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PAGE NO.
Resolution R-98-160
A RESOLUTION AUTHORIZING THE CHAIRMAN OF THE BOARD OF
COUNTY COMMISSIONERS TO EXECUTE THE GRANT APPLICATION
AND GRANT AGREEMENT FOR THE ALZHEIMERS DISEASE
INITIATIVE PROGRAM.
WHEREAS, Manatee County has determined that continuation of the Alzheimers Disease
Initiative Program is in the best interest of the health and welfare of the citizens of Manatee County;
and
WHEREAS, Manatee County has previously entered into an agreement with the West
Central Florida Area Agency on Aging for the Alzheimers Disease Initiative Program;
NOW, THEREFORE, BE IT RESOLVED, by the Board of County Commissioners of
Manatee County, Florida, that:
1. The submission and acceptance of the Alzheimers Disease Initiative Grant Application
from the West Central Florida Area Agency on Aging, Inc. is authorized.
2. The Chairman of the Manatee County Board of County Commissioners is authorized
to execute the Grant Application Agreement and all related documents for the
Alzheimers Disease Initiative Program.
3. The Director of the Community Services Department is authorized to sign any
documents which may be required in connection with the administrative functions
pursuant to the terms of the Application and Agreement.
ADOPTED with a quorum present and voting this 16th day of June, 1998.
BOARD OF COUNTY COMMISSIONERS
OF MANATEE COUNTY, FLORIDA
BY^7 ^-» ^ ^U ^,f)U^ ^ ,,. . / c \y f v^i ^u vr^
% ^ ^, ':., PATRICIA/M. GLASS
^ It V'1
:.., Chairman
ATTEST:,, \R. B^Shore
^T^ CCerk of Circuit Court -t^-:-----
. _
BY: //) /^^,U. OYI^-^/^ •
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MANATEE COUNTY
ALZHEIMER ^ DISEASE INITIA TIVE
JULYL 1998 - JUNE 30. 1999
MANATEE COUNTY
COMMUNITY SERVICES DEPARTMENT
P. 0. BOX 1000
BRADENTON,FL 34206
(941) 749-3030
04/02/98
TABLE OF CONTENTS
SUMMARY INFORMATION PAGE
SECTION 1 - PROGRAM MODULE - CCE
A. Component I - Program Implementation Plan
B. Component II - Description of Service Delivery
C. Component III - Staff Development/Training Plan
SECTION 1 - PROGRAM MODULE - HCE
A. Component I - Program Implementation Plan
B. Component II - Description of Service Delivery
C. Component III - Staff Development/Training Plan
SECTION 1 - PROGRAM MODULE - ADI
A. Component I - Program Implementation Plan
B. Component II - Description of Service Delivery
C. Component 111 - Staff Development/Training Plan
SECTION 2 - CONTRACT MODULE
A. Personnel Cost Flow Worksheet
Staff Allocation Worksheet(s)
B. Unit Costing Worksheet
MIS Cost Allocation Worksheet
C. Supporting Budget Schedule by Program Activity
D. Commitment Documentation
1. Cash Donation
2. In-Kind Staff Personnel
3. In-Kind Volunteer Personnel
4. In-Kind Building Space
5. In-Kind Supplies
6. In-Kind Equipment
E. Indirect Cost Rate Proposal
F. Program Income Summary
PAGES
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TABLE OF CONTENTS
SECTION 3 - GENERAL ASSURANCES
A. Civil Rights Assurance
B. Section 504 Assurance
C. Availability of Documents
D. Insurance Coverage
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SERVICE PROVIDER APPLICATION
SUMMARY INFORMATION PAGE
1. PROVIDER INFORMATION:
Executive Director: Frederick J. Loveland
Legal Name of Agency:
Manatee County Board of County
Commissioners
Community Services Department
Mailing Address:
P.O. Box 1000
Bradenton, Florida 34206-1000
Telephone: [ 941 ] 749-3030
2. GOVERNING BOARD CHAIR:
Patricia M. Glass, Chairman
Manatee County Board of
County Commissioners
1112 Manatee Ave. West
Suite 903
Bradenton, Florida 34205
[ 941 ] 745-3700
3. ADVISORY COUNCIL CHAIR:
{Name/Address/Phone}
N/A
4. TYPE OF AGENCY:
[ ] Private, Non-Profit
[X ] Governmental Entity
[ ] Other (please specify)
5. PROPOSED PERIOD OF FUNDING
AND FEID NUMBER:
07/01/ 1998 - Q6/ 3Q/ 1999
_5a_ - 600797
6. FUNDS REQUESTED:
[ ] Community Care for the Elderly (CCE)
[ ] Home Care for the Elderly (HCE)
[X ] Alzheimers Disease Initiative (ADD
[ ] Local Service Program (LSP)
7. SERVICE AREA:
[ X ] Single County
[ ] Multiple Counties (list)
8. ADDRESS FOR PAYMENT CHECKS ITEM ff: [X] tfl [ ] ff2
9. CERTIFICATION BY AUTHORIZED AGENCY OFFICER:
I hereby certify that the contents of this document are true, accurate, and complete
statements. I acknowledge that intentional misrepresentatiom or falsification may result
in the termination of financial assistance.
Name: Patricia M. Glass ^)/^C
Title- "Chairman, Manatee County Board nf Commissioners Date:/ lojil^jlQ
ATTEST: R. B. Shore, Clerk of Circuit Court
By:/.J^/ T /^——f . ' ( ^ -,
0<—
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I.PROGRAM IMPLEMENTATION PLAN - ADI
A. NEEDS ASSESSMENT
The most recent needs assessment conducted by Manatee County in conjunction with United Way
of Manatee occurred in 1994. Results of the assessment were published and continue to be
utilized throughout the community today. The Aging Services Section establishes its services from
this assessment. Outcomes of this assessment were derived by a task force surveying local
service agencies and residents of the county. Based on the results of this assessment in regards
to seniors, several goals and tasks were identified, the goals which directly support the need for
Manatee County Aging Services are as follows:
Assure that all elderly citizens are allowed an opportunity to remain in their homes, to
continue to participate in community activities, and to have a dignified and meaningful
existence for the longest possible period of time.
Provide a protective system of assisting vulnerable older persons who are at risk of neglect,
abuse, or exploitation through professional case management and/or guardianship.
Assure that the quality cf life of the family is maintained while the elderly citizen is cared
for at home.
The District VI Department of Children and Family Services conducted a county wide needs
assessment to develop the District FY 1996/97 Plan. Senior issues identified centered around the
need to increase services that will provide an alternative to pre-mature institutionalization
and keep vulnerable senior adults free from harm.
The need for services is also documented through the screened waiting list for ADI services which
as of February 28, 1998, included 3 persons waiting to receive ADI Case Management services.
During the current grant year efforts to increase services to the underserved populations of the
Parrish area of Manatee were minimally successful. This effort will continue and be prioritized in
the 1998/99 grant year.
B. CLIENT ASSESSMENT AND PRIORITIZATIQN
Individuals seeking services through funding provided by the Department of Elderly Affairs may be
referred by themselves, family/friends, or other agencies. Initial contact with a case manager is
often established when the Elder Helpline staff, link them to the Aging Services Section. Case
managers are assigned office duty on a rotating schedule during office hours (Monday through
Friday 8:00 am to 5:00 pm) to receive all referral inquires to the Aging Services Section. During
this first phone contact the Intake and Screening form and the Telephone Screening form are
completed.
Preliminary eligibility is determined by guidelines established through the Department of Elderly
Affairs. The individual must be sixty years of age or older, functionally impaired with mental or
physical limitations which restrict the ability to perform normal activities of daily living and impede
the capacity to live independently without the provision of core services. Persons must also be
inflicted by Alzheimer's Disease, Parkinsons Disease or Dementia and require 24 hours care.
Persons referred meeting preliminary eligibility criteria for services will be placed on the waiting list
and procedures outlined in I.C. below will be followed.
5112
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As funding allows, needed core services are provided to clients having the highest risk scores.
Clients will be ranked in priority by risk scores ranging from 0-100, with 100 being the highest risk
client and displaying the most characteristics of people commonly placed in nursing homes. Each
week, as new clients are added to the waiting list, the list will incorporate new clients into the
proper numerical ranking. When two or more individuals have the same score, time on the waiting
list will become criterion for prioritizantion.
A Care Plan is developed through the combined input of the Client, Case Manager and any
caregivers involved with the client. During this meeting all needed core services, as well as other
core services, are identified which will assist the client in maintaining their independence to avoid
institutional placement. Once clients are assessed utilizing the comprehensive assessment and a
care plan is developed, at a minimum, a quarterly review is completed by the case manager to
monitor the clients condition and adapt the care plan as necessary to address the clients needs for
additional or reduced ADI services or the need for other services and provide the appropriate
linkages. Depending on the clients needs, more frequent contact may be made with the client
either by telephone or home visit. Annually, each client undergoes a complete reassessment. At
this time a new care plan is developed based on the new comprehensive assessment. The client
may receive new services, be placed on a waiting lis.t for services or have a service reduction. The
client is not only evaluated for ADI services but other services which may be available in the
community.
C. WAITING LIST POLICIES
Two waiting lists are maintained by the Aging Services Section, a screened waiting list and an
assessed waiting list. Upon completion of the Intake, Screening and Assessment Form client
information is entered into the CIRTS Data Base the Aging Services Section Data Base. A potential
client is placed on the screened waiting list with information to include program area, service need
and score. A client will move from the screened waiting list to the assessed waiting list upon
completion of the Comprehensive Assessment by a case manager and services become available.
A client may be receiving one or more core services and be on the assessed waiting list for other
needed core services. Clients are moved from the screened waiting list to the assessed and from
the assessed waiting list to service delivery by utilizing the Department of Elder Affairs Priority
requirements which are based on highest risk score and if more than one client has the same risk
score, length of time on the waiting list. The computer system tracks the individual's movement
from referral to screened waiting list to assessed waiting list to service provision. While on the
screened waiting list persons are contacted every six months by a case manager. This ensures
that persons on the screened waiting list continue to be in need of services, or if conditions have
changed, allows for the scores to be updated to reflect the person's improvement /deterioration.
Persons no longer requiring services are removed from the list.
Clients on the assessed waiting list are reviewed a minimum of quarterly with the care plan.
During this time case managers re-assess current services and if the need continues to exist for
the services the client is on the assessed waiting list to receive. The client may be added to the
waiting list or removed from the waiting list depending on their needs at the time of the quarterly
review or at any other time. Clients on the assessed waiting list are given priority over those on
the screened waiting list.
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.5113
Q
Should a need arise to reduce active client services to address the needs of those on the waiting
list with a higher priority, those clients with the lowest comprehensive assessment score will be
the first to receive a service reduction which may include termination.
The waiting lists are maintained by the Office Assistant and reviewed weekly by the Human
Services Coordinator. Average duration for an individual on the waiting list is approximately
seven months. The waiting list for ADI services as of February 28, 1998, included 2 persons
waiting to receive ADI Case Management services.
D. ELDER HELPLINE OR INFORMATION AND REFERRAL
Manatee County operates an Elder Helpline through the office of the County Administrator. Two
staff members employed through this office respond to telephone inquiries during regular business
workdays, Monday through Friday, 8:00 am to 5:00 pm. During weekends and holidays the Elder
Helpline utilizes an answering machine, informing callers of business hours, or in the case of an
emergency situation to direct their call to 911 or to the abuse registry for cases of abuse or
neglect. All messages left on the answering machine are responded to on the morning of the
following business day. All inquiries to the Elder Helpline are recorded on a monthly tracking form
and reported to the Area Agency on Aging.
The Elder Helpline staff communicates regularly with the Aging Services Section staff and
Community Affairs Department to maintain up-to-date information on resources available to local
citizens. As new resources are discovered, information is forwarded to Elder Helpline staff to
incorporate into their information/referral program. Callers are referred directly to other
agencies/services by the Elder Helpline staff, or if appropriate, referred to a case manager in the
Aging Services Section. A case manager is assigned to office duty Monday through Friday, 8:00
am to 5:00 pm in the Aging Services Section to respond to referrals from the Elder Helpline.
If the Elder Helpline staff identify that a referral should be made on behalf of a caller, the caller is
linked to a case manager who will make the referral and provide follow-up to ensure the service
referred was provided.
Manatee County has purchased the IRIS Information and Referral software package and is in the
process of negotiating an agreement with First Call For Help, Inc. (the agency in Manatee County
that handles information and referral for all ages and is recognized by IRIS as the agency to
coordinate with all Information and Referral programs operated by other agencies). Once an
agreement is reached, the information and referral services will be fully computerized.
Manatee County employs multi-lingual staff who are available to assist in interpretation for non-
English speaking individuals. TDD services for the hearing impaired is provided by Manatee County
Government.
E. CLIENT CONFIDENTIALITY
All staff in the Human Services Division are aware of the confidentiality requirements associated
with the ADI program. All client records are maintained in locked file cabinets. Client files are
not permitted to be removed from the office by any County staff.
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4
Q
Prior to receiving services each client is required to sign a release of information form. With this
form case managers are able to coordinate services on the client's behalf. However, Aging
Services staff are not permitted to discuss client information with any other person or to
acknowledge requests as to who is being served by the program. Should special circumstances
arise outside of the area of coordinating services, a new information release form, specific to the
information requested, must be signed.
All procedures related to client confidentiality are in accordance with the Florida Statutes and the
Department of Elderly Affairs Super Manual.
F. APPEALS AMD COMPLAINTS
Each client is informed of their right to appeal any decision or to file a complaint regarding any
service area at the time the comprehensive assessment and care plan are completed. The
procedures are reviewed verbally and provided in writing. In addition, subcontractors are provided
information of the appeals process at the time the Request for Proposals are submitted.
Any client, care giver or subcontractor not satisfied with service, or who does not agree with any
decisions regarding CCE provision of services, would contact the following person/agency in the
order listed:
STEP: 1. Case Manager
2. Human Services Coordinator
3. Human Services Division Manager
4. Community Services Department Director
5. Manatee County Administrator
6. West Central Florida Area Agency on Aging
Clients will be notified in writing of any decision adversely affecting their receipt of services 30
calendar days prior to action occurring. This notice will contain action to be taken, reason for
action and the individuals rights to appeal this action. Current services will continue to be provided
during the appeal period. A written request for a grievance review must be postmarked to initiate
the grievance process.
Informal efforts to satisfactorily resolve issues will be attempted at steps one, two through four
during the thirty (30) day notification period. Documentation will be maintained of all proceedings
throughout the process in a confidential manner. If unsatisfactory resolution continues the client
may request an impartial review by the Manatee County Administrator. A written request must
be submitted for this hearing within fourteen days of (postmarked) receipt of decision made at step
five. Within seven (7) days written acknowledgement of the request will be provided the client,
setting the time, location and date of the hearing. Within seven (7) days after the hearing, written
outcome of this hearing will be provided to the client.
Further appeal of adverse decisions will be directed to the Area Agency on Aging and must be
received from the individual within seven (7) calendar days. Assistance in this process will be
provided to the individual if required. Within seven (7) calendar days, the AAA must acknowledge
receipt of the appeal in writing to the individual, informing them of the time, place and designated
G:\USER\COS06\WPDOCS\GRANT98.ADI Q
5115
hearing officer. The individual may bring counsel of their choice, review documents prior to the
hearing, and receive assistance in order to attend. A written statement of the appeals decision
must be provided to the individual within seven (7) calendar days of the AAA hearing. The
decision of the AAA will be final.
G. EMERGENCY SERVICE PRQViSIQM
Emergency services are available to clients who are at risk of immediate institutionalization. When
an emergency situation presents itself, the case manager will immediately make a home visit to
substantiate the urgency of the referral. Upon establishing the emergency situation, the case
manager will contact the appropriate service entity to provide service to stabilize the situation. In
accordance with the agreement between subcontractors and Manatee County the subcontractor
must provide services within 24 hours of receiving a referral in cases of emergency. In addition,
all subcontractors are required to provide emergency service outside the Monday to Friday 8:00
am - 5:00 pm work week as requested if an emergency situation.
H. UNUSUAL INCIDENTS
All subcontractors are required to report unusual incidents to the Aging Services Section per their
agreement with Manatee County. In Addition, Aging Services staff complete incident reports for
any incident they encounter. All reports are submitted to the Human Services Coordinator for
review as well as placed in the client's file and a separate incident file. The Human Services
Coordinator will investigate reported incidents and provide a written outcome of the investigation
in the client's file. Any serious or major incident must be reported within ten (10) days. Copies
of any serious or major incidents along with all accompanying documentation/information will be
forwarded to the Program Manager of the West Central Florida Area Agency on Aging.
Serious/major incidents include occurrences which pose a threat to the health/safety of a client,
could result in the closure of a service site, media contact, or termination of a subcontractor.
I. DISASTER/EMERGENCY
In the event of a natural disaster or emergency situation elderly clients requiring special assistance
have been identified and vital information provided to the Manatee County Public safely
Department. In the case of evacuation a special shelter has been identified for meeting special
needs of local residents. In addition, case managers of the Aging Services Section are assigned
specific shelter sites that they are to report to during an emergency situation to assist in the care
of the elderly population within that shelter. Transportation assistance is provided for those
requiring this service during an evacuation.
During the actual emergency situation all regular services activities of the Aging Services Section
will be suspended. Once the immediate emergency threat has subsided, case mangers will contact
all clients served to assure the safety of the clients and assist in making arrangements for their
post-emergency needs.
Services Agreements between subcontractors and Manatee County require each provider to permit
G:\USER\COS06\WPDOCS\GRANT98.ADI Q
5116
the Department of Elderly Affairs or the County Administrator/designee to exercise authority over
the provider in order to implement emergency relief measures and/or activities to the elderly in the
area. This action will be for the purpose of assuring the health, safety and welfare of elderly.
Designated shelters consists of the Public School Facilities located throughout the County. Moody
Elementary School, 5425 38th Ave. West is designated as the Special Care Site.
J. SPECIAL LICENSE ASSURANCE
Not applicable to Manatee County.
G:\USER\COS06\WPDOCS\GRANT98.ADI
5117
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L. STAFFING PATTERNS
Organizational Chart - See Attachment #2.
Several staff within the Community Services Department, Human Services Division serve functions
which assist to administer the ADI program. The fiscal areas of the program are administered by
the Fiscal Section of the Division with the program areas administered by the Aging Services
Section of the Division. The positions within the Human Services Division which are funded in
whole or part by the ADI program are as follows:
ACCOUNTANT: Under the direction of the Fiscal Management Analyst, this position monitors
fiscal performance of subcontractors and county staff, maintains fiscal records, reviews monthly
billing and recommends action to be taken to ensure compliance with all fiscal procedures ,
standards and contractual agreements.
ACCOUNT CLERK III: Under the direction of the Fiscal Management Analyst, reviews monthly
subcontractor billing to generate co-pay invoices for CC_E clients. Prepares and mails co-pay
invoices, records and deposits co-pay receipts. Maintains financial records.
HUMAN SERVICES COORDINATOR: under the direction of the Human Services Division Manager,
this position is responsible for all aspects of the CCE program to include preparing requests for
proposals for subcontractors, contractual development and monitoring, monitoring units and clients
relative to expenditure levels, preparation of reports, conducts outreach activities, ensures
coordination with other agencies, participates in aging related committee activities to promote
awareness of senior issues, coordinates service provision to encourage cooperation and lessen
duplication, and provide supervision to all case managers and clerical support.
CASE MANAGER: Under the direction of the Human Services Coordinator, this position performs
professional tasks associated with the case management functions to include intake, telephone
screening, comprehensive assessment, development of care plans, monitoring of client progress,
as well as planning, arranging and coordinating appropriate services on behalf of the client.
OFFICE ASSISTANT IV: Under the direction of the Human Services Coordinator, this position is
responsible to maintain all client information within the client files and computer and maintains the
waiting list. Prepares reports as necessary related to client information, maintains administrative
files and prepares all correspondence for the Aging services Section. Maintains CIRTS data.
OFFICE ASSISTANT 11: Under the direction of the Office Assistant IV, this position assists the
Office Assistant IV in maintaining information in the client files and computer Data Base, and
maintains waiting lists. Performs clerical functions as requested by the Office Assistant IV.
The following information specifically identifies the academic achievements, major area of study
and length of time with the Aging Services Division of Manatee County, for case management
staff:
Human Services Coordinator: John Schwartz, Bach. of Science/Elementary and Special Education
Additional graduate hours in Developmental Disabilities
Aging Services Section - 7 months.
G:\USER\COSOS\WPDOCS\GRANT98.ADI Q
Case Manager II - ADI: M^e Pattersnn, Bach. of Arts/Behavioral & Social Sciences
Aging Services Section - 14 years.
M. QUALITY ASSURANCE-
Manatee County Aging Services recognizes the client as the focal point of quality assurance
efforts. For this reason monitoring tools utilizing client input will be incorporated into evaluation
of services to the elderly. A client satisfaction survey will be performed by telephone or home
visit, with a random sampling of ADI clients. The survey will provide feedback-on clients receiving
a high quality of care through appropriate treatment, services being available when needed and in
a timely fashion, in a respectful and caring manner. This survey will be performed quarterly by the
Aging Services Section. All concerns noted by clients will be followed up for resolution within 30
days of the survey. Home visits will be conducted semi-annually to randomly selected clients to
observe service delivery in the client's home.
Case files for ADI clients will be internally monitored utilizing the Department of Elder Affairs Case
Monitoring Checklist. This process will be completed semi-annually for a randomly selected 30%
of the ADI client case load. Case file reviews will identify such quality issues as: appropriate
documentation, daily service log/case note consistency, completeness of file and care plans as
related to the VCAT, and timeliness of entries. Results of this monitoring will be utilized as training
information for case managers in proper procedures of case management as well as to assure
quality of the case management services being provided. Compliance with ADI contractual
requirements, state and federal regulations, as well as assurance of efficient/effective provision
of services will be included in this review.
Subcontractors will be monitored annually employing the monitoring tool provided for Section l.k.
of this application (Attachment #1).
N. CO-PAY COLLECTION/FEE ASSESSMENT-
Each client in the ADI program will be assessed a Co-Pay in accordance with the Department of
Elder Affairs Fee for Service Guidelines and Co-Pay requirements. It has been determined by the
Manatee County Human Services Division that no waiver of the Co-Pay will be implemented for
ADI clients receiving core services. Clients failing to pay the Co-Pay on a monthly basis per
invoice will have services placed on hold and notified of the outstanding balance due. Upon
payment services will be resumed. Failure to meet Co-Pay obligations for two consecutive invoice
periods (60 days) will result in termination of services.
AAA will be notified 30 days prior to occurrence of termination due to non-payment of co-
payments.
G:\L)SER\CQ5Q6\WPDOCS\GRANT98.ADI Q
Co-Pay Collection Procedure:
1. Client co-pay assessed annually
2. Co-Payment invoice mailed monthly
3. 30 days after mailing co-pay due
4. Non-receipt after 30 days phone call to client by the Case Manager. Services placed
on hold pending payment.
5. 60 days non-receipt letter sent by Human Services Coordinator, informing of intent
to terminate sent. AAA informed.
6. 90 days - termination of service.
0. CLIENT INFORMATION AND TRACKING (CIRTS) SYSTEM STAFFING:
REFER TO CCE SECTION I-O
G:\USER\COS06\WPDOCS\GRANT98.ADI Q|
II.A. DESCRIPTION OF SERVICE DELIVERY
PROVIDER:
DATE SUBMITTED: March 17, 1998
Manatee County Board of
County Commissioners
PROGRAM
PERIOD:
: ALZHEIMERS DISEASE
INITIATIVE (ADD
July 1, 1998 to June 30, 1999
SERVICE: CASE MANAGEMENT
1. SITE LOCATION: Manatee County
2. DAYS AND HOURS OF OPERATION: Monday through Friday
____________________________8:00 am to 5:00 pm
3. SPECIFIC ACTIVITIES PROVIDED UNDER THIS SERVICE:
ADI Case Management provides a single point of entry into the service delivery system for
the client and their family. Assessment through use of the Comprehensive Summary Form
to determine client needs, linkage with community resources to meet these needs and
regular monitoring of services is provided through case management. As the clients
condition changes the case manager assists in adapting service delivery to address these
changes.
Intake, Referral and telephone screenings, initial and annual comprehensive assessments,
annual care plan development, linkage with community resources and subcontractor
services for in-home care are all performed under the case management service.
Documentation and management of client files are duties additionally performed by case
management. Quarterly reviews are performed by case management to assure appropriate
and satisfactory service delivery on-an on-going basis. Advocacy is provided for the client
on an as needed basis.
Examples of clients needing ADI case management are those who have Alzheimers
Disease, Dementia, or Parkinsons Disease, and require 24 hour care from a caregiver.
In-home training is provided through the case manager to the care giver to assist in the
specific needs of disease. Case management assist in outside referrals for support which
will assist the caregiver and family in care fore the client.
Case Management will coordinate additional services beyond ADI services for clients
requiring in-home assistance through CCE, HCE or Medicaid Waiver.
The goal of case management is to allow, through the provision of appropriate resources,
the client the opportunity to live independently in their home environment and community
with the maximum amount of dignity and respect possible.
Use Back Sheet or Attach Additional Sheets as Needed
G:\L)SER\COS06\WPDOCS\GRANT98.ADI
5122
Q
II.B. PROVIDER WORK PLAN
PROVIDER:
DATE SUBMITTED: March 17, 1998
Manatee County Board of
County Commissioners
PROGRAM: ALZHEIMER DISEASE
INITIATIVE (ADD
PERIOD: July 1, 1998to June 30,1999
SERVICE: CASE MANAGEMENT__________________________
OBJECTIVE: Assure appropriateness of care plan services are maintained.
______MAJOR WORK TASK TO ACHIEVE SERVICE OBJECTIVE______
TASK: Conduct quarterly (minimum) reviews with client/caregivers to assure continued
needs/eligibility of services.
________________________________Estimated Completion Date 06/30/99
TASK: Determine client satisfaction of services through quarterly visits, satisfaction
surveys, monitoring visits.
__________________________________Estimated Completion Date _Qfi/3Q/aa
TASK: Identify additional in-home services eligibility and need to support client in the
home (formal and informal).
_________________________________Estimated Completion Date Q6/3DZa9
TASK: Conduct joint staffings with subcontractors on an as needed basis to assure
appropriate provision of services to clients.
__________________________________Estimated Completion Date Q6/3QZ93
Attach Continuation Sheets as Needed
G:\USER\COS06\WPDOCS\GRANT98.ADI Q|
II.B. PROVIDER WORK PLAN
PROVIDER:
DATE SUBMITTED: March 17, 1998
Manatee County Board of
County Commissioners
PROGRAM: ALZHEIMER DISEASE
INITIATIVE (ADD
PERIOD: July 1, 1998 to June 30,1999
SERVICE: CASE MANAGEMENT
OBJECTIVE: Coordinate services to assist client/family dealing with Alzheimer's Disease.
______MAJOR WORK TASK TO ACHIEVE SERVICE OBJECTIVE______
TASK: Identify support needs for caregivers of persons with Alzheimers and make
appropriate referrals for assistance.
________________________________Estimated Completion Date 06/30/99
TASK: Screen all new referrals for eligibility of receiving ADI Respite Care.
______________________Estimated Completion Date .DfiZ3QZa9
TASK: Provide information/literature/training opportunities to caregivers to better cope in
caring for persons with Alzheimer's Disease.
________________________________Estimated Completion Date 06/30/99
TASK:
Estimated Completion Date
Attach Continuation Sheets as Needed
G:\USER\COS06\WPDOCS\GRANT98.ADl Q
SERVICE: CASE MANAGEMENT
OBJECTIVE: Ensure that Case Management units of service are reasonably uniform in
utilization throughout the contract year.____________________________
______IV1AJOR WORK TASK TO ACHIEVE SERVICE OBJECTIVE
TASK:Maintain client caseloads at maximum level.
_______________________________Estimated Completion Date _Q£A3QZ99-
TASK:Review utilization of units based on daily service logs. Assign new clients from
waiting list as available units are identified.
_____________________________Estimated Completion Date _Q£i/3QZa9_
TASK: Identify under/over production patterns and project annual utilization based on
pattern.
_______________________________Estimated Completion Date _Q£ZaQZ93_
TASK:Submit, if required through completion of above task, unit adjustment request to
Area Agency on Aging identifying required units adjustments from case management to
services where under-utilization occurs.
__________________________Estimated Completion Date 4/99
Attach Continuation Sheets as Needed
G:\USeR\COS06\WPDOCS\GRANT98.AOI
II.A. DESCRIPTION OF SERVICE DELIVERY
PROVIDER:
DATE SUBMITTED: March 17, 1998
Manatee County Board of
County Commissioners
PROGRAM: ALZHEIMERS DISEASE
INITIATIVE (ADD
PERIOD: July 1, 1998 to June 30, 1999
SERVICE: ADI - RESPITE
1. SITE LOCATION: Manatee County
2. DAYS AND HOURS OF OPERATION: Monday through Friday 8:00 am to 5:00 pm.
Hours may be available outside the normal business
hours as required by client or caregiver need.
Emergency service is available and will be provided
________________________within 24 hours of notification to the provider.___
3. SPECIFIC ACTIVITIES PROVIDED UNDER THIS SERVICE:
ADI respite Services are provided for caregivers of individuals requiring 24 hour, seven day
a week care. A trained respite worker will be provided for clients afflicted with Alzhei.mer
Disease, Dementia or Parkinson Disease where the disease impacts the client's mental
abilities. Respite is provided in the home, allowing the caregiver the opportunity to attend
to personal needs, as well as receiving temporary relief from the demands of care for the
client. The respite worker will provide assistance in personal needs such as feeding,
grooming, dressing, ambulation and basic companionship as authorized in the Department
of Elder Affairs Super Manual. Assuring the safety of the individual while under their care
is priority for the respite provider. Through the support of this service it is anticipated that
the client will be better able to maintain living in an independent arrangement, delaying
need for restrictive accommodations. All services will be delivered as detailed in the Client
Care plan.
Use Back Sheet or Attach Additional Sheets as Needed
G:\USER\COS06\WPDOCS\GRANT98.ADI Q
II.B. PROVIDER WORK PLAN
PROVIDER: Manatee County Board of
________County Commissioners
PROGRAM: ALZHEIMER DISEASE
INITIATIVE (ADD
DATE SUBMITTED: March 17, 1998 PERIOD: July 1, 1998 to June 30,1999
SERVICE: ADI-RESPITE
OBJECTIVE: Ensure that API - Respite services are coordinated for eligible clients.
MAJOR WORK TASK TO ACHIEVE SERVICE OBJECTIVE
TASK:Conduct screening of potential clients utilizing Intake and telephone screening or the
Comprehensive Assessment Tool to determine need for ADI Respite service. Based on
score obtained upon completion of screening/assessment, client is prioritized on waiting list
if units not immediately available. Once service is available clients will be assigned based
on highest risk first. If more than one individual with the same score, date person was
placed on waiting list will determine priority.
__________________________________Estimated Completion Date _Q6/3Q/3a
TASK:ldentify ADI services and required units in care plan of client and monitor quarterly,
at a minimum, service provision to assure ADI service is provided as identified in care
plan.
__________________________________Estimated Completion Date _QfiZ3Q.Z33
TASK: Reassess Clients annually, at a minimum, to determine if persons of a higher risk
require service and take steps to serve clients falling into higher risk categories.
___________________________________Estimated Completion Date 06/30/99
TASK:Quarterly, at a minimum, services to be reviewed with client to assure satisfaction
and receipt of services as required by care plan.
___________________________________Estimated Completion Date Q6/3QZ93
TASK: Conduct joint staffings with subcontractors on an as needed basis to assure
appropriate provision of services to clients.
__________________________________Estimated Completion Date Q&13Q13S.
Attach Continuation Sheets as Needed
G:\USER\COS06\WPDOCS\GRANT98.ADI
5127
SERVICE: ADI- RESPITE
OBJECTIVE: Ensure that ADI - Respite units of service are reasonably uniform in utilization
throughout the contract year._____________________________________
MAJOR WORK TASK TO ACHIEVE SERVICE OBJECTIVE
TASK:Maintain a computerized waiting list to ensure efficient method of listing clients
needing services, risk category and date placed on the waiting list.
_____________________________Estimated Completion Date .06/30/99.
TASK:Review utilization of units based on provider weekly service reports. Assign new
units/clients from waiting list as available units are identified.
_____________________________Estimated Completion Date _QSZ3Qza9_
TASK:Assess on a quarterly basis, utilization and waiting lists services to determine trends
in needed services. Identify under/over production patterns and project annual utilization
based on pattern.
___________________Estimated Completion Date 06/3Q/99
TASK-.Submit, if required through completion of above task, unit adjustment request to
Area Agency on Aging identifying required units adjustments between services.
_________________________Estimated Completion Date __AZ9jL
Attach Continuation Sheets as Needed
G:\USER\COS06\WPDOCS\GRANT98.ADI
SERVICE: API-RESPITE
OBJECTIVE: Prevent/reduce premature institutionalization of an Alzheimer Disease client
through support to caregivers.___________________________________
______MAJOR WORK TASK TO ACHIEVE SERVICE OBJECTIVE______
TASK:Provide routine respite to caregivers as temporary relief from daily stress of caring
for client.
________________________________Estimated Completion Date Ofi/3n/Q9
TASK:ldentify additional specialized care needs and required units in care plan of client and
monitor quarterly, at a minimum, service provision to assure Personal Care service and
provided as identified in care plan.
__________________________________Estimated Completion Date _Q£Z3nzaa
TASK:Provide special training needs of the caregiver and assist in accessing community
resources to assist in meeting these needs.
Estimated Completion Date 06/30/9^
G:\USER\COS06\WPDOCS\GRANT98.ADI
111. STAFF DEVELOPMENT/TRAINING PLAN
PROVIDER:
DATE SUBMITTED: March 17, 1998
Manatee County Board of
County Commissioners
PROGRAM:
PERIOD: July 1, 1998 to June 30, 1999
ALZHEIMER DISEASE
INITIATIVE (ADD
TOPIC
Uniform Client Assessment
Training
Florida Council on Aging
Conference
Case Records, Chart
Documentation/Maintenance
Adult Protective Services
IRIS System Training
Coordinating Resources in Client
Home Training
CARES Procedure Training
Sensitivity Training
# TRAINEES
All new staff
1
1
1
1
1
3
3
TRAINER
Area Agency on
Aging
Florida Council on
Aging
Manatee County
Aging Services
Manatee
County/CF&S
Manatee County
Aging Services
Manatee County
Aging Services
CARES
TBA
DATE
TBA
TBA
As
need
TBA
TBA
TBA
TBA
TBA
LENGTH
TBA
24
hours
1 hour
1 hour
3 hours
1 hour
TBA
TBA
G:\USER\COS06\WPDOCS\GRANT98.ADl
5130
Q|
DESCRIBE THE SEMINARS/WORKSHOPS IDENTIFIED ABOVE.
WHAT ARE THE TRAINING OBJECTIVES?
Uniform Client Assassmpnt Training - Objective of training all new case management staff in the proper
procedures for completion of assessment tool.
Bnriria Council on Aging Conffirencfi - Attendance at annual conference to expose case management staff to
the various aspects of serving elderly citizens and developments in the field.
Casa Records, Chart Dor.iimentation/Maintenance - Outcomes of periodic case file reviews will be utilized to
illustrate correct procedures in maintaining client files and highlight positive/negative practices.
Adult Protective Services - Annual meeting to be held with APS staff to discuss, share ideas on working
relationship of the two agencies and cooperative efforts required to best meet needs of those clients mutually
served.
IRIS Systpm Training - Computer training for case managers to understand and develop skills enabling them
to utilize and access information/resources available through IRIS.
Coordinating Resources in Client Hnme Training - Training to assist case managers identify and access
available in the community beyond the traditional funded services, to better meet the needs of clients.
Volunteers, neighborhood/community resources, other agencies, etc.
FARES Procedure Training - Training to assist Case mangers in understanding/following procedures for CARES
referral.
Sensitivity Training - To provide case managers with better awareness of the needs of elderly persons and
how to best assist the elderly and their caregivers in meeting these needs.
G:\USER\COS06\WPDOCS\GRANT98.ADI Q|
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2.A.1 Staff Allocation Worksheet
Employee Title: Fiscal Management Analyst (SR)
Annual Salary: $36,292.00
Line#
Line-l
Line 2
Line3
Line 4
Line 5
Line 6
Line 7
Functional Activities
+ Total work hours per year
- Holidays
- Annual Leave
- Sick Leave
- Breaks & other non-productive time
- Non-services related activities
= Net available hours
Available Work Hours
2,080
88
156
104
108
1,416
208
Staff Allocation Worksheet
Employee Title: Account Clerk III (LW)
Annual Salary: $21,874.00
Line#
Line 1
Line 2
Line 3
Line 4
Line 5
Line 6
Line 7
Functional Activities
+ Total work hours per year
- Holidays
- Annual Leave
- Sick Leave
- Breaks & other non-productive time
- Non-services related activities
= Net available hours
Available Work Hours
2,080
88
104
104
112
1,048
624
24a
Staff Allocation Worksheet
Employee Title: Fiscal Coordinator (AS)
Annual Salary: $25,087.00
Line#
Line 1
Line 2
Line3
Line 4
Line5
Line 6
Line 7
Functional Activities
+ Total work hours per year
- Holidays
- Annual Leave
- Sick Leave
- Breaks & other non-productive time
- Non-services related activities
= Net available hours
Available Work Hours
2,080
88
130
104
110
171
1,477
Staff Allocation Worksheet
Employee Title: Office Asst IV (FR)
Annual Salary: $19,582.00
Line#
Line 1
Line 2
Line 3
Line 4
Line 5
Line 6
Line 7
Functional Activities
+ Total work hours per year
- Holidays
- Annual Leave
- Sick Leave
- Breaks & other non-productive time
- Non-services related activities
= Net available hours
Available Work Hours
2,080
88
104
104
112
38
1,634
|24b
Staff Allocation Worksheet
Employee Title: Human Services Coordinator (JS)
Annual Salary: $30,058.00
Line#
Line 1
Line 2
Line3
Line 4
Line 5
Line 6
Line?
Functional Activities
+ Total work hours per year
- Holidays
- Annual Leave
- Sick Leave
- Breaks & other non-productive time
- Non-services related activities
= Net available hours
Available Work Hours
2,080
88
104
104
112
178
1,494
Staff Allocation Worksheet
Employee Title: Human Services Manager (LS)
Annual Salary: $41,798.00
Line #
Line 1
Line 2
Line 3
Line 4
Line 5
Line 6
Line 7
Functional Activities
+ Total work hours per year
- Holidays
- Annual Leave
- Sick Leave
- Breaks & other non-productive time
- Non-services related activities
= Net available hours
Available Work Hours
2,080
88
130
104
110
1,440
208
24c
Staff Allocation Worksheet
Employee Title: Case Manager II (RW)
Annual Salary: $21,189.00
Line#
Line 1
Line 2
Line 3
Line 4
Line 5
Line 6
Line 7
Functional Activities
+ Total work hours per year
- Holidays
- Annual Leave
- Sick Leave
- Breaks & other non-productive time
- Non-services related activities
= Net available hours
Available Work Hours
2,080
88
104
, 104
112
178
1,494
Staff Allocation Worksheet
Employee Title: Case Manager I (DB)
Annual Salary: $22,495.00
Line#
Line 1
Line 2
Line 3
Line 4
Line 5
Line 6
Line 7
Functional Activities
+ Total work hours per year
- Holidays
- Annual Leave
- Sick Leave
- Breaks & other non-productive time
- Non-services related activities
= Net available hours
Available Work Hours
2,080
88
130
104
110
178
1,470
Staff Allocation Worksheet
Employee Title: Case Manager II (MP)
Annual Salary: $29,523.00
Line#
Line 1
Line 2
Line3
Line 4
Line 5
Line 6
Line 7
Functional Activities
+ Total work hours per year
- Holidays
- Annual Leave
- Sick Leave
- Breaks & other non-productive time
- Non-services related activities
= Net available hours
Available Work Hours
2,080
88
156
104
108
178
1,446
Staff Allocation Worksheet
Employee Title: Case Manager II (GW)
Annual Salary: $29,330.00
Une#
Line 1
Line 2
Line 3
Line 4
Line 5
Line 6
Line 7
Functional Activities
+ Total work hours per year
- Holidays
- Annual Leave
- Sick Leave
- Breaks & other non-productive time
- Non-services related activities
= Net available hours
Available Work Hours
2,080
88
156
104
108
178
1,446
Staff Allocation Worksheet
Employee Title: Case Manager Asst (Vacant)
Annual Salary: $17,396.00
Line#
Line 1
Line 2
Line3
Line 4
Line 5
Line 6
Line 7
Functional Activities
+ Total work hours per year
- Holidays
- Annual Leave
- Sick Leave
- Breaks & other non-productive time
- Non-services related activities
= Net available hours
Available Work Hours
2,080
88
104
104
112
178
1,494
Staff Allocation Worksheet
Employee Title: Case Manager I (MW)
Annual Salary: $24,938.00
Line#
Line 1
Line 2
Line 3
Line 4
Line 5
Line 6
Line 7
Functional Activities
+ Total work hours per year
- Holidays
- Annual Leave
- Sick Leave
- Breaks & other non-productive time
- Non-services related activities
= Net available hours
Available Work Hours
2,080
88
130
104
110
178
1,470
24f
Staff Allocation Worksheet
Employee Title: Office Asst II (Vacant)
Annual Salary: $16,411.00
Line#
Line 1
Line 2
Line 3
Line 4
Line 5
Line 6
Line 7
Functional Activities
+ Total work hours per year
- Holidays
- Annual Leave
- Sick Leave
- Breaks & other non-productive time
- Non-services related activities
= Net available hours
Available Work Hours
2,080
88
104
104
112
74
1,598
Staff Allocation Worksheet
Employee Title: Case Manager I (JS)
Annual Salary: $21,831.00
Line#
Line 1
Line 2
Line 3
Line 4
Line 5
Line 6
Line 7
Functional Activities
+ Total work hours per year
- Holidays
- Annual Leave
- Sick Leave
- Breaks & other non-productive time
- Non-services related activities
= Net available hours
Available Work Hours
2,080
88
104
104
112
178
1,494
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11 B.1 MIS COST ALLOCATION WORKSHEET
Service
Case Management (New Client)
Case Management (Existing Client)
Emergency Alert Response
Homemaker
Medical Transit
Personal Care
CCE Respite
Home Delivered Meals
ADI Respite
Non- Casemanagement Sen/ices
TOTALS
Clients
348
435
190
357
40
198
38
115
30
0
Factor
15
3
3
3
3
3
3
3
3
0
Annual
Frequency
1
24
24
24
24
24
24
24
24
0
Total
5,220
31,320
13,680
25,704
2,880
14,256
2,736
8,280
2,160
•6
106,236
%
5%
29%
13%
24%
3%
13%
3%
8%
2%
0%
100%
* See page 26 of the DOEA Unit Cost Methodology Manual
25a
5144
LINE ITEM CASH BUDGET NARRATIVE PROVIDER NAME: MANATEE COUNTY DATE: MARCH 17,1338
ALZHEIMERS DISEASE INITIATIVE 52WKS
POSITION FY98/99 PORTION ALLOC. .
WAGES OF YEAR •/. AMOUNT
ANNUAL • POSITION •
FISCAL MGMT ANALYST/SR $36.292 100% 100% $36.292
ACCOUNT CLERK III/LW $21.074 100% 100% $21.074
FISCAL COORDINATOR/AS $25.087 100% 100% $25,087
CASE MANAGER VACANT (PT) $0 100% 100% $0
OFFICE ASST IV / FR 110.582 100% 100% $13.582
HUMAN SRVCS COORD/JS . $30.058 100% 100% 130.058
HUMAN SERVICES MGR/LS $41,798 100% 100% $41,798
CASE MANAGER II/RW $21.189 100% 100% $21,189
CASE MANAGER TOO $22,495 100% 100% $22.495
CASE MANAGER IIA<P $20,523 100% 100% $29.523
CASE MANAGER 11/GM $29.330 100% 100% $29,330
CASE MANAGER ASSISTANT VACANT $17.396 100% . 100% $17,396
CASE MANAGER 1/MW $24.938 100% 100%' $24.938
OFFICE ASST 11/VACANT $10,411 100% 100% $16,411
CASE MANAGER 1/JS $21.831 100% 100% $21,831
$0 0% 100% $0
$0 0% 100% $0
$357.804
PERSONNEL 250 EDUCATION 310 OFC SUPPLIES 311 OFC SUPPLIES /CSMGNT 320 OPERATING SUPPLIES 32G PRINTING/IN-HOUSE 330 EQUIP MAINTENANCE 332 MAINT OIS / DIS 350 BOOKS / PUBLICATIONS 410 TELEPHONE 420 POSTAGE 430 RENTS / LEASES 450 TRAVEL 451 TRAVEL / CS MGNT 480 PRINTING 481 PRINTING/CS MGNT 510 CONTRACTED SVCS (see below) 520 ACCOUNTING / AUDIT 530 EMPLOYEE ASST PROGRAM 630 DUES/SUBSCRIPTIONS
SUBTOTALS 510 CONTRACTED SERVICES
TOTAL EXPENDITURES
BALANCE
ALLOC.
;ASE MGNT ADMIN % ADI
$0 0% 0.0000
$1,094 5% 0.0500
$1.254 5% 0.0500
$980 5% 0.0500
$902 3% 0.0300
$0 0% 0.0000
$0 0% 0.0000
$821 5% 0.0500
~swr
ADI
FTE CMGNT 0.2300 0.23
$14.794
CS/ADM ADI CS MGNT $5.051 SALARY $9.743
386 F1CA 745 880 RETIRE 1.698
10 LIFE 31 19 LTD 37 35 FLEX 50
744 HEALTH 1643 $7,132 $13.947 «
TOTAL PERSONNEL ADI $21,079 |
:S MGNT AOI CS MGNT ADMIN"
$7.132 $13.947
:il 0.
100 0
44 i
. :250 '"•'504
'L1^':'^ ••' 'ti•i'•" :'• '"'•: -300'
^.^S'^
"•'^'O' : ' 0
$8.029 $14.247 ^v^rf $90.515
•" ' $112,792 EXPENDITURES
($109.792> FUNDING
. . , ($3,000) CO PAY ($0)
ALLOC.
CASE MGMT. % ADI
$0 0% 0.0000
$0 0% 0.0000
$0 0% 0.0000
$0 0% 0.0000
$0 0% 0.0000
$0 0% 0.0000
$9.743 33% 0.3300
~yjj43
ADI
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5146
3.A. CIVIL RIGHTS ASSURANCE
ASSURANCE OF COMPLIANCE WITH
THE DEPARTMENT OF HEALTH AND HUMAN SERVICES REGULATION UNDER
TITLE VI OF THE CIVIL RIGHTS ACT OF 1964
Manatee County Rnard of County Commissioners , (Hereinafter "Applicant") HEREBY AGREES THAT it will
comply with Title VI of the Civil Rights Act of 1964 (P.L. 88-352) and all requirements imposed by or pursuant
to the Regulation of the Department of Health and Human Services (45 CFR Part 80) issued pursuant to the
title, to the end that, in accordance with Title VI of that Act and the Regulation, no person in the United
States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the
benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant
receives Federal financial assistance from the Department; and HEREBY GIVES ASSURANCE THAT it will
immediately take any measures necessary to effectuate this agreement. If any real property or structure
thereon is provided or improved with the aid of Federal financial assistance extended to the Applicant by the
Department, this assurance shall obligate the Applicant, or in the case of any transfer of such property, any
transferee, for the period during which the real property or structure is used for a purpose for which the
Federal financial assistance is extended or for another purpose involving the provision of similar service or
benefits. If any personal property is so provided, this assurance shall obligate the Applicant for the period
during which it retains ownership or possession of the property. In all other cases, this assurance shall
obligate the Applicant for the period during which the Federal financial assistance is extended to it by the
Department. THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and all
Federal grants, loans, contracts, property, discounts or other Federal financial assistance extended after the
date hereof to the Applicant by the Department, including installment payments after such date on account
of the applications for Federal financial assistance which were approved before such date. The Applicant
recognizes and agrees that such Federal financial assistance will be extended in reliance on the representations
and agreements made in this assurance, and that the United States shall have the right to seek judicial
enforcement of this assurance. This assurance is binding on the Applicant, its successors, transferees, and
assignees, and the person or persons whose signatures appear below are authorized to sign this assurance
on behalf of the Applicant.
Signature and Title of Authorized Official
Date:^J^_
Patricia M. Glass, Chairman
Title:___________Board of County Commissinnsrs
ATTEST; ^ R. B. Shore
^ Clerk qi Circuit Court
G:\USER\COS06\WPDOCS\GRANT98.ADI
5147
[^
3.B. SECTION 504 ASSURANCE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ASSURANCE OF COMPLIANCE WITH SECTION 504 OF THE REHABILITATION
ACT OF 1973. AS AMENDED
Manatee County Board of Fnnnty Cnmmissinnprs (hereinafter called the "recipient") HEREBY AGREES THAT
it will comply with Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), all
requirements imposed by the applicable HHS regulation (45 C.F.R. Part 84), and all guidelines and
interpretations issued pursuant thereto.
Pursuant to 84.5(a) of the regulation [45 C.F.R. 84(a)], the recipient gives this Assurance in consideration of
and for the purpose of obtaining any and all federal grants, loans, contracts (except procurement contracts
and contracts of insurance or guaranty), property, discounts, or other federal financial assistance extended
by the Department of Health and Human Services after the date of the Assurance, including payments or other
assistance made after such date on applications for federal financial assistance that were approved before
such date. The recipient recognizes and agrees that such federal financial assistance will be extended in
reliance on the representations and agreements made in h s Assurance and that the United States will have
the right to enforce this Assurance through lawful means.
This Assurance is binding on the recipient, its successors, transferees, and assignees, and the person or
persons whose signatures appear below are authorized to sign this Assurance on behalf of the recipient.
This Assurance obligates the recipient for the period during which federal financial assistance is extended to
it by the Department of Health and Human Services or provided for in 84.5(b) of the regulation [45 C.F.R.
84.5(b)L The recipient:
a) [ ] employs fewer than fifteen (15) people;
b) [X ] employs fifteen (15) or more persons and pursuant to 84.7(a) of the regulation [45 C.F.R.
84.7(a)], has designated the following person(s) to coordinate its efforts to comply with the
HHS regulation:
Signature and Title of Authorized Official
y /^7^g^^^./>^^
Patricia M. Glass, Chairman
Title:_________Board nf County Commissioners
Da.,;_A^
ATTEST: R. B. Shore .- -
Clerk of Qrcun? Court
/^^•"-/^ •^V^i^-^C
G:\US6R\COS06\WPDOCS\GRANT98.ADI Q
3.C. AVAILABILITY OF DOCUMENTS
The undersigned hereby gives full assurance that the following documents are maintained in the administrative
office of the provider and will be filed in such a matter as to ensure ready access for inspection by the Area
Agency or its designee(s) at any time. The provider will furnish copies of these documents to the Area
Agency upon request for maintenance.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
CERTIFICATION BY AUTHORIZED AGENCY OFFICIAL
I hereby certify that the documents identified above currently exist and are properly maintained in the
administrative office of the provider. Assurance is given that the Area Agency or its designee(s) will
be given immediate access to these documents, u|:
/) / /)
x ^7^<AL^
DATE: G^^Q
Current Board Roster
Articles of Incorporation
Corporate By-Laws
Advisory Council By-Laws and Membership
Corporate Fee Documentation
Insurance Coverage Verification
Bonding Verification
Staffing Plan
(a) Position Descriptions
(b) Pay Plan
(c) Organizational Chart
(d) Executive Director Resume
Personnel Policies Manual
Financial Procedures Manual
Operational Procedures Manual
Fixed Asset / Inventory Listing
Interagency Agreements
Affirmative Action Plan
Outreach Plan (if applicable)
Americans with Disabilities Act Assurance (and supporting documentation)
Unusual Incident File
Service Subcontracts
Contribution / Fee Assessment System
-
-
pon request.
NAME: Patricia M. Glass
TITLE: Chairman, Board of County Commissioners
Attest: R. B. Shore^.
,of Citc.uit' Court
G:\USER\COS06WPDOCS\GRANT98.ADI
5149
Q
3.D. INSURANCE COVERAGE
The undersigned agrees to provide adequate liability insurance coverage on a comprehensive basis and to hold
such liability insurance at all times during the grant period. The undersigned accepts full responsibility for
identifying and determining the type(s) and extent of liability insurance necessary to provide reasonable
financial protections for the undersigned and its clients to be served.
PLE EASE
X
CHEC ;K ONE:
The undersigned is a state agency or subdivision as defined in Section 768.28,
Florida Statutes. The undersigned shall furnish the Area Agency, upon request,
written verification of liability protection in accordance with Section 768.28,
Florida Statutes.
The undersigned is aol a state agency or subdivision as defined in Section 768.28,
Florida Statutes, and shall attach a certification of insurance supporting both the
determination and existence of such insurance coverage. Such coverage may be
provided by a self-insurance program established and operated under the laws of
the State of Florida.
CERTIFICATION BY AUTHORIZED AGENCY OFFICIAL
I hereby certify that the above information is complete and correct to the best of my knowledge.
^>-.. y /——
^v <^/b). Z^^^
NAME: Patricia M. Glass
DATE: ^/%
TITLE: Chairman, Board of County Commissioners
ATTEST: '. R. B, Shore ^-. ',
Clerk of OrcuitsCourt
/^--
G:\USER\COS06\WPDOCS\GRANT98.ADI
K~f\
[^
Attachment //I
Issued:
Revised:
02/05/96
AGENCY MONITORING PROCEDURES
Overview
Each Community Care for the Elderly (CCE) and Alzheimer's Disease
Initiative (ADI) contract must be monitored for contract compliance
at least one time per year. The contract monitoring attempts to:
verify that the department/agency is in compliance with the terms
of the contract for programs which are funded by the County in the
areas of program delivery, fiscal/accounting, and general contract
provisions; provide the agency with technical assistance in meeting
the terms of the contract or improving services provided per the
contract; ensure that any concerns are addressed by the agency,
and identify any needed modifications in the contract.
The staff assigned to the contract is responsible for scheduling
the monitoring visit. The monitoring can be scheduled on separate
dates to address program, fiscal/accounting, and general
contractual issues. The staff assigned to the contract should
coordinate the scheduling of the monitoring with the fiscal or
other sections so that, when possible, a joint monitoring may be
scheduled. All areas of the monitoring should be completed prior
to conducting the exit interview.
The following procedures should be followed when conducting a
monitoring;
A. Department/Agency notification:
1. Department/Agency should be notified by telephone to
coordinate the date of the monitoring. A letter signed
by the Division Manager should be mailed to the agency as
confirmation of the monitoring. The letter should
include information the agency should have available for
review by the monitors at the time of the visit and
include a copy of the monitoring tool.
B. Monitoring Contract Provisions:
The contract is divided into three main areas for purposes of
monitoring; programmatic, fiscal/accounting, and special
conditions. The process for. monitoring each area will be
discussed below. If the monitoring is to be completed over a
period of time, any of the three areas can be monitored first.
There is no order to monitoring any of the three areas.
1. Programmatic Contract Provisions:
a. Prior to the site visit, the contract must be
reviewed to identify all of the provisions in the
scope of services and special conditions that the
department/agency must adhere to. The monitor
shall complete the Pre-Sifce/Desk Monitoring
checklist for each program which would include
contract provisions so at the time of the visit,
compliance with each item could be addressed.
b. The program monitoring could be announced or
unannounced. The monitoring may include
observation of service delivery and/or review of
personnel files, client files and program files.
When client files are reviewed, be sure to pull
files at random and review at least 10% of the
files;.
c. After conducting a review of the program, the
director or department/agency representative should
be informed of the findings of the visit and
informed that the findings will be included at the
time of the exit interview.
d. Upon returning to the office, the findings of the
visit should be incorporated into the monitoring
report form. If the • department/agency is not in
compliance with the program provisions of the
contract, report to your supervisor at that point.
2. Fiscal Contract Provisions:
a. Review department/agency contract file to determine
if department/agency has submitted all required
documentation to process payment to finance and to
become familiar with the payment provisions of the
contract.
b. Review payment requests submitted and determine
what period of time will be analyzed during the
agency monitoring. As a rule, any billing where
the units have fluctuated more than the norm or
where there were many errors on the billing would
be good time periods to select.
c. At the time of the visit, request department/agency
provide information for the period of time being
analyzed. This information should be the source
documents which the agency used to arrive at the
information submitted with their payment requests.
The source documents would also include client
staff time sheets with client or caregivers
signature.
d. After conducting a review of the source documents,
the director or department/agency representative
should be informed of the findings of the visit and
informed that the findings will be included at the
time of the exit interview.
e. Upon returning to the office, the findings of the
visit should be incorporated into the monitoring
report form. If the department/agency" is not in
compliance with the fiscal/accounting provisions of
the contract, report to your supervisor at this
point.
3. General Contract Provisions:
a. Review agency contact file to determine if
department/agency has submitted all documents
required in the contract. Utilize the desk
monitoring form attached. .The desk monitoring tool
provides an outline to review information that the
agency should have submitted to the County in
compliance with the contract. This information
should be reviewed to see if all requested
information was submitted and if the information
submitted is still current. Any areas found not in
compliance should be addressed during the
department/agency site monitoring.
b. Utilizing the department/agency monitoring report
attached, list all provisions of the contract not
addressed above so, at the time of the monitoring
visit, compliance with each issue will be
addressed.
c. At the time of the visit, request department/agency
provide actual documents as outlined in letter or
monitoring report to verify compliance with the
contract.
d. After conducting a review of the program, the
director or department/agency representative should
be informed of the findings of the visit and
informed that the findings will be included at the
time of the exit interview.
e. Upon returning to the office, the findings of the
visit should be incorporated into the monitoring
report form. If the department/agency is not in
compliance with the general monitoring, report to
your supervisor at this point.
C. Exit Interview
1. During the exit interview all areas reviewed during the
monitoring should be addressed with the
department/agency. Any areas of non-compliance should be
identified and discussed; Department's/Agency's strengths
should be identified; this is also an opportunity for the
agency to discuss their concerns and requests. If the
monitoring was conducted at separate times, all County
staff involved in the monitoring should be scheduled to
attend the exit interview. .The executive director of the
department/agency or the department/agency representative
should indicate which department/agency personnel should
be present at the exit interview.
D. Monitoring Report
1. Within 30 days from the exit interview/ the attached
monitoring report form must be sent to the
department/agency along with a cover letter signed by the
Division Manager. Be sure to include in the monitoring
report if any non-compliance issues were noted, the date
the department/agency is to submit required documents or,
if necessary, the date the follow-up monitoring will be
scheduled to address the issues.
2 . Any follow-up required by the department/agency should be
tracked by the monitor and/or section supervisor.
3. If follow-up monitoring is required, follow section A,
applicable parts of section B, section C and section D.
4. After all monitoring issues are addressed send, from the
Division Manager, a letter to the department/agency
indicating all areas are in compliance as attached.
CONFIRMATION LETTER
TO BE USED WHEN INFORMING AGENCY OF MONITORING DATE
Date
Agency Name
Dear Agency Director
The agreements for Community Care for the Elderly (CCE) Personal
Care, Respite and Alzheimer's Disease Initiative (ADI) Respite
services between Manatee County and your Agency provides an
opportunity for County staff to monitor and evaluate the services
provided under the agreement.
This letter is to confirm the County's intent to visit your agency
at 8:00 AM on March 20, 1996. Enclosed is the monitoring tool
which will be used during the visit. Please have the agency staff
that will be involved with the monitoring visit review this tool
and the agreements so that any information required by County staff
to complete the monitoring will be available.
If this date or time is no longer convenient, please contact your
Gerald S. White, Human Services Coordinator, at 749-3030 to arrange
another time.
Sincerely,
Frederick J. Loveland
Director
FJL:LA:
Enclosure
5155
PRE-SITE MONITORING/DESK MONITORING FORM
TYPE OF MONITORING: [ ] PRE-SITE MONITORING
[ ] DESK MONITORING
[ ] PRE-SITE MONITORING/DESK MONITORING
CONTRACT
AGENCY: _______________________________ MANAGER:_____________
PROGRAM TITLE:
SITE MONITORING SCHEDULED FOR:.
YES NO
I. SET MEETING WITH ALL COUNTY STAFF THAT WILL
BE PRESENT ON THE MONITORING VISIT TO
DISCUSS APPROACH
II. CONTACT DEPARTMENT/AGENCY TO SCHEDULE VISIT
III. COMPLETE ON SITE MONITORING REPORT
A. SECTION I.
1. GENERAL CONDITIONS ITEM 1.
2. COMPLIANCE WITH LAWS ITEM 2.
3. LICENSES \
4. AGENCY REPRESENTATIVES
5. INSURANCE ITEM 1
6. INSURANCE ITEM 2
7. SPECIAL CONDITIONS ITEM 1
8. SPECIAL CONDITIONS ITEM 2
9. OTHER - LIST SPECIAL CONDITIONS \
B. SECTION II.
1. TOTAL FUNDING TO AGENCY
2. CONTRACT TERM
3. LIST PROGRAM COMPONENTS
4. PREPARE CHART ITEM B.
C. SECTION III.
1. PREPARE CHART ITEM B.
2. REQUEST FOR PAYMENT ITEM C.
D. SECTION IV.
1. COMPLETE FOLLOW UP OF PROBLEMS
II. TECHNICAL ASSISTANCE PROVIDED BY COUNTY, IF
APPLICABLE
A. LIST'ANY FUNDING INFORMATION SENT TO
AGENCY
B. LIST OTHER TECHNICAL ASSISTANCE PROVIDED
TO AGENCY
III. SEND CONFIRMATION LETTER WITH COMPLETED
MONITORING REPORT ATTACHED
5156
COMMUNITY SERVICES DEPARTMENT
AGENCY SITE MONITORING REPORT
AGENCY: DATE;
HUMAN SERVICES DIVISION STAFF:.
AGENCY STAFF:.
OBSERVERS:__
I. GENERAL CONTRACT PROVISIONS
A. NOTICES
1. ARE NOTICES LISTED IN CONTRACT __YES __NO
ACCURATE?
2. LIST CHANGE IN NOTICE IF APPLICABLE
B. GENERAL CONDITIONS
1. DATE OF MOST RECENT FINANCIAL AUDIT:
a. IS AUDIT LESS THAN TWO YEARS OLD? __YES __NO
b. IF AUDIT IS LESS THAN TWO YEARS OLD, INDICATE DATE
NEXT AUDIT IS DUE:_________________________________
c. IS AUDIT COMPLETED BY INDEPENDENT CERTIFIED PUBLIC
ACCOUNTANT REGISTERED IN THE STATE OF FLORIDA?
__YES __NO
d. DOES AUDIT INDICATE THAT RECORDS,. ACCOUNTS, PROPERTY
RECORDS AND PERSONNEL RECORDS ARE IN ACCORDANCE WITH
GENERALLY ACCEPTED ACCOUNTING PRINCIPLES?
__YES __NO
COMMENTS:
7
515?
2. DATE(S) OF OTHER AUDITS OR MONITORING OF THE PROGRAMS FUNDED BY
THE COUNTY AND CONDUCTED BY AGENCIES OTHER THAN MANATEE COUNTY:
DATE WHO CONDUCTED
a. AFTER REVIEW OF AUDITS AND MONITORING, WERE ALL AREAS IN
COMPLIANCE? ___YES ___NO
IF NO, INDICATE ISSUE OF NON COMPLIANCE AND DATE OF
ANTICIPATED COMPLIANCE.
b. DID AGENCY PROVIDE COUNTY ALL INFORMATION REQUESTED BY
COUNTY FOR MONITORING AND EVALUATING SERVICES?
__YES __NO
IF NO, INDICATE WHY INFORMATION WAS NOT AVAILABLE:
COMMENTS:
C. COMPLIANCE WITH LAWS
1. AGENCY'S COMPLIANCE WITH AMERICAN'S WITH DISABILITIES ACT TO
INSURE ACCESSIBILITY TO THE VISUALLY, PHYSICALLY, AND HEARING
IMPAIRED PERSONS IN MANATEE COUNTY.
a. HAS AGENCY COMPLETED AN EVALUATION OF THEIR PROGRAM TO
DETERMINE IF IT IS ACCESSIBLE? ___YES ___NO IF YES,
REVIEW INFORMATION.
b. HAS AGENCY COMPLETED AN EVALUATION OF THEIR FACILITY TO
DETERMINE IF THE PROGRAM IS ACCESSIBLE? __YES __NO IF
YES, REVIEW INFORMATION.
K-«
c. IF NO FOR a. AND b. ABOVE, WHEN DOES AGENCY ANTICIPATE
COMPLIANCE?
COMMENTS:
2 . INDICATE ANY OTHER LAWS THAT AGENCY MUST COMPL WITH AND INDICATE
IF AGENCY IS IN COMPLIANCE.
LAW YES NO
IF AGENCY IS NOT IN COMPLIANCE PROVIDE EXPLANATION.
COMMENTS:
3. REVIEW AGENCY'S NON DISCRIMINATION POLICY. IF AGENCY DOES NOT
HAVE A NON DISCRIMINATION POLICY, WHAT PROVIDES DOCUMENTATION
THAT AGENCY DOES NOT DISCRIMINATE? ________________________.
COMMENTS:
D. LICENSES/REGULATORY REPORTS REQUIRED FOR AGENCY TO OPERATE, DATE OF
LICENSE/REGULATORY REPORT EXPIRATION AND IF REPORTS PROVIDED BY
LICENSING/REGULATING AGENCY WERE SENT TO COUNTY WITHIN TEN DAYS OF
ISSUANCE.
LICENSE/REPORT EXPIRE. INFO W/I 10 DAYS
FIRE INSPECTION
COMMENTS:
E. SUBCONTRACTS
1. DOES AGENCY SUBCONTRACT WITH ANY OTHER AGENCY FOR SERVICES OTHER
THAN LEASES FOR MATERIALS, SUPPLIES, FACILITIES, M OR OTHER
SUPPORT SERVICES FOR THE PROGRAM? __YES __NO
IF YES, LIST NAME OF AGENCY, REASON FOR SUBCONTRACT, IF COUNTY
REPRESENTATIVE APPROVED.
AGENCY REASON APPROVED
10
F. AGENCY REPRESENTATIVES
1. DID COUNTY RECEIVE LIST OF REPRESENTATIVES AUTHORIZED TO ACT ON
BEHALF OF THE AGENCY AS APPROVED BY THE AGENCY'S BOARD OF
DIRECTORS WITHIN 30 DAYS FROM THE EXECUTION OF THE CONTRACT?
YES NO
IF NO, WHEN WILL LIST BE FURNISHED?
a. IS LIST CURRENT? ________________________
IF NO, WHEN WILL CURRENT LIST BE FURNISHED?
COMMENTS:
G. AGENCY DIRECTORS
1. ARE ANY PAID STAFF VOTING OR ELECTED MEMBERS OF THE AGENCY'S
BOARD OF DIRECTORS? __YES __NO
IF YES, INDICATE WHICH AGENCY EMPLOYEE(S)
(REVIEW LIST OF BOARD MEMBERS/ LIST OF EMPLOYEES AND BY LAWS OF
BOARD.
COMMENTS:
H. INSURANCE
1. IS AGENCY INSURANCE CURRENT: YES __NO
IF NO, WHEN WILL INSURANCE CERTIFICATE BE ISSUED?
a. ARE THE AMOUNTS AND TYPES OF COVERAGE INDICATED IN
ATTACHMENT D OF THE CONTRACT CURRENTLY IN FORCE?
__YES __NO
IF NO, INDICATE AREAS OF NON-COMPLIANCE AND WHEN AGENCY
INSURANCE COMPLY WITH ATTACHMENT D._________ ___________
b. IS COMMERCIAL GENERAL LIABILITY INSURANCE CARRIED IN AN
AMOUNT NOT LESS THAN $500,000 AGGREGATE? __YES __NO
5161 11
IF NO, INDICATE-WHEN INSURANCE WILL BE IN COMPLIANCE:.
c. HAS THE COUNTY BEEN PROVIDED WITH RENEWAL OR REPLACEMENT
CERTIFICATES IF APPLICABLE, 15 DAYS PRIOR TO THE EXPIRATION
OR REPLACEMENT OF THE ORIGINAL CERTIFICATE? __YES __NO
IF NO, WAS EVIDENCE OF A BINDER PROVIDING CONTINUATION OF
COVERAGE PROVIDED- TO COUNTY 15 DAYS PRIOR TO EXPIRATION?
_YES __NO
IF NO, WHEN DOES AGENCY ANTICIPATE RECEIPT. OF A BINDER OR
CERTIFICATE:___________________________________________
COMMENTS:
2. IS MANATEE COUNTY, A POLITICAL SUBDIVISION OF THE STATE OF
FLORIDA, NAMED AS ADDITIONAL INSURED?
__YES __NO
IF NO, WHEN WILL ADDITIONAL INSURED BE SO NOTED:
a. HAS AGENCY SUBMITTED A COPY OF ADDITIONAL INSURED
ENDORSEMENT? __YES __NO
IF NO, WHEN WILL COUNTY ANTICIPATE RECEIPT OF THE
ENDORSEMENT: ___________________________________________
b. IS COUNTY REFERENCED ON THE ENDORSEMENT AS ADDITIONAL
INSURED FOR COMMERCIAL GENERAL LIABILITY COVERAGE?
__YES __NO
IF. NO, WHAT ARE AGENCY'S PLANS TO ENSURE COUNTY IS NAMED AS
ADDITIONAL INSURED WITH ENDORSEMENT REFERENCING COMMERCIAL
GENERAL LIABILITY? ___
COMMENTS:
12
I. SPECIAL CONDITIONS
1. HAS AGENCY SUBMITTED BY THE 15TH OF THE MONTH/QUARTER THE
MONTHLY/QUARTERLY REPORT COMPLETED TO INCLUDE THE FOLLOWING:
REPORT COMPONENT YES IF LATE, DATE
COMMENTS:
2. HAS AGENCY PROVIDED QUARTERLY EXPENDITURE REPORTS TO INCLUDE
EXPENDITURES AND % OF ANNUAL BUDGET EXPENDED? ___YES ___NO
IF NO, INDICATE AREA OF NON COMPLIANCE:______________________
COMMENTS:
3. REVIEW AGENCY LIST OF MANATEE COUNTY CLIENT NAMES AND ADDRESSES.
ARE ALL NAMES ON THE LIST MANATEE COUNTY CLIENTS? __YES _NO
IF NO, INDICATE NUMBER OF NON MANATEE COUNTY CLIENTS AND PROVIDE
AGENCY WITH NAMES PRIOR TO LEAVING IF NAMES ARE CONFIDENTIAL:
COMMENTS:
13
II. OTHER
1. LIST OTHER SPECIAL CONDITIONS IDENTIFIED IN THE CONTRACT AND
REVIEW FOR COMPLIANCE (INCLUDE COMMENTS IF APPLICABLE.)
a.
b.
c.
14
5:
III. PROGRAMMATIC CONTRACTUAL PROVISION
PROGRAM TITLE:________________________
A. LIMITATIONS TO COSTS AND PAYMENTS
1. TOTAL FUNDING TO AGENCY:____
B. CONTRACT TERM
1. DATE CONTRACT EXECUTED:.
2. DATE CONTRACT EXPIRES:_
3 . DATE CONTRACT AMENDED :
LIST ANY REVISIONS TO CONTRACT TERM AS A RESULT OF AN
AMENDMENT:
C. IS AGENCY IN COMPLIANCE WITH THE SERVICE DESCRIPTION?
___YES ___NO IF NO, INDICATE DATE OF ANTICIPATED COMPLIANCE.
COMPONENT YES IF NO DATE
COMMENTS:
E-/3 iCC" (3J.O<3
15
D. IF APPLICABLE, PREPARE A CHART WITH COMPONENTS ABOVE AND
DOCUMENT BY CASE FILE OR OTHER METHOD THE SERVICE IS BEING
PROVIDED IN ACCORDANCE WITH CONTRACT. INDICATE METHOD USED,
TYPE SAMPLE AND SAMPLE SIZE REVIEWED.
COMMENTS:
E. UTILIZING THE SAMPLE ABOVE, IF AGENCY USES CLIENT FILES AND IF
CONTRACT STATES THAT COUNTY SHALL NOT PAY FOR PRIVATE PAYING
CLIENTS, DETERMINE IF CLIENT THAT IS COUNTED FOR RECEIVING
PAYMENT FROM COUNTY IS PRIVATE PAY. IF SO, UNITS TO BE
DISALLOWED IF IT IS A PROVISION OF CONTRACT THAT COUNTY SHALL
NOT PAY FOR PRIVATE PAY.
COMMENTS: _______________________________________________________
16
IV. FISCAL/ACCOUNTING CONTRACT PROVISIONS
PROGRAM TITLE:________________________ FUNDING AMOUNT :.$.
A. HAS AGENCY DOCUMENTED THE UNITS PROVIDED AS REPRESENTED ON THE
REQUEST FOR PAYMENTS? __YES __NO
IF NO, INDICATE UNITS TO BE ADJUSTED OR DISALLOWED AND REASONS.
COMMENTS:
B. IF APPLICABLE, PREPARE A CHART TO INCLUDE DATA TO BE REVIEWED
AND CASE RECORD THAT WAS REVIEWED TO VERIFY UNIT INDICATE BELOW
SOURCE DOCUMENTS TO BE CHECKED AND TYPE OF SAMPLE AND SAMPLE
SIZE.
COMMENTS:
C. ARE THE REQUEST FOR PAYMENT FORMS COMPLETED AND ACCURATE?
__YES __NO
IF NO, INDICATE MONTHS INFORMATION WAS NOT ACCURATE.
17
COMMENTS:
D. IF APPLICABLE, IS AGENCY FOLLOWING GENERAL ACCEPTABLE ACCOUNTING
PRINCIPLES RELATING TO CASH HANDLING, INVENTORY CONTROL, ETC.?
__YES __NO
IF NO, INDICATE AREAS NOT ACCEPTABLE:_______________________
COMMENTS:
18
V. FOLLOW-UP OF PROBLEMS IDENTIFIED IN PRIOR REPORT;
A. _________________________________________
B.
C.
COMMENTS:
VI. TECHNICAL ASSISTANCE REQUESTED BY AGENCY!
A. ________________________________
COMMENTS:
VII. TECHNICAL ASSISTANCE PROVIDED BY COUNTY:
A. HAS AGENCY RECEIVED ANY INFORMATION REGARDING POSSIBLE FUNDING
OPTIONS? __YES __NO
IF YES/ INDICATE WHEN FUNDING OPTIONS WERE PROVIDED AND IF
AGENCY HAS PURSUED ANY OPTIONS AND IF NOT WHY.
FUNDING OPTION YES, PURSUED-RESULTS IF NO/ WHY
19
COMMENTS:
B. LIST OTHER TECHNICAL ASSISTANCE PROVIDED;
COMMENTS:
20
VIII. EXIT INTERVIEW
A. LIST OF PERSONS PRESENT:.
B. POSITIVE AND NOTEWORTHY ACTIVITIES BY AGENCY;
C. RECOMMENDATIONS BY COUNTY:
D. CORRECTIVE ACTION:
IX. ITEMS TO BE ADDRESSED AT NEXT MONITORING
A. _________________________________
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DATE
DEAR PRESIDENT:
Enclosed is a report concerning the Human Services Division's monitoring
visit to the ______________
conducted on ______________. Please be
advised that Agency staff were cooperative and pleasant during the visit.
agency name continues its commitment to providing quality services to
the residents of Manatee County.
The enclosed report contains the results of the monitoring. (I£ applicable
Please coordinate with agency executive director to provide a written
response to the following items noted in the ________________________
_______________(Sample - Section II, Programmatic Contractual
Provisions, Day Care, Item C.) report by ___________.) Many thanks to
you and your staff for your cooperation during this monitoring visit.
Sincerely,
Frederick J. Loveland
Director
FJL:
Enclosure
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SAMPLE
December 19, 1994
Mr. Robert More, Executive Director
Manatee Glens Corporation
P.O. Box 9478
Bradenton, Florida 34206
Dear Mr. More:
We are in receipt of your response to the monitoring report summarizing the
Human Services Division visits conducted between July 27 and August 24,
1994.
No further action is required at this time. We appreciate your timely
response, and look forward to visiting your Agency again soon.
Thank you for your cooperation.
Sincerely,
Frederick J. Loveland
Director
FJL:cd
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