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RAPPAHANNOCK RAPIDAN COMMUNITY SERVICES

Serving the Counties of Culpeper, Fauquier, Madison, Orange, and Rappahannock

Board of Directors

Regular Meeting July 12, 2016

NOTE: To navigate this document, click on items in the Table of Contents to be taken to supporting documents in the package.

TABLE OF CONTENTS

Board Meeting Information Page # Board of Directors Meeting Agenda July 12, 2016 2 Board of Directors Called Meeting Minutes June 28, 2016 4 Executive Director Report July 12, 2016 6

Board Meeting Informational Content Page #

Board Member Reimbursement Form 12 Comprehensive (Children’s) Service Act (CSA) 13 Access to Acute Psychiatric Care Report 14 Strategic Plan 18 Settlement Statements 31 Rapid Access Implementation Summary 35 Volunteer Hours Report 43 Other Informational Content

• HPR-1 Emergency Services Report Summary 45 • Bowl for Seniors Thank You Letter 46 • Chronic Disease Self Management Program Newsletter - July 47

Other Meeting Minutes Page # Administrative Services Committee June 28, 2016 49 Aging Services Advisory Council June 21, 2016 51 Development Committee June 14, 2016 54 Executive Committee June 7, 2016 56 Planning & Development Committee Meeting June 13, 2016 59 Program Committee June 28, 2016 68 Senior Management Team, 1st Bi-Monthly Meeting June 14, 2016 71 Senior Management Team, 2nd Bi-Monthly Meeting June 29, 2016 79

Board Member Resources / Development Content Page # Board Members and Terms 86 Senior Management Team Roster and Useful Websites 87 Board & Administrator Newsletter 88

Board Chair

E. Alan Anstine Culpeper County

Executive Director

Brian Duncan [email protected]

Director, Aging and

Transportation Services Ray Parks

[email protected]

Director, Clinical Services Ryan Banks

[email protected]

Director, Community Support Paula Stone

[email protected]

Director, Finance and Administration

Anna McFalls [email protected]

Administrative

Assistant Laura Wohlford

[email protected]

P.O. Box 1568 Culpeper, VA 22701

(540) 825-3100 www.rrcsb.org

RRCS does not discriminate on the basis of race, color, national origin, sex, religion, age, disability, or any other characteristic protected by law, in employment matters and in its programs and services.

Rappahannock-Rapidan Community Services

Regular Board Meeting July 12, 2016 at 1:00pm

AGENDA

1. Call to Order — Board Chair, Alan Anstine

2. Moment of Silence

3. Agenda Review — Board Chair, Alan Anstine • Additions/Deletions • Adopt

4. Board Chair Remarks / Announcements

5. Public Comment

6. Corrections / Review / Approval of Minutes

• Board Meeting Minutes (page 4)

7. Executive Director Report (page 6) • Report

8. Closed Session — Not Scheduled

9. Committee Reports to the Board of Directors

• Executive Committee: Chair’s report (page 56) o Action: None

• Program Committee: Chair’s report (page 68) o Action: None

• Administrative Services Committee: Chair’s report (page 49) o Action: Approval of three new position classifications – Mobility Specialist; Auxiliary Program

Specialist (PT); and Lead Cook/Boxwood • Development Committee Meeting: Chair’s report (page 54)

o Action: None 10. Other Business 11. Announcements (members and staff)

12. Call to Adjourn

RRCS – Agenda Page 2 July / August 2016 Meeting Schedule

Date Time Committee Location July 12, 2016 1:00pm Board Meeting Board Room, 2nd Floor

August 2, 2016 9:00am Executive Committee Conference Room B

August 23, 2016 9:30am Program Committee Board Room, 2nd Floor August 23, 2016 11:00am Admin Services Committee Board Room, 2nd Floor

Other: Notes:

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Committee Assignments for 2016

Executive Committee Admin Services Committee

Development Committee

Program Committee

Alan Anstine (C) Elizabeth Blubaugh Sarah Altman Mary Lou McFarland Robert Legge (VC) Pat Balasco-Barr (S) Mary Lou McFarland All RRCS All RRCS

Demaris Miller

Rappahannock-Rapidan Community Services

Called Board Meeting June 28, 2016 at 1:00pm

MINUTES

Members Present: Sarah Altman, Alan Anstine, Pat Balasco-Barr, Elizabeth Blubaugh, Marcia Brose, Bonita

Burr, Paula Howland, Christina Kearney, Clare Lillard, Mary Lou McFarland

Members Excused: Elizabeth Davis, Robert Legge, Demaris Miller, Robert Weigel

Staff Present: Brian Duncan, Ryan Banks, Anna McFalls, Ray Parks, Laura Wohlford

Guests Present: Jenny Biché, Jackie Dare, Eileen Peet

1. Call to Order — Board Chair, Alan Anstine Alan Anstine called the meeting to order at 11:05pm.

2. Moment of Silence Alan Anstine called for a moment of silence.

3. Agenda Review — Board Chair, Alan Anstine • Additions/Deletions

There were no additions or deletions to the Agenda.

• Adopt ACTION: Paula Howland moved to adopt the agenda as presented. Marcia Brose seconded the motion. There

being no further discussion, the Board voted unanimously to approve the agenda as presented.

4. Board Chair Remarks / Announcements Alan Anstine, Chair, asked for comments from the public for the budget. Jenny Biché, Rappahannock-Rapidan Regional Commission, indicated that the CSB and AAA do a phenomenal job given the amount of funding received. She remarked that staff go above and beyond, showing up for events, working after hours, etc. She requests that RRCS make an effort to invest more in its employees in the future. Eileen Peet, Chair of the Aging Advisory Council, requested volunteers for the Council and thanked the CSB for their assistance and participation in the Division’s activities and fundraisers.

5. Public Hearing: Comments on the RRCS Fiscal Year 2017 Program Plan A Public Hearing was advertised for this meeting for public comments to the following:

• Fiscal 2017 Program Plan for Mental Health, Intellectual Disability, Substance Use Disorder, and Aging Services

• Department of Behavioral Health and Disability Services Performance Contract and Virginia Department of Aging and Rehabilitative Services/Virginia Division for the Aging Area Plan

6. Corrections / Review / Approval of Minutes

• June 14th Board Meeting Minutes ACTION: Marcia Brose moved to approve the June 14th Minutes as presented. Paula Howland seconded the

motion. There being no further discussion, the Board voted unanimously to approve the June 14th Minutes as presented.

7. Executive Director Report (page 13)

• Presentation of Fiscal Year 2017 Budget and Program Plan Brian welcomed the public attendees. Brian presented the Budget and Program Plan. He commented that this is a relative high-level summary of the budget. This is similar to what is presented to the local boards of supervisors. Questions/Discussions: What are some of the “extra services” that localities ask us to provide? Response: For example, Culpeper asked that we provide jail-based and probation/parole-based services. This is not a priority at the state and federal level, so Culpeper funds the service. Over the past several months, we have heard proposals about staff reductions, as well as benefits and salary reductions. At the last meeting, it was suggested that we should look at other options for reductions. This will not have a large impact, but as a board, we should look at what we can do. Can board members consider returning or not taking their stipends? Can we forego mileage reimbursement? Do we need this expansive meal spread at each meeting? Elizabeth asked that board members attend the golf tournament dinner as a group; maybe we pay for our own dinner so more funds could be applied to our programs. These gestures would indicate to staff that we are not indifferent to the sacrifices employees are making. These measures would be voluntary for board members.

8. Action on Fiscal Year 2017 Budget and Program Plan ACTION: Pat Balasco-Barr moved to approve the Fiscal 2017 Budget and Program Plan as reviewed and

presented. Paula Howland seconded the motion. There being no further discussion, the Board voted unanimously to approve the Fiscal 2017 Budget and Program Plan

9. Other Business

There was no other business

10. Announcements (members and staff) There were no announcements

11. Call to Adjourn The meeting adjourned at 12:55pm.

The next meeting will be on July 12 at 1:00pm.

Rappahannock Rapidan Community Services Executive Director Report

July 2016 1. Board Member payment and reimbursement options

In your package (page 12), I have included the form used by members to designate their choices specific to member payments. The form has been included based on discussions at your last meeting and can be used to update your preferences if desired. Last year we changed the member annual payment from $600 to $599 so that IRS reporting would not be required for members accepting the payment. As a reminder member payments are allowed under Virginia law specific to Community Services Boards. http://law.lis.virginia.gov/vacode/title37.2/chapter5/section37.2-503/

Notes:

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2. Bridges Construction Project

I am pleased to report that on July 5 our Bridges project closed and a pre-construction conference was held. The General Contractor will be mobilizing this week and beginning site work. Under their schedule, the building will be complete next spring (April / May). While construction is taking place, we will begin the process of program transition planning. I am certain that we will be moving Fauquier Bridges into the new building first since that location is current being renovated for a new brewery operation in downtown Warrenton. http://www.worthogbreweryllc.com/

Notes:

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3. Culpeper Senior Center and Culpeper Behavioral Health Projects - Updates

Both projects continue on schedule without major concerns. We will schedule another board visit to both sites possibly at the Program Committee time for either August or September when both projects will be nearing completion.

Notes:

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http://law.lis.virginia.gov/vacode/title37.2/chapter5/section37.2-503/

http://www.worthogbreweryllc.com/


July 2016 4. Crisis Intervention Team Assessment Site Planning

We have started our planning and implementation efforts for the new CIT Assessment Site aimed at becoming operational by October 1, 2016. Two of our staff (Kristi South, CIT Coordinator, and Melanie Sheppard, Senior Clinician in Crisis Services) are taking the lead in working with hospital staff on this development. Our CIT Steering Committee will be meeting in late August to review and discuss where we are at that point in our development plans.

Notes:

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5. Update on County Forums with Board Members

All County forums will be completed during the week of July 11. At our meeting, we will discuss our best follow-up summary for these meetings leading up to our local funding request for Fiscal 2018.

Notes:

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6. Comprehensive (Children’s) Services Act (CSA)

You will often hear us talking about CSA and local teams known as Family Assessment and Planning Team (FAPT) and Comprehensive Planning and Management Teams (CPMT) as vehicles for the review and funding of local children’s services. These teams form the core of program review and pooled funding going to support children’s services in each of our localities (and statewide). Each County has a sizable contribution coming from County funds for CSA and some RRCS services are paid for out of local CSA funds. On page 13 of your report, you will find a brief summary of how all of this works that you may find helpful in understanding this process. RRCS has staff attending and participating in all local FAPT and CPMT’s in our region. This staffing support comes through our Clinical Services Division.

Notes:

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July 2016 7. RRCS Bowl for Seniors, upcoming Golf Tournament

Thank you to all of you who supported our bowling event which raised approximately $8,900. We are now gearing up for the Golf Tournament scheduled for July 22.

Notes:

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8. Access to Acute Psychiatric Care

I have recently talked to you about pressures mounting in State Psychiatric facilities over increased utilization and a shortage of beds. During the past year, utilization of State Hospitals as “last resort placements” has grown dramatically and is a cause for concern. On pages 14 to 17, you will find data for our region (us and 7 other CSBs) on how much we have spent on the purchase of private hospital beds since July 1st last year ($1,249,263). You will also find information on RRCS as compared to other CSBs in our region for Emergency Custody Orders (ECOs) and Temporary Detention Orders (TDOs). In Virginia, if a private hospital bed cannot be found within the allowed time frame (8 hours) then the State Hospital must accept the admission. These “last resort” placements to State hospitals have grown dramatically over the past year which is a growing concern. RRCS placements take place at Western State Hospital in Staunton.

Notes:

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9. Updated Strategic Plan

Our Planning and Development Workgroup has recently met and, among other things, has updated our agency Strategic Plan. The updated plan in provided for your information on pages 18 to 30. We update this plan every six months and it should include any major initiatives of the organization.

Notes:

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July 2016 10. Settlement Statements: Land at Elkwood and RD Construction Loan

In your report (pages 31 and 32), you will find two HUD-1 Settlement Statements for transactions that were completed on July 5. One involves our purchase of the 6-acre lot in Elkwood for the construction of our new Bridges building and the other our closing for the Bridges construction project. We now begin construction, during which time funds will be drawn down to pay for the construction activities over the next 9 to 10 months. Following construction close out, we will begin normal debt service next summer. When funds were originally committed to this project almost three years ago, interest rates were at 4.25% while at closing the rates to be applied are at 2.75%. This is a substantial savings to us and will mean our debt service obligations will be less than we currently spend on rent. Alan Anstine and Pat Balasco-Barr participated in the closing (as you Chair and Secretary) and stayed to attend the pre-construction conference held with the Architect and General Contractor.

Notes:

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11. Rapid Access Implementation in Culpeper and Warrenton

On pages 35 to 42, I have included a summary and update on our implementation of Rapid Access in our two outpatient offices. I have been using this with organizations I have been meeting with to provide information and address community questions. It provides a good overview of our new program of access with detailed information about fee assessments and what happens at our initial intake for services. This is a dramatic shift in our delivery of nonemergency outpatient services and more responsive to referral sources and individuals seeking help.

Notes:

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July 2016 12. Report on volunteer hours for RRCS

Some of you will recall that we discontinued our role as a sponsoring organization for the Retired and Senior Volunteer Program (RSVP) over a year ago. Despite that change, we continue to benefit from the work of volunteers in a number of areas in the organization as reflected on a recent monthly report you can see on page 43. This report details the many hours of work that benefit our programs and seniors.

Notes:

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13. Executive Director Goals

a. Project development completion and oversight of capital projects at the Culpeper Senior Center, Culpeper Behavioral Health and Bridges consolidation project.

i. July: 1. Culpeper Senior Center: see above 2. Culpeper Behavioral Health: see above 3. Bridges Consolidation: see above

b. Complete a review of the Executive staff structure for distribution of responsibilities and capacity. Reviewed is aimed at improved outreach, community education and development and capacity of current structure. Provide a report the Board of Directors by September 2016. Interim reporting and feedback on this goal will come from the Executive Committee.

i. July: On August Executive Committee agenda c. Plan County forums to target elected officials and County Administrators for review

of agency priorities and local funding needs. i. July: Last two meetings are scheduled to complete in July.

d. Leadership and oversight of ID Services transition to Virginia’s new waiver design starting in July 2016. Provide regular updates to the Board on critical issues and impact on ID programs and funding.

i. July: No current update, implementation of new waiver design was moved up to August 1.

e. Leadership and oversight of Outpatient and psychiatric services transition. Provide regular updates to the Board on critical issues and impact on behavioral health services programs and funding.

i. July: Rapid access program has started, see above for summary report.


July 2016

Notes, Comments, Questions from online content:

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BOARD MEMBER PAYMENT PREFERENCE FORM

Revised August 2015

Name: County: Fiscal Year: 2017 The Code of Virginia provides for board member compensation up to an annual amount of $600 per year (board members may also be reimbursed for certain expenses in addition to this amount by completing an expense reimbursement form). During its regular meeting in September 2015, the board voted to change the annual reimbursement amount to $599, effective in calendar year 2016. This payment is requested from each County and, if approved, is then paid to members. During its regular meeting in December 1993, the board voted to request this compensation amount from the Counties as part of its ongoing funding request. Please indicate your instructions for the disbursement of these funds.

I would like quarterly payments of $150 paid in March, June, and September with a final payment of $149 paid in December ($599 total payment).

I would like an annual payment of $599 paid during December.

I do not want an annual payment and desire that the funds be utilized in the general operating budget.

Once compete, payments will be made to members automatically unless otherwise directed by Board action. Payments will only be made during active, appointed terms. Signature Date

Original on file in Finance and Administration Services cc: Board Member File

Updated July 2016

Rappahannock Rapidan Community Services 2016–2018 Strategic Plan

Introduction The Strategic Plan is built on the RRCS mission and inputs from stakeholder groups including consumers, family members, elected officials, other agencies, employees, and funding sources. The overall objective of the plan is to function as an input tool to shape day-to-day operations and future planning in a way that brings the greatest efficiency to service delivery within available resources. The plan is built on eight governing principles with supporting goals. The Board of Directors updates the Strategic Plan on the same timeline used for annual budget development. Progress on goals is reviewed every six-months and reported on in the Annual Report.

Mission Statement The mission of the RRCS is improve the quality of life of the citizens of Planning District 9 (counties of Culpeper, Fauquier, Madison, Orange, and Rappahannock) by providing comprehensive behavioral health, intellectual disability, substance use disorder, and aging services. The vision is to have quality define our services, our practices, our behaviors, and our outcomes.

Principle A: Ongoing commitment to sustaining successful existing programs A considerable amount of the agency resources are aimed at maintaining and strengthening existing services that are meeting local needs. Meeting this principle means making sure the day-to-day needs of existing services, operations, and facilities are addressed.

1) Identify property for potential use for a combined Bridges Rehab facility and regional

transportation activities. (added July 2013) a) December 2013: Property identified, evaluated, and placed under contract. b) December 2014: Planning continues. Project plans and specifications are 70%

complete. Board Committee formed to monitor through to completion. c) July 2015: This is on track for construction to begin late 2015. Planning

documents have been submitted to the Culpeper Planning Department for a building permit. The property will be acquired this fall and project construction should begin shortly thereafter.

d) March 2016: Project is in final stages of development prior to construction which should begin early summer. Bids have been released.

RRCS 2014–2016 Strategic Plan

2 of 13 Updated July 2016

e) July 2016: Project has been awarded and construction is scheduled to begin in July for completion in mid-2017. Program transition planning will begin on the same schedule.

2) Review and strengthening of Intellectually Disabled (ID) Services for programs,

structure, and funding. (added December 2014) a) December 2014: Considerable changes are anticipated over the next 12 – 18

months focused on conflict of interest free case management, implementation of new rate structures for ID services, and opening of two new group homes. A staff work group will be formed to analyze impacts, challenges, and opportunities to plan on this changes.

b) July 2015: The final rule survey is complete and revised policies governing support coordination services are in final review as of this writing. A transition plan for ID residential services is currently being implemented aimed at completion prior to the implementation of Virginia’s new waiver design. The two new group homes will be transitioning their services to fit within the structure of the new waiver design.

c) March 2016: Final preparations are being made for the implementation of waiver re-design. Group home schedules have been restructured, one program has been consolidated into others and skilled nursing services have been developed for high need individuals in care. Currently negotiating with DBHDS on specific rate per diem modifiers for high needs individuals.

d) July 2016: Preparations for waiver redesign are completed. Will be assessing overall impact of redesign and new site and conflict free rules through-out FY 2017.

3) Outpatient and Psychiatric Transition (added July 2015)

a) July 2015: Outpatient and psychiatric services will begin a transition to overall shorter term services with longer term services limited to those with serious mental illness and in need of ongoing therapy and/or psychiatric support. The aim of this objective is to focus clinical and medical resources to those most in need, while limiting other services to shorter term, rapid access models of service delivery.

b) March 2016: A contract with MTM consulting has been initiated to move the overall outpatient system to a rapid access model within the next 6 – 8 months. Specific training (Daily Living Assessment – DLA) is being provided to staff to better define length of care needed. Telepsychiatry is being developed for adult populations that are more stable.

c) July 2016: Clinicians and Support Coordinators have been trained on Daily Living Assessment tool for service assessment and planning. Rapid Access has been initiated for Tuesday – Friday: 8:30 – 11:00. Telepsychiatry contract negotiation completed with new adult services planned for FY 2017.



4) Nutrition Services (added July 2015) a) July 2015: Assess trends and development of nutrition services including

differences between counties and evaluate feasibility for fee-for-services programs.

b) March 2016: Focus in nutrition services has been initiated around changes to liquid supplements. Division has used this as an opportunity to review and better define eligibility criteria and mission of RRCS nutrition programs as well as to transition a portion of the program to fee-for-service.

c) March 2016: Evaluating future fee-for-service/Home Delivered Meals potential for new Village Models in Orange and Rappahannock Counties.

d) July 2016: Continuing to evaluate fee-for-service Home Delivered Meals potential locally as well as part of AAA Statewide Network learning collaborative to develop long term care (MLTSS) service packages.

5) Chronic Disease Self-Management Programs: (Added March 2016) Seeking alternative

funding for sustainability following the expiration of DARS grant. a) July 2016: Significant program growth with outreach and multiple workshops

scheduled; increased emphasis on diabetic self-management. New DARS/PPHF grant funding is pending.

6) Virginia Respite Care Initiative: (added July 2016)

a) RRCS contract with DARS for this service has been extended to 9/30/16. RRCS has completed application requirements for continued funding.

Principle B: Initiatives designed to develop needed new services and resources The organization desires to maintain vigilance in its advocacy and application for new sources of revenue to support new services to address local needs. Meeting this principle means having specific projects that are aimed at new resource development on an ongoing basis.

1) Launch initiative to develop new case management services for children with serious

emotional disturbance and at-risk with local Head Start programs. (added July 2011) a) December 2011b)

: Initiative launched at start of Fiscal 2012. July 2012

c)

: Initiative in full operations now in three of five localities with development plans in the other two. Have also added a Collaborative Care Program in conjunction with local pediatric offices. December 2012

d)

: Program is planning expansion into Fauquier and Culpeper in Head Start and other settings. July 2013: Program continues to play a key role in region for children’s services. Focus now is on stability and study of best ways to develop program further to meet local needs.



e) December 2013

f)

: Focus is now on program stability and management support during transition to electronic health records. Consider closing this as a goal during next review. December 2014

g)

: Goal continued with focus placed on expansion into Head Start programs in other localities. July 2015

h)

: This goal is continued with a focus to expand both Head Start and pediatric office programs into Fauquier County. March 2016

i)

: Both Clinical and Community Support Divisions are working together in approaching interested pediatric clinics for children’s Support Coordination services. July 2016

: Children’s Behavioral Health Support Coordinators have been trained in the Parent Café Model and will also be starting to provide “Too Good for Drugs” groups in the schools starting with Orange County in September 2016.

2) Further develop Intellectually Disabled Children’s Case Management in conjunction with existing Infant Toddler Connection program of RRCS and local schools. (added July 2012) a) December 2012

b)

: Program has been successfully rolled out to schools and is meeting goals for Fiscal 2013. July 2013

c)

: Program continues to be successful and its role will be studied along with other children’s services during the next six months. December 2013

d)

: Program continues as core component of service system, stable and growing. Consider closing as goal during next review. December 2014

e)

: Development in this continues with new services expanding into case management for +3 children. July 2015

f)

: This objective continues and the oversight of this activity has been moved to the Community Support Division. March 2016

g)

: Community Support manages this initiative now with goals of improved ties to schools and potential for adding DD Support Coordination to an area of responsibility for CSBs. July 2016

: All DD CM services transitioning to CSBs in July 2016 with full completion by 12/1/2016. RRCS offering contracts for existing providers under some circumstances and will contract with one community provider to allow for consumer choice going forward.

3) Collaboration with Free Clinic in Fauquier to provide support (supervision) to student interns to see indigent clients with mental health issues. (added December 2012) a) July 2013

b)

: Agreement has been signed and an intern has been identified for this to begin in the fall of 2013. December 2013

c)

: Services have begun and project will be evaluated as to effectiveness. December 2014: First intern process for this is complete and deemed successful. A new intern is currently being considered so that this activity can continue.



d) July 2015

e)

: This is ongoing and we would like to expand this into Culpeper and Orange. March 2016

f)

: Free Clinics are now able to attract licensed professionals to volunteer for some nonemergency outpatient services which has significantly helped. Fauquier Free Clinic, in collaboration with the Mental Health Association, local pediatricians, RRCS and others is evaluating integrated care and telepsychistry. July 2016

: RRCS has continued as part of the planning collaborative in Fauquier County for integrated care services through the Free Clinic of Fauquier. No new students are being placed at this time.

4) Seek local funding support for improvements in outpatient services aimed at improved access for nonemergency appointments, seeking to see people when they need to be seen. (added December 2012) a) July 2013

b)

: Regional appeal has been made and Fauquier County has signed on for a pilot project in Fiscal 2014. December 2013

c)

: Both Fauquier and Rappahannock County have funded a pilot project which was initiated on November 5, 2013. Project data will be collected and shared with both localities and the remainder of the region. December 2014:

d)

Project data has been shared with localities and deemed successful. Second year and continued funding is being requested. July 2015

e)

: This project continues in Fauquier and Rappahannock with continue local support. During the next review this will be incorporated into the overall transitions taking place in outpatient services. March 2016

f)

: We will be working to transition this funding support to help support our rapid access program development moving forward. July 2016

: Rapid Access in process of being implemented and funding request going forward will be regional and focus on sustaining rapid access for all localities.

5) Expansion of Boxwood Recovery Center to provide six beds of medically managed detox services. (added July 2013) a) December 2013

b)

: Direct service and clinical staff have been hired. Facility renovations are being completed and a start date for the service is imminent. Contract for medical oversight has been completed and final licensing will be done following completion of renovations. December 2014

c)

: Program operations have started and are being reviewed. Have met with medical staff and Department of Behavioral Health and Disability Services after six months of operations. Seeking ways to broaden program and increase utilization. Close monitoring and work within the region continues. July 2015

d)

: This is ongoing and includes weekly utilization monitoring. We are also pursuing medication assisted treatment for individuals in detox. March 2016: Identifying a medical provider for certain types of medication assisted treatment continues to be a challenge. Certain new detox protocols



have been developed and implemented but a lack of medical providers for both Boxwood and in the community plus funding continue to be a barrier. To sustain higher levels of overall utilization we are starting to accept individuals who fund their own placement (private pay).

e) July 2016

: Boxwood detox has started using Naltrexone for medication assisted withdrawal for opiates and alcohol.

6) Care Transition Initiatives (added July 2015) a) July 2015: Pursue development of hospital care initiative. Became charter

members of the Central Virginia Transitions Collaborative (CVTC). Follow-up on meetings with UVA Culpeper Hospital staff.

b) March 2016: We are working with UVA/Culpeper Hospital and Aging Together (applicant) on a grant application to the AstraZenica Foundation for a cardiovascular focus for Care Transitions, Chronic Disease Self-Management Education, and caregiver support groups.

c) July 2016: Partnering with the Virginia AAA Collaborative, a statewide network for care transitions and long term care services package development. We are active members of the Fauquier Readmissions Coalition.

7) Children’s Mobile Crisis (added July 2015)

a) July 2015: Develop local children’s mobile crisis capability in conjunction with overall region to respond to children in crisis resulting from intellectual disability, developmental disability, acute stress disorder and/or mental health issues.

b) March 2016: Two clinical staff have been hired, trained and began providing services in collaboration with Crisis Services.

c) July 2016: Services continue with successful outcomes with reduced hospital admissions for children and improved community-based crisis response.

Principle C: Responses to funding source and regulatory changes The organization is resilient, able to quickly adapt to external changes in its regulatory and funding environment. Meeting this principle means that the organization can respond to changing requirements without interfering with organizational stability.

1) Evaluate overall incident reporting system for RRCS operations and leading to

recommendations for unified, digital reporting system. (added December 2014) a) July 2015

b)

: This task has been assigned to one of the Quality Assurance staff for development over the next 9 to 12 months. March 2016

c) : Project has just initiated no specific updates at this time.

July 2016

: Preliminary work plan has been developed, meetings with stakeholders of process are planned in the next quarter.



2) Review and improve reporting to the Department of Behavioral Health and Disability Services on Community Consumer Submission (CCS) and Performance Contract indicators. Reports are now being required every quarter. (added December 2014) a) July 2015

b)

: We have functional collaboration between information technology and Quality Assurance (QA) for generating reports. There are some incomplete service items that have not been resolved, but these items are not part of CCS. IT and QA work together to identify data quality issues and follow-up with staff for education and corrections. March 2016

c)

: Workgroup continues work with monitoring CCS errors and tie in between Credible Electronic Health Record and CCS reporting. This workgroup will continue due to the changing nature of this issue and its importance to DBHDS reporting. July 2016

: Workgroup focus on data issues continue with emphasis on incomplete services. Many root issues are with the proper use of the Electronic Health Record so emphasis is being placed on superuser roles and training in support of their program staff.

3) Bridge Funding for Aster and Millfield Group Homes (added July 2015) a) July 2015

b)

: Develop plan to transition both new group homes from current bridge funding model to new waiver design funding model by July 1, 2016. March 2016

c)

: Transition plan is under development. Two meetings have been held with DBHDS to discuss two high needs individuals currently in care whose needs are not addressed under the new waiver re-design. July 2016

: Applications for revised rate structures for two individuals have been submitted to DBHDS, pending review and approval.

4) Implementation of Waiver Redesign: (added July 2016) Review of program procedures, practices, and reimbursement in view of new requirements under waiver redesign. Review of Support Coordination, Day Support / Employment, Residential.

Principle D: Initiatives to improve business process operations The organization is consistently seeking business process efficiencies and to strengthen its overall operational integrity. Meeting this principle means monitoring and reporting data that enables the Board and management to review the cost of doing business and target areas of improvement initiatives.

1) Evaluation of new software suite for accounting, HR and procurement. (added

December 2014) a) July 2015

b)

: This will be addressed in late fall 2015 or early 2016. Need to finish audit with new auditors first. Want to include human resources and procurement in system, not just accounting functions. March 2016: An RFP has been issued and vendors are currently demonstrating their products for a possible selection later in the spring / summer of 2016.



c) July 2016

: Formal negotiations are being conducted with vendor aimed at securing a new accounting / HR platform for implementation in FY 2017.

2) Overtime Review Workgroup to review causes of overtime and how best to manage overtime requirements. (added July 2015) a) July 2015

b)

: Workgroup has convened and has begun reviewing historic and current overtime data. March 2016

c)

: Workgroup has made specific recommendations about getting more accurate program staffing needs and the development of 3, full time floater positions in residential to help in overall management in residential programs. Workgroup has also drafted a standard, agency wide attendance policy. July 2016

Principle E: Initiatives for workforce development needs

: Agency attendance policies have been implemented and efforts continue to identify strategies to hire and retain employees. HR is tasked with analyzing and making recommendations specific to the new Federal overtime rules that become effective in December 2016.

The organization is committed to maintaining an effective workforce in the delivery of services to local citizens. Meeting this principle means that the organization has a consistent focus on initiatives to improve its workforce to better provide services.

1) Focus priority on maintaining a competitive overall benefits and compensation program to enable recruitment and retention of qualified staff. a) July–December 2008

b)

: Workforce Development and subgroups met to evaluate and develop recommendations for strengthening agency benefit programs. January – December 2009

c)

: A benefits consultation RFP has been advertised and received. Responses are currently under review by staff. January – June 2010

d)

: The benefits RFP was reviewed. After consideration the decision was made to not proceed with the consultation. July – December 2010

e)

: Competitive health benefits were maintained for employees in Fiscal 2011. December 2010 – December 2011

f)

: Focus on benefits and compensation continues. Ongoing concerns over inability to sustain across-the-board increases for staff have been expressed by board. Management and staff are reviewing compensation and strategic methods of increasing revenue with certain classifications to better support overall increases in the future. Improved benefits have been recommended and approved related to annual leave, medical leave and retiree benefits. July 2012: Considerable work was completed and changes implemented related to employee health insurance (increased) Virginia Retirement System (per General Assembly) plus both a one-time payment and an across-the-board salary



increase for all staff in July 2012. Work remains to be done on career ladders and a planned benefit study for the fall of 2012.

g) December 2012

h)

: Benefit consulting firm has been engaged and is bidding employee health insurance and reviewing all employee benefits for possible recommendations. July 2013

i)

: Organization implemented major health benefits change with assistance from consultant and will continue to engage firm for assistance with implementation of the Affordable Care Act and new requirements for disability programs from Virginia Retirement System. December 2013

j)

: Organization making preparations for transition to Virginia Retirement System hybrid plans and disability programs for January 2014. Using benefits consultant to evaluate changes to existing policies and requirements of new programs for employees. December 2014

k)

: Organization initiated full classification review to be completed by spring 2015. July 2015

l)

: Classification review is pending completion. Added benchmarking to requirement, which still needs to be completed. March 2016

m)

: Classification and benchmarking project have been completed. Recommendations will be incorporated into Fiscal 17 planning as feasible with available funding. July 2016

: Classification revisions and benchmarking results are planned for implementation on July 1, 2016.

2) Workforce Development: Wellness Programs (added July 2015). a) July 2015

b)

: Wellness programs and biometric screening is ongoing and has been well received by employees. March 2016

c)

: Wellness programs are planned for FY 2017 with stronger incentives for employee participation (premium rate reductions) July 2016

: New wellness initiative with incentives has been implemented as part of open enrollment for FY 2017 benefits program.

3) Workforce Development: Professional Enrichment and Enhancement Program (added July 2015) a) July 2015

b)

: Look at developing career ladders and mentoring opportunities for certain positions. March 2016

c)

: PEEP program has been developed and launched with three enrollees. July 2016

: Three staff have successfully completed program and graduated with excellent feedback provided.

4) Workforce Development: Employee Recognition Program (added July 2015) a) July 2015: Implement the recently developed employee recognition program

including an employee newsletter.



b) March 2016

c)

: Program is being marketed within the organization and four people have received recognition and awards. July 2016

Principle F: Initiatives for short- and long-term capital needs

: Recognition program has been well received through-out organization and continues.

The organization plans for both short-term operational needs and long-term capital needs through planning and needs assessment. Meeting this principle means assessing and prioritizing funds for capital expenditures on an ongoing basis.

1) Identify alternatives for expansion of capacity in both the Culpeper and Madison Senior Centers. (added July 2011) a) December 2011

b)

: Preliminary feasibility analysis completed in Culpeper and fund raising initiative in Madison is moving rapidly to its established goal. July 2012

c)

: Culpeper project has moved to formal fund raising and Madison project is currently under development. December 2012

d)

: Fund raising and development has moved quickly forward for both Madison and Culpeper. In Madison construction for expansion has started and in Culpeper a very successful fund campaign has been held and formal request have been made to local government. July 2013

e)

: Madison project should be completed within the next 60 days. Culpeper project continues with local government support and preparation for a grant application. In Madison volunteers will be asked about future interest for priorities for Nest Egg proceeds. December 2013

f)

: Madison project being completed and an open house will be planned. Next priorities for Nest Egg proceeds are being considered by RRCS and volunteers in Madison. Grant letter to Weinberg Foundation for Culpeper Senior Center is being submitted and Fund Raising Committee is continuing to sponsor events for support. December 2014

g)

: Culpeper project planning its final funding push for the winter of 2015 with hopeful start-up in the summer of 2015. July 2015

h)

: Culpeper Senior Center building permit applied for, project should go out to bid in the fall of 2015. March 2016

i)

: Senior Center project has been started with a projected completion in August 2016. July 2016: Senior Center project continues on schedule. Fundraising committee continues with a focus on furnishings for new space.



2) Conduct facility needs assessment for a report to the Board of Directors by June 2012. (added December 2011) a) July 2012: Capital plan developed and approved by Board. Feasibility Studies

are in process for potential funding in fall 2012. Studying both intellectual disability rehab facility needs and office space needs for outpatient services.

b) December 2012: Two capital projects submitted to Rural Development for funding. One for the adaptive reuse of the old Boxwood building and one for a consolidated Bridges location in Culpeper.

c) July 2013: Both projects continue in their development with next steps being presentations and discussions with local governments.

d) December 2013: All critical elements of capital plan have funding sources. Attention now will be on managing project development factors and fiscal planning for facilities over the next two years.

e) December 2014: Board subcommittee has been formed for final analysis of both projects that are now moving into final development stages prior to construction.

f) July 2015: Following review, the Bridges project will move forward for full development and the Boxwood project was cancelled due to concerns over ability to service debt without program reductions.

g) March 2016: Bridges project goes to bid in March 2016 with construction start-up anticipated in summer 2016. Culpeper Behavioral Health renovations have been specified, bid, and awarded for work to begin. A partnership has been formed with Genoa Pharmacy to a 450 square foot addition to the building for an onsite pharmacy.

h) July 2016: Bridges project starts construction in July. Culpeper Behavioral Health renovation on schedule.

3) Enterprise vehicle leasing program to provide regular replacement of fleet vehicles that

do not offer wheelchair accessibility (added July 2015) a) July 2015: Lease has been signed and initial shipment of new vehicles have been

received. b) March 2016: Lease program working well and will be expanded in FY 2017 to

replace all vehicles currently leased through the Virginia DGS program. c) July 2016: Plan for FY 2017 is being implemented as noted above.

4) Fauquier Behavioral Health Services Facility Needs Study (added July 2015)

a) July 2015: Grant received from the Fauquier Health Foundation and consultant hired. Work is ongoing.

b) March 2016: Interim report has been provided to the Foundation as to outcomes. County has expressed willingness to partner with Foundation and RRCS to review and potentially fund renovations to current location or pursue others depending on needs and feasibility.



c) July 2016: Path Foundation, Fauquier County and RRCS will partner in FY 2017 to complete a formal architectural / engineering documents for improvements and expansion of the Fauquier Behavioral Health offices.

Principle G: Initiatives based on local priorities The organization maintains strong ties to local communities and consistently tailors activities to address unique community needs. Meeting this principle means having consistent contact with community stakeholders to foster understanding of local priorities.

1) Initiate pilot project for Culpeper County for access services for individuals being

released from jail and those involved with criminal justice services. (added December 2014) a) July 2015: Project is ongoing and has been successful in getting rapid access for

individuals released from jails and jail-based support. Funding received for year two.

b) March 2016: Program continues to be successful and funding is being sought for year 3. Excellent feedback from locality on program results.

c) July 2016: Staff have begun conducting intake assessment in the jail pending release to enable individuals to immediately engage in services upon release.

2) Local provider expansion initiation for development of a medicated assisted treatment program (added July 2015) a) July 2015: Currently working with the National Association of Behavioral Health

and the American Association of Addiction Priorities. b) March 2016: Local workshops held with national experts. Low medical

community response and still working to enroll more local medical professionals to make medication assisted treatment a part of their practice. Also was key sponsor for regional conference on the opiate epidemic.

c) July 2016: Boxwood detox is providing for medication assisted treatment and withdrawal. Agency is participating in local forums for collaboration and sharing of program information.

Principle H: Develop and nurture critical partnerships The organization recognizes that as a provider of human services its success is linked to its ability to develop and maintain partnership collaborations with a wide variety of public and private entities within the local community. Meeting this principle means spearheading initiatives aimed at bringing interested parties together in productive coalitions.

1) Develop more formal relationships with both medical centers in the region for the provision of telepsychiatry and evaluations via Polycom. (added December 2014)



a) July 2015

b)

: This is ongoing, especially as it relates to the mental health and psychiatric transition program and seeking alternative sources for psychiatric services for RRCS clients. March 2016

c)

: Agency has entered into a contract with a telepsychiatry provider for both children and adult services. Children’s services have been initiated and adult services are preparing to start. July 2016

: Adult telepsychiatry services are slated to begin during the first quarter of FY 2017.

2) Provide active leadership towards the development of a regional Crisis Intervention Team (CIT). (added December 2014) a) July 2015: CIT Coordinator hired after a successful effort to get regional

participation in the program b) March 2016: CIT Leadership team has met and review recently held local

training for local program. New training sessions are scheduled and protocols are being developed.

c) July 2016: Three CIT training classes have been held and well attended / received. A funding application for a CIT Assessment Site has been submitted.

3) Reviewing terms of our Mobility Management agreement with Regional Commission in light of New Freedom grant funding sustainability and call center relocation to the renovated Culpeper Senior Center. (Added March 2016) a) July 2016: New Mobility Specialist position description has been developed to

match scope of work in FY 2017 and contract with Regional Commission. Relocation of call center / mobility specialist staff to dedicated office space within renovated Culpeper Senior Center is planned for October 2016.

File=bodsup/RRCSStrategicPlan2016_18

HUD-1 (3-86) RESPA, HB4305.2

OMB NO. 2502-0265B. TYPE OF LOAN:A.

1. FHA 2. FmHA 3. CONV. UNINS. 4. VA 5. CONV. INS.U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT

6. FILE NUMBER: 7. LOAN NUMBER:2016-57SETTLEMENT STATEMENT 8. MORTGAGE INS CASE NUMBER:

C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.

1.0 3/98 (2016-RRCSB.PFD/2016-RRCSB/39)

D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:

ELKWOOD DOWNS LIMITED PARTNERSHIP

Rappahannock-Rapidan Community Services Board 3186 Airway Ave.

P.O. BOX 1568 Costa Mesa, CA 92626

CULPEPER, VA 22701

G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTLEMENT DATE:Parcel A, 6.1165 acres John C. Bennett, Attorney at LawBrandy Station, VA July 5, 2016Culpeper County, Virginia PLACE OF SETTLEMENT

Parcel A, 6.1165 acres306 N. West Street

Rt. 676, Stevensburg Mag. DistCulpeper, VA 22701

J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:101. Contract Sales Price 799,304.00 401. Contract Sales Price 799,304.00

102. Personal Property 402. Personal Property

103. Settlement Charges to Borrower (Line 1400) 23.00 403.

104. 404.

105. 405.Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Seller in advance

106. City/Town Taxes to 406. City/Town Taxes to

107. County Taxes to 407. County Taxes to

108. Assessments to 408. Assessments to

109. 409.

110. 410.

111. 411.

112. 412.

120. GROSS AMOUNT DUE FROM BORROWER 799,327.00 420. GROSS AMOUNT DUE TO SELLER 799,304.00

200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:

201. Deposit or earnest money 25,000.00 501. Excess Deposit (See Instructions)

202. Principal Amount of New Loan(s) 502. Settlement Charges to Seller (Line 1400) 1,324.50

203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to

204. 504. Payoff First Mortgage

205. 505. Payoff Second Mortgage

206. 506.

207. 507. (Deposit disb. as proceeds)

208. 508.

209. 509.Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller


211. County Taxes to 511. County Taxes 01/01/16 to 07/06/16 912.53


213. REBATE per contract 559,513.00 513. REBATE per contract 559,513.00

214. 514.

215. 515.

216. 516.

217. 517.

218. 518.

219. 519.

220. TOTAL PAID BY/FOR BORROWER 584,513.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 561,750.03

300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:

301. Gross Amount Due From Borrower (Line 120) 799,327.00 601. Gross Amount Due To Seller (Line 420) 799,304.00( ) ( )302. Less Amount Paid By/For Borrower (Line 220) 584,513.00 602. Less Reductions Due Seller (Line 520) 561,750.03

303. CASH ( X FROM ) ( TO ) BORROWER 603. CASH ( X TO ) ( FROM ) SELLER 237,553.97214,814.00

The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein.

Borrower Seller_________________________________Rappahannock-Rapidan Community Services Board

_________________________________ELKWOOD DOWNS LIMITED PARTNERSHIP

( 2016-57 / 2016-RRCSB / 39 )

L. SETTLEMENT CHARGES

700. TOTAL COMMISSION Based on Price $ @ 0.00 % PAID FROM PAID FROM

Division of Commission (line 700) as Follows: BORROWER'S SELLER'S

701. $ to FUNDS AT FUNDS AT

702. $ to SETTLEMENT SETTLEMENT

703. Commission Paid at Settlement $14,113.44 COMMISSION P.O.C.

704. to

800. ITEMS PAYABLE IN CONNECTION WITH LOAN

801. Loan Origination Fee 0.00 % to

802. Loan Discount % to

803. Appraisal Fee to

804. Credit Report to

805. Lender's Inspection Fee to

806. Mortgage Ins. App. Fee to807. Assumption Fee to

808.

809.

810.

811.

900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE

901. Interest From to @ $ /day ( days %)

902. MIP TotIns. for LifeOfLoan for months to

903. Hazard Insurance Premium for 0.00 years to

904.

905.

1000. RESERVES DEPOSITED WITH LENDER

1001. Hazard Insurance months @ $ per month

1002. Mortgage Insurance months @ $ per month

1003. City/Town Taxes months @ $ per month

1004. County Taxes months @ $ per month

1005. Assessments months @ $ per month

1006. months @ $ per month



1100. TITLE CHARGES

1101. Settlement or Closing Fee to John C. Bennett, Attorney at Law PAID OUTSIDE CLOSING

1102. Attorney's Fee to Davies, Barrell, Will, Lewellyn & Edwards 500.00

1103. toTitle Examination1104. Title Insurance Binder to

1105. Document Preparation to

1106. Notary Fees to

1107. Attorney's Fees to

(includes above item numbers: )

1108. Title Insurance to Old Republic National Title Insurance Company(includes above item numbers: )

1109. Lender's Coverage $ 0.00

1110. Owner's Coverage $

1111.

1112.

1113.

1200. GOVERNMENT RECORDING AND TRANSFER CHARGES

1201. Recording Fees: Deed $ 23.00 ; Mortgage $ ; Releases $ 23.00

1202. City/County Tax/Stamps: Grantee Tax 0.00 Grantee Tax;;1203. State Tax/Stamps: Grantee Tax 0.00 Grantee Tax

1204. Grantor Deed Recording Tax to 799.50Clerk of the Circuit Court1205.

1300. ADDITIONAL SETTLEMENT CHARGES

1301. Survey to

1302. Pest Inspection to

1303. OUTGOING WIRE FEE to John C. Bennett, Attorney at Law 25.00

1304.

1305.

1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 23.00 1,324.50

By signing page 1 of this statement, the signatories acknowledge receipt of a completed copy of page 2 of this two page statement.

John C. Bennett, Attorney at LawCertified to be a true copy.Settlement Agent

HUD-1 (3-86) RESPA, HB4305.2

OMB NO. 2502-0265B. TYPE OF LOAN:A.

1. FHA 2. FmHA 3. X CONV. UNINS. 4. VA 5. CONV. INS.U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT

6. FILE NUMBER: 7. LOAN NUMBER:2016-57SETTLEMENT STATEMENT 8. MORTGAGE INS CASE NUMBER:

C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.

1.0 3/98 (2016-RRCSBLOAN.PFD/2016-RRCSBLOAN/4)

D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:

UNITED STATES DEPT. OF AGRICULTURE

RAPPAHANNOCK-RAPIDAN COMMUNITY SERVICES RURAL DEVELOPMENT

BOARD 1934 Deyerle Avenue Suite D

P.O. Box 1568 Harrisonburg, VA 22801

Culpeper, VA 22701

G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTLEMENT DATE:6.1165 ac. & 1.15 ac. John C. Bennett, Attorney at LawCulpeper County, VA 22701 July 5, 2016Culpeper County, Virginia PLACE OF SETTLEMENT

6.1165 acre on Rt. 676306 N. West Street

1.15 acre, Town of CulpeperCulpeper, VA 22701

J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:101. Contract Sales Price 401. Contract Sales Price

102. Personal Property 402. Personal Property

103. Settlement Charges to Borrower (Line 1400) 27,047.60 403.

104. CONSTRUCTION ESCROW to USDA, RURAL DEVELOPMENT3,791,000.00 404.

105. 405.Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Seller in advance




109. 409.

110. 410.

111. 411.

112. 412.

120. GROSS AMOUNT DUE FROM BORROWER 3,818,047.60 420. GROSS AMOUNT DUE TO SELLER

200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:

201. Deposit or earnest money 501. Excess Deposit (See Instructions)

202. Principal Amount of New Loan(s) 3,791,000.00 502. Settlement Charges to Seller (Line 1400)

203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to

204. 504. Payoff First Mortgage

205. 505. Payoff Second Mortgage

206. 506.

207. 507.

208. 508.

209. 509.Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller




213. 513.

214. 514.

215. 515.

216. 516.

217. 517.

218. 518.

219. 519.

220. TOTAL PAID BY/FOR BORROWER 3,791,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER

300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:

301. Gross Amount Due From Borrower (Line 120) 3,818,047.60 601. Gross Amount Due To Seller (Line 420)( ) ( )302. Less Amount Paid By/For Borrower (Line 220) 3,791,000.00 602. Less Reductions Due Seller (Line 520)

303. CASH ( X FROM ) ( TO ) BORROWER 603. CASH ( TO ) ( FROM ) SELLER 0.0027,047.60

The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein.

Borrower Seller_________________________________RAPPAHANNOCK-RAPIDAN COMMUNITY SERVICES BOARD

( 2016-57 / 2016-RRCSBLOAN / 4 )

L. SETTLEMENT CHARGES

700. TOTAL COMMISSION Based on Price $ @ 6.0000 % PAID FROM PAID FROM

Division of Commission (line 700) as Follows: BORROWER'S SELLER'S

701. $ to FUNDS AT FUNDS AT

702. $ to SETTLEMENT SETTLEMENT

703. Commission Paid at Settlement

704. to

800. ITEMS PAYABLE IN CONNECTION WITH LOAN

801. Loan Origination Fee 0.00 % to

802. Loan Discount % to

803. Appraisal Fee to

804. Credit Report to

805. Lender's Inspection Fee to

806. Mortgage Ins. App. Fee to807. Assumption Fee to

808.

809.

810.

811.

900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE

901. Interest From 07/05/16 to 08/01/16 @ $ /day ( 27 days %)

902. Mortgage Insurance Premium for months to

903. Hazard Insurance Premium for 1.0 years to

904.

905.

1000. RESERVES DEPOSITED WITH LENDER

1001. Hazard Insurance months @ $ per month

1002. Mortgage Insurance months @ $ per month

1003. City/Town Taxes months @ $ per month

1004. County Taxes months @ $ per month

1005. Assessments months @ $ per month




1100. TITLE CHARGES

1101. Settlement or Closing Fee to John C. Bennett, Attorney at Law 17,000.00

1102. Updates for Draws to SECURITY TITLE, L.C. 9 @ $150 each 1,350.00

1103. toTitle Examination1104. Title Insurance Binder to SECURITY TITLE, L.C. 175.00

1105. Mechanic's Lien underwriting to SECURITY TITLE, L.C. 250.00

1106. Title Search to SECURITY TITLE, L.C. Elkwood Downs 250.00

1107. Title Search to SECURITY TITLE, L.C. Culpeper Senior Cent 165.00

(includes above item numbers: )

1108. Title Insurance to Security Title, L.C. 7,795.60(includes above item numbers: )

1109. Lender's Coverage $ 3,791,000.00 150.00

1110. Owner's Coverage $ 3,791,000.00 7,645.60 20% DISCOUNT

1111.

1112.

1113.

1200. GOVERNMENT RECORDING AND TRANSFER CHARGES

1201. Recording Fees: Deed $ ; Mortgage $ 22.00; Releases $ 22.00

1202. City/County Tax/Stamps: Grantee Tax Grantee Tax 3,159.15 0.00;;1203. State Tax/Stamps: Grantee Tax Grantee Tax 9,477.50 0.00

1204. Financing Statement to 20.00Clerk of the Circuit Court1205. Financing Statement to State Corporation Commission 20.00

1300. ADDITIONAL SETTLEMENT CHARGES

1301. Survey to

1302. Pest Inspection to

1303.

1304.

1305.

1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 27,047.60

By signing page 1 of this statement, the signatories acknowledge receipt of a completed copy of page 2 of this two page statement.

John C. Bennett, Attorney at LawCertified to be a true copy.Settlement Agent

Rappahannock Rapidan Community Services (RRCS)

RRCS Volunteer Services Report -----~.----.- ~------

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... ________ ._ ... _________ ... _. __________ .. __ . _____ ._,_, _____ .. . ________ .' _______ .l~ ._ ~. __ .. _ ,. ______ .. _______ ,. _ ___ ... _ RSVP Driving - # of Round Trips Medical Transport i 11

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Rappahannock Rapidan Community Services (RRCS)

Care a Van Round Trips

VAN # CULPEPER FAUQUIER MADISON ORANGE RAPP TOTALS

Van 148 1 1 1 1 4 Van 181 12 12

Cars 164, 1 1 165,175

Van 171 1 3 4

Van 215 1 1

Van 218 4 4

Volunteers 2 2 4

cars 1

Van 193 1

TOTAL TRIPS 5 1 5 20 31

CULPEPER FAUQUIER MADISON ORANGE RAPPHANNOCK TOTAL

TRIPS 1 10 11

RRCS Driving Programs Round Trips

Region 1 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Average/MN

CSB/BHAAllegheny Highlands Community Services Board 89 71 80 68 60 75 83 66 90 76Harrisonburg-Rockingham Community Svc. Bd. 126 221 223 180 186 163 218 234 282 204Horizon Behavioral Health 186 115 167 194 177 173 166 196 195 174Northwestern Community Services 91 109 113 120 116 104 104 102 89 105Rappahannock Area Community Services Board 336 339 386 429 358 474 433 512 565 426Rappahannock-Rapidan Community Services Board 145 155 170 174 147 132 125 136 127 160 147Region Ten Community Services Board 329 298 298 299 289 278 233 260 292 286Rockbridge Area Community Services 56 50 52 51 37 36 47 45 47 47Valley Community Services Board 226 238 277 302 247 215 250 300 340 266

Region 1 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Average/MN

CSB/BHAAllegheny Highlands Community Services Board 399.6 318.8 359.2 305.2 269.4 336.7 372.7 296.3 404.1 340.2Harrisonburg-Rockingham Community Svc. Bd. 98.9 173.5 175.1 141.3 146.0 64.1 171.2 183.7 221.4 152.8Horizon Behavioral Health 73.2 45.2 65.7 76.3 69.6 127.9 65.3 77.1 76.7 75.2Northwestern Community Services 40.7 48.8 50.6 53.7 51.9 46.5 46.5 45.6 39.8 47.1Rappahannock Area Community Services Board 101.0 101.9 116.0 128.9 107.6 142.4 130.1 153.9 168.8 127.8Rappahannock-Rapidan Community Services Board 86.6 92.6 101.5 103.9 87.8 78.8 74.6 81.2 75.8 87.0Region Ten Community Services Board 137.8 124.8 124.8 125.2 121.0 116.4 97.6 108.9 122.6 119.9Rockbridge Area Community Services 136.5 121.9 126.7 124.3 90.2 87.7 114.6 109.7 114.6 114.0Valley Community Services Board 186.1 196.0 228.2 248.7 203.4 177.1 205.9 247.1 280.0 219.2

Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Average/MN

Allegheny Highlands Community Services Board 10 10 8 6 6 2 6 6 7 7Harrisonburg-Rockingham Community Svc. Bd. 23 26 22 30 20 23 27 23 30 25Horizon Behavioral Health 80 67 73 63 62 62 82 73 67 70Northwestern Community Services 37 41 36 46 39 36 46 37 31 39Rappahannock Area Community Services Board 77 65 82 83 77 81 73 99 86 80Rappahannock-Rapidan Community Services Board 19 18 20 24 22 16 26 25 17 23 21Region Ten Community Services Board 72 64 66 54 53 53 47 41 54 56Rockbridge Area Community Services 11 21 17 16 13 9 14 9 12 14Valley Community Services Board 54 43 40 40 45 44 46 40 51 45

Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Average/MN

Allegheny Highlands Community Services Board 44.8 44.8 35.9 26.9 26.9 8.9 26.9 26.9 31.4 30.4Harrisonburg-Rockingham Community Svc. Bd. 18.1 20.4 17.3 23.6 15.7 18.0 21.2 18.1 23.6 19.6Horizon Behavioral Health 31.4 26.3 28.7 24.8 24.4 24.3 32.2 28.7 26.4 27.5Northwestern Community Services 16.5 18.3 16.1 20.6 17.5 16.1 20.6 16.6 13.9 17.4Rappahannock Area Community Services Board 23.1 19.5 24.6 24.9 23.4 24.3 21.9 29.8 25.8 24.1Rappahannock-Rapidan Community Services Board 11.3 10.7 11.9 14.3 13.1 9.6 15.5 14.9 10.2 12.4Region Ten Community Services Board 30.1 26.8 27.6 22.6 22.2 22.1 19.6 17.2 22.6 23.4Rockbridge Area Community Services 26.8 51.2 41.4 39.0 31.7 21.9 34.1 21.9 29.2 33.0Valley Community Services Board 44.4 35.4 32.9 32.9 37.1 36.2 37.8 32.9 42.0 36.8

HPR 1 EMERGENCY SERVICES REPORT SUMMARY - FY16

CSB/BHA

RRCS Board of Directors

Number of Emergency Evaluations - by Month

Number of Temporary Detention Orders (TDO) Issued

Number of Emergency Evaluations - Adjusted for Population (per 100,000)

CSB/BHANumber of Temporary Detention Orders (TDO) Issued - Adjusted for Population (per 100,000)

Administrative Offices P. O. Box 1568 Culpeper, VA 22701 Telephone: (540) 825-3100 FAX: (540) 825-6245 TDD: (540) 825-7391

July 05, 2016 Board of Directors, RRCS c/o Mr. Brian Duncan PO Box 1568 Culpeper, VA 22701 Dear RRCS Board Members, Thank you so much for your generous support of our annual Bowl for Seniors Fundraiser to benefit aging services programs of RRCS. As you know, the limited funding for aging services programs require us to provide fundraising events in the community to increase and enhance our ability to be successful with our programs. These programs for older adults in PD9 continue to assist individuals maintain healthy and fulfilling daily living. In addition, knowledgeable staff provide assistance to eligible individuals who might need help applying for or understanding complicated paperwork. With such a great commitment from citizens in PD9, we were able to raise over $8,900 to benefit our programs. We want to thank you again for your continued support! Sincerely, Judy Seale Judy Seale Bowl for Seniors Chairperson Aging Services Specialist [email protected]

“It felt great to know that I

was not alone.”

“I learned how to not

overdue, and not underdo.”

“”I’ve felt happier and happier

each week.”

“I enjoyed learning from other

people’s perspectives.”

“ Our leaders were friendly

and knowledgeable.”

Comments from past participants

Find or Form a Workshop

near you!

Join a Group

Host a Workshop

Become a Leader

Contact Kristin Worthington, Program Coordinator, Rappahannock Rapidan Community Services

540-718-9341

[email protected] Small groups meet in a casual, interactive atmosphere. (Culpeper June 2016)

Chronic Disease Self Management Education (CDSMP) evidenced based programs were researched and

developed by Stanford University

Workshops are designed for individuals with

Asthma * Diabetes * Heart Disease * Joint Pain * Depression * Lung Issues

Lyme’s Disease * Neuropathy

Or any other chronic health condition

Plus Caregivers and Family members

How will this program help me?

By taking part in a 6 week workshop, you will learn better ways of coping and managing your health by:

Setting goals that are do-able

Relaxing and managing stress

Finding support and solutions

You practice simple effective tools in:

Problem solving

Pain and fatigue management

Healthy eating and physical activity

Better breathing

CDSMP News July 2016

More comments from past participants: “… interesting discussion on topics not discussed during my normal day.” “(this workshop) increases my aware-ness that I am not a victim and I can be proactive.” “(Leader) sharing her own problems and strategies normalized issues.” “I feel more alive and look forward to tomorrow.” “ 7 fruits and veggies per day? I thought you were crazy…..it was so much easier than I thought. Thank you for the strategy and encouragement.” “ I want to thank (leader) for waking us up and think about how to better manage our health.”

Get Out and Enjoy Life!

Upcoming Workshops

John Barton Payne Building—Warrenton Library

Thursdays 10:00—12:00 pm

July 28—September 1

Warrenton Aquatic and Recreation Facility

Wednesdays 10:00—12:00 pm

September 21—October 26

Leaflin Lane Apartments

Tuesdays 10:00—12:30 pm

August 16—September 20

Culpeper Library

Fridays 10:00 am—12:00 pm

October 7—November 18

Call 540-718-9341 or [email protected] to register!

1

Rappahannock Rapidan Community Services Administrative Services Committee Minutes

Tuesday, June 28, 2016 Bradford Road Offices

11:55 a.m.

Members Present: Sara Altman, Alan Anstine, Pat Balasco-Barr, Elizabeth Blubaugh,

Marcia Brose, Paula Howland, Christina Kearney, Clare Lillard and Mary Lou McFarland

Members Excused: Bonita Burr, Elizabeth Davis, Robert Legge, Demaris Miller and Robert Weigel

Staff Present: Brian Duncan, Executive Director

Anna McFalls, Director; Finance & Administrative Services Ray Park, Director; Transportation & Aging Services Ryan Banks, Director; Clinical Services

Deanne Cockerill, Administrative Services Support Supervisor Call to Order: The meeting was called to order by Liz Blubaugh. Updates to the Agenda: There were no updates to the agenda. 1. Review of new classification recommendations ACTION Anna provided background on positions classifications for Board consideration. The Mobility Specialist position is a reclassification and is staffed under a grant with the Regional Commission. The grant has always required staff to work directly with targeted individuals and groups to help them gain access to transportation resources. The scope of the work now requires case management skills, increased community outreach, fieldwork, increased negotiation, presentation, computer skills, as well as “real-time” reporting. To meet this need the position has been reclassified from a current grade 3 to proposed grade 5. There will be two positions under this classification, one full-time and one part-time. A new part-time position, Auxiliary Program Specialist – Aging Services, was developed to support the Nest Egg at Madison Senior Center. The position will be .4 FTE at a grade 2 with a cost of $12K per year which will be supported by proceeds from the Nest Egg. Currently our senior site supervisor has been providing support with additional hours in her position. It is hopeful the Nest Egg will be open a second day per week. The third classification is for a Lead Cook at Boxwood. The management requested we consider this position to provide staff oversight and supervision. This adds an additional cost of $1,150 per year.

2

After discussion, a motion was made by Alan Anstine and seconded by Pat Balasco-Barr to recommend to the full Board approval of the three classifications as presented. The motion was unanimously approved. 2. Update on Accounting and HR software Anna provided an update on the Accounting and HR software being considered. We have met with the representative from Munis and reviewed the entire scope of the contract, pricing and an implementation plan. She reviewed the timeline of implementation which would coincide well with the beginning and year-end timelines if we sign a contract later this summer with implementation to begin in October. The first phase of implementation would include general ledger, accounts payable, budgeting and procurement and would go live on July 1, 2017. The second phase would include human resources and payroll and would go live on January 1, 2018. As our current software is very outdated, staff are very committed to this process. The company has an excellent reputation and several organizations in the area are using this software successfully. The funding would require approximately $100K in the first year. We will put future financing in place similar to our electronic health record purchase with a combination of fund balance money and operating budget. The contract is a fixed cost for a seven year period. Pat Balasco-Barr suggested Brian contact the Path Foundation to explore any possible funding opportunities for this project. Board members were unanimously in support of proceeding with this software upgrade. 3. Other Items Anna noted she has not received open enrollment numbers from Optima yet but will forward them to the Board once received. Brian informed Executive Committee members that there would not be an Executive Committee meeting on Tuesday, July 5 due to the Orange Bridges closing. Brian will contact Alan and Pat once he finds out the time of the closing. The next regularly scheduled meeting will be the Board meeting on July 12th at 1:00 p.m. There being no further business, the meeting adjourned at 12:20 p.m. Note: The next regular meeting of the Administrative Services Committee will be held on August 23, 2016.

RRCS Aging Services Advisory Council Meeting June 21, 2016

M I N U T E S

Members Present: Nancy Babb, Erika Bays, Jenny Biche, Jackie Dare, Richard Fletcher, Jim Livingston, Eileen Peet, David Pollok Staff Present: Ray Parks, Lola Walker, Judy Seale, Brian Duncan, Anita Richards Eileen Peet, Chair, called the meeting to order at 10:05 AM. Approval of Minutes Eileen Peet asked for a motion to approve the May 17, 2016 minutes. David Pollok made a motion to approve the minutes. Richard Fletcher seconded the motion. There being no further discussion, the motion to approve the minutes was passed. New Business Eileen Peet – The council needs membership representation from Fauquier and Rappahannock Counties. There should be at least two members from each of the five counties. Ray Parks – Handout: FY17 SHIP Funding Threat / Opportunities for Action. For FY17 at the Federal level, the Senate Appropriations Committee has approved a bill that eliminates all funding for the Medicare State Health Insurance Assistance Program (SHIP); on the local level it would eliminate funding for the Virginia Insurance Counseling and Assistance Program (VICAP). The House Appropriations Subcommittee is expected to mark up its bill as soon as June 23. Jenny Biche will provide our senators’ contact information and a template letter for council members to consider calling or writing. The Senior Employment program was also recommended to be cut; it is the older workers program for low income seniors. Encourage others to take action and advocate for us. Question: What are seniors supposed to do if the bill is passed? RRCS Support Coordinators-Aging will not be funded to provide assistance and compare/show other options. Old Business Ray Parks – reminder: Council members are invited to the called Board Meeting/Public Hearing at 11:00 on June 28. Brian Duncan will present the program plan and the RRCS Board will vote on the Agency budget, which includes the Area Plan. Brian Duncan – Discussed FY17 Budget and Area Plan. Council members’ input/public comments are welcome at the Public Hearing. Some RRCS Board members and Brian have attended meetings with local elected officials to discuss funding needs for the next 2-4 years related to strategic planning and new initiatives. Brian thanked the Council for their time and

support. Questions: Were the funding requests for staff or programs? Mostly for the development of program initiatives. Can you give any examples? The Culpeper County Jail base program and family assistance program for at-risk youth in Fauquier County. How do you cover costs if additional staff is needed? Local funding also supports staff and we ask for general support. What about offering learning opportunities at the senior centers? Our main focus is on health issues / quality of life and nutrition education at the senior centers. Rapid Access Implementation was effective in June for Culpeper and Warrenton (behavioral health services). Volunteer Services Program updates – Lola Walker • Materials distributed: Volunteer Services Report / May 2016. • The Culpeper Senior Center expansion project is coming along; time lapse pictures are in

progress. • FAMS subcommittee meeting scheduled for 6/21. Members will discuss work plans for the

coming year. Lola will focus on the need for more volunteer drivers for medical appointments. If you know of anyone who would like to volunteer, please ask them to contact Lola.

• May 2016 Report – Nest Egg Thrift Store had 457.5 hours for two months! • PMMP going well. • Thank you for your help with the annual Bowl for Seniors fund raiser on 6/18. Judy Seale –

T-shirts are available for members that did not receive one; the net amount raised was $8,880.00!

• The Madison Senior Center outdoor pavilion is under construction – funded by the Nest Egg Thrift Store.

Aging Services updates – Ray Parks • Materials distributed: The Area Agency’s Plan For Aging Services (Area Plan) Fiscal Year

2016 – 2019; Area Plan & Other Indicators for Review of Program Performance & Service Delivery Goals for FY16.

• The Area Plan is put together each June. We invite council members’ opinions and recommendations for FY17.

• Ray reviewed details of the Area Plan for Aging Services. He also addressed questions and noted suggestions.

• Members provided assistance for the completion of Page 8: General Membership Characteristics on July 1, 2016.

• The terms of office will expire September 30; we will have to hold elections. Idea/suggestion from Ray – ask a standing Board of Directors member to serve as chair or liaison of the Aging Services Advisory Council when our officers’ term date ends. After a discussion, the Council recommended a liaison from RRCS Board to represent Aging Services. Ray will take the input to Senior Management Team.

• Copy of Performance Indicators – for your information.

• Potential growth area for RRCS to bring in revenue – hospital care transitions thru a statewide coalition; contracts with managed care companies to provide service packages for a fee.

• We normally cancel the July or August meeting due to vacations, etc. After a brief discussion, Eileen Peet asked for a motion to cancel the August meeting. David Pollok made a motion to cancel the August meeting. Eileen Peet seconded the motion. There being no further discussion, the motion to cancel the August meeting was passed. The Senior Center Satisfaction Surveys will be distributed at the July meeting.

Adjournment Eileen Peet asked for a motion to adjourn. David Pollok made a motion to adjourn the meeting. Jackie Dare seconded the motion. There being no further discussion, the meeting adjourned at 12:15 PM.

Rappahannock Rapidan Community Services Development Committee Meeting

June 14, 2016 – 12:00 MINUTES

Members Present: Sarah Altman, Alan Anstine, Marcia Brose, Bonita Burr Members Excused: Pat Balasco-Barr, Elizabeth Blubaugh, Elizabeth Davis, Christina Kearney,

Robert Legge, Paula Howland, Clare Lillard, Mary Lou McFarland, Demaris Miller, Robert Weigel

Staff Present: Brian Duncan, Laura Wohlford

1. Call to order: Sarah Altman, Committee Chair Sarah Altman, Chair, called the meeting to order at noon.

2. Review of agenda: Additions / Deletions There were no additions or deletions to the agenda.

3. Bowl for Seniors: Planning update and discussion on upcoming event on June 18 Brian will pass around a pledge sheet for support of the board team – Bowl of Directors — at the board meeting. There are 24 teams registered. Our goal is to raise $8,000 - $10,000 after expenses.

4. Golf Tournament: Planning update and discussion on upcoming event on July 22 Elizabeth and Paula will be providing detailed updates at the board meeting. There is a planning committee working on this tournament. Historically, these tournaments raise around $10,000 per event.

5. Update and outcomes for Give Local Piedmont Our goal was $2,500 and we raised $2,630. We received $1,680 from on line donors; the balance was received from drop-off locations in the area.

6. Culpeper Senior Center: Update on fundraising during renovations and focus The project is moving along. The renovation completion date is anticipated for late September. We have a separate fundraising committee meeting to raise funds for furniture and equipment after the center re-opens. They are setting up a wish list registry to specify what needs to be purchased. No money was raised for furniture and equipment during the original fundraising campaign.

Rappahannock Rapidan Community Services Development Committee Meeting

June 14, 2016 – 12:00 MINUTES

Question: Do we have a plan to consolidate senior centers from other counties into Culpeper? Response: This was never discussed and was not part of the planning process. We own the buildings in Culpeper and Orange. We occupy county-owned facilities in Fauquier and Rappahannock. We rent the facility in Madison.

7. Other updates / discussions No updates or additional discussion

Next meeting: September 13, 2016 at noon

Rappahannock Rapidan Community Services Executive Committee – Agenda

Tuesday, June 7, 2016 – 9:00 a.m. Bradford Road Offices – Culpeper

MINUTES

Members Present: Alan Anstine, Pat Balasco-Barr, Robert Legge, Mary Lou McFarland

Members Excused: Demaris Miller

Staff Present: Brian Duncan, Laura Wohlford

1. Call to order: Alan Anstine, Chair Alan Anstine, Chair, called the meeting to order at 9:08am.

2. Review of agenda for additions / deletions There were no additions or deletions to the agenda.

3. Transitions in ID services – what we are learning and monitoring for FY 17 and beyond Historically, funding for ID services has changed quite a bit – initially, it was solely a state funded activity, without any federal funds. In the 90’s, it became a Medicaid waiver funded program. This was a dramatic shift. More and more, all services for individuals with development disabilities moved towards the Medicaid waiver template. We are now entering the third “era” of funding with waiver redesign. This was initiated under the DOJ settlement. The settlement addressed the situation where the state was funding large hospitals instead of community-based residential options. The settlement agreement was signed two years ago and will probably influence the provision of DD services for at least ten years. Starting in July, the new funding mechanism will be in effect. The level of funding was not as high as we had hoped. More services are being funded – some at a higher funding level – but there are also higher expectations (with attendant higher costs). The emphasis is shifting from institutional to community-based services. We are now seeing individuals with higher needs than we have seen before. We receive adequate funding for these individuals. Historically, we served individuals with moderate disabilities. The new funding models provide incentives to encourage moderate-need individuals to higher levels of independent living. None of this will happen in a single fiscal year, but is something that is on the horizon. We are heavily invested in group homes and day support programs. There are few private providers in the area – if we didn’t do it, no one would provide these services. Questions Do we need to bring more high-need individuals into our homes to make sure we have sufficient funds for the homes? Response: The model is moving towards taking more high-need individuals. We need to look at how we can provide for moderately-disabled

individuals in a more independent setting. The challenge for us is the transition. Many of our group homes were funded through HUD; we can’t sell them easily. Will any of the training schools remain open? Response: Yes, the one in Williamsburg. Some individuals are being relocated to the Central Virginia Training School as other schools are closed. Central Virginia will be the last facility to close. Is day support also changing? Response: In some cases, we will receive less funding; the goal is to get individuals into integrated settings in the community. Our new building is in the middle of an industrial park that provides opportunities for vocational training and jobs. Do we have a working relationship with the Virginia Department for Aging and Rehabilitation Services and Virginia Employment Commission? Response: We have a relationship with these groups and will work more closely with them as we move forward.

4. State Psychiatric Hospital utilization, update on pressures and pressure from the Department of Behavioral Health Utilization has gone up – the new facility has been full. When occupancy is at capacity, the state has to buy beds in regular hospitals to house the overflow. The state hospital is the placement of “last resort”. Individuals are only admitted to the state hospital if there is no availability in a private facility or the needs are such that no other place will take the individual. There has been a variety of communications from Department of Behavioral Health and Disability Services (DBHDS), offering incentives to place individuals into the community and not in the state hospital. The director doesn’t want more beds built, but to increase resources in the community. Adding infrastructure to a community is more time consuming, instead of expanding existing facilities on state owned land. We use discharge assistance plans (DAP) – dollars available from DBHDS - to provide services to individuals discharged from the state hospital to cover rent, medication, etc. These are ongoing funds.

5. CIT Assessment Site funding proposal: Update on submission and work with Culpeper Medical Center Our funding proposal has been submitted for review. By the end of June, we should know if our request was successful. If funding is received, implementation will need to be fast tracked. We need to continue to garner local support through education and publicity.

6. Bridges project updates and tentative closing date (June 24) This is moving forward; Brian will meet with general contractor this week. The closing date is getting firmer. Construction will start in July. We will do a ground breaking once some of the infrastructure is in place. We purchase the land and close the Rural Development financing on the same day.

7. Senior Center project updates This renovation is moving along well with no major scheduling issues.

8. Board meeting times – will be on full board agenda, discuss as needed This was introduced at the last board meeting. We need to understand the barriers to attendance before we can make a determination. Do we have any baseline attendance data? Yes, we can pull together board, program, and administrative services meetings attendance for this year (2016) and include it in the board packet. Upcoming Meetings:

July 5th – Executive Committee (at new time of 9:30am) July 12th – Board Meeting July 26th – no Program or Administrative Services Committee meetings August 2nd – Executive Committee (at new time of 9:30am) August 9th – no Development Committee or Board Meeting August 23rd – Program and Administrative Services Committees will meet

9. Behavioral Health project updates

The basement area is essentially done and construction is ready to start upstairs. The waiting area will move into the new pharmacy area as work is done on the 1st floor.

10. Rapid Access implementation report We are doing a soft launch now. We are contacting our current waiting list to come in during the open access times. We are no longer giving new appointments. This should be fully implemented in both clinics in July.

11. Other The executive committee decided to change their meeting start time to 9:30am from 9:00am. This will take effect with the July meeting.

There being no further business, the meeting adjourned at 10:30am.

Planning and Development Meeting Monday, June 13, 2016 - 3:00 p.m. – Room B

MINUTES

Staff Present: Brian Duncan, Ryan Banks, Anna McFalls, Ray Parks, Paula Stone

The meeting started at 3:10pm.

1. Review of 3 year trends for local funding and fee / program transfers (see attachment) – discuss trends, implications and what this means for our multiple year financial planning. These documents provide a view of the budget before accounting applies the tools to balance the budget. The vacancy rate is already applied, but the local funding has not been added. We are interested in looking at trends, not specific surpluses or deficits. We are moving fee money around in a way that has consequences. What do we want to understand about fees that are being applied to other programs to keep them viable? Where do we want to use local money? In the past, we apply the minimal local funds needed on the CSB side to match federal/state funds and the balance goes to aging programs. In the past, MH and ID case management were revenue generators, why has this changed over the last three years? Also, group homes have always been at least break-even. Due to the changes in the staffing, this is less true going forward. Many of our programs will always need federal/state/local funds to balance – especially in AAA. What to think about during the review of these documents: We need to apply some new thinking about local money. We are working with the Executive Committee on this. When we look at the other CSBs, we are in the mid-to high-range for local funding. When we deduct the funds used for the AAA, the CSB does not get much at all. Normally, AAAs and CSBs are funded separately in other localities. As we are the only consolidated AAA/CSB in the state, we are penalized in the total amount received from our localities. We should work towards an increase in local funding in future years. Case Management – are we charging correctly or is this the new normal? Are there things we can do to reduce the costs to provide case management? Aging – We need to educate the board and localities about where the funds are going. We should discuss the costs of maintaining our infrastructure. We can look at how local dollars are used in other localities. We have the CSB numbers, but we don’t have those numbers for AAAs. Ray will ask DARS for this information. We would like to limit the transfer of fees to “within programs” on the CSB side (for example, ID programs would support other ID programs; SED programs would support other SED programs, etc.). This would be a long-term goal and should shape where we focus our programmatic efforts. Another goal is that programs in the “other category” should be self-sustaining, without any local funds.

2. Quick review of Strategic Plan for updates / additions / deletions (current attached) The Senior Management team will provide updates for the Strategic Plan to Brian. Brian will consolidate those updates and add his edits. Updates need to be given to Brian by June 27th.

Planning and Development Meeting Monday, June 13, 2016 - 3:00 p.m. – Room B

MINUTES

3. Review and updates for Risk Management and QI plan (current attached). June Update Item 1: Rapid Access – Brian to update Item 2: ID Day Support – Incorporating DD and HCBS (Home and Community Based Services) and

new waiver redesign (n box 1). Brian to update Item 3: Critical Incident Reporting – Brian to update with QA Item 4: Aging Services Coordination and Collaboration – Monitor State no-wrong-door program.

Continue developing partnerships with local hospitals and regional transition coalitions. Add conflict-free ombudsman issues

Item 5: Outreach to Medicaid eligible Children and Adults – Delete this entire item Item 6: Emergency Services Capacity – Brian to update Item 7: DBHDS Performance Contract Education – Brian to update with QA staff Item 8: CCS Data review and analysis – Brian and Anna to update with QA staff Item 9: High Medical Need Individuals in Group Homes – Services provided as part of the group

home. Brian to reframe the item; it may be possible to delete this at the next review. Should we add something about a new accounting/HR software? The risk would be associated with maintaining the current, out-dated, system. Brian will draft a new item covering this. Community support will have risks managing DD contracts with outside providers. Brian will draft a new item covering this.

4. Other No other items were discussed.

The meeting ended at 4:30pm.

Budget ComparisonREVENUES EXPENSES Surplus Local REVENUES EXPENSES Surplus Local REVENUES EXPENSES Surplus Local

W/ VAC RATE (Deficit) Funds used W/ VAC RATE (Deficit) Funds used W/ VAC RATE (Deficit) Funds used10-10XX Young Adults 604,686 531,079 73,607 548,545 514,477 34,068 10-13XX Outpatient 1,975,594 1,961,376 14,218 1,960,518 1,960,518 (0) 2,169,622 2,311,224 (141,602) 10-17XX Psychosocial 507,735 574,116 (66,381) 27,000 591,989 591,989 0 571,331 583,585 (12,254) 10-24XX MH Supports 388,232 390,094 (1,862) 375,690 375,690 0 321,775 328,592 (6,817) 10-32XX CIT 68,330 76,751 (8,421) 68,600 68,600 - 10-39XX MH Emergency 919,145 925,813 (6,668) 914,145 914,145 0 879,255 898,490 (19,235) 10-45XX Sponsored 124,080 124,080 - 10-4201 Children's Mobile 167,000 153,547 13,453 186,428 186,428 - 10-45XX Sponsored 137,875 137,875 - 134,016 134,016 - 10-55XX Limited 11,000 12,650 (1,650) 9,075 9,075 - 9,075 9,075 -

10-114XX CSP CM 659,409 718,093 (58,684) 27,000 772,511 675,967 96,545 721,107 745,904 (24,797) 10-155 Children's 42,336 8,828 33,508 42,336 7,304 35,032 42,336 550 41,786 10-213 ICC 56,000 4,191 51,809

10-214XX SED Targeted 503,887 557,149 (53,262) 28,563 598,319 687,337 (89,018) 622,385 614,718 7,667 10-628XX MH Liberty 372,449 392,870 (20,421) 319,689 367,451 (47,762) 309,641 316,135 (6,494) TOTAL MH 6,357,678 6,440,241 (82,563) 82,563 6,521,861 6,492,996 28,865 - 5,826,607 5,936,544 (109,937) -

921-16XX Part C 436,246 436,246 - 389,372 389,372 - 291,984 291,984 - 20-16XX ITC 558,686 558,686 (0) 629,825 589,957 39,868 568,017 556,195 11,822 20-91401 Case MGT 155,040 187,110 (32,070) 126,720 - 126,720 20-1901 Bridges Admin 16,093 98,745 (82,652) 3,128 94,194 (91,066) 91,066 6,234 73,764 (67,530) 67,530 20-1913 Bridges Fauquier 526,800 702,348 (175,548) 59,671 585,111 714,059 (128,948) 128,948 531,259 694,545 (163,286) 163,286 20-1915 Bridges Orange 682,584 934,440 (251,856) 251,856 654,701 951,372 (296,671) 212,253 597,346 910,345 (312,999) 312,999 20-24XX Supp Living 82,187 148,799 (66,612)

20-114XX CSP Case 1,029,915 796,358 233,557 983,700 766,933 216,767 941,820 769,787 172,033 20-414XX ID CM ITC 334,290 318,933 15,357 20-514XX Case Mgt 352,620 286,582 66,038 391,800 428,528 (36,728) 93,098 108,455 (15,357) 20-2801 GH Admin - 711,315 (711,315) 15,750 519,213 (503,463) 34,350 661,758 (627,408) 20-2812 ID Liberty 523,845 329,016 194,829 439,603 335,550 104,053 20-2823 Evergreen 427,807 336,129 91,678 329,943 297,698 32,245 325,550 302,751 22,799 20-2832 Canterbury 409,307 284,656 124,651 338,223 529,682 (191,459) 359,858 546,799 (186,941) 8,183 20-2833 Airlee 218,869 331,187 (112,318) 171,915 244,125 (72,210) 505,553 527,011 (21,458) 21,458 20-2842 Locust Grove 460,028 414,885 45,143 478,942 373,315 105,627 431,645 415,235 16,410 20-2853 Foxcroft 420,807 258,507 162,300 251,180 267,308 (16,128) See Airlee for Dumfries Road combined amounts20-2862 High Point 381,386 316,730 64,656 342,448 248,919 93,529 295,456 259,450 36,006 20-2863 Remington 570,853 576,608 (5,755) 446,575 474,695 (28,120) 502,705 487,441 15,264 20-2865 Aster 655,677 695,151 (39,474) 815,297 815,297 - 658,674 658,674 - 20-2872 Millfield 589,735 656,680 (66,945) 838,511 838,511 - 658,674 658,674 - 20-2875 Orange 356,085 358,861 (2,776) 222,122 254,322 (32,200) 310,062 260,258 49,804 TOTAL ID 8,248,538 8,941,225 (692,687) 311,527 8,621,295 9,275,317 (654,022) 432,267 7,886,178 8,837,609 (951,431) 573,456

- - 30-070X Prevention 125,019 86,764 38,255 125,019 102,341 22,678 125,019 99,326 25,693 30-11XX Primary Care/ 1,824,247 1,550,370 273,877 1,803,553 1,597,706 205,847 1,916,656 1,474,500 442,156 30-12XX DETOX 875,265 797,983 77,282 875,265 888,224 (12,959) 875,260 850,464 24,796 30-13XX Outpatient 272,647 270,017 2,630 258,447 281,125 (22,678) 401,680 406,413 (4,733) 30-14XX SA Case 141,899 147,399 (5,500) 82,097 82,097 - 89,066 89,066 (0)

30-22 Consumer 6,000 6,000 - 6,000 6,000 - 6,000 6,000 - 30-3117 SARPOS 96,171 96,171 - 96,171 96,171 - 96,171 96,171 - 30-38XX SA Diversion 47,574 47,574 - 47,574 47,574 - 47,574 47,574 - 30-39XX SA Emergency 95,136 100,519 (5,383) 84,222 84,222 0 63,198 63,198 (0)

30-55 Limited Svcs. 1,500 1,500 - 1,500 1,500 - 1,000 1,000 - TOTAL SA 3,485,458 3,104,297 381,161 - 3,379,848 3,186,960 192,888 - 3,621,624 3,133,712 487,912 -

FY2017 FY2016 FY2015

Budget ComparisonREVENUES EXPENSES Surplus Local REVENUES EXPENSES Surplus Local REVENUES EXPENSES Surplus Local

W/ VAC RATE (Deficit) Funds used W/ VAC RATE (Deficit) Funds used W/ VAC RATE (Deficit) Funds used

FY2017 FY2016 FY2015

40-101 Administration 2,771,180 2,771,180 0 2,811,024 2,811,024 - 2,899,753 2,899,753 (0)

Total DBHDS 18,091,674 18,485,763 (394,089) 394,090 18,523,004 18,955,273 (432,269) 432,267 17,334,409 17,907,865 (573,456) 573,456

183-101 Administration 46,000 63,763 (17,763) 17,763 46,000 62,423 (16,423) 16,423 46,000 62,723 (16,723) 16,723 183-2001 Volunteer 12,977 15,172 (2,195) 2,195 12,977 12,830 147 13,630 13,630 - 183-3401 Legal 2,400 2,400 - 3,000 3,000 - 2,460 2,460 -

183-3501 Transport 131,656 142,949 (11,293) 167,825 167,825 - 169,940 162,734 7,206 183-3701 C R I A 65,751 65,751 0 64,230 64,431 (201) 201 64,770 64,770 - 183-3301 Public Info 17,866 17,866 0 17,925 17,925 0 17,925 17,925 - 183-1401 Case Mgmt - 73,958 (73,958) 73,958 - 77,135 (77,135) 77,135 - 80,476 (80,476) 80,476

183-3901 Emergency 13,500 13,500 - 13,500 13,500 - 3,500 3,500 - 183-7101 Cong Meals-Admin 211,497 291,526 (80,029) 60,029 276,863 277,010 (147) 267,543 298,179 (30,636) 30,636 183-7112 Cong Meals-Culp 12,000 80,978 (68,978) 68,978 7,400 88,378 (80,978) 80,978 12,700 61,774 (49,074) 49,074 183-7113 Cong Meals-Fauq 15,000 47,310 (32,310) 32,310 16,100 59,944 (43,844) 43,844 14,300 32,423 (18,123) 18,123 183-7114 Cong Meals-Madison 61,000 122,143 (61,143) 61,143 48,500 92,475 (43,975) 43,975 66,000 78,645 (12,645) 12,645 183-7115 Cong Meals-Orange 10,000 65,040 (55,040) 55,040 9,900 70,273 (60,373) 60,373 10,100 45,356 (35,256) 35,256 183-7116 Cong Meals-Rapp 11,000 58,224 (47,224) 47,224 13,400 64,945 (51,545) 51,545 14,900 38,246 (23,346) 23,346 183-71XX Soc & Rec 73,000 53,000 20,000 45,000 45,000 - 40,000 40,000 - 183-72XX Home Del 221,264 264,361 (43,097) 43,097 242,715 306,812 (64,097) 64,097 248,785 248,785 - 183-7501 Elder Abuse 2,044 17,365 (15,321) 15,321 2,252 17,536 (15,284) 15,284 2,610 17,857 (15,247) 15,247 183-7601 Disease 15,409 22,215 (6,806) 6,806 16,744 34,925 (18,181) 17,512 17,512 - 183-7701 Ombudsman 20,287 29,177 (8,890) 8,890 20,587 29,739 (9,152) 9,152 21,131 29,156 (8,025) 8,025 184-7401 Warrenton ADC 192,294 204,856 (12,562) 24,150 201,022 195,681 5,341 31,363 222,439 249,436 (26,997) 26,997 184-7323 Respite 48,777 78,792 (30,015) 18,427 51,777 75,242 (23,465) 4,942 51,977 70,121 (18,144) 18,144 181-5001 V I C A P 40,398 33,167 7,231 39,809 28,121 11,688 21,241 29,017 (7,776) 7,776 160-101 C D S M P 15,000 15,000 - 18,000 18,000 - 150-1408 Care Coord 65,411 79,425 (14,014) 6,783 65,411 81,793 (16,382) 4,694 65,411 74,295 (8,884) 8,884 TOTAL DEPT of AGING 1,304,531 1,857,940 (553,409) 542,114 1,382,937 1,886,941 (504,004) 504,006 1,412,874 1,757,020 (344,146) 351,352

- 170-2001 RSVP 89,825 89,825 0 50-101 PMMP 12,000 21,626 (9,626) 9,626 15,900 21,648 (5,748) 190-3501 TRANSIT 1,386,575 1,386,575 (0) 1,453,678 1,453,678 0 1,456,800 1,456,800 (0) 195-3501 MOBILITY MGT 86,900 75,607 11,293 83,400 77,652 5,748 70,312 77,518 (7,206) 70-101 KITCHEN 363,882 363,882 0 381,289 381,289 (0) 401,465 401,465 (0) 800-8001 VHDA 112,590 110,827 1,763 111,828 100,809 11,019 105,300 105,300 400-2880 LEAFLIN APTS - 30,863 (30,863) 29,100 - 29,231 (29,231) 18,212 - 29,674 (29,674) 29,674

14-101 DJJ CSU 55,747 55,747 0 Total Other 2,017,694 2,045,126 (27,432) 38,726 2,046,095 2,064,306 (18,211) 18,212 2,123,702 2,160,582 (36,880) 29,674

GRAND TOTAL 21,413,899 22,388,829 (974,930) 974,930 21,952,036 22,906,521 (954,485) 954,485 20,870,985 21,825,468 (954,482) 954,482

Budget ComparisonDepartments with Surplus REVENUES EXPENSES Surplus Local REVENUES EXPENSES Surplus Local REVENUES EXPENSES Surplus Local in FY2017 W/ VAC RATE (Deficit) Funds used W/ VAC RATE (Deficit) Funds used W/ VAC RATE (Deficit) Funds used

10-10XX Young Adults 604,686 531,079 73,607 548,545 514,477 34,068 10-13XX Outpatient 1,975,594 1,961,376 14,218 1,960,518 1,960,518 (0) 2,169,622 2,311,224 (141,602) 10-4201 Children's Mobile 167,000 153,547 13,453 186,428 186,428 - 10-155 Children's 42,336 8,828 33,508 42,336 7,304 35,032 42,336 550 41,786 TOTAL MH 2,789,616 2,654,830 134,786 - 2,737,827 2,668,727 69,100 - 2,211,958 2,311,774 (99,816) -

20-114XX CSP Case 1,029,915 796,358 233,557 983,700 766,933 216,767 941,820 769,787 172,033 20-514XX Case Mgt 352,620 286,582 66,038 391,800 428,528 (36,728) 93,098 108,455 (15,357) 20-2823 Evergreen 427,807 336,129 91,678 329,943 297,698 32,245 325,550 302,751 22,799 20-2832 Canterbury 409,307 284,656 124,651 338,223 529,682 (191,459) 359,858 546,799 (186,941) 8,183 20-2842 Locust Grove 460,028 414,885 45,143 478,942 373,315 105,627 431,645 415,235 16,410 20-2853 Foxcroft 420,807 258,507 162,300 251,180 267,308 (16,128) See Airlee for Dumfries Road combined amounts20-2862 High Point 381,386 316,730 64,656 342,448 248,919 93,529 295,456 259,450 36,006 TOTAL ID 3,481,870 2,693,847 788,023 - 3,116,236 2,912,384 203,852 - 2,447,427 2,402,478 44,949 8,183

30-070X Prevention 125,019 86,764 38,255 125,019 102,341 22,678 125,019 99,326 25,693 30-11XX Primary Care/ 1,824,247 1,550,370 273,877 1,803,553 1,597,706 205,847 1,916,656 1,474,500 442,156 30-12XX DETOX 875,265 797,983 77,282 875,265 888,224 (12,959) 875,260 850,464 24,796 30-13XX Outpatient 272,647 270,017 2,630 258,447 281,125 (22,678) 401,680 406,413 (4,733) TOTAL SA 3,097,178 2,705,134 392,044 - 3,062,284 2,869,396 192,888 - 3,318,615 2,830,703 487,912 -

Total DBHDS 9,368,664 8,053,811 1,314,853 - 8,916,347 8,450,508 465,839 - 7,978,000 7,544,954 433,046 8,183

183-71XX Soc & Rec 73,000 53,000 20,000 45,000 45,000 - 40,000 40,000 - 181-5001 V I C A P 40,398 33,167 7,231 39,809 28,121 11,688 21,241 29,017 (7,776) 7,776 TOTAL DEPT of AGING 113,398 86,167 27,231 - 84,809 73,121 11,688 - 61,241 69,017 (7,776) 7,776

- 195-3501 MOBILITY MGT 86,900 75,607 11,293 83,400 77,652 5,748 70,312 77,518 (7,206) 800-8001 VHDA 112,590 110,827 1,763 111,828 100,809 11,019 105,300 105,300 Total Other 199,490 186,434 13,056 - 195,228 178,460 16,768 - 175,612 182,818 (7,206) -

GRAND TOTAL 9,681,552 8,326,411 1,355,141 - 9,196,384 8,702,089 494,295 - 8,214,853 7,796,789 418,064 15,959

FY2017 FY2016 FY2015

Budget ComparisonDepartments with Deficit REVENUES EXPENSES Surplus Local REVENUES EXPENSES Surplus Local REVENUES EXPENSES Surplus Local in FY2017 W/ VAC RATE (Deficit) Funds used W/ VAC RATE (Deficit) Funds used W/ VAC RATE (Deficit) Funds used

10-17XX Psychosocial 507,735 574,116 (66,381) 27,000 591,989 591,989 0 571,331 583,585 (12,254) 10-24XX MH Supports 388,232 390,094 (1,862) 375,690 375,690 0 321,775 328,592 (6,817) 10-32XX CIT 68,330 76,751 (8,421) 68,600 68,600 - 10-39XX MH Emergency 919,145 925,813 (6,668) 914,145 914,145 0 879,255 898,490 (19,235) 10-55XX Limited 11,000 12,650 (1,650) 9,075 9,075 - 9,075 9,075 -

10-114XX CSP CM 659,409 718,093 (58,684) 27,000 772,511 675,967 96,545 721,107 745,904 (24,797) 10-214XX SED Targeted 503,887 557,149 (53,262) 28,563 598,319 687,337 (89,018) 622,385 614,718 7,667 10-628XX MH Liberty 372,449 392,870 (20,421) 319,689 367,451 (47,762) 309,641 316,135 (6,494) TOTAL MH 3,430,187 3,647,536 (217,349) 82,563 3,650,018 3,690,253 (40,235) - 3,434,569 3,496,499 (61,930) -

20-91401 Case MGT 155,040 187,110 (32,070) 126,720 - 126,720 20-1901 Bridges Admin 16,093 98,745 (82,652) 3,128 94,194 (91,066) 91,066 6,234 73,764 (67,530) 67,530 20-1913 Bridges Fauquier 526,800 702,348 (175,548) 59,671 585,111 714,059 (128,948) 128,948 531,259 694,545 (163,286) 163,286 20-1915 Bridges Orange 682,584 934,440 (251,856) 251,856 654,701 951,372 (296,671) 212,253 597,346 910,345 (312,999) 312,999 20-2801 GH Admin - 711,315 (711,315) 15,750 519,213 (503,463) 34,350 661,758 (627,408) 20-2833 Airlee 218,869 331,187 (112,318) 171,915 244,125 (72,210) 505,553 527,011 (21,458) 21,458 20-2863 Remington 570,853 576,608 (5,755) 446,575 474,695 (28,120) 502,705 487,441 15,264 20-2865 Aster 655,677 695,151 (39,474) 815,297 815,297 - 658,674 658,674 - 20-2872 Millfield 589,735 656,680 (66,945) 838,511 838,511 - 658,674 658,674 - 20-2875 Orange 356,085 358,861 (2,776) 222,122 254,322 (32,200) 310,062 260,258 49,804 TOTAL ID 3,771,736 5,252,445 (1,480,709) 311,527 3,879,830 4,905,789 (1,025,959) 432,267 3,804,857 4,932,470 (1,127,613) 565,273

30-14XX SA Case 141,899 147,399 (5,500) 82,097 82,097 - 89,066 89,066 (0) 30-39XX SA Emergency 95,136 100,519 (5,383) 84,222 84,222 0 63,198 63,198 (0) TOTAL SA 237,035 247,918 (10,883) - 166,319 166,319 0 - 152,264 152,265 (1) -

Total DBHDS 7,438,958 9,147,900 (1,708,942) 394,090 7,696,167 8,762,360 (1,066,193) 432,267 7,391,690 8,581,233 (1,189,543) 565,273

183-101 Administration 46,000 63,763 (17,763) 17,763 46,000 62,423 (16,423) 16,423 46,000 62,723 (16,723) 16,723 183-2001 Volunteer 12,977 15,172 (2,195) 2,195 12,977 12,830 147 13,630 13,630 -

183-3501 Transport 131,656 142,949 (11,293) 167,825 167,825 - 169,940 162,734 7,206 183-1401 Case Mgmt - 73,958 (73,958) 73,958 - 77,135 (77,135) 77,135 - 80,476 (80,476) 80,476

183-7101 Cong Meals-Admin 211,497 291,526 (80,029) 60,029 276,863 277,010 (147) 267,543 298,179 (30,636) 30,636 183-7112 Cong Meals-Culp 12,000 80,978 (68,978) 68,978 7,400 88,378 (80,978) 80,978 12,700 61,774 (49,074) 49,074 183-7113 Cong Meals-Fauq 15,000 47,310 (32,310) 32,310 16,100 59,944 (43,844) 43,844 14,300 32,423 (18,123) 18,123 183-7114 Cong Meals-Madison 61,000 122,143 (61,143) 61,143 48,500 92,475 (43,975) 43,975 66,000 78,645 (12,645) 12,645 183-7115 Cong Meals-Orange 10,000 65,040 (55,040) 55,040 9,900 70,273 (60,373) 60,373 10,100 45,356 (35,256) 35,256 183-7116 Cong Meals-Rapp 11,000 58,224 (47,224) 47,224 13,400 64,945 (51,545) 51,545 14,900 38,246 (23,346) 23,346 183-72XX Home Del 221,264 264,361 (43,097) 43,097 242,715 306,812 (64,097) 64,097 248,785 248,785 - 183-7501 Elder Abuse 2,044 17,365 (15,321) 15,321 2,252 17,536 (15,284) 15,284 2,610 17,857 (15,247) 15,247 183-7601 Disease 15,409 22,215 (6,806) 6,806 16,744 34,925 (18,181) 17,512 17,512 - 183-7701 Ombudsman 20,287 29,177 (8,890) 8,890 20,587 29,739 (9,152) 9,152 21,131 29,156 (8,025) 8,025 184-7401 Warrenton ADC 192,294 204,856 (12,562) 24,150 201,022 195,681 5,341 31,363 222,439 249,436 (26,997) 26,997 184-7323 Respite 48,777 78,792 (30,015) 18,427 51,777 75,242 (23,465) 4,942 51,977 70,121 (18,144) 18,144 150-1408 Care Coord 65,411 79,425 (14,014) 6,783 65,411 81,793 (16,382) 4,694 65,411 74,295 (8,884) 8,884 TOTAL DEPT of AGING 1,076,616 1,657,256 (580,640) 542,114 1,199,473 1,714,964 (515,491) 503,805 1,244,978 1,581,348 (336,370) 343,576

50-101 PMMP 12,000 21,626 (9,626) 9,626 15,900 21,648 (5,748) 400-2880 LEAFLIN APTS - 30,863 (30,863) 29,100 - 29,231 (29,231) 18,212 - 29,674 (29,674) 29,674 Total Other 12,000 52,489 (40,489) 38,726 15,900 50,879 (34,979) 18,212 - 29,674 (29,674) 29,674

GRAND TOTAL 8,527,574 10,857,645 (2,330,071) 974,930 8,911,540 10,528,203 (1,616,663) 954,284 8,636,668 10,192,255 (1,555,587) 938,523

FY2017 FY2016 FY2015

RRCS Risk Management and QI Plan: FY 2017–2018 Planning and Development Workgroup

Updated 6/16

Goal Rationale Strategies Measure(s) Responsible Party Updates / July 2016

1 Develop system wide rapid access model.

Outpatient wait times present risk to the organization and the community. Offering a rapid access service for triage and support prior to full service engagement will help in reducing this risk.

• Implementation of centralized scheduling.

• Program team for services outside of episode of care.

• Decrease time allowed for new intakes.

• Orientation groups.

• Wait time as measured by time from initial contact to first appointment.

• Number of people participating in orientation groups.

Ryan, Anna Rapid Access is rolling out in June and will be announced in all localities in July. RCCT Team has worked well with Core Team to coordinate necessary changes.

2 Assure staff in ID day support, residential and case management have current information on DBHDS expectations and requirements including DOJ requirement, Conflict Free CM and Best Practices.

To effectively respond to significant new and rapidly changing demands related to ID Services communication linkages to all levels of staff is critical.

• Staff meetings and training

• QA staff to assist staff in applying requirements in day to day work.

• Add review of critical elements to new employee orientation at programs.

Stable reports on DOJ and DBHDS compliance measures.

Support Coordinators, Residential and Day Support staff have been trained and are prepared. DD CM has been added to the transition and ID Support Coordinators are trained in this as well.

3 Evaluate and adopt a new critical incident reporting system for all agency programs.

The current manual reporting system is inadequate for agency needs.

• Complete review of external expectations for critical incident reporting.

• Complete review of internal needs.

• Evaluate and propose technologies that address these needs.

• Products and technology evaluation outcomes.

• Successful implementation of integrated system by June 2016.

Basic process has been outlined; next step will involve receiving input from key users of the current process for needs.


Updated 6/16

4 Coordination and partner collaboration expectations continue to grow specific to Aging services. Agency needs to be positioned as providing regional leadership to key aging issues.

The organization focuses virtually all of its resources on the provision of direct services to seniors. Time and resources are also required for long range planning and positioning the agency for the future and partnerships with other entities such as hospitals and community-based providers.

• AT Board of Directors to act as NWD Advisory Council.

• Increase engagement of Aging Advisory Council in Area Plan approval and oversight.

• Continue strategic focus on development, including evaluation of grant-funded program initiatives as well as fundraising efforts

RRCS Aging Services ongoing recognition as regional leader in the provision of and advocacy for aging services for local citizens.

Continue to monitor No Wrong Door implementation and to continue to work in local Transition Coalition for development of services for hospitals. Long Term Care Ombudsman function needing modification due to changes related to conflict of interest free requirements from CMS.

5 Work towards a smooth transition for DD CM services accountability to RRCS

Effective 7/1/2016 DD CM services will be provided by CSBs with the private provider transition to be completed by 12/1/16.

• Contracts to current providers.

• RFP for choice provider. • Training of contracted

providers. • Overall implementation

of new service within RRCS

Individuals and families receiving and/or needing DD CM services can get needs addressed and questions answered.

6 Evaluate emergency services response capability and staffing credentials in view of statutory changes and significant growth in local and state expectations regarding the provision of this service.

A strong emergency services system is an essential component to responding to local community needs. Recent statewide attention to this issue and statutory changes necessitate a review.

• Evaluate scheduling and capacity of current system.

• Lead consideration of the development of a Crisis Intervention Team.

• 100% compliance with DBHDS required response times.

• Monitor and report on TDO exception reporting.

RRCS has met requirements and is prepared to implement changes effective 7/1/16.


Updated 6/16

7 Improved education regarding DBHDS Performance Contract requirements for program managers.

Improved knowledge leads to improved compliance and meeting of standards of care.

Development of materials and conducting staff training

Training records and meeting minutes.

FY17 Contract has been reviewed with plans in place for divisional information sessions for managers.

8 Active review and analysis of CCS data requirements and reports to identify performance, technical and staff training issues.

Agency data should accurately reflect RRCS services.

• Production, review and analysis of CCS reports.

• Feedback from staff • Producing meaningful

reports for staff and management.

DBHDS CCS Data Reduced error rates in key data areas

A CCS workgroup is formed and meets routinely. Group focuses on errors and corrections to support improved reporting.

9 Develop program for structured monitoring of high medical needs individuals residing in RRCS group homes.

Over the past two years RRCS has admitted into care individuals with high medical needs.

• Nursing staff to training and monitor care.

• Protocols for group home managers and staff to go by for day to day monitoring of medical needs.

Stability of placement that responds quickly to needs and avoids medical emergencies, ER visits and hospitalizations.

Exceptional rate justifications submitted to DBHDS for adjusted fees once bridge funding discontinues and new waiver rates begin on 7/1/16.

10 RRCS requires a robust accounting and HR platform to respond to internal, funding source and employee needs.

The current platform is extremely dated and unable to fully address agency needs.

• Evaluate market • Solicit and review

proposals • Visit preferred users • Select a product /

vendor.

Purchase and implementation of a new platform.

Fmteam/RiskManagementandQIPlan2017_18

Rappahannock Rapidan Community Services Program Committee Meeting

Tuesday – June 28, 2016 – 9:30 a.m. Bradford Road Offices – Culpeper

MINUTES

Members Present: Alan Anstine, Pat Balasco-Barr, Elizabeth Blubaugh, Marcia Brose, Bonita

Burr, Paula Howland, Christina Kearney, Clare Lillard, Mary Lou McFarland

Members Excused: Sarah Altman, Elizabeth Davis, Robert Legge, Demaris Miller, Robert Weigel

Staff Present: Brian Duncan, Ryan Banks, Ray Parks, Laura Wohlford

1. Call to order Committee Chair – Mary Lou McFarland

Mary Lou McFarland, Chair, called the meeting to order at 9:35am.

2. Review agenda for additions / deletions There were no additions or deletions to the agenda. Brian has a few announcements he will add at the end of the meeting, but not any discussion items.

3. Area Plan for Aging Services – Ray Parks / Brian Duncan You will be approving the Area Plan for Aging Services with the budget vote at the called meeting today. Ray discussed the background of the Older Americans Act of 1965. He then discussed the funding threat to the State Health Insurance Program (our VICAP insurance counseling). Ray explained the resource guides for our clients at the senior centers, Leaflin Lane Apartments, and our homebound clients. This was our Older American’s Month project. This program was recognized at the state level in the Governor’s proclamation. Ray reviewed the Area Agency’s Plan. We are starting year two of a four-year plan. The Area Agency on Aging (AAA) follows the federal fiscal year (Oct 1 – Sept 30). There are 25 AAAs in the state. The AAAs are not dependent on fee-for-service or insurance reimbursement. Additional funding comes from donations, grants, local sources, and fundraising activities. Questions/Discussion: What are the eligibility criteria for home delivered meals? Response: Individuals must be age 60 plus and homebound as defined by the state. Volunteers deliver meals to the senior

centers. Our transit drivers pick up the meals at the senior centers and make the home deliveries. The transit drivers also assess the condition of the recipient during delivery. Aging Together – what is their connection with RRCS? Response: They started through RRCS as part of the Community Services Division. It is now a separate entity from RRCS. We serve on their board and we work closely together. They provide caregiver services that we don’t have funds to develop. Are there performance measures for our services? Response: Yes, that is one of the functions of the Peer Place database. DARS reviews and aggregates that information and presents it at the Federal level.

4. Crisis Intervention Team Assessment Site Proposal Overview – Brian Duncan This project has been funded. We are getting our leadership team together this week to establish the assessment site within 90 days. Our site will be at the Culpeper Hospital. We have had an assertive Crisis Intervention Team development in process for the past 18 months. We began the process about two years ago with Lou Battle representing local law enforcement. This initial process provided local funding for the CIT coordinator position.

5. Other program updates • A grant request was submitted to the Culpeper Wellness Foundation to cover store

assessments for smoking and vaping materials. The grant was funded for $10,000 to cover staffing costs to perform these assessments. The program will last through the summer.

• A model letter to the editor for the golf tournament was distributed. Board members

are encouraged to submit a letter to their local newspapers and continue to solicit sponsorships and participants.

6. Adjourn

The meeting adjourned at 10:55am.

The next meeting will be August 23, 2016 at 1:00pm

NOTE: TO REDUCE THE LENGTH OF THIS BOARD PACKAGE, THE ATTACHMENTS TO THE PROGRAM COMMITTEE MINUTES HAVE BEEN DELETED.

PLEASE REFER TO THE PROGRAM COMMITTEE MINUTES ON THE WEBSITE FOR THE HANDOUTS RELATING TO THE AREA AGENCY ON AGING AND THE CIT ASSESSMENT SITE FUNDING.

https://www.rrcsb.org/wp-content/uploads/2015/08/ProgComm-160628-minutes-FINAL-with-ATTACHMENTS.pdf

https://www.rrcsb.org/wp-content/uploads/2015/08/ProgComm-160628-minutes-FINAL-with-ATTACHMENTS.pdf�

Rappahannock Rapidan Community Services Senior Management Team Meeting

June 14, 2016 – 9:00 a.m. – Room B MINUTES

Staff Present: Brian Duncan, Ryan Banks, Anna McFalls, Paula Stone Staff Excused: Ray Parks Meeting started at 9:10am.

Item Discussion Action/Follow-up Who

Financial and Reimbursement Reports

• Current – updates / questions / close – out of FY16.

• Fiscal 17: Informational budget to

Board today, vote on June 28.

• Fiscal 17: Budget meetings scheduled

• Current – Reimbursement o Review and discuss May report

(attached) as needed

We are in the last two weeks of FY16. Accounts are in the process of being closed. Staff need to submit their payment paperwork to accounting ASAP for processing in FY16. Not discussed All meetings are scheduled. Accounting is in the process of setting up the templates for FY17 and getting the open enrollment paperwork to payroll. Brian to discuss using Boxwood as a diversion at the next HPR-1 meeting. The fee report only represents Medicaid fees, no other fee income.

Brian

Board Committee Support

Program Committee • June – Area Plan and CIT

Assessment Site proposal • July – no meeting

Administrative Services Committee

• June – Called Board meeting • July – no meeting

Other Committees: • Development

June - Ray will discuss the Area Plan and Brian will provide an update for the Crisis Intervention Team assessment site funding. June - Called meeting will start at 11:00. Brian will cover the development committee and discuss Bowl for Seniors and the Golf Tournament.

Ray, Brian Brian


June 14, 2016 – 9:00 a.m. – Room B • Golf Tournament

Elizabeth and Paula will discuss the golf tournament at the board meeting.

Paula, Elizabeth

Human Resources Recruitment Report Open Enrollment outcomes Overtime rule: report from HR due at our July 27 meeting.

Anna handed out the recruitment report. No firm numbers yet. Not discussed.

DBHDS Licensing Credible

Updates as needed ● Licensing for new services and DD

CM

Updates / Questions

We have signed off on the removal of the license for ID supported living and Valerie is getting a license for day support services. The core team is planning new training for superusers. We need to make sure superusers know the difference between a supervisor and superuser. There needs to be some mechanism for senior managers to have access to the core team to allow feedback. Individuals need to realize that they need to run the quality reports themselves (for incompletes and errors, etc.). Can managers be trained to run these reports and how often should these reports be run? Do we have a plan specific to the new DD providers for HR processes (orientations, background checks, etc.) and other requirements? Are we doing this as a big group or should it be done by provider? The providers currently use Survey Monkey to submit their data to the department. Should they be using CCS? If so, when should it be implemented (July 1 or start of contract?) We also need to figure out the logistics of invoicing and payment for the private providers. Paula’s staff is working on supervision of the private providers. These providers will have partial access to Credible – how to do we make this work and train the providers. We want to have all the contracts in place on June 30 at the latest. Training needs to start as soon as the contracts are signed. Anna and

Valerie Anna Anna, Paula


June 14, 2016 – 9:00 a.m. – Room B Paula will decide who should attend a meeting to discuss these items.

Other DBHDS Regional Designations – impact on REACH services and Crisis Staff Transitions for DD CM / Paula – upcoming meeting on RFP Culpeper Renovations – updates Senior Center Renovations - updates Genoa – call to Remington Pharmacy Contract Agreement Routing Process / clarify as needed

Anna will provide the letter she received from Horizon to Brian for follow-up. The region is submitting a proposal for modified FY17 navigator funding for mental health. Discussed above The contractor is working on the waiting room expansion. Brian met with staff yesterday. Renovations should be completed by the end of August. This is going well and should be done in the fall. Brian spoke to Remington Pharmacy. Orange Apartments and Liberty House will continue with their local pharmacy to procure medications as part of client training for independence. We have updated the contract routing guidelines and form. If you have questions about a contract, bring it to a SMT meeting to discuss

Anna, Brian

Divisional Reports and Announcements

Clinical Division: We are extending staffing the rest of the month for clinician training. We are starting the new clinical assessment on June 15th and rapid access starts on June 28th. ● One of the issues is whether clients get an initial GAP screening – we are going wait for 60 – 90 days before starting this. They will do the referral based upon the clinical assessment. The only change is that if there is no proof of income, they will wait the 60 – 90 days for the GAP assessment. This is a temporary adjustment until all the front-office staff is fully trained and comfortable with the rapid access process. ● We will implement level of care scoring in July. ● We have two interns starting in August, one each for Fauquier and Culpeper. Aging and Transportation Services: Not discussed in Ray’s absence. Finance and Admin Services: Anna has a planning call to discuss implementation of the accounting/HR software. There will be an additional follow-up call to discuss contracting and pricing.


June 14, 2016 – 9:00 a.m. – Room B Community Support: We have individuals on the department’s waiting list for public guardian funding. Some of our clients will receive funding to cover court costs for this service. The department will be sending a check shortly. ● Sheri and Laurie are working on a policy regarding visitations at the group homes. ● We are discovering some issues in using the SOAR program. It is taking so long to get approvals, the clients receive a lump sum payment to cover three-to four-months, which puts the client over the asset limit and they are no longer eligible for Medicaid. The payment must be spent within 30 days to get back on Medicaid. ● On MH Support, we are getting partial approvals, which requires re-submitting requests. ● Are we going to publicize and get newspapers to come to the golf tournament? We should make them aware of the tournament and invite them to attend the on the day of the event.

Next meeting: June 29, 2016 – 9:00 a.m.

Reports to Senior Management Discussion Action/follow-up Who

Health/Safety No report

Accessibility No report

Human Rights Problem Resolution No report

Stakeholder Communications – Newsletter

Update on Facebook and content for all pages

Workforce Development Updates

• Can we change the day of supervisors training so that it is not on a Monday? Wednesdays or Thursdays would be better.

• We had our first wellness group meeting – we are going to meet again by the end of the month. Kim from Digital is working with us, we will add people from Optima as well.

• We received the summary information from the biometric screenings – we rated high on obesity and blood pressure.

Planning and Development Risk Management No updates

QA Policy Reviews / Updates No updates

Meeting adjourned at 11:30am.


June 14, 2016 – 9:00 a.m. – Room B

Community Support

Program Monthly Budget Units

May Units

May Variance

May %

YTD Budgeted

Units

YTD Monthly

units

YTD Variance %

ID CMAdult 250 240 -10 96% 2750 2571 -179 93% ID CMCHILD 90 79 -11 88% 990 792 -198 80% ID F-BRIDG 1208 1371 163 113% 13288 13396 108 101% ID GH AIRL 740 746 6 101% 8140 8226 86 101% ID GH ASTER 1915 2024 109 106% 21065 21212 147 101% ID GH CANT 1498 1493 -5 100% 16478 9423 -7055 57% ID GH EVER 1435 1440 5 100% 15785 14183 -1602 90% ID GH FOXC 1429 1481 52 104% 15719 16032 313 102% ID GH HIGH 1485 1389 -96 94% 16335 15866 -469 97% ID GH LIBE 0 0 0 0 0 13221 13221 0 ID GH LOCU 2383 2377 -6 100% 26213 26409 196 101% ID GH MILL 1588 1666 78 105% 17468 18707 1239 107% ID GH ORAN 1489 1364 -125 92% 16379 14036 -2343 86% ID GH REMI 2183 2521 338 115% 24013 25397 1384 106% ID O-Bridg 1511 1583 72 105% 16621 16857 236 101% ID SUPPORT 275 161 -114 59% 3025 2667 -358 88% MH LIBERTY (Old Guinn Ln) 120 128 8 107% 1320 1187 -133 90% MH SMI CM 120 141 21 118% 1320 1544 224 117% MH ORANGE APARTMENTS 160 157 -3 98% 1760 2147 387 122% MH VISIONS 930 897 -33 96% 10230 9884 -346 97%


June 14, 2016 – 9:00 a.m. – Room B

Clinical Services

Program Monthly Budget Units

May Units

May Variance

May %

YTD Budgeted

Units

YTD Monthly

units

YTD Variance %

ID CM ITC 70 84 14 120% 770 753 -17 98% MH SED CM 115 94 -21 82% 1265 1117 -148 88% SA BOXWOOD 593 661 68 111% 6523 6487 -36 99% SA BX DETX 127 132 5 104% 1397 1150 -247 82%

Rappahannock Rapidan Community Services Senior Management Team Meeting June 29, 2016 – 9:00 a.m. – Board Room

MINUTES

Staff Present: Brian Duncan, Ryan Banks, Anna McFalls, Ray Parks, Paula Stone The meeting started at 9:05am. Brian made some general announcements before the meeting officially started: we received our Crisis Intervention Team Assessment Site funding, we have a new Fauquier County Appointee, and we received a grant from the Culpeper Wellness Foundation for our smoking/vaping retail analysis and educational program. Item Discussion Action/Follow-up Who

Financial and Reimbursement Reports

• FY16 closeout – questions / updates • Fiscal 17: Budget approved, meetings

scheduled.

• Meals per diem rates / clarifications

• Performance Contract or Area Plan items / discussion?

• Reimbursement

No additional closeout information. Not discussed Accounting has sent out information about per diem rates. Question: A volunteer recruitment and training meeting included a meal, is that allowable? Response: The cost can’t exceed $10 per person. Email Anna if you get something that doesn’t seem right or if you have questions. Question: Is there anything significant that divisions need to be aware of in the performance contract? Response: Right now, it is all administrative issues. Ray is working with Dawn on the Aging Plan to review the revisions and updates. The plan is due August 1. The DD/ID waiver start date has moved to August 1. As of the conference call yesterday, the new DD waiver amount ($242.71) will go into effect on July 1. We will be following the new procedures and can be reimbursed at this new rate.

Board Committee Support

Program Committee • June – f/u from yesterday’s

meeting?

No follow-up.


• July – no meeting

Administrative Services Committee • June – f/u from yesterday’s

meeting? • July – no meeting

Other Committees:

• Development - nothing • Golf Tournament

Meeting schedule change New appointee from Fauquier County –

No follow-up. Not discussed. Don’t forget your divisional presentation board - let Paula know when it is ready. The program will be reviewed by SMT at the July 13 meeting – it will be sent out to the SMT prior to that meeting. July Board meeting – we will hand out the stipend paperwork and make this an annual event. Admin Services will start at 2:30pm, after the program committee. Matthew Parker

Human Resources Recruitment Report Open Enrollment outcomes Overtime rule: report from HR due at our July 27 meeting.

Anna handed out the recruitment report. Question: What is the process for getting a position on hold? Response: Brian, Anna, or senior managers are the only ones who can put a position on hold. Anna will follow-up with any questions from the report. We have not gotten our final enrollment numbers yet from Optima. The numbers we have so far are: 183 enrolled, the majority chose the least expensive high deductable plan. 122 have provided information for biometric screening. These numbers are subject to change once the information comes in from Optima. Not discussed.

Anna


Implementation of new pay scale – discuss, provide info to Senior Managers and discuss how questions should be managed.

The board approved the new pay scale at their June 28th meeting. The new scale will be distributed to supervisors. Individual employees affected will receive notification at their home address. There will also be an all-staff email explaining the process. Direct any additional questions to HR. The new scale will go into effect on July 3. The new scale has new numbering. It is completely different from the old scale. For a few positions, the entry-level salary went down. This reduced salary was not passed on to any current employees (no salary was reduced). However, starting salaries for future recruitment would be at the lower level for those positions.

DBHDS Licensing Credible

Updates as needed

Updates / Questions

For the DD providers, we will not be adding their location to our license. Our next superuser meeting will be on the 13th. Anna will send out the new expectations to SMT for review before the meeting. We will also discuss what to do in the case of loss of connectivity at the meeting.

Anna

Other DBHDS Regional Designations – impact on REACH services and Crisis Staff Transitions for DD CM / Paula Culpeper Renovations – updates Senior Center Renovations – updates

Brian has been sharing his communications with DBHDS with SMT. All the funding should work through, but there may be a quarter where we need to carry the salary of the Navigator position until the change is in place. In HPR-2, everything is contracted. For children, HPR-2 uses the National Counseling Group; for adults, it is Easter Seals. Not discussed. No updates, all going well. The fundraising committee will be meeting next week to discuss funding for equipment and furniture.


Bridges Project

This land purchase will close on July 5. The site needs some preparation before an “official” groundbreaking can be held.

Divisional Reports and Announcements

Clinical Division: Rapid Access started yesterday. All seems to be going well. At Culpeper, seven people arrived for screening and only one person wasn’t seen (they came in today). At Fauquier, there were also seven people. Four intakes were completed; three individuals were asked to return with additional information. The Fauquier juvenile justice position should be circulating for approval. What is the status on using Telepresence for crisis services? Didn’t it turn out that this didn’t work? Response: We are going to table this for the time being. The assessment center will further reduce the need for this. Lynne attended the maternal substance abuse conference. Parent Café training went well and everyone is ready to get started with it. Our Regional CPMT meeting was yesterday with representation from all counties except Culpeper. Ryan is out next week. Aging and Transportation Services: We met last Friday with the director of social work at Fauquier Hospital to discuss Care Transitions, managed care, and other aging services. We are also participating in their transitions coalition. The advisory council would like the board to consider a liaison position between the board and council. Could we ask a board member to volunteer to serve on the advisory council? Finance and Admin Services: We are moving forward with the HR/Accounting software. We would like to begin implementation in October. It will take 15 months to implement. We will use this opportunity to look at our processes and make changes to improve efficiencies. Community Support: For day support and group homes, the funding information from the DBHDS is on target with what we have in our budget, with one exception whose tier was lowered. We will appeal this, as well as a couple of other individuals. We are still working on the bed vacancies, especially at Locust Grove where a client is in the hospital. Susan is part of the team to work on the discharge activities.

Next meeting: July 12, 2016 – 9:00 a.m.

Reports to Senior Management Discussion Action/follow-up Who

Health/Safety No report

Accessibility No report

Human Rights Problem Resolution No report


Stakeholder Communications – Newsletter

Update on Facebook and content for all pages

Workforce Development Updates

Wellness – we got back all the information about biometrics. Digital attended our last meeting and we looked at the biometric information to determine what sorts of programs should be implemented. Our target areas are obesity and blood pressure. We decided that our initial program would be “On the Move” for the next four weeks to encourage physical activity. We are also looking at more educational programs. Question: From the last supervisor’s training, is there any follow-up regarding internal consistency and evaluation scoring? There was a lot of material covered at the session, but will there be any internal follow-up? Response: The trainer suggested implementing evaluation scoring consistency measures with concrete ideas for each position description. Can we do this at the next supervisor’s training? We could have the supervisors prepare the models for each scoring level, and then HR can review what the supervisors develop. Staff wanted to continue the conversation. In the past few years, our evaluations have become more consistent throughout the organization.

Planning and Development Risk Management No updates

QA Policy Reviews / Updates No updates

The meeting ended at 11:45am.

RAPPAHANNOCK RAPIDAN COMMUNITY SERVICES BOARD OF DIRECTORS

2016

December 14, 2015

OFFICERS OF THE BOARD

Mr. Edward Alan Anstine, Chair (Culpeper) Mr. Robert Legge, Vice-Chair (Madison)

Ms. Pat Balasco-Barr, Secretary (Fauquier)

Culpeper County (Terms)

Mr. Edward Alan Anstine (1/13 – 12/18) Ms. Elizabeth Davis (1/14 – 12/16)

Ms. Christina Kearney (1/15 – 12/17)

Fauquier County (Terms)

Ms. Pat Balasco-Barr (1/15 – 12/17) Mr. Robert Weigel (1/14 – 12/16)

Vacant

Madison County (Terms)

Ms. Bonita Burr (1/15 – 12/17) Mr. Robert Legge (1/15 – 12/17) Ms. Clare Lillard (1/15 – 12/17)

Orange County (Terms)

Ms. Sarah Altman (1/14 – 12/16) Ms. Marcia Brose (1/11 – 12/18)

Ms. Mary Lou McFarland (1/11 – 12/16)

Rappahannock County (Terms)

Ms. Elizabeth Blubaugh (1/14 – 12/16) Ms. Paula Howland, Ph.D. (1/16 – 12/18) Ms. Demaris Miller, Ph.D. (1/15 – 12/17)

The mission of RRCS is to improve the quality of life of the citizens of Planning District 9 by providing comprehensive behavioral health, intellectual disability, substance use disorder, and aging services. Vision Statement: To have quality define our services, our practices, our behaviors and our outcomes.

RAPPAHANNOCK RAPIDAN COMMUNITY SERVICES

SENIOR MANAGEMENT TEAM ROSTER 2016

Brian D. Duncan 825-3100, ext. 3145 Executive Director email: [email protected] Anna B. McFalls 825-3100, ext. 3144 Director, Finance and Administrative Services email: [email protected] Paula Stone 825-3100, ext. 3437 Director, Community Support Services email: [email protected] Ray Parks 825-3100, ext. 3331 Director, Aging and Transportation Services email: [email protected] Ryan Banks 825-3100, ext. 3008 Director, Clinical Services email: [email protected]

USEFUL WEBSITES

Virginia Association of Community Services Boards www.vacsb.org Department of Behavioral Health and Developmental Services (DBHDS) www.dbhds.virginia.gov Virginia Division for the Aging (VDA) www.vda.virginia.gov National Association of Behavioral Health and Developmental Disabilities Directors http://nacbhdd.org/

National Association of Area Agencies on Aging http://www.n4a.org/ Virginia Association of Area Agencies on Aging http://vaaaa.org/

mailto:[email protected]�





http://www.vacsb.org/�

http://www.dbhds.virginia.gov/�

http://www.vda.virginia.gov/�

http://nacbhdd.org/�

http://www.n4a.org/�

http://vaaaa.org/�

© 2016 Wiley Periodicals, Inc., A Wiley Company • All rights reservedView this newsletter online at wileyonlinelibrary.com • DOI: 10.1002/ban

Editor: Jeff Stratton

Supplement

Two ‘favors’ the board can do for its CEOConsultant Carol Weisman (http://www.board

builders.com) has a wealth of knowledge to bring to bear on the board and administrator relationship. Here are some of her thoughts on how to keep it effective by showing support for your executive director:

• Stress a positive relationship between the chair and the CEO. For Weisman, what’s key is a set of mutually agreed-upon expectations between the chair and executive director. This is necessary, because the relationship between this pair must be rock solid due to its importance to the health of the organization.

“One of the things I preach is the need for a ‘prenuptial’ agreement between the executive di-rector and the chair,” she said.

The “prenup” should be a verbal one and specify how often the two will meet, the types of information the chair wants to receive, how each party defines an emergency and issues surrounding what is “personal time” for both parties.

The prenuptial should be verbal, Weisman said, because it gives each party a chance to really talk through the issues. “There needs to be some give-and-take, some compromising, and this needs to be done verbally,” she said.

“Have this meeting in person and not over the telephone, so you can negotiate,” Weisman said.

Issues of importance to the chair and execu-tive can arise from this type of conversation. For instance, Weisman met with an executive director who didn’t want to have meetings that involved alcohol due to personal demons and spoke to the chair about it. “That is a very personal type of con-

versation,” she said. Another example of personal boundaries and

the give-and-take that should occur in this type of conversation: When Weisman served as chair of a board, she told the executive director that if he wanted to call her at 5:30 a.m., that was fine. But by 9:00 p.m., please don’t call. The ex-ecutive director said he was recently separated from his wife and had his kids on weekends and Wednesday nights, so he didn’t want calls dur-ing these times.

• Avoid unrealistic expectations on the part of the board. Boards have a tendency to say things to their CEO such as “We are going to see revenue increase by 25% next year,” Weis-man said. That can put the administrator in an untenable spot.

The board should do everyone a favor when it “thinks” big and ask how such a high goal would go over in their own business or com-pany.

“When boards say something like this, I turn it back on them and ask, ‘How much would it cost to raise their bottom line by 25% in one year?’” Weisman said. Board members typically tell Weisman that this would be far too costly to consider.

“Then I ask why they think that something that won’t work in their business will work for the non-profit,” she said.

Point: It’s fine for a board to think big and dream. That’s part of giving the organization a secure future. But the responsibility that comes along with this is that the board must figure out a way to pay for its plans. ■

July 2016 Vol. 32, No. 11

http://www.wileyonlinelibrary.com

http://www.boardbuilders.com

http://www.boardbuilders.com

B&A For Board Members

DOI 10.1002/ban © 2016 Wiley Periodicals, Inc., A Wiley Company All rights reserved

Policy language for board relationship with staffOne of the more difficult things to learn about

being a board member is the board’s relationship with staff.

The board-staff connection can be tricky. It may be your instinct to just pick up the phone and have a staff member track down some information you need or perform a little work, just like you would in the business you own or with the em-ployees you manage.

That’s not how it should work in the board member/staff member relationship, however.

It’s always important to remember that the

board has one employee: your executive director.The executive director is your go-to person when

you need something from an employee. That’s because the board hired him or her to manage personnel for the organization.

In a board/executive director relationship poli-cy, I recommend the board include this language to reinforce this important concept:

“The Board supports the executive director in the day-to-day decision-making process, avoiding any direct communication with staff on day-to-day matters.” ■

Bylaws aren’t for ‘tweaking’ to get your wayNonprofit consultant Terrie Temkin (http://

www.Corestrategies4nonprofits.com) said board members (or founders) only create problems for themselves and future boards if they write bylaws for self-serving reasons. Here’s how:

• Tweaking bylaws to help yourself. A classic example: The organization’s founder writes into the bylaws that he will have a permanent seat on the board or have a place on the board for a family member in perpetuity. “This can be extremely det-rimental to the organization, but it is done all the time,” Temkin said.

• Eliminating checks and balances. Prob-lems also occur if the CEO votes or signs checks without checks and balances in place. “The CEO will make a case to the board that ‘I’m here daily. I care about this organization. I know what needs to be done, so let’s just write this into the bylaws,’” Temkin said. “The board must ensure the bylaws put healthy checks and balances in place.”

• Allowing conflicts of interest situation-ally. Conflicts of interest are another area where boards make mistakes with bylaws, Temkin said. An example would be allowing directors with an “interest” in a financial transaction to remain in the room during board discussions on a purchase.

“Let’s say a board member is a roofer. He has a service to offer the organization,” said Temkin. “That’s perfectly fine, if the conflict-of-interest policies are written to say that a position on the board doesn’t preclude a board member from sell-ing something to the organization.” In fact, this is typical language in some conflict-of-interest state-

ments, Temkin said.However, it becomes dicey if the bylaws state-

ment allows the individual board member to be in on the purchase discussion as well as in the room when ballots are cast.

“To handle that most ethically, the board mem-ber should not be in on the board’s discussion and should not be there when the board votes un-less all bidders are present,” she said. “The board member’s presence can be intimidating to other board members, and it is an unfair advantage to the board member.”

• Eliminating membership for expediency’s sake. Temkin has also seen bylaws written to do away with an organization’s members and leave all responsibilities to the board. It’s usually done from a desire to expedite the work. “But you have to step back and look at why there is a role for members in your organization and determine if that reason is still valid today,” she said. Today, most organizations do not have members, Temkin said, but she has seen bylaws written to get rid of the membership. “This can be done just to benefit the people in power,” she said.

• Allowing a “board within a board.” Execu-tive committees, when used improperly, can create a “board within the board,” Temkin said. “They can use their power to make decisions without a lot of discussion that you get with a full board,” she said.

Board discussions limited to only the executive committee are not as rich and therefore not as valuable to the organization as they would be with the full board involved, she said. ■

rappahannock rapidan community ervices · 2016. 7. 7. · • chronic disease self management...

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