recorded -y ^a page no. uinutebookno. —————^5. a ... › boardrecords › browse ›...

Â

rnuc nu. . rn / *——— • 11

UINUTEBOOKNO. —————^5.

RECORDED -y

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 ^-» ^ Û ^,f)U^ ^ ,,. . / c \y f vî û vr^

% ^ ^, ':., PATRICIA/M. GLASS

^ It V'1

:.., Chairman

ATTEST:,, \R. B^Shore

^T^ CCerk of Circuit Court -t^-:-----

. _

BY: //) /^^,U. OYI^-^/^ •

5107

3^723

'-^' s'-f^ '.\ .^ '•' •1 f' ^

'"/ /

^7^

^^(2-Z<^Z& C^t^rs (sL^e—-^

'

<^^^^^

4®^^^

^ <._'''' ^S. ''f^'

-„ to . -.^S' •S-. •••S"

'•^' '•: -; ^

fK^^.. .

^3/g^- ^^fe^-

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



C. Component III - Staff Development/Training Plan

SECTION 1 - PROGRAM MODULE - ADI



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

3

N/A

N/A

N/A

N/A

N/A

N/A

^_

-L3_

-22_

-^24_

^5_

95A

^fi-

N/A

N/A

N/A

N/A

-_bL/A.

N/A

N/A

G:\USER\COS02\WPDOCS\99SPA99.WP

TABLE OF CONTENTS

SECTION 3 - GENERAL ASSURANCES

A. Civil Rights Assurance

B. Section 504 Assurance

C. Availability of Documents

D. Insurance Coverage


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<—

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

G:\USER\COS06\WPDOCS\GRANT98.ADI -^J

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.

G:\USER\COS06\WPDOCS\GRANT98.ADI

.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.


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


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.


5117

Q

LLJ

-J

LL

0

cc

Q.

LJLJ

0

0:

LJJ

0)

s^

•

0) en en r—

0 CO

(D C 3

-1

0 •i-'

CD 0) CD

,"

>

3 -~3

Q

0

cr LU D-

U

< oc h- Z

0

u

^ c 3 0

u

•4- 0

-0

(D 0

CQ

> +-i C 3 0

U

0) (D •I-' (0 c "

01 .> k- — (U

.. c

oc .2 LU CO Q "

n

ir o a. u

y^^^ ':.:;:':': :•:

^:.:,;::. :"

i-i!- ̂ :•:":":-?:-

^;:?

;::•::;

11 j

.: :• :•:: :

:.;; :1:;

::::•: 5; ;

|1|;?|

;i? ;.;i;: ::

:;i?i :¥S ;'

00 en en

r^

.c u

ii

2

, , Q LU H

—

^ a

en

LU i-

< Q

k. 3 0 >

> J3

> . •l-i U (D

'•V

-0 0

-0 '>

0 • ^

Q.

M ID 0

'> k- 0 (0

(U U) 0

.c <->

k. 0

'+-

M •I-' C (0 k- 0)

(D 3 C (U > 0)

cr

"TO

£ c 0}

U c

> E

^-5

1§

<r '- - 0 (0 -g <u - 1- ro

<g

£ ° •^ " $ -Q ' 3

•O CO >

u

-a

m

•»-> 0 (0 <-> c 0

U '0

c 0

Q- 'M

(0 (U k-

-0 -a

<

L. 0 •*-' u (0 L- 4-' c 0 0

J3 3

CO

(U u

'> k (U

CO

'E

(0 L 03 0

a:

. M N (U t: ." " > i- ^ S) 5

-Scoj

CO C ^ (D D

i E 5

0 =3 0 -3 1 U

en en en '

> '5

3 i

^3 (U

a.

(0 o (U ^ >

c »— o en

.•55 m

s§| > x >-

„ <" LL

^ ^

5 ^0

M CO ^- 01 ^j-

-i ^^S

r: T— « 1- »- ro ^ ro cs 

1^

5°

c ^ 0) •-= +-' TO .'2 3

0 0

0) 4-'

' '0-

Fi <0 U (u < a:

. w N (U t; ^ "3 > >

| S§

-gO) g

CO t= - (U •O

^ E 5

0 3 0 -1 I U

cn en en

'^

Q. <

(D (5 a? 4. >

c r- o en

-•55 gl

sSS

> ^ >

CO " E

(3 " '-' 01

i TO — C Q (0

< s

—i 0

0

0

^

E

3

^

0

^

J

< cr

Z

0

U CD •=>

CO

cr

0 u-

=t»;

1- •Z. LU

1 U

< 1- \-

<

LU LU CO

LU 1-

0

z

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



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:




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



PROVIDER:





INITIATIVE (ADD

PERIOD: July 1, 1998 to June 30,1999


OBJECTIVE: Coordinate services to assist client/family dealing with Alzheimer's Disease.


TASK: Identify support needs for caregivers of persons with Alzheimers and make

appropriate referrals for assistance.


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.


TASK:

Estimated Completion Date


G:\USER\COS06\WPDOCS\GRANT98.ADl Q


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


G:\USeR\COS06\WPDOCS\GRANT98.AOI

II.A. DESCRIPTION OF SERVICE DELIVERY

PROVIDER:




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



PROVIDER: Manatee County Board of

________County Commissioners


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.



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



SERVICE: API-RESPITE

OBJECTIVE: Prevent/reduce premature institutionalization of an Alzheimer Disease client

through support to caregivers.___________________________________


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^


111. STAFF DEVELOPMENT/TRAINING PLAN

PROVIDER:




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.


5131

Q LU W

S Q;

CO m

n o

ooooooooooooinoooooooo 10 »p ^. W W WH^ U* U* U* W-V> W-<» V> CO U* U* V*'W-W^ W-W W^ cog,

|S ? ^-5

§ U tft f>

OOOOOOOOOOOOtOOOOOOOOO (0 (0 ^ (0(00'

^ 9. ^.e; 9.5"

2§ T" --«•-'-

I

_a°^^^SS2°^S°5?^^^S°^S°^5?S°^^^ Zoooooooooooomoooooooo Ooooo0 °. ° ° ° ° ° ° csl P ° 0. °. °. ° °. °

(/5 F o o d o d o d d d d o o i-~ o d o o o d d d

ini-cicooiotoo ooooooooooooo CM »s .,.. 01 co CM n co n en <><>•««>• w. w «/» ft. M- f» f» «>'»• u^ w w> w Q "\ ^ h; t. ®. •". <». •r-. fo ". . '^S '-''"fMT-oi'a-t-oir^ t0^; $OCMMCM(MCM<MT- <0 (N

§ (j «» t<» <(» <>'» •A w- w T-<o

5132

O^TtOOTtO^'00000000000000 ^•O'S i— r-'-oi^rf-.CTTCi '-£ UM??????? "S

SO: 0 cd

^R en 0 < I U

i- g° ^ ^ s? ^ ^ ^ ^ ^ s? ^ ^ ^ a? s5 a° g° ^ ^ s? s° zZooooooooooooooooôoooo IK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 splddddodddodddddddddodo ^ôoooooo IU"^-^-^T-»-T-»-

^ U11-

o'^rtDO'^-to'^-co'^-cor^-'tr^rcoooooooo h~ ^g _iC/3^~-ci'^'t~-oi^>'o»ooior~-cMnoi m "" ^(^•»»-T'<r-q-'<r'«r^r(M'v(s<T(0(Dm in 0

er""""""'' "" &

i

m'«-ncooio(oooooi-MCMT-ooooooo r'-'s i(/3cnncMnconcncoinnT-(DcoT-(i»<><»t»»9-</»w-<>» n°;

Ûjôomc>t-ncoi-o<Dcoio>r)'^- 01 § 1— 0 (NT T-' 01" •ff" T-" 0" i^ •<•" o' M i< (D' oi (0 •<y • (-l.ffMfMCMC^fMt'^'^t^nM-'t-WT-'t- <oS ;— S»/»t»</»</»</»</»«/» </» <^» «^ <>4 CM0 •' > w-

^•

a

U a U z

Cd S

w C td -^

^ l!

ES^^£

^^1^^

> ^- 2 t- (- •" Z "" 0 2

-3 Cd -3 ,:, tri ,<^;<û ^- a^ — a 0 td 0 Z td i- c- i- 3 e-

T •<r

n n o o

2 3

U 2

j-

s — c\ ^ s <3 2 5 c- o S

^ ^ ^ z

? =)

s : y E. = U

^ c

M — '

0 ° ?- U c: E-

, = 2 5 i-

g

i s 8

^ 2 •- yi - -2

§ ° ^

'- " Z

< 5 ^ N -a «=

I- l!- •^ ^• tfl

— ^—s

—, ^~"-' ^"- ^ ^-.—."2

m â- ^ S: $ S d?vj'D: o5'S: o: 8

Sd-^^.S.^^d-d.",*1: d.'^-z. ^^'^'~"-"~"~^ ^- '-"—'•^•—'

0 ^

•- "" ^ " c " OI'T; c ro ^ < c o (0 0 •P 2 U 5 S ^ =

— — — —~ — ""E'ro »-— (uaiailuaiiu .^.OOl¥;=:n^tB oioioioioicn >>ro;:^c~;'?s (orororoTOniOC.c.coi;;.*"-" cccccc'o,fl',fli^ô'u(fll/'lual<ua)0)t-l- (acgrororoni^COCO^nnuiuiSSajQjSaSa)

2SSSSS- c c~-"'<< >.>.>.>.>.^^

SSSiSS!SSeiSS8|||tttt§§ n)raniron)(ora33.".£>."!t:!t:EEEEE^"o

UUUU(-)(-)UXIu-u.u.OOlUlUUJUJUJ>>

0 2 (-

b} 0 Ut-

Sl

^

OK

|22?

IS!

^ge e -i i-

§E^

=5= J 3 - < -J < fr-Ui- 0 X 0 (- U (-

ooooooooooooooooooooo ^-»s ,,, v> w> <» w-wt v^w> w v> w a> w a> w » »* w> w> w w-w^ o ?-; UJ 1— •<r <N i-. o (5 (/) w- </» w" <0 °

?"

u-LU S° ^ ^ o? ^ S? ^ ^ ^ o5 S? =5 S? ^ S° ^ 5? 5° ^ ^ 5? Oôoooooooooiooooooooooo

Sooooooooooi^-omoooooppo S?l—ddddddddddcNidT-dddddddd

ooooooooooooooooooooo >oui~e m»oo 000000000000000000000 (0 CO " <0«0

(-ddddddddddddddddddddd ci

2 °

2 i

OOOOOOOOOOCÔi-OOOOOOOO ^—ioooooooooo<oomoooooooo —'t—dddddddddddd-^dddddddd < fc2 T (NJ

ui ?>-

,,,, OOOOOOOOOOOOOOOOOOOOO O^P Lu I— <(» W> W t^ «1» t^- W W- M- WM- <.»» U* W> f» M- «A- tO- f» (1» t^ »g

< 0 0

Û 0

nic/iooooooooooooooooooooo oo's ooo UK o < 3 o Q- 0 d co i

z^s?ss5°^s°^^s°5es°^^=?^s°as^^^^ [ijO000000000000000000000 Lu ~

p o o o o o o opooooopoopo o o <r[~, ddddddddddddddddddddd

0- Z "i

OOOOOOOOCOO'r-MOT-OOOOOOO M^P ,,., w-w>v>-ww-wn»-oau^r>0{DW>i-u^w-w>-w>w'u*w' •v "' ^l- ••-ococMin-q- 0;'' -} •S, •tf 0' (T' CM' CO' (0' d' ., $0 «•»• c^ to- ^- »» •»- ^-t'; ^ (J «» «<» f» tq- (N'

ooooooooo'q-coin'q-ocoooooooo •<i-^»'~° •'r^'o' 20) oolOTtNoi •^•^"; 'r^^' _n- r-)-<r<Nr-<om '-^S '-? û- —•— -^c^- .. SD •^ mio—iolo

^ i a

^^^^^S°S°S°^^^S5^S°^S°^^SS^^ Zôoooooooooooooooooooo — ^-oooooooooomoooooooooo ^—dddddddddocdddoddddddd Q|— OOOU300 << (^) T— T- t— 1— T-

22 LU 3 0 u-

^- l— L- — y,

i E

r*' '• g S

^ ^ ? 3

S : U

^ § ^ VI -) ' 0 0 > U 1^ ^-

-3 - z

U f- 3

Z BB 0 y C\ U

0 2 " V) - Id

S ^ '- S 2 < 3 $

^13^

i

S s ^ ?-, m^ c y:

criyj'CL$s;§: 8(/?a?Q:a5§;^ S

03.220:0 Sd.-it^x^.^z.

£ "

ro ^ < C 0 ro ° 'E . ^

SUoio >.•=.

a) a) cu 0) oi (u y.yoi.==i5<o oocnooo} >>rofc'.^fs'*^ (0 (0 ro (0 ro CB ,>>>.>,>>Q) a

a,a,o>a)a)ai<ug?'5cn-i5gg-2-|-^^-21c inoiinMtninuiEcuuu"""-0-0-0- "-2 5 (S(BTOtBro(oro33.i2.'2."-t:fcEEEEEo^

UUUO(-)U(-)IXll-U.U.OOlUUJlULULU>>

t-

U S i- ci u Z

u S

S ^

u g£ < =i •*.

2^^^^

^|^

> ^ 2 b- (-

^S3^^

^"^^ ^ ^- e; fc E ct 0 '-.i 0 Z id t- e. fr- 3 ft.

C: Ed 1/3

td 0 U i-

? Q

Kg C-l ^ co =

b. E

°£

t2zJ2

IP

C/3 - C e Sb:

§£1 - Q C

-33-3 < J < Ût- o x; o i- U ^-

ooooooooooi'-onoooooooo o»S uû^w^w*»*w^v*w*WtW^W)»*-vy*w*wm*wv*w^»* 0?^^

U W w* w T-" ^ < 0 w0 $ ^

u-uj^^^^^^^^^^^^^^^^^^^^^ Ctôooooooooomomoooooooo — ôooooooooocNOt'-ooqqoqoq c?l—ddddddddddtrdt-dddddddd

000000000000000000000 <-^<P T-T-O ,000000000000000000000 01 CD ". 01 81 — ddddddddddddddddddddd 10

^1 a a: V» W- W- W- «» tf» (^ M- W- 0 M- 01 W- W- M- M- (A- Wt M- tft Cl "; LLJ )— CO ^— OT •*• 0 c/) u^ w* w>" < 0 °

§ <-•

S?^^5°^^^^^SS^S°S°^5?^ôSgS^=? ll.tl|000000000000000000000 Osoooooooooomoooooooooo ,o—dddddddddd-vdT-dddddddd 0s- r- —

000000000000000000000 fOW»P C1P10' oooooooooooqoooqooqqp - coco"; coco^^

t—ddddddddddddddddddddd •^•

2 °

(0 5 z £ < x

E~—i,,,oooooooooot'~OTroooooooo ' <u-loooooooooo•<ro<>ôooooooo O^-SodddddddddtDdcodddddddd ^ j3 p co T-

OOOOOOOOOOi-OOOOOOOOOO •^'5 ,,, wtwû^wtu^wm^w-wwow-mwuû^wm^vô^w oi"; — ^ co -q- CM cl 0 W «<q- M- _- ^: <0 So $ U

u-ajc^^^^^s^^^^^c^sS^^s?;^^ Oôoooooooooooooooooooo

^^qooqqqoqqomqiriqqoqoqqq S^l— dddddddddd^dcMdddddddd

ooooooooooooooooooooo c^»».,s r-r'.o oooqoooqoooqqoooooqoo 00°' oo ddddddddddddddddddddd ''"'"£ '^'T-

o

3 QL

oooooooooorômoooooooo Q;-!..,oooooooooo'q-ocooooooooo ^^•^ddddddddddcodddddddddd

Eo| tD ^

cdo?0-^?^ 8(n(â:o?§;t^ "

".^.^^^"^.s'-d.'a.s^'-'^'-s-

l::l ^ s- <! Si ^•m t-f 0)— C ^1 (D ^ <

ni o •s 5(-> §o ^ v) <n £

i-i-i-t-i-i- di a) ai ? — '£ "£ (u<ua)a)ii»>ro^^*--- nironinioiniaij-'-co1--"'-'" cccccc'o,o),Q)îo^)(n'/'<U(Ulua)lUl-l- n]n)rocDnsni^C/3C05(i(jUi</)(u(u(ug)Q,(uiu

S2SS2S c c<< >•>•>•>•>• £ a

SS!S?S!SiaSiiJSS5|gttttt§§ rororo(iiro(0(a33M<!'."St:Sc:fcEcEEoo (jC)00(-)003:n:u-Li-ii-OOmmLLiiLim>>

i-

Exi

Id a, u

cd

C/l I— Id t- » MM ^ ^s

a^ss^

^||S

> ^ s & i- " z •- o z

^<?g (~ e ^- S- ct 0 u 0 Z u t- c. (- 3 e-

e: u sn

Cd 0 U i-

^ 0

K fc]

y ^

21

og

t2z?

|Si

s " o C/3 ^ C ciSi- 3 P -3

2u= =QCS ^ 3 -3

i^di^

?a?

000000000000000000000 0^$ I- wwtwmtu^vtWtwmû^v^w-wtw-wtu^v^w'w^w^wyu^ w-S

_ 0 tU g 35 i? o

°S

(A ^P iP ^P ^P ^0 ^0 ^p ^0 ^0 ^P ^9 up <sP ̂ >P —^ ^^ ^^ '•5 ^9 '^0 ^^ ^^ i"S^S'&'S~&~&'o'o^&'5~&'ff~&~&~o~o'o'~5~S'S^S'- 5' 'S-ooooooooooooooooooooo o

==^.= 0000000 00 00000000 00 00 0 <*-2ooddocioodcicicioooooodoo d

OS ooooooo

W________________________'" •'" T' •r' •r' •^ •^

0000000000<OOCOOOOOOOOO (M»8 ^. , w- w- v> » w- «fl-«» Wt w w^ -v w- 01 (/» y» «A- w- w t^ e» w •<»• g

0 CO S W °-M.

< 0 w° §<->

u. uj ^ S° ^ ^ S° Si° S? S° ^ ^ ^ ^ S° S° ^ ^ ^ S° S? S? S? n^soooooooooomoooooooooo

ÔOOOOOOOOOCÔOOOO 00000 S° I— d d d d d d d d d d •T d T- d d d d d d d d

ooooooooooooooooooooo <O<D»S .000000000000000000000 0000"' —ddddddddddddddddddddd •^•

i d

D: I

0000000000<00-^-00000000 </l—j0000000000<-0(000000000 —^—odd dddddddddtoddddd odd

^gF " '

(0 (0 0 00 00

oooooooooomooioooooooo ^r'p ,.., W>-W-W-W-W>W>W>W>WWr-W^t^W>W>W-WW-W>W>W 01- IU 1— 01 £T) CO 0> 0(0 ^ W ^-°. < 0 «» »»^ § u

^P^P^PÔ^P^P^P^PÔÔ^^p^p^p.sP^P^P^P^P^P^P i. ..iS'S^tf'tf'ff'o^tf'S^S'o^fiô^ff'S'S'tf'S'S'S'tf^S^ "-^JOOOOOOOOOOIDOOOOOOOOOO OSoooooooooor'.ooo ooooooo g°pddddddddddddiridddddddd

ooooooooooooooooooooo oo'e ,000000000000000000000 '^''^'K —ddddddddddddddddddddd ^^K

3 D:

UJ I

t —!.,.oooooooooocooooooooooo ^.ctmooooooooooiôh-oooooooo w ^Sodddddddddcddi-dddddddd lU 0 i— m as g '-___________________=___________

000 •T IT (M CM

"(^"-^.SS 5coa?[i:c^§;£^ "

S.d.22^0^.^^.".^^1^.^.

&! i^

^1 §>|^ vi ro T3 <

c ° — ro o "P ^^ < ̂ ™* 0 a; S >. u> m E Ta 81- i- >- i- >- i- <U<Ur — '?'£

mailuaiaia) oo>••-:=i5i5 oolcsioioioi >>")^se—— ro ni ro ni ni ro o c- c- c o T: •"' •" cccccc•oa',^"^ôJJ«"'"<ualala)ll)l-^ nioiroroni(D<i-w"3'S(i(i"<'iii)iuaiQiQ)tt)W

SSSSSS' c c---<< >>>>>.>,>.jia (i,a,iu<i)(Dai<uPiST5'!5'<5gg-§5-§--J[cc inininoitOininEEuou^^^-O-p-G-^-^^ nioinin)niniro3=i.".""!t=fcEEEEEoo

U(-)UUUUUXlL.L-u-OOlUlLlllJLlJLU>>

E-

Cd s C-3 Ci U z

u z

tfl p

i si

a^^^^

^|is

^!§^ -3 u -J ,- y ,<U<Û ^ cs: ^- C a 0 Cd 0 Z Ci! h- c. ^- 3 e-

e: i- c/i

a 0 (J ^

^ Q ^£ " b Sl

0 K

jSzS

|S§

sig

g^^ 2 M -

:§s

E^d^

oxo i- t-l i-

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)


Line#

Line 1

Line 2

Line 3

Line 4

Line 5

Line 6

Line 7



- Holidays

- Annual Leave

- Sick Leave





2,080

88

104

104

112

1,048

624

24a


Employee Title: Fiscal Coordinator (AS)


Line#

Line 1

Line 2

Line3

Line 4

Line5

Line 6

Line 7



- Holidays

- Annual Leave

- Sick Leave





2,080

88

130

104

110

171

1,477


Employee Title: Office Asst IV (FR)


Line#

Line 1

Line 2

Line 3

Line 4

Line 5

Line 6

Line 7



- Holidays

- Annual Leave

- Sick Leave





2,080

88

104

104

112

38

1,634

|24b


Employee Title: Human Services Coordinator (JS)


Line#

Line 1

Line 2

Line3

Line 4

Line 5

Line 6

Line?



- Holidays

- Annual Leave

- Sick Leave





2,080

88

104

104

112

178

1,494


Employee Title: Human Services Manager (LS)


Line #

Line 1

Line 2

Line 3

Line 4

Line 5

Line 6

Line 7



- Holidays

- Annual Leave

- Sick Leave





2,080

88

130

104

110

1,440

208

24c


Employee Title: Case Manager II (RW)


Line#

Line 1

Line 2

Line 3

Line 4

Line 5

Line 6

Line 7



- Holidays

- Annual Leave

- Sick Leave





2,080

88

104

, 104

112

178

1,494


Employee Title: Case Manager I (DB)


Line#

Line 1

Line 2

Line 3

Line 4

Line 5

Line 6

Line 7



- Holidays

- Annual Leave

- Sick Leave





2,080

88

130

104

110

178

1,470


Employee Title: Case Manager II (MP)


Line#

Line 1

Line 2

Line3

Line 4

Line 5

Line 6

Line 7



- Holidays

- Annual Leave

- Sick Leave





2,080

88

156

104

108

178

1,446


Employee Title: Case Manager II (GW)


Une#

Line 1

Line 2

Line 3

Line 4

Line 5

Line 6

Line 7



- Holidays

- Annual Leave

- Sick Leave





2,080

88

156

104

108

178

1,446


Employee Title: Case Manager Asst (Vacant)


Line#

Line 1

Line 2

Line3

Line 4

Line 5

Line 6

Line 7



- Holidays

- Annual Leave

- Sick Leave





2,080

88

104

104

112

178

1,494


Employee Title: Case Manager I (MW)


Line#

Line 1

Line 2

Line 3

Line 4

Line 5

Line 6

Line 7



- Holidays

- Annual Leave

- Sick Leave





2,080

88

130

104

110

178

1,470

24f


Employee Title: Office Asst II (Vacant)


Line#

Line 1

Line 2

Line 3

Line 4

Line 5

Line 6

Line 7



- Holidays

- Annual Leave

- Sick Leave





2,080

88

104

104

112

74

1,598


Employee Title: Case Manager I (JS)


Line#

Line 1

Line 2

Line 3

Line 4

Line 5

Line 6

Line 7



- Holidays

- Annual Leave

- Sick Leave





2,080

88

104

104

112

178

1,494

S^SSSSSSS 5 SSSSSS S S S S SSSSSS SS S° SS S° Sg Sg S

1 •" ° ° 5 S S 0) 0 0 - °

< 6) *fl

uj lo'^p'-eooooooo o oooooo o o o o in o o o o o o ^ o*rt f^> ID T <o r'- aS o» ̂ $ CD o> •- o co o »- i- S££c»w*»»»t»*»»» w *A*A*A*»*»f •* <A w t» —*»*ftt»K»w> *» o> o »- ^ r- f- »- n0' 0°; *n co co f» m CD BO — n ° — o» *° cootfiMM^'—'^tD'-rt^-rt n^-n 0. ^ o* '-. w> . o' n' *n *n r-' co ** . w << ̂ CM ^ ^ (N i/3 ^ o »- <n o> fM ID «* (M ^ OTO^- U— *4 W U «9 ft _ ,- .^ ;-

(.I (M»t-*?«Moooooo o oooooo o o o o ôoooo o vi o »- »n v v r-. «o s? -v -^ "T *n n o T *n ci —1 S-S^SSwSww** w *« 14 ** *A w •* •» *« 44 «* m «* w «* «« «» »» .n o ao »n r* o'- ^-g; n ^ *o «» 2 w IOCT-V < 0 0) u* V c^ ÔOnvOVWWU'•V— IDOICD (0 ff) 03 LLI ^ ''. tr *ft ui isT tn" T-" tD' (0" ** — CM' r^.' o>' (n h-' 01' r). ^ t, 0 0 p». roNtn«»rM "wco^-^-to.-^r — *ft •^^Vt^ »^ *» W ^

uj CO'S'POOOOOOO o oooooo o o o o oooooo oeo oo oto NN flo-^ n^p o m o o omo i— o^'0'*-*^^^*^^*^ ^ »» *» »» w w *^ ^ M ^ *« n M h« *•> *A *^> MT on ui^- mrj ^» 0' '- c' <o »n r^ ^ 00 m r-, — K 0* '?• fsi ^ •r-OTtf>»^*o ';cr>"nfMp nMO g- W- ^ t» ^ rM" *0 »0 tf>* *0 •* 3 •^ 0 O' 5 0 CT 0 "OO '- '-CMCOWCM "CMnCMM c: 5 S*^**** ^ ^ ^ ^

O'^'^tDOOOOOO 0 OOOOOO 0 0 0 0 ^00000 Oh» 0»- tD(D NO f'-»S o°';£ui»»ww»w»»»^ w *A*Ak»«^*A*»» «A *» *>* *« (T>t«w»«AtA*A wv oo* r»m (D»O ^°' ""S^ c* tnocicOtnTW^ »-' '• _ •^ ^:1 to* *n' 0*' 10' <o' »-' -• »»00 M fOrMOW*{M««°

M (M M CM »» M MM

r--^»<p^-000000 0 OOOOOO 0 0 0 0 OOOOOO 0«- 00 trt ^ 00 t/) ô CT'^^'-MWMWW** ^ »»»ttft»»W^ W V> ^ ^» OMMttft*^ ^^ W»0 <D»- ^» *~^

(0 ^p r^ o <o *n ^ r- n i- c» ^ 03 n ^

^- 0 ID ^ m r»- 03 n r^. ,M m-*rt

2 S? 0 -ff 0 ' W 00'

V- 'vl d

»-' v d

Q: '-..BÔIOOOOOOO 0 OOOOOO 0 0 0 0 tD 0 0 0 "0 0 OtM OtO tD(D U) 0) 0'fi n'? r^VtO 0 Vtf) ^ oi°-2'r>*»t»»w*»»»»» *» wo»*»k»ww «* «* w «* kn«*»»«*«*«« fco o*n TCM '-10 fM^ o^ ioco»- w CD'- ^fMS'-tn »o ^-oioo'*coo»rt'''n';r^ô rô ^ '-' 3 S t* '-' "' " «o «o *o N S ^ <"' *->•lft n *•? --^00 n n(MOv>rM«ft°M'vcMO CMO CM <M W <M *» fSI»- »-

W W W V» M 44

.»; ^•^p.ipinoooooo o oooooo o o o o rôoooo oui or*- oco «M^ (M'< IO^P »DMN o rt(M CO»'"'rM*»W»W»W»*At^ ** »<»*»*»»»tft» V» ^ W ** 0 <A Irt <A »* V» »»<- 00 tDO C^CM <-^ »?>$; S^-— W •<T<- <^»•o^^m us r'-oior-.^-iDwISoiSo^-co ôa S ^ 2 S ^ " ^ •"'fo to lo w S rt io ^<J) < a>

00 ^ •vrM»-»»o< °w*mtf)OUtno

11

S s ^"

j 0

UJ 0 ^g

^ (J

1^ 12

Sg "8

^ S 0

a. »— (/l 0 u

5d S 0 UJ 0. t/i >— < M <-> 0

(J

0 ^

rt S n r^.

tn 03 0 h-'

fM

g

b9

s?

d

5? h- in r*-' (M

£S m <r <£>

<M (fi

d

^ 0 n 01 (M

^ PM

00

CO in

SSS222S

o! v» ^> «»«»«* rt CM 0" n

U1 0 0 0 0 0 0 GO V> M ^ 4^ W M 0 f^.' ^

— 0 0 0 0 0 0

0** (C v»

0 M

0 «»

§ n

w

0 ftt

>n »»

0000 W «« «4 ««

0000 V> fr* t4 *«

0000

fM m 0'

w

0 f>

(M m T 0'

M

0 0 w w

0 0 •9 «*

0 0

ID «M V»

S

S N fM ^

S

0

M r^ 00 «4

0

0 *4

0 *«

S

w

0 w

0 *«

0 0^ M" M

g

0

0> ^•

v>

0 «•«

0 in (M ^

S

0

M

0 v»

0

0 V¥

0 w

0

00000 W» W» ̂ *4 V>

00000

SO 0 0 0 «« «* 4^ 4^

00000 *•» »» »» <^ *>»

00000

SS <0,

M

0 (M ^• o*

«»

0 <N CO 0) 0 0 CM' V' <ft »-

«*

0 »- W h-

(M **

o r^

IM' v (M «^

0 0 W tf>

SS

0 0 w w

SS

0 0 4^ W>

01 01

55 «»

(0 (M o »n r"- ^ SS

w

fM' 0) 0 ^'

v»

5?: CM ̂ • tf>' <r ^> (M

w»

0 h* o M 01 01 N <M' io v w> tM

•«

CO '- in r- ^ 03 n'

w»

«o r- ^- (M 0 V 01' M

01 0 o in ^ (M r-» M

CD rt 0 (M* «t

^ 0 n 0> CM

^ S ^ '?

« S w

n^p iDô tnv<o o tfivio '-0' 'v0' OIT-CD w cn'-co c*i0 n2 ^•rim <rri»n 5-5 S" a?S SS^ '••"5 S^ Rn

W» •» »» t^

.»5^0>000000-»CÔOOOOUl>n-<--q- 0 00 ^? '^.îDwwwwwwvifiwwwwwr^r^-oo^ co oo »- "* riggco r-v nTOi^n o— § s§§s or;s°- x ^^^^p; ''K es

: § I -----, S2

£' ;: g 5 § E S §1 •III III w § - ^sa-sas S3S38S i'l 8 =• ^^^8^^^ 11111^ < ^

M_2,-T;-a-3T5-S"5 SoSSS"^ £ ^

=. 5p=11îli gli^£&|§ a I $ = ^'^liJîii l^"-5>"^s § .i^.l'si.l.s.l.l.li^S

;S2£î?'i?^l- ISllililsSoig.Isg^mggjS^ •yy .-c"'"F•'C'— Si i==7 3 = 3 3 3:=;—==;'=— î^==ui=:s^s=^C.jS='<

ySS^fss^ss' dîlsf^ssS^s^sî-i^S.:; "^^^K "-• •^•-^^ssssssi >^=s^s3s^â^s£:s^-;=5as"a'=25£'s-; :;2:3:SE5g=£S <:S=S=S=g"SEZ==lSS:s5sSS=S^=5^-

f-.^ /q5-r -aji^^^Ji-s ^s-ssssss.ôsusvs^-sSssSSss^-so —âf tjFf ~ ^ ^. ^. ^. ^C. ̂C. ̂C.\ t~-;a^l^:-£^^:f-U-*;£--£l-;-£0-£U'>^S-£-i-£^^0-CP-

•J (J

-^ ^•

S ^ s ;/' 0 .^ " c C

i i ss s

!C ^ Vi ~

S •= «, ' 0 £

^S i? s-3 i Ss§ ^< <ri SS- US S.; eSo vv ?» u" rl eg. <=S

jj S^ 2s ^ ^ §1^ oo "TB =-"i a- Sy.SSs yy ^ vs ^s ^t® ^6 's-^ •=•£ ti uf x^" «,=- ^'-3 t^>^ '35 T;i£ •Sc 'SS ^"S; S S ».= i " S e S j 7. S t- 11 si s| sg s'2 £IS ^ 18 s i- x.S = £ ss s ?zu

e ^ H ^ ?»•

C

^ ^ 6

1 =

'j L. ^

cs ^ it. — \r> ^ :: ^

= z £ 2 •^ z S «?

§1 c ^ u ^ !ÎS

s|l.

Ill

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

FTE CMGNT 0.3300 0.33

0.56 FTE

co ci 01 co ••- 0) <D- ?

in

>. p-i m n %

€

^

o 0 o: Q.

03 01

3 Q UJ X 0 CO

LU 0 Q

CD

0

£ 0 CL Q. 3 M CQ

0: UJ

S s i

Q g Z

^ Q § Z LU ° — co en 0 5 > Q; UJ UJ CO 0 CC CUJ

0: UJ (/) Q UJ (A I- ra U »

m •7 ^ Q u- < 2 S 0 U = 5 ^

^ <u<u<uaia>7_ujii UJ a) ££EE£OQ"(/5"2 h-l-h-t-l-Q<U-illll ^^^^^.^

^ .———^,——^'———^ »^ ^-'——~^ ^^ •———^~^ < Q_

co UJ 0:

1-

0

^ 3 0

CO

1 "•0 C

UJ en - 0 ?•

hf

Umu] •- UJ 0 <D

g0^! < Q. CO Q.

<

§ 0 0

o d

o o o o 0 0

§ 8

0 0

8 8

0 0

0 0 0 0 d d

o o o o d d

§0 0 d d

§0 o d d

o o o o d d

o o d

o o d

f- C~ 0 0) °. ° °. K 555^. (D ID h-_ co 0) o co ^^

co o co co p co h- d t~~ oo oo

0)' 01'

in o io 0) 0 0) i- d •'- n CT <o_ co co' oo PI n

o CO UJ Z 3 —a

i 0

CO 8

UJ T'-

t^o

^

^^

o in

§ 5. 10

5

00 0 00 0 do d

o o o o d d

o o o o d d

8888. 8. d d d d d

o o CO

§0000 0000

d d d d d

00000 00000 d d d d d

0)

(0

.£••0

< §•§ V) 0 <u CL U Q.

000 000 odd

r»- '- o »- •«r . en

m <o 5

d|d

o CO"

co ci co T r-~ T- co n »- w 0)

in 01

n co in CO

s I &

^ s ^1

a w. "S iS0 a 8 a S ^ -g? 8 0 8 •£. o oS^ " •^Utft3 E E13-^"0

fsj I .

s I I

< i|| I

IS? i S < S = I I III «

?SS t ? § -s I ! 3 j6l

s

CD •o % CQ l- =' U £ "- |- CL U U ^ -<5<i- -(5 % a % % A as%a 5

i2£g ? s ^. ^ ^ ^ ^ ^5Jli ^

T- -r- T- CM tM__r> •9 fi tO_____1^ CO 0> •r-

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^_


Title:___________Board of County Commissinnsrs

ATTEST; ^ R. B. Shore

^ Clerk qi Circuit Court


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^^^./>^^


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

/^--


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



e. Upon returning to the office, the findings of the


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



e. Upon returning to the office, the findings of the


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. _________________________________

t^-4 21

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,


Director

FJL:

Enclosure

22

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,


Director

FJL:cd

5173 23

§

>—I 00 t—I

> >—I

Q

OQ

e

»—i

§

02

^

5174