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9-20-19 letter from Mariane Lorini re Area Agency on Aging Monitoring reportto Area Agency on Aging FOR SOUTHWEST FLORIDA Your Aging and 01sabiI fty Resource Canter RECEIVED September 20, 2019 SEP 24 2019 William McDaniel, Jr., Board Chair OFFICES OF COLLIER COUNTY 3299 Tamiami Trail, E. 80ARO OF COUNTY COMMISSIONERS Suite 303 Naples, FL. 34112 Dear Mr. McDaniel: The Florida Department of Elder Affairs (DOEA) mandates that the Area Agency on Aging for Southwest Florida (AASWFL) perform an annual monitoring for each of the Lead Agencies within our seven county region. In Collier County, our lead agency is Collier County Services for Seniors. Our annual monitoring process includes tests of compliance with federal and state programs, contracts, and sub awards. It should be noted that testing is not comprehensive in scope, but is done on a random basis in order to identify any deficiencies. Our agency is required to send you, as Chair of the Collier County Board of Commissioners, the enclosed copy of the 2019 Collier County Services for Seniors monitoring report. We are pleased to inform you that during this monitoring process, there were no findings or areas of concern for the programs or nutrition portions of the review. The fiscal review for the annual monitoring will be completed at a later date. On behalf of AAASWFL, I want to thank you and the Collier County Services for Seniors staff for the courtesy extended to our staff during this annual monitoring process. We look forward to continuing our shared commitment in making a positive difference in the lives of those receiving these much needed services. Please do not hesitate to contact me if you have any questions or need more information. Sincerely, Marianne Lorini President & CEO Enclosures c: Kristi Sonntag, Director c: Louise Pelletier, Manager of Social Services and Senior Programs Helpline: 1-866-413-5337 Charlotte I Collier I Desoto I Glades I Hendry I Lee I Sarasota 15201 N. Cleveland Ave., Suite 1100, North Fort Myers, FL 33903 1 Office: 239-652-6900 1 Fax: 239-652-6989 1 www.AAASWFL.org • Area Agency on Aging . FOR SOUTHWEST FLORIDA Your Aging and Disability R96010MG Contac Collier County Services for Seniors Monitoring Report 2019 PROVIDER: CONTACT PERSONS: TELEPHONE: ADMINISTERING AGENCY: FUNDING PERIOD: FUNDING SOURCE: PURPOSE OF MONITORING VISIT: Collier County Services for Seniors (CCSS) 3339 East Tamiami Trail, Ste. 211, Naples, FL. 34112 PRIVATE NONPROFIT ORGANIZATION PUBLIC AGENCY X COUNTY GOVERNMENT Louise Pelletier Kristi Sonntag (239) 252-2696 Area Agency on Aging/Aging & Disability Resource Center for Southwest Florida (AAASWFL/ADRC) General Revenue Programs (CCE, ADI, HCE) July 1, 2017 — June 30, 2018 Older Americans Act (OAA) January 1, 2018 — December 31, 2018 Older Americans Act Title III (OAA) Community Care for the Elderly (CCE) Home Care for the Elderly (HCE) Alzheimer's Disease Initiative (ADI) X Annual _ Special Collier County Monitoring Report 2019 �I Page 1 of 8 Desk Review: September 16-20, 2019 SITES VISITED: Meal Sites: Golden Gate Senior Center 4898 Coronado Pkwy Naples, FL 34116 EXECUTIVE SUMMARY Collier County Services for Seniors (CCSS) is a division of Collier County Community and Human Services. CCSS bases its operation at 3339 East Tamiami Trail, Building H, Naples, Florida 34112. They serve Collier County as a lead agency for the Area Agency on Aging for Southwest Florida (AAASWFL). As a Lead agency, CCSS is a recipient of federal and state funding through the Area Agency on Aging of Southwest Florida (AAASWFL). They oversee and deliver programs and services for older adults and adults with disabilities in Collier County. They currently serve 390 clients. They provide case management services and also serve as a nutrition provider, operating four meal sites and delivering meals to the homes of clients in need in Collier County. FOLLOW-UP FROM PREVIOUS MONITORING VISIT ■ Follow up with estimated date email encryption program (along with policy and procedure) will be implemented in 2019. Completed as requested ■ CCSS complaint logs are currently being reviewed on a monthly basis due to a PSA wide corrective action plan (CAP) currently in place. This CAP is almost complete. It is recommended that CCSS continue submitting logs until an official letter of completion is issued by the AAASWFL. It is also recommended that CCSS ensure vendor monitoring reports reflect trending complaint issues with specific vendors. Completed as requested AREAS OF CONCERN All requested documentation was reviewed with no areas of concern. Collier County Monitoring Report 2019 Page 2 of 8 RECOMMENDATIONS FOR IMPROVEMENT (All follow up for recommendations will be reviewed during the next monitoring period unless otherwise noted.) There are no recommendations at this time. CORRECTIVE ACTION There is no corrective action at this time. POSITIVE/NOTEWORTHY ACTIVITIES • CCSS has been successful in meeting the goals from their 2018 targeting plan. They continue to partner with several local ministries, the VA Office, the State Public Guardianship program, two Collier Senior Centers and the local business community. CCSS participated in community health fairs and met with local medical clinics and health centers practices to address the needs of the senior population that are low income, minorities and non-English speaking. • CCSS partnered with State of Florida Health Department in promoting positive aspects of adults who are aging and mailed over 500 letters to all the medical physicians in Collier County informing them of the Services for Seniors program. Posters were displayed in all County museums and libraries and advertising was secured for 30 days with the local radio station in Naples FL. • CCSS served an average of 6300 meals monthly in combination of home delivered meals and four congregate meal sites. ADMINISTRATIVE COMPLIANCE Administrative (This section of the report provides an overview of the administrative documentation reviewed by AAASWFL for the past year.) Collier County Services for Seniors continues to efficiently meet the needs of older adults in Collier County. The AAASWFL program staff have reviewed all documentation through a desk review. CCSS continues to comply with the Department of Elder Affairs' (DOEA) standards in all of the areas that were monitored. Policies and procedures are readily available either at their administrative office or on the County's intranet. Policies and procedures evaluated were in compliance with DOEA requirements. All safety, health and operating licenses are up to date and Collier County Monitoring Report 2019 Page 3 of 8 facilities have demonstrated the ability to meet the needs and protect the well-being of persons served. Case managers and staff have demonstrated exceptional service provision. Quality Assurances (This section of the report pertains to satisfaction surveys completed with active clients of CCSS and an analysis of completed surveys.) Collier County Services for Seniors mailed 171 surveys and 69 (40%) were completed and returned. Of the surveys returned, 89% of clients expressed their satisfaction with CCSS programs and services and 64% of those rated them as superior, which is the highest ranking satisfaction level on the CCSS survey form. Seventy two percent of the respondents reported to have superior services provided by the vendor agencies. Three percent of the respondents said they were dissatisfied with the vendor agencies. Dissatisfaction included issues of poorly trained staff, staff breaking items when cleaning, and minimal or no notification when services were canceled. CCSS program staff communicates weekly with contracted vendors to discuss any issues that clients have with their agencies and assigned aides. CCSS manager, grant coordinator and the case management staff have reviewed and discussed the client issues, comments and complaints contained in the surveys. The CCHS manager has discussed the survey results with all of the contracted vendors. To date, each agency states they are making a sincere effort to provide quality in home services and have replaced aides immediately upon request. CCSS continues to strive to maintain a high level of satisfaction, as well as exceed the clients' expectations by continually monitoring the services provided and address concerns and needs of the clients as effectively and efficiently as possible throughout the year. AAASWFL staff also surveyed CCCS clients actively receiving services under ADI, CCE, HCE, and OAA funding sources. Surveys were conducted by mail for all funding sources. Some congregate meal recipients were surveyed by AAASWFL face-to-face on site. Of the 50 surveys mailed, 18 (36%) were completed and returned to AAASWFL. All clients stated that they were satisfied with case management services and survey questions yielded mostly positive results. The area with the lowest satisfaction rating had to do with the amount of hours needed each week to provide in home services. This is based on funding availability and was an area of need in all counties surveyed. Overall, the clients were satisfied with the services provided by CCHS. There were no specific areas of concern to address at this time. Collier County Monitoring Report 2019 Page 4 of 8 Prioritization and ADRC Outsourced Functions (This section of the report provides the number of referrals from the AAASWFL to CCSS that were authorized for an in-home assessment (701B).) Assessments are completed within the required 14 business day time frame in Collier County. Services are also implemented within 14 business days of the 701 B. CIRTS is updated appropriately. CCSS has done a good job following prioritization and assessed prioritization consumer list protocols implemented by the AAASWFL. They have also been successful in referring potentially Medicaid eligible clients back to AAASWFL for waitlist placement. Outcome Measures (This section of the reportprovides an analysis of measures based on the assessments of active clients and the changes that take place between annual assessments) The date range for CCSS Outcome Measure reporting for the 3rd quarter was January 1, 2019 — March 31, 2019. In the 3rd quarter, five outcome measures were monitored for CCSS: IADL, Environmental, Caregiver Ability, APS Referrals Receiving Services Within 3 Days, and ADL. CCSS exceeded the standards in IAD, Caregiver Ability and ADL categories. There were no measurable outcomes for the Environmental and APS Referrals Receiving Services Within 3 Days categories. Collier County Services for Seniors Legislatively Mandated Outcome Measures January 1, 2019 - March 31, 2019 100.0% 7s.a,A so.o% zs.05A 0.0% - — ni. Environmental Caregiver Ability APS Referrals ADL Receiving Services Within 3 Days Performance —*--Standard Collier County Monitoring Report 2019 Page 5 of 8 The date range for CCSS Outcome Measure reporting for the 4r" quarter was April 1, 2019 — June 30, 2019. In the 4t" quarter, five outcome measures were monitored for CCSS: IADL, Environmental, Caregiver Ability, APS Referrals Receiving Services within 3 Days, and ADL. The CCSS exceeded standards in the IADL and Caregiver Ability categories. There were no measurable outcomes for the Environmental and APS Referrals Receiving Services Within 3 Days categories. The standard for the ADL category was not achieved due to declining client health and enrollments in the Medicaid Long -Term Care Program. Explanations were provided. Collier County Services for Seniors Legislatively Mandated Outcome Measures April 1, 2019 - June 30, 2019 100.0 7s.0•,6 S0.0% 25.0% 0.0% SAM Environmental Caregiver Ability APS Referrals Receiving ADL Services Within 3 Days Performance +Standard CIRTS Data Integrity (The section of the report pertains to the maintenance, accuracy, and consistency of data as it relates to CCSS. This information is derived from CIRTS reports and file reviews.) In 2018, the AAASWFL implemented new CIRTS reporting procedures for all lead agencies. CCSS has consistently met due dates with this procedure and there have been no monthly errors. In addition, the AAASWFL Programs Department runs monthly reports to ensure accuracy of client data within the CIRTS system. Overall, CCSS reports rarely require follow up. Collier County Monitoring Report 2019 Page 6 of 8 Sub -Contractor Oversight (This section of the report provides verification of completion of the CCE/OAA Vendor Monitoring & Reporting.) All CCE and OAA vendor monitoring was completed as required through a Shared Monitoring Agreement. All vendor monitoring activities, reports, and applicable corrective action follow-up documentation were completed and submitted on time. PROGRAM COMPLIANCE Nutrition Compliance (This section of the report provides an overview of CCSS Meal Site Monitoring Visit and Documentation Reviews.) CCSS operates four meal sites in Collier County. Meals meet the standards of the Department of Elder Affairs and priority is given to older adults and adults with disabilities with the greatest economic/social need. Meal sites are accessible and located in areas with a high level of need. Equipment is sufficient and fire, health, safety and sanitation standards are met. Documentation for home -delivered meals and all congregate meal sites is completed, received promptly and in accordance with the AAASWFL's document submission schedule. The Area Agency on Aging for Southwest Florida program staff visited the Golden Gate Senior Center meal site on April 23, 2019. The meal site had approximately 58 attendees on the date visited. Food temperatures were within appropriate ranges on the date of the visit and documentation was readily available upon request. The site was in compliance in all areas reviewed. Also, activities including art therapy, dominos and Zumba classes were available for clients. Overall, CCSS manages exemplary nutrition programs that are in compliance with Older Americans Act requirements. File Documentation (This section of the report provides a snapshot of the most recent four quarters of file reviews leading up to the annual monitoring for CCSS File Reviews by the AAASWFL.) This file review period is from September 2018 - June 2019. The Area Agency on Aging for Southwest Florida conducts quarterly file reviews of random samplings of client files to monitor data accuracy, program requirements and case management activities. A review of 16 files yielded five errors during this monitoring period. Errors varied and there were no specific areas of concern. Quarterly error rates remained well under the error rate threshold. Errors were corrected immediately. Collier County Monitoring Report 2019 Page 7 of 8 Collier County Services for Seniors File Review Error Rates 3 25 2 1.5 1 0.5 ® ■ 0 r 3rd Quarter 2018 4th Quarter 2018 1st Quarter 2019 2nd Quarter 2019 Performance Threshold Adult Protective Services (This section of the report protides an annual snapshot of rhe APS referrals processed by COS.) During the January 1, 2018 — December 31, 2018 timeframe, one high-risk referral was accepted by CCCS. The high-risk referral was accepted within the required time frame. There were no issues or concerns in this area. Low and Intermediate referrals are handled internally by AAASWFL. EXIT INTERVIEW No Exit Interview was conducted due to no areas of concern or findings. Signatures: ( /'(22a�2 AnKa Woo Program Specialist 6� I Date Am Bryan, grogram S ialist Date Collier County Monitoring Report 2019 Page 8 of 8