to the Area Agency on Aging by written request within 7 calendar days to: Area Agency on Aging for Southwest Florida - Executive Director, 15201 N. Cleveland Ave, Suite 1100, N. Fort Myers, FL, 33903. Updated April 5, 2018 8 C Cole r County Public Services Department Community & Human Services Division SERVICES FOR SENIORS GRIEVANCE PROCEDURE Collier County Services for Seniors staff endeavors to provide quality service to each of our clients. In the event of client disagreement with this agency's client care decisions; the following grievance procedure is available to all clients: Step 1: Discuss with your Case Manager the problematic issue. If resolution at this level does not meet your expectations: Step 2: A formal meeting* between the client, Case Manager, and the Manager of Senior Programs will be arranged within 7 calendar days. If resolution following this meeting is not acceptable: (*Phone conferences may be substituted) Step 3: A formal meeting between client, Manager of Senior Programs and Division Director will take place. If resolution following this meeting is not acceptable: Step 4: A written request by the client for a formal hearing with the Manager of Senior Programs, Division Director, and Public Services Administrator will take place at the office of the Public Services Administrator. A written response detailing the date and time of this hearing will be sent to the client within 14 calendar days of receipt of the client's request. Final determination of appropriate action on this level will be determined at this hearing. Address requests for this meeting to: Public Services Administrator 3339 Tamiami Trail East, Bldg H, Rm 217 Naples, FL 34112 Step 5: This decision may be appealed to the Area Agency on Aging by written request to: Area Agency on Aging for Southwest Florida, Inc. — Executive Director 15201 N. Cleveland Ave., Suite #1100 North Fort Myers, FL 33903 Please be aware the case notes and any pertinent correspondence with the clients will be referenced throughout this process. If any part of this procedure requires further clarification, please call the Manager of Senior Programs at 239-252-2696. Signature below confirms receipt of the "Minimum Guidelines for Recipient Grievance Procedures". Client Signature Date Cm Initials Community & Human Services Division - 3339 Tamiami Trail East, Suite 211 • Naples, Florida 34112-5361 239 -252 -CARE (2273) • 239-252-CAFt (2233) 239-252-4230 (RSVP) - www.colliergov.neBhumanservices lul ILIILVA Lei Ti[4Nll» 1ILI1*1011400111714011[h:f MY/Al ![•1A7ZiZAAZ0TO 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 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 APPEALTO 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 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 Collier County Community and Human Services Division Standard Operating Procedures Quality Assurance Purpose: To ensure services provided to clients are satisfactory and provided with professionalism and care and in compliance to the service authorization between CHS and the contracted vendor. Description: All services will be monitored for quality assurance by CHS case managers, CHS Manager and the CHS Monitoring Unit. According to the Department of Elder Affairs Manual. Procedures: Staff: 1. Will authorize client services via a service authorization form that will be emailed to the vendor. 2. The case manager will contact the client within 14 days to verify/review with the client that the services are being delivered, the services received are correct and the services are satisfactory. 3. If services change and/or increase, the case manager will complete an additional 14 days review with the client. 4. There is an annual client satisfaction survey that is mailed directly to the client and their caregiver, results are tabulated in a report that is reviewed by the Division Director and Board of County Commissioners. All surveys received are reviewed by the CHS Manager and clients requesting to speak to a Manager are contacted by the Manager to get more information and to ensure client satisfaction. 5. Clients are informed to contact their case manager and/or the vendor to report any problems, complaints or issues. Case managers make every effort to work with the assigned vendor and may need to go to the rotation list and choose another vendor to staff the case. 6. CHS as a Formal Complaint Log that is maintained by case managers and the manager, who receive client complaints. The complaint log is reviewed during the AAA Annual Monitoring and submitted to the DOEA annually. Updated January 3, 2018 Sincerely, Manager Senior Programs and Social Services How was our service? Click here to take the survey. CID 7871 79nty Community and Human Services Making our Community Stronger: One life, one home, one project at a time. NOTE: Email Address Has Changed Louise.Pelletier@colliercountyfl.gov 3339 East Tamiami Trail, Building H, Room 211, Naples, FL 34112 Phone: 239-252-2696 Fax: 239-252-6539 To improve our services and technical assistance to our clients, vendors or subrecipients, we ask that you provide us feedback on our services to your organization by completing the short survey contained at the following link: NOTICE OF DISCLOSURE: Confidential Health Information Enclosed. This message may contain Protected Health Information that is of a sensitive and confidential nature and has been disclosed to you from records whose confidentiality is protected for Florida State Statues and Federal Law. It Is being sent to you with the authorization of the patient or under circumstances where authorization is not required. You are required to maintain this Information without first obtaining the specific written consent of the person whom such Information pertains, or as otherwise permitted by State/Federal law. Unauthorized re -disclosure my subject you to Federal and/or State law penalties. IMPORTANT WARNING: The inforamtion contained in this message is intended only for the personal and confidential use of the designated recipient named above. This message may contain confidential or privileged information,the disclosure of whichh is governed by applicable laws. If the reader of this message is not the Intended recipient or an agent responsible for delivering it to the Intended recipient, you are hereby notified that you received this message in error and that any review disclosure, dissemination, distribution, or copying of this message or taking any action in reliance on its contents, Is strictly prohibited. If you received this communication in error, please notify us immediately and destroy the documents. Client Name: leviewed by: General Documents to all Files: n CCSS Monitoring Cheeldist Case Manager: Date: Comments/Corrections Needed: 701B Assessment Tool Care Plan Sr. Choices Authorization CIRTS Enrollment Screen CIRTS Care plan Screen CIRTS Turnaround Report (Signed) Service Authorization Grievance Procedure Release of Information Notice of Privacy Practice Policy Complete case notes/narratives 14 day Follow-up narrative Nutrition Frozen Food Form 217 Vendor Work Sheets (if requested by AAA) ADUCCE HCE OAA/SCAS Cl/C2 701 B. Assessments: 'es / No: Does the turnaround report match the CM's 701B assessment and are the assessments signed? Notes: Yes / No: Is the 701B Nutrition score> 5.5? Care Plan: Yes / No: Are any programs listed on the CIRTS enrollment screen not listed on the Care Plan or vice versa? Notes: Yes / No: Does CIRTS care plan match the file care plan? Notes: Yes / No: Care Plan signed and dated by Case Manager and client? If HCE, signed by caregiver? Yes / No Yes / No: Are non-DOEA funds used to address some of the client's needs? Are all NDP services listed? Note: Yes / No: Is the care plan costs calculated accurately and noted on the plan? Note: APS: Yes / No: Was the Intake/Assessment completed within 72 hours for the High Risk Referral? If not, why? Yes ! No: Were services started within 72 hours for the High Risk Referral? If not, why? Yes / No: Was the APS High Risk Documentation Form completed during the initial 30 day period? Yes / No: Is the 1099 form DCF present in file? CCE: Yes /No: Yes / No: Notes: Does client meet ICP criteria for the LTCC program? Note: If yes, has the client been identified in CIRTS as LTCC-APCL: Yes Has a 2515 been sent to DCF: Note: Miscellaneous: Yes / No: For newly enrolled clients, was a 14 day follow-up contact made? Note: Yes / No: Is the co -pay amount correct based on payment schedule? Note: Comments/Corrections / No Partnership Meetings It is the policy of CHS to hold quarterly partnership meeting with each of its active sub - recipients. CHS seeks to maintain a positive relationship with all its sub -recipients. In order to promote this collaboration effort CHS will host sub -recipient partnership meetings on a quarterly basis. These meetings will be hosted at the aggregate and at the individual organization level on a quarterly basis. At the aggregate level, CHS will provide technical assistance on specific subject areas (i.e. Davis Bacon, Section 3 reporting, etc.), any upcoming news, information/programs and/or requirements from HUD, announce new changes to programmatic requirements by the county, and share best practices. CHS seeks to have an informed cadre of sub -recipients, and will ensure they are aware of upcoming changes and/or areas of emphasis by HUD. At the organization level, CHS will use partnership meetings to ensure agreements are progressing, discuss any questions or concerns the sub -recipient may have, and/or discuss any issues involving pay requests. CHS staff may also use these meetings to address programmatic problem areas unique to the sub -recipient, provide one to one technical assistance, or discuss possible future projects. The Grant Operations Coordinator will set up the scheduling of individual partnership meetings for each active sub -recipient organization. This schedule will ensure individual partnership meetings occur at least quarterly during the term of the sub -recipient agreement. The Grant Operations Coordinator will email the assigned time and date of each partnership meeting to the sub - recipient, the grant coordinator, and the CDBG program manager. 2. The assigned Grant Coordinator is responsible for setting the agenda of the partnership meeting and securing a conference room for the meeting. At a minimum the agenda will include; Project Status, Old Business (if any), New Issues/Concerns (if any), Next actions, date/time of next partnership meeting. The work plan for each project will be provided and reviewed. The CDBG program manager is responsible for reviewing and approving the meeting agenda. 3. The Grant Coordinator is responsible for chairing the partnership meeting. The CDBG program manager will take notes of the proceedings of the meeting and will provide them to the Grant Operations Coordinator for transcription. Once the meeting notes are reviewed and approved by the CDBG program manager, the Grant Operations Coordinator will email a copy of the minutes to the Grant Coordinator, the sub -recipient and the CDBG program manager. 4. The Grant Coordinator will print a copy of the minutes of the partnership meeting and file it in the project file. 5. The Grant Coordinator will monitor and track any follow up items noted in the minutes through to completion. PARTNERSHIP MEETING AGENDA t March 25, 2019 2:00 pm GA Foods • Introductions • Minutes: (Louise Pelletier) o Minutes approved with no changes or corrections noted • Fiscal: (Dory Carrillo) o Program progression as of 3/20/19 is C1 TOTAL EXPENDITURES FOR 2019 $32,088.84 C1 Inv. Wk Date' Amount Payment Sent' Date+ WK 2/23/19 $2,176.12 Payment in proc WK 2/28/19 $2,625.59 WK 3/01/19 $656.40 WK 3/09/19 $3,219.16 C2 TOTAL EXPENDITURES FOR 2019 $37,562.12 C2 Inv. Wk Amount Date Payment Sent' Date WK 2/23/19 $4,504.36 Payment in proc WK 2/28/19 $3,924.40 Payment in proc WK 3/01/19 $604.13 Payment in proc WK 3/09/19 $4,543.02 Payment in proc WK 2/16/19 $4,253.04 Payment in proc C1 Payments: o Total expenditures so far: $32,088.84 o Invoices not received: wk 3/16/19 C2 Payments: o Total expenditures so far: $37,562.12 o Invoices not received: wk 3/16/19 • Timeliness: (Dory Carrillo & Wendy Klopf) o Invoices and backup documentation have been submitted on time o All outstanding Signatures —received to date by Wendy o Be sure all invoices show the invoice date and current PO #, or Clerk will reject o Invoice submittal process: o BCCAPCIerk — has 30 days to review/process from invoice date o BCCAPCIerk — forwards to Dory, who forwards to Wendy to approve/reject o Revisions start the clock over o Mark "REVISION" and change date on invoice when resubmitting to BCCAPCIerk and Wendy • Program & Performance (Danielle Mordaunt) o Deliveries to home • No rejections due to temp issues ■ New clients receiving first delivery in timely manner o Deliveries to congregate meal sites ■ Rejected meals 02.22.19 due to temping issues ■ Reimburse for meals to East Naples & Goodlette Arms & Golden Gate • Reimburse for Pizza & fruit cups purchased $140.00 & $64.96 for the 3 sites o Menu- New menu began March 2019 with positive client feedback • Subrecipient Comments: (GA Foods) • Deliverables: (Dory Carrillo Wendy Klopf) o Weekly invoices for C1 and C2 being received timely • Reports: (Danielle) o Next HDM Client Delivery List due ???? • Follow-up Items: (Louise) • Congregate Meal Deliveries • Senior Nutrition RFP • Next Meeting: 06/24/19 2:00 pm G®'r Prlblic �erV#oe� I�Ivislon Community & Heiman Services COLLIER COUNTY COMMUNITY & HUMAN SERVICES SERVICES FOR SENIORS PROGRAM PROVIDER TRAINING January 23, 2019 AGENDA Welcome II. Introductions III. Program Overview IV. Billing and Invoicing V. Vendor payment schedule VI. Questions and Answers co er ct)u ty MEETING -Sign in Sheet Vendor Kick Off: a6 Q �E�tIIC�i Date: ` r',oq I I O Meeting Location: a� Lo Name -Print Name Ak �'���-�,�,u�xa �rG►1.ec' Al Signature d`. • revise 'revise, revisal • revisal revisal 'revised COLLIER COUNTY SERVICES FOR SENIORS CCE, ADI, HCE & OAA July 1, 2018 to June 30, 2019 EACH BILLING PERIOD ENDS THE SUNDAY BEFORE THE LAST SUNDAY OF THE OF THE REPORTING PERIOD SERVICE MONTH SERVICE PERIOD *WEEKLY BILLING MONTHLY INVOICE DUE DATE DUE DATE JULY,CCEIADIIHCE July 1 - July 22, July 11, 18 & 28 2018 July27, 2018 JULY -OAA June 18 -July 22, June 27 July 8, 11, 2018 18, 25 (OAA) July 23 - August 19, AUGUST Aug 1, 8, 15, 22 Aug 24,2018 2018 i SEPTEMBER August 20 - Aug 29, Sept 5, 12, Sept 21,2018 September 16, 2018 19 OCTOBER September 17 - Sept 26 -Oct 3, 10, October 26, 2018 October 21, 2018 17 & 24 October 22- Oct 31, Nov 7,114 & NOVEMBER November 98, 2098 21 November 23, 2018 DECEMBER, November 19- CCHIADIIHCE December 16, 2018 Nov 28, Dec 5, 12 December 21, 2016 November 19 - i DECEMBER -OAA December 39 2018 Nov 28, Dee 5,12, December 37 2018 * End of OA30 & Week of December OAA Final Billing OA3E grant 30.31 1/11/2019 December 22- Dec 23, 30 Jan 6,13 JANUARY. January 20, 2019 8.20 CCE/ADIIHCE January 1, January 25, 2019 JANUARY. 2019 -January 20, Jan 09, 16, & 23 1 2019 OAA FEBRUARY January 21 - Jan 30, Feb 6, 13 &'' February 22, ZD19 February 17, 2019 Y0 MARCH February 18 - March Feb 27 Mar 6, 13, 20 2019 24 2019 r & 27,March.29, APRIL March 25 - April 21, Apr 3, 10, 17 & 24 April 26, 2019 2019 April 22 -May 19, MAY 2019 May 1, B, 15 & 22 May 24, 2019 May 20 - June, 30, JUNK-CCEIADIIHCE 2019 May 29, June 5, 12, July 121, 2019 End of CCEIADI 19 & 26, July 3 grants JUNE -OAA May2O - June 30, May 29, June 8,12, June 28, 2019 2019 19 & 26 ***" WEEKLY BILLINGdS DUE ON WEDNESDAY FOR THE SERVICES PROVIDED DURING Holidays may affect the billing cycle. Providers will be notified In advance of any change. wrnpany s rvarno nere Collier County Services for Seniors Homemaker/Personal Care/Res itelCom anion Work Sheet Client Name: Client Signature: Week Ending: Each Time You Perform one of the Activities Below: Put in arrival and departure times for the day worked: "***Client should Initial time of arrival and departure. (Required) ****Client should Sign form at top. (Required) ****Aide should sign name at the bottom. (Required) Date: Day: MON TUES WED THURFRI SAT SUN TOTAL TIME ARRIVAL TIME: DEPARTURE TIME: ****CLIENT INITIALS: PERSONAL Arrive: CARE Depart: Assist W/Bath tub Shower Bed Assist W/Dressing Bathroom Assist Shave Face Only) Oral Hygiene Walking/Ambulation Feeding Assistance Wash/Set Hair Backrub Soak Feet Nails File only) Chane Make Bed Take out Trash Clean Bedroom Clean Bathroom Prepare Meals Laundry HOME Arrive: MAKING Depart: Vacuum/Sweep Light Dustin Clean Kitchen Floor Wash Dishes Mop/Sweep Grocery Shop Errands Arrive: RESPITE Depart: Arrive: COMPANION Depart: EMPLOYEE'S Signature (Required) 7 @3 )/ R® (( (( (( » / / / ( % i b Q 7 •p o QQ � b y Qi N bO O .� O .� b'n m a U N s V Cl) N �bbb N Cl) Q •�a+ O P N N N 04 GL H w •� � U@ v i a � 3 0 � N '� �° a 0 0 OM 4 �' w �a �n 'a Q a W y � .LJ —p�I .�' .li � {C O � p .�/Ml [!. � p Cy G❑ti YH (� 1Y-� f0 O N t3 O N O y> 1Y-� t0 N p COi N I_0� �O N MGO id �p (•Oy U N N N N N � 0 0 o rn o � � T O � A m q0 U .q � ry O r' N q'O iJ V z d N b T 0 d[tiff d b�.hUs y � y A y 0��T d n 00o Y qqG M,o �OC/ q °n oO 0 $PyYaw'�a U q d�H� 0 qq5 U LNay Gn°❑Cq« w z �w ,.� 0.1w a a •ia ��" O 'PI tj 3.���• r7 w c ""'o d y o 0 q 0 O 4v ro °% id a 0 o �' o L o q o U o c> U> `� .'� d .� o °4 0 `� d m m >' sV. •C v o U w a °n d o0 00 00 y v oo roa t� n oo oo in '� T ❑ o � ,y a U a DO N r '�" C \ O N � N N t -i T ,� OH O q� O q � q H '� Nq C .rd 'O 0 N H ,0 0 {e .d b 0 N H q •a'S •� wad 0 0 N N l6 /y 0 '� IUE� H •ti 4d Aw H tOy fO /r U H wac7 X M tL {6 70 c70 q 0 0 q0 O .N 0 q 0 — 0 0 0 , 0v N O O NO tO p 0NO UaA Au VAa> O C N o0 o � 0 � 0 N abi abi T T abi � N .0 0 ° r z z z bJD W) �O U q .� A .p� N 7 •� V] 0� o� °O ti Q� y �y U U Py U •n Q p O Q d•ro UO b4 by v � �U Z t w U op3 aw � nr�TjoU t7 w w Uzcn• N�Qv�OZA 00 C p O o ^J 14°vi U a �; A U A a 0 0 O U O c0 20 z z 0 z cn b5 m .P y Py U U 7 H U 00 O H 04 fi i fd O U — .Cr .F, 11 C ^'-� O FU. y 0bi) C r' O }y. O N O O 00 ixd, .0 U P Ucn� O O � bAQ GL ���� U U C O y�0❑^O U A 00 a N O F, y ON f0 N� /yPH N P, PQ 0 N � d pt O O O d p O O a'Di p O 00 00 00 00 O � N a w A p w o 0 0 0 0 .G M �A a U Np vi b •� � � O O >' a U o A W w m p N p `ani r/ ' bA W p V p O U A ;10O � w A o � a� � N p d .� W '�' •o � •� � w w a w t w ¢� U ] W b Y q Y Y a s 0 0 0 o'G 'B o y m •a� •a' N o'G o •°: p p �a a - U � w v a a 0 U w o'ci o W qm . a� .,, ^" o .O .p� N •-' rO ,ay' o m P1 •� U .pHp J� � _ t� O U a.�.AAv� O O id p a) aA,? O nt O A.4 i.0 m UAa.�A a) p 0 t�o R UA.�..a a) 0 0 0 0 0 .0 rn o _ A N cn NO 7 O M M N O N b a \ N o O � N N -+ N U N L b .7i � O •� • ^ bi td N O C. bA O .� y W v 'C P+.� N O b .. Cl) Q O Q U "may N' '� •" .tiN n v o d o d as C O � � O Wr ti L H N N vi .�. b a0 U •R �+ V] F: t. "y' c�} .s1 O bq L 'q U .� w d 'a 0 a vii w Nn N N •p w 'N •�Q � �� A=dd �aFU•.°'p � `�(�Q v '9 c U a Y s° •�' i. � H T.5 � .�' � '5 aLi 0.l � ro � o � •�'' a' p, •�'' ro �i o � � � Q h�w3�w¢���x3ti q? q? N A •� '�^ a � � 'G �^ c7 � q •� N b 'd 1�y iY. U Ua,?AA� Ua.',QA Ua�WW rn r' � � � � o N 0 I. Goals, Objectives and Performance Measures Outcome Measure 1: to be Completed by C1 & C2 Applicants Only Outcome Measure 1 Percent of new service recipients with high risk nutrition scores whose nutritional status improved. Standard: 66 percent (Percent of new consumers with a "high risk" nutritional score in the DOEA 701 C assessment form that improved at their next assessment.) Strategy/Action Steps: Describe your strategies for meeting this outcome measure with the services you are proposing. If you plan to exceed the standard describe how this will be accomplished. • Completion of 701A & 701C assessments • Provide referrals for additional food resources (SNAP, food banks, etc.) • New clients with the highest nutritional risk will be added to C1 & C2 first from the waitlist • Target older adults who have the greatest economic or social need with attention to low- income minority and rural clients Outcomes: Describe the result or impact of program activities on the client/consumer. • Client's nutritional score will no longer be at high risk • Reduce client's hunger and food insecurity • Delayed onset of adverse health conditions resulting from poor nutritional health or sedentary behavior • Increased knowledge of nutrition • Promote socialization for C1 client's Outputs/Inputs: Describe the services that will be delivered to clients/consumer (units of service) to meet the objective and the resources used to provide those services (dollars, staff, etc). Completion of 701A annual assessments by Case Manager Assistant & Nutrition Program Supervisor Completion of 701C annual assessments by Meal Site Coordinators, Case Manager Assistant & Nutrition Program Supervisor Congregate & home delivered meals provided will be a minimum of 113 of the adequate dietary intake for an age 70+ female as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences in compliance with the current Dietary Guidelines for Americans published by the secretaries of the Department of Health and Human Services and the Department of Agriculture • Nutritional Counseling offered with contracted Licensed and Registered Dietician • Monthly Nutrition Education developed by Licensed and Registered Dietician, provided by Meal Site Coordinator's Outcome Measure 2: to be Completed by 3B Applicants Only Outcome Measure 2: Percentage of new service recipients whose ADL assessment scores has been maintained or improved. Standard: 65 percent (refers to percent of Consumers whose ADL assessment score in DOEA 701A or DOEA 701 B assessment forms, improved or stayed the same from one fiscal year to the next.). Strategy/Action Steps: Describe your strategies for meeting this outcome measure with the services you are proposing. If you plan to exceed the standard describe how this will be accomplished. 1. CM completes the 701B Assessment with the Client and develops a specific Care Plan with needed and requested in home services and equipment to improve Client's ADL's. 2. CM implements the services in the Care Plan to enhance Client's limited abilities to complete ADL's with assistance in HMK, PECA. The purchase of assistive devices and functional equipment for Client to maintain or improve current ADL skill level. Outcomes: Describe the result or impact of program activities on the client/consumer. 1. The in-home services that the Client receives enables he/she to maintain living in their own home. If family is involved, they will have support in letting others assist Client and allowing Client to complete his tasks with minimal assistance. 2. Homemaking, Personal Care and eating, transferring and assistance with walking will assist Client with bathing, dressing, eating, which includes the purchase of adaptive assistive devices to complete some ADL's, using the bathroom, transferring and walking/mobility skills and supplies. Outputslinputs: Describe the services that will be delivered to clients/consumer (units of service) to meet the objective and the resources used to provide those services (dollars, staff, etc.). Case Management Homemaking 4-6 units per week Personal Care4-6 units per week Supplies/Equipment SCSM 1 unit per month, Equipment 1 -time purchase: Assistive Devices one time purchase annually Home Delivered Meals 5-7 units weekly Outcome Measure 3: to be Completed by 3B Applicants Only Outcome Measure 3: Percentage of new service recipients whose IADL assessment scores has been maintained or improved. Standard: 62.3 percent (refers to percent of Consumers whose IADL assessment score in DOEA 701A or DOEA 701 B assessment forms, improved or stayed the same from one fiscal year to the next.) Strategy/Action Steps: Describe your strategies for meeting this outcome measure with the services you are proposing. If you plan to exceed the standard describe how this will be accomplished. 1. CM completes the 701B Assessment with the Client and develops a specific Care Plan with needed and requested in home services and equipment to improve Client's IADL's. 2. CM implements the services in the Care Plan to enhance Client's limited abilities and no abilities to complete IADL's with assistance in HMK, using the phone, meal prep, shopping & using transportation Outcomes: Describe the result or impact of program activities on the client/consumer. 1. The in-home services that the Client receives enables he/she to maintain living in their own home. If family is involved, they will have support in letting others assist Client and allowing Client to complete his tasks with minimal assistance. 2. Homemaking, using the phone, managing bills, meal prep, shopping and using transportation will assist Client in current IADL's completion/assistance. Outputs/Inputs: Describe the services that will be delivered to clients/consumer (units of service) to meet the objective and the resources used to provide those services (dollars, staff, etc.) Case Management 1 unit/month CHORE/HEAVY CHORE 6-8 units/ one time episode for Heavy chores Homemaking 4-6 units/wk Personal Care 4-6 units/wk Transportation for medical appts 2-4 units/wk Home Delivered Meals 7 units/wk Supplies 1 unit per month Adaptive Equipment. As needed one episode per care plan Outcome Measure 4: to be Completed by 3B Applicants Only Outcome Measure 4: Percentage of elders assessed with high or moderate risk environments who improved their environment score. Standard: 79.3 percent (refers to percent of Consumers whose environment assessment score on the DOEA 701 B assessment form, improved or stayed the same from one fiscal year to the next.) Strategy/Action Steps: Describe your strategies for meeting this outcome measure with the services you are proposing. If you plan to exceed the standard describe how this will be accomplished. 1. 701 B assessment completed in Client's home with a case manager with a focus on the environment of which the client resides in, alone or with others. Observations should include: Exterior/Interior issues, bathroom, utilities, telephone, house temperature, pets, and sanitary conditions 2. Environment assessed by case manager to see if the Client's home environment is meeting the Client's physical and mental needs. Assess whether structural repairs are needed and ergonomically what adaptive equipment is needed for Client to remain in the current residence. Outcomes: Describe the result or impact of program activities on the client/consumer. 1. Case manager can recommend environmental changes that include new appliance, AC/Heat repair, outside handicap ramps, adaptive equipment in the bathroom, CHORE for unsanitary conditions, HMK as an ongoing in-home service. CM can provide EHEAP assistance for overdue electric bills twice a year. Client will feel mentally better with their home accessible and well maintained. 2. Replacement and repair of broken items and worn environment will decrease any safety threats to the Client and their family. 3. Care Plan will include schedule and calendar of maintenance and reviewed every six months. Outputs/inputs: Describe the services that will be delivered to clients/consumer (units of service) to meet the objective and the resources used to provide those services (dollars, staff, etc.). Case Management 1 unit/mo CHORE- 3-6 units of one time episode if deep clean/pest control is determined. HMK 2-4 hrs/wk EHEAP assistance 2/yr Ministry donation to build a ramp, repair interior and exterior home damage -one time episode Purchase of appliances, furniture including a hospital bed, adaptive equipment in bathroom to shower and toileting Outcome Measure 5: to be Completed by 3B and 3E Applicants Only Outcome Measure 5: Percentage of caregivers who self-report being very confident about their ability to continue to provide care. Standard: 90 percent (refers to percent of caregivers who self-report being very confident about their ability to continue to provide care in the DOEA 701A or DOEA 701 B assessment forms from one fiscal year to the next.) Strategy/Action Steps: Describe your strategies for meeting this outcome measure with the services you are proposing. If you plan to exceed the standard describe how this will be accomplished. 1. Case Manager completes 701 B assessment and observes the caregiver and the client's interaction with each other, and their mental and physical well- being. 2. Assess the number of tasks that the caregiver has to complete for the client on a daily/weekly basis. Is the caregiver employed outside of the home, have any health conditions and how long as the care been going on. 3. Is there other assistance that the Client receives from family and/or friends. 4. Does the caregiver report to be in crisis, financially, emotionally and/or physically. 5. Does the Client have a diagnosis of Dementia Outcomes: Describe the result or impact of program activities on the client/consumer. 1. Caregiver will receive respite services either in home or facility respite 2. Caregiver will attend caregiver support groups and spouse can attend when an activity group is available for the client at the same time. 3. Client can attend adult day care part-time and/or full-time. 4. Facility Respite reservation can be scheduled for Client so Caregiver can have respite in 24/7 intervals. Outputs/Inputs: Describe the services that will be delivered to clients/consumer (units of service) to meet the objective and the resources used to provide those services (dollars, staff, etc). Case Management 1 unit per/mo Caregiving Training PRN Community Support Groups Respite in home 8-10 units/wk. Adult Day Care Center 24 units/wk. (3-4 days/wk.) Respite Facility 14 units/yr. (3-14 days/yr. Supplies 1 unit/mo. Collier County Community and Human Services Division Standard Operating Procedures CIRTS Reporting Purpose: To describe the process for running programmatic and fiscal CIRTS reports for the Services for Seniors Program. Description: Services for Seniors utilizes CIRTS reporting to maintain operations as the lead agency. Procedure: 1. Both the program and fiscal units of the Lead Agency have reporting responsibilities. The following is a list of reports generated by the agency identified by name, responsible staff, frequency of use and the purpose of the report: • Programmatic: • Assessment Due Report: CIRTS, Manager and Grant Support staff, monthly; to assure assessments are completed within designated DOEA time frames. • Data inconsistencies Found when comparing Vital Statistics Death Certificates with CIRTS Open Enrollment Reports: CIRTS, Manager, monthly • Incomplete Assessment: CIRTS, Manager, Grant Support Staff; monthly; to assure the completeness of assessments. • Assessment Inconsistencies: CIRTS, Manager and Grant Support staff, monthly; to assure the accuracy of assessments. • MLTC Enrollees Receiving Services in Another Program: CIRTS, Manager • CIRTS Data Cleanup Report: CIRTS, Manager, monthly • Outcome Measures: CCSS Manager, quarterly; to assess change in a client as a result of the services provided. • Current Active Clients by Program or Provider; Admin Supervisor Nutrition; bi-annually or as needed; used to register clients for C I or C2 services. • Priority Ranldng for APCL Clients; Manager, Supervisor Nutrition; monthly; to identify clients waiting for services. • Fiscal. • Enrollment Terminations with Reasons; Grant Coord, Accountant& Grant Support staff; monthly; Updated April 2, 2018 Collier County Community and Human Services Division Standard Operating Procedures CIRTS Reporting to count the number of termed clients in a date range. • New Enrollments for a Date Ranee; Accountant, Grant Coord monthly; to count the number of newly enrolled clients in a date range. • Client Units Report by Individual Service; Grant Support staff, monthly; to verify the # of units entered by client. • Monthly and YTD Service Units with Undu lip cated Clients; Grant Coord; monthly; to verify the monthly and YTD units entered. • Total Units of Service by Program Component; Grant Coord & Grant Support staff, monthly; to verify units entered for each vendor. • Units for One Worker for a Period; Accountant & Grant Support Specialist monthly; to verify/get list of CM clients entered. • HCE Monthly Service Utilization Report; Accountant; monthly; provided to Senior Choices showing client expenditures. 2. Reports are run by assigned staff according to the identified schedule and the data is either a) submitted to the concerned entity (i.e. Area Agency on Aging for SW FL) reviewed for completion, completeness, corrections or updates and assigned to the appropriate staff (i.e. assigned Case Manager, fiscal, etc...) to address. Updated April 2, 2018 Collier County Community & Human Services Emergency Response Plan Revised: June 2018 Purpose: To provide a plan for division operations and emergency response in the event of a catastrophic event. Description: This plan provides for on-going activities to ensure -preparedness, actions to be taken during an emergency event and the division's responsibilities in responding to the needs of the department and county should a disaster occur. Roles for Emergency Response: All members of the department located at Building H shall participate in the preparedness and recovery of the department. PRE -EVENT During Pre -event / Event / and Post Event: Track and document "contracted" case management which include interface with existing case management processes in the event of overlap. Louise Pelletier Each staff member shall prepare their individual office computers per instructions provided by Facilities and IT but not to begin until instructed by Director or her designee. All Staff Order and have supplies on hand for covering equipment (bags, tape, etc) Barbetta Hutchinson, Michelle Rubbo Be responsible for overseeing preparations of computers and equipment of people who may be on vacation or absent from work. (Ask for assistance from other staff as needed.) Barbetta Hutchinson, Michelle Rubbo, Cynthia Kemner Prepare office equipment for possible water or wind damage. Barbetta Hutchinson, Ana Diaz Confirm accuracy of office phone list. Louise Pelletier Confirm plans for staff and get contact numbers. Managers/Supervisors Run updated lists of senior clients and contact senior for their evacuation plans. Services for Seniors Case Managers & Nutrition Staff Clean out refrigerator/turn up temp to maximum. Nancy Mesa, Maggie Lopez Each program area needs to have at least one person in the office at all times to handle calls or requests for that program. Managers will create a schedule. During the storm, protect yourself and your family. POST -EVENT (once the building has been cleared for re-entry) Each staff member is responsible for setting up their computers and checking for any damage. Staff phones in office and front desk. Barbetta Hutchinson, Wendy Klopf, Ana Diaz Provide direction in office for Social Services & Services for Seniors Programs — Louise Pelletier Call Clients — All CMs in all program areas TO ENSURE Clients are safe Call Service Providers — all CM Services for Seniors call home health providers. Nutrition Coordinator confirms operating schedules & staffing for meal sites as well as site safety. Wendy Klopf, Danielle Mordaunt, Dory Carrillo If Activated: Answer special needs phones in 4 hour shifts — Dory Carrillo, Ana Diaz, Margo Castorena, Ivonne Garcia Assigned to Special Needs Shelters: Marco Chouinard, Lori Blanco, Danielle Mordaunt Canvass neighborhoods, mobile home parks and/or hardest hit areas with teams from other areas as directed by EOC to help deliver food and water or other tasks as needed — Debbi Maxon, Carlton Bronson, Zena Sellers, Help register folks for food stamps —Nancy Mesa, Rosa Munoz, Help with Blue Tarp program registration: Wendy Klopf, Elizabeth Hernandez EOC Representative from Department: Louise Pelletier, Maggie Lopez, Lisa Oien Collier County Community & Human Services Senior Nutrition Emergency Response Plan Revised: June 2018 Purpose: To provide a plan for the Senior Nutrition Program pre and post operations and emergency response in the event of a catastrophic event. Description: This plan provides for on-going activities to ensure preparedness, actions to be taken during an emergency event and the program's responsibilities in responding to the needs of the senior clients should a disaster occur. Roles for Emergency Response: All full time/part time members of the program shall participate in the preparedness and recovery of the department. PRE -EVENT During Pre -event / Event / and Post Event: Pre -event: Contact client's who wish to be checked on. Arrange services for those in need. Danielle Mordaunt & Bonnie Lee Evans Pre -event: Contact each staff member to do a safety check. Pre -event: If it is anticipated that the Fort Myers kitchen will not be able to provide meals to the sites and that there will be no area restaurants in business then hurricane meals (shelf stables) will be ordered ahead of time for each congregate client in the amount of business days that the program is estimated to be without service. Order and have supplies on hand for covering equipment (bags, tape, etc.) Danielle Mordaunt Be responsible for overseeing preparations of computers and equipment of people who may be on vacation or absent from work. (Ask for assistance from other staff as needed.) Prepare office equipment for possible water or wind damage. Meal Site Coordinators Confirm accuracy of office phone list. Danielle Mordaunt Confirm plans for staff and get contact numbers. Danielle Mordaunt Run updated lists of senior clients. Danielle Mordaunt Clean out meal site refrigerators. Meal site coordinators Updated: 7/16 Each program area needs to have at least one person in the office at all times to handle calls or requests for that program. Supervisors will create a schedule. During the storm, protect yourself and your family. POST -EVENT Post -event: Contact client's who wish to be checked on. Arrange services for those in need. Danielle Mordaunt Post -event: Contact each staff member to do a safety check. Danielle Mordaunt Post -event: If GA Foods is in operation, meal service will continue as normal. If not and there are area restaurants on the approved vendor list in operation, meals will be ordered from them if necessary. Post -event: Contact East Naples (Kathy Topoleski 793-4414) ; Golden Gate Senior Center (Tatiana Fortune 410-8777); Goodlette Arms (Debbie Raff 262-3229) to find out if the sites are able to be occupied. Anita Silva (IM Meal Site Coordinator) will assess site ASAP when safe to do so. Each staff member is responsible for setting up their computers and checking for any damage. Man phones Danielle Mordaunt Provide direction Danielle Mordaunt Call Clients — Danielle Mordaunt, Meal site coordinators Call Service Providers — Danielle Mordaunt Confirm operating schedules & staffing for meal sites as well as site safety. Danielle Mordaunt EOC Representative from Department: Louise Pelletier, Maggie Lopez, Lisa Olen Updated: 7/16 February 22, 2019 Nourishment. Delivered. In response to recent requests for information regarding GA Foods back-up plan should a kitchen facility be closed for any reason, we have compiled the following information excerpted from the GA Foods Business Continuity Plan. This plan is available to our customers upon request, and can be reviewed in more detail as part of the annual monitoring's. GA Foods has seven service production facilities in the State of Florida. The Company also maintains pre -plated frozen meal inventory at numerous cold storage facilities across the country, which enables the company to provide, to the best of its ability based on the nature of the emergency, uninterrupted service to its customers. The company also has contingencies in place to produce additional meals should one or more of its facilities be inaccessible, whether in one of its other existing facilities, or through the services of a contracted third -party. In the event of an emergency such as a hurricane that may impact the functioning of one or more of our facilities, production support would come from one of our other operating units. A preliminary plan for this support is shown below (plan subject to change based on the extent of the need). GA Foods Unit Support System IN THE EVENT OF AN EMERGENCY WHERE PRODUCTION IS UNABLE TO OCCUR AT THIS UNIT THIS UNIT WOULD HAVE THE PRIMARY SUPPORT FUNCTION THIS UNIT WOULD BE THE SECONDARY SUPPORT ST. PETERSBURG, FL LAND O' LAKES CENTER HILL FT. LAUDERDALE, FL FORT MYERS ST. PETERSBURG FT. MYERS, FL ST. PETERSBURG FT. LAUDERDALE DAYTONA BEACH CENTER HILL ST. PETERSBURG ORLANDO, FL DAYTONA BEACH ST. PETERSBURG LAND O'LAKES, FL ST. PETERSBURG CENTER HILL CENTER HILL, FL ST. PETERSBURG DAYTONA BEACH GA Foods also operates eight other kitchen production units in Alabama and Georgia that can produce and ship meals to Florida in emergency events such a 12200 32p11 Couri North = St. Petersburg, Florida 33716 - (8001852-2211 a www.GAFoods.com hurricane, Shelf stable meals are also produced daily and are readily available for distribution to congregate sites and home bound clients. We are proud that in our 46 years of service in the state of Florida, we have never had a closure that has affected our ability to serve seniors. Should you need additional information regarding this matter, please reach out to David Karpan at d_i arpanOc afoods.00_sn or 727-388-0008. Kenneth A. LoBianco, CEO Glenn Davenport, President Collier County Case Management and Disaster Housing Plan - June 2018 Health and Welfare: Disaster Case Management Community & Human Services Disaster Coordinator. Louise Pelletier Alternate Coordinator: Lisa Oien Division Director., Kristi Sonntag Introduction - Statement of Need In a catastrophic event, a broad collaborative casework and management approach will be needed from response through longterm recovery; the spectrum of needs will be greater than any one agency or organization can handle. Casework Services A common accepted description of casework is meeting the short term needs of the applicant - one or two referrals for services that the applicant can follow up on and then manage on their own. This could include a referral to a voluntary organization providing assistance for housing (temporary and permanent), clothing, food, utility deposit, minor repair, and/or debris removal or assisting an applicant to reconnect with their pre -disaster social services benefits. Many disasters affect individuals and families that require a variety of client service - sometimes beginning before the disaster has occurred (those evacuated because of a pending threat), immediately after a disaster has occurred and/or through the response and relief phases. Some then need Disaster Case Management during the recovery phase but many are able to accomplish their long term recovery without the need for case management. Disaster Case Management Traditionally Disaster Case Management has been defined as the service provided to assist a disaster affected individual or family develop and execute their personal plan for long term recovery. As defined by FEMA Headquarters: Disaster Case Management is a partnership between the case manager and the client in the development of a Disaster Recovery Plan. The process involves assessing needs based on verified disaster damage, developing a goal -oriented plan that outlines all necessary steps to achieve recovery, organizing and coordinating the information on available resources that match the disaster caused needs, monitoring the progress towards reaching the stated goals and, when necessary, acting as an advocate for the client, Historically, those requiring case management have received the maximum federal assistance, insurance settlement, exhausted or would exhaust any other personal assets yet still have outstanding disaster caused needs. Those requiring case management often include but are not limited to homeowners with unlivable homes, the self-employed with a complete loss of tools and/or other business resources, loss of employment, and those with extraordinary medical expenses as a result of serious disaster caused injury or illness. In addition to the direct disaster assistance provided by disaster relief organizations and local, state/tribal, FEMA and other federal agencies, clients face the sometimes -daunting task of "re -accessing" their pre -disaster benefits and entitlements while others now find themselves in the position of possibly qualifying for benefits and entitlements that were not needed prior to the disaster. Disaster Housing The goal of the Temporary Housing Plan is to provide housing within Collier County and to secure all residents who may need alternative housing in Collier County. Real Property Management will be the lead regarding County current property changes and to inform the County of available single-family homes to house homeless residents post Disaster. The Public Utilities Department (PUD) will be the lead in securing and notifying the County which geographic land areas have not been flooded, the current conditions of the flood zone areas and the availability of land to have mobile trailers ordered and placed for homeless residents. Permitting for temporary housing will be lead by the Growth management Division (GMD). The HMIS system will be used for tracking available properties sites and shelters and to locate relocated residents by name and location to assist continuity and assisting other families in relocating their family members. Purpose, Goals, and Objectives Purpose The Disaster Casework Management and Housing Processes include caseworkers/managers working with survivors to assess needs, develop action plans for immediate relief, and later recovery, identify sources of assistance for unmet needs and then help survivors obtain assistance through referral and Long -Term Recovery Committees. The Case Management approach complements, not duplicates, the efforts of FEMA, State-run, Community, Faith Based, Humanitarian and other Non-government Organizations Goals • Limit the amount of paperwork for clients to process • Address survivor needs early to lessen the extent of needs throughout the recovery process. • Promote timely assistance and avoid frustrating delays. The survivor should feel that each action taken is an active step to recovery. • Assist clients in securing safe, temporary housing Reduce duplicative intake, case management and assistance by utilizing the the web based Homeless Management Information System (HMIS) ]mown as Client Track. Objectives Casework services for disaster survivors are required immediately after an event occurs and will be provided as needed by those organizations and agencies offering this type of service. In a catastrophic event, casework will begin at the onset of the event, to collaborate with the Emergency Operations about the available space in the two Collier shelters, St. Matthew's House in Naples and the Friendship Center in Immokalee utilizing ClientTrack to register residents and secure needed services. Collier Organizations Active in Disasters (COAD) will take an active leadership role in the coordination of the case management process to include casework and long-term case management. Collier agencies included are the Red Cross, Salvation Army, Harry Chapin Food Bank, St. Matthew's House, and Catholic Charities and several faith -based congregations/churches. Those who are not in shelters may have difficulty knowing where and how to obtain casework and case management services. Coordinating with the Florida Department of Health and the Florida Department of Children and Families (likely through the appropriate HHS Regional Office), the Department of Health and Human Services (HHS) (funded by FEMA) is available to provide casework services and disaster case management through a third party (governmental or non-governmental). A team may be deployed within 24 hours of the State's request. The State submits a proposal to FEMA for Disaster Case Management. The State lead agency will provide program oversight, ensure standardized case management coordinated communication to the agencies and organizations they have awarded DCM funding. These service providers ensure case management is provided and that recovery objectives are met. Both FEMA funded Disaster Case Management programs are available after a disaster area receives a declaration including Individual Assistance. Federal Disaster Case Management assistance, either through HHS or FEMA, funds case management and will not directly aid residents. EOC will need to make the request to FEMA for DCM funding then may contract with government and nongovernmental (if this is authorized State policies and legislation) entities providing case management services. The success of Disaster Case Management is the coordination and collaboration with those organizations, foundations, disaster funds (example Governor's Disaster Relief Fund), etc. providing financial and other tangible assistance. Counties in nearby Communities such as Lee, Hendry, DeSoto, Charlotte may also provide assistance if they are not in a disaster mode. Consequences Early casework in the aftermath of an event promotes more timely recovery activities and allows residents to be less dependent on the service delivery system. Organized and systematic casework will be a springboard to an efficient and effective case management process. A solid case management process will be able to use a myriad of resources more efficiently Disaster survivors will participate in their own recovery. Conditions for Casework Services and Case Management to begin • The Disaster Casework process will begin as soon as people are displaced, (which could include pre -landfall in a tropical event) and emergency, disaster - caused needs are evident. • FEMA funding of DCM requires a Major Disaster Declaration with Individual Assistance. • The two Homeless Shelters, the EOC's designated county school properties that serve as emergency shelters will be the headquarters where the Service Point web site will be able to register and assist residents with temporary housing, targeting the sheltered population first. • If requested by the State, CHS is prepared to deploy a DCM team within 72 hours of the declaration. Survivors evacuating from the impacted area to an unaffected community will not be offered full case management services until they are in their final congregate shelter location • Initial screenings of clients can be accomplished in some of the first shelter stops residents make through the HMIS/Service Point. • Service Point will provide the initial picture of the residents' needs and capabilities and will match the client's current need(s) with capabilities (resources) that are currently available. The goal will be to increase the transition of residents in their community into long-term housing allowing for a percentage of residents will resettle in other nearby counties. • Case Managers will be able to inform clients when schools, businesses and jobs are available to return to for participation. • Survivors staying in the impacted area will receive case management services as resources become available. Concept of Operations Effective casework services, case management and securing housing will be a shared responsibility among County government, local Red Cross, faith -based churches, humanitarian and other non- governmental agencies/organizations from the local, State/Federal/national levels. A combination of methods may be needed to provide services including caseworkers staffing congregate care facilities such as shelters, schools, trailers, motels and transitional housing information centers and assistance centers. Telephonic and web based application systems such as HMIS will need to be in place. Inter- agency referral of evacuees among organizations and agencies may be an effective way to ensure that evacuees are being helped by the most appropriate entity for their needs and situation. Requests and referrals for disaster case management will come from multiple sources and locations. The severely impacted, impacted and host areas will require varied disaster case management and housing depending on the needs of the survivors. Collier Organizations Active in Disasters (COAD) will play an active role in assuring that Disaster casework and case management planning and execution is taking place, and that Florida's Organizations are engaged in this planning and execution. The State lead agency will provide program oversight, ensure standardized case management coordinated communication to the agencies and organizations they have awarded DCM funding. Either the State lead agency or one of their contracted service providers may be designated as the central agency or organization for clients seeking assistance. The Coordinated Assistance Network (CAN) provides a platform for sharing information by case managers, recording assistance and referrals made as well as resource directory information. During response, the organizations and agencies initiating disaster casework in shelters or congregate facilities will collaborate to meet the requirements of disaster survivors. They will: • Establish a home-based facility that will be deemed Headquarters for the Case Management and Housing efforts to be housed in after the disaster. • HMIS will be the central web -based registration system for information and the intake process and/or services available for evacuees will establish a standardized application and reporting process • Determine how referrals will be made through the HMIS system • Ascertain space needed and available for agencies and organizations • Establish a system of notification and referral for services available as survivors move from congregate care to transitional housing • CHS will participate in the EOC Disaster Planning Meetings to educate local Emergency Management and the Response Community about Casework Services and Disaster Case Management • Identify the various groups who do Needs Assessment, define their purpose and support needs review their forms and decide and share/use information within the HMIS with other agencies assisting, addressing HIPPA and Confidentiality Issues. • Establish a standardized application and reporting process in HMIS that all agencies and case managers can utilize in assisting residents with shelter and other services. As communities and residents begin the recovery process, the County EOC will have an active role in ensuring collaboration among agencies and organizations, supporting a standardized Case Management process, providing planning for the transition from a state Case Management Process to the local Collier County community. The Department of Children and Families, Department of Health, Florida Crisis Consortium, Volunteer Florida, FIND (Florida Interfaith Networking in Disasters) U.S. Department of Health and Human Services, FEPA, and others as appropriate involving stakeholders in the program design increases likelihood of buy -in and decreases probability of unforeseen obstacles or consequences that could have been avoided. Both DCM models are likely to be needed. The HHS model promotes rapid deployment and relief activities for 30, 60, 90 days while the FEMA/State model emphasizes long term recovery. Both HHS and the FEMA Disaster Case Management unit have guidance for States in Recovery. Issues to be Resolved/Developed: • Involvement of and standardized ways to interface with local Emergency Management Agencies • Standardized way of how the County will utilize volunteer assistance • Communication with and education of existing Case Management systems to the agencies/groups not presently involved to ensure coordinated effort • Define roles and responsibilities of all Case Management/Recovery activities: Who is doing what, when, where and why? • Formal Referral System clearly identified and communicated to all involved. This includes referral to available resources, as well as handling referrals from elected/government officials and responders. Key Factors/Concerns • Continue developing a formal referral system to provide client services and housing through HMIS/Service Point • Major concern of all agencies: protecting the resident • Client confidentiality • Universally understand rules and regulations Phased Goals Timeframe: Clear articulation of expectations throughout the process to include the change in needs/demands as the disaster response/recovery unfolds: Page seven Look at time -line for Case Management service delivery and transition points between Response and Recovery • Phase 1 — Day 1 - Day 14 • Phase 2 — Day 15 - Day 30 • Phase 3 —Day 31 -Day 45 RISK MANAGEMENT DEPARTMENT CoSr County STANDARD OPERATING PROCEDURE SUBJECT: EMERGENCY ACTION PLAN REFERENCE: CMA 5201, CMA 5902 & ALL APPLICABLE STATE, LOCAL, COUNTY & FEDERAL REGULATIONS EFFECTIVE DATE: 9/1996 LATEST REVISION DATE: 5/2018 Purpose: To provide a consistent Emergency Action Plan for the BCC. This will assist in the attainment of the Incident Objectives, which are the safety and security of all employees and clients of the Collier County Government at each location. This document is part of the Collier County Government Location emergency response plan. 2. Authoritative Reference: Collier County Office of the County Manager, Administrative Doctrine, Collier County Emergency Building Emergency Action Plan, Chapter 5201, Florida Department of Health — Collier County Department Heads building closure; Collier County Sheriff Office Bomb Squad; East Naples Fire Department, Collier County, Collier County CMA 5201, "Emergency Building Emergency Action Plan, CMA 5902. "Workplace Safety & Health Policy", ADAAG, 'Americans with Disabilities Act Accessibility Standards (2010)', ANSI 117.1-2003 'Accessible and Usable Buildings and Facilities and NFPA 72, the National Fire Alarm Code, 2016 edition. Scope: This Policy and Procedure Guideline outlines the employee's responsibilities in preparation for and response to an evacuation or emergency situation of the Collier County Government at each location. 4. Related Guidelines: Annex 1 Fire Annex 2 Bomb Annex 3 Suspicious Packages Annex 4 Tornado Annex 5 Active Shooter Annex 6 Chemical Release Annex 7 Assignments Annex 8 Signage Annex 9 Floor Plans Annex 10 Bomb Threat Checklist f 5. General Responsibilities: Each Collier County Director with employees working in the building/location is ultimately responsible for ensuring that the plan has been reviewed and in place. All Collier County Government Directorates located within a Collier County Government location will familiarize new employees with the Emergency Action Plan and the Annexes. Operations Chiefs, Evacuation Area Supervisors and their Alternates will be familiarized with responsibilities and their respective duties at the time of their selection. All meetings with employees will have attendance taken and a copy all rosters forwarded to Risk Management EHS Manager. There will be an annual review of the Emergency Action Plan and its Annexes by Collier County Administrative Services Department — Risk Management & Public Utilities Department Governmental Security/Facilities Divisions. Topic Annex Page Purpose Authoritative References 1 Table of Contents 2 Terms and Definitions 3 Annex 1 Fire 6 Annex 2 Bomb 7 Annex 3 Suspicious Package 8 Annex 4 Tornado 10 Annex 5 Workplace Violence 11 Annex 6 Chemical Release 12 Annex 7 Assignments if nec 13 Annex 8 Signage 14 Annex 9 Floor Plans 16 Annex 10 Bomb Threat Checklist 17 2 Term Definition Emergency Action Plan/ F Incident Action Plan Provide all Incident personnel with direction for This Document. future action Incident Objective The measurable outcome of the Incident Action At the end of the activation of this plan all pe Plan building will be evacuated to a safe area Meeting Place Designated site for staff to meet and to report to • Staff report to Area Evacuation Sup( Area Evacuation Supervisor • Area Evacuation Supervisor reports Evacuation Orderly, safe, quick evacuation of the building Evacuation of the building Command Post Location where the primary command functions are This will be determined by Facilities Manage performed Department and/or Law Enforcement Re -Entry Safe return to the building Facilities Management (Security), Fire Depa are the only ones who may give the re-entry Operations Chief will communicate that it is to staff. • Extent of damage should be assess Notification of Closure The County Manager will consult the Collier County possible under the circumstances Department Head to determine need for building 0 Department/Program Directors/Desi closure. assessment to Collier County Depar Management and the Department D • Activation of the Continuity of Opera Director/Designee Confidential Records These are records that are deemed confidential by When medical or other confidential/imp the Collier County Government and Florida State • Assessment of damage and possibl, Statute building damage will be completed t • Reported by Department/Program C County Department Directors and R Damage Assessment Damage to building, equipment, supplies When allowed to enter after damage he facility, each area will: • Contact Collier County Risk Manag • Do a damage assessment of their a • Complete a STARS Report within 2 • Report to Administration as soon a: • Administration will file a report for & Facilities Management(Security) fo Operations Section Responsible for directing the tactical actions to Each Operations Section and their alternate meet the Incident Objective Emergency Response Training through Risk Operations Chief Each Operation will have one Operations Chief and Each Operations Chief and their alternate wi one alternate who have the responsibility to Emergency Response Training through Risk implement the Incident Action Plan. At the time of the incident, the Operations Chief has authority over the Incident Operations Pre -event Planning • The Collier County Government will Operations Chief and one alternate. • Identify any potential evacuee with E plan of action with affected Area Ev( the following discussion: o Provisions needed to assist o Determine equipment need( o Decide staging area for Spa o Designate someone to mee predetermined external doo Department as to the locatic o Notify Fire Department of Sl needed o Perform and document one o (real evacuations can be do • Collier County Administrative Servic Management & Governmental Secu review/update the Emergency Actioi needed. • Green vest Operations Chief • Clip Board with the current call list o Supplies (1 primary per • Pen floor and a secondary) • Floor plan • Crank powered radio and flash light Operations Chief This is the designated term used in the Incident Pick up supplies • Put on the Green Vest Responsibilities at time Command System • Go outside (300 yards away) and ka of alarm/event At the time of an evacuation, this person has the building to meeting place authority over the Incident Operations until relieved • Give update to and take direction frc in accordance with ICS Operations. Management, Fire Department, Law • Receive reports from Area Evacuat Typically, the Security Supervisor at a location or a a Report any unaccounted for employ Designated Senior Leader and one alternate. • County Department Directors 1. During an emergent situation, the Collier County Government at each location's employees that evacuate will be directec primary rendezvous point at the 2. In the event of unsafe weather (lightning / heavy rain) the Collier County at each location's employees that evacuate will Supervisors to proceed to the alternate rendezvous point 3. In the event of Chemical Spill, the Collier County at each location's employees will be directed by Area Supervisors to pn rendezvous point as determined by Collier County Administrative Services Department — Risk Management & GovernmE Divisions. Those locations can be found in Annex 6, Chemical Release/Spill. 4. This alternate rendezvous site will not be used during a bomb threat, as distance is a critical consideration and the prima 5. State and local government facilities must follow the requirements of the 2010 ADAAG, 'Americans with Disabilities Act P including both the Title II regulations at 28 CFR 35.151; and the 2004 ADAAG at 36 CFR part 1191, appendices B and D • Stay at meeting place until all clear i • Keep records of the evacuations Each Area will have an Area Evacuation Each Area Evacuation Supervisor ai Area Evacuation Supervisor and one alternate required to complete Emergency Re Supervisor (multiple The Area Evacuation Supervisor is in charge of Management (EHS Section). per floor) designated geographical area Responsibilities at time of Alarm • Pick up equipment • Put on Blue Vest • Walk through Designated Area to & • Go to Meeting Place • Use call list to check off people who • Report findings to Operations chief ( • Remain in meeting area until all clee Management (Security), Fire Depart • Clip board Area Evacuation • Crank powered flash light Supervisor Supplies 0 Pen • Blue Vest • Crank powered radio • Floor Plans • Updated call list of their geographic Government Departments. • Sign in three languages that say "A We must leave the building." 1. During an emergent situation, the Collier County Government at each location's employees that evacuate will be directec primary rendezvous point at the 2. In the event of unsafe weather (lightning / heavy rain) the Collier County at each location's employees that evacuate will Supervisors to proceed to the alternate rendezvous point 3. In the event of Chemical Spill, the Collier County at each location's employees will be directed by Area Supervisors to pn rendezvous point as determined by Collier County Administrative Services Department — Risk Management & GovernmE Divisions. Those locations can be found in Annex 6, Chemical Release/Spill. 4. This alternate rendezvous site will not be used during a bomb threat, as distance is a critical consideration and the prima 5. State and local government facilities must follow the requirements of the 2010 ADAAG, 'Americans with Disabilities Act P including both the Title II regulations at 28 CFR 35.151; and the 2004 ADAAG at 36 CFR part 1191, appendices B and D 4 .. . 0 0, ` j 1, 1 1104 When you enter a room or corridor of a building: • Make note of the exits. • Know the location of the alarm stations and fire extinguishers in the area. If you see a fire or smell smoke: • Pull the alarm immediately (This will initiate the Emergency Action Plan). BCC Annex buildings without alarm stations: Call 911 o Stay calm and give specific directions. o Speak slowly and clearly. Building H and F o Pick up telephone and press " # 11 " and wait for the beep, then press " 00 ". This will activate the intercom system on both the first and second floor hallway. o Announce 3 times over the public address system. • "Attention! Attention! Please evacuate the building" Area Evacuation Supervisors need to quickly encourage evacuation — "Please evacuate the building, nowt" • Evacuation Supervisors from first / second floors will ensure third floor evacuation in addition to usual assignment, as well as meeting the ADAAG, 'Americans with Disabilities Act Accessibility Standards (2010) for evacuating individuals with disabilities. • Notify other volunteers and clients in the area to evacuate immediately. • All doors are to remain unlocked to allow Fire Rescue access. • If the fire has potential to reach Chemicals, the BCC Emergency Spill Response Program (ESRP) goes into effect and the Collier County Emergency Response Team (CCERT) is immediately notified. • Close the door on the fire and notify others in the area to evacuate immediately. Fire Extinguisher Use USE THE FIRE EXTINGUISHER IF: 1) The fire is small and in its beginning stage. 2) There is a fire extinguisher handy. 3) You know how to operate it. DO NOT USE THE FIRE EXTINGUISHER IF: 4) Fire is not in the beginning stages. 5) Fire is too large to control with a fire extinguisher. 6) There is no extinguisher handy. 7) You have not been trained on how to use it. [. All Collier County Government employees with a telephone that receive incoming calls should have a Bomb Threat Check List Card (at bottom of policy) posted by their phone. If you receive a bomb threat call, follow directions on the card. Ask as many questions as possible listed on both sides of the Bomb Threat Checklist Card. • All bomb threats should be considered valid. No "new" power sources are to be activated. New power sources refer to light switches, copy machines, computers, etc. If it is on, leave it on and if it is off, leave it off. Hard line phones are not considered new power sources UNLESS the phone suddenly appears in the area of the threat. o Activate building Fire Alarm. o Call 911. ■ Speak slowly and clearly. ■ Stay calm and give the information you received. o Notify Campus Security at 2222. • Do not use a cell phone, two-way radio or public address system. • Cell phones may be used at a distance of 300 yards or more for emergency calls only. • Each person; look at their own area quickly to determine what, if anything, is suspicious. • Take your personal possessions. • Calmly, but quickly, exit the building and proceed to the designated rendezvous point. • Provide evacuation support in accordance with the ADAAG, 'Americans with Disabilities Act Accessibility Standards (2010) for evacuating individuals with disabilities. • Be alert to possible threats; pay close attention to suspicious boxes or unclaimed briefcases. • Share any information gathered with the Operations Chief (Green Vest) or Area Evacuation Supervisor (Blue Vest). • Do not lock office doors. • Direct clients to the evacuation rendezvous point. • Be alert to others with special needs and assist if help is needed. • Operations Chief will notify Department Directors, Risk Management Director and Security Director. • Facilities Management, County Security, or Local Emergency Providers will stop all clients and staff from entering the building. 7 Purpose: To provide guidelines for safe response to a suspicious letter, package, or container; this guidance is generally focused on the initial response to potential biological threats, so all personnel responding to such incidents must be aware of the potential for exposure to hazardous chemicals and/or radiological materials in addition to biological hazards. 2. Authoritative Reference: Florida Department of Law Enforcement, International Association of Fire Chief's, National Response Plan, ADAAG, 'Americans with Disabilities Act Accessibility Guidelines', ANSI 117.1- 2003 'Accessible and Usable Buildings and Facilities. Collier County CMA 5201, "Emergency Building Emergency Action Plan and CMA 5902. "Workplace Safety & Health Policy" 3. Scope: This Policy and Procedure Guideline outlines the Collier County Government /BCC employee's responsibilities in preparation for and response to a suspicious letter or package or container. 4. Related Policy and Procedure Guidelines: N/A 5 Policy Statement: The Collier County Government at each location will be able to safely respond to a suspicious letter / package / container based on these guidelines. Division Directors and Supervisors: These Supervisors are responsible for ensuring that all staff is familiar with the "Response to a Suspicious Letter or Package or Container" policy. ** Please emphasize to staff that the person discovering the item is responsible for initiating the 911 response" Supervisors: Supervisors will familiarize new employees with the plan at the time of hire. ACTIONS TO TAKE IN THE EVENT OF SUSPICIOUS LETTER OR PACKAGE OR CONTAINER • Do not touch, move or open any suspicious letter, package or container. • If holding, gently set the item down. • Move away from the item and evacuate the immediate area. • Provide evacuation support in accordance with the ADAAG, 'Americans with Disabilities Act Accessibility Standards (2010) for evacuating individuals with disabilities. • Notify appropriate law enforcement *Call 911 First" and then Campus Security at 2222. • Notify Division Directors, Risk Management Director and Government Security Director. • If it is determined to be a Hazardous Material, the BCC Emergency Spill Response Program (ESRP) goes into effect and the Collier County Emergency Response Team (CCERT) is immediately notified. • Do not allow anyone else in the area. • Treat the area as a crime scene. • Wash your hands well. • When you go home, remove all of your clothes and wash them in hot water. • Take a shower. Collier County Coordinated Response to a Suspicious Letter, Package or Container: • 911 Call received. • Law enforcement response will be based on Department of Homeland Security and Center for Disease Control joint guidelines. o Potential threats or incident scenarios: • Letter/container with unknown powder -like substance and threatening communication with or without illness. • Letter or container with a threat, but no visible powder or substance present. • Letter/container with unknown powder, no articulated threat and no illness. • Letter/container with no visible powder and no threat but recipients are ill. • Letter/container arrives with no powder, no threat, the recipient is not ill, but the recipient is concerned about the package. • Credibility is determined. • Law enforcement calls Fire and Emergency Medical Services. o Under no circumstances should an unprotected responder attempt to package a specimen. • Hazmat/fire performs necessary field safety screening as required by Bureau of Laboratory, (BOL) policy. • Fire/hazmat obtains specimen (if small enough to place in designated can or utilizing appropriate swab as per BOL policy). • Law-enforcement will coordinate the delivery of the specimen with DOH -Collier. • Only Public Information Officers should respond to the media. w] he National Weather service issues tornado watches and tornado warnings. These are broadcast via National Oceanic and Atmospheric Administration (NOAH) public alert radios. NOAA Radios is located at at each location. SW Florida frequency for a NOAA weather radio is 162.525. The Specific Area Messaging Encoder (SAME) number (Collier County specific) is 012021. Monitor The NWS Forecast Office Miami - South Florida Website for more information. Departments with an assigned NOAA public alert radio are responsible for: • Programming the public alert radio. • Leaving the public alert radio on at all times. • Ensuring the public alert radio is in working condition. • Changing the back up battery of the public alert radio as needed. RESPONSE ACTIONS: • If a tornado watch is issued, monitor the public alert radio and The NWS Forecast Office Miami - South Florida for situational updates. • Building H and F (If tornado warning is issued), o Pick up telephone and press " # 11 " and wait for the beep, then press " 00 " o Announce 3 times over the public address system: ® "Attention! Attention! A tornado Warning has been issued and all Employees are to proceed to the nearest interior stairwell". o Area Evacuation Supervisors need to quickly encourage employees to move to safe location and will "sweep" the location to ensure all people are out. • Collier County Government at each location employees will proceed to the interior stairwells as evacuation Supervisors direct. • Provide support in accordance with the ADAAG, `Americans with Disabilities Act Accessibility Standards (2010) for evacuating individuals with disabilities. • Crouch down along the wall and protect your head with your hands to reduce potential injury. • Remain sheltered until "All Clear" given by the Operations Chief. • If the building is damaged, attempt to safely exit the building. • If unable to exit the building, use a cell phone and call 911. IIn Prepare, Prepare, Prepare—Additional Training and Assessments available from Security Know your surroundings 1. Identify all possible exits and where they lead out to 2. Designate a safe room, pick a room that can be easily defended, and locked from the inside 3. Identify items that can be used as weapons 4. Locate all panic alarms 5. Assign roles for each employee, train and document. 6. Report any strange behaviors or conversations to your immediate supervisor and security. (These incidents should be documented and reported to H.R. and Security ext. 2222). Hardening the target: Compile a list of things in your office that you feel should be improved upon to make it safer. Badge access only doors, cameras, panic alarms, enhanced door locking devices, security presence etc. Please adhere to the procedures below for responding to an active shooter or work place violence incident within your assigned building. Evacuate the area only if it can be done safely. Law Enforcement encourages: RUN! HIDE! FIGHT! ECURE YOUR IMMEDIATE AREA: • Press the panic button If one is available to you. • Lock / barricade doors with any available objects (chairs, tables, cabinetry). • Turn off lights, close blinds / block windows and silence cels phones. • Stay calm, quiet, and out of site by lying close to the ground. • Take adequate cover behind a concrete wall, filing cabinet, or desk. • Facilitate basic first aid or triage victims in your secured area. • Do not attempt rescues of the injured outside of your secured area. • Remain in place until Security Forces give an "All Clear". WHAT TO REPORT: • Quietly alert security (2222) and call 911 • Your specific location, address, floor, office / room number. • Number of people at your specific location. • Number of injured, types of injuries, and severity of injuries. • Assailant (s) description, type of weapon, and identity if known. • First responders will assist with un -securing area and rescuing victims. • Follow the directions of the Security Forces. • Leave personal belongings behind when evacuating. 11 Annex 6 RESPONSE TO CHEMICAL RELEASE 1) Chemical Release, with Injured Personnel: • Immediately contact Area Evacuation Supervisor. • Activate the BCC Emergency Spill Response Protocol. • A potentially dangerous situation exists. The initial condition of the victim is not a good indicator of the urgency of the problem. Recognize that symptoms from many inhalation exposures take up to 12 hours to appear, and may lead to pulmonary edema and death. • Alert nearby co-workers of the potential of danger from exposure to the chemical release. • Remove the injured person form the area of exposure. Do this only if you can do it without injury to yourself!! Otherwise, wait for properly trained emergency personnel to perform the rescue. • From a safe location, call for emergency medical assistance: Call 911 a) Give the location of the emergency- Building H, Floor # b) Give the extent and nature of injury, if known. c) Give any details that may be important in a rescue situation - what chemicals are involved, toxic fumes involved, etc. • Evacuate all non-essential personnel. • Ensure all appropriate Risk Management STARS Report is filed within 24 hours of incident. 2) Chemical Release, with no Injured Personnel • Immediately contact Area Evacuation Supervisor. • Activate the BCC Emergency Spill Response Protocol. • Take action to prevent injuries to co-workers. • Get away from the area until proper provisions can be made. • Notify personnel in the immediate area of the chemical release. • Evacuate all non-essential personnel. • If the chemical spill is large, in a poorly ventilated area or is extremely toxic (that is, if it is beyond the capabilities of the attending personnel or of the equipment at hand), call 911 • Ensure all appropriate Risk Management STARS Report is filed within 24 hours of incident. NOTE: Do NOT attempt to clean the spill unless trained to do so! If properly trained to respond to a chemical release in accordance with the instructions described in the Emergency Spill Response Protocol. Contact Risk Management 12 13 A disturbance has been reported We must leave the building Spanis h Un problema a surgido y necesitamos que evacuen (salgan) del edificio Creole Nou Fe'k apran-n gen yon derapaj nan bilding nan. Nou dwe kite bilding nan kounyfe a. 14 Annex 8 page (2) Danger!! Do not Enter P e l i g ro, no Entre (Spanish) D a n j e Pa a n t re IN (Creole) 15 TM's quick reference d;eckfbt is designed to help respcndio a bomb Ntreat n an orderly and corkroped manner nub the first respxlders and other stakeAavkrs. Most barb threats are receved by phone. Bomb threats are serous uti proven otic- 'se. Aa quickly, trot remah calm and obtain Wwwton with the checklist on the reverse of the cad. If a bomb threat is received by phone: i. Remain calm. Keep the ca'keron the line for as long as pcssule. DO NOT HkNG UP, ever, R the caller does. 2. Listen carefully. Be polite and show merest 3. Try to keep to cakr taking to learn more inlctmation. 4. If possible, We a nae to a mkmgueto call the whaities or. as soon as the caller hangs up, immediately notify them yourself. 5. If your ph" has a display, copy the number and+or letters on the windwr display. 6. Complete the Bomb Threat Checklist immediately. Write dove as much &W as you can remember. Try to get eka Y"ds. 7. Imed3Wy upon temtinkon of cal. DO NOT HANG UP, but tram a different phone, contact audwdties immedately vith infemLation and aeait instruct , w& If a bomb threat is received by handwritten note: • call • Hanr&rwteasmnimaiyaspossbte. If a bomb threat is received by a -mall: • Call • DormtdOetethemessage. Signs of a suspicious package: • No return address • poorly Irmt1wriuvri • Excessive postage • Misspelled meds • Stains • Inconea titles • Snange odor • Foreign postage • Strange sounds • Restrictive notes • Unexpected delivery 'Refer to our emergency response plan for evacuation criteria DO NOT: • Use two-vrayradios acePILv phone. Rano sgmais have the potential to detonate a bomb. • Touch a more a suspidous package. For more information about this form contact the Risk f' Management office at 252.8461. Co ler Ca1+rlL,y A.M T16ta tva Sw 4op* Rmpaltmamt RaP 61ana�rlrWrt Osisg DATE: TIME CALLER HUNG UP: • wneie is the DomD locatea? (ouisng, tbor, room, etc.) • Vlnat kind a Lamb Is It? • What wil hate • Dkt yvJ place Ne bxnD? Yee No • Esefnated age: TIME: PHONE NUMBER WHERE CALL RECEIVED: Information About Caller: • Is 1oce fdmllaf7 d so, ono does k sound Ile? Grata Vale. Fen s Male Accent Myo ZC rn okL Wads cowhlnp 0r405v vane crAnp Deep Deep bmmna DlcpJ Monet salted Lanhtu Lnp L9ud Nast Nor Rapped Rapw Raspy svw Send cot erAw eaoe•ro.mt 2..l . Memo W -es Haut 4.40, Iplctxn naLea soca nate. BaoN MsAlem C Vtl bl= MUIC Mawr Gest smc O m m3"M Fad* Ma nery L.Cd LGM aaume OU*r IeNrmetlan: Tan.] uneuape IneaSemnl I�M,Qe M64 T.FM message IRatWAI Nro ne VWHpdten 13CC Emergency Action Plan for the Collier County Government Building 112nd Ft. NW "kill 111"VVIR-1111i Collier County Government Reviewing Entities: Division Director: Sean Callahan Environmental, Health•& Safety: Ron Diller Facilities: Josh Cashdollar Security: Keith Wallace Collier County Administrative Services Department Approving Entity. Director of Risk Management Jeff Walker Collier County Public Utilities Department Approving Entity: Interim Director, Facilities Management Collier County Public Services Department Approving Entity: Department Head, Public Services Department Steve Carnell Collier County Administrative Services Department Approving Entity: Department Head, Administrative Services Department Collier County DiVI6161t Director, Q ra Vs V to n Services _ Approved: � (s6/ Date �J D Sean Callahan, Division Director, Operations & Veteran Services Collier County Environtel, H •alth & safe p Approved: � �Sn� Date �� 1 f Ron Miller Environmental, Health & Safety Manager, Risk Management Division BCC Emergency Action Plan for the Collier County Government Building H 2nd FL NW Collier County Facilities Approved: Josh Cashdollar Collier County Security Approved: Date Acting Supervisor, Facilities Management Division Keith Wallace Deputy Chief of Security; G4S Date Collier County Public Services Department Approved:Date NAME: Steve Carnell Department Head, Public Services Department Collier County Administrative Services Department Approved: Date Len Golden -Price Department Head, Administrative Services Department Collier County Administrative Services Department — Risk Management Approved: Date Jeff Walker Director, Department of Risk Management Collier County Public Utilities Department — Facilities Management Approved: Date Miguel Carballo Interim Director, Division of Facilities Management 2 BCC Emergency Action Plan for the Collier County Government Building H 2nd FL NW 1. Purpose: To provide a consistent Emergency Action Plan for the BCC. This will assist in the attainment of the Incident Objectives, which are the safety and security of all employees and clients of the Collier County Government, BLDG H 2ND FL NW AREA 11. This document is part of the Collier County Government Location emergency response plan. 2. Authoritative Reference: Collier County Office of the County Manager, Administrative Doctrine, Collier County Emergency Building Emergency Action Plan, Chapter 5201, Florida Department of Health — Collier County Department Heads building closure; Collier County Sheriff Office Bomb Squad; East Naples Fire Department, Collier County, Collier County CMA 5201, "Emergency Building Emergency Action Plan, CMA 5902. "Workplace Safety & Health Policy", ADAAG, 'Americans with Disabilities Act Accessibility Standards (2010)', ANSI 117.1-2003 `Accessible and Usable Buildings and Facilities and NFPA 72, the National Fire Alarm Code, 2016 edition. 3. Scope: This Policy and Procedure Guideline outlines the employee's responsibilities in preparation for and response to an evacuation or emergency situation of the Collier County GovernmentBLDG H 2ND'FL NVV AREA 11. 4. Related Guidelines: Annex 1 Fire Annex 2 Bomb Annex 3 Suspicious Packages Annex 4 Tornado Annex 5 Active Shooter Annex 6 Chemical Release Annex 7 Assignments Annex 8 Signage Annex 9 Floor Plans 5. General Responsibilities: Each Collier County Director with employees working in the building/location is ultimately responsible for ensuring that the plan has been reviewed and in place. All Collier County Government Directorates located within a Collier County Government BLDG H 2ND FL NW AREA 11 will familiarize new employees with the Emergency Action Plan and the Annexes. Operations Chiefs, Evacuation Area Supervisors and their Alternates will be familiarized with responsibilities and their respective duties at the time of their selection. All meetings with employees will have attendance taken and a copy all rosters forwarded to Risk Management EHS Manager. BCC Emergency Action Plan for the Collier County Government Building H 2nd FL NW There will be an annual review of the Emergency Action Plan and its Annexes by Collier County Administrative Services Department — Risk Management & Public Utilities Department Governmental Security/Facilities Divisions. To is=Fire Page Purpose Authoritative3 References Table of Contents4 Terms and Definitions5 Annex 1 8 Annex 2 Bomb 9 Annex 3 Suspicious Package 10 Annex 4 Tornado 12 Annex 5 Active Shooter 13 Annex 6 Chemical Release N/A Annex 7 Assignments 14 Annex 8 Signage 15 Annex 9 Floor Plans 17 Ell LO m N o N m'b N 0 7. m ro Ati-E Ea mora- ..� a° •A U ro >�a) Cm a) N 'C , ro a c h 46 LL N U q (D a) O a) n% v c U U rn N N N U 1 c� E N �- O c 3 a) U O_ m a N _zo OU d 0)d '..p.. a) N r ® C a) p m c N N p u - m m a) �'- roQo m N=�0. m o V) C N O U O ro Q o c @ ro m Z a O ca a c E 0 O V.0 �. a) o a N ' C 0 W a. � A o ro °' L' W N a. N N m c N ro A a L h o �° ro 0 (D NQ m� a E'er Ea ro a° C ca m mcm mac m ovum m e E N Lp40 O Ly' "_ N E Q. M 0 N E Y '� N A N U= M a E .O°. c O a .O a) O N K y Co U 'N a Co. a .4.' a E E O m •c )i ro U C a i. U M Q ro > a .C) tj '� o p U p c a c. 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L. w+L• >t%U v ll� CV M V L6 I- BCC Emergency Action Plan for the Collier County Government Building H 2nd FL NW When you enter a room or corridor of a building: • Make note of the exits. • Know the location of the alarm stations and fire extinguishers in the area. If you see a fire or smell smoke: • Pull the alarm immediately (This will initiate the Emergency Action Plan). • BCC Annex buildings without alarm stations: Call 911 o Stay calm and give specific directions. o Speak slowly and clearly. • If the Alarm is not sounding or you know the location of the fire dial "0" on the telephone for the operator (Health building). Tell the operator answering exactly where the fire is. • In the Health building, if the fire alarm is not sounding, the operator will: o Pick up telephone and press " # 11 " and wait for the beep, then press " 00 ". This will activate the intercom system on both the first and second floor hallway. o Announce 3 times over the public address system. ® "Attention! Attention! Please evacuate the building" o Area Evacuation Supervisors need to quickly encourage evacuation — "Please evacuate the building, nowl" • Evacuation Supervisors from first / second floors will ensure third floor evacuation in addition to usual assignment, as well as meeting the ADAAG, `Americans with Disabilities Act Accessibility Standards (2010) for evacuating individuals with disabilities. • Notify other volunteers and clients in the area to evacuate immediately. • All doors are to remain unlocked to allow Fire Rescue access. • If the fire has potential to reach Chemicals, the BCC Emergency Spill Response Program (ESRD) goes into effect and the Collier County Emergency Response Team (CCERT) is immediately notified. • Close the door on the fire and notify others in the area to evacuate immediately. Fire Extinguisher Use USE THE FIRE EXTINGUISHER IF: 1) The fire is small and in its beginning stage. 2) There is a fire extinguisher handy. 3) You know how to operate it. DO NOT USE THE FIRE EXTINGUISHER IF: 4) Fire is not in the beginning stages. 5) Fire is too large to control with afire extinguisher. 6) There is no extinguisher handy. 7) You have not been trained on how to use it. 9 BCC Emergency Action Plan for the Collier County Government Building H 2nd FL NW Annex 2 RESPONSE TO A BOMB THREAT All Collier County Government employees with a telephone that receive incoming calls should have a Bomb Threat Check List Card (at bottom of policy) posted by their phone. If you receive a bomb threat call, follow directions on the card. ® Ask as many questions as possible listed on both sides of the Bomb Threat Checklist Card. All bomb threats should be considered valid, No "new" power sources are to be activated. New power sources refer to light switches, copy machines, computers, etc. If it is on, leave it on and if it is off, leave it off. Hard line phones are not considered new power sources UNLESS the phone suddenly appears in the area of the threat. o Activate building Fire Alarm. o Call 911. • Speak slowly and clearly. • Stay calm and give the information you received. o Notify Campus Sectari$ at 2222. • Do not use a cell phone, two-way radio or public address system. • Cell phones may be used at a distance of 300 yards or more for emergency calls only. • Each person; look at their own area quickly to determine what, if anything, is suspicious. • Take your personal possessions. Calmly, but quickly, exit the building and proceed to the designated rendezvous point. • Provide evacuation support in accordance with the ADAAG, 'Americans with Disabilities Act Accessibility Standards (2010) for evacuating individuals with disabilities. • Be alert to possible threats; pay close attention to suspicious boxes or unclaimed briefcases. • Share any information gathered with the Operations Chief (green Vest) or Area Evacuation Superarisor (orange vest). • Do not lock office doors. • Direct clients to the evacuation rendezvous point. • Be alert to others with special needs and assist if help is needed. • Operations Chief will notify Department Directors, Risk Management Director and Security Director. • Facilities Management, County Security, or Local Emergency Providers will stop all clients and staff from entering the building. BCC Emergency Action Plan for the Collier County Government Building H 2nd FL NW Annex RESPONSE TO A SUSPICIOUS LETTER / PACKAGE / CONTAINER j. Purpose: To provide guidelines for safe response to a suspicious letter, package, or container; this guidance is generally focused on the initial response to potential biological threats, so all personnel responding to such incidents must be aware of the potential for exposure to hazardous chemicals and/or radiological materials in addition to biological hazards. 2. Authoritative Reference: Florida Department of Law Enforcement, International Association of Fire Chiefs, National Response Plan, ADAAG, 'Americans with Disabilities Act Accessibility Guidelines', ANSI 117.1- 2003 'Accessible and Usable Buildings and Facilities. Collier County CMA 5201, "Emergency Building Emergency Action Plan and CMA 5902. "Workplace Safety & Health Policy" 3. Scope: This Policy and Procedure Guideline outlines the Collier County Government /BCC employee's responsibilities in preparation for and response to a suspicious letter or package or container. 4. Related Policy and Procedure Guidelines: N/A 5 Policy Statement: The Collier County Government BLDG H 2ND FL NW AREA 11 will be able to safely respond to a suspicious letter / package / container based on these guidelines. Division Directors and Supervisors: 4` These Supervisors are responsible for ensuring that all staff is familiar with the "Response to a Suspicious Letter or Package or Container" policy. ** Please emphasize to staff that the person discovering the item is responsible for initiating the 911 response** Supervisors• Supervisors will familiarize new employees with the plan at the time of hire. ACTIONS TO TAKE IN THE EVENT OF SUSPICIOUS LETTER OR PACKAGE OR CONTAINER • Do not touch, move or open any suspicious letter, package or container. • If holding, gently set the item down. • Move away from the item and evacuate the immediate area. • Provide evacuation support in accordance with the ADAAG, 'Americans with Disabilities Act Accessibility Standards (2010) for evacuating individuals with disabilities. • Notify appropriate law enforcement *Call 911 -First** and then Campus Security at 2222. • Notify Division Directors, Risk Management Director and Government Security Director. • If it is determined to be a Hazardous Material, the BCC Emergency Spill Response Program (ESRP) goes into effect and the Collier County Emergency Response Team (CCERT) is immediately notified. • Do not allow anyone else in the area. • Treat the area as a crime scene. • Wash your hands well. • When you go home, remove all of your clothes and wash them in hot water.. • Take a shower. 10 BCC Emergency Action Plan for the Collier County Government Building H 2nd FL NW oilier County Coordinated Response to a Suspicious Letter, Package or Container: 911 Call received. Law enforcement response will be based on Department of Homeland Security and Center for Disease Control joint guidelines. Potential threats or incident scenarios: • Letter/container with unknown powder -like substance and threatening communication with or without illness. • Letter or container with a threat, but no visible powder or substance present. • Letter/container with unknown powder, no articulated threat and no illness. • Letter/container with no visible powder and no threat but recipients are ill. • Letter/container arrives with no powder, no threat, the recipient is not ill, but the recipient is concerned about the package. • Credibility is determined. • Law enforcement calls Fire and Emergency Medical Services. o Under no circumstances should an unprotected responder attempt to package a specimen. • Hazmat/fire performs necessary field safety screening as required by Bureau of Laboratory, (BOL) policy. • Fire/hazmat obtains specimen (if small enough to place in designated can or utilizing appropriate swab as per BOL policy). • Law-enforcement will coordinate the delivery of the specimen with DOH -Collier. • Only Public Information Officers should respond to the media. 11 BCC Emergency Action Plan for the Collier County Government Building H 2nd FL NW Annex 4 ACTIONS TO 'TAKE IN THE EVENT OF A "TORNADO WARNING i he National Weather service issues tornado watches and tornado warnings. These are broadcast via National Oceanic and Atmospheric Administration (NOAA) public alert radios. NOAA Radios is located at BUILDING H 2ND FL Suite 217 — PSD Administration. SW Florida frequency for a NOAA weather radio is 162.525. The Specific Area Messaging Encoder (SAME) number (Collier County specific) is 012021. Monitor The NWS Forecast Office Miami - South Florida Website for more information. Departments with an assigned NOAA public alert radio are responsible for: • Programming the public alert radio. • Leaving the public alert radio on at all times. • Ensuring the public alert radio is in working condition. • Changing the back up battery of the public alert radio as needed. RESPONSE ACTIONS: If a tornado watch is issued, monitor the public alert radio and The NWS Forecast Office Miami - South Florida for situational updates. If tornado warning is issued, Dial "0" for the Operator and request that a message be broadcast through the 15f and 2"d hall intercom system. o Operator will pick up telephone and press " 11 " and wait for the beep, then press " 00 ". This will activate the intercom system on both the first and second floor hallway. o Announce 3 times over the public address system: • "Attentionl Attentiont A tornado Warning has been issued and all Employees are to proceed to the nearestinterior stairwell". o Area Evacuation Supervisors need to quickly encourage employee Compliance and Evacuation Supervisors from first / second floors will ensure third floor employees are aware in addition to usual assignment. • Collier County Government BLDG H 2ND FL NW AREA 11 employees will proceed to the interior stairwells as evacuation Supervisors direct. • Provide support in accordance with the ADAAG, 'Americans with Disabilities Act Accessibility Standards (2010) for evacuating individuals with disabilities. • Crouch down along the wall and protect your head with your hands to reduce potential injury. • Remain sheltered until "All Clear" given by the Operations Chief. • If the building is damaged, attempt to safely exit the building. • If unable to exit the building, use a cell phone and call 911, 12 BCC Emergency Action Plan for the Collier County Government Building H 2nd FL NW Anne 5 ACTIONS TO TAKE IN THE EVENT OF WORK PLACE VIOLENCE erepare, Prepare, Prepare Know your surroundings 1. Identify all possible exits and where they lead out to 2. Designate a safe room, pick a room that can be easily defended, and locked from the inside 3. Identify items that can be used as weapons 4. Locate all panic alarms 5. Assign roles for each employee, train and document. 6. Report any strange behaviors or conversations to your immediate supervisor and security. (These incidents should be documented and reported to H.R. and security.) Hardening the target: Compile a list of things in your office that you feel should be improved upon to make it safer. Badge access only doors, cameras; panic alarms, enhanced door locking devices, security presence etc. Please adhere to the procedures below for responding to an active shooter or work place violence incident within your assigned building. Evacuate the area only if it can be done safely. Law Enforcement encourages: RUN! BIDE! FI HTI SECURE YOUR IMMEDIATE AREA: • is the panic button if one is available to you, • Lock / barricade doors with any available objects (chairs, tables, cabinetry). • Turn off lights, close blinds / block windows and silence cell phones, • Stay calm, quiet, and out of site by lying close to the ground. • Take adequate cover behind a concrete wall, filing cabinet, or desk. • Facilitate basic first aid or triage victims in your secured area. • Do not attempt rescues of the injured outside of your secured area. • Remain in place until Security Forces give an "All Clear". WHAT TO REPORT: • Quietly alert security (2222) and call 911 • Your specific location, address, floor, office / room number. • Number of people at your specific location. • Number of injured, types of injuries, and severity of injuries. • Assailant (s) description, type of weapon, and identity if known. • First responders will assist with un -securing area and rescuing victims. • Follow the directions of the Security Forces. • Leave personal belongings behind when evacuating. VT411111JIM11111! 11 111 1 111111111 1 1111111111 111 il -1 13 BCC Emergency Action Plan for the Collier County Government Building H 2nd FL NW Annex 8 14 BCC Emergency Action Plan for the Collier County Government Building H 2nd FL NW disturbance •i.:. I been ... w•.:- iWe must leave the building - • • • • • ! • • � : • s que Creole •' kounyfer 15 BCC Emergency ,fiction Plan for the Collier County Government Building H 2nd FL NW Annex 8 page (2) SmEmisweem Peofli,rb Entre (Spanish) inje r ian(Creole) 16 FENNO] BCC Emergency Action Plan for the Collier County Government Building H 2nd FL NW This qulckonerence checklist Is designed to help employees and decision makers of commemraifacihfies, schools, eta respond to a bomb threat in an ofdedy and con- Irolled manner will, the first responders and other stakeholders. Most bomb threats are received by phone. Bomb threats ore serious until proven otherwise. Act quickly, but remain calm and obtain Information with the eheckifst on the reverse of ihls card. If a bomb threat Is rocelved by phone: t. Remain calm. Keep the caller on the line for as long as possible, DO NOT HANG UP, even if the caller does. 2. Listen carefully, Be polite and Show Interest- 3. nterest3. Try to keep the caller talking to learn more information. 4. If possible, write a note to a colleague to call the authorities or, as soon as the caller hangs up, immediately notify them yourself. 5. if your phone has a display, copy the number and/or letters on the window display. 6. Complete the Bomb Threat Checklist immediately. Write down as much detail as you can remember. Try to gel exact words. 7. Immediately upon termination of call, DO NOT HANG UP, but ((oma a different phone, contact authorities immediately with Information and await Instructions. If a bomb threat is received by handwritten note: • Cail • Handle note as minimally as possible. If a bomb threat is received by email: • Cali • De not delete the message. r,. ilgns of a suspicious package: E • No return address a poorly handwritten • Excessive postage • Misspelled words • Stains • Incorrect titles • Strange odor • Foreign postage • Strange sounds • Restrictive notes • Unexpected delivery " Refer to your local bomb threat emergency response plan for evacuation criteria DO NOT: • Use two-way radios or cellular phone. Radio signals have the potential to detonate a bomb. • Touch or move a suspicious package. For more information about this form contact the DHS Office for Bombing Prevention at OBP@dhs.gov �SPAYTLF^ Homeland a 2014 °fr pF Security DATE: TIME: TIME CALLER PHONE NUMBER WHERE HUNG UP: CALL RECEIVED: • Where Is the bomb located? (building, floor, room, etc.) • Wnen will it go on • What does It look like? • What kind of bomb Is It? • What will make It explode? • Old you place the bomb? 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W M 2i K N IN LL mJi vm l Z M M m IN N H N N M m ON N M N N mm m m w vQt m �w-i N T O X c c pp C N t' is OC by •Z 0 a O m �: T C CO Y 9 N 0 0 a 3 v o `a f2Y° E m v E E E v > u _ — c — E w E E W L 2 a 2 Z J Z> a O] gN In O X C o p v >; O > > m N N UO N O c. O v > .. •- c 3 O s C N o U C O U l7 N T N W — O tm m E m •= v ai c ¢� l9 N > c[ Y !0 U l7 a a Fes- N a Z = 0 po N L N U rLo E io C N E 'o o m o " T v t`� m N m w v m O N + m E. a �= v o o a vvry 6 N V v [_� O v E ° m v W H E 3 io o f 0 ti u a o o v m 'v a o s a x a a a a u w (D (Dx 0u 5 v > Bureau of Emergency Services `ca°o''2r SPECIAL Collier County Emergency Management 8075 Lely Cultural Parkway, Naples, FL 34113 . - Phone: 239.252.3608 Welcome to the Special Needs Program registry! Life safety is number 1 in our book and we need you to help us exceed this expectation! This registry is not a shelter registration form. The Collier County shelter is considered a shelterof last resort. Residents should exhaust every effort to make alternative arrangements with a health agency, care facility, friends, or family for shelter needs during an emergency. Due to the high volume of residents seeking shelter, conditions are stressful, loud, crowded and may be uncomfortable for patients. Program Guidelines Collier County Emergency Management in collaboration with the Department of Health -Collier County maintains a Special Needs Registry. This is not a shelter registration form. In the event of a disaster, Collier County along with the Collier County Health Department will strive to provide special medical sheltering and/or transportation to a special needs shelter on a critical priority medical basis. Registering with the Special Needs Program automatically enrolls you in ALERT Collier for emergency communications. If you prefer to submit your registration on-line, please visit CollierEM.ora Registration Criteria 1. You have a medical or physical need that may require medical assistance during an evacuation and sheltering situation but you do not require transportation to the shelter. i 2. You have a medical or physical need that may require medical assistance during an evacuation and sheltering situation and do require transportation to the shelter. 3. IIfyou are age 60 or above and have no medical needs but require transportation to a general population shelter during an evacuation and sheltering situation. Due to limited shelter space and mass care medical teams it is strongly suggested that you pursue personal evacuation plans with family, friends, and neighbors. If you plan to evacuate to a special needs shelter, you must have a caregiver accompany you. For assistance in developing a personal disaster plan, visit FLGetAPlan.ora Definitions People with Special Needs — Populations whose members may have additional needs before, during, and after an incident in functional areas, including but not limited to maintaining independence, communication, transportation, supervision, and medical care (National Response Framework, FEMA 2013.) Special Needs Shelter - Special Needs shelters are designed to care for people with minor medical or nursing needs as defined in Persons with Special Needs (PSN). The professional care available at the special needs shelter depends upon the number and type of nursing and medical volunteers. General Population Shelter—General population shelters will accept anyone who is self-sufficient. People that do not require assistance in performing activities of daily living can utilize a general shelter. The information provided annually on the registration will remain confidential. It will be given to first response agencies (fire, police, health, etc.) at the time of an emergency and only to those who are directly involved with your well-being. This Collier County Emergency Management, Human Services Division, CollierEM.org, Lauren Bonica@CollierGov.net, 239-252-3608 � �, Page 1 CoYlier County form also authorizes these same emergency response agencies to enter onto your property during post -disaster search and recovery activities. It is important that the information you provide be accurate and up to date. People With Special deeds (General criteria) • Visually Impaired • Hearing Impaired • Use of Wheelchair/ Adaptive Equipment • Elderly with Physical or Emotional Needs • Respiratory Problems - Acute or Chronic • Recent Discharge from the Hospital or Recent Surgery • Oxygen Dependent • Recent Cataract Surgery • Cardiac Problems • Seizures • Diabetic • Tracheostomy • Gastrostomy Feeding • Pregnant Women — 3rd Trimester Only (No High Risk Pregnancies) • Contagious Diseases • Urinary Catheter • Immune System Condition • Wound Care • Colostomy • Physical Handicaps • Emotionally or Socially Dependent Upon Others for Independent Living • Mental, Cognitive, Impairment or Sensory Deficit Persons requiring skilled nursing care, life support, etc. should find alternative locations to shelter and discuss evacuations and sheltering needs with their doctor and health care agency prior to disasters. Referral to an alternate location may be necessary. If your doctor has determined that you must be evacuated to a hospital or other skilled nursing facility, please work with them in advanced to make these critical plans. It is important that those needing transportation or special needs care register with Collier County Emergency Management as soon as the need becomes apparent. Do not wait until it's too late! If a wildfire pops up we want to be able to contact you ASAP for support or welfare check. ! ., Please complete all sections of the form as completely as possible. A telephone number is required. Emergency Management officials must be able to contact you if it becomes necessary to evacuate your neighborhood. If you do not have a telephone, please provide a friend or local relative's name & phone number so that a message can be left for you. Please remember to include the area code. Sign and date the form. The form must be signed by either the registrant, or authorized caregiver for the registrant. Preparation Guidelines Special Needs Shelter Location: Palmetto Ridge High School, 1655 Victory Lane Rd Naples, FL 34120 Persons requiring medical/nursing assistance and or transportation will be sheltered at this location. Shelter opening times are broadcast on government TV, local radio, and TV stations. If providing your own transportation, please do not report to the shelter prior to the announced opening time. If you can stay in a general shelter, please opt for that as this shelter is very limited in space. Evacuation Mobile homes, RV's, and some manufactured home residents must evacuate for all hurricanes and may be evacuated for certain tropical storms. It is unsafe to remain in certain structures, as they may not be designed to withstand high winds. Single family homes, condos and apartments may not be evacuated for all types of hurricanes/ tropical storms. Please monitor Collier Government TV as well as local radio and TV stations for evacuation information. Due to the time required and limited resources to safely evacuate the special needs population, the evacuation process is conducted well in advance of any expected hazardous weather conditions. You must be ready to evacuate when told to do so by emergency officials. Collier County Emergency Management, Human Services Division, CollierEM.org, Lauren Bonica@CollierGov.net, 239-252-3608 � Page �2 CO1Lier G014Hty If it appears that a disaster may affect Collier County, every attempt will be made to contact those persons currently registered via telephone. This is to alert you to the situation and to advise that an evacuation may be necessary. Ideally, the attempt to contact those registered will be made 24-36 hours prior to the arrival of the disaster and should allow ample time for you to complete your preparations. Those persons currently registered who requested transportation would be notified of a time frame for the bus to arrive. Example: Pick-ups will start at _ and should be completed by—. If the bus has not arrived by the expected completion time CALL EMERGENCY MANAGEMENT AT 239-252-8444. BUSES MAY BE DELAYED DUE TO TRAFFIC AND WEATHER CONDITIONS. What to Bring to the Shelter At the beginning of hurricane season, (June 1st - Nov. 30th) gather the following items. Keep these items in a place where you can get to them quickly. Please label your items, and make them as easily transportable as possible by using containers, bags, luggage, or other similar items. Important Paperwork • A list of phone numbers of family or friends to notify if you evacuate. • Medicare, Medicaid, or health insurance cards (make copies). • DNR paperwork or living will; The DNR must be the original form. Bring it with you to the shelter. • Write down a plan for housing after the storm in case you are unable to return to your home due to damage. • Copies of homeowner's policy, insurance policies for vehicles. • List of names, addresses, and phone numbers of doctors and pharmacies. F Medications • Bring at least a fourteen (14) day supply of all prescription and non-prescription medications that you use. A list of all medications & dosage schedules, dialysis supplies, and any items needed to administer the medications (syringes, alcohol preps, etc.). Bring original prescription bottles even if you have your pills in a daily dosage container. • If you use an oxygen concentrator, bring it with you to the shelter. Concentrators can be used as long electrical power is available. • Bring additional portable oxygen cylinders (size D or E) with a regulator and all necessary tubing. Put a label with your name on your oxygen cart. • All Liquid oxygen users- you must bring extra HELIOS / liquid oxygen cylinders with you to use when you leave the shelter. The shelter cannot refill your cylinders. Drinking Water Bring at least two gallons of drinking water per day. The small individual size bottles are a lot easier for many people. Food • 5 -day supply of non-perishable foods or snacks and a hand or battery operated can / bottle opener. There will be limited meals provided. Special dietary foods will not be available. Collier County Emergency Management, Human Services Division, CollierEM.org, Lauren Bonica@CollierGov.net, 239-252-3608 Page Co er County • Be sure to bring pillows and blankets, a folding cot/sleeping mat. Caregivers will also need to bring bedding items, and cot sleeping mat or folding chair. LABEL your belongings with your name & address. f Personal Hygiene Items • Towel, Washcloth, Soap, Shampoo • Over -the -Counter medications • Deodorant, Bandages/Dressings Other Items • Wheelchair and/or Walker • Hearing Aids & Batteries • Prosthetic Devices • Nebulizer Equipment • Cell Phone/Chargers • Denture Cleaner, Toothbrush & Paste Comb / Brush • Adult Diapers, Sanitary Supplies, Bed Pan/Urinal (if needed) • Flashlight/Radio/Spare Batteries • Extra Change of Clothes • Books/Games/Hobbies • Sunscreen & Mosquito Spray • Small Cooler & Ice Pack Animals Depending on the emergency, certain shelters will be pet friendly. Service animals are allowed in the shelters. If you do have a service animal you are required to bring to the shelter: food, water, feeding dishes, extra leash, vaccination records, and waste bags. If you have a pet please make advanced arrangements as space is limited. Have the following items on hand for your pet sheltering plan: • Current Vaccination Records • Food & Water for 14 Days • Feeding Dishes/Bedding • Pet Carrier Label w/ name, address, and phone number. If necessary, the County's Domestic Animal Services may be able to shelter pets for those persons with the Special Needs Program if you cannot make other arrangements. Please register with the Department of Animal Services by calling 239-252-7387, shelter capacity is limited. Disaster Information During times of emergency, current updates and advisories from Collier County's Emergency Operations center will be broadcast on: Cable TV Channels • Channel 97 (Collier Gov) • Local TV Media Stations • NOAA Weather Radio 162.525 WSGL Radio —104.7 FM • WGCU Radio — 90.1 FM Important Phone Numbers Collier Info Center Hotline: 239-252-8444 or 311 Department of Health -Collier County: Sheriff Non -Emergency: 239-252-9300 239-252-8200 American Red Cross: 239-596-6868 Salvation Army: 239-775-9447 Collier County Emergency Management, Human Services Division, CollierEM.org, LaUCenBonica@CollierGov.net, 239-252-3608 Page 14 Co er County Bureau of Emergency Services '.ty,FL Collier County Emergency Management 8075 Lely Cultural Parkway, Naples, FL 34113 Phone: 239.252.3608 Welcome to the Special Needs Program registry! Life safety is number 1 in our book and we need you to help us exceed this expectation! This registry is not a shelter registration form. The Collier County shelter is considered a shelter of last resort. Residents should exhaust every effort to make alternative arrangements with a health agency, care facility, friends, or family for shelter needs during an emergency. Due to the high volume of residents seeking shelter, conditions are stressful, loud, crowded and may be uncomfortable for patients. (Please printortype. Callus to renew or update yourapplication on a yearly basis.) This information may also be entered into the Collier County Special Needs Registry by visiting CollierEM.org PERSONAL INFORMATION FOR INDIVIDUAL WITH NEED - You will automatically be enrolled into ALERT Collier for emergency notifications and evacuation alerts. Name: (First Name, Mi. Last Name) Physical Address: City: State: Zip Code: Residence Type: ❑- Single Family Home ❑ - Multi -Family Home❑ - Mobile Home❑ - Apartment Mailing Address: (Please enter If different than your Physical Address) City: Email Primary Phone: ( ) Secondary Phone: ( ) - Date of Birth (mm/dd/yyyy) __j,. State: Zip Code: Is Primary Phone TTY/TTD - ❑ ❑ - I do not have a phone Height: Gender: Female, Male, Non-binary/third gender, Prefer not to say, Prefer to self describe: Eye Color: Weight: PERSONAL INFORMATION FOR EMERGENCY CONTACT Primary Contact Name: (First Name, Mi. Last Name) Address: City: Relationship:❑- None ❑ - Friend ❑ - FamilyE]- Neighbor ❑ -Caregiver Zip Code: Email: Primary Phone: ( ) Secondary Phone: ( ) State: Collier County Emergency Management, Human Services D'vision, CellierEM.org, LaurenBonica@CollierGov.net, 239-252-3608 Co er County Rev. 4.2019 Page I 1 Secondary/Out of Area Contact Name: (First Name, Mi. Last Name) Address: City: Relationship:❑- None ❑ - Friend ❑- Family[]- Neighbor[—]- Caregiver Zip Code: Email: Primary Phone: ( ) Additional Contact Information Physician Information Name: Caregiver Information Name: Home Health Care Information Name: Pharmacy Information Name: Evacuation Assistance Information Secondary Phone: ( ) Phone:( ) Phone: ( ) Phone: ( ) Phone:( ) State: I Blind/Low Vision I Moderate I Assistance needed with LI Deaf/Hard of Hearing Dementia/Alzheimer's Insulin Behavioral Health Issues I Severe I Requires Refrigerated Meds I Contagious Disease Dementia/Alzheimer's I Autism I II Frail/Elderly I Hemodialysis at Facility I Special Dietary I I Speech Impediment II Hemodialysis at Home Needs/Restrictions I I Physical Disability I I Peritoneal Dialysis I I Seizures II Bedridden II Requires Constant Skilled 1:1 Other I.I Mentally/Memory Impaired Nursing Care I Mild Dementia/Alzheimer's I Assistance with Medications Communication Limitations I I Does Not Have Radio Difficulty Walking and Requires Oxygen Dependent Requires Medical Equipment That II Does Not Have Television Il Walker/Cane I:I 24 Hour Is Not Easily Transportable I I Does Not Telephone, TTY, or VRI I I Standard Wheelchair I Only Overnight I Ventilator I I Does Not Have Internet fa Motorized Scooter I I Nebulizer I.1 Suction Machine I I Does Not Speak English (Spanish/creole/other f I Attendant to Assist in I CPAP I I Catheters Transportation Needs Walking I I Other (Type/Litersll I Feeding Tube LI Car 11 Wheelchair Van 11 Requires Stretcher I Oxygen Concentrator II Bus 11 Ambulance Transportation fl Other Equipment I.I Hoyer Lift Collier County Emergency Management, Human Services D'vision, CollierEM.org, LaurenBonica@CollierGov.net, 239-252-3608 C ly, CODirity Rev. 4.2019 Page 12 Required Assistance 1. Are ALL of the support needs resulting in the need for evacuation assistance temporary? (Example: The individual is bedridden due to pregnancy difficulties, but is expected to be fully recovered after the baby is delivered.) ❑ - Yes F-]- No, the conditions) are expected to be permanent. 2. Is the person in need a seasonal resident? ❑ - Yes ❑- No From: to 3. Does the person in need require evacuation assistance 24 hours/day? ❑-Yes ❑- No 4. Does the person in need have a 24 hour caregiver? ❑ - Yes ❑ - No a. Will the caregiver travel and/or stay with you? ❑ -Yes ❑ - No *Collier County mandates you bring a caregiver with you to the Special Needs Shelter* Medication List In lieu of filling out this section of the registration, you may attach a copy of your medication list from your Doctor or Pharmacy. If using this form, please list medication information below. Medication Name Dosage Frequency Service Animals as defined in § 35.104 and § 36.104 (2010) -Please bring food and water for your service animal Name: Type: ❑ - Dog ❑ - Miniature Horse Pets -Not Service Animals -Please bring food and water for your pets Name: Type: ❑ - Dog ❑ - Miniature Horse ❑- Cat ❑- Other Name: Type: ❑ -Dog ❑ -Miniature Horse ❑- Cat ❑- Other Name: Type: ❑ -Dog ❑ -miniature Horse ❑ - Cat ❑- Other If you are using Domestic Animal Services Pet Shelter during an evacuation -please remember to have your pet ready in a carrier with a leash and food for at least 3 days. Collier County Emergency Management, Human Services Division, CollierEM.org, LaurenBonEca@CollierGov.net, 239-252-3608 Go er Courity Rev. 4.2019 Page 13 IMPORTANT NOTICE AND STATEMENT OF UNDERSTANDING • The information contained herein is true and correct to the best of my knowledge. I have read and understand the information on this form as well as the attached Guidelines document. • 1 understand: The registration is voluntary and hereby request registration in the "Special Needs Program". • Emergency shelters are made available to provide protection during a period of immediate danger. • I am required to bring a caregiver while at the shelter. • 1 have a copy of the Special Needs Program Guidelines and will take the things that I need with me to the shelter should I choose to go. • I will ensure that a pet carrier or crate and necessary items is available for my pet being taken to or going to the pet shelter. • Limited volunteer nursing, medical assistance, supplies, and equipment at the Special Needs Shelter will be available to assist me and/or my caregiver. • 1 understand that I will need to make alternative arrangements in the event that I am unable to return to my home after the event. • 1 will be responsible for any charges and costs associated with hospitalization or other medical facilities including care and medical transportation, if they should become needed. • Transportation: I may be asked to evacuate my residence. All reasonable attempts will be made to give advance notice by phone of the date and time expected to be picked up for transport to the Special Needs Shelter. Monitor government TV (Channel 97), Local TV stations or Local Radio Stations for updated hurricane information. If I decline transportation when the transporter arrives, I will be required to sign a "Refusal Form". I understand that upon declining transportation, I may not have another opportunity to request this service. • 1 agree to opt -in to receive Collier County Emergency Management's automated telephone notifications through ALERT Collier and or texts prior to and after an emergency. This will include occasional tests to make sure our system is up to date and functional. • By signing this form, I give my authorization for medical information contained herein to be released to the Florida Department of Health, State and County emergency management agencies, and receiving facilities for the purpose of evaluating my needs and providing emergency transportation and sheltering. Records relating to registration of disabled citizens are exempt from the provisions of F.S. 119.07 (1), Public Records Law. The information contained here will be kept confidential. • By signing, I grant permission to health care providers, transportation agencies, and responders as necessary to provide care, and to disclose any information that is necessary to respond to my needs. Signature of Registrant/Authorized Caregiver/Person Completing the Form Date Please complete and return form to: Or scan and email Collier County Emergency Management EMHumanServices@CollierGov.Net 8075 Lely Cultural Pkwy Naples, FL 34113 Collier County Emergency Management, Human Services QWision, CollierEM.org, LaurenBonica@CollierGov.net, 239-252-3605 4 er County Rev. 4.2019 Page 14 EXHIBIT 2 Florida Statutes Chapter 501, Title XXXIII, Section 171 Chapter 501 Section 171 - 2014 Florida Statutes - The Florida Sedate Page 1 of 5 The Florida Senate 2014 Florida Statutes Title XXXIIT Chapter 50l SECTION 171 l� REGULATION OF TRADE, CONSUMER PROTECTION Security of confidential personal COMMERCE, INVESTMENTS, information. AND SOLICITATIONS Entire Chanter 501.171 Security of confidential personal information.— (1) DEFINITIONS.—As used in this section, the term: (a) 'Breach of security" or "breach" means unauthorized access of data in electronic form containing personal information. Good faith access of personal information by an employee or agent of the covered entity does not constitute a breach of security, provided that the information is not used for a purpose unrelated to the business or subject to further unauthorized use. (b) "Covered entity" means a sole proprietorship, partnership, corporation, trust, estate, cooperative, association, or other commercial entity that acquires, maintains, stores, or uses personal information. For purposes of the notice requirements in subsections (3)-(6), the term includes a governmental entity. (c) "Customer records" means any material, regardless of the physical form, on which personal information is recorded or preserved by any means, including, but not limited to, written or spoken words, graphically depicted, printed, or electromagnetically transmitted that are provided by an individual in this state to a covered entity for the purpose of purchasing or leasing a product or obtaining a service. (d) "Data in electronic form" means any data stored electronically or digitally on any computer system or other database and includes recordable tapes and other mass storage devices. (e) "Department" means the Department of Legal Affairs. (f) "Governmental entity" means any department, division, bureau, commission, regional planning agency, board, district, authority, agency, or other instrumentality of this state that acquires, maintains, stores, or uses data in electronic form containing personal information. (g)1. "Personal information" means either of the following: a. An individual's first name or first initial and last name in combination with any one or more of the following data elements for that individual: (I) A social security number; (11) A driver license or identification card number, passport number, military identification number, or other similar number issued on a government document used to verify identity; (111) A financial account number or creditor debit card number, in combination with any required security code, access code, at password that is necessary to permit access to an individual's financial account; (IV) Any information regarding an individual's medical history, mental or physical condition, or medical treatment or diagnosis by a health care professional; or -(V) An individual's health insurance policy number or subscriber identification number and any unique identifier used by a health insurer to identify the individual. b. A user name or e-mail address, in combination with a password or security question and answer that would permit access to an online account, 2. The term does not include information about an individual that has been made publicly available by a federal, state, or local governmental entity, The term also does not include information that is encrypted, secured, or modified by any other method or technology that removes elements that personally identify an individual or that otherwise renders the information unusable. (h) "Third -party agent" means an entity that has been contracted to maintain, store, or process personal information on behalf of a covered entity or governmental entity. https://www.flsenate.gov/laws/statutes/2014/501.171 4/3/2019 Chapter 501 Section 171 - 2014 Florida Statutes - The Florida Senate Page 2 of 5 (2) REQUIREMENTS FOR DATA SECURITY.—Each covered entity, governmental entity, or third -party agent shall take reasonable measures to protect and secure data in electronic form containing personal information. (3) NOTICE TO DEPARTMENT OF SECURITY BREACH.— (a) REACH.— (a) A covered entity shall provide notice to the department of any breach of security affecting 500 or more individuals in this state. Such notice must be provided to the department as expeditiously as practicable, but no later than 30 days after the determination of the breach or reason to believe a breach occurred A covered entity may receive 15 additional days to provide notice as required in subsection (4) if good cause for delay is provided in writing to the department within 30 days after determination of the breath or reason to believe a breach occurred. (b) The written notice to the department must include: 1. A synopsis of the events surrounding the breach at the time notice is provided. 2. The number of individuals in this state who were or potentially have been affected by the breach. 3. Any services related to the breach being offered or scheduled to be offered, without charge, by the covered entity to individuals, and instructions as to how to use such services. 4. A copy of the notice required ruder subsection (4) or an explanation of the other actions taken pursuant to subsection (4). 5. The name, address, telephone number, and e-mail address of the employee or agent of the covered entity from whom additional information may be obtained about the breach. (c) The coveted entity must provide the following information to the department upon its request: 1. A police report, incident report, or computer forensics report. 2. A copy of the policies in place regarding breaches. 3. Steps that have been taken to rectify the breach. (d) A covered entity may provide the department with supplemental information regarding a breach at any time. (e) For a covered entity that is the judicial branch, the Executive Office of the Governor, the Department of Financial Services, or the Department of Agriculture and Consumer Services, in lieu of providing the written notice to the department, the covered entity may post the information described in subparagraphs (b)l.-4. on an agency - managed website. (4) NOTICE TO INDIVIDUALS OF SECURITY BREACH.— (a) A covered entity shall give notice to each individual in this state whose personal information was, or the covered entity reasonably believes to have been, accessed as a result of the breach, Notice to individuals shall be made as expeditiously as practicable and without unreasonable delay, taking into account the time necessary to allow the covered entity to determine the scope of the breach of security, to identify individuals affected by the breach, and to restore the reasonable integrity of the data system that was breached, but no later than 30 days after the determination of a breach or reason to believe a breach occurred unless subject to a delay authorized under paragraph (b) or waiver under paragraph (c). (b) If a federal, state, or local law enforcement agency determines that notice to individuals required under this subsection would interfere with a criminal investigation, the notice shall be delayed upon the written request of the law enforcement agency for a specified period that the law enforcement agency determines is reasonably necessary. A law enforcement agency may, by a subsequent written request, revoke such delay as of a specified date or extend the period set forth in the original request made under this paragraph to a specified date if further delay is necessary. (c) Notwithstanding paragraph (a), notice to the affected individuals is not required if, after an appropriate investigation and consultation with relevant federal, state, or local law enforcement agencies, the covered entity reasonably determines that the breach has not and will not likely result in identity theft or any other financial harm to the individuals whose personal information has been accessed. Such a determination most be documented in writing and maintairned for at least 5 years. The covered entity shall provide the written determination to the department within 30 days after the determination. (d) The notice to an affected individual shall be by one of the following methods: 1. Written notice sent to the mailing address of the Individual in the records of the covered entity; or https://www.flsenate.gov/laws/statutes/2014/501.171 4/3/2019 Chapter 501 Section 171 - 2014 Florida Statutes - The Florida Senate Page 3 of 5 i 2. E-mail notice sent to the e-mail address of the individual in the records of the covered entity. (e) The notice to an individual with respect to a breach of security shall include, at a mh»rnum: 1. The date, estimated date, or estimated date range of the breach of security. 2. A description of the personal information that was accessed or reasonably believed to have been accessed as a part of the breach of security. 3. Information that the individual can use to contact the covered entity to inquire about the breach of security and the personal information that the covered entity maintained about the individual. (f) A covered entity required to provide notice to an individual may provide substitute notice in lieu of direct notice if such direct notice is not feasible because the cost of providing notice would exceed $250,000, because the affected individuals exceed 500,000 persons, or because the covered entity does not have an e-mail address or mailing address for the affected individuals, Such substitute notice shall include the following: 1. A conspicuous notice on the Internet website of the covered entity if the covered entity maintains a website; and 2. Notice in print and to broadcast media, including major media in urban and rural areas where the affected individuals reside, (g) Notice provided pursuant to rules, regulations, procedures, or guidelines established by the covered entity's primary or functional federal regulator is deemed to be in compliance with the notice requirement in this subsection ff the covered entity notifies affected individuals in accordance with the rales, regulations, procedures, or guidelines established by the primary or functional federal regulator In the event of a breach of security. Under this paragraph, a covered entity that timely provides a copy of such notice to the department is deemed to be in compliance with the notice requirement in subsection (3). (5) NOTICE TO CREDIT REPORTING AGENCIES.—If a covered entity discovers circumstances requiring notice pursuant to this section of more than 1,000 individuals at a single time, the covered entity shall also notify, without unreasonable delay, all consumer reporting agencies that compile and maintain files on consumers on a nationwide basis, as defined in the Fair Credit Reporting Act, 15 U.S.C, a,1681a(p), of the timing, distribution, and content of the notices. (6) NOTICE BY THIRD -PARTY AGENTS; DUTIES OF THIRD -PARTY AGENTS; NOTICE BY AGENTS.— (a) In the event of a breach of security of a system maintained by a third -party agent, such third -party agent shall notify the covered entity of the breach of security as expeditiously as practicable, but no later than 10 days following the determination of the breach of security or reason to believe the breach occurred. Upon receiving notice from a third -party agent, a covered entity shall provide notices required under subsections (3) and (4). A third -party agent shall provide a covered entity with all information that the covered entity needs to comply with its notice requirements. (b) An agent may provide notice as required under subsections (3) and (4) on behalf of the covered entity; however, an agent's failure to provide proper notice shall be deemed a violation of this section against the covered entity. (7) ANNUAL REPORT.—By February I of each year, the department shall submit a report to the President of the Senate and the Speaker of the House of Representatives describing the nature of any reported breaches of security by governmental entities or third -party agents of governmental entities in the preceding calendar year along with recommendations for security improvements. The report shall identify any governmental entity that has violated any of the applicable requirements in subsections (2)-(6) in the preceding calendar year, (8) REQUIREMENTS FOR DISPOSAL OF CUSTOMER RECORDS.—Each covered entity or third -party agent shall take all reasonable measures to dispose, or arrange for the disposal, of customer records containing personal information within its custody or control when the records ate no longer to be retained. Such disposal shall involve shredding, erasing, or otherwise modifying the personal information in the records to make it unreadable or undecipherable through any means. (9) ENFORCEMENT.— https://www.flsetiafe.gov/laws/statutes/2014/501,171 4/3/2019 Chapter 501. Section 171 - 2014 Florida Statutes - The Florida Senate Page 4 of 5 (a) A violation of this section shall be treated as an unfair or deceptive trade practice in any action brought by the department under s. 501.207 against a covered entity or third -party agent. (b) In addition to the remedies provided for in paragraph (a), a covered entity that violates subsection (3) or subsection (4) shall be liable for a civil penalty not to exceed $500,000, as follows: 1. In the amount of $1,000 for each day up to the first 30 days following any violation of subsection (3) or subsection (4) and, thereafter, $50,000 for each subsequent 30 -day period or portion thereof for up to 180 days. 2. If the violation continues for more than 180 days, in an arnormt not to exceed $500,000. The civil penalties for failure to notify provided in this paragraph apply per breach and not per individual affected by the breach. (c) All penalties collected pursuant to this subsection shallbe deposited into the General Revenue Fund. (10) NO PRIVATE CAUSE OF ACTION.—This section does not establish a private cause of action, (11) PUBLIC RECORDS EXEMPTION.— (a) All information received by the department pursuant to a notification required by this section, or received by the department pursuant to an Investigation by the department or a law enforcement agency, is confidential and exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution, until such time as the investigation is completed or ceases to be active. This exemption shall be construed in conformity with s.119.071(2)(c). (b) During an active investigation, information made confidential and exempt pursuant to paragraph (a) may be disclosed by the department: 1. In the furtherance of its official duties and responsibilities; 2. For print, publication, or broadcast if the department determines that such release would assist in notifying the public or locating or identifying a person that the department believes to be a victim of a data breach or improper disposal of customer records, except that information made confidential and exempt by paragraph (c) may not be released pursuant to this subparagraph; or 3. To another governmental entity in the furtherance of its official duties and responsibilities. (c) Upon completion of an investigation or once an investigation ceases to be active, the following information received by the department shall remain confidential and exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution: 1. All information to which another public records exemption applies. 2. Personal information. 3. A computer forensic report, 4. Information that would otherwise reveal weaknesses in a covered entity's data security. 5, Information that would disclose a covered entity's proprietary information. (d) For purposes of this subsection, the term "proprietary information" means information that: 1. Is owned or controlled by the covered entity. 2. Is intended to be private and is treated by the coveted entity as private because disclosure would harm the covered entity or its business operations. 3. Has not been disclosed except as required bylaw or a private agreement that provides that the information will not be released to the public. 4. Is not publicly available or otherwise readily ascertainable through proper means from another source in the same configuration as received by the department. 5. Includes: a. Trade secrets as defined in s, 688,002. b. Competitive interests, the disclosure of which would impair the competitive business of the covered entity who is the subject of the information. (e) This subsection is subject to the Open Government Sunset Review Act in accordance with s. 119.1.5 and shall stand repealed on October 2, 2019, unless reviewed and saved from repeal through reenactment by the Legislature. https://www.flsenate.gov/laws/statutes/2014/501.171 4/3/2019 Chapter 501 Section 171 - 2014 Florida Statutes - The Florida Scuate Page 5 of 5 Hfstoxy.—s.3, ch. 2014189; s.1, ch. 2014-190. Disclaimer: The information on this system is unverified. The journals or printed bills of the respective chambers should be consulted for official purposes. Copyright © 2000- 2019 State of Florida. htlps://www.flsenate.gov/laws/statutes/2014/501.171 4/3/2019 Collier County Community and Human Services Division Standard Operating Procedures Health Insurance Portability and Accountability Act 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 served by Social Services and Services for Seniors programs will be given a copy of the Notice of Privacy Practices, which will explain how their health information may be used. Procedures: Staff: 1. Annually, all staff will read and become familiar with CMA 5207, SANCTIONS FOR FAILURE TO COMPLY WITH HIPAA POLICIES, and complete the Human Resources' Collier University course on HIPAA. New employees shall review CMA 5207 and complete the Confidentiality form within 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 and emails are to be sent with the secure and confidential Data Encryption process. (See Collier County, FL Community and Human Services Administrative Policy/Procedure: Data Encryption). 4. New employees shall complete training on HIPAA, the Standard Operating Procedure and Data Encryption within 30 days of the commencement of employment. All other employees will receive this training annually. Training shall be conducted by the Collier County Human Resources Collier University and by the Division's HIPAA Privacy Officer. Updated 4/9/2019 Collier County Community and Human Services Division Standard Operating Procedures Health Insurance Portability and Accountability Act E Offices: 1. A copy of the Notice of Privacy Practices is displayed in thelobby. 2. Client related information and files are in lockable cabinets in secured offices after hours and on weekends. 3. All case managers have a key to their own cabinets where client files are stored, and a second key is kept in a locked desk drawer of the Operations Coordinator'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 or have security cover screens. 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. Updated 4/9/2019 Collier County Community and Human Services Division Standard Operating Procedures Health Insurance Portability and Accountability Act 4. The client will sign the Authorization/Consent form indicating their receipt of the NPP. 5. The clients will be provided a copy of their signed Authorization/Consent form. 6. The original of the signed Consent is kept in the client's file. 7. Files should be re -filed immediately after the notes are completed. 8. Specific authorization does not have to be given by the client if the transaction is related to treatment or payment (see the NPP under Treatment). 9. Information can be shared with the family of a client provided the client has signed a release of information for the specific family member. Services for Seniors: 1. New clients will be given a copy of Notice of Privacy Practices. A signed receipt of the notice is maintained in the client's record. 2. The original signed consent form will be kept in the file. The client signs this form annually. 3. A copy of the Consent will be given to the client. 4. All emails or faxes sent to any Vendor or to the Area Agency on Aging for Southwest FL will be emailed with the Data Encryption email process. 5. CIRTS transactions are encrypted and are HIPAA compliant. 6. Do not share information with anyone except on a need to know basis. All staff in the CHS office are considered in the circle of need to know and need to comply by annually Updated 4/9/2019 Collier County Community and Human Services Division Standard Operating Procedures Health Insurance Portability and Accountability Act signing the CHS 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 HIPAA Privacy Officer. 2. The clients have the right to request: ❑ Access to their records ❑ Amendments to their records ❑ Restriction to access of their records 3. The client has the right to file a complaint about the privacy policies. 4. The client's legal representative has the right to access the client's information in lieu of the client. Updated 4/9/2019 Collier County, FL Community and Human Services Administrative Policy/Procedure Data Encryption Revision 1 Effective Date 2/1/19 Writer: Louise Pelletier Sponsor: Kristi Sonntag Director -CHS I Approved / i IOW sonntng, CHS Mrecto Dnte Page 2 RECORD OF REVISIONS REVISION SUMMARY OF REVISIONS DATE 0 Initial Issue 1/23/2019 1 Re -write of Section I (J): Notification and Disclosure of Data Breaches; addition of CMA 5405 as Exhibit 1, and addition 4/3/2019 of FL Statutes, Cha ter 501, Section 171 as Exhibit 2. Attachment 2, Procedure Change Request Policy/Procedure Number: Policy/Procedure Name: Proposed Change: Reason for Change: Submitted By: Page 3 Page 4 Data Encryption. Policy Information Security Policy/Procedure: Data Encryption I. Policy A. Put -pose: This Policy shall serve to set forth the guidelines on the use of encryption to secure Personally Identifiable Information ("PTI") and/or Protected Health Information ("PHP') in e-mail communications. Further, this Policy shall serve to prohibit Collier County employees from sending PTI or PHI "to" or "from" an email established and/or maintained for personal use and/or an email account not issued, approved, and supported by the County (e.g. Cnnail). Violation of this Policy and/or Procedure may be grounds for disciplinary action up to and including termination. This document provides Collier County Community & Human Services Division (CHS) with the information required to effectively and efficiently plan, prepare, and deploy encryption solutions to secure Legally/Contractually Restricted Information (Sensitive Data). When properly implemented, encryption provides an enhanced level of assurance that the data, while encrypted, cannot be viewed or otherwise discovered by unauthorized parties in the event of theft, loss, or interception. Access to data will be as broad as possible, consistent with the classification of the date, role(s), and responsibilities of the user and their level of training. Data will be classified according to its sensitivity to unauthorized exposure as per the standards defined in this document. Items of information are created, collected, maintained, and utilized by CHS for the purposes of carrying out the Division mission. B. Policy Statement: CHS is required to utilize an approved encryption solution to preserve the confidentiality and integrity of, and control access to, CHS data classified as "Legally/Contractually Restricted" where this data is processed, stored, or transmitted. This document provides CHS with the information required to effectively and efficiently plan, prepare, and deploy encryption solutions to secure Legally/Contractually Restricted Information (Sensitive Data). C. Audience: This policy applies to all CIIS employees and affiliates, including contractors, vendors, subrecipients, and any others (including third parties) entrusted with Sensitive Data. It Page 5 addresses encryption policy and controls for Sensitive Data stored in e-mails at rest (including portable devices and removable media), data in motion (transmission security), and encryption key standards and management. This policy should be/is compatible with but does not supersede or guarantee compliance with all State and federal encryption standards. D. Definitions: 1, Personally, Identifiable Information (PII): Data that includes an individual's first name or first initial and last name in combination with any one or more of the following data elements for that individual: a. A social security number; b, A driver license or identification card number, passport number, military identification number, or other similar number issued on a government document used to verify identity; c, A financial accoia rt number or credit or debit card number, in combination with any required security code, access code, or password that is necessary to permit access to an individual's financial account; d. Any information regarding an individual's medical history, mental or physical condition, or medical treatment or diagnosis by a health care professional; or e. An individual's health insurance policy number or subscriber identification number and any unique identifier used by a health insurer to identify the individual. The tern PII does not include information about an individual that has been made publicly available by a federal, state, or local governmental entity. 2. Protected Health Information (PHI): Individually identifiable health information, including demographic information, related to the past, present, or future physical or mental health or condition, the provision of health care to an individual, or the past, present, or future payment for such healthcare, which is received or created by the County. PHI may be oral or recorded in any other medium including electronic or paper format. PHI does not include individually identifiable health information contained in education records or employment records of County employees. 3. Data Access: Protecting information assets is driven by a variety of considerations including legal, financial and other business requirements. CHS is committed to nurturing open, information -sharing requirements of its culture while preserving the confidentiality, integrity, and availability of its information resources. To promote the highest standards of decision -malting and management, CHS Page 6 intends to provide the community expeditious access to authoritative and accurate data from information systems. The policy contained in this document will support and promote greater understanding of and appropriate use of data, and heightened awareness of the sensitive nature of data based on various risk factors. It is expected that this policy will improve the ability of the CHS community to properly manage access to CHS data in compliance with Federal and State laws and regulations, and other CHS policy requirements. A. Breach of Security (Breach): Unauthorized access of data in electronic form containing PII or PHI. Good faith access of personal information by an employee or agent of the County does not constitute a breach of security, provided that the information is not used for a purpose unrelated to the business or subject to further unauthorized use. E. Eneryption Solutions: The value of the data that requires protection and the system storing the data need to be considered carefully. Physical security refers to being able to control access to the system's storage media. All encryption methods detailed in these guidelines are applicable to desktop and mobile systems. A defense in depth strategy is recommended when evaluating and deploying encryption products. In an ideal situation, full disk and/or boot disk encryption would be combined with file/folder encryption to provide two "layers" of encryption to protect data in the event the first layer is compromised. This typically involves a combination of boot/full disk encryption and file/folder encryption. The Collier County Information Technology Division (IT) recommends the use of integrated encryption solutions in combination with preferred third -party products defined in the following scenarios. a. Boot Disk Encryption Scenario: Mobile systems such as laptops are highly susceptible to theft and frequently contain valuable data. Boot disk encryption requires the key to start the operating system and access the storage media. In this scenario, the operating system is removed as a vector for an attack in the event of a physical compromise. Boot disk encryption is typically implemented in conjunction with full disk encryption. Products(s): BitLocicer, Symantec Endpoint Encryption, PGP Desktop, V eraCrypt, BitLocicer Page 7 Preferred Product(s): Symantee Endpoint encryption b. Mobile Device Encryption Scenario: Mobile devices such as tablets and smattphones allow users to exchange, transfer, and store information from outside the office. The extreme portability of these devices renders them susceptible to theft or loss. Preferred Produets(s): Apple Whone Encryption c. Email Encryption Scenario: Email -specific products integrate encryption into the email client, allowing messages and attachments to be sent in an encrypted form transparent to the user. This is most appropriate for departments whose users require frequent and regular encryption or email communications. Most departments can make use of a broader range of file/folder encryption products to encrypt individual files and folders. Products(s): PGP Desktop, Microsoft Office Message Encryption (OME), ProtonMail, Zix Preferred Product(s): Microsoft Office Message Encryption (OME) F. Data at Rest: Confidential data at rest on computer systems and networks owned by Collier County IT and/or CHS must be protected by encryption with strict access controls that authenticate the identity of those individuals prior to providing access the specific system or data. G. Data Access Exceptions: There are two main types of allowable data access exceptions: a. An exception may be granted to address the specific circumstances or business needs relating to an individual program or department. Requests for exceptions of this type should be in writing and should be initiated by the Data Owner, b. Broader exceptions may be issued to cover circumstances that span the agency, Requests for exceptions of this type may come from any person, or such exceptions may be. initiated by the County's IT Security Officer. Page 8 e Collier County's Security Officer shall approve and document all exceptions based on an assessment of business requirements weighed against the likelihood of an unauthorized exposure and the potential adverse consequences for individuals, other organizations, or Collier County if an exposure occurs because of the exception. As a condition for granting an exception, the IT Security Officer may require implementation of compensating controls to offset the risk created by the lack of encryption. Exceptions must be documented and must include the following elements: a. A statement defining the nature and scope of the exception in terms of the data included and/or the class of devices included. b. The rationale for granting the exception. c. An expiration date for the exception, d. A description of any compensating security measures that are to be required. H. Standards for Data Classification: 1, Public Information: available to all members of CHS and may be released to the public. CHS reserves the right to control the content and format of Public Information. This information is not restricted by local, state, national, or international statute regarding disclosure or use. 2• Internal Information: Internal information that is intended for use by and made available to members of CHS who have a business need to know. This information is not restricted by local, state, national, or international statute regarding disclosure or use. Internal information is not intended for public dissemination but may be released to external parties to the extent there is a legitimate business need, CHS reserves the right to control the content and format of internal information when it is published to external parties. a. Recognizing that inappropriate disclosure of certain internal information may result in unauthorized use of the data, CHS reserves the right to designate that certain subsets of internal information require paining in the appropriate use and handling of the data. 3. Legally/Contractually Restricted Information: Information that is required to be protected by applicable law or statute (erg. HIPAA, FIPA). Access is granted to those individuals who have a business need to know and who have signed the appropriate release of information and/or confidentiality agreement. Recognizing that unauthorized use of certain Restricted information may expose CHS to particularly heightened risk, Page 9 CHS reserves the right to designate that users be required to undergo additional training as appropriate. I. Encryption Standards, Key Creation, and Key Management: Collier County IT will ensure the encryption methods employed meet all applicable standard policies, procedures, rules, regulations, and laws in addition to following industry best practices when appropriate. Encryption keys will be created and managed by Collier County IT and will be sufficiently secured to prevent unauthorized access/breach. J. Notification and Disclosure of Data Breaches: Should Sensitive Data be breached or suffer an unauthorized disclosure, CIIS staff shall follow the standard incident response procedures as outlined in Collier County CMA #5405 (EXHIBIT 1) and as required by law, specifically Florida Statutes, Chapter 501, Title XXXIII, Section 171 (EXHIBIT 2). K. Enforcement: Any employee found to have violated this policy may be subject to disciplinary action. A violation of this policy by a temporary worker, contractor, or vendor may result in the termination of their contract or assignment with Collier County, Additionally, employees, contractors, and agents who violate this policy may be subject to civil and criminal prosecution under the law. II. Procedures for E-mail Encryption: A. Prohibited Email Activity: Collier County employees from sending PII or PHI "to" or "from" an email established and/or maintained for personal use and/or an email account not issued, approved, and supported by the County (e,g. Gmait). (a) For Senders: 1. When to Ellerrynt When sending PI or PHI via email you must use the encryption feature described in paragraph 2 below. Care should be taken when replying to a message that contains Sensitive Data to ensure e-mail replies also use encryption. 2. How to Every Employees will send the message through our secure email gateway. Employees will use the Outlook Protect Feature and click on a "Confidential' button within the new email when including PI or PHI information. Page 10 (b) For Recipients; 1. Flow to Access Encrypted E-mail The e-mail recipient will receive a message advising that they have been sent a secure message that provides instructions on how they are to retrieve that secure message. 2. E-mail Feature Restrictions The recipient will only be able to read and reply to the secure message once it has been retrieved using the instructions provided. Recipients WILL NOT be able to forward, print, or copy content. E-mail replies to the Sender will continue to be secured. Compliance Reference Index: 45CFR 164.312 EXHIBIT I County Manager Policy 5405 Microsoft Office 365 Message Encryption (OME) Utilizing Microsoft Azure Information Protection (AIP) Once you have a subscription for the AIP Outlook Add -In and it is installed by IT, you will have the ability to send Encrypted Emails. Message rl ` A A I✓@ k14�: �' .K.,; ; P wlmwup- -. •� �^ 1 Nighlmpodanc< Padeg I u _ A - Adderr Check Attach Attach Signature Protect Do Not AttachfI A& Adobe F Book Name, File, Item• Forward D < resod Claud 5 Kowimpodance Cnpbortd aed<Ietl Hrmnotation er 'mute ion 'Adobe Document Cloud l Lar d�. T V & 1Mt, Ali - For I I Subject When you click on the New Mail Icon, this is what you will see now with the Encryption Add-in AIP installed. Please note the Confidential button in the middle of the Bar below the Ribbon. On the left of this Bar it indicates that Sensitivity: Not set. ME Message a. a ea �-p• �' Cul (Callbn (got • 71 _ A A { ,— • Fd I b ©� _ i' 'r iP Follow Up, ! Highlmpodanae Paste g f g <ry '_I = E_.a_' Address Check j Attach Attach Signature Protect D'oflot Attach FieviaAdobe alFormat Painter U e.. '� Book Names; File, Item, Fomard_! Document Claud ykmvlmpodance Clipboard is Basic Teat a' Names Include I Protection (Adobe Document Cloud Tags r. i Sensitivity. aCADNdentril 0 Do Not Fonuard. Recipients can read this message, but cannot forward, print, or copy content. The conversation owner has lull peim ssion to their message and all replies. Permission granted by. Nanry.Kdek@colllercountyll.gov To -� C ] L Subject To send an Encrypted Email, click on the Confidential button which will set the default permissions for the recipient of this email whether internal or external. These default permissions are: 1) Recipients can read this message 2) Recipients cannot Forward 3) Recipients cannot Print 4) Recipients cannot copy content Notes: 1) An Encrypted Email cannot be recalled. 2) Only a Request a Read Receipt can be used. 3) Please note that each user will need to authenticate to be able to view an encrypted email. Once authenticated, any subsequent encrypted emails received will open automatically in Outlook. 4) Microsoft supports Outlook, Gmail and Yahoo mail. If a recipient has another email provider, they will have to use the one-time passcode option (see examples below). Collier County Community & Human Services Policy on Confidentiality Given the nature of our work, it is imperative that we maintain the confidence of client information that we receive in the course of our work. Collier County Community and Human Services Department prohibits the release of any client information to anyone outside the Department unless required for purposes of treatment, payment, health care operations or that which has been authorized by the client. Discussions of Protected Health Information (PHI) within the Department should be limited. Acceptable uses of PHI within the Department but are not limited to exchange of client information needed for the treatment of the client, billing, and other essential health care operations, Case Management review, and quality control. I understand that Collier County Community and Human Services provides services to clients that are private and confidential and that I am a crucial step in respecting the privacy rights of Collier County Community and Human Services' clients. I understand that it is necessary, in the rendering of Community and Human Services assistance, that clients provide personal information and that such information may exist in a variety of forms such as electronic, oral, written, or photographic and that all such information is strictly confidential and protected by federal and state laws. I agree that I will comply with all confidentiality policies and procedures set in place by the Community and Human Services Department during my entire employment or association with the Community and Human Services Department. If I at any time, knowingly or inadvertently, breach the client confidentiality policies, I agree to notify the Privacy Officer of the Community and Human Services Department immediately. In addition, I understand that a breach of client confidentiality may result in my suspension or termination of my employment with Collier County Community and Human Services Department. Upon termination of my employment or association for any reason, or at any time upon request, I agree to return any and all client confidential information in my possession. I have read and understand CMA 5207, SANCTIONS FOR FAILURE TO COMPLY WITH HIPAA POLICIES and all policies and procedures that have been provided to me by Collier County Community and Human Services. I understand that the Policy on confidentiality may be amended or otherwise modified and such modification will apply to me. I agree to abide by all policies or be subject to disciplinary action, which may include written or oral warning, suspension, or termination of employment. This is not a contract of employment and does not alter the nature of the existing relationship between Collier County Community and Human Services and me. SIGNATURE: NAME PRINTED: DATE: CMA 5207 SANCTIONS FOR FAILURE TO COMPLY WITH HIPAA POLICIES [Effective Date: January 1, 2005 (Revised: September 1, 2017)] § 5207-1. Purpose. The purpose of this Instruction is to define and provide for the implementation of progressive disciplinary procedures authorized by the County Manager to be followed when an employee breaches or violates the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules and/or the County's policies and practices related to the use and disclosure of protected health information (PHI) as mandated by HIPAA. The County is designated as a hybrid entity since only a limited number of its activities require compliance with HIPAA. Although compliance may not be required under HIPAA'S privacy regulations for employees other than those designated by the County, all employees should maintain the privacy and confidentiality of any individual's identifiable health information that may be subject to HIPAA or any other applicable federal and state privacy laws. This Instruction supports the County's HIPAA policy and may require further development of department specific practices and procedures. § 5207-2. Concept. The County is strongly committed to ensuring compliance with all applicable privacy laws, E regulations, standards, policies and procedures, including HIPAA. Progressive discipline is an effective means of correcting inappropriate employee conduct and will be utilized when employees engage in conduct that violates an individual's privacy rights and the County's privacy and security policies. The progressive discipline process is intended to help employees in recognizing the seriousness of their conduct and encouraging their commitment to changing these behaviors. The failure of an employee to comply with this policy or any County HIPAA procedures in place will be grounds for discipline as set forth herein or as established in any collective bargaining agreement, subject to any available appeal rights established in CMA 5351. A. Philosophy: Supervisors are responsible for accurately and timely documenting alleged violations of HIPAA or the County's policy. Employees will be informed of their expectations regarding confidentiality and HIPAA requirements through HIPAA confidentiality training sponsored by the County. Depending on the nature of the violation, in many instances, informal counseling will be utilized by the supervisor after consultation with the Privacy Officer and the Human Resources Director prior to the formal corrective action process. Before commencing the formal corrective action process, the Privacy Officer should be consulted to determine whether a particular behavior actually violated HIPAA or the County's policy. At that time, the Privacy Officer will also determine whether the alleged behavior must be reported as a HIPAA violation. B. Definitions: As used in this CMA, the following terms shall have the meanings indicated: CLEAR CUT VIOLATION— An incident where there is no question as to the severity, intent and pattern of the violation. Page I of 7 CMA 5207 SANCTIONS FOR FAILURE TO COMPLY WITH HIPAA POLICIES HIPAA INVESTIGATIVE TEAM— A group of two or more persons selected to respond to alleged privacy or confidentiality breaches or violations with the authority to investigate, evaluate and recommend sanctions. HIPAA SECURITY OFFICER— The person responsible for managing the County's HIPAA security compliance program. LEVELS OF VIOLATION— The three levels determined according to the severity, intent and pattern or practice of the violation. NEED TO KNOW— Limiting access to PHI to only those persons with a legitimate business reason needed to perform their job. NON -CLEAR CUT VIOLATION— Any violation not covered under the definition of "clear cut violation." PRIVACY OFFICER— A person designated by the County to be responsible for the development and implementation of the privacy policies and procedures of the County and responding to complaints of violations of the County's privacy policies and procedures. PRIVACY OFFICER ASSISTANT— A person designated by the County to assist the Privacy Officer in the development and implementation of the privacy policies and procedures of the County and to aid in the investigation of alleged breaches or violations of the County's privacy policies. Each of the County's divisions subject to complying with HIPAA will have an assigned Privacy Officer Assistant. PRIVACY OR INDIVIDUAL CONFIDENTIALITY VIOLATIONS— Incidents of noncompliance with County HIPAA privacy and confidentiality practices and procedures. PRIVACY TRAINING— Mandatory privacy training required for HIPAA compliance. Additional training may be required as part of the disciplinary process. PROTECTED HEALTH INFORMATION (PHI)— Individually identifiable health information in any form or media, whether electronic, paper or oral, including demographic information, that is created or received by a health care provider, benefit health plan, or health care clearinghouse that relates to an individual's past, present or future physical or mental health or condition, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to the individual and that identifies the individual; or with respect to which there is a reasonable basis to believe the information can be used to identify the individual. WHISTLE -BLOWER— An individual who believes in good faith that the County has acted unlawfully or otherwise violated HIPAA and, in that belief, discloses PHI to a health oversight agency, appropriate public health authority, or some other legal governing authority. WORKFORCE— Encompasses employees, volunteers, trainees, and other persons whose conduct, in the performance of work for a covered entity, is under the direct control of such entity, whether or not they are paid by the covered entity. C. Levels of Violations: The level of the breach of confidentiality or privacy violation is Page 2 of 7 CMA 5207 SANCTIONS FOR FAILURE TO COMPLY WITH HIPAA POLICIES determined according to the severity of the breach or violation, whether the breach or violation was intentional or unintentional, and whether the breach or violation indicates a pattern or practice of improper use or release of PHI or violation of an individual's privacy. The degree of discipline may range from a verbal warning to immediate termination. The three levels of breach or violation are as follows: (1) Level 1: Carelessness or Inadvertent. This level of breach or violation occurs when a County employee unintentionally or carelessly accesses, reviews, or reveals PHI to himself/herself or others without a legitimate need to know. Examples include, but are not limited to: (a) When an employee discusses confidential PHI in a public area. (b) When an employee leaves a medical record or written document containing PHI unattended in an accessible area. (c) When an employee fails to log off a computer terminal or shares a password that allows access to PHI. (d) When an employee leaves a computer unattended in an accessible area with confidential PHI unsecured. (2) Level 2: Intentional Without Malice. (a) This level of breach or violation occurs when an employee intentionally accesses or discusses PHI for purposes other than the care of the subject individual or other authorized purposes but for reasons unrelated to personal gain. Examples include but are not limited to: [1] When an employee looks up birth dates or addresses of friends or relatives. [2] When an employee accesses and reviews a record of a individual's PHI out of concern or curiosity. [3] When an employee reviews a high-profile citizen's (politician, celebrity, etc.) records. (b) Under this level of breach or violation, although intentional, the employee causing the violation is not seeking personal gain. (3) Level 3: Intentional With Malice (Personal Gain). This level of breach or violation occurs when an employee accesses, reviews, or discusses confidential PHI for personal gain or with malicious intent. Examples include but are not limited to: (a) When an employee reviews an individual's records to use that information in a personal relationship. (b) When an employee gathers PHI to be sold to a third party. Page 3 of 7 CMA 5207 SANCTIONS FOR FAILURE TO COMPLY WITH HIPAA POLICIES D. Investigative Process: The following process is followed when an employee breaches or is suspected of breaching an individual's confidentiality or violates or is suspected of violating and individual's privacy. Initial Reporting. (a) All employees who become aware of a breach or violation must report it to their immediate Supervisor. The Supervisor is then required to report it to the HIPAA Privacy Officer. If the Supervisor is in breach of the rules or policies, then the employee shall report the breach directly to the Privacy Officer. (b) The failure to report a Level 2 or Level 3 breach or violation of which one has knowledge will result in a disciplinary action up to the disciplinary action accorded the violator. (c) There is no retaliation for a report made in good faith. (2) All Level I and Clear Cut Level 2 Breach/Violations: For all Level 1 breaches or violation and Clear Cut Level 2 breaches or violations, the Supervisor or Department Director, in conjunction with the HIPAA Privacy Officer and the HIPAA Security Officer (if any security implications exist) will identify and implement a written plan to correct the improper behavior in a timely manner. A copy of the plan shall be maintained in the Privacy Officer's files and in the employee's Human Resources personnel file. (3) Non -Clear Cut Level 2 and All Level 3 Breach/Violations: For Non -Clear Cut Level 2 breaches or violations and all Level 3 breaches or violations, the HIPAA Privacy Officer will establish an investigative team (the HIPAA Investigative Team) consisting of two persons to investigate the alleged breach or violation, which may contain representation as follows: (a) The employee's immediate Supervisor. (b) A HIPAA Privacy Officer Assistant from any of the County's Divisions subject to HIPAA. (c) The HIPAA Privacy Officer. (d) County employees with training and/or experience in investigating employment-related matters. (e) The HIPAA Security Officer. (4) The HIPAA Investigative Team shall conduct the necessary and appropriate investigation commensurate with the level of the breach and include specific facts, which may include, but not be limited to, interviewing the employee accused of the breach, interviewing other individuals, and reviewing documentation. (5) Upon conclusion of the investigation, the HIPAA Investigative Team shall prepare a Page 4 of 7 CMA 5207 SANCTIONS FOR FAILURE, TO COMPLY WITH HIPAA POLICIES written report, which shall include its findings, conclusions and recommendations with regard to the alleged breach. The report shall be submitted to the HIPAA Privacy Officer who shall review the report and forward it to the employee's Supervisor and Division Director who will, in conjunction with the Human Resources Division, determine the appropriate disciplinary action. The final disciplinary decision will then be communicated to the employee. (6) Those who obstruct individuals from participating in investigations or inquiries will be subject to discipline as set forth in CMA 5311.1 and CMA 5351. E. Disciplinary Action: Disciplinary action shall be administered in a progressive manner consistent with current Human Resources Practices and Procedures. The following examples are guidelines for disciplinary action for confidentiality breaches and privacy violations. More serious offenses may warrant deviation from these guidelines. (1) All Level 1 and Non -Clear Cut Level 2 Breaches/Violations. (a) Depending on the facts, verbal warning, written warning, suspension, or termination documented in writing and maintained in the employee's Human Resources personnel file. (b) Except in the case of termination, the employee shall be required to repeat privacy training in a timely fashion. (2) Clear Cut Level 2 Breaches/Violations. (a) Clear Cut Level 2 Breaches/Violations shall be as follows: [1] First offense: Depending upon the facts, verbal or written warning documented and maintained in the employee's Human Resources personnel file. [2] Second offense: Depending upon the facts, a final written warning documented and maintained in the employee's Human Resources personnel file and a suspension up to three days without pay, or termination. [3] Third offense: Termination with a report to the appropriate agencies. (b) Except in the case of termination, the employee shall be required to repeat privacy training in a timely fashion. (3) All Level 3 Breaches/Violations: Termination with reports to the appropriate agencies. F. Disclosures Not Resulting in Sanctions. (1) Disclosures by Whistle -blowers: Any disclosure of PHI by an employee acting as a whistle -blower to a health oversight agency, public health authority or law enforcement agency will not subject the employee to sanctions for violation of the Page 5 of 7 CMA 5207 SANCTIONS FOR FAILURE TO COMPLY WITH HIPAA POLICIES County's privacy policies and procedures, provided that the employee in good faith believes that the County has acted unlawfully. (2) Other Disclosures: An employee will not be subject to sanctions for violation of the County's privacy policies and procedures if the employee: (a) Files a complaint of violation of the HIPAA with the Secretary of the United States Department of Health and Human Services. (b) Testifies, assists or participates in an investigation, compliance review, proceeding or hearing authorized under HIPAA. (c) Opposes any act or practice as unlawful under the HIPAA, if the employee has a good faith belief that the practice opposed is unlawful, and the manner of opposition involved is reasonable and does not involve a disclosure of PHI in violation of HIPAA. G. Appeals Process: Any employee who wishes to appeal the imposition of disciplinary measures under this Instruction may file an appeal consistent with the Human Resources Practices and Procedures set forth in CMA 5351. H. Privacy Sanctions Log. (1) Each instance of employee disciplinary action taken in regard to a breach or violation of the County's HIPAA policy is to be recorded and reported to the HIPAA Privacy Officer. The HIPAA Privacy Officer shall notify the HIPAA Security Officer of any security implications. (2) The HIPAA Privacy Officer shall maintain a Privacy Sanctions Log. Entries in the log shall include: (a) The name of breaching/violating employee. (b) The level of breach or violation and nature of the violation. (c) The location of the breach or violation. (d) The date and time of the breach or violation. (e) The disciplinary action taken. (f) The mitigation steps taken, if applicable. 1. Review: The HIPAA Privacy Officer is responsible for the management and content of this policy. The HIPAA Privacy Officer shall review and evaluate this policy each year commencing on its effective date. J. Notice of Civil And Criminal Penalties: HIPAA provides for federal criminal penalties for violations for either the covered entity and/or the individual who commits the violation. The current violation types and the respective penalties are listed below: Page 6 of 7 CMA 5207 SANCTIONS FOR FAILURE TO COMPLY WITH HIPAA POLICIES (1) Civil penalties. (a) $100 per incident, not to exceed $25,000 per person per year for all violations of an identical requirement. (2) Criminal penalties. (a) Up to $50,000 for knowingly or improperly obtaining or disclosing individually identifiable health information. (b) Up to $100,000 and five years in prison if the offense is committed under false pretenses. (c) Up to $250,000 and 10 years for obtaining or disclosing individually identifiable health information with the intent to sell or use the information to cause malicious harm. § 5207-3. Currency. The Risk Management Division is responsible for maintaining the currency of this Instruction. Page 7 of 7 CMA 5405 COWUTER/TECHNOLOGY USE, [Effective Date: Jame 10, 1999 (Revised: December 1, 2000; Revised: February 12, 2001; Revised: October 1, 2001; Revised: October 1, 2003; Revised: May 30,2004; Revised: June 11, 2004; Revised: January 1, 2005; Revised: April 1, 2006; Revised: July 1, 2009; Revised: December 16, 2009; Revised: March 18,2011; Revised July 11, 2018)] § 5405-1. Purpose. A. The goal of this instruction is to ensure the integrity, proper operation and security of the County's technology resources by setting rules of conduct for use by all County employees, contract employees, and business partners. B. This instruction applies to the Collier County Board of Commissioners Agency's internal business network and associated systems and resources. This instruction does not apply to the, the Transportation Signalization Network, the Public Utilities Plant Control and SCADA Networks, Emergency Management non -IP two-way communication systems and their associated systems and resources, except where they interface with the Agency's internal business network. C. This instruction sets forth the Agency's practices and procedures governing the utilization of technology resources and disciplinary recourse for violations, This instruction also sets forth guidance for compliance with applicable laws governing the handling of specific kinds of data created with or transmitted by network resources, § 5405-2. Definitions. A. AUTHORIZED ADMINISTRATIVE STAFF — IT staff and other staff authorized by the Director, Information Technology Division who have elevated privileges and access rights for maintaining network resources and services. B. BUSINESS PARTNERS — any person not directly employed by the Board of County Commissioners who is authorized to utilize County technology resources. Examples of business partners would include, but not be limited to: vendors, contractors, and advisory board members. C. DATA — Information stored by technology assets or transmitted from or through the network. D. DATA CUSTODIANS - Staff with the authority for acquiring, creating, and maintaining data within their assigned area of control. E. INAPPROPRIATE CONTENT - Content that is fraudulent, harassing, embarrassing, sexually explicit, profane, obscene, intimidating, defamatory, or contains sexual comments, obscenities, nudity, pornography, abusive or degrading language, antisocial behavior, or inappropriate comments concerning race, color, religion, sex, national origin, marital status, or disability or is otherwise unlawful is inappropriate for the workplace and may not be sent by e-mail or other form of electronic communication or displayed on County computers or stored in the County's systems. F, LIMITED NON -BUSINESS USE — Use of the County's technology assets that does not impact employee productivity and complies with all other aspects of this instruction. Page l oft l CMA 5445 G. NETWORK — The data, voice, and multimedia communication system made up of devices (switches / routers / firewalls and the like), wires, fiber optics, jacks, access points (physical and wireless), software and services. IL NETWORK RESOURCES — Any services which may be accessed through the Collier County network. Examples include, but are not limited to: software applications, e-mail, data, telecommunications, the Public Safety Radio System, and Internet resources accessed from or through the network. REGULATED DATA — data that requires special handling due to statutes, regulations or agency policies. At this time, regulated data includes, but not limited to: Protected Health Information (PILI) protected under I-IIPAA rules and statutes, Payment Card Industry (PCI) and other personal financial information (PFI) (e.g. credit card and bank account numbers) and personal identifying information (PTT) (e.g. social security numbers), PTT protected by the Florida Information Protection Act (FIPA), addresses and names of judges and law enforcement officials, and other data exempted from the State of Florida's Public Records Laws by statute. J. SLATE — a form factor for a computing device that meets the following criteria: 1. Does not run Windows operating system as its base operating system, and 2. Uses "touch" as its primary mode of user interface. K. TECHNOLOGY ASSETS — any devices owned by Collier County that are part of or used for data or voice communications. Examples include, but are not limited to: computers, network switches and routers servers databases smart hones, cellular air cards printers, telephones, public , , P ,p , p ,P safety radios, and associated software and accessories. L. TECHNOLOGY RESOURCES — includes all of the following: TECHNOLOGY ASSETS, information/data stored or in transit, the County's private data network, NETWORK RESOURCES, and all resources and services associated with other networks accessed from or, through the County network, including the Internet, Internet Services, and other agencies' or corporate networks and services. M. USER — Inclusively, staff, elected / appointed officials, and/or business partners authorized to use County technology resources. § 5405-3, Concept. A. Compliance: 1) This instruction applies to all users of Collier County technology assets, network and/or network resources including authorized administrative staff except when utilizing properly authorized elevated privileges or access rights in the discharge of their duties. a. Authorized administrative staff s use of elevated privileges is governed by IT Division instructions. b. Employee violations will be assessed, and disciplinary actions will be governed by CMA 53 51 — Discipline, and CMA 5311.1 - Standards of Conduct. c, Business partner violations will be subject to loss of the use of technology assets, network and/or network resources and contractual sanctions. Page 2 of 11 C1VIA 5405 2) Because of the interdependent nature of network and communications systems, interruptions of service can have a broad impact with the potential for large adverse financial consequences or impact to health and safety. Loss of technology resources and/or misuse of network resources can cause financial damage to the County, the taxpayers of Collier County, and those who depend on County services, therefore, these resources must be protected. As such, violations of this instruction may unduly expose the network to intended or unintended risks, which may or may not result in actual losses. a. The Director, Information Technology may disable network access for violations of this instruction. b. The severity of infractions will be assessed by the Director, Information Technology who will forward a risk / threat assessment to the supervising Division Director for use in making recommendations for disciplinary actions in accordance with CMA. 5351 - Discipline. c. The Human Resources Division will advise Division Directors in order to ensure consistency in the handling of employee violations of this instruction. 3) Collier County, at its discretion, reserves the right to monitor any use of network resources, to monitor computer and internet usage, including, but not limited to: sites visited, searcbes conducted, information uploaded or downloaded and to access, retrieve and delete any data stored in, created, received, or sent over the network or using network resources for any reason and without the permission or prior knowledge of any user. Collier County may monitor the use of technology assets, content of electronic communications and the usage of network resources to support operational, maintenance, auditing, security, disciplinary, and Investigative activities. 4) County employees and authorized business partners using County owned teclmology or network resources have no right or expectation of personal privacy for any voice communications, e-mails, internet searches, internet sites visited, or data stored in, created by, received with, or transmitted using technology resources, Use of passwords or other security measures, whether mandatory or voluntary, does not in any way diminish Collier County's rights or create any privacy rights of users. Collier County has administrative tools that permit it to monitor all activities on the network and access all data stored within technology resources. 5) All Collier County employees and business partners who have access to technology assets and/or network resources must affirm that they have read and understood all applicable policies annually. B. User Responsibility: 1) Authorized network users are responsible to ensure that network resources are used only for their intended purposes. a. Except for services intended for use by the public (kiosks, terminals and public wireless services) technology assets, technology resources, network resources, the network and data are intended exclusively for the use of authorized employees and business partners only. Page 3 of 11 CMA 5405 b. Technology assets, technology resources, network resources, the network and data are the property of Collier County Government. Collier County provides these systems to be used for County business purposes, although limited non -business use is permitted. All communications and data transmitted by, received from, passed through, or stored in these systems are the exclusive property of Collier County. At all times, employees and authorized business partners have the responsibility to use these resources in a professional, ethical, and lawful manner. c. Use of technology and network resources is a privilege that may be monitored, restricted or revoked at any time. Collier County reserves the right to revoke the privileges of any user at any time. d. Conduct that interferes with the normal and proper operation of Collier County's network or network resources, which adversely affects the performance of the network or the ability of others to use the network or network resources or, which is harmful or offensive to others will not be permitted. Such actions may subject employees to disciplinary action in accordance with CMA 5351 - Discipline. Such actions by business partners may result in the loss of network privileges and/or contractual sanctions. e. The Director, Information Technology can authorize actions to remediate network or application performance problems during an incident where network or application performance has been adversely affected. f. A user may not use the County network or technology assets to connect to or make use of other computer systems unless specifically authorized to do so by the operators of those systems. g. Because network and data security are dependent upon physical security, all Collier County employees have a responsibility to ensure that only authorized employees and/or business partners or properly escorted visitors have access to areas where network access is available and that only authorized employees have access to secure spaces where network resources are located. 2) Staff and authorized business partners are issued credentials (user name and password) for accessing the network and network resources. Users are responsible for periodically changing their passwords and safeguarding their passwords. a. Users are responsible for all transactions made using their credentials. b. Users are responsible for protecting the confidentiality of their credentials and are prohibited from sharing their credentials with anyone. c. Users shall not leave their computers unattended while their account is logged in without first lockingthe computer, using the Windows "Lock Computer" functionality. d. User passwords for County network accounts or passwords for County application / system access may not be printed or stored online in any file, database or Internet service. It is the user's responsibility to safeguard their password. If a user suspects for any reason that their password may have been compromised, they must immediately change it. Passwords may be stored electronically in an IT Division encrypted removable USB drive. e. No user may access the network or network resources with another user's credentials. If access to another user's account is required, access can be granted by the IT Service Desk upon request from the user's manager. f. All network access must be accomplished by user specific credentials, and as a normal course of business, generic or "shared" network accounts are not issued. In special cases the IT Director can authorize the use of shared accounts with proper authorization from the users' management under circumstances where Page 4 of It CMA 5405 individual accounts can't adequately meet business needs and their use will not compromise identity integrity and auditing. g. Misrepresenting, obscuring, suppressing, or replacing a user's identity on the network is forbidden. The user name, e-mail address, County affiliation, and related information Included with electronic messages or postings shall reflect the actual originator of all messages or postings. 3) Network Security a. Users shall report any suspicion of violations of any provision of this instruction to their supervisor or the Information Technology Division Service Desk. Users shall notify the Service Desk of any instances where they observe or have reason to believe that data is inappropriately accessible to employees, the public, or business partners. b. Users shall promptly report all information security alerts, warnings, suspected system vulnerabilities, etc. to the IT Service Desk, c. Users shall not exploit inadvertent rights or deficiencies in information systems security to damage systems or data, obtain resources beyond those to which they have been authorized, or to obtain or take resources away from other users or gain access to other systems for which proper authorization has not been granted. d. Users who receive malware alerts or notice unusual system behavior, such as missing files, frequent system crashes, misrouted messages, etc., should immediately notify the IT Service Desk. To prevent possible damage to Collier County data, technology assets and network resources, users are not permitted to remove malware on their own. If users believe they may have been the victim of malicious software, tbey must immediately inform the IT Service Desk. e. In order to ensure that malware signatures, patches and security software are up to date, any workstations or portable computers that have not been updated within 30 days will be removed from the network. Updates occur upon login. Action by the IT Service Desk will be required to restore connectivity. 4) Inappropriate Use a. Internet browsing on websites with inappropriate content is prohibited. Use of the Internet will be monitored, and corrective actions will be taken by the user's division, in coordination with Human Resources and Information Technology. b. Collier County's technology assets, network and network resources may not be used for dissemination or storage of commercial or personal advertisements, solicitations, promotions, political material, inappropriate content or any unauthorized use deemed inappropriate. c. Users are not permitted to store, download or transmit copyrighted materials with network resources .unless written permission has been granted. Examples of copyrighted materials include, but are not limited to: commercial music, video, graphics, or other intellectual property. Collier County will not provide a defense for violators of copyrights. Collier County allows reproduction of copyrighted material only to the extent legally considered "fair use" or with the permission of the author/owner. All doubt about whether software or other material is copyrighted, proprietary, or otherwise inappropriate for duplication should be resolved in favor of not duplicating such information. d. Users are not permitted to make any defamatory statements using networkresources. Page 5 of 11 CATA 5405 e, County Employees are not permitted to subscribe to information services without the approval of their supervisor. f Users are not permitted to capture, store or create digitized images of signatures (other than their own) or attach or affix a digitized image of a signature (other than their own) to any document or e-mail or use such image of a signature in any way that could be interpreted as representing information as being originated, approved, or sanctioned by another person without the express permission of the signatory. C. Business Partners. 1) Employees are responsible to ensure that business partners requiring access to the network or network resources are properly authorized. Business partner accounts will be issued on a monthly basis and will expire on the last day of each month. Employees are responsible for requesting extension of business partner accounts if required. Generic business partner accounts will not be issued. All business partner accounts must be issued in the name of the user. 2) Any business partner requiring access to the network or network resources must complete the Third -Party Use Agreements, file them with the IT Division and maintain compliance with the terms of that agreement. 3) Once granted access, business partners must comply with this instruction in its entnety. Business partner violations of this instruction may result in loss of access and purchasing sanctions. D. E-mail 1) All e-mails entering or leaving the County's e-mail system are duplicated and retained in an administrative mailbox in addition to each user's mailbox. As such, users are free to delete e- mails from their mailbox when their usefulness to the user has ended. However, if the user would like future access to such e-mails, they should retain them. At the designated time, all e- mail in Outlook will be archived. At this time, e-mails are never deleted from the arebive. 2) BCC staff are required to use the county email system and only the comity email system for county business. Use of external email systems compromise the Agency's ability to execute complete public records requests. 3) Users shall not send unsolicited/non-business email to persons without their consent. Chain letters or other non -business-related use of network resources is prohibited. 4) Mass e -mailing for business purposes must be coordinated with the IT Service Desk. Non- business -related mass e -mailing is prohibited. 5) The use of the "Subscribers" and "BCC -Agency" distribution lists are restricted to department heads, division directors and the County Manager's office. 6) Tampering, forging, or altering e-mail identity information is prohibited. Sending an e-mail which in any way appears as though it was sent by someone else (who did not send it) is prohibited. Page 6 of 11 CMA 5405 7) Inappropriate content may not be sent by e-mail or other form of electronic communication or displayed on or stored in the County's computers, Any message received that contains intimidating, hostile, offensive or inappropriate content should be reported immediately to management so that appropriate measures can be taken. 8) Users mast not originate or forward any e-mails with inappropriate content as defined in section 2(E) and 3(D)6. Reference CMA 5311.1 (Standards of Conduct). 9) Users receiving e -snail messages with inappropriate content as defined in section 2(E) or 3(D)6 must immediately notify their supervisor, manager, or division director. Reference CMA 5311.1 (Standards of Conduct). a. The following information must be provided: (1) the date and time the e-mail was sent/received; (2) the sender's e-mail address (or, if unavailable, any identifying information); (3) and the subject line. b. Do not forward the e-mail. Once the information specified in Section D(8)a is passed on to a supervisor, the e-mail should be deleted. o, Supervisors, managers or directors receiving such reports from their employees shall provide these reports to the human Resources Director . Additionally, if the user reports having received repetitive inappropriate or explicit e- mails from the same external sender, these reports and all supporting documentation should be provided to the IT Service Desk as well as Human Resources, 10) Signatures, tag lines, and background settings should be professional in nature and reflect positively on the County. a. Signatures may contain some or all of the following: Name, Agency Name, Department/Division, Title, Address, Telephone Number, Fax Number, Cell Phone Number, e-mail Address. Colors and fonts other than the default settings are acceptable. b. Tag lines conveying personal, inspirational, or political messages are subject to interpretation and are, therefore, prohibited. Tag lines may contain agency, department or division mottos, mission or vision statements, or logos, c. To portray a professional image, no backgrounds should be used in e-mail settings. E. Hardware/Equipment: 1) County technology assets, network and network resources are provided as a tool to enhance productivity and perform j ob duties. Access to County technology assets is a privilege. a. Only devices which are managed by the IT Division are permitted on the Agency's business network. b. The processes and procedures for purchasing technology are on the Agency's Intranet and updated periodically. Improperly purchased technology items may be refused network access. c. The use of personally owned computing devices is permitted but such devices will be limited to publicly available websites and internet resources. Personal owned computing devices are not managed by the IT Division and are not permitted access to the Agency's business network, d. SLATE computers may be approved for purchase by the IT Division, SLATE computers most be configured and managed by the IT Division . 2) Unauthorized Equipment. Pago 7 of 11 CMA 5405 a. Users may not connect any device to County technology assets or the network. Only authorized administrative employees are permitted to add devices to the network. This prohibition includes, but is not limited to, personal network hubs, routers or switches, wireless access devices, USB hubs, portable computers, smart phones, and storage devices. IT Employees are required to disconnect and remove any such equipment upon discovery. b. Portable storage devices like USB "thumb" drives are permitted for the transport of non -executable (data) files as long as thea, use does not require any installable software or cause the installation of software. Executing programs stored on these devices is prohibited. These devices shall not be used as primary storage. Transporting regulated data files via these devices is prohibited. c. Employees and business partners may not use cameras, cell phone cameras, digital cameras, video camera, or other form of image -recording device in the workplace without the express permission of the supervising Division Director and of each person whose image is recorded. This provision does not apply to employees who must use such devices for business purposes in connection with their positions of employment. 3) Users shall not tamper with technology assets in any manner. All repairs must be. coordinated through the IT Service Desk. a. Users shall not connect or disconnect anytechnology asset or network resource without prior coordination with and approval from the IT Service Desk. All hardware installations, repairs, moves, additions or changes must be coordinated through the IT Service Desk. b. Users shall not install, deactivate, uninstall or change any settings for any software provided by the County on any technology asset. Software provided includes, but is not limited to, malware detection and correction software, internet filtering software, monitoring software, power management settings, screen savers, and agents for software distribution. c. Users are prohibited from setting BIOS passwords. d. Settings in windows that are user accessible (e.g. desktop wallpaper, power management settings, color schemes, etc.) and application settings that are user accessible (e.g. browser favorites) are not covered under this instruction and may be set and personalized by the user, although they may be altered by operating system patches and may or may not be transported in machine replacements. 4) Supervisors have the discretion to allow Collier County computers to be used by employees at home for County -related work purposes. The restrictions pertaining to the use of County computers at home will be the same as if they were directly connected to the County network and all policies apply. Use of County technology assets and network resources are for the exclusive use of authorized users only. IT support for home use will be limited to telephone support, or users will be required to bring County equipment to the workplace and will be Page 8 of l 1 CMA 5405 provided assistance during business homy, The IT Division does not provide on-site support for home use of computers. F, Operating System/Software 1) Users are prohibited from possessing or distributing computer viruses, spyware, or other malicious software development and/or distribution tools, Users found to be in possession of such software may be subject to disciplinary action, including discharge, and possible civil and/or criminal penalties. 2) Users are prohibited from possessing tools commonly used for gathering technical information about the network or network resources useful for attempts to hack or breach security. Users found to be in possession of such software may be subject to disciplinary action, including discharge, and possible civil and/or criminal penalties, 3) Installing Software. a. Users are not permitted to download executable software. b. Users are not permitted to install executable software on IT Assets. The IT Service Desk will assist users with authorized software installs, c. Users with Windows Administrative Rights have been granted these rights solely to permit them to use software that requires these rights to run properly. Users with Windows Administrative Rights are not permitted to install executable software on IT Assets, unless they have an agreement authorized by the Director, Information Technology to do so. 4) License Compliance. a. The IT Division is responsible for the Agency's compliance with certain software license agreements. Users are forbidden firm making unauthorized copies of software. Collier Comity will not provide a defense for violations of licensing agreements, b. Collier County allows reproduction of copyrighted material only to the extent legally considered "fair use" or with the permission of the author/owner. All doubt about whether software is copyrighted, proprietary, or otherwise inappropriate for duplication should be resolved in favor of not duplicating such information. c. The IT Division provides license compliance services, however if the user prefers not to use IT's compliance service, they shall be responsible for proper and adequate physical security and protection of software in their possession. A locked file cabinet or locked desk drawer should be used to safeguard software. d. Users shall not copy or use County owned software on their personally owned home computers, laptops, or other electronic devices. e. Users shall not provide copies of County owned software to any business partner, client, or third person, or perform any other action that would cause non-compliance with any licensing agreement. f. Unlicensed or unauthorized software will be removed immediately upon discovery by IT employees. Staff found to be in possession of unlicensed or unauthorized software may be subject to disciplinary action, including discharge, and possible civil and/or criminal penalties. Employees who become aware of any misuse of software Page 9 of 11 CMA 5405 or violation of copyright law should immediately report the incident to their immediate supervisor. G. Data Management: 1) Users should be aware that deletion of any data may not truly eliminate the information from systems. Most data are stored in a central back-up system in the normal course of data management. 2) In order to protect overall network performance, the County reserves the tight to reprioritize and/or apply size limitations on data stored in or transmitted over the network. The County reserves the right to disconnect or otherwise manage circuits during incidents which jeopardize network performance. 3) Users may not access or alter in any manner data that is not involved in the execution of their job functions. a. Users aro not permitted to access, modify, delete, and/or utilize data, which they may have access to, for any purpose except their job duties, Collier County business objectives, or business practices. b. Users shall utilize information that they are authorized to access only for the specific purposes for which it is intended. o. Except for authorized public records searches and special investigations, data and communications (e.g. e-mail and voice communications) shall be treated as confidential and accessed only by the intended custodian/recipient(s). Users are strictly prohibited from accessing any data or communications to which they are not intended to have access or are not the intended recipient. 4) No user may encrypt data for transmission over or storage on network resources without written permission from the Director, Information Technology. The system and methods required to encrypt, and decrypt data must be approved by the Information Technology Division. If the encryption method relies on secret keys, the Information Technology Division must manage the storage and security of such encryption keys. The Information Technology Division has methods in place to store secret keys securely, assuring the secrecy of encryption keys and the . ability to decrypt data. If encrypted data is discovered, the data owner must provide clear text/urrencrypted data along with tire encryption system and secret keys to the Director, Information Technology upon request. 5) Regulated Data. a. Generally, all data and records created, stored, sent, or received on the Collier County network and network resources are public records except those exempted in Chapter 119 and 435.09 of the Florida Statutes or in any other applicable laws. Protected Health Information (PHI) protected under HIPAA rules and statutes as well as Payment Card Industry (PCI) data, personal financial information (PFI) (e.g. credit card and bank account numbers) and personal identifying information (PII) as identified inthe Florida Information Protection Act (FIPA) (e.g. social security numbers) are specifically excluded from the public record. b. Based on the content of data, statutes and/or agency policies may apply to the proper handling. It is the responsibility of the user to know the statutes/policies/rules that govern the handling of the regulated data to which they have access and to act in accordance with the applicable statutes/rules. Employees should consult with the Page 10 of 11 CMA. 5405 County Attorney's Office to resolve any questions regarding proper legal handling of data. The data custodian shall be responsible to inform the Director, Information Technology of any regulated data that is collected or stored in any network resources so that it may be handled appropriately. The County has taken measures to ensure the confidentiality, integrity and availability of sensitive information, including PHI, PPI, and PII and that access to sensitive information is restricted to authorized users. Users must take steps to minimize the possibility of unauthorized access including, but not limited to, making sure that the position of their monitor is not subject to unauthorized viewing, not leaving regulated data on an unattended computer screen, and, proper custodianship of printouts. Regulated data shall not be stored on any computer's local storage or any other type of portable storage device. Regulated data shall never be stored on a portable computer. Any inadvertent access of regulated data by users who should not have access must be reported to the Director, Information Technology. c. Users shall not make copies of regulated data, encryption keys, or secure (encrypted) data in its clear text (unencrypted) state. The approval of the Director, Information Technology is required if it becomes necessary to make a copy or replicate regulated or encrypted data. This includes storing such data in documents, data warehouses, secondary databases, portable computers, or portable storage devices. H. Social Media Services: Internet based social media services (SMS) (e.g. Facebooly Twitter, MySpace) accounts may be authorized for agency or divisional promotion, outreach, or other public relations purposes and must be authorized by the Communications and Customer Relations Division. All use of social media must comply with the provisions set forth in CMA 1200, Media and Public Relations. Upon approval, a request for access must be submitted to IT by the Division Director. IT will provide approved site owners with the tools and instructions to archive their information for compliance with Public Records statutes and agency procedures. Each division is responsible for the proper archiving and retention of social media records. § 5405-4. Currency. The Information Technology Division is responsible for the currency of this instruction. Page 11 0£ 11 cAer CountY Public Services Department Community & Human Services Division 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 Collier County Community and Human Services Division. Such information may be used by Collier County Community and Human 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. I hereby acknowledge that I have reviewed a copy of the Collier County Community and Human Services Notice of Privacy Practices and have been provided an opportunity to receive a copy. I hereby confirm I am not a relative of a Collier County employee nor am I a current or former employee of Collier County. If this statement is not correct please provide Collier County Community and Human Services Division with additional information about the relative's name and title and/or your past employment with Collier County so that it can be determined whether a conflict of interest exists. Determination of a conflict of interest will be reviewed by the Director of Collier County Community and Human Services. (See attached Addendum) Client Signature: Additional information: Date: Cm Ind's: Community & Human Services Division • 3339 Tamiami Trail East, Suite 211 • Naples, Florida 34112-5361 239 -252 -CARE (2273) • 239 -252 -CAFE (2233) 239-252.4230 (RSVP) • www.colliergov.neghumanservices Florida Department of Elder Affairs: WHY ARE WE COLLECTING YOUR SOCIAL SECURITY NUMBER? We are required to explain that your Social Security number is being collected pursuant to Title 42 Code of Federal Regulations, Section 435.910, to be used for screening and referral to programs or services that may be appropriate for you. The provision of your Social Security number is voluntary, and your information will remain confidential and protected under penalty of law. We will not use or give out your Social Security number for any other reason unless you have signed a separate consent form that releases us to do so. 13 DOEA 701A, April 2013 °^fir Employment Eligibility Verification USCIS Department of Homeland Security Form I-9 b e OMB No. 1615-0047 �qHu SES U.S. Citizenship and Immigration Services Expires 08/31/2019 ►START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form. ANTI -DISCRIMINATION NOTICE: It is illegal to discriminate against work -authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination. Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form 1-9 no later than the first; day of employment but not before accepting a job offer.) Last Name (Family Name) First Name (Given Name) Middle Initial Other Last Names Used (if any) Address (Street Number and Name) Apt. Number City or Town State ZIP Code Date of Birth (mm/dd/yyyy) U.S. Social Security Number m Employee's E-mail Address Employee's Telephone Number I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form. attest, under penalty of perjury, that I am (check one of the following boxes): ❑ 1. A citizen of the United States 2. A noncitizen national of the United States (See instructions) 3. A lawful permanent resident (Alien Registration Number/USCIS Number): ❑ 4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy): Some aliens may write "N/A" in the expiration date field. (See instructions) Aliens authorized to work must provide only one of the following document numbers to complete Form 1-9: An Alien Registration Number/USCIS Number OR Form 1-94 Admission Number OR Foreign Passport Number. QR code - Section r Do Not Write in This Space 1. Alien Registration NumberfUSCIS Number: OR 2. Form 1-94 Admission Number: OR 3. Foreign Passport Number: Country of Issuance: Signature of Employee Today's Date (mm/dd/yyyy) Preparer and/or Translator Certification (check one): Q I did not use a preparer or translator: E] A preparer(s) and/or translator(s) assisted the employee In completing Section 1. (Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.) attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my me mrormanon is true ana correct. Signature of Preparer or Translator Last Name (Family Name) Address (Street Number and Name) First Name (Given Name) City or Town 0 Employer Completes Next Page 0 Today's Date (mm/dd/yyyy) State I ZIP Code Form 1-9 07/17/17 N Page 1 of y+°^fir Employment Eligibility Verification o�F Department of Homeland Security U.S. Citizenship and Immigration Services Employee Info from Section 1 Identity and Employment Authorization First Name (Given Name) Identity USCIS Form I-9 OMB No. 1615-0047 Expires 08/31/2019 Status Employment Authorization Document Title s Document Title Document Title Issuing Authority Document Number Expiration Date (if any)(mm/dd/yyyy) Document Title ! Issuing Authority Document Number ':;, Expiration Date (ifany)(mm/dd/yyyy) Issuing Authority Document Number Expiration Date (if any)(mm/dd/yyyy) Issuing Authority City or Town Additional Information ZIP Code Do Not Mite lnThis Spa. Document Number Expiration Date (if any)(mm/dd/yyyy) Document Title Issuing Authority Last Name (Family Name) Document Number Expiration Date (if any)(mm/dd/yyyy) Certification: I attest, under penalty of perjury, that (1) 1 have examined the document(s) presented by the above-named employee, (2) the above -listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States. The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions) Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Title of Employer or Authorized Representative Last Name of Employer or Authorized Representative First Name of Employer or Authorized Representative Employer's Business or Organization Name Employer's Business or Organization Address (Street Number and Name) City or Town State I ZIP Code Section 3.;Remif1cation and Rehires (Tobe completed and signed by employer or authorized representative:) A. New Name (if applicable) B. Date of Rehire (if applicable) Last Name (Family Name) First Name (Given Name) Middle Initial Date (mm/dd/yyyy) C. If theemployee s previous grant of employment authorization has expired, provide the information for the document or receiptthat establishes.'. continuing employment authorization in the space provided below. Document Title Document Number Expiration Date (if any) (mm/dd/yyyy) attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual. Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Name of Employer or Authorized Representative Form 1-9 07/17/17 N Page 2 of 3 LISTS OF ACCEPTABLE DOCUMENTS All documents must be UNEXPIRED E Employees may present one selection from List A or a combination of one selection from List B and one selection from List C. Examples of many of these documents appear in Part 13 of the Handbook for Employers (M-274). Refer to the instructions for more information about acceptable receipts. Form I-9 07/17/17 N - Page 3 of 3 LIST A of LIST B LIST C Documents that Establish Documents that Establish Documents that Establish Both Identity and Identity Employment Authorization Employment Authorization OR AND 1. U.S. Passport or U.S. Passport Card 1. Driver's license or ID card issued by a 1. A Social Security Account Number ';; State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address card, unless the card includes one of the following restrictions: (1) NOT VALID FOR EMPLOYMENT (2) VALID FOR WORK ONLY WITH INS AUTHORIZATION 2. Permanent Resident Card or Alien Registration Receipt Card (Form 1-551) 3. Foreign passport that contains a temporary 1-551 stamp or temporary 2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address 1-551 printed notation on a machine- readable immigrant visa (3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION 4. Employment Authorization Document that contains a photograph (Form 1-766) 2. Certification of report of birth issued by the Department of State (Forms DS -1350, FS -545, FS -240) 3. School ID card with a photograph 5. For a nonimmigrant alien authorized 3. Original or certified copy of birth 4. Voter's registration card to work for a specific employer certificate issued by a State, because of his or her status: a. Foreign passport; and b. Form I-94 or Form I -94A that has county, municipal authority, or territory of the United States bearing an official seal 5. U.S. Military card or draft record 6. Military dependent's ID card 7, U.S. Coast Guard Merchant Mariner 4. Native American tribal document the following: (1) The same name as the passport and (2) An endorsement of the alien's nonimmigrant status as long as that period of endorsement has Card 5. U.S. Citizen ID Card (Form 1-197) 6, Native American tribal document 6. Identification Card for Use of Resident Citizen in the United States (Form 1-179) 9. Driver's license issued by a Canadian government authority not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form. For persons under age 18 who are unable to present a document listed above: 7. Employment authorization document issued by the Department of Homeland Security 6. Passport from the Federated States of Micronesia (FSM) or the Republic of 10. School record or report card 11. Clinic, doctor, or hospital record the Marshall Islands (RMI) with Form 1-94 or Form 1-94A indicating nonimmigrant admission under the 12. Day-care or nursery school record Compact of Free Association Between the United States and the FSM or RMI Icr Examples of many of these documents appear in Part 13 of the Handbook for Employers (M-274). Refer to the instructions for more information about acceptable receipts. Form I-9 07/17/17 N - Page 3 of 3 Collier County Solicilalion 18-7470 EXHIBIT I.A FEDERAL CONTRACT PROVISIONS FEDERAL CONTRACT PROVISIONS Administrative, contractual, or legal remedies (Ref. 41 U.S.C, 1908, 2 CFR § 200 Appendix II (A) Unless otherwise provided in this contract, all claims, counter -claims, disputes and other matters in question between the local government and the contractor, arising out of or relating to this contract, or the breach of it, will be decided by arbitration, if the parties mutually agree, or in a Florida court of competent jurisdiction. Access to Records and Reports (Reference: 2 CFR § 200.333, 2 CFR § 200.336) The contractor/vendor agrees to maintain all books, records, accounts and reports required under this contract for a period of not less than three years after the date of termination or expiration of this contract, except in the event of litigation or settlement of claims arising from the performance of this contract, in which case the Contractor agrees to maintain same until the Purchaser, the Grantor Administrator, the Comptroller General, or any of their duly authorized representatives, have disposed of all such litigation, appeals, claims or exceptions related thereto. Furthermore, the County shall maintain written policies and procedures for computer system backup and recovery and shall have the same requirement of its Contractors. No Government Obligation to Third Parties - The Federal Government is not a party to this contract and is not subject to any obligations or liabilities to the non -Federal entity, contractor, or any other party pertaining to any matter resulting from the contract." Program Fraud and False or Fraudulent Statements of Related Acts The contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to the contractor's actions pertaining to this contract." Clean Air and Federal Water Pollution Control Acts (Reference: 2 CFR § 200 Appendix II (G)) Contracts and subgrants of amounts in excess of $150,000 shall contain a provision that requires the Contractor or recipient to comply with all applicable standards, orders, or requirements issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387). Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). Energy Policy and Conservation Act - (Reference 2 CFR § 200 Appendix II (H) The contractor shall comply with any mandatory standards and policies relating to energy efficiency which are contained in the F I o r i d a state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub. L. 94-163, 89 Stat. 871, 42 U.S.0 Section 6201) Debarment and Suspension (Reference 2 CFR § 200 Appendix 11 (I) Contract awards that exceed the small purchase threshold and certain other contract awards shall not be made to parties listed on the government wide Excluded Parties List System in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1986 Comp., p. 189) and 12689 (3 CFR Part 1989 Comp., p. 235), "Debarment and Suspension." The Excluded Parties List System in SAM contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. The successful bidder, by administering each lower tier subcontract that exceeds $25,000 as a'covered transaction', must verify each lower tier participant of a 'covered transaction" under the project is not presently debarred or otherwise disqualified from participation in this federally assisted project. Byrd Anti -Lobbying Amendment (31 U.S.C. 1352) (Reference 2 CFR § 200 Appendix II (J) Vendors must certify it will not and has not used Federal appropriated funds have been paid or will be paid, by or to any person or organization for influencing or attempting to Influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the FCP-2 10130/2018 7:14 AM p. 14 Collier County Solicitation 18-7470 EXHIBIT LA FEDERAL CONTRACT PROVISIONS making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. The certification Includes any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Procurement of Recovered Materials (Reference 2 CFR § 200.322) Contractor and subcontractor agree to comply with Section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act, and the regulatory provisions of 40 CFR Part 247. (1) In the performance of this contract, the Contractor shall make maximum use of products containing recovered materials that are EPA designated items unless the product cannot be acquired (i) Competitively within a timeframe providing for compliance with the contract performance schedule; (ii) Meeting contract performance requirements; or (iii) At a reasonable price. (2) Information about this requirement is available at EPA's Comprehensive Procurement Guidelines web site, http://www.ei)a.ciovi. The list of EPA -designate items is available at https://www epa gov/smm/comprehensive-procurement-guideline-cgg-program. Diversity (Reference 2 CFR § 200.321) The County is dedicated to fostering the continued development and economic growth of small, minority-, women-, and service -disabled veteran business enterprises. All contracting and subcontracting opportunities afforded by this solicitation/contract are strongly encouraged to contribute as both Contractors and Sub -Contractors. Firms may be required to submit documentation addressing diversity and describing the efforts being made to encourage the participation of small, minority-, women-, and service -disabled veteran business enterprises. Information on Certified Minority Business Enterprises (CMBE) and Certified Service -Disabled Veteran Business Enterprises (CSDVBE) is available from the Office of Supplier Diversity at: http•//dms.myfloridacom/other programs/office of supplier diversity cadl Termination for Cause and Convenience See County's Standard Terms and Conditions. Nondiscrimination -Civil Rights Compliance The Contractor will 1. not discriminate against any person in the provision of services or benefits under this contract or in employment because of age, race, religion, color, disability, national origin, marital status or sex in compliance with state and federal law and regulations. 2. Assumes others with whom it arranges to provide services or benefits in connection with any of its programs and activities are not discriminating against clients or employees because of age, race, religion, color, disability, national origin, marital status or sex. And 3. Assures others with whom it arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those participants or employees in violation of the above statutes, regulations, guidelines, and standards. Computer Use and Social Media Policy The Florida Department of Elder Affairs has implemented a Social Media Policy, in addition to its Computer Use Policy, which applies to all employees, contracted employees, consultants, OPS and volunteers, including all personnel affiliated with third parties, such as, but not limited to, contractors and subcontractors. Any entity that uses the Department's computer resource systems must comply with the Department's policy regarding social media. Social Media includes, but is not limited to blogs, podcasts, discussion forums, Wilds, RSS feeds, video sharing, social networks like MySpace, Facebook and Twitter, as well as content sharing networks such as flickr and YouTube. This policy is available on the Department's website at: http•//eideraffairs.state.fl.us/doea/financiai.php STATE CONTRACT PROVISIONS Discriminatory Vendors List In accordance with Section 287.134, Florida Statutes, an entity or affiliate who has been placed on the discriminatory vendor list may not submit a bid on a contract to provide any goods or services to a public PCP -3 10/30/2018 7:14 AM - P. 16 Collier County Solicitation 18-7470 EXHIBIT I.A FEDERAL CONTRACT PROVISIONS entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity. Inspector General Cooperation The Parties agree to comply with Section 20.055(5), Florida Statutes, for the inspector general to have access to any records, data and other information deemed necessary to carry out his or her duties and incorporate into all subcontracts the obligation to comply with Section 20.055(5), Florida Statutes. Equal Employment Opportunity The Contractor shall not discriminate against any employee or applicant for employment because of race, age, creed, color, sex or national origin. The Agency will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, age, creed, color, sex, or national origin. Such action shall include, but not be limited to, the following: Employment upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or otherforms of compensation; and selection fortraining, including apprenticeship. Contractors must insert a similar provision in all subcontracts, except subcontracts for standard commercial supplies or raw materials. Interest of Members of Congress No member of or delegate to the Congress of the United States shall be admitted to any share or part of this contract or to any benefit arising therefrom. Interest of Public Officials No member, officer, or employee of the public body or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. For purposes of this provision, public body shall include municipalities and other political subdivisions of States; and public corporations, boards, and commissions established under the laws of any State. Interest of Public Officials No member, officer, or employee of the MPO or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. Lobbying No funds received pursuant to this Agreement may be expended for lobbying the Legislature, the judicial branch or a state agency. EVerify Vendors/Contractors/Subcontractors: 1. shall utilize the U.S. Department of Homeland Security's E -Verify system to verity the employment eligibility of all new employees hired by the Vendor/Contractor during the term of the contract; and 2. shall expressly require any subcontractors performing work or providing services pursuant to the state contract to likewise utilize the U.S. Department of Homeland Security's E -Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the contract term. FCF-4 10/30/2018 7:14 AM P• 10 CMA 5390 FINGERPRINTINGBACKGROUND CHECKS [Effective Date: January 1, 2005; Revised: May 1, 2009; Revised: January 31, 20191 § 5390-1. Purpose. The purpose of this Instruction is to provide fingerprinting and background checks for all positions within the County Manager's Agency. § 5390-2. Concept. A. In response to Homeland Security, the State of Florida (§ 126.5801, Florida Statutes) authorizes the Board of County Commissioners to conduct background checks on County employees and other individuals. B. On October 9, 2007, the Board of County Commissioners amended Ordinance 04-52 with Ordinance 07-64, which provides that the County mandates state and federal criminal history records checks for all applicants for positions of employment with Collier County and for all current incumbents/employees, as well as similar employees and other similar representatives of contractors, vendors, repair persons and delivery persons, in each position of employment with the Board of County Commissioners agency. C. Each new applicant for positions of employment with the County will be hired contingent upon the results of the applicant's background checks. If a relevant offense is discovered, the results of these background checks will be forwarded to the Human Resources Division. The Human Resources Generalist will work with the employee's Division Director to determine if the discovered offense is serious enough to consider termination of the employee or, in the alternative, reassignment to a position of employment (job classification) that is not controlled by the respective background checks. § 5390-3. Procedures. A. New applicants: (1) Positions of employment will be identified within the posting announcement as subject to Florida and federal criminal background checks. (2) During post -offer screening, individuals will be required to complete fingerprinting with the Facilities Management Division. (3) The fingerprint records are sent to the Florida Department of Law Enforcement (FDLE) for a state of Florida background check and to the Federal Bureau of Investigation (FBI) for the national background check. (4) With the exception of potentially relevant convictions, the information will remain in electronic form within the Facilities Management, Government Security Section's database. This data is not subject to disclosure pursuant to Florida's Public Records Law. (5) Both new and incumbent employees in all positions are required to be fingerprinted, in accordance with the fingerprinting plan approved at the time of the ordinance Pagel of 3 CMA 5390 FINGERPRINTING/BACKGROUND CHECKS amendment in 2007, and as financial resources allow. B. Existing Positions: (1) Division Directors will be notified by Human Resources of the schedule to fingerprint existing employees for screening or re -screening. (2) Any background check that uncovers a relevant criminal conviction will be delivered via printed hard copy to the HR Division staff. The Human Resources Director and the employee's Division Director will determine, after discussion and gathering relevant data, whether the offense warrants termination of employment or reassignment to another job description. (3) Once notified of their requirement to be fingerprinted/re-fingerprinted, employees must make every effort to complete his/her fingerprinting procedure within 10 workdays after receipt of notification to do so. Employees who do not complete the procedure as required, which includes fully cooperating in supplying all information needed to complete the background investigation, may be subject to suspension, termination or reassignment. Extensions of the ten-day time frame shall be granted only in writing by the Human Resources Division. (4) If County management has reason to suspect that a covered individual may have been convicted of a relevant crime subsequent to the then most recent background check, the County may mandate a subsequent background check. (5) The cost of the fingerprinting procedures and background checks will be budgeted and be the responsibility of the Human Resources Division. C. Contractors with employees or other individuals who will have access to sensitive locations and/or sensitive information: (1) Each contractor entering into a contract with the County, as well as such contractor's employees or other representatives, including all subcontractors at every tier (including vendors, repair persons and/or delivery individuals) who will have physical access to County facilities or locations related to security or public safety shall be required to comply with the fingerprinting and background checks. (a) All new formal competitive County solicitations (e.g., for bids and requests for proposals) and contracts shall include a clause that mandates fingerprinting and background checks performed by County Security Section staff and paid for by the Contractor or subcontractor, etc., as the case may be. (b) The clause shall mandate that the contractor in privity with the County shall be responsible to ensure that these requirements are complied with at all lower tiers associated with the project. (c) Prior to the issuance of each formal solicitation, the project manager responsible for the contract shall work with the appropriate Procurement Division representative to develop and include text in the solicitation that references the mandated checks Page 2 of 3 CMA 5390 FINGERPRINTING/BACKGROUND CHECKS and provides each prospective bidder/respondent with the means for obtaining more information about these requirements prior to tendering the bid or proposal. (d) To the greatest extent possible, the results of these background checks should be on file in the Facilities Management Division's Security Section files prior to the commencement of work. (2) Contractors and others as listed above should be selected for background checks if they will have physical access to locations, facilities, documents or other information related to security and/or public safety. Contract employees with relevant offense results may be denied all access to the site, may be restricted to specified geographic areas and/or at certain times of the day and must always be personally escorted by a County or contract employee that is not subject to any such restrictions. The Facilities Management Division shall have the sole discretion of determining what restrictions apply in every such situation. (3) All contractors doing business regularly on County owned or leased property will display an Agency Contractor's identification badge at all times when on County property. Each badge must be returned to the Security Section Operations Center at the conclusion of each respective individual's assignment. (a) It is the responsibility of the host division to facilitate and coordinate this procedure with the Security Section Operations Center. (b) It is the responsibility of the host Division and the Government Security Section to ensure that contractors under their supervision have been cleared by the County's Government Security Section and continue to strictly comply with the requirements to display the County -issued ID badges. (c) All individuals who are granted access to geographic areas and/or access to sensitive information because of the individual's relationship to a contractor in privity with the County on County -owned or County -leased property (County as landlord or tenant) must display these ID badges at all such times. (d) Contractor ID badges are valid for a one (1) year period from date of issuance. Any subsequent ID badges needed during this time for replacement due to loss or damage, will come at a $5.00 time and material processing fee from the contractors. § 5390-4. Currency. The Facilities Management Division is responsible for maintaining the currency of this Instruction. § 5390-5. Reference. Collier County Ordinance No. 2007-64, § 1; Ord. No. 07-64, § 1 provides for state and federal criminal history records checks for specified positions of employment by Collier County or by outside contractors or vendors pursuant to § 125.5801, Florida Statutes. F Page 3 of 3 RiCK SCOTT GOVERNOR SAMUEL P. VERGIIESE SECRETARY 4040 ESPLANADE WAY TALLAHASSEE, FLORIDA 32399.7000 phone 850-414.2000 fax 850.617.6595 TDD 850-414.2001 MEMORANDUM Notice #: 082515-1-I-SCBS TO: Area Agency on Aging Executive Directors FROM: Samuel P. Verghese, Secretary DATE: August 25, 2015 SUBJECT: Notice of Instruction: Background Screening Clearinghouse Results Website Pre -Registration The purpose of this Notice is to provide information concerning the Department of Elder Affairs' (Department) entrance in the Agency for Health Care Administration's (ARCA) Background Screening Clearinghouse Results Website (Clearinghouse). The Department and AHCA are working diligently for a September 14, 2015, start date. Providers must be registered with the Clearinghouse prior to referring the employee/volunteer or potential employee/volunteer for fingerprinting. Provider pre -registration begins on August 28, 2015. The following information is pertinent to the pre -registration process: • Starting August 28, 2015, pre -registration for the Clearinghouse will be available. The Department is listed as DOEA. • The Department and AHCA strongly encourage all providers to PRE -REGISTER starting August 28, 2015. • Registration for the Clearinghouse is free and is available at https:l/apps.alica.mvfloi-ida.coin/SingleSi gnOnPortal. • The current Originating Agency Identification (ORI) Number FL92431OZ will be turned off permanently on August 28, 2015, two weeks prior to the Department's entrance into the Clearinghouse. • Any use of the old ORI number on or after August 28, 2015, will incur additional fees to the entity requesting the screening. • As of September 14, 2015, the Department will begin using the new ORI number EDOEA310Z. h tip://elderaffairs.state, fl. us Notice of Instruction: Background Screening Clearinghouse Results Website Pre -Registration August 25, 2015 Page 2 Instructions to pre -register (The complete user instruction guide with screen shots is available at littp:Hahea.my$orida.com/MCHO/Central Services/Background Screening/BGS results.shtml.) 1. Click https://apps.ahea.myflorida.com/Sing]eSienOnPortal to open your browser to the AHCA Portal. 2. Click on the link for "New User Registration." 3. Check the box for user Authorization and click the "Continue" button. 4. Fill out the information fields to create your account: a. Important note: the email address entered on this page will be used for all future user account notifications and background screening notifications. 5. Click the "Register" button. 6. Click the "Return to Login" button on the next screen. 7. Log in using the username and password you created. 8. Select "Department of Elder Affairs — DOEA" from the "Select Program" drop down list and click "Request Program Access." 9. Select "Provider" from the "Role" drop down list. 10. Select "DOER" from the "Provider Type" dropdown list. 11. Begin typing the name of the provider you represent. 12. Select the "Provider" from the list when it appears, and be sure your OCA number matches. 13. Click "Add Provider" button. 14. Repeat steps 10-12 for additional providers you represent, if applicable. 15, Click "Submit Request and Generate User Agreement." 16. Review the user registration agreement that opens in the next window. 17. Print the agreement by clicking the "Here" link in the upper -right-hand corner of the window under your email and user ID. 18. Sign the agreement and have your owner/administrator/supervisor sign it. 19. Send the agreement and a copy of your driver's license or state -issued photo ID to DOEA in one of the following ways: Mail To: Florida Department of Elder Affairs Background Screening Unit 4040 Esplanade Way Room 335U Tallahassee, FL 32399-7000 Scan and E -Mail To: Fax To: doeanetwork u, elderaffairs.ora (850) 617-6595 Subject Line: BGS User Agreement Notice of Instruction: Background Screening Clearinghouse Results Website Pre -Registration August 25, 2015 Page 3 Please note these additional important details for the pre -registration process: The Department will finalize provider registration from the Clearinghouse on or by September 14, 2015. Providers will receive an email when their registration is complete with a link to the Clearinghouse and training materials. Entities may begin using the Clearinghouse to search for applicants, initiate screenings, and check eligibility determinations upon receiving the registration approval email. As a reminder, all individuals who meet the definition of Direct Service Provider as per Section 430.0402(1)(b), Florida Statutes (F.S.) must be screened through the Clearinghouse. Direct Service Provider: "means a person 18 years of age or older who, pursuant to a program to provide services to the elderly, has direct, face-to-face contact with a client while providing services to the client and has access to the client's living areas, funds, personal property, or personal identification information as defined in s. 817.568. The term includes coordinators, managers, and supervisors of residential facilities and volunteers." (Section 430.0402(1)(b), F.S.) Personal Identification Information: "means any name or number that may be used, alone or in conjunction with any other information, to identify a specific person, including any: 1. Name, postal or electronic mail address, telephone number, social security number, date of birth, mother's maiden name, official state -issued or United States -issued driver license or identification number, alien registration number, government passport number, employer or taxpayer identification number, Medicaid or food assistance account number, bank account number, credit or debit card number, or personal identification number or code assigned to the holder of a debit card by the issuer to permit authorized electronic use of such card; 2. Unique biometric data, such as fingerprint, voice print, retina or iris image, or other unique physical representation; 3. Unique electronic identification number, address, or routing code; 4. Medical records; 5. Telecommunication identifying information or access device; or 6. Other number or information that can be used to access a person's financial resources." (Section 817.568(1)(f), F.S.) Please note that the Department does not have the authority to background screen individuals who do not meet the "Direct Service Provider" definition. If you have any questions pertaining to this Notice, please contact the Background Screening Unit at (850) 414-2093 or via email at doeanetwork(�elderaffairs.org. Thank you for your cooperation. DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E Background Screening Clearinghouse Instructions DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Introduction/Requirements Introduction • All Candidates who are Direct Service Providers per Section 430.0402 (1) (b), F.S., are required to complete a Level 2 background screening with an attached photograph through the Care Provider Background Screening Clearinghouse (Clearinghouse). • All Direct Service Providers (Candidates/Employees) of any service provider agency, subcontractor, or vendor of the Department of Elder Affairs (Department/DOEA) are required to have a DOEA-Aging Network eligibility determination in the Clearinghouse. • All Providers of Department programs are required to enter all eligible participating Candidates/Employees within the Specified Agency "Employee/Contractor Roster" tab of the Clearinghouse. • An Employer may hire a Candidate into a position that requires background screening prior to the Candidate/Employee completing the screening process. This period is for training and orientation purposes only, and the Employee shall not provide direct service until the screening process is finalized and the Employee's status is "Eligible" within the DOER -Aging Network Clearinghouse. Use of the Clearinghouse must be limited to Direct Service Providers as defined by 430.0402 (1) (b), F.S. • Failure to comply with any background screening requirement is a violation of Section 430.0402, F.S. Per Section 435.12 F.S., the Agency for Health Care Administration (ANCA), in consultation with the Department of Law Enforcement, created the Clearinghouse. The purpose of the Clearinghouse is to provide a single data source for background screening results of persons required to be screened by law for employment in positions that provide services to children, the elderly, and disabled individuals. The Clearinghouse allows the results of criminal history checks to be shared among specified agencies when a person has applied to volunteer, be employed, be licensed, or enter into a contract that requires a state and national fingerprint -based criminal history check. July 2018 E-2 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Introduction/Requirements Specified agencies include: • Agency for Health Care Administration (ARCA); • Agency for Persons with Disabilities (APD); • Department of Children and Families (DCF); • Department of Elder Affairs (DOEA); • Department of Health (DOH); • Department of Juvenile Justice (DJJ); • Division of Vocational Rehabilitation within the Department of Education (DOEVR); and • Local licensing agencies approved pursuant to Section 402.307, F.S. Specified agencies of the Clearinghouse are identified through registration in the Clearinghouse, based upon statutory screening authority. Registration in the Clearinghouse: All agency -connected service provider agencies, subcontractors, and vendors must create a user account under the appropriate agency, generate a user agreement in the Background Screening Clearinghouse, and email a scanned copy of the user registration agreement and driver's license to the appropriate agency email address for processing. All DOEA service provider agencies, subcontractors, and vendors must send registration information to doeanetwork(d,elderaffairs.org for processing. Utilizing the Clearinghouse: Once processed, the service provider agency, subcontractor, or vendor may begin the process of fingerprinting Candidates/Employees, and adding or updating the employee roster. However, it is necessary for service provider agencies, subcontractors, and vendors to initiate a search to determine whether the Candidate/Employee is already in the Clearinghouse before initiating a new screening. As the specified agencies are human services governmental entities, responsible for administration of similar services to authorized service populations, it is common for Direct Service Providers to provide services across corresponding agency provider networks; however, Direct Service Provider Candidates/Employees of DOEA programs must have a DOEA-Aping Network eligibility determination in the Clearinghouse. July 2018 E-3 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions t Introduction/Requirements DOER Agency Review: If a Direct Service Provider Candidate/Employee is already in the Clearinghouse with an "eligibility statement' from another specified agency, other than DOEA, then the DOEA- funded service provider agency, subcontractor, or vendor must initiate a DOEA Agency Review. The DOEA Agency Review is necessary for information sharing between specified agencies. The Agency Review allows Direct Service Providers to be identified in the Clearinghouse under DOEA, and DOEA-funded service provider agencies, subcontractors, or vendors can access employment history records, including subsequent arrest notifications and expiring fingerprint notifications. Initiating the DOEA Agency Review allows background screening information for a Direct Service Provider, e.g., in-home worker to be accessible by DOEA. AARs must inform lead agencies, OAA -funded direct contractors, and other direct AAA contractors, that upon subcontracting with a service provider/vendor, the provider must obtain proof of eligibility (background screening result displaying DOEA as the specified 4' agency) for a Candidate/Employee that will serve clients enrolled in DOEA programs. July 2018 E-4 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Introduction/Requirements Rules in the Clearinghouse Each User must access the Clearinghouse website and abide by the following rules: • Create a unique account. (There is no limit on the number of Users per program Provider). Do not disclose or lend your USER ID AND/OR PASSWORD to anyone. Your User ID and Password serve as your "electronic signature." This means that you are responsible for the consequences of unauthorized or illegal transactions. Copies of all User Registrations and supporting documents are required for monitoring purposes. o Failure to comply: Sharing a User ID and Password will result in immediate suspension of access to the Clearinghouse. o Providers cannot regain access to the Clearinghouse Portal until a Corrective Action Plan is in place. o All User Registration Violation information and a Corrective Action Plan must be submitted to the AHCA for further review. • Do not browse or use Clearinghouse information for unauthorized or illegal purposes. c Per Section 435.11(1)(b), F.S., it is a misdemeanor of the first degree to use records information for purposes other than screening for employment or to release records information to other persons for purposes other than screening for employment. o Do not make any disclosure of Clearinghouse data that is not specifically authorized. o Do not intentionally cause corruption or disruption of data files. • Edit your user information (i.e., email address, phone number), as needed. It is important that you maintain a current email address. Your email address will be required should you need to have your password reset. Also, important notifications are sent to the email address on file within the Portal, such as background screening updates, Employee arrest notifications, account registration notices, and portal updates. Passwords must be updated every 90 days. Failure to do so will result in being locked out of the system. If you have been locked out of the system or forgotten your password, please go to the 'Reset Password Instructions" under the Portal Log -In, and follow all prompts. July 2018 E-5 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Instructions: Account Registration and Generating a User Agreement First Time Portal User Requirements First-time Users are required to create a log -in and a password to access the Clearinghouse. These credentials can be established by visiting the ARCA web portal at https://apps.ahca.mvflorida.com/SingleSignOnPortal Once on the website: A. Select "New User Registration." B. Check the confirmation box and select continue. C. Complete the Account registration by entering all required information indicated by the red asterisk (*) and select "Register" to continue. D. Select "Return to Login" to request access to the Clearinghouse results website. Portal Users Requirements The Portal Login page will provide authorized user access to external systems maintained by AHCA. To view and maintain information: A. Enter the User ID and Password created in the previous steps. Select "Log In." B. From the drop-down list, select "Department of Elder Affairs" (DOEA) under Background Screening Clearinghouse. C. Select "Request Program Access" to continue. D. A role is necessary to obtain proper access. Select "Provider" from the drop- down list. E. Select the "Provider Type." F. Start typing the "Provider Name" associated with your DOEA account. G. Select your provider from the list when it appears. Select "Add Provider." o If your Provider information is not located in the drop-down selection, please contact the Department for instructions using the contact information provided below: Contact — Background Screening Unit Email Address — doeanetwork aC )elderaffairs.org Subject Line — BGS User Registration Body of Email — Require Template for User Registration. July 2018 E-6 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Instructions: Using the Clearinghouse Results Website H. If the requested Provider is correct, select "Submit Request and Generate User Agreement." o If it is incorrect, select Delete and choose the appropriate "Provider Name." "Submit Request and Generate User Agreement with a copy of Driver's License." Select the link in the upper right corner and print the document. Both, the signature of the User and the Provider are required prior to sending the agreement to the Department for approval. Send, via encrypted email, the scanned copy of the "User Registration Agreement" with a copy of Applicant's driver's license to doeanetwork6Delderaffairs.org. Note: Your request for access to the Clearinghouse Results Website will be in 'Pending' status until the DOEA Coordinator receives and processes your "User Registration Agreement." Only after the approval occurs, will the User have access to the Clearinghouse. Clearinghouse Results Website Overview: The Clearinghouse Results Website allows users to initiate a screening, search for screening results, connect to specified agencies' screenings, select a LiveScan service provider, and connect to the service provider's website to schedule appointments. Utilizing the Clearinghouse website to initiate screening requests provides the user the following benefits: • Ability to share results of criminal history checks among specified agencies; • Ability to view subsequent arrest information for employees with retained fingerprints (only available to current employers of the individual); • Ability to track screenings from the time the screening request is initiated in the Clearinghouse until a determination is made; • Ability to receive email notifications regarding status updates to requests initiated; • Ability to search for LiveScan service providers by certain criteria (county, name, etc.). Provides information and ability to connect to the fingerprint service provider's website to make appointments; July 2018 E-7 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Instructions: Using the Clearinghouse Results Website • Ability to receive the Transaction Control Reference Number (TCR#) needed for sending an applicant to be rescreened for rejected prints; • Ability to access Public Record version of state criminal history record (RAP sheet) for review by the provider requesting the original screening; • Ability to connect to a screening request in process for notification when results are available (reduces duplicative screening); • Ability to create a "status" report and a "completed screening listing" report of screenings requested by the User eliminating the need to search for each screening result individually; • Ability to maintain an employee roster by entering hire and separation dates for each employee. This facilitates a notification to the employer if the eligibility status of an employee changes; and o Section 435.12(2)(c) requires an employer of persons subject to screening by a specified agency to register with the Clearinghouse and maintain the employment status of all employees within the Clearinghouse. Initial employment status and any changes in status must be reported within 10 business days. • Ability to access the Redesigned Individual Profile Page that includes: o Eligibility results; o Photograph, if the individual is in the Clearinghouse; o Department of Health professional licensure status; o Screenings in process; o State criminal history report viewable for the provider initiating the screening; and o Employment history. July 2018 E-8 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Instructions: Using the Clearinghouse Results Website and Applicant Profile Clearinghouse Results Website Portal Access: A. Log in at https://apps.ahca.myflorida.com/SingleSignOnPortal. B. On the "Portal Landing," select.Background Screening Clearinghouse- DOEA; C. From the Program Access, select the Background Screening Clearinghouse link to access the Clearinghouse results website. Candidate Search Prior to sending any Candidate to the LiveScan Vendor (Fingerprint Provider), Clearinghouse Users are required to initiate a search to determine whether the Candidate is already within the Clearinghouse to avoid replication of Candidate information within the system. Search for Screening Results The "Search Page" allows the User to review the eligibility status of a Candidate, if the Candidate has undergone a screening or has a screening in -process with the Clearinghouse. Search by social security number and last name or social security number and date of birth. If the Candidate does not have a screening, the User must initiate a screening. If the Candidate has a screening, the Candidate's "Profile Page" will appear. If screened by another specified agency and entered in the Clearinghouse, the eligibility status will be "agency review required." If a Candidate/Employee possesses an "Eligibility Statement" from another Specified Agency within the Clearinghouse, a Provider is required to request a DOEA Agency Review at no cost. The DOEA Agency Review is possible if a photograph is attached to the Profile Page. However, if no photograph is attached to the Profile Page, a DOEA Agency Review will not be available, and the Provider will have to "Initiate a New Screening." The DOEA Agency Review allows the Specified Agency to make an eligibility determination for employment purposes. Benefits of requesting a DOEA Agency Review include the following: "Agency Review" requests are FREE to the Provider and Candidate/Employee. The Candidate/Employee does NOT need to visit a LiveScan location to submit new fingerprints. July 2018 E-9 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Clearinghouse Results Applicant Profile The Provider will receive a copy of the public rap sheet after initiating a DOEA Agency Review. Prior to initiating an Agency Review for a Candidate/Employee, the user must complete the following actions: A. Ensure the "Clearinghouse Screening Available" indicator states "Yes"; B. Ensure the "Privacy Policy" has been signed and acknowledged; C. Ensure the "Office of Inspector General (OIG) List of Excluded Individuals and Entities" has been searched and acknowledged; D. Ensure the "National Nurse Aide Registry (NNAR)" search has been completed; E. Ensure the demographic portion of the profile page is completed; F. Ensure the correct Social Security Number is on the "LiveScan Request Form"; G. Complete the "Requesting Provider" field within the Clearinghouse; H. Provide Candidate with a "LiveScan Request Form," before the fingerprinting process; I. Instruct the Candidate to request a photograph from the LiveScan Vendor at the time of LiveScan fingerprinting and ensure correct photograph has been uploaded to Candidate/Employee Profile Page; J. Return to the Clearinghouse Website upon receipt of email notification to check the Candidate's status. Initiating an Agency Review: To ensure the appropriate criteria is applied during the screening review, the position type and reason for screening the individual must be entered. • Select the "Initiate Agency Review" button. • Select the provider that the individual has applied to work for from the drop- down list. o Please note the provider drop-down will only display if you are accessing the website on behalf of multiple providers. • Select the position that the individual is applying for from the drop-down list. • Select the "Privacy Policy" link to view and print the privacy policy. Check the affirmation box to confirm that the Candidate/Employee has signed and agreed to the Privacy Policy. o If a candidate already has a signed Privacy Policy on file, they do NOT have to resign the updated Privacy Policy. July 2018 E-10 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Clearinghouse Results Applicant Profile Initiate New Screening: To initiate a new screening for a Candidate, select "Initiate Screening," and follow prompts. Initiate Resubmission: The retention of fingerprints in the Clearinghouse provides cost savings for Candidates that have had a lapse in employment greater than 90 days. If there is a lapse in employment, a new national criminal history check (including the resubmission of the retained fingerprints) is required. A new state criminal history search will also be conducted at no additional charge. To initiate a resubmission for a Candidate, select "Initiate Resubmission," and follow prompts. Initiate Clearinghouse Renewal: A Clearinghouse Renewal is completed from the Users Home page of the `Portal Landing" at https://apps.ahca.myflorida.com/SingleSignOnPortal. A welcome message and your provider information will appear on the Clearinghouse Results Website Home page. This page will also display the Employees with Expiring Retained Prints table and bulletin messages. If an employee is on your Employee/Contractor roster and their retained prints expiration date is within the renewal window, their information will display in the Employees with Expiring Retained Prints table. You can renew an employee by selecting Renew, their Last Name, or from the Person Profile page. Providers may initiate a Clearinghouse Renewal 60 days before the `Retained Prints Expiration Date" is reached. If the Clearinghouse Renewal is not initiated 14 -days before the 'Retained Prints Expiration date," a new screening will need to be initiated. Benefits of Initiating a Clearinghouse Renewal: • The request and payment for screening renewal occurs in one system resulting in cost savings. o The current cost for a Clearinghouse Renewal is $42.00, a cost-saving of over $30; the average cost for a new screening is $75.00. The processing time is faster since the request is immediately sent to the Clearinghouse; no need to wait for the employee to be fingerprinted at a LiveScan Service Provider location. July 2018 E-11 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Clearinghouse Results Applicant Profile An updated criminal history is completed to ensure compliance with background screening requirements. • The print retention time is extended an additional five years. To initiate a Clearinghouse Renewal, select the Initiate Renewal button from the Person Profile Page and follow the prompts. For the Clearinghouse Renewal Instruction Guide, log in at htto:Helderaffairs.state.flus/doea/bs/Clea ring house Renewals User Guide.pdf July 2018 E-12 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Required Forms Required Provider Procedures: DOEA is a participant of the Privacy Policy Form, OIG LEIS, and NNAR website lists, Privacy Policy: The privacy policy requires an acknowledgment that the Candidate/Employee has received a copy of the privacy policies from the Florida Department of Law Enforcement and the Federal Bureau of Investigation, which describes the exchange of information where criminal record results will become part of the Care Provider Background Screening Clearinghouse. The Candidate/Employee must indicate understanding and agreement that they have read and complied with guidelines contained in the privacy policies prior to the Level 2 screening being initiated. Check Department of Health and Human Services Office of Inspector General (OIG) List: Search Medicare/Medicaid Exclusions Individuals who do not have a prior screening must be manually checked in the OIG List of Excluded Individuals and Entities (LEIE), upon initial screening. Once an individual has a record in the Clearinghouse system, an automated review of the OIG LEIE will occur when the list is updated every 30 days. To employ or contract with any individual participating within any DOEA Program all service providers, subcontractors, and vendors are required to complete an online search of the OIG LEIE and a Level 2 Criminal History Screening. The OIG LEIE website lists individuals and entities excluded from federally -funded health care programs pursuant to sections 1128 and 1156 of the Social Security Act. There is no fee associated with conducting a search on the OIG LEIE website. When you select the "OIG Search" button, you will be redirected to the OIG's website. Follow the instructions to search for the individual and complete the OIG LEIE search. Close the OIG website and return to the Clearinghouse OIG Search page. Check the affirmation box to confirm the search was conducted and select "Initiate Screening" to continue or "Cancel" if you do not wish to proceed with the screening. July 2018 E-13 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Clearinghouse Results Applicant Profile Note: Health care providers that receive federal funding and employ an individual on the LEIS may be subject to civil monetary penalties (CMP). Individuals on the Exclusion List are not eligible for employment with providers of Medicare and/or Medicaid services. National Nurse Aide Registry (NNAR) Search The NNAR is a web service that allows providers to check multiple state Nurse Aide Registries at once. These are auto -match results based on personal identification information provided by the candidate of states that participated in the NNAR. The states currently participating in the NNAR are Florida, Georgia, New Mexico, Ohio, Oregon, Utah, Washington D.C., and West Virginia. When you initiate a new screening, resubmission or agency review, a NNAR search will be performed and display as a separate step in the initiation process. If a match of the applicant is found on a participating state's registry, to confirm the results, use the provided hyperlink on the registry research page to perform a manual search of the registry. The registry check and its results are provided for informational purposes only and have no bearing on Agency eligibility determinations. Select Initiate Screening to continue. Required Forms All approved DOEA-Aging Network Employee/Volunteers and all approved SHINE Volunteers are required to sign the "Affidavit of Compliance Employee Form, Effective April 2016," and attach the "Eligibility Statement." These documents remain within the personnel records; however, for SHINE Volunteers, a copy of the "Eligibility Statement" is required to be sent to the DOEA SHINE Contract Manager. Email transmission of the Required Forms must be encrypted. The following forms are a requirement for monitoring purposes: • Signed and dated Privacy Policy; o If a candidate already has a signed Privacy Policy on file, they do NOT have to resign the updated Privacy Policy. July 2018 E-14 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Clearinghouse Results Applicant Profile O "Eligibility Statement' with proof of Employment History from DOEA; o This is not a screenshot of the Profile Page. Each Provider must scroll down to the bottom of the Profile Page, and select the "View/Print Version Tab." This will give you the "Eligibility Statement' with Provider instructions and the Specified Agency statute for Background Screening. • Signed and dated Affidavit of Compliance Employee Form, Effective April 2016. o The Candidate should not sign the DOEA Affidavit Compliance Employee Form prior to the receipt of the Eligibility Determination Notification. Note: The Affidavit of Compliance Employee Form, Effective April 2016 is included as Attachment 1. July 2018 E-15 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Employee/Contractor Roster Employee/Contractor Roster The employment history records are vital to receiving necessary information from the Clearinghouse, or another Specified Agency, and receiving updates such as follows: • Subsequent arrest notifications; and Y Expiring retained fingerprint notifications; o The Florida Department of Law Enforcement removes all screenings that do not have an active link to a Provider in the Retention Data Base. Add Employment/Contractor Record Per Section 435.12(2) (c) F.S., an Employer of persons, subject to screening by a Specified Agency is required to register with the Clearinghouse and maintain the employment status of all Employees within the Clearinghouse. Initial employment status and any changes in employment status are required to be entered within 10 business d ays. Add employment history: A. Open the "Candidate Profile Page" and select "Add Employment/Contractor Record." B. Enter the required information and select "Save." This will bring you back to the "Candidate Profile Page." C. View the new employment record displayed in the "Employment/Contractor History" section. Edit Employment Record You may edit an Employee record from the "Employment/Contractor History" section on the "Applicant Profile Page," or from the "Employee/Contractor Roster Tab" as follows: A. Select the "Edit' link under the action column for the Candidate record you wish to update and enter the required information and select "Save." B. Enter an end date for the employment record by selecting the calendar icon in the "End Date" column. C. Enter the required information and select "Save." July 2018 E-16 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Computing Devices, Electronic Mail, and Physical Documentation Computing Devices, Electronic Mail, and Physical Documentation The purpose of this section is to outline the responsibilities associated with the safeguarding of Candidates/Employees. Personally Identifiable Information (PII) and Criminal Justice Information (CJI). These responsibilities are applicable to DOEA employees and DOEA —Aging Network Clearinghouse participants. Detailed guidance regarding the operational compliance of processing and maintaining PH and CJI can be found in the following documents: • Criminal Justice Information Services (CJIS) Security Policy — Version 5.6, Dated June 5, 2017 o Link: http://www.fdle.state.f1.us/NCJA-CSP-Compliance/Resources • Federal Information Processing Standards Publication 140-2, Security Requirements for Cryptographic Modules — Dated December 3, 2002 o Link: https://www.nist.gov/publications/security-requirements- crvptographic-modules-includes-change-notices-1232002 Computing Devices and Physical Documentation Computing devices used and the storing of physical documentation involved in the Candidate/Employee background screening/eligibility process shall at a minimum: 1) Adhere to CJIS Security Policy—Version 5.6, Dated June 5, 2017, Section 5.9.2 — Controlled Area. 2) Adhere to CJIS Security Policy — Version 5.6, Dated June 5, 2017, Section 5.10.1.2.1 — Encryption for CJI in Transit. 3) Adhere to Section 5.10.1.2.2 — Encryption for CJI at Rest. Electronic Mail All electronic mail messages containing PII, CJI, and information and/or document(s) related to the Candidate/Employee background screening/eligibility process shall be encrypted. Electronic mail encryption shall be utilized by both DOEA employees and DOEA—Aging Network Clearinghouse participants. Request Assistance Requests for assistance, clarification, or general questions regarding the responsibilities related to PH and CJI should be sent to the DOEA Background Screening Coordinator. July 2018 E-17 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Clearinghouse Concerns Concerns The Agency for Health Care Administration (ARCA) requires each agency to handle its unique Clearinghouse problems and concerns appropriately. All DOEA- Aging Network Clearinghouse concerns are to be addressed within an encrypted email: Notification to the Background Screening Coordinator— Valerie Brinkley (850) 414-2093 Email Address: doeanetwork(a.elderaffairs.org Subject Line: BGS Clearinghouse Concern Body of Email; State the exact problem and include a screenshot (if possible.) When inquiring about a Candidate/Employee, the following information is required: • Full Name • DOB July 2018 E-18 DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Appendix E: Background Screening Clearinghouse Instructions Resources Clearinghouse Informational Page: The additional resources listed below are located on the Clearinghouse informational page at the following Website: http://ahca.myflorida.com/MCHQ/Central Services/Background Screening/CH Instructi on Guides.shtml. User Registration Training: o User Registration Training Video o User Registration Guide Clearinahouse Results Trainina Videos: 7=R6iiC7, . aiCrIFI:T? o User Registration Guide o Search and Profile Page Clearinghouse Results Website Guide: o Department of Elder Affairs FORMS: o Adding Employment o Initiating an Agency Review o Initiating a Resubmission o Additional Information: (last bullet on left) Regulations and Forms: 1. Clearinghouse Applicant Request Form 2. Privacy Policy July 2018 E-19 Attachment 1 Affidavit of Compliance —Employee D, „ t ELDER AFFAIRS 11 VTr OP rl aRMA Affidavit of Compliance - Employee AUTHORITY: This form is required of all employees who are direct service providers when claiming an exception to Level 2 background screening set forth in sections 430.0402(2) and (3), Florida Statutes, or to comply with the attestation requirements set forth in section 435.05(2), Florida Statutes. This form may be used by all employees to comply with: • The attestation requirement of section 435.05(2), Florida Statutes, which states that 'every employee required to undergo Level 2 background screening must attest, subject to penalty of perjury, to meeting the requirements for qualifying for employment pursuant to this chapter and agreeing to inform the employer immediately if arrested for any of the disqualifying offenses while employed by the employer;" AND The proof of screening within the previous 5 years in section 408.809(2), Florida Statutes, which requires proof of compliance with Level 2 screening standards that have been screened through the Care Provider Background Screening Clearinghouse created under section 435.12, Florida Statutes, or screened within the previous 5 years by the Agency, Department of Health, Department of Elder Affairs, the Agency for Persons with Disabilities, Department of Children and Families, or the Department of Financial Services for an applicant for a certificate of authority to operate a continuing Care retirement community under Chapter 051, Florida Statutes, if that agency is not currently implemented in the Care Provider Background Screening Clearinghouse. This form must be maintained in the employee's personnel file, if this form is used as proof of screening for an administrator or chief financial officer to satisfy the requirements of an application for a health care provider license, please attach a copy at the screening results and submit the licensure application. The term °employee" as used herein refers collectively to all persons required by law to undergo background screening. This includes, but is not limited to, persons who are determined to be a direct service provider. A direct service provider is a person at least 18 years of age who, pursuant to a program to provide services to the elderly, has direct face -to -fate contact with a dient while providing services and has access to the client's living areas, funds, personal property, or personal identification information asdefined in F.S. 817.568, Florida Statutes. A direct service provider also includes coordinators, managers, and supervisors of residential facilities and volunteers. DOEA Farm 236,Affidavitof Compliance-Emplmree, EaediVe Apnl 2016 Section 435A5(2), F.S. Page 3of7 Forma Rable at: hapJ/eldestfairs.state.n.us/ena3ishlfrackerout3dsaeea"vn¢.php July 2018 E-20 Attachment 1 Affidavit of Compliance — Employee Personal identification information defined in F.S. &17.568(iJtfJ, F.S. means "any name or number that may be used, alone or in conjunction with any other information, to identify a specific individual, including any: 1. Name, postal or electronic mail address,telephone number, social security number, date of birth, mother's maiden name,official state -issued or United States -issued drivel's license or identification number, alien registration number, government passport number, employer or taxpayer identification number, Medicaid orfood assistance account number, bank account number, credit or debit card number, or personal identification number or code assigned to the holder of a debit card by the issuer to permit authorized electronic use of such card; 2. Unique blometric data, such as fingerprint, voiceprint, retina or iris image, or other unique physical representation; 3. Unique electronic identification number, address, or routing code; 4. Medical records; 5. Telecommunication Identifying information or access device; or 6. Other number or information that can be used to access a person's financial resources." EMPLOYER: IF AN EMPLOYEE IS DETERMINED TO BEA DIRECT SERVICE PROVIDER, THIS COMPLETED FORM MUST BE RETAINED IN THE EMPLOYEE'S FILE. IF AN EXCEPTION TO BACKGROUND SCREENING IS CLAIMED, A COPY OFTHE REQUIRED EVIDENCE MUST BE ATTACHED TO THIS FORM. STEP ONE: Complete identification information. Employee Name Employer Position Applied For July 2018 E-21 Attachment 1 Affidavit of Compliance — Employee STEP TWO: The employee must review the following list of disqualifying offenses set forth in Chapters 430 and 435, Florida statutes. You must attest to meeting the requirements for employment and you may not have been arrested for and awaiting final disposition of, have been found guilty of, regardless of adjudication, or have entered a plea of nolo contendere (no contest) or guilty to, or have been adjudicated delinquent and the record has not been sealed or expunged for, any offense prohibited under any of the following provisions of state law or similar law of another jurisdiction: Criminal offenses listed in section 435.04. F.S. (a) Section 393135, relating to sexual misconduct with certain developmentally disabled clients and repotting of such sexual misconduct. (b) Section 394.4593, relating to sexual misconduct with certain mental health patients and reporting of such sexual misconduct. (c) Section 415.111, relating to adult abuse, neglect, or exploitation of aged persons or disabled adults. (d) Section 782.04, relating to murder. (e) Section 782.07, relating to manslaughter, t aggravated manslaughter of an elderly person or disabled adult, or aggravated manslaughter of a child. (f) Section 782.071, relating to vehicular homicide. (g) Section 782.09, relating to killing of an unborn quick child by injury to the mother. (h) Chapter 784, relating to assault, battery, and culpable negligence, if the offense was a felony. (I) Section 784.011, relating to assault, if the victim of the offense was a minor. Q) Section 784.03, relating to battery, if the victim of the offense was a minor. (k) Section 787.01, relating to kidnapping. 11) Section 787.02, relating to false imprisonment. (m) Section 787.025, relating to luring or enticing a child. (n) Section 787.04(2), relating to taking, enticing, or removing a child beyond the state limits with criminal intent pending custody proceedings. (o) Section 787.04(3), relating to carrying a child beyond the state lines with criminal intent to avoid producing a child at a custody hearing or delivering the child to the designated person. (p) Section 790.115(1), relating to exhibiting firearms or weapons within 1,000 feet of a school. (q) Section 790.115(2)(b), relating to possessing an electric weapon or device, destructive device, or other weapon on school property. (r) Section 794.011, relating to sexual battery. (s) Formers. 794.041, relating to prohibited acts of persons in familial or custodial authority. (t) Section 794.05, relating to unlawful sexual activity with certain minors. (u) Chapter 796, relating to prostitution. (v) Section 798.02, relating to lewd and lascivious behavior. (w) Chapter 800, relating to lewdness and indecent exposure. (x) Section 806.01, relating to arson. (y) Section 810.02, relating to burglary. (x) Section 810.14, relating to voyeurism, if the offense is a felony. (aa) Section 810.145, relating to video voyeurism, if the offense is a felony. (bb) Chapter 812, relating to theft, robbery, and related crimes, if the offense is a felony. (cc) Section 817.563, relating to fraudulent sale of controlled substances, only if the offense was a felony. (do) Section 825.102, relating to abuse, aggravated abuse, or neglect of an elderly person or disabled adult. July 2018 E-22 tee) Section 825.1025, relating to lewd or lascivious. offenses committed upon or in the presence of an elderly person or disabled adult. (ff) Section 825.103, relating to exploitation of an elderly person or disabled adult, if the offense was a felony. (gg) Section 826.04, relating to incest. (hh) Section 827.03, relating to child abuse, aggravated child abuse, or neglect of a, child. (ii) Section 827.04, relating to contributing to the delinquency or dependency of a child. (jj) Former s. 827.05, relating to negligent treatment of children. (kk) Section 827.071, relating to sexual performance by a child. (II) Section 843.01, relating to resisting arrest with violence. (mm) Section 843.025, relating to depriving a law enforcement, correctional, or correctional probation officer means of protection or communication. (nn) Section 843.12, relating to aiding in an escape. (oo) Section 843.13, relating to aiding in the escape of juvenile inmates in correctional institutions. (pp) Chapter 847, relating to obscene literature. (qq) Section 874.05(1), relating to encouraging or recruiting another to join a criminal gang. (rr) Chapter 893, relating to drug abuse prevention and control to include the use, possession, sale, or manufacturing of illegal drugs, only if the offense was a felony or if any other person involved in the offense was a minor. (ss) Section 916.1075, relating to sexual misconduct with certain forensic clients and reporting of such sexual misconduct. (tt) Section 944.35(3), relating to inflicting cruet or inhuman treatment on an inmate resulting in great bodily harm. (uu) Section 944.40, relating to escape. (vv) Section 944A6, relating to harboring, concealing, or aiding an escaped prisoner. Attachment 1 Affidavit of Compliance — Employee (ww) Section 944.47, relating to Introduction of contraband into a correctional facility. (xx) Section 985.701, relating to sexual misconduct in juvenile justice programs. (yy) Section 985.711, relating to contraband introduced into detention facilities. (ZZ) Section 741.28 relating to domestic violence. Criminal offenses found in section 430,0402. F.S. (a) Section 409.920, relating to Medicaid provider fraud. (b) Section 409.9201, relating to Medicaid fraud. (c) Section) 741.28, relating to domestic violence. (d) Section 817.034, relating to fraudulent acts through mail, wire, radio, electromagnetic, photoelectronic, or photooptical systems. (e) Section 817.234, relating to false and fraudulent insurance claims. (f) Section 817.505, relating to patient brokering. (g) Section 817.568, relating to criminal use of personal identification information. (h) Section 817.60, relating to obtaining a credit card through fraudulent means. (i) Section 817.61, relating to fraudulent use of credit cards, if the offense was a felony. (j) Section 831.01, relating to forgery. (k) Section 831.02, relating to uttering forged Instruments. (I) Section 831.07, relating to forging bank bills, checks, drafts, or promissory notes. (m) Section 831.09, relating to uttering forged bank bills, checks, drafts, or promissory notes. Criminal offenses found in other sections. (n) Section 775.21, sexual predator. (o) Section 775.261, Career offender. (p) Section 943.0435, Sexual offender; unless the requirement to register as a sexual offender has been removed pursuantto section 943.04354. July 2018 E-23 Attachment 1 Affidavit of Compliance — Employee ❑ I have been granted an Exemption from Disqualification through the Agency for Healthcare Administration (AHCA) Date of Decision: ❑ I have been granted an Exemption from Disqualification through the Florida Department of Health. Date of Decision: ** A copy of tate Exemption from Disqualification decision letter must be attached** If you are also using this form to provide evidence of prior Level 2 screening (fingerprinting) in the last S years and have not been unemployed for more than 90 days, please provide the following information. A copy of the prior screening results mast be attached. Purpose of Prior Screening: Screening Conducted by: ❑ Agency for Healthcare Administration ❑ Department of Health ❑ Agency for Persons with Disabilities Date of Prior Screening: ❑ Department of Elder Affairs M Department of Financial Services ❑ Department of Children and Family Services July 2018 E-24 Attachment 1 Affidavit of Compliance — Employee STEP THREE: The employee must complete this section if claiming an exception to level 2 background screening conducted by the Department of Elder Affairs. if not claiming an exception, then skip to Step Four. if you are claiming that you qualify for an exception to level 2 background screening pursuant to sections 430.0402(2) or (3), Florida Statutes, and thereby, you are not required to undergo background screening through the Department of Elder Affairs, please indicate the type of exception and attach the required evidence. EXCEPTION: ❑ Attorney - An attorney in good standing with the Florida Bar if you are providing a service within _ (initials) the scope of your licensed practice. Evidence: A copy of the screen shot of your membership in good standing with the Florida Bar. ❑ Relative- A relative of the client. _ (initials) Evidence: Circle your relationship to the client: husband, wife, father, mother, son, daughter, brother, sister, grandmother, grandfather, great-grandmother, great- grandfather, grandson, granddaughter, uncle, aunt, first cousin, nephew, niece, father- in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half brother, or half sister. ❑ Volunteer- A volunteer who assists for less than 20 hours per month and you are not listed on the (initials) FDLE Career Offender Search database or the Dru S)odin National Sex Offender Public Website. Evidence: A copy of your search results screen shot from each criminal database showing no records were found. EMPLOYER: IT IS THE EMPLOYER'S RESPONSIBILTY TO VERIFY THE AUTHENTICITY AND ACCURACY OF ANY DOCUMENTATION REQUIRED AS EVIDENCE OF AN EMPLOYEE'S QUALIFICATION FOR AN EXCEPTION, July 2018 E-25 Attachment 1 Affidavit of Compliance — Employee STEP FOUR: Each employee determined to be a direct service provider must complete the required attestation below. Claiming an Exception: If you are claiming that you qualify for an exception to level 2 background screening, you are not required to undergo background screening through the Department, and you must sign the attestation below. Not Claiming an Exception: If you are not claiming one of the exceptions to level 2 background screening listed in Step Three, you must complete level 2 background screening through the Department. Once you have been determined qualified for service by the Department, you must sign the attestation below. Under penalty of perjury, I that I meet the requirements for ATTESTATION qualifying for employment pursuant to the standards set forth in Chapter 435 and section 430.0402, Florida Statutes. hereby swear or affirm background screening '.n addition, I agree to immediately inform my employer if arrested or convicted of any of the disqualifying offenses while employed by my employer. Employee Signature Date EMPLOYER: ONCE THE ATTESTATION IS SIGNED, KEEP THIS COMPLETED FORM IN THE EMPLOYEE'S FILE. July 2018 E-26 COLT 0.014- ty Public Services Division Community & Human Services Nutrition Education Plan January - December 2019 January: Eat Right with Less Salt February: Make Better Beverage Choices March: 6 Ways to Eat Well as You Get Older April: Cooking Safely in the Microwave Oven May: Eat Right and reduce Food Waste June: Eat Right When Money's Tight July: Preparing for a Disaster: Strategies for Older Adults August: A Quick Guide to Reading the Nutrition Facts Label September: Healthy Living: Reliable Websites October: Food Safety: Ready -to -Eat Foods November: My Plate, My Wins: Make It You December: Make Healthier Holiday Choices Coe+r County Public Services Division Community & Human Services Nutrition Education Plan January -June 2018 January: Fall Proofing Your Home February: Healthy Eating: Storage Guide March: Healthy Eating: Are You at Risk for Drug Interactions? April: Good Sleep Hygiene Handout May: Disaster Planning Tips for Older Adults June: Make Better Beverage Choices July: Drinking Enough Fluids August: Exercise and Osteoporosis September: Nutrition Facts: Reading the Label October: Shopping for Food That's Good for You November: Healthy Living: Reliable Websites December: Food Safety: Five Steps to Food Safety Outline of Food Safety Training (for all new Nutrition Staff) I. Foodborne Pathogens II. Basics for handling Food Safely (temperatures) III. Proper handwashing IV. Proper glove use V. Proper work attire VI. Proper way to wear hairnet VII. Food & chemical storage (FIFO method) VIII. Sanitizing IX. Thermometer calibration guide Avoid Poodbortre Tlltiess MagumWAM ® Young older adults F' ah t BAO 1 imen,mune and persons with weakened immune systems are persons with weakened at a higher risk fur-foodborrne Illness. Immune systems may be weakened by medical treatments, The VS food supply is among the safest in the World, such as steroids or chemotherapy, or by but organisms that you cant see, smell, or taste— conditions, such as AIDS, cancer or diabetes, You are also at Increased risk If if you suffer from liver bacteria, viruses and tiny parasites—are everywhere disease or alcoholism or if you have decreased in the environment. These microorganisms—called stomach acidity (due to gastric surgery or the chronic use of antacids). pathogens ---can invadc food and cause illness, sometimcs severe and even life-threatening illness, especially in young children, older adults, and persons, if you face a higher risk of f6odborne Illness you with weakened immune systems, In pregnant women, are advised not to eat: . Rawflsh or shellfish, Including oysters, foodborne illness can endanger their unborn babies, clams, mussels and scallops . Raw or unpasteurized milk or soft cheeses . • unless they are labeled "made with pasteurized The most common symptoms of foodborne illness milk" are diarrhea, abdominal cramps, vomiting, head -or - Refrigerated paths or meat spreads (canned or shelf stable paths and meat spreads,may be . muscle -aches, and fever, Symptoms usually appear 12 eaten) to 72 hours after eating contaminated -food but may • Raw or lightly cooked eggs or foods containing raw or lightly cooked eggs, Including certain occur between 30 minutes and 4 weeks later, Most salad dressings, cookie and cake batters, sauces people recover within 4 to 7 days without needing and beverages such as unpasteurized egg ring (foods made from commercially pasteurized eggs antibiotic treatment. are safe to eat) r Refrigerated smoked Sanford unless in a ' Ifsymptoms are severe or the Ill person Is very young, cooked dish such as a casserole Raw or undercooked meat or poultry very old, pregnant, or already III, call your doctor Raw sprouts (alfalfa, clover and radish) immediately, unpasteurized or untreated fruit Juices or vegetable Juices (these Juices will terry a ' warning label) Everyone should fallow. >`� . these %ur'sitnple steps �pl.Sr ye' �Q p Js Important: Some foodsthatare bought pre. cooked should be reheated because they can become contaminated with pathogens after they have been processed and packaged, These foods Include: hot dogs, luncheon meats (cold cuts), to `Food safety o � �ooq fermented and dry sausage and other dell -style moat and poultry products, SPF 1. Clean: Washhands and surfaces often. Bacteria, viruses, and parasites can be spread throughout dm kitchen and get onto cutting boards, u utensils, and canteru ps, Here's how to FightBAC10i • Wash your hands with hot, soapy water before and -after handling Food and after using the bathroom, changing diapers, and handling pets. • Wash your cutting boards, dishes, utensils, and countertops with hot, soapy water after preparing each food Item and before you go on to the next food, • Important Rinse raw produce in water. Dodc use soap or detergents, If necessary, use a small vegetable brush to remove surface dirt. 2, Separate: Dont Cross -Contaminate, Ctoss-contaminadoh is the word for how bacteria, viruses, and parasites an ba sprrad from one rand product to another. This is especially true when handling raw meat, poultry, seafood, and eggs, to keep these foods and theirjuices away from ready -to -eat foods, Here4 how to Fight DACIO: • Separate raw meat, poultry, and seafmcl from other foods In your grocery shopping cart and in your refilgomtuc ' • if possible, use a different cutting board for'mw, meat, poultry and seafood products, • Always wash hand s, cutting boards,dishes, and utensils with hot, soapywater after they come In contact with raw meat, poultry, seafood, and eggs, • Use separate places for cooked food and raw, foods, 3. Cook: Cook to proper temperatures, Food safety experts agree that foa3s are properly cooled when they are heated for a long enough rime and at a high enough comperaturo to (till the harmful pathogens that cause foodborne Illness. The best way eo Pight BACIm Is to; • Use a clean thermometer that measures the internal temperature of cooked food to make sure meat, poultry, and casseroles are cooked ca the temperatures in the chart at right, • Cook eggs until the yolk and white are firm, Ifyou use roc(pes in which eggs remain raw or only partially cooked, use pasteurized eggs, • Fish should be opaque and flake eaeilywkh a fork, • When cooking in a microwave oven, make sure there ata no cold spots where pathogens can survive. For best results, cover food, stir, and rotate for oven cooking. If there Is no turntable, tmatc the dish by hand once or twice during cooking, • Bring sauces, soups, and gravy to a boll when reheating, 4. Chill: Refrigerate pro.t>.aptly, Refrigerate foods quickly because cold temperatures keep harmful pathogens from growing and multiplying. So, get your refrigerator no higher than 40°P and the freezer at 0"F Chepk•these,temparature; occadonallywith an appliance thermometer, Then, Fight BACP by following these steps; • Refrigerate or freeze perishables, prepared foods, and Ichovcrs within two hours or sooner. • Never defrost food at room temperature. Thaw food In the refrigerator, under cold running water, or In the microwave• • Marinate foods IAA6 refrigerator, • Divide large amounts of leftovais Into shallow containers for quick cooling in the rcfrigcrame • Don't pack the refrigerator, Cool air must circulate to keep food safe. Learn more about Fight BAC°D at: www,6ghr1bac,tmg Internal tempOatum Ground Meat & Meat Mixtures Beef, Pork, Veal, Lamb _ 160•F Turkey, Chicken 165•P Fresh Beef, Veal, Lamb Medium Rare _ 14511' Medium �160111 Well Done 170•P Poultry Chickon&Turkay, whole 180°F Poultry breasts, roast 1707 Poultry ihlghs,wings 180.11 Duck & Goose 180•I, Stuffing (cooked alone or In bird)_ 1654F Fresh Pork _ Modlu_m 160.11 _ Well Done17014 Nam Fresh (raw) 1s0°F Pre-cooked (to reheat) 140.11 . Eggs & Egg Dishes Eggs Cook until yolk & white ore firm _Fog dishes 1601F Seafood _ Fin Fish 145•F orflesh Is opaque & - separates easily with for Shrimp, Lobster _Shells red &flesh & Crabs poorly & opaque Clams, oysters & Mussels Shells are open Leftovers&[osmoles 165.11 For more information: US Department ofAgrlculture, Nicer and Poultry Hodinei 1.888-MPHOTLINA TTY; Goo 256-7076 US Food and Drug Administration, Food Information Hollins 1488SAFEVOOD wwwJoodrafetygov Least Wanted Foodborne Pathogens The U,S, Public Health Service has identified the following microorganisms as being the biggest culprits of foodborne illness, either because of the severity of the sickness or the number of cases of illness they oausc, Beware of those pathogens: Fight BACIO ht. ARN WHERE THEY ARE AND HOW TO AVOID THEM Campylobacter- Second most common bacterial cause of diarrhea in the United States; Sources: raw and undercooked poultry and other meat, raw milk and untreated water. NAKINM Clostridlum botulinum- This organism produces a toxin which causes botulism, a life-threatening illness that can prevent the breathing muscles from moving air in and out of the lungs. Sources: improperly prepared home -capped foods; honey should not be fed to ohildron less than 12 months old, E. colt 0157:117- A baoterium that can produoe a deadly toxin and causes approximately 73,000 cases of foodborne illness each year in the U.S. Sources: beef, especially undercooked or raw Hamburger; produce; raw milk; and unpasteurized juices and ciders, Llsterla monocytogenes- Causes listerlosis, a serious disease for pregnant women, newborns and adults with a weakened immune system. Sources: unpasteurized dairy producta, including soft cheeses; sliced -deli meats; smoked fish; hot dogs; pate; and doli-prepared salads (i.e. egg, ham, seafood, and chicken salads), Norovirus- The leading viral cause of diarrhea in the United States, Poor hygiene causes Norovirus to be easily passed 8tom person to person and from infected individuals to food items, Sources: Any food contaminated by someone who is infected with this virus, Salmonella- Most common bacterial oauso of diarrhea in the United States, and the most common cause of foodborne deaths, Responsible for 1.4 million cases of foodborne illness a year, Sources: *raw and undercooked eggs, undercooked poultry and moat, fresh fruits and vegetables, and unpasteurized dairy products, t. Staphylococous aureus- This bacterium produces a toxin that causes vomiting shortly after being ingested; Sources: 000ked foods high in protein (e.g. cooked ham, salads, bakery products, dairy products) that are hold too long at room temperature, ' Shigella- Causes an estimated 448,000 cases* of diarrhea illnesses per year. Poor hygiene causes Shigella to be easily passed from person to person and ftom infected individuals to food items. Sources: salads, unclean water, and any food handledby someone who is infected with. the bacterium, Toxoplasma gondii- A parasite that causes toxoplasmosis, a very sovere disease that can produce central nervous system disorders particularly mental retardation and visual impairment in children. Pregnant women and people with weakened immune systems are at higher risk; Sourocs; raw or undercooked pork, �1 Vibrio vulnificus- Causes gastroenteritis, wound infection, and severe bloodstream infections. People with liver diseases are especially at high risk, Sources: raw or undercooked seafood, particularly shellfish. "Tan Least Wanted Pathogens" information provided by the Centers for Disease Control. For more information visit www.cdo,aov. The Partnership for Food Safety Hduoation www,fightbao.oru Basics for Handling Food Safely Safe steps In food handling, cooking, and storage are essential to prevent foodborne Illness, You can't see, smell, or taste harmful bacteria that may cause Illness. In every step of food preparation, follow the four right BACIO guidelines to keep food safe: Clean - Wash hands and surfaces often. Separate - Don't cross -contaminate. Cook = Cook to proper tomperatures. Chill - Refrigerate promptly. shopping Purchase refrigerated or frozen Items after selecting your non -perishables. Never choose meat or poultry In packaging that Is torn or leaking, Do not buy food past "Sell -By," "Use -By,' or other expiration dates. storage Always refrigerate perishable food within 2 hours (1 hour when the temperature Is above 90 °F). Check the temperature of your refrigerator and freezer with an appliance thermometer. The refrigerator should be at 40 OF or below and the freezer at 0 OF or below. Cook or freeze fresh poultry, fish, ground meats, and variety meats within 2 days; other beef, veal, Iamb, or pork, within 3 to 5 days, Perishable food such as meat and poultry should be wrapped securely to maintain quality and to prevent meat juices from getting onto other food, To maintain quality when freezing meat and poultry In Its original package, wrap the package again with foil or plastic wrap that is recommended for the freezer. In general, high -acid canned food such as tomatoes, grapefruit, and pineapple can be stored on the shelf for 12 to 18 months. Low - acid canned road such as meat, poultry, fish, and most vegetables will keep 2 to 5 years - If the can remains in good condition and has been stored In a cool, clean, and dry place. Discard cans that are dented, leaking, bulging, or rusted, Preparation Always wash hands with warm water and soap for 20 seconds before and after handling food, Don't cross -contaminate. Keep raw meat, poultry, fish, and their juices away from other food, After cutting raw meats, wash cutting board, utensils, and countertops with hot, soapy water. Cutting boards, utensils, and countertops can be sanitized by using a solution of 1 tablespoon unscented, liquid chlorine bleach In 1 gallon of water. Marinate meat and poultry In a covered dish In the refrigerator. Thawing Refrigerator; The refrigerator allows slow, safe thawing. Make sure thawing meat and poultry juices do not drip onto other food, Cold water: For faster thawing, place food In a leak -proof plastic bag. Submerge In cold tap water, Change the water every 30 minutes, Cook Immediately after thawing. Microwave; Cook meat and poultry Immediately after microwave thawing. Cooking Beef, veal, and Iamb steaks, roasts, and chops may be cooked to 145 OF, All cuts of pork, 160 OF, Ground beef, veal and Iamb to 160 OF, All poultry should reach a safe minimum Internal temperature of 165 OF. Serving Hot food should be held at 140 OF or warmer. Cold food should be held at 40 OF or colder. When serving food at a buffet, keep food hot with chafing dishes, slow cookers, and warming trays, Keep food cold by nesting dishes In bowls of Ice or use small serving Place food Into shallow containers and trays and replace them often. Immediately put In the refrigerator or freezer for Perishable food should not be left out more rapid cooling. than 2 hours at room temperature (I hour Use cooked leftovers within 4 days, when the temperature Is above 90 °F). Leftovers Discard any food left out at room temperature for more than 2 hours (I the temperature was above 90 °F), Refreezing Meat and poultry defrosted In the refrigerator may be refrozen before or after cooking. If thawed by other hour if methods, cook before refreezing, COLD STORAGE CHART These short, but safe, time limits will help keep refrigerated food from spelling or becoming dangerous to eat. Because freezing keeps food safe Indefinitely, recommended storage times are for quality only. Product Refrigerator Freezer (40 OF) (0 °F) EGGS Fresh, In shell 3 to 5 Do not weeks freeze Raw yolks & whites 2 to 4 days I year Hard cooked I week Does not BACON & SAUSAGE Bacon freeze I month Sausage, raw — from well LIQUID PASTEURIZED EGGS, EGG SUBSTITUTES opened 3 days Does not pork, beef freeze w ^~•Y _ .r well _ Y . unopened 10 days I year MAYONNAISE, COMMERCIAL Refrigerate after2 months Do not opening months freeze FROZEN DINNERS & ENTREES Keep frozen until '— 3 to 4 ready to heat 3 weeks months DELI & VACUUM-PACKED PRODUCTS Store -prepared (or months Does not homemade) egg, 3 to B days freeze chicken, ham, tuna, months well & macaroni salads 5 to 7 days Drained, HOT DOGS & LUNCHEON MEATS ^ Hot Vis,_.._ _ opened package 1 week Ito 2 labeled "Keep Refrigerated" months y unopened package J 2 weeks 1 to 2 months months Product Refrigerator Freezer (40 °F) (0 °F) Luncheon meat opened package 3 to 5 1 to 2 days months unopened package 2 weeks~ Ito 2 rr months BACON & SAUSAGE Bacon 7 days I month Sausage, raw — from I to 2 days I toV2 chicken, turkey, months pork, beef Smoked breakfast 7 days i to 2 links, patties months Hard sausage�- 2.to 3 1 to 2 pepperoni, jerky wealca months sticks SUMMER SAUSAGE labeled "Keep Refrigerated" opened 3 weeks 1 to 2 months Unopened 3 months 1 to 2 months CORNED BEEF Corned beef, in pouch 5 to 7 days Drained, with pickling juices 1 month HAM,CANNED labeled "Keep Refrigerated" Opened 3 to S days 1 to 2 months Unopened 6 to 9 Do not months freeze Product Refrigerator Freezer Chicken or turkey, (40 °F) (0 °F) HAM, FULLY COOKED Vacuum sealed at plant, 2 weeks Chicken or turkey, undated, unopened _ pieces _ - vacuum sealed at plant, "Use -By" 1 to 2 dated, unopened date on months Package vJ7 COOKED MEAT AND POULTRY LEFTOVERS --�----Whole days' 2 to 3 Half 3 to s days months Slices 3 to 4 days 2 to 3� HAMBURGER, GROUND & STEW MEAT Hamburger & stew meet 1 to 2 days 3 to 4 3 to 4 days 4 months — Ground turkey, veal, TCooked poultry 3 to 4 days pork, Iamb, & mixtures casseroles of them Poultry pieces, _ 3 to 4 days FRESH BEEF, VEAL, LAMB, PORK steaks 3 to 6 days 6 to 12 _ _ _Chops— ___.._ _ t_p_ontha_ broth or gravy S to 5 days 4 to 6 Chicken nuggets, 1 to 2 days months .....�.-_.'� Roasts...,_.'- 3ta•8days -466. OTHER COOKED LEFTOVERS Pizza, cooked 3 to 4 days I to 2 months '" ar e`i'a meats = tongue; �ry'"'"�'""`""' liver, heart, kidneys, I to 2 days 3 to 4 chitterlings `.: ET,(Englasl?:o.r. ' ;};; , ,.`,;.>•: ::ti:;•;£5;t;.i- ;j: months Pre -stuffed, uncooked pork chops, Iamb chops, I day Does not or chicken breasts freeze stuffed with dressing well soups & Stews ^— Vegetable or meat 3 to 4 days 2 to 3 added months Food Safety Questions? Product Refrigerator Freezer (40 °F) (0 °F) FRESH POULTRY Chicken or turkey, I to 2 days A your whole u Chicken or turkey, 1 to 2 days 9 pieces _ - months -_ Giblets- I to 2 days 3 to 4 months COOKED MEAT AND POULTRY LEFTOVERS Cooped meat & meat 3 to 4 days 2 to 3 casseroles months Gravy & meat broth 1 to 2 days 2 to 3� months — rv.. Fried chicken 3 to 4 days 4 months TCooked poultry 3 to 4 days 4 to 6 casseroles months Poultry pieces, _ 3 to 4 days 4 plain months Poultry places in 1 to 2 days 6 broth or gravy months Chicken nuggets, 1 to 2 days 1 to 3 patties months OTHER COOKED LEFTOVERS Pizza, cooked 3 to 4 days I to 2 .__......,_...._...._... ..,._n�.,_ months �N3 Stuffing, cooked to 4 days 1 month �.SiYi:•'.:r....,\s:.r: C,\;q'�i.'�c�a.e •ai:F'^= •�' iu` �'`i'; _ x::19'<r4'F:4:Lrj'�s;il `i:h�; �iiY�•,Li:S-x{ ^"¢ifip :, C.;' •.....,,;:lit?.'i..:, ah+..:�.:; i+?.......ri" ,., •.;`. ,:. .p ' l`.(:^.`..S an.yea•r round'SXS;IaUeiipattd;T.ponse;!;;' ;hrougi,Frlda,y •{ syStejpCC.ari proV:lde;f otj;;sa sty? ' :.. ,l,i l ,1:.:' .• :.uy. :.i5 i. a.,Tn,',to.:4:P,rti:' :'.•}•5: ;''Il7fPrrrtkibasz4%7:,:: '° -- - `.: ET,(Englasl?:o.r. ' ;};; , ,.`,;.>•: ::ti:;•;£5;t;.i- ;j: Ish);;Recoided v :::'i7`ti :'t`. �;t-.�`.; ...i.:, a j; h:'..^.,-;:w.(:::I '' r✓.�iy;'. .. •: ti;., Proper Handwashing Fact Sheet You should follow these five steps to wash your hands properly. The hand washing process should take approximately 20 seconds. Washing yourhands properly is one of the most Important things you can do to keep microorganisms from contaminating food. You should wash your hands before you start work and after the following activities; • Using the restroom • Handling raw meat, flsh, or poultry (before and after) Touching your hair, face, or body • sneezing, coughing, or using a tissue Smoking, eating, drinking, or chewing gum or tobacco • Handling chemicals that might affect the safety of the food • Taking out garbage • Clearing tables or bussing Ali dirty dishes . Touching clothing or aprons v Touching anything else that .6 me contaminate hands iP such as unsanitized equipment, work surfaces or wash 11", cloths os`` Q© SOAP yv nro 1 Wet your hands with running water as hot as you can comfortably stand (at least IOUT/38°C). L3] Apply soap, Vigorously scrub hands and arms for at least 10-15 seconds. Clean under fingernails and between fingers. 0 A^ "} ASL Dry hands and arms with a single - use paper towel or warm -air hand dryer. Use a paper towel to turn off the faucet; use a paper towel to open the door. Rinse thoroughly under running water. eeproduc@lo lot l4ftollonat use only by pormission of lho Nalbnal ftesleurentAssaciallon EAucelfunal l'oWd Von, Not la InGvldoalsale, 02000 Proper Glove Use Fact Sheet When using gloves, you should: Wash your hands before putting them on and when changing to a fresh pair. ake sure they fit properly. A glove that is too big will not stay on your hand, and one that is too small will rip or tear easily. Gloves can help keep food safe by creating a barrier between hands and food, But If they are not properly used, they can contaminate food Just as easily as dirty hands. Change them when necessary. You should change them at the following times: • As soon as they become soiled or torn • Before beginning a different task • At least every four hours during continual use • After handling raw iy meat, fish, or poultry and before handling cooked or ready -to -eat food Remove them properly. Grasp them at the cuff and peel them off Inside out over your fingers, Avoid touching your palm or fingers with the glove. Never wash and reuse them, Foodhandling gloves should only be used for one foodhandling task. Roproduclble fonlnsVucllonal use only by poronsslon of M National0estemanlAssalnilon Cducallonel fwndailon. Not (or anilvialval Bale, 02000 M ake sure they fit properly. A glove that is too big will not stay on your hand, and one that is too small will rip or tear easily. Gloves can help keep food safe by creating a barrier between hands and food, But If they are not properly used, they can contaminate food Just as easily as dirty hands. Change them when necessary. You should change them at the following times: • As soon as they become soiled or torn • Before beginning a different task • At least every four hours during continual use • After handling raw iy meat, fish, or poultry and before handling cooked or ready -to -eat food Remove them properly. Grasp them at the cuff and peel them off Inside out over your fingers, Avoid touching your palm or fingers with the glove. Never wash and reuse them, Foodhandling gloves should only be used for one foodhandling task. Roproduclble fonlnsVucllonal use only by poronsslon of M National0estemanlAssalnilon Cducallonel fwndailon. Not (or anilvialval Bale, 02000 PataonAll Behavlors That Can Con.taminato Food o� 0 Scratching the scalp ., Running fingers through hair Touching the nose . Rubbing an ear ' 0 Touching a pimple/sore ( Wearing a dirty uniform Q Coughing/sneezing into the hand Spitting Foodhandlers must remove!; ,Rings (exceptfora plain band) Bracelets (ihcluding medical ID's) Watches Earrings Necklaces Faclaljeweiry Foodhandlers: should; Weara clean hat or other hair restra Int. Wearciean clothing daily RenioVe aprons when leaving fooq= preparation areas RemoVe jewelry Wear clean;:closed;fae shoes. Page 1 of 1 v It Is Impossible to completely remove bacteria from your hair. Even after you've just washed It, your hair contains bacteria. Hairnets serve two purposes, The first Is to keep hair from contacting exposed food, clean and sanitized equipment, utensils and linens, or unwrapped single -service articles, The second purpose Is to keep worker's hands out of their hair. If you touch your hair with a gloved hand, you must change your gloves and wash your hands, Hairnets must be worn when food is delivered, being temped and/or being served. Hair nets are used to prevent hair from escaping from the scalp. Though they aren't usually the most stylish piece of flair to wear, they do look professional, And, of course, there's the fact that you are protecting others by remaining hygienic, Tnstructions 1. Hold the hair net in your hands, with the opening facing you, 2, Place your hands inside the hair net. Gently widen the opening by pulling your hands apart, 3, Wrop the hair net around the front of your head. Set it down on your forehead enough to cover the hairline in front, 4. Move your hands to pull the outside edges of the hair net, Slide your hands along the inside of the hair net until you get to the edges, 5. Pull the rest of the hair net over the back of your head. You can fit it over your ears or behind them, as long as your hairline Is hidden, 6. Check to make sure the hair net is wrapped around the outside of your hairline, It should fit snugly, 93 mm foodsafety"', First In, First Out (FIFO) Past -dated f6o4 will lose their quality and someti . mos become unsafe. FWO. ensures proper rotation; of foolu. M, When fa ds are roeeived, put the olde'gt. in the front and the newest in trig : back,. Identify padcagg date. , preparation date, or date .of purchase, I N Prevention; • Only use chemicals approved for use in foodservice operations • Purchase chemicals from approved, reputable suppliers • Store chemicals away from prep areas, food -storage areas, and service areas, a Chemicals must be separated from food and food -contact surfaces by spacing and partitioning Chemicals must NEVER be stored above food or food -contact surfaces • Use chemicals for their intended use and follow manufacturer's directions 2.35 i I smsefe Note: If you have long hair, put hair in a braid or ponytail for easier hair net application. • ALL hair must be covered, this Includes braids, ponytails and bangs, If you can't get all your hair in the net, you may need to wear hair combs or barrettes. If I can tell what color your hair is, then you are not wearing the hair net properly, • Flip your head upside down. Make sure all of your hair is down and not in its normal position. • Take the hairnet and spread it apart. Start at the tips of your hair and work your way to your head, • When you get to your head make sure all your hair is in the hairnet and also tuck in any fly aways. Cold temperatures keep most harmful Haeter[a ficin multiplying, so be store' to refrigerate or freeze foods quickly and follow these tipal m6'11 6 40 °Fahrenheit, That"s Rightl �j Make suee the temperature in your home refrigerator is 40 IF or below and 0 OF or below in the freezer, Check the temperature occasionally with a refrigerator/freezer thermometer., Avoid the Pack Attack Don't overpack the refrigerator, Cold air must circulate to help keep food safe. cool Rule Refrigerate or freeze perishables, prepared food, and leftovers within 2 hours of shopping or preparing. The time limit Is I hour If the .temperature Is 90 OF or higher, When traveling or before outdoor. events, keep frozen or perishable foods chilled in the freezer or refrigerator until you're ready to go. . Just the Facts, Ma'am Here are some common misconceptions about refrigeration and defrosting, along with Just the factsl Myt h.' It wilt harm my refrigerator or ruin other foods (fl put hotfood insure, so I should let food coot f trst Fach i It's not true, Hot food will not harm your refrigerator nor ruin other foods, In fact, prompt refrigeration of foods will keep your food and you safer. For quicker cooling, divide large quantities of food Into shallow containers before refrigerating. Myth: l can sgfely thaw food on my kitchen counter at room temperature. Fad: 'Remember, bacteria grow rapidly at room temperature, and you should avoid keeping foods In the Danger Zone — the unsafe temperatures between 40 IF and 140 IF, To keep food safe,always follow the Thaw Law: Never defrost food at room temperature, Thaw food In the refrigerator. You can also submerge food in cold water.in airtight Rh packaging or.thaw food in the e y�t%M microwave if you'll be cooking ll}' it immediately. 14e 'F . Danger zone 40I How to Use a Sanitizing Buclret & Lid When working in an environment that deals with food, it Is of the utmost Importance to adhere to proper sanitation techniques, Sanitizing kills harmful bacteria. Your most Important tool when it comes to this is the sanitizer bucket, Any item that comes in contact with foods and utensils should be sanitized. A bucket filled with sanitizer solutions should be kept near the food preparation area at all times, Proper guidelines should always be followed when using any type of chemical around food and food preparation surfaces. Instructions Things You'll Need: Clean Cloth • Red sanitizing bucket Chlorine or FDA approved sanitizer Test strips Filling the Bucket 1. Fill the bucket about halfway with extremely hot water. It is imperative that the mixture be accurate for effectiveness. Mix chlorine with the water, Use a paper test strip to check the balance. 2. Add a clean cloth to the mixture. Squeeze out excess before wiping surfaces down. 3. Change the water every couple of hours, Store the bucket near the food preparation area, but not on it, An ideal place might be under the work area. Empty it and put in storage with the lid when not in use, How to Sanitize Cooking Utensils With Bleach Simply scrubbing your cooking utensils In dish water does not remove the germs ---that only loosens and lifts the dirt, You have to kill the germs by sanitizing the tools as well. You can sanitize your utensils with basic household bleach. Bleach is a simple yet effective sanitizing agent that can be used In a wide variety of places In your home, particularly in the kitchen where germs tend to thrive, Instructions Things You'll Need; Bleach Dish scrubbing tool Dish detergent • Three compartment sink Clean the utensils first. Sanitizing an item is not truly effective unless all of the food Is removed from the surface first. So soak the utensils in a sink full of hot soapy water (dish detergent is fine). Use a scrub brush to thoroughly remove the particles, 2. Rinse utensils in sink filled with plain, clean water. 3. Drop the utensils into the bleach solution (check strength of solution before using) and allow them to sit for 30 seconds. Remove the utensils from the sink and allow them to dry, The bleach and water will evaporate from the surface. rlorida Departmentef State of Florida mus, eS ) Department of Business and Professional Regulation ®' Professi'f'1"a l Division of Hotels and Restaurants 3 Regulation www•MyFloridaLicense,comldbpr/hr/ THERMOMETER CALIBRATION GUIDE Using a food thermometer Is the only sure way of knowing your food is at the proper temperature — whether you are cooking, cooling, reheating or holding. Each type of food thermometer has Its own Individual characteristics. Choose the one that best fits the Intended use within your establishment, Digital Thermometers Digital thermometers are the best to use for most foods. They can measure food temperature quickly. Because temperature is measured at the tip of the thermometer's probe, digital thermometers can measure both thin and thick foods. Dial Probe Thermometers Checking for Accuracy Although commonly used, it Is harder to get a correct reading from a dial food thermometer because they take longer to measure the food temperature. The thermometer reading Is averaged from the point to the dimple along several inches of the probe. This means dial probe thermometers cannot be used to measure the temperature of thin foods, There are two ways to check the accuracy of a food thermometer. One method uses Ice water, the other uses boiling water. Many probe food thermometers have a calibration nut under the dial that can be adjusted, Some digital stemmed thermometers cannot be calibrated or must be returned to the manufacturer for calibration, Check food thermometers regularly to ensure that they are working properly Page 1 of 2 DRPR rarm HR 6000.062 wwwAyFloddaUcense,aom 2007 December 11 Calibrating Thermometers Thermometers should be calibrated using either the Ice -point or boiling -point method, The ice -point method Is typically used because the boiling -point method may be less reliable due to variations In altitude or atmospheric pressure, Fill a large glass with crushed Ice, Add Stir the mixture well, clean tap water until the glass Is full. Put the thermometer or probe stem Into Do not let the stem touch the the ice water so that the sensing area is bottom or sides of the glass, completely submerged. Walt 30 The thermometer stem or seconds. probe stem must remain in the Ice water. Hold the adjusting nut securely with a Press the reset button on a wrench or other tool and rotate the digital thermometer to adjust head of the thermometer until It reads the readout. 320F. Step Process Notes Bring clean tap water to a boll In a deep pan. Put the thermometer or probe stem Into the boiling water so that the sensing area is completely submerged. Wait 30 seconds. Hold the adjusting nut securely with a wrench or other tool and rotate the head of the thermometer until it reads 2120F. Using a Thermometer DBPR Form HR 6030-062 Do not let the stem touch the bottom or sides of the pan. The thermometer stem or probe stem must remain In the boiling water, Press the reset button on a digital thermometer to adjust the readout, When taking food temperatures, the probe should be placed Into the thickest portion of the food. This placement is ospeclally Important for a whole turkey or large roast, Use a digital thermometer when taking temperatures of thin food like hamburgers or chicken breasts. Page 2 of 2 www.MyFlorldaLlcense.com Ice -Point Method - 4— Nead rHex Adluntinp Nut A stem 0 oQ 0 a Q Ca R�r . Mlnllmum OF 2007 December 11 JANET CALDERWOOD, RDN CSG LD/N P.O. BOX 1934, RONITA SPRINGS, FLORIDA 34133 C: (239) 248-6191 1 IANETCALDEIMOODRDRb G41AIL.CONI 2016 Florida Media Dietitian of the Year KNOWLEDGE/SKILLS • Bilingual in Spanish Communication, organization, • Strong background in Federal/ and computer skills State/Local Food & Nutrition • Ability to organize multiple Guidelines and Regulations tasks, establish priorities, and • Experienced Public Speaker and meet deadlines Media Liaison • Ability to solve problems, • Awareness of politics and role of generate ideas, and think outside organizations in creatively influencing policy • Word, Excel, PowerPoint AFFILIATIONS/C FRTIFICATIONS/LICENSURE • Board Certified Specialist in Gerontological Nutrition • Member of The Academy of Nutrition and Dietetics • Member Florida Academy of Nutrition and Dietetics • Former Board Member SW Florida Dietetic Association • Former Team Leader—Juvenile Diabetes Research Foundation • Neighborhood Health Clinic Volunteer • ServSafe Certification • National Registry of Food Safety Professionals Course Administrator and Instructor • Certificate of Training in Adult Malnutrition (Abbott Nutrition Health Institute) • Certificate of Training in Adult Weight Management, Pediatric Weight Management (Commission on Dietetic Registration) • Dietetic Practice Group Memberships include: Clinical Nutrition Management, Diabetes Care and Education, Dietetics in Health Care and Communities, Healthy Aging, Medical Nutrition Practice Group EXPERIENCE: 10/2011 -Present Host, Writer, Executive Producer, and Sponsor, The Dietitian on a Mission Tice,Florida. Responsible for all aspects of the design, content development, distribution and production of weekly televised program. 10/2011 -Present President, Janet Calderwood, PA, Bonita Springs, FL. Oversee PACE program at multiple sites. Manage private home health settings. Responsibilities include: compliance review of the Department of Elder Affairs Nutrition Program in Southwest Florida, nutrition assessment, patient and staff education, inpatient setting and dietary (menu design) management, inservice training, attend and participate with Interdisciplinary Team (IDT) meetings, survey readiness and preparation, contract negotiator, prepare and edit policy and procedures, employee relations, design individual care plans and performance improvement projects, and organize events and present dietetic lectures to a variety of professional and public audiences. 10/2008-04/2011 Clinical Dietitian, Moorings Park, Ft Myers, FL. Provides individualized diet education for participants, develops care plans, collaborates with interdisciplinary team, completes nutrition inspections for congregate meal sites, completes individual care plan MDS (Minimum Data Set), develops policies and procedures for dietary services, performs food safety training for staff and volunteers, and coordinates foodservice operations. 08/2003-05/2006 Clinical Dietitian, Naples Community Hospital, Naples, FL. Provided medical nutrition therapy to patients. Communicated with health team members, departmental staff to coordinate patient care. Provided nutrition education to patients and caregivers. Involved in performance improvement. 11/1997-08/2000 Food and Beverage Manager, The Dunes Golf and Beach Club, Myrtle Beach, South Carolina. Responsible for hiring, training and scheduling wait staff, banquet staff, beverage cart and bartending personnel. Managed daily operations of dining room, banquet facilities and lounge. Established job descriptions, policies and procedures and member catering activities. Organized and managed special events including Senior PGA golf tournaments. 1989-1997 Dining Supervisor, JW Marriot, Century City, CA. Responsible for restaurant and special party dining. Managed customer reservations and supervised/scheduled dining room/ kitchen staff. EDUCATION 2003 Bachelor of Science, Dietetic and Nutrition, Winthrop University, Rock Hill, SC. 01/2003-06/2003 Dietetic Internship, Winthrop University, Rock Hill, South Carolina. NOTABLE: ACHIEVEMENTS 2016 Florida Media Dietician of the Year 2014 -Present Humanitarian trips to Guyana and Guatemala r� t* 4-t LAA !J FL DOH MQA Search Portal Department of Health JANET SEAN CALDERWOOD License Number: ND4440 Data As Of 6/14/2019 Profession License License Status License Expiration Date License Original Issue Date Address of Record Page 1 of 2 Dietitian/Nutritionist N D4440 CLEAR/ACTIVE 5/31/2021 03/15/2004 4766 26th Ave SE NAPLES,FL 34117 UNITED STATES Discipline on File No Public Complaint No The information on this page is a secure, primary source for license verification provided by the Florida Department of Health, Division of Medical Quality Assurance. This website is maintained by Division staff and is updated immediately upon a change to our licensing and enforcement database. https://appsmga.doh.state.fl.us/MQASearchServices/HealthcareProvidersILicenseVerificati... 6/14/2019 Registered I ,1 ^ Registered Commission Dietitian^ )' Dietitian On Dietetic Nutddomsl^ Registration CDR certifies that rt.e.umrnv+m�rwm. Janet S Calderwood a Academyo.f Nutrition fight. and Dietetics Ens successful!)) emnpplend reguiremeuls for dielefrie'�registration f 4/. 6.Cill Registered Dietitian' (RD-) 1 nature Registered Dietitian Nutritionist" (RDN') Registration I.D. Number 926084 ReglSlNllollPeVlllellLPedOdL !M4 l�,�iNt //+---µ4flDN,C50.CON 09/01/2014 - 08131/2019 Chair, Commission on Dietetic Registration CE Broker I Transcript License Transcript Name JANET SEAN CALDERWOOD l'ranscrlpt Name ND4440 Profession DletitianlNutritfonist Completion Date 05/31/2013 Days Remaining 0 Status Active/Clear Scenario ND, Standard Transcript Dales 06/01/2011 - 05/3112013 Printed Date 10-NOV-2014 Subject Area Medical Errors ff.DUCINGMEDICAL ERRORS ANDPRQMQTINt PATIFNT 0212512012 SAFETY General Nutrition and Wound I loallng The Gluten Free Boom 07/16/2011 Mal Every 11, rill Needs la.lno1 11/05/2011 LSinalon F. Depression 01 QI(lia Adulta 111felaCtIVO W6(4;sholl, 11/05/2011 Laboratmy Values pocurpenti ng Severe _& Non Seveje Munia hloq 07/02/2012 11le Roe ol;Nslt_rilm—OL, Itollrep-re Ouq_orttes 07/02/2012 Nurnidn Care Process 07/0212012 Inn I.c Ry Quit 07/02/2012 Mirillop 0,11he,1I1tq IIID-1BIJ�} te(�fJb�lyICP Yen GEI].I Judge a Food by its Pone None Falatq D1_sordu Fmorgirlrl 07/03/2012 Science on Spices and i P(bi, Prc¢sgle Uloels. Nututlon Interyen0ons a!1 Mole 0212812013 F rossl pe UIrU+I' plcyUll of ;?. r�,aallOq 04/25/2013 Qc tnfJlelN,10(trnll rlH la nom, Cnlianl la lgjjAemenll orrery 04/2512013 Nutrition Inlervalbons MUS_30 SulilRr(r 04/25/2013 Home Cme S}arnq 2012 04/2512013 1Mc Uonnld s.9pon Duo, lour 04/2912013 Cts! Ma a G nen/ Wm1ur 2012 OI1 My Achwq 5loraoch 04/30/2013 Tian r( rOrng 1'hie ProlesN n pr4o d on of lylodical Filo-S Fp)wC 04/13/2013 I r msiortlury. 1 ha I rolesslon PleVenllr!-Ii i 9.1 LI $ill Lrl Ilhl 04/13/2013 Page 1 of 2 Hours Hours Hours Required Posted Needed 2 M 2 2 (LIve) 31.5 2.5 (Live) 2 Nivel 2 Inve) (u.e) 1 awe/ 1.5 (Lw') 1 /reel 4.5 (Lwc) 1 (LW) 1 IAnYl�me) 1 Iryomel 2 IAnyhmc) 1 fAnYlLne) 2 uwe) 4 (AnY0ma1 7 (LiM 2 aiwt 0 0 httDS://www.cebroker.com/licensee/le transcript dtl.asox 11/10/2014 1 Q0 0 0o1 l0 0 00 . 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O n G uC4HO GW p]UUHO WU HH Id OP8 O 114 F7 1 O HN NV� 1 I F rp U1 H iC IBJ NO .0 .Ci Ol Q1 rG 0 N.c;o MH U wyy r�, U Wk4 wm 1 P m W NO F HNU Cq GO q I w EG7 Hp7> H ; i 1 i I Commission on Dietetic Registration eht. AcadentyofNutrition rig and Dietetics 120 South Riverside Plaza SulIP, 2000 Chicago, Illinois 606066995 312.899.0040 ext. 5500 www.cdmet.org October 2013 Dear Janet Calderwood: Congratulations on becoming a Board Certified Specialist in Gerontological Nutrition. Information regarding your specialty certification is below. Guidelines for Credential Placement: The recommended order of listed credentlals for Registered Dietitians (RD) is graduate academic degree, RD, specialty certifications with the Commission on Dietetic Registration (e.g. CSG, CSR, CSP, CSSD, CSR), licensure designation, other certifications (e.g. CDG, CNSC, etc), Fellow of the American Dietetic Association (FADA). Example: K. Bolek, MS, RD, CSR, LD, CPE, FADA. When referring to your CDR specialty Certification status in written text or verbally, the phrase to be used is Board Certified as a Specialist in Gerontological Nutrition, For example, an introduction of a speaker might read: Ann Apple is a registered dietitian who is Board Certified as a Specialist in Gerontological Nutrition. More information is available on CDR's website at the following link: litti)://c(iriiet.orP/cmicl(-Iitil<s/ uideiiiies-for-credential-placement, Specialty Online Directory: The Specialty Online Directory includes contact Information and practice interests for all CDR board certified specialists. You are able to enter your own data and update your information through the CDR website at any time. You may complete as many or as few data fields as you like making you in charge of your privacy and the information seen by the public. Anyone looking for a specialist in dietetics is able to search the database using any of the fields. The directory web link is available on CDR's website: littn:/Icdriiet.orp/certifications/cdr-board-specialty-online-directory. Your password to access the Specialty Online Directory is above your specialty identification card. Janet Calderwood PO BOX 1734 Bonita Springs FL 34133 1734 Specialty Online Directory Password: G12569 Certification Period 07/2013-09/2018 Form 9; 141691 Commission on Dietetic Registration the credentraling agency for the Academy of Nutrition and Dietetics Certifies that #926084 Janet Calderwood is a Board Certified Specialist in Gerontological Nutrition and Is entitled to use the credential "RD, CSG" October 2013 — Page 2 Press Release: Please feel free to give the press release to your employer, local newspapers or newsletters, etc. If you would like us to send a copy of the press release instead, send an e-mail to specialists@eatri hg t.org with contact Information for the newspaper or other communication facility to which you would like the information sent. Subject Matter Expert (SME) Volunteer Opportunities: As part of our ongoing process of examination quality management, we are in the process of expanding our pool of subject matter experts (SMEs) to participate in future test development and review meetings in Chicago and possibly become a member of the specialty examination workgroup. New SME's are invited to participate when members of the current workgroup cannot attend or when current member terms expire. Participants are invited on a trial basis, receive an invitation describing meeting responsibility, and test information as needed from the testing vendor. Each participant is required to sign a confidentiality agreement, indicating they will not share any Information and/or participate in any test preparation courses. If you are interested in this opportunity, please see the handout enclosed. 75 CPEUs for RD recertification: Passing the CSG examination has been approved by CDR for 75 CPEUs, it is Activity Type 335: CDR -Board Certification as a Specialist in Gerontological Nutrition. The CPE activity would have to relate to a Learning Need Code from your active Step 3 Learning Plan. Please record the activity on your Step 4 Learning Activities Log. For more information, please see the Professional Development Portfolio Guide. If you have any questions regarding this information, or your certification in general, please contact us, at 1.800/877-1600 ext. 4816, 4705 or specialists@eatrlght.org. Sincerely, Jessica M. Rapey, RD Kim White, RD Senior Manager, Professional Assessment Senior Manager, Professional Assessment 0 (J V LU W W Z 0 Cn L 0 Attachment I Site Information Form (To be completed by applicants for Adult Day Care, Congregate Dining, In -Facility Respite, and Support Group Service Providers) If this application is requesting funding for Congregate Meals, please provide the following information for each proposed meal site/senior center (add rows as necessary): Congregate Meal/Senior Center Site Information Site Address (Street, number, City, Zip Code) Capacity(room) Number of OAA Currently funded Clients (If none enter Zero) 1. East Naples Community Park: 3500 Thomasson Dr. Naples, FL 34112 200 24 2. Golden Gate Senior Center: 4898 Coronado Pkwy. Naples, FL 34116 130 115 3. Goodlette Arms: 950 Goodlette Rd. Naples, FL 34102 40 27 4. Roberts Center: 905 Roberts Ave. Immokalee, FL 34142 100 31 5. If this application is requesting funding for Support Group Service Providers, please provide the following information for each proposed meal site/senior center (add rows as necessary): Support Group Site Information Site Address (Street, number, City, Zip Code) Capacity Number of OAA Currently funded Clients (If none enter Zero) 1. 2. 3. 4. 5. AAASWFLRFP — 01— 2019 SITE INFORMATION FORM If this application is requesting funding for Adult Day Care, please provide the following information for each proposed site (add rows as necessary): Adult Day Care Facility Site Information Site Address (Street, number, City, Zip Code) Number of License # T OAA applicable Site Address (Street, number, City, Zip Code) m Currently W funded U Clients 1.Shifting Sands Adult Day Center, 28410 Bonita 0 Crossings Blvd. Suite B7, Bonita Springs, FL 34134 60 New Vendor #9427 2. 3. 4. 5. If this application is requesting funding Respite in Facility, please provide the following information for each proposed site (add rows as necessary): Respite in Facility Site Information Number of License # if T OAA applicable Site Address (Street, number, City, Zip Code) m Currently m funded U Clients 1.Arden Courts of Lely Palms, 6125 Rattlesnake Hammock Rd., Naples, FL 34113 56 3E -4 clients #AL9326 2. 3. 4. 5. Collier County Community and Human Services Division Standard Operating Procedures Title IIIE National Family Caregiver Support Program Purpose: To provide for guidance in the expenditure of IIIE, IIIES, IIIEGfunds provided by the Older Americans Act Title IIIE National Family Caregiver Support Program. Description: Clients requesting services through IIIE, IIIEG, or IIIES are able to receive supports whether they are a caregiver of a senior or a caregiver grandparent. Procedure: 1. All new intakes will be processed by the assigned case manager and existing cases by the current case manager to gather information and authorize services. 2. The assigned case manager will schedule a home visit to complete the 701(A) condensed assessment and obtain a signed Release of Information and Fair Hearing form. 3. The assigned case manager will consult with the Case Management Supervisor to determine whether funds are available and then add the services to the care plan. The authorization for services will be provided to the Manager who will sign and submit paperwork to the accountant for processing. 4. A copy of the Authorization and/or Supply request is provided to the designated fiscal staff for generating a Purchase Order and payment of services. The Case Manager provides this to the accountant ensuring that they designate IIIE or IIIES and documents the total cost on the forms and in the case notes. The Case Manager will provide to the caregiver a self-addressed envelope with the Case Manager's name for the recipient of services to send original receipts associated with the services provided by IIIE. 5. The packet needs to have: Authorization, Care Plan, Release, Notice of Privacy Practices, Grievance Procedure, 701 (A), and case notes. Updated November 16, 2018 Collier County Community and Human Services Division Standard Operating Procedures Title IIIE National Family Caregiver Support Program U 6. If a person receives in-home respite and they hire their own caregiver, the family needs to provide the original timesheet to the Case Manager for submittal for payment. 8. The IIIE cover sheet needs to note if the service is a one- time only service. Whether the service is one time only or not, the IIIE stays open until the end of the fiscal year. Recipients for IIIE Respite may receive no more than a total of twenty one days (21) of 24-hour care per year with Services for Seniors paying up to and no more than $225 toward each 24-hour periods. 9. Consideration for any request over the 21 days is reviewed by the Manager, the assigned Case Manager and after consultation with fiscal staff to determine if sufficient funds are available to assist the individual. Emergency Respite requests are prioritized over all other requests. Emergencies are defined as unplanned situations arising for the caregiver, where no other resource is available to them. Examples of this would be death in the family where the caregiver must attend the funeral, or hospitalization of the caregiver. Updated November 16, 2018 .ya,. Public Services Department Community & Human Services Division Collier County Services for Seniors Client Satisfaction Survey September 2018 To continue to provide excellent service to our seniors, an annual satisfaction survey was completed, and the results were reviewed and tabulated with the following results. Out of the 189 surveys mailed out, 74 (39.2%) were completed and returned. This response was 4.8% lower than last year in 2016. The 2018 satisfaction survey tabulated that the CCSS program received a 4.55 % rate out of 5.00 in satisfaction, which .05% lower than last year. The CCSS program received an 89% Satisfaction rate. 69% of the clients expressed that the services they receive are Superior. 23% expressed Above Average satisfaction. 8% reported Average satisfaction. 1% Below Average Satisfaction with the contracted home health vendors and 1% Poor service with the supplies they received. of the clients reported their Case Managers returned their calls and responded to their requests in a timely manner. 72% of the respondents reported to be Superior service with the service provided by the vendor agencies, which included Accu -Care Nursing Services, Home Instead, Almost Family, Always There and Health Force. This is a 14% drop in vendor satisfaction from 2017. Eight (8%) clients responded they were Satisfied and 3% indicated that they were Dissatisfied with the vendor agencies. Dissatisfaction with the vendor agencies included issues of staff not being properly trained, staff breaking items when cleaning, some incontinent supply products' quality had changed, and aides do not call if they are going to be late. The survey results also included those clients who receive EAR services (emergency medical alert) from Phillips Lifeline and ADT are Very Satisfied with the service provided to them by these vendors. When clients replied to the question what services could be improved or added, 42% responded with the following answers: • Other services should include dental, vision and prescription assistance • Request for additional hours of in home services • Adult Day Care is needed for caregivers who work full time • Would like transportation to the hairdresser and grocery shopping Community & Human Services Division • 3339 Tamiami Trail East, Suite 211 • Naples, Florida 34112-5361 239 -252 -CARE (2273)+ 239.252 -CAF@ (2233) • 239.252-4230 (RSVP) • www.colliergov.noUhumanservlces page 2 Collier County 2018 Services for Seniors General comments on the survey included: • Thank you for being there and your services have help my husband & I so much I could never take care of him by myself. • We are so grateful for the services & supplies, we can never afford this on our own • 1 have Macular Degeneration; your services have helped me more than I can say • Carlton is an A+ guy • We love Debbi • Ivonne Garcia is the best, wonderful, helpful & considerate! • Debbi is wonderful and really knows her stuff • Staff are personal, professional and know about senior resources CCSS Manager, Grant Coordinator and the Case Management staff have reviewed and discussed the client issues, comments and complaints contained in the surveys. The Manager has discussed with all the providers the survey results and providers have agreed since the contract rates have increased, this will assist in hiring better trained staff. to develop a plan of moving forward to address the program's concerns. To date, each agency states they are making a sincere effort to provide quality in home care services and have replaced aides immediately upon request. Also, CCSS program and Fiscal staff meet weekly to review budget expenditures to determine client requests for increased services and requests for medical transport. CCSS will begin to provide transportation to the grocery store and hairdressers since these services assist seniors in feeling their quality of life is stable. CCSS makes every effort to work with the seniors' neighbors, families and volunteers from local agencies/church volunteers to provide partnership in providing other services to our seniors. CCSS program staff communicates weekly with contracted vendors to discuss any issues that clients have with their agencies and assigned aides. In summation, the 2018 annual survey indicates that 91% of the clients who responded are completely Satisfied with the Collier County's Services for Seniors program. Beginning in January 2019, case managers will provide the handwritten survey to the senior during the assessment at their annual and 6 - month intervals. In addition, the annual report will incorporate the CCSS Complaint Log results to capture specific problems that have occurred in the program. Services for Seniors program will continue to strive to maintain a high level of satisfaction, as well as to exceed the clients' expectations by continually monitoring the services provided and by addressing concerns and needs of the clients as effectively and efficiently as possible throughout the year. Customer Service Feedback Public Services CHS -Services for Seniors 8 7/1/2017 6/30/2018 Direct to Client via Mail 2018 Services for Seniors Satisfaction Survey Senior Clients of CHS IM 1. Please rate the time it takes your Case Manager to return your calls and respond to your requests. 2. Please rate your satisfaction of your case management services. 3. Please rate your level of satisfaction with the agency that provides your in home services. 4. If you or your family member attends Adult Day Care, please rate your level of satisfaction with the program. 5. Pleases rate the quality of the supplies you receive. _ 6.What other services would behelpful toyou ? 7. How long have you been receiving services? j Please turn page over for additional questions. _ Thank you. 1 1.5 2 2.5 3 3.5 4 4.5 5 PUBLIC SERVICES CHS -SERVICES FOR SENIORS Customer Service Feedback Customer Service Feedback circle the name of your case manager: Maxon Carlton Bronson Ivonne Garcia Louise Pelletier are receiving in home services, which agency is providing the services —circle one ADTSecurity Almost Home Always There HealthForce— Naples Arden Court Lifeline Summit PUBLIC SERVICES CHS -SERVICES FOR SENT( Additional Information At T Public Services Community & Human Services Division Collier County Nutrition Services Customer Service Feedback Report 2018 In an effort to continue to provide excellent services, the annual customer service feedback survey was completed this year and the results were reviewed and tabulated. Out of the 77 surveys mailed out to home delivery clients, 17 were returned (22 %). Out of 125 handed out at the meal sites, 75 were returned (60 %). This year we also tallied surveys by individual site to get a better understanding of the results and to provide proper follow up. Below are the tabulated OVERALL results for Congregate Meal Sites on a scale of 1-5 (5 being the highest): 1. Participant helped feel less isolated- 4.1 2. Depressed before but less after- 3.8 3. Attending site improved wellbeing- 4.0 4. Learned more nutrition and healthy living- 4.0 5. Staffs friendliness & helpfulness- 4.5 6. Satisfaction with selection of food- 3.7 7. Quality and taste of meals received- 3.6 8. Satisfaction with activity programs at site- 4.0 9. Satisfaction with amount of time spent- 4.1 Total score: 4.0 Below are the tabulated results for Golden Gate Senior Center on a scale of 1-5 (5 being the highest): 1. Participant helped feel less isolated- 3.0 2. Depressed before but less after- 2.8 3. Attending site improved wellbeing- 2.9 4. Learned more nutrition and healthy living- 2.6 5. Staffs friendliness & helpfulness- 4.3 6. Satisfaction with selection of food- 1.9 7. Quality and taste of meals received- 1.6 8. Satisfaction with activity programs at site- 3.0 9. Satisfaction with amount of time spent- 3.5 Total score: 2.8 Community & Human Services Division • 3339 Tamiami Trail East, Suite 211 • Naples, Florida 34112-5361 239 -252 -CARE (2273) • 239-252-CAFt (2233) • 239-252-4230 (RSVP) • www.colliergov.noUhumanservices Collier County 2018 Customer Service Feedback Results- page 2 Below are the tabulated results for Goodlette Arms Meal Site on a scale of 1-5 (5 being the highest): 1. Participant helped feel less isolated- 4.8 2. Depressed before but less after- 3.6 3. Attending site improved wellbeing- 4.5 4. Learned more nutrition and healthy living- 4.8 5. Staff's friendliness & helpfulness- 5.0 6. Satisfaction with selection of food- 4.6 7. Quality and taste of meals received- 4.5 8. Satisfaction with activity programs at site- 4.8 9. Satisfaction with amount of time spent- 4.8 Total score: 4.6 Below are the tabulated results for East Naples Meal Site on a scale of 1-5 (5 being the highest): 1. Participant helped feel less isolated- 4.1 2. Depressed before but less after- 4.1 3. Attending site improved wellbeing- 4.1 4. Learned more nutrition and healthy living- 4.1 5. Staff's friendliness & helpfulness- 4.1 6. Satisfaction with selection of food- 4.0 7. Quality and taste of meals received- 3.9 8. Satisfaction with activity programs at site- 3.8 9. Satisfaction with amount of time spent- 3.8 Total score: 4.0 Below are the tabulated results for Immokalee Roberts Center on a scale of 1-5 (5 being the highest): 1. Participant helped feel less isolated- 4.5 2. Depressed before but less after- 4.5 3. Attending site improved wellbeing- 4.5 4. Learned more nutrition and healthy living- 4.4 5. Staff's friendliness & helpfulness- 4.6 6. Satisfaction with selection of food- 4.4 7. Quality and taste of meals received- 4.3 Collier County 2018 Customer Service Feedback Results- page 3 8. Satisfaction with activity programs at site- 4.5 9. Satisfaction with amount of time spent -4.5 Total score: 4.5 Below are the tabulated results for Home Delivered Meals: 1. Friendliness of person delivering- 4.4 2. Appropriate arrival time of meal- 3.6 3. Satisfaction with number of meals- 4.6 4. Better knowledge of nutrition/health- 3.6 5. Satisfaction with selection of meals- 3.2 6. Quality and taste of received meals- 3.4 Total score: 3.8 General Comments: "I appreciate that there has always been a hot meal waiting for me as long as I lived at Goodlette Arms. The program has become so much better and the service superior. I'm very satisfied, delighted and thankful." "Good service. I love Bonnie. It's fun to eat with people." "I am very well taken care of by staff and the people who assist." "Staff are very friendly and very respectful, in that sense, I feel very well. " Suggestions for improvement: "More hot food." "Less pasta." "More variety of food. Its practically the same every day." "Please we need more Latin food. This center has many Latinos, the great majority. It's a shame to see money wasted in the garbage with food made bad." Collier County 2018 Customer Service Feedback Results- page 4 Suggestions for additional activities: "Any activity that gives us joy and communication to each other". "More social gatherings of dinner." "Recreational activities -dominoes, crosswords, etc." "Painting, ceramics, floral arrangements." In summary, the survey results indicate that most congregate meal participants are highly satisfied with services who attend Goodlette Arms, East Naples and Immokalee Roberts Center. Survey results for Golden Gate Senior Center were below average. Overall score for Congregate Meals declined from 4.3 in 2017 to 4.0 in 2018. Home Delivered Meals score went from 4.25 in 2017 to 3.8 in 2018. Home Delivered meal participants gave an average score in areas of meal arrival time, selection of meals and quality and taste of the received meals. Survey results were shared with our food vendor, GA Foods. We will continue to inform GA Foods on issues as we are notified of them as part of an ongoing effort to improve level of satisfaction. We continue to monitor the services provided and will consider the suggestions and comments made by the respondents. PUBLIC SERVICES CHS -CONGREGATE MEALS Customer Service Feedback Customer Service Feedback PUBLIC SERVICES CHS -CONGREGATE MEAT Additional I oformatl on Collier County Community and Human Services Division Standard Operating Procedures Consumer Satisfaction Purpose: Collier County has made customer service a focus area of all divisions in the agency. It is important to understand the client's perspective, both internal and external, on the services provided Data -driven analysis of customer service surveys better informs CHS of the program's successes, improvements and gaps in service delivery. Description: To provide excellent customer service to our clients, CHS must evaluate the client satisfaction responses to the services they receive from their case managers and the vendors. The survey results are vital for client interaction and to continually evaluate and redefine service delivery Procedures: 1. CHS mails a hard copy of the Annual Satisfaction Survey to all seniors receiving in home and nutritional services in July; the survey covers July I to June 30 of the previous service year. After thirty (3 0) days, the results are tabulated in a formal Customer Service Feedback report. 2. The Manager contacts all the clients who have requested a telephone call contact and who have expressed dissatisfaction with their services. 3. The Manager completes an annual report with the formal tabulated results and reviews it with the Division Director and the case managers. Recommendations are made and necessary changes occur to increase consumer satisfaction. Vendors are contacted and are given both positive and negative feedback so that necessary improvements can be developed. 4. Survey report and results are provided to AAA annually during the annual lead agency monitoring or upon request. 5. The survey report results assist with the implementation of the Division's QA/QC and the County's Strategic Plan. Updated January 4, 2018 Collier County Community and Human Services Division Standard Operating Procedures Customer Service r Purpose: To describe the policies and procedures implemented to ensure optimal customer service for all public calls to the department regarding social services and senior issues. Description: The administrative secretary answers all incoming calls to the main line of the Community and Human Services Division and refers callers to the Elder Helpline or to a staff member in the Seniors program as deemed appropriate. Procedure 1. When a Services for Senior client calls requesting to speak with their assigned Case Manager (CM), the call is forwarded by the Administrative Secretary to the Case Manager's extension. If the client does not know who their assigned CM is, the call is transferred to the Manager or to another CM if the Manager is known to be unavailable 2. If the caller is requesting information in general regarding senior services or issues in Collier County, or is requesting in-home services specifically, they shall be directed to the 1-866-413-5337 number of the Elder Helpline, the identified Information and Referral section of the Area Agency on Aging of SW Florida. 3. If the caller requests specifically to speak with any staff within the Seniors Program, the Administrative Secretary shall: 1) transfer the call to the Manager who will either address the callers questions/concerns personally or will delegate the task to another staff member or, 2) email the caller's name and phone number and brief description as to the nature of the call to the Manager and will cc another case management staff member requesting a return call. Upon receipt of the email, the Manager will either address the questions or concerns of the caller personally or will delegate the task to another staff member. If the Manager is not present and/or available to follow up with the email, the staff member cc'd shall complete the follow-up. 4. When information and referral services have been provided to the public, the staff member handling the case will be responsible for follow-up with the caller within five (5) business days to ensure satisfaction and further assistance is not required. October 11, 2017 Ul U Z � w 00 v on a V m c m S u w M c t = m of v o m s� a � QJQ \ W N O O O O p n V Z � 00 v on a — vi n u Vo - 00 s� QJQ \ W N O O O O p n 0 0 0 0 O n Z U V U N V ry V ry ry H 10J N O u u a m na c M � v a'mt viZ � D umi Z N Z� .mi QN a p. _ n Z 2 a u m WR t a Z s O O O c o o o '� u o �at�,n0 00 a „naa¢ao a nO m o c N0 a c m o 6 s �s� ooi� �pma>ZUx 03ZZq w W ni O \Zop,.E. ON -q. o yn1� N 9 O A G N O O A� pOp pOp pp pp pp pp O O O O V V V V V i GI c c c c c c a a a a F E O y O a M p g m m c'q o F .Mi 4a ? C O � c Y jII �+ ✓ � O 'y DO V C l% L ✓ U V1 _ C O v O a 12 C O N 2 O N U v01 U ,il U l'l A v M U CCO W H v ro N go N ani �.j q s. o o c y c o 4) m j 0 (n t V O cl ro W H O O C pp 'ji a q d yOyQQ yUyy.� d � � O C 0 1er co"Ilty Public services Deparhnent Community & Human Services Division Signatory ATTACHMENTS INDEX i. Contract Terms and Conditions ii. Statement of No Involvement iii. Administrative Asset Checklist iv. Proposal Fatal Criteria v. Bidders Checklist vi. Funding Match Commitment vii. Statement Assuring No OAA Funds Utilized in the Development of RFP S /177Wi71►=W Contract Terms and Conditions Statement In the event Collier Countv Board of Commissioners (Name of Agency) should be awarded a contract for the provision of services based on this Request for Proposals for Older Americans Act Funded Local Service Provider Designation, Collier County Board of Commissioners (Name of Agency) agrees to abide by the terms and conditions of the Older Americans Act Contract and all respective attachments, including the billing and payment process. 1- q -'Qon Date AAASWFL RFP — 2019 — 01 Approved as to form and legality Assistant County A rnt nvy APPENDIX IV Statement of No Involvement I, Leo Ochs , as an authorized representative Of the Collier County Board of Commissioners , certify that no member of this agency nor any person having interest in this agency has been awarded a contract by AAASWFL, on a noncompetitive basis to: (1) develop this Request for Proposals; (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. Signature of Au hori presentative M Approved as to form and Icgality Assistant County Anon cy AAASWFL RFP — 2019 — 01 APPENDIX V Administrative Assessment Checklist Agency: Collier County Board of County Commissioners Date Address: 3339 Tamiami Trail East. Suite 211 City, State, Zip: No. of Employees: No. of Business: t ocations: Director's Name: FL 34112 Community & Human Services Staff = 42 Services for Seniors Staff = 15 Kristi Sonntag 07/08/2019 Administrative Assessment: An assessment of your organization's managerial, financial, and administrative capabilities will be made partially on the basis of your response to the following questions. If response other than "yes" or "no" needs to be made, please reference the appropriate question and give your response on a separate page. This information must be completed and returned with your response to our Request for Proposals AAASWFL RFP - 2019 - 01 AAA SWFL RFP - 2019 - 01 Are property records which describe the equipment, including the Property item number, the manufacturer's model number, equipment Management identification number, grant or contract identification number, X acquisition date, location and condition of equipment maintained? Are written purchasing policies for procurement of supplies, X equipment, construction, and other services on file? Procurement Is a code of conduct, in writing, maintained which governs performance of the officers, employees or agents engaged in X procurement which states that they will avoid any conflict of interest? Are financial reports prepared monthly for internal management X for internal management purposes? Does an independent auditor perform a certified audit annually? X Are basic books of accounting maintained? (1) General Ledgers X Accounting (2) Project Ledgers (3) Accounts receivable/cash receipt journal 4 Accounts payablefcash disbursement journal Is there adequate segregation of duties among personnel in accounting functions listed: (1) Is payroll prepared by someone other than the timekeepers and person who deliver paychecks to employees? (2) Are duties of the bookkeeper separate from X cash -related functions? (3) Is the signing of checks limited to those authorized to make disbursements and whose duties exclude posting and recording of cash received Are receipts recorded in a cash receipt journal by individual cost X centers? Is an equitable system of allocating fees and other third party X Revenue payments to funding sources used when two or more sources are involved? Do controls exist to ensure that all appropriate costs for eligible service provisions are billed to third party payers in a timely X manner? Are there guidelines for assessing fees? X X Are these guidelines known to the bookkeeper/cashier? Is every effort extended to collect fees? X Are uncollectible write-offs approved by a responsible official? X Are all checks marked "For Deposit Only" immediately upon X receipt? Are receipts deposited on a regular basis? X AAA SWFL RFP - 2019 - 01 AAASWFL RFP - 2019 - 01 Are expenditure entries posted by cost centers? X Is there a system for allocating direct cost when the project is funded by two or more sources? X Expenditures Are there written procedures for making refunds to clients, third party payers and others? X If non-profit, does the agency have a tax -exempt number? X Are written travel policies maintained? X Are time and attendance records kept for all employees by program, by funding source? X Are Federal quarterly payroll tax forms (U.S. 941) submitted in a timely manner? X Are individual payroll records maintained on each employee? X Are checks issued in pre-numbered sequential order and are all applicable check numbers accounted for? X Are banks notified in writing when authorized check signers terminate employment with theprovider? X Are ledgers/journals reconciled to bank statements on a monthly basis? X Disbursements When not in use, are checks locked in a secure cabinet? X Is it prohibited to make disbursements for cash receipts? X Are cash receipts from accounts receivable or other sources mixed with petty cash funds? X Are disbursements from petty cash documented by approved supporting invoices? X-N/A Are personnel policies in writing and approved by appropriate authority? X Are job descriptions provided to all employees at time of initial employment? X Personnel Are job descriptions on file for allpositions? X Is each staff member appraised on performance, at least annually? X Are staff members asked to review and comment on their evaluation? X AAASWFL RFP - 2019 - 01 APPENDIX VIII PROPOSAL FATAL CRITERIA Bidder Collier County Board of County Commissioners Reviewer: Date: The "fatal" criteria listed below must be fully met in order for the proposal to be considered for further evaluation. Failure to receive a "YES" response on any item may result in an automatic rejection of the proposal. ITEM Was the proposal received by the time and date specified in the RFP? 2. Were all copies of the proposal delivered in an envelope or box that was securely sealed and clearly marked on the outside with the RFP title and the name of the bidder? 3. Does the proposal include a signed statement certifying that the bidder has had no prior involvement with the Area Agency on Aging by performing a feasibility study concerning the scope of work contained in this RFP; by participating in the drafting of this RFP; or by developing a program similar to the ones contained in this RFP? 4. Does the proposal contain a signed statement that the bidder agrees to all contract terms and conditions? Does at least one copy of the Service Provider Summary Information page contain the required original signature of the person authorized to bind the agency to all contractual obligations? 6. Does the proposal include signed commitment forms or a comparable document (i.e. letter from a funding source) guaranteeing the bidder's ability to provide adequate matching funds? AAASWFL RFP - 2019 - 01 YES NO Appendix XII Bidders Checklist Bidders are encouraged to use this checklist to assure that all required proposal items/timelines have been met. The proposer is cautioned to read and become familiar with all sections of the AAASWFL proposal documents. Failure to do so may result in the submission of an irregular proposal resulting in its possible rejection by the AAASWFL. The following itemized checklist identifies various items of the proposal documents, which should be particularly examined by the proposer. Proposers should carefully review the items specified for submission in all of the RFP documents. No representation is made that the following checklist is a complete guide to every submission requirement in the RFP documents. Minimum Requirements for Proposal to be Considered: HH 1. Delivered by 3:00 p.m. on Tuesday, July 9, 2019 2. All copies of the proposal must be delivered in an envelope or box that is securely sealed JL[H and clearly marked on the outside with the name of the bidder 9TH 3. Signed Statement of No Involvement HH 4. Signed Contract Terms and Conditions Affidavit 5. Summary Information signed by a person authorized to bind the agency to all contractual HH obligations (Title Page of Service Provider Application, Section I.A. 6. Signed cash and/or in-kind commitment forms that guarantee the bidder's ability to provide HH adequate matching funds or, lacking that, written justification for its non -submission Verify that the following sections of the Service Provider Application have been properly submitted: I.A. Service Provider Summary Information II.A. Program Module Documents: 1. Needs Assessment 2. Targeting 3. Linkages 4. Consumer Targeting and Prioritization 5. Services 6. Subcontractor Monitoring Schedule 7. Quality Assurance 8. Process for Adverse Incidents, Consumer Complaints, and Reducing or Terminating Services AAA SWFL RFP — 2019 — 01 Initial if Submitted HH HH HH HH HH HH HH HH HH / 9. Reporting HH ` 10. Client Confidentiality and Security HH 11. Disaster Preparedness HH 12. Organizational Chart 9-H 13. Description of Service Delivery (by Service) HH 14. Objectives and Performance Measures HH 15. Nutrition Requirements (Nutrition Provider Only) ,7f3{ 16. Legal Services Program Delivery (Legal Providers Only) N/A 17. Organizational Chart HH 18. SPA Appendix HH 19. Program Module Review Checklist HH Initial if Submitted II.B. Contract Module Documents: 1. Personnel Allocations Worksheet HH 2. Unit Cost Worksheet HH 3. Supporting Budget Schedule by Program Activity HH 4. Commitment of Cash Donation HH 5. Commitment of In -Kind Contribution of Space N/A 6. Commitment of In -Kind Contributions of Supplies N/A 7. Commitment of In -Kind Contributions of Equipment N/A 8. Commitment of In -Kind Contributions of Services N/A 9. Commitment of In -Kind Volunteer Personnel and Travel N/A 10. Availability of Documents HH 11. Contract module Review Checklist HH New Bidders Only - Verify that the following sections of the Organizational Capability Package have been properly submitted: NOT APPLICABLE Initial if Submitted 1. Approved Organizational Chart 2. Job Descriptions for all Staff Involved in the OAA Program 3. Personnel Policies Certification Statement 4. Most Recent Audited Financial Statements 5. Complete Roster of Board of Directors/Corporate Officers 6. Corporate Bylaws 7. Articles of Incorporation 8. IRS Determination Letter on Tax Exempt Status 9. IRS Form 990 10. Certificate of Insurance 11. Administrative Assessment Checklist (Appendix V) 12. Certification of 30 Days Operating Funds 13. Monitoring Reports 14. Reference Letter 15. Documentation of Experience AAA SWFL RFP - 2019 - 01 II. B. 4. Match Commitment of Cash Donation Agency Name: Collier County Government Donor Identification: Name: Community and Human Services of Collier County Street: 3339 East Tamiami Trail, Building H, Room 211 City: Naples State: FL Zip: 34112 Phone: 239 252-4228 Authorized Representative: Kristi Sonntag, Director Total Amount # Payments Amount/Payment Contribution Period Special Conditions: Donor Certification: $452,119.39 26 $17,389.21 1/1/20 — 12/31/20 None I hereby certify intent to make the cash donation set forth above for use in the specified program during the program's upcoming funding period. This cash is not included as match for any other State or Federally assisted program or contract and is not borne by the federal government directly under any federal grant or contract. Signature of Donor or January 2018 Page 26 of 32 Approved as to form and legality Assistant Count 11t roey C APPENDIX XIII Statement Assuring No OAA Funds Utilized in the Development of RFP To be completed by currently designated OAA Providers I, Leo Ochs, County Manager , as an authorized representative of Collier County Board of Commissioners certify that no funding received from AAASWFL including Older Americans Act federal grant revenue was used in preparing this Request for Proposal bid. Signature of Authorized 11. C)_(joie Date \pproved as to form and legality As, Stant CountyIturney AAASWFL RFP — 2019 — 01