HomeMy WebLinkAbout20130477.tiffRESOLUTION
RE: APPROVE VICTIM'S ASSISTANCE AND LAW ENFORCEMENT (VALE) GRANT
APPLICATION FOR LONG TERM CARE OMBUDSMAN/FRIENDLY VISITOR
PROGRAM AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Victim's Assistance and Law
Enforcement (VALE) Grant Application for the Long Term Care Ombudsman/Friendly Visitor
Program from the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Services, Area Agency
on Aging, commencing July 1, 2013, and ending June 30, 2014, with further terms and
conditions being as stated in said application, and
WHEREAS, after review, the Board deems it advisable to approve said application, a
copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the VALE Grant Application for the Long Term Care
Ombudsman/Friendly Visitor Program from the County of Weld, State of Colorado, by and
through the Board of County Commissioners of Weld County, on behalf of the Department of
Human Services, Area Agency on Aging, to the Victim's Assistance and Law Enforcement
Board be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said application.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 20th day of February, A.D., 2013.
BOARD OF COUNTY COMMISSIONERS
ATTEST: ryt rye ,.
Weld County Clerk to the Board
BY:
Deputy Cle
APP' e D AS TO
ttorney
FEB 2 6 2013
Date of signature:
0-149 raecia." ivy -
WELD COJ3NTY COLORADO
William F. Garcia, Chair
7 `J
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s Rade 68acher Pro-Tem
ike,Freeman
'Barbara Kirkmeyerr
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2013-0477
HR0084
MEMORANDUM
DATE: February 14, 2013
TO: William F. Garcia, Chair, Board of Coun Co,nmissioners
FROM: Judy A. Griego, Director, Hum ervi es
RE: Weld County Department of Human Services' Area Agency
on Aging's 2013-2014 Victim Assistance and Law
Enforcement (VALE) Grant Application
Enclosed for Board approval is the Department's Area Agency on Aging's Victim Assistance and
Law Enforcement (VALE) Grant application. This Grant was reviewed by Pass -around
Memorandum dated February 8, 2013, and approved for placement on the Board's Agenda.
This grant will allow the Ombudsman program to provide elder abuse education programs to long
term care staff, continue the long term care friendly visitor program, and maintain and strengthen
the Volunteer Ombudsman program.
The amount being requested for the July 1, 2013 through June 30, 2014, funding cycle is
$12,000.00.
If you have any questions, give me a call at extension 6510.
f/.P [(J:
VALE Grant Application Signature Page
Applicant Agency: Weld County Department of Human Services, Area Agency on Aging
Project Title: Weld County Long Term Care Ombudsman/Friendly Visitor Program
Grant Period: July 1, 2013 to June 30, 2014
We hereby certify that the information contained herein is true and correct to the best of our
knowledge and belief. The following signatories understand and agree that any grant received as a
result of this application shall incorporate and be subject to the statements made within the above
described VALE Grant Application (The Application). Furthermore, the signatories certify that
they have each read The Application and are fully cognizant of their duties and responsibilities for
this project.
Original signatures of each party to this application (i.e., Project Director, Financial Officer and
Authorized Official) are required. Please use BLUE INK to distinguish the original documents
from copies. Refer to Application Instructions for definitions for the signing authorities.
Project Director:
Name: Eva M. Jewell Position/Title: AAA Division Head
Agency (including Division or Unit): Weld County Department of Human Services, Area Agency on Aging
Mailing Address: Post Office Box 1805, Greeley, CO 80632
Phone: (970) 346-6950 ext 6101
Signature:
Financial Officer:
Name: Lennie L. Bottorff
Agency (including Division or Unit):
Mailing Address: Post Office Box A,
Phone: (970) 352-1551 ext 6537
Signature:
Authorized Official!
Name: William Garcia
Fax: (970) 346-6951
E -Mail: ejewell@weldgov.com
Date: 7. 4/- / ?
Position/Title: Fiscal and Budget Manager
Weld County Department of Human Services
Greeley, CO 80632
Fax: (970) 346-7691
E -Mail: lbottorff@weldgoy.com
Date: 2 k/12
Position/Title: Chair
Agency (including Division or Unit): Weld County Board of Commissioners
Mailing Address: Post Office Box A, Greeley, CO 80632
Phone: (970) 336-7264 extFax: (970) 352-0242
Signature: - 1/ - _ Date:
E -Mail: wgarcia@weldgov.com
FFA 2 fl 2013
In accordance with the Colorado Revised Statutei 24-72-202.6, information suppne° in tins application is considered a public record.
18 oe0/3-0(117
2013-2014 VALE ASSISTANCE FUNDS
19th Judicial District, Weld County Application
SECTION A - AGENCY INFORMATION:
1. APPLICANT AGENCY:
Program Name: Weld County Department of Human Services, Area Agency on Aging
Street Address (if not confidential): 315 C. North 11th Avenue
Greeley, Colorado 80631
Mailing Address (if different): Post Office Box 1805
Greeley, Colorado 80632
Phone: (970) 346-6950 extension 6128 Fax: (970) 346-6951 E -Mail: rmaldonadona weldgov.com
2. CONTACT PERSON: Raegan Maldonado
Title: Lead Long Term Care Ombudsman
Phone: (970) 346-6950 extension 6128 Fax: (970) 346-6951 E -Mail: rmaldonado(aweldgov.com
3. Agency Status (i.e., governmental, private -non-profit, or private -for-profit): Governmental
14-02101 Non -Profit agencies include their TAX ID Number here.
NOTE: If you are claiming non-profit status and if you have not previously provided documentation supporting this claim
to the VALE Board, then you must provide sufficient documentation concerning your agency's non-profit status with this
application.
4. PROJECT TITLE: Weld County Long Term Care Ombudsman/Friendly Visitor Program
5. Give a problem statement that is specific to the community the project will serve: The funding will
allow the Ombudsman Program to have a consistent presence in Weld County long term care
settings, allowing for advocacy and education. The funding will enable the LTC Ombudsmen to
maintain a friendly visitor and awareness program.
6. FUNDS REQUESTED: $12,000
ITEMS 1 - 6 MUST REMAIN ON THIS PAGE
1
SECTION B - NARRATIVE SUMMARY:
7. Agency description: The Weld County Long Term Care Ombudsman Program is housed under the
umbrella of the Weld County Area Agency on Aging and the Weld County Department of Human
Services. The authority of the local Ombudsman Program comes from the Older American's Act,
Colorado Revised Statutes 25-11.5 and the Nursing Home Reform Law of 1987. The Weld County
Ombudsman acts as a consumer voice for the concerns of the elderly living in institutions, who may
have no one else to speak for them. The Ombudsman also receives and resolves questions, issues,
problems and complaints made by, for, or on behalf of residents of long term care facilities.
The purpose of the Weld County Long Term Care Ombudsman Program is to assist and empower
consumers of long term care services by providing information about these services and furnish
support in complaint resolution. These issues or complaints may include, but are not limited to
access to long term care services, redress of neglectful or abusive care, and information and
assistance with civil and human rights. The Long Term Care Ombudsman Program is a
resident/patient/consumer-centered advocacy program.
Long Term Care Ombudsmen have statutory status under the Older Americans' Act of 1965 as
amended and are required by federal and state law to visit every nursing home monthly and every
assisted living facility on a quarterly basis. They also receive, investigate and resolve complaints;
identify needs of long term care residents; and help establish programs to meet those needs. The
Ombudsmen also document and report problems of long term care and help to stimulate and
promote improvement of the system.
8. Brief Project Description for which the funds are being requested.
The V.A.L.E. grant has allowed the Ombudsman Program to maintain staff time to keep up with the
increasing demand for advocacy on behalf of this very vulnerable population. The funds have also
enabled the program to maintain an educational program aimed at educating residents, Certified
Nursing Assistants (C.N.A.'s), other long term care staff, and family members. Education material
includes, but is not limited to: information about the Long Term Care Ombudsman Program; Resident
Rights; Elder Abuse and Neglect; and Victim Compensation. The Ombudsman's role, through
observation and a frequent presence in the facilities, is to insure that resident rights are being
respected and that quality care is being administered. In addition, our program focuses on the
importance of recognition and appropriate response to signs and symptoms of elder abuse and
neglect. Continued V.A.L.E. funding will make it possible for the Weld County Area Agency on Aging
Ombudsman Program to serve the increasing number of vulnerable long term care residents and
their families.
9. RESPONSIBLE PARTIES:
a) List the two individuals who are responsible for ensuring the grant is administrated as
proposed by the organization and approved by the VALE Board.
NAME
TITLE
PHONE
EMAIL
Eva Jewell
AAA Division Head
(970) 346-6950 6101
ejewell@weldgov.com
Raegan Maldonado
Lead LTC Ombudsman
(970) 346-6950 6128
rmaldonado@weldgov.com
b) Who (give name and title) in your agency is responsible for reviewing agency bank statements
against agency financial reports for accuracy of financial information?
Chris D'Ovidio
County Accounting
SECTION C - GOALS AND OBJECTIVES:
(Goal 1, objectives 1 and 2, are mandatory for all applicants.)
10. GOAL 1 (standard): This project will provide direct services that assist crime victims with emotional
and physical needs to stabilize their lives, provide a measure of safety and security, and/or enhance
victims' experience with the criminal justice system.
OBJECTIVE 1 (standard): To provide services to the following estimated unduplicated number of crime
victims during the 12 -month grant period.
Although a person may be a victim of multiple crimes in one criminal episode, they can be counted
only once using the predominant crime.
Definitions:
Victims: primary and secondary victims
Primary victim: The person against whom the crime was committed, except in the case of homicide, and DUI/DWI
deaths where the primary victims are the survivors of the victim. In domestic violence crimes, children of the primary
victims (who are receiving services) are also considered to be primary victims.
Secondary Victims: Persons other than primary victims receiving services because of their own reaction or needs
resulting from a crime.
Unduplicated Count: New and continuing victims served by the project . Continuing victim is a person served in the
prior grant year who is continuing to receive services in the new grant year.
EST. NO.
VICTIMS
TYPE OF CRIME
EST. NO.
VICTIMS
TYPE OF CRIME
Child Physical Abuse
Adults Molested as Children
Child Sexual Abuse
Survivors of Homicide
DUI/DWI - Victims of vehicular assault or
vehicular homicide, DUI/DWI crashes or
careless driving resulting in death.
Robbery
Domestic Violence
Assault
10
Adult Sexual Assault
Other violent crimes such as hate and
bias crime, gang violence (specify).
80
Elder Abuse (including economic
exploitation and fraud crimes)
Other, please specify
TOTAL UNDUPLICATED VICTIMS ESTIMATED TO BE SERVED DURING THE 12 -MONTH PERIOD
90
3
OBJECTIVE 2 (standard): To provide the following types of services to the following estimated number of
unduplicated victims during the 12 -month grant period.
Number of Victims Receiving Each Type of Service: Estimate the number of victims who will receive
each type of service during the grant period. A victim may receive the same type of service more than
once (i.e. counseling), but the type of service can be counted only once during the grant period. An
individual service category cannot exceed the total number of victims listed in table A.
EST. NO.
VICTIMS
SERVICES
EST. NO.
VICTIMS
SERVICES
Civil Legal Advocacy/Court
Accompaniment
Individual Therapy
Civil Legal Attorney Assistance
50
Information / Referral (in person)
Criminal Justice Support /
Advocacy/Court Accompaniment
Information / Referral (by phone)
50
Crisis/Counseling Intervention (in person)
40
Language Services (interpretation)
40
Crisis/Counseling Intervention (by phone)
Shelter / Safehouse
Emergency Financial Assistance
Transitional Housing
90
Follow-up (in person, by phone, or written)
Transportation
Forensic Exam
90
Victim Compensation Assistance
(required)
Group Treatment / Support
Victim/Survivor Advocacy
Hospital/Clinic Response
Victim Rights Act Services
4
11. PROJECT -SPECIFIC GOALS AND OBJECTIVES:
Add at least one more goal with objectives but no more than four additional goals with objectives.
Use format provided below. Goals should be clear, concise, broad statements that highlight what the project
intends to achieve. They should relate to the Project Description and Budget pages of the Application.
Objectives (no more than three per goal) should be specific and measureable -(i.e. a number can be attached) in
order to measure changes brought about by the project toward achieving each goal. Objectives state specifically
what will be done, by whom, and by when. Objectives should be related to the personal positions requested in the
budget. A timetable of projected achievement should be indicated in the Goals and Objectives.
Efficiency and Effectiveness are measured in Goals and Objectives and reported on in quarterly reports.
Efficiency: Were the project's proposed activities accomplished as projected?
Effectiveness: How will you determine that your project is effective or has made a difference to the victims served?
GOAL 2: The Assistant Ombudsman and the Lead Ombudsman will educate long term care residents
and their families about the Ombudsman Program, their Rights as Residents and crimes committed
especially against the elderly. This education will also include information regarding Victim Rights and
Victim Compensation.
Objective 1: Provide one-on-one education to 20 long term care residents per quarter.
Objective 2: Provide group education during 2 Resident Council meeting per month (6 per quarter)
during the funding cycle.
Objective 3: Provide education to 4 Family Councils by the end of the funding cycle, June 2014.
GOAL 3: Collaborate with Adult Protective Services when applicable.
Objective 1: Attend monthly Adult Protective Services meetings and provide information and
assistance, 10-12 by June 2014.
Objective 2: Refer cases to Adult Protective Services when the Ombudsman Program is notified of an
elder abuse crime that took place outside of the long term care facility, throughout the July 2013 -June
2014 funding cycle. Examples include but are not limited to physical abuse, neglect of an at -risk adult,
and financial exploitation.
Objective 3: Combine efforts with Adult Protective Services when both programs are responding to a
case that took place in a Weld County long term care facility.
GOAL 4: The Assistant Ombudsman and the Lead Ombudsman will provide education regarding the
Ombudsman Program, Resident Rights and elder abuse detection and response topics. This education
will also include information regarding Victim Rights and Victim Compensation.
Objective 1: Schedule trainings with the Nurse Aide Coordinator at AIMS Community College (both
campuses, Fort Lupton and Greeley), 2-4 times a quarter during the funding cycle.
Objective 2: Educate 50-75 students from July to December 2013, and 50-75 students from January
to June 2014.
Objective 3: Provide education to 3-4 nurse aide high school classes during this funding cycle.
5
12. Address what problems, if any, you anticipate in implementing your program's goals and objectives.
We do not anticipate any problems with implementing our program goals and objectives.
How do you plan to resolve these problems?
N/A
13. Services as defined in the V.A.L. E. statute, 24-4.2-105 (4) (a — m) C.R.S.
13a. Indicate YES for services which are indicated in the Goals and Objectives of this application, and
NO for services NOT indicated in the Goals and Objectives of this application.
YES
NO
Services: C.R.S. 24-4.2-105 (4) (a — m)
V
(a) Provision of services for early crisis intervention;
x
(b) Provision of telephone lines for victims and witnesses
assistance;
V
(c) Referral of victims to appropriate social service and victim
compensation programs and assistance in filling out forms for
compensation;
V
(c.5) Assistance programs for victims and their families;
x
(d) Education of victims and witnesses about the operation of the
criminal justice system;
x
(e) Assistance in prompt return of the victims' property;
x
(f) Notification to the victim of the progress of the investigation,
the defendant's arrest, subsequent bail determinations, and the
status of the case;
x
(g) Intercession with the employers or creditors of victims or
witnesses;
x
(h) Assistance to the elderly and to persons with disabilities in
arranging transportation to and from court;
X
(i) Provision of translator services;
x
(j) Coordination of efforts to assure that victims have a secure
place to wait before testifying;
x
(k) Provision of counseling or assistance during court appearances
when appropriate;
x
(I) Protection from threats of harm and other forms of
intimidation;
x
(m) Special advocate services
(7) (b) "Special advocate services" means the services offered to aid victims
who are children, including, but not limited to, court -appointed special advocate
(CASA) programs, sexual assault treatment and prevention programs,
community -based youth and family servicing programs, gang alternative
programs, school -based intervention and prevention programs, big brother and
big sister programs offering aid to children who are victims, restitution
programs, partners programs offering aid to children who are victims, and child
abuse treatment programs.
6
Only grants submitted by the Court Administrator's Office would check (2.5) (a) (I) below.
(2.5) (a) (I) The court administrator of each judicial district may apply for grants of
moneys for the purpose of collecting all moneys assessed by the courts, including moneys owed
pursuant to this article, and collecting and disbursing restitution owed to victims of crime;
Only grants submitted by the local Probation Department would check (2.5) (a) (II) below.
(2.5) (a) (I) The local probation department may apply for grants of moneys for the
purpose of implementing the right of victims.
13b. For each YES listed in 13 a), reference the Goal and Objective that relates to the service
provided with a brief explanation. DO NOT RESTATE THE GOAL OR OBJECTIVE.
List letter (a — m)
which refers to
question 13.a
List Goal and Objective(s) pertaining to the service provided in your GOALS and
OBJECTIVES.
a
Goal 2 and Objectives 1, 2 and 3
Goal 3 and Objectives 1, 2 and 3
Goal 4 and Objectives 1, 2 and 3
c
Goal 1 and Objectives 1 and 2
c5
Goal 2 and Objectives 1, 2 and 3
Goal 3 and Objectives 1, 2 and 3
14. Will this project utilize volunteers and or interns? No, however, we did use a volunteer
July -December 2012. We will be continuing our volunteer recruitment efforts during the 2013-
2014 funding cycle.
If yes, please answer the following:
1 Number of volunteers/interns which were utilized from July 1, 2012 through
December 31, 2012.
32 Number of volunteer/intern hours from July 1, 2012 through December 31, 2012.
7
SECTION D - SERVICE INFORMATION:
15. What is the population and geographic area targeted for service through this project?
Populations targeted are older adults, age 60 plus, who reside in nursing homes and assisted living
facilities located in Weld County. This population is becoming more frail and at -risk for abuse or neglect.
Many of these individuals have a dementia diagnosis. These residents are often unable to speak for
themselves and rely on the Ombudsman Program and others (such as direct care staff) to speak on their
behalf. Currently there are approximately 1,500 Weld County residents who live in long term care
facilities, and an additional long term care facility is being built in the Windsor area. All of these residents
receive services through the Ombudsman Program, either directly with visitations and complaint
resolution, or indirectly thought training and technical assistance provided to staff to improve the quality of
care. By extension, the program may also represent the concerns of relatives and/or friends of long term
care residents, as long as the concern reflects the concerns of the resident. Continuation of support will
make it possible for the Area Agency on Aging Ombudsman Program to continue to serve all of the long
term care residents and their families with the same type an degree of services that we are currently
providing.
1 How many crime victims have you served and will you serve?
VICTIMS SERVED
1 YEAR
July 1, 2010
Through
June 30, 2011
VICTIMS SERVED
1 YEAR
July 1, 2011
Through
June 30, 2012
PROJECTED VICTIMS
SERVED
July 1, 2012
Through
June 30, 2013
PROJECTION OF
VICTIMS TO SERVE
July 1, 2013
Through
June 30, 2014
87
103
90
90
b) What is the number of victims served July 1, 2012 through December 31, 2012? 46
c) Are there other community agencies currently providing like services to the targeted population?
There are no other community agencies that provide such services to long term care residents.
If yes, explain how this project is not a duplication of services.
N/A
8
16. Document community support, coordination and networking by providing the following information:
a) List the too five agencies who your agency works most closely with in coordination and provision
of crime victim services and indicate how you work with them.
AGENCY
HOW YOU COORDINATE
1 Home and Community Based Services
SEP quarterly meeting, collaborate efforts if working with the same
resident/client. Information and referral regarding Weld county long term
care facilities.
2 Adult Protective Services
APS monthly meeting, APS case staffing meeting, collaborate efforts if
working with the same resident/client, together facilitate trainings to
groups. Referral of abuse and neglect cases that occur in Weld county.
3 Medicaid Technicians
Refer residents and families when they are in need of applying for
Medicaid.
4 Victim Advocates
Education, information and referral.
5 SAVA
Education, information and referral. Anticipate working together to
develop and provide education.
b) Is your agency an active participant in Weld County's Coordinating Committee for Victims of Crime
(CCVC)? If "yes," provide the name(s) and position(s) of the CCVC participant(s) and their level of
involvement in that group.
NAME OF MEMBER
HOW THEY PARTICIPATE
Raegan Maldonado
Quarterly Meetings, Victims Rights Day, Subcommittee as needed, Training
Kathleen Alvarado
Quarterly Meetings, Victims Rights Day, Subcommittee as needed, Training
b) Briefly describe any other agency actions that demonstrate its high priority for developing
community support, coordination, networking, and cooperation.
The Ombudsman Program also participates in the following committees:
COMMITTEE
HOW WE PARTICIPATE
APS Meeting
Monthly meetings, present Ombudsman perspective during case review,
provide group with information regarding LTC and the Ombudsman Program.
The Weld County Bio-Ethics Committee
Attendance at quarterly meetings and emergency meetings. Develop case
studies for review. Provide education regarding LTC and the Ombudsman
Program.
The Weld County Functional Needs
Committee
Participation in scheduled meetings and assist in marketing this committee.
Ensure that facilities have an emergency plan including responses to sexual
assault and abuse.
9
SECTION E - VICTIM COMPENSATION:
Provide the following information concerning your agency's involvement with the Crime Victim
Compensation Program:
17. a) Does your agency regularly inform victims about Victim Compensation and help them to apply
when appropriate? Yes
How? We meet with residents, victims, family members and staff members 1:1 to provide them with
information regarding Victim Compensation and their rights. In addition, we inform people about Victim
Compensation during Ombudsman trainings and meetings. We also educate individuals via telephone
and email, when appropriate. We also inform them that we can assist them with the application process if
they would like us to do so.
b) Explain any major issues that hinder your agency in helping crime victims to understand Victim
Compensation eligibility requirements and to apply for benefits.
We have no major issues that hinder our agency in helping crime victims to understand Victim
Compensation eligibility requirements and to apply for benefits.
c) Does your agency regularly conduct/receive Victim Compensation training for direct services staff
and volunteers? Yes
Date of the last training: July 25th, 2012
Person who conducted the training: Karol Patch
2 Number of Staff and Volunteers in your agency providing services to crime victims.
2 Number of Staff and Volunteers who attended the last Victim Compensation Training.
DO NOT INCLUDE VICTIM COMPENSATION BROCHURES WITH YOUR APPLICATION.
VALE USE ONLY
Reviewed Victim Compensation Coordinator
Comments:
10
SECTION F - VICTIM RIGHTS ACT:
18. Has your agency taken steps to assure that all staff and volunteers have read and understand the
GUIDELINES FOR ASSURING THE RIGHTS OF VICTIMS OF AND WITNESSES TO CRIMES:
Rights afforded to crime victims - C.R.S. 24-4.1-302.5; Procedures for assuring rights of victims of
crimes; C.R.S. 24-4.1-303; and Child victim orwitness— rights and services—C.R.S. 24-4.1-304
Yes
a) Briefly describe how your agency assures that all staff and volunteers are trained on VRA.
We require that the Ombudsman staff read, "Crime Victims Have Rights," on the DCJ website:
www.dci.state.co.us, on a yearly basis. If we are able to recruit appropriate volunteers, we will require
that they review this information as part of their training.
b) Does your agency have a statutory mandate to notify victims about their rights under VRA?
No
c) VRA Training:
Date of the last training: July 26`h, 2012
Person who conducted the training: Kelly Kissell
2 Number of Staff and Volunteers in your agency providing services to crime victims.
2 Number of Staff and Volunteers who attended the VRA Training.
d) How does your agency notify victims of their rights under VRA?
We provide residents, family members and facility staff members with information from, "Crime Victims
Have Rights," from the DCJ website: www.dci.state.co.us when appropriate. We provide the large print
brochures to individuals who have visual impairments. We also have Ombudsman brochures that we
distribute that specifically explain Residents Rights when they live in an assisted living facility or nursing
home.
e) Does your agency have a brochure describing VRA? No
If "yes", list the languages in which your brochure is available. See SECTION I. ATTACHMENTS
f) If you agency does not have a brochure describing VRA, please indicate if your agency utilizes
brochures from other agencies. See SECTION I ATTACHMENTS. DO NOT INCLUDE VICTIM
COMPENSATION BROCHURES TO YOUR APPLICATION. VRA brochures SHOULD be included
in the application (all languages).
"Crime Victims Have Rights," for DCJ website: www.dci.state.co.us
11
SECTION G - EVALUATION:
How will you evaluate the effectiveness of this project?
(1) By reviewing whether or not we are meeting and/or exceeding our goals and objectives.
(2) With the use of our Ombudsman training evaluations and client satisfaction surveys.
19. If this is an application for continuing funding, how successful has this project been in the past in
accomplishing its proposed goals and objectives?
We have been very successful with meeting and/or exceeding our goals and objectives in the past, and
have accomplished all goals and objectives throughout the years.
20. What is the projected cost per client served (cost/benefit ratio)?
Funds requested divided by number of victims projected to serve = cost per client
$12,000 divided by 90 = $133.33 cost per client
12
SECTION H - BUDGETARY INFORMATION:
All Budget pages MUST be completed.
All figures should be rounded to the nearest dollar.
21. What is the management plan for the project? (Specifically, who will be responsible or
accountable for the administration of the project?)
Eva Jewell, AAA Division Head, will work with Raegan Maldonado, Lead Ombudsman, to insure that we
are meeting our goals and objectives. Raegan Maldonado will directly supervise Kathleen Alvarado,
Assistant Ombudsman. Raegan Maldonado and Kathleen Alvarado will work together to meet and/or
exceed the goals and objectives outlined for this project.
22. What controls and processes does your agency have in place for writing checks? The answer
should include information including: who in the agency is authorized to request a check, who is
authorized to write a check, who is authorized to sign a check, whether or not dual signatures are
required on any checks, and whether or not a person authorized to write a check could sign a check to
themselves. If you were asked to rewrite the answer to this question last year, be sure you are
using the updated language in this application.
Weld County has separate processes in place to order goods and services, authorize payment, approve
payment and write checks. Program personnel order goods or services with the assistance of the county
purchasing office. After the order is received, an invoice is sent to the departmental fiscal office where
the accounts payable staff verify the delivery of the item, obtain authorization for payment and code the
payment in the accounting system. Approval of the payment is completed by a departmental accounting
supervisor and the central county accounting office verifies the approval and writes the check. The
system of internal control ensures that authorization, approval and disbursement are done by different
offices; no checks are authorized and written by the same individual.
23. What process does your agency have in place to reconcile financial information with the quarterly
VALE Financial Report?
The Lead Ombudsman submits a request to the Weld County Human Services fiscal department,
requesting that the fiscal department complete the required information/paperwork. The completed
information is then reviewed by the Lead Ombudsman, the AAA Department Head and the Financial
Officer. The AAA Department Head and the Financial Officer sign the quarterly VALE reports.
13
BUDGET INFORMATION
TOTAL AGENCY VICTIM SERVICES
Please indicate the sources for ALL funding your agency receives for victim
services.
FUNDING
AMOUNT
START DATE
Month/Day/Year Month/Day/Year
END DATE
VALE Grant (if
applicable)
$12,000
07
/
01
/ 12
06 /
30 /
13
DCJ Consolidated Grant
VOCA or VAWA
01
/
01
/ 12
12 /
31 /
13
Grant
/
/
/
/
Other Victim Services
Grants received from
other VALE JD
/
/
/
/
Other — Federal Funds
$108,042.00
07
/
01
/12
06
/ 30
/
13
Other
/
/
/
/
TOTAL
$120,042.00
Please specify the source of "Other" funds ( other grants, government funds,
city funds, donations, fund-raising, etc.) "Other" funds should reflect hard
dollars and NOT in -kind contributions (office space, phones, etc)
HOW WILL FUTURE FUNDING NEEDS BE MET?
Future funding needs will be met through the Older American's Act funds that support the
Long Term Care Ombudsman Program.
VALE PROJECT BUDGET INFORMATION
PROJECT FUNDS REQUESTED BUDGET:
Continuation Applicants fill out Columns 1, 2, and 3.
New Applicants fill out Column 2 only.
ROUND TO NEAREST DOLLAR
Continuation Applicants
ALL APPLICANTS
Continuation
(Column 1)
2012 - 2013
(Column 2)
2013 - 2014
Applicants
(Column 3)
Current Grant Award
Requested Budget
Increase or
Decrease
PERSONNEL
PERSONNEL
(+/-)
Job Position/NAME
Job Position/NAME
Kathleen Alvarado
8,086
Kathleen Alvarado
7,348
-738
Assistant Ombudsman
Assistant Ombudsman
Raegan Maldonado
1176
Raegan Maldonado
2,180
+1,004
Lead Ombudsman
Lead Ombudsman
Fringe Benefits
2,038
Fringe Benefits
1,772
-266
Subtotal
11,300
Subtotal
11,300
-0-
SUPPLIES AND OPERATING
EXPENSES
SUPPLIES & OPERATING EXPENSES
(+ / -)
Training Materials
200
200
-0-
Subtotal
200
Subtotal
200
-0-
IN-STATE TRAVEL
IN -STATE TRAVEL
(+ / -)
Mileage
500
500
-0-
Subtotal
500
Subtotal
500
-0-
PROFESSIONAL SERVICES
PROFESSIONAL SERVICES
(+ / -)
Subtotal
Subtotal
TOTAL FUNDS: $12,000
TOTAL FUNDS REQUESTED: $12,000
VALE PROJECT
BUDGET DETAIL AND JUSTIFICATION
title,
A. PERSONNEL:
List each job position, include the name of the employee, if available. If two individuals have the same job
list it twice.
Indicate FTE of individual (EX: 1 FTE; .5 FTE; .75 FTE)
TOTAL COST - Show the total amount of salary and fringe benefits of the position
(SALARY and FRINGE BENEFITS are to be shown separately.)
VALE % - Show the VALE percent requested for the total cost of the position
VALE Funding - Calculate the VALE funding request based on the TOTAL COST and VALE %.
Other Funding Source(s) - Indicate how the position is paid for other than VALE funding. If the
position cannot be funded (because 100% VALE Funding) indicate this.
Title of Job
Position\Name
FTE
Total
Cost
VALE
%
Requested
VALE
Funding
Requested
If THIS grant funding will not pay for
the entire position, what other SOURCE
will be used to pay for the rest of the
position
Kathleen Alvarado,
Assistant Ombudsman
(Salary)
1
34918
21.4%
7348
Older Americans Act -Federal and State
Kathleen Alvarado,
Assistant Ombudsman
(Fringe)
5569
21.5%
1201
Older Americans Act -Federal and State
Raegan Maldonado,
Lead Ombudsman
(Salary)
1
43710
4.9%
2180
Older Americans Act -Federal and State
Raegan Maldonado,
Lead Ombudsman
(Fringe)
11583
4.9%
571
Older Americans Act -Federal and State
Narrative Justification: Explain and justify the project's budget and relate the personnel budgeted to
project activities and their qualifications.
Position: Kathleen Alvarado, Assistant Ombudsman
VALE Cost: (S: 7,348 B: 1,201)
Duties to be performed\project activities: Carry out role and duties of the Long Term Care
Ombudsman Program. Conduct visitations with residents who reside in long term care facilities.
Facilitate elder abuse response education programs offered during this grant cycle. Recruit and
coordinate training for Long Term Care Volunteer Friendly Visitors.
QUALIFICATIONS: Associates Degree, and one year full time experience in the field of long term
care, home health care or in a human services environment. Must possess and maintain the Colorado
Ombudsman Certification. Must possess a valid Colorado Driver's License and adequate liability
insurance, and must provide own transportation and be willing to travel throughout Weld County.
Knowledge of computer programs such as Microsoft Windows and Word, Excel, and Outlook.
Position: Raegan Maldonado, Lead Ombudsman
VALE Cost: (S: 2,180 B: 571)
Duties to be performed\project activities: Supervise Assistant Ombudsman. Carry out role and
duties of the Long Term Care Ombudsman Program. Assist with facilitating elder abuse response
educational programs offered during this grant cycle. Conduct visitations with residents who reside
in long term care facilities.
QUALIFICATIONS: Bachelors Degree in a Human Services or related field, such as Gerontology,
Psychology, Rehabilitation, or Sociology. Three years full time experience in the field of long term
care, home health care or a human services environment. Must have one year full time experience
supervising and managing employees that include directing work activities and evaluating employee
performance. Possess and maintain the Colorado Ombudsman Certification. Must possess a valid
Colorado Driver's License and adequate liability insurance. Must provide own transportation and be
willing to travel throughout Weld County. Knowledge of computer programs such as Microsoft
Windows and Word, Excel, and Outlook.
B. SUPPLIES AND OPERATING REQUEST: All supplies and operating requests must be specific,
itemized costs related to victim services.
We are requesting $200 to purchase additional supplies, i.e. DVD's, etc.
C. IN -STATE TRAVEL REQUEST: Itemize travel expenses of project personnel by purpose
Mileage reimbursement for travel to and from long term care facilities in Weld County, and for
travel to and from training events.
D. ROFESSIONAL SERVICES REQUEST: List consultants or independent contractors who will
provide victim services under the grant.
We are not requesting funding for professional services.
E. DIFFERENCES FROM LAST YEAR'S REQUEST (Continuation Applicants only): If this is
an application for continuing funding, explain any changes from last year's awarded funding and this
proposed funding.
The amount being requested for our long term care/friendly visitor program is $12,000, which is the
same amount that we requested for the 2012-2013 funding cycle. The amount that we are requesting
for supplies ($200) and operating expenses, and in -state travel ($500) will remain the same. The
subtotal for personnel will remain the same ($11,300), however, altered the distribution slightly,
between the two employees and overall fringe benefits.
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