HomeMy WebLinkAbout20132422.tiffMEMORANDUM
DATE: August 22, 2013
TO:
FROM: Judy A. Griego, Director,
RE:
William F. Garcia, Chair, Board of County Commissioners
iaiftS1/2 ces DPpartme0
Individual Provider Contracts for Purpose of Foster Care
Services and Foster Care Facility between the Weld
County Department of Human Services and Various
Providers for Consent Agenda
Enclosed for Board approval is an Individual Provider Contract for Purpose of Foster
Care Services and Foster Care Facility Agreement between the Department and Various
Providers. These were reviewed under the Board's Pass -Around Memorandum dated
July 17, 2013, and approved for placement on the Board's Agenda.
The major provisions for these Agreements are as follows:
No.
Provider/Term
Facility Type/Location
Foster Home
Greeley, Colorado
1
Johansen, Amber and
White, Drew
June 24, 2013 — June 30, 2013
2
McNear, Nikki
April 24, 2013 — June 30, 2013
Foster Home
Loveland, Colorado
If you have questions, please give me a call at extension 6510.
Co -R .A
VSPS
2013-2422
UWS-7A (1(10-10/99)
INDIVIDUAL PROVIDER CONTRACT
FOR PURPOSE OF FOSTER CARE SERVICES
AND
FOSTER CARE FACILITY AGREEMENT
THIS CONTRACT AND AGREEMENT, made this date, 1 Dime 4013 by and between
the Board of Weld County Commissioners, sitting as the Board of Social Services, on behalf of
the Weld County Department of Human Services, hereinafter called "County Department" and,
Amber Johansen and Drew White, 1608942, 2405 13th Ave, Greeley, CO 80631 , hereinafter
called "Provider."
2. This Contract and Agreement shall be effective from loofa e fl db)3 and continue in force until
June 30, 2013 or until the facility certificate is revoked or surrendered. This contract and
agreement may be renewed at any time during the term of the valid facility certificate. This
contract and agreement is in lieu of and supersedes all prior purchase contracts between the
parties hereto and relating to the services herein described.
3. The Provider holds a valid certificate/license as a Family Foster Home/Emergency Shelter Home.
Such certification standards shall be maintained during the term hereof. The provider has read
and is fully familiar with the Minimum Rules and Regulations for Family Foster Homes issued by
the Colorado Department of Human Services.
4. The County Department may, but shall not be obligated to, purchase foster care services. The
County Department or any duly authorized agent may request such services to be provided to
any child at any time within the limits of the certificate and without prior notice. At such time or as
soon as possible after the acceptance of a child for services, the County Department and the
Provider shall verify foster care placement of each child in writing on the required form, which
shall become an addendum to this contract, subject to all the terms and conditions hereof.
The Provider agrees:
1. To furnish foster care services to eligible children at the established rate based on type of facility
and individual child rates negotiated between the county and the provider.
2. To safely provide the 24 -hour physical care and supervision of each child until removed or until
the agreement is renewed.
3. To accept children only with the approval of the certifying/licensing agency.
4. To cooperate fully with the County Department or its representatives, and participate in the
development of the Family Service Plans for children in placement, including visits with their
parents, siblings, and relatives, or transition to another foster care facility.
5. To maintain approved standards of care as set by the State Department of Human Services.
6. To keep confidential the information shared about the child and his/her family.
7. Not to accept money from parents or guardians.
8. Not to make any independent agreement with parents or guardians.
9. Not to release the child to anyone without prior authorization from the Department.
10. To allow representatives of the County Department to visit the foster home and to see the child at
any reasonable time.
1
C W S -7A (1{10-10/99)
11. To give the County Department two weeks notice, except in an emergency, to remove a child for
placement elsewhere and to work with the County Department as requested in preparing the child
for the next placement.
12. To provide transportation to the child to enable the utilization of professional services when
necessary. The amount of transportation to be provided will be agreed upon at placement and
may be changed upon mutual agreement of the provider and the County Department, as
recorded in the Family Services Plan.
13. To report promptly to the Department:
a. Any unplanned absence of the child from provider's care.
b. Any major illness of the child.
c. Any serious injury to the child.
d. Any significant change in the child's sleeping arrangement.
e. Any contemplated change of address or change of household members.
f. Any conflict the child may have with law enforcement, school officials, or other persons in
the authority.
g. Any emergency.
h. Any pertinent discussion with parents or guardians about the child or supervising
agency.
i. Any information received regarding a change of address of the parents or guardians.
14. To comply with the Civil Rights Act of 1964, Section 504, Rehabilitation Act of 1973, and the ADA
of 1990, concerning discrimination on the basis of race, color, sex, age, religion, political beliefs,
national origin, or handicap.
15. To attend core certification training prior to the placement of any child.
16. To attend on -going training as required by State Department regulations.
17, To attend Administrative Reviews for children in placement.
18. To fully comply with the Minimum Rules and Regulations for Foster Family Homes or Specialized
Group Facilities.
19. Not to enter into any subordinate subcontract hereunder.
20. To keep such records as are necessary for audit purposes by state and federal personnel. The
records shall document the type of care and the term during which care is provided for each child.
In addition, medical, educational, and progress summary records shall be maintained for each
child in accordance with Volume 7 requirements.
21. To maintain medical, dental and educational records for each child/youth and supply updated
information to the County Department.
Department agrees:
1. To share all available information about the child, including relevant social, medical and
educational history, behavior problems, court involvement, parental, sibling and relative visitation
plans, and other specific characteristics of the child, with the provider before placement and to
share additional information when obtained.
2. To inform the provider of expectations regarding the care of the child, such as meeting medical
needs, handling special psychological needs, and separation/loss issues.
3. To arrange for a medical examination of the child before placement or within 14 days after
placement and give a copy of the completed form to the out -of -home provider.
4. To give the provider a written record of the child's admission to the home at the time of
placement.
2
C: W S -7A (R10-10/99)
5. To give the provider a written procedure or authorization for obtaining medical care for the child.
6. To involve the provider in service planning for the child as part of the overall treatment team.
7. To give the provider a copy of the Family Services Plan for the child at the time of placement or
as soon as it is completed following placement.
8. To give at least two weeks notice of plans to remove a child from the facility. The two-week notice
may be waived by mutual consent to allow immediate removal of said child for placement
elsewhere, or without such waiver in the event of an emergency. An emergency is defined as any
situation in which a provider's inability to provide services threatens the health, safety or welfare
of children.
9. To pay the provider at the rates established by the State Department of Human Services or as
negotiated between the provider and the county. The rate of payment per month shall be based
on the type of facility and individual rates. Payment shall be by warrant drawn by the duly
authorized county officer.
10. To provide or arrange through statewide contracted training a minimum of twelve hours of core
certification training for family foster homes. The county department is responsible for providing
information on county specific procedures.
11. To invite the provider to Administrative Reviews for Children in placement.
12. To incorporate provider information in planning for the child.
13. To assure that the service described herein has been accomplished and a record made thereof
on a case by case basis.
14. To provide notice of hearings.
Additional Agreement regarding a Particular Child:
Please refer to the Weld County Addendum and
the child specific Needs Based Care Addendum to this agreement.
ATTEST: Weld County Clerk to the Boa „f r
By:
Deputy he ' lerk to the Board
Approval as to Substance:
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
/Lot �0)
Direct is Sign4 re/Date`
ELD COUNTY BOARD OF SOCIAL
RVICES, ON BEHALF OF THE WELD
NTY DEPARTMENT OF HUMAN
ICES
Chair Signature
PROVIDER
Amber Johansen & Drew White
2405 13th Ave
GreeCO 80
B
By:
rovider's Signature/Date
AUG 2 6 2013
3
ci2oc3 - Qya
t -WS -/A (K1U-IU/99)
r•.
INDIVIDUAL PROVIDER CONTRACT
FOR PURPOSE OF FOSTER CARE SERVICES
AND
FOSTER CARE FACILITY AGREEMENT
•
1. THIS CONTRACT AND AGREEMENT, made this date, VJ` I ( 3 by and between
the Board of Weld County Commissioners, sitting as the Board of Social Services, on behalf of
the Weld County Department of Human Services, hereinafter called "County Department" and,
Nikki McNear, Provider ID#1599706, 1220 N. Grant Ave, Loveland, CO 80537, hereinafter
called "Provider."
2. This Contract and Agreement shall be effective from April 24, 2013 and continue in force until
June 30, 2013 or until the facility certificate is revoked or surrendered. This contract and
agreement may be renewed at any time during the term of the valid facility certificate. This
contract and agreement is in lieu of and supersedes all prior purchase contracts between the
parties hereto and relating to the services herein described.
3. The Provider holds a valid certificate/license as a Family Foster Home/Emergency Shelter Home.
Such certification standards shall be maintained during the term hereof. The provider has read
and is fully familiar with the Minimum Rules and Regulations for Family Foster Homes issued by
the Colorado Department of Human Services.
4. The County Department may, but shall not be obligated to, purchase foster care services. The
County Department or any duly authorized agent may request such services to be provided to
any child at any time within the limits of the certificate and without prior notice. At such time or as
soon as possible after the acceptance of a child for services, the County Department and the
Provider shall verify foster care placement of each child in writing on the required form, which
shall become an addendum to this contract, subject to all the terms and conditions hereof.
The Provider agrees:
1. To furnish foster care services to eligible children at the established rate based on type of facility
and individual child rates negotiated between the county and the provider.
2. To safely provide the 24 -hour physical care and supervision of each child until removed or until
the agreement is renewed.
3. To accept children only with the approval of the certifying/licensing agency.
4. To cooperate fully with the County Department or its representatives, and participate in the
development of the Family Service Plans for children in placement, including visits with their
parents, siblings, and relatives, or transition to another foster care facility.
5. To maintain approved standards of care as set by the State Department of Human Service
6. To keep confidential the information shared about the child and his/her family.
7. Not to accept money from parents or guardians. "?
8. Not to make any independent agreement with parents or guardians.
9. Not to release the child to anyone without prior authorization from the Departmenf
10. To allow representatives of the County Department to visit the foster home and to see the child at
any reasonable time.
L-WJ-/H(ktU-IU/99)
ti11.
To give the County Department two weeks notice, except in an emergency, to remove a child for
placement elsewhere and to work with the County Department as requested in preparing the child
for the next placement.
12. To provide transportation to the child to enable the utilization of professional services when
necessary. The amount of transportation to be provided will be agreed upon at placement and
may be changed upon mutual agreement of the provider and the County Department, as
recorded in the Family Services Plan.
13. To report promptly to the Department:
a. Any unplanned absence of the child from provider's care.
b. Any major illness of the child.
c. Any serious injury to the child.
d. Any significant change in the child's sleeping arrangement.
e. Any contemplated change of address or change of household members.
f. Any conflict the child may have with law enforcement, school officials, or other persons in
the authority.
g. Any emergency.
h. Any pertinent discussion with parents or guardians about the child or supervising
agency.
i. Any information received regarding a change of address of the parents or guardians.
14. To comply with the Civil Rights Act of 1964, Section 504, Rehabilitation Act of 1973, and the ADA
of 1990, concerning discrimination on the basis of race, color, sex, age, religion, political beliefs,
national origin, or handicap.
15. To attend core certification training prior to the placement of any child.
16. To attend on -going training as required by State Department regulations.
17. To attend Administrative Reviews for children in placement.
18. To fully comply with the Minimum Rules and Regulations for Foster Family Homes or Specialized
Group Facilities.
19. Not to enter into any subordinate subcontract hereunder.
20. To keep such records as are necessary for audit purposes by state and federal personnel. The
records shall document the type of care and the term during which care is provided for each child.
In addition, medical, educational, and progress summary records shall be maintained for each
child in accordance with Volume 7 requirements.
21. To maintain medical, dental and educational records for each child/youth and supply updated
information to the County Department.
Department agrees:
1. To share all available information about the child, including relevant social, medical and
educational history, behavior problems, court involvement, parental, sibling and relative visitation
plans, and other specific characteristics of the child, with the provider before placement and to
share additional information when obtained.
2. To inform the provider of expectations regarding the care of the child, such as meeting medical
needs, handling special psychological needs, and separation/loss issues.
3. To arrange for a medical examination of the child before placement or within 14 days after
placement and give a copy of the completed form to the out -of -home provider.
4. To give the provider a written record of the child's admission to the home at the time of
placement.
2
' VV /Pt IICIV-lV/YY)
5. To give the provider a written procedure or authorization for obtaining medical care for the child.
6. To involve the provider in service planning for the child as part of the overall treatment team.
7. To give the provider a copy of the Family Services Plan for the child at the time of placement or
as soon as it is completed following placement.
8. To give at least two weeks notice of plans to remove a child from the facility. The two-week notice
may be waived by mutual consent to allow immediate removal of said child for placement
elsewhere, or without such waiver in the event of an emergency. An emergency is defined as any
situation in which a provider's inability to provide services threatens the health, safety or welfare
of children.
9. To pay the provider at the rates established by the State Department of Human Services or as
negotiated between the provider and the county. The rate of payment per month shall be based
on the type of facility and individual rates. Payment shall be by warrant drawn by the duly
authorized county officer.
10. To provide or arrange through statewide contracted training a minimum of twelve hours of core
certification training for family foster homes. The county department is responsible for providing
information on county specific procedures.
11. To invite the provider to Administrative Reviews for Children in placement.
12. To incorporate provider information in planning for the child.
13. To assure that the service described herein has been accomplished and a record made thereof
on a case by case basis.
14. To provide notice of hearings.
Additional Agreement regarding a Particular Child:
Please refer to child specific Needs Based Care Addendum to this agreement.
ATTEST: Weld County Clerk to the B6a4,d;
ts w-aa
Approval as to Substance:
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By: _A&(�/ Q o n
( Dire3tor's Sign ure/Date"'
Deput "' Ierk to the Board ' 7 z: ' ' ' Chair Signature
3
WELD COUNTY BOARD OF SOCIAL
ERVICES, ON BEHALF OF THE WELD
UNTY DEPARTMENT OF HUMAN
RVICES
AUG 2 6 2013
PROVIDER
Nikki McNear
1220 N Grant Ave
Loveland, CO 80537
L /t!" &tcu �
ByLO H 5 L3
Provider's Signature/Date
By:A Laie4P. 6 13
Provider's Signature/Date
07®/3 — ®75<afeR
Hello