HomeMy WebLinkAbout20120491.tiff RESOLUTION
RE: APPROVE VICTIM'S ASSISTANCE AND LAW ENFORCEMENT (VALE) GRANT
APPLICATION FOR LONG TERM CARE OMBUDSMAN ADVOCATE/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 Advocate/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, commencing July 1, 2012, and ending June 30,
2013, 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
Advocate/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 22nd day of February, A.D., 2012.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATT EST: e. `ys�F'i
Sean P. Co Co
6az Chair C.
Weld County Clerk to the Board f!
r 1 ' p ): 141.4%``illiam F Garcia, Pro-Tem
BY: _ it
Deputy ClerPto the Boars fe Zs, Olx '2_ - in-0-^, �-,
4,.4;2 •-' -r ra Kirkmeyer
AP D A FORM:��. F�
.A' ,� �i,a .—•. David E. Long
ounty Attorney y }-t ��C O GO21
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Date of signature: .3-/"/--/a
cg eruct Vo Su5CuN c N5' 2012-0491
01 ' &g" I 3- W- 1a HR0083
MEMORANDUM
1861 "y
DATE: February 17, 2012
f TO: Sean P. Conway, Chair, Board of County Commissioners
G O U N T ,. FROM: Judy A. Griego, Director, Human ervic
RE: Weld County Department of Human Services' Area Agency
on Aging's 2012-2013 Victim Assistance and Law
Enforcement (VALE) Grant
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 9, 2012, 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, 2012 through June 30, 2013, funding cycle is
$12,000.00.
If you have any questions, give me a call at extension 6510.
2012-0491
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 1,2012 to June 30, 2013
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 Fax: (970)346-6951 E-Mail: ejewell@co.weld.co.us
Signature: Qica?ll gre Date:J I( I )1,
Financial Officer:
Name: Lennie L. Bottorff Position/Title: Fiscal and Budget Manager
Agency(including Division or Unit): Weld County Department of Human Services
Mailing Address: Post Office Box A,Greeley, CO 80632
Phone: 970)352-1551 ext. 6537 Fax: (970)346-7691 E-Mail: bottorll@co.weld.co.us
Signature: 7-.779 Date: 2- lI 2-c.) z
Authorized Official:
Name: Sean P. Conway Position/Title: Chair
Agency(including Division or Unit): Weld County Board of Commissioners
Mailing Address: Post Office Box 758,Greeley,CO 80632
Phone: (970)336-7204 ext 4200 Fax: (970)352-0242 E-Mail: sconwav@co.weld.co.us
Signature: �----. 0, e----' Date: FEB 2 2 2012
In accordance with the Colorado Revised Statutes 24-72- • rmation supplied in this application is considered a public record.
&ea- -z)99/
SECTION A - AGENCY INFORMATION:
VALE USE ONLY
1. APPLICANT AGENCY:
Grant#:
Program Name: Weld County Department of Human Services Amount Requested:
Area Agency on Aging Amount Funded:
Street Address (if not confidential): 315 C North 11th Avenue
Greeley, Colorado 80632
Mailing Address (if different): Post Office Box 1805
Greeley, Colorado 80632
Phone: (970) 346-6950 extension 6128 Fax: (970) 346-6951 E-Mail: rmaldonadoaco.weld.co.us
2. CONTACT PERSON: Raegan Maldonado Title: Lead Long Term Care Ombudsman
Phone: (970) 346-6950 extension 6128 Fax: (970) 346-6951 E-Mail: rmaldonado(dIco.weld.co.us
3. Agency Status: X governmental private-non-profit private-for-profit
Non-profit TAX ID#: 14-02101
Functions or activities for which VALE funds will not be approved include but are not limited to offender
or rehabilitative services, religious instruction, or proselytizing.
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 VALE funds 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. In addition, the Assistant Ombudsman will be able to
continue recruitment and training for the Ombudsman Volunteer 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 for 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 my 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 quarterly. 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. Educational 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 administered. In addition, our program
focuses on the importance of recognition and appropriate response to signs and symptoms of elder
abuse and neglect. Continued funding of the Assistant Ombudsman position 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 ejewell@co.weld.co.us
6101
Raegan Maldonado Lead LTC Ombudsman (970) 346-6950 rmaldonado@co.weld.co.us
6128
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
2
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.
EST. NO. EST. NO.
VICTIMS TYPE OF CRIME VICTIMS TYPE OF CRIME
Adults Molested as Children
Child Physical Abuse
Child Sexual Abuse Survivors of Homicide Victims
DUI/DWI —Victims of vehicular assault or Robbery
homicide, DUI/DWI crashes, or careless
driving resulting in death
Domestic Violence Assault
Other violent crimes
10 Adult Sexual Assault
Elder Abuse (including economic Other, please specify
80 exploitation and fraud crimes)
TOTAL UNDUPLICATED VICTIMS ESTIMATED TO BE SERVED DURING THE 12-MONTH PERIOD 90
Refer to Application Instructions for information on how to count victims.
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.
EST. NO. EST. NO.
VICTIMS SERVICES VICTIMS SERVICES
Civil Legal Advocacy/Court Individual Therapy
Accompaniment
Civil Legal Attorney Assistance 70 Information / Referral (in person)
Criminal Justice Support/ 70 Information / Referral (by phone)
Advocacy/Court Accompaniment
30 Crisis/Counseling Intervention (in person) Language Services (interpretation)
30 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)
Victim/Survivor Advocacy
Group Treatment/Support
90 Victim Rights Act Services
Hospital/Clinic Response
Refer to Application Instructions for the definitions of the services listed in the chart.
4
11. PROJECT-SPECIFIC GOALS AND OBJECTIVES:
Add no more than four additional goals with objectives. Use format provided below.
Goals should be clear, concise, general statements that highlight what the project intend to achieve. They should
relate to the Project Description and Budget pages of the Application.
Objectives (no more than three per goal) should be quantifiable (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. 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, Volunteer Ombudsmen and the Lead Ombudsmen 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 with 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 2013.
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 2013.
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 2012—June
2013 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 long term care facility.
GOAL 4: The Assistant Ombudsman, Volunteer Ombudsmen 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 Adie 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 2012, and 50-75 students from January
to June 2013.
Objective 3: Provide education to 3-4 nurse aide high school classes during this funding cycle.
12. Address what problems, if any, you anticipate in implementing your program's goals and objectives.
We do not anticipate any problems of reaching the new goals and objectives for July 2012-June 2013
funding cycle.
How do you plan to resolve these problems?
N/A
5
13. Services as defined in the V.A.L.E. statute, 24-4.2-105 (4) (a— m) C.R.S.
a) 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)
(a) Provision of services for early crisis intervention;
(b) Provision of telephone lines for victims and witnesses
assistance;
(c) Referral of victims to appropriate social service and victim
J compensation programs and assistance in filling out forms for
compensation;
✓ (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 (1) 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.
(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;
(2.5) (a) (1) The local probation department may apply for grants of moneys for the
purpose of implementing the right of victims.
6
b) For each YES listed in 13 a), reference the Goal and Objective that relates to the service
provided with a brief explanation.
List letter(a—m) List Goal and Objective(s) pertaining to the service provided in your GOALS and
which refers to 13.a OBJECTIVES.
Goal 2 and Objectives 1, 2 and 3
a Goal 3 and Objectives 1, 2 and 3
Goal 4 and Objectives 1, 2 and 3
Goal 1 and Objectives 1 and 2
c
Goal 2 and Objectives 1, 2 and 3
c5 Goal 3 and Objectives 1, 2 and 3
14. Will this project utilize volunteers and or interns? /Yes No
If yes, please answer the following:
2 Number of volunteers/interns which were utilized from July 1, 2011 through
December 31, 2011.
35 Number of volunteer/intern hours from July 1, 2011 through December 31, 2011.
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SECTION D - SERVICE INFORMATION:
15.What is the population and geographic area targeted for service through this project?
Populations targeted are 60 plus elderly residing in nursing homes, assisted living facilities and personal
care boarding homes located in Weld County. This population is becoming more frail and many
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 1,600 Weld County residents who live in long term care facilities. All of
these residents receive services through the Ombudsman Program, either directly with visitations and
complaint resolution or indirectly through training and technical assistance provided to staff to improve the
quality of care. By extension, the program also may 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 and degree of services that we are
currently providing.
a) How many crime victims have you served and will you serve?
VICTIMS SERVED VICTIMS SERVED VICTIMS SERVED PROJECTION OF
1 YEAR 1 YEAR SIX MONTHS VICTIMS TO SERVE
July 1, 2009 July 1, 2010 July 1, 2011 July 1, 2012
Through Through Through Through
June 30, 2010 June 30, 2011 December 30, 2011 June 30, 2013
73 45 41 90
b) 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 top 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 SEP quarterly meeting, collaborate efforts if working with same
Services resident/client. Information and referral regarding Weld county long
term care facilities.
2 Adult Protective Services APS monthly meeting, collaborate efforts if working with 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 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, Subcommittees as needed, Training
Kathleen Alvarado Quarterly Meetings, Victims Rights Day, Subcommittees as needed, Training
c) 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 Ombudsman Program.
The Weld County Functional Needs Committee Quarterly meetings, Subcommittees as needed, assist in
marketing this committee, ensure that facilities have an
emergency plan including responses to sexual assault and
abuse.
The Weld County Bio-Ethics Committee Scheduled meetings, emergency meetings, develop case
studies for review, provide education regarding LTC and the
Ombudsman Program.
The Colorado Culture Change Coalition Attendance at CO events, encourage Weld county facilities to
become active participants
The Weld County Senior Service Network Attendance and presentations as needed.
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 No
How?
We meet with residents, victims and family members 1:1 and provide them with information regarding
Victim Compensation and their rights. In addition, we inform people about Victim Compensation during
Ombudsman trainings and meetings.
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 No
Date of the last training: July 13th, 2011
Person who conducted the training: Karol Patch
4 Number of Staff and Volunteers in your agency providing services to crime victims.
3 Number of Staff and Volunteers who attended the last Victim Compensation Training.
VALE USE ONLY
Reviewed Victim Compensation Coordinator
Comments:
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 or witness— rights and services—C.R.S. 24-4.1-304
■Yes No
a) Briefly describe how your agency assures that all staff and volunteers are trained on VRA.
We require that Volunteer Ombudsmen and the Ombudsmen staff read, "Crime Victims Have Rights," on
the DCJ website: www.dci.state.co.us, on a yearly basis.
b) Does your agency have a statutory mandate to notify victims about their rights under VRA?
Yes •No
*However, the LTC Ombudsman Program is mandated through the Older American's
Act to educate long term care residents about their rights as residents. We do have a
printed Ombudsman brochure that describes these rights, and a brochure can be made
available upon request.*
c) VRA Training:
Date of the last training: June 21s`, 2011
Person who conducted the training: Dan Griffin
4 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 and family members with information from, "Crime Victims Have Rights," from DCJ
website: www.dci.state.co.us, when appropriate. 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? Yes •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.
"Crime Victims Have Rights," from 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. a) What is the projected cost per client served (cost/benefit ratio)?
We are requesting $12,000 divided by 700 long term care residents = $17.14 per individual.
b) How did you calculate this figure?
Estimated unduplicated number of victims: 90
Estimated 1:1 education to Ito residents: 80
Estimated# present at resident council meetings: 480
Estimated# present at family council meetings: + 40
Total: 690 (Rounded to 700)
21. What is the number of victim surveys you sent out in 2011 and number received back? Attach a
survey giving overall client response which indicates overall success rate.
Ombudsman Program/Residents' Rights Training Evaluation:
We distributed 176 immediately following trainings and received 176 back during 2011.
Customer Satisfaction Questionnaire:
We distributed 32 customer satisfaction surveys and received 24 responses during 2011.
12
SECTION H - BUDGETARY INFORMATION:
All Budget pages MUST be completed.
22. 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, and Kathleen will directly supervise the Volunteer Ombudsmen.
23. 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.
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
24. 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 START DATE END DATE
AMOUNT Month/Day/Year Month/Day/Year
VALE Grant (if applicable) $12,000 07 / 01 / 11 06 / 30 / 12
DCJ Consolidated Grant 01 / 01 / 11 12 / 31 / 11
VOCA or VAWA or
State VALE
Grant (if applicable) / / / /
Other / / / /
Other / / / /
Other - Federal Funds 103,273.76 07 / 01 / 11 06 / 30 / 12
TOTAL 115,273.76 / / / /
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. ROUND TO THE NEAREST DOLLAR
New Applicants fill out Column 2 only.
Continuation Applicants ALL APPLICANTS Continuation
(Column 1) (Column 2) 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 8,086 -0-
Assistant Ombudsman Assistant Ombudsman
Raegan Maldonado 1,176 Raegan Maldonado 1,176 -0-
Lead Ombusdman Lead Ombudsman
Fringe Benefits 2,038 Fringe Benefits 2,038 -0-
11,300 11,300 -0-
Subtotal Subtotal
SUPPLIES AND OPERATING SUPPLIES & OPERATING EXPENSES (+/-)
EXPENSES
Training Materials 200 200 -0-
Subtotal 200 Subtotal 200 -0-
1N-STATE TRAVEL IN-STATE TRAVEL (+/-)
Mileage 500 500 -0-
500 Subtotal 500 -0-
Subtotal
PROFESSIONAL SERVICES PROFESSIONAL SERVICES (+/-)
Subtotal Subtotal
TOTAL FUNDS: $12,000 TOTAL FUNDS REQUESTED: $12,000 -0-
VALE PROJECT
BUDGET DETAIL AND JUSTIFICATION
A. PERSONNEL:
List each job position, include the name of the employee, if available. If two individuals have the same
job title, 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 show 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 FTE Total VALE VALE If THIS grant funding will not pay for
Position\Name Cost °/u Funding the entire position,what other SOURCE
Requested Requested will be used to pay for the rest of the
position
Kathleen Alvarado, 1 34,747 23.00% 8086 Older Americans Act-Federal and State
Assistant Ombudsman
(Salary)
Kathleen Alvarado, 1 8,687 20.00% 1779 Older Americans Act-Federal and State
Assistant Ombudsman
(Fringe)
Raegan Maldonado, 1 43,531 2.00% 1176 Older Americans Act-Federal and State
Lead Ombudsman
(Salary)
Raegan Maldonado, 1 10,883 2.00% 259 Older Americans Act-Federal and State
Lead Ombudsman
(Fringe)
Narrative Justification: Explain and justify the project's budget and relate the personnel budgeted to
project activities and their qualifications.
Name of and Title of Person: Kathleen Alvarado, Assistant Ombudsman
VALE Cost: $9,865.00 (S:$8.806 B:$1,779)
Duties to be performed\project activities: Recruit and coordinate training for Long Term Care
Volunteer Friendly Visitors. Carry out role and duties of the Long Term Care Ombudsman Program.
Facilitate elder abuse response educational programs offered during this grant cycle. Conduct
visitations with resident who reside in long term care facilities.
Name of and Title of Person: Raegan Maldonado, Lead Ombudsman
VALE Cost: $1,435 (S:$1,176 B:$259)
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 resident who reside in
long term care facilities.
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. PROFESSIONAL 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 in proposed funding.
The amount being requested for our long term care/friendly visitor program is $12,000. The 2012-
2013 funding request is the same as we requested for the 2011-2012 funding cycle. No changes
have been made.
SECTION I- ATTACHMENTS:
ATTACH WITH EACH COPY OF THE APPLICATION GRANT:
X Client Survey completed as described in Question 21.
X A list of your agency's Board of Directors, (private non-profit).
ATTACH ONLY WITH ORIGINAL APPLICATION:
X Your agency's VRA brochure OR the VRA brochure your agency utilizes.
X A signed copy of the attached Grant Applicant Memorandum of Understanding Concerning the Rights
Afforded to Crime Victims.
X Include a copy of agency's most recent audit report or financial review. If agency is not subject to audit,
explain how proper management and disbursement of funds is monitored. (Only one copy of the audit or
financial review is required.)
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ATTACHMENT
VICTIM ASSISTANCE AND LAW ENFORCEMENT BOARD
GRANT APPLICANT MEMORANDUM OF UNDERSTANDING
CONCERNING THE RIGHTS AFFORDED TO CRIME VICTIMS
As provided in C.R.S. 24-4,2-105 (4.7), Colorado law requires the following:
A REQUESTING AGENCY OR PERSON SHALL ACKNOWLEDGE IN WRITING THAT
SUCH AGENCY OR PERSON HAS READ AND UNDERSTANDS THE RIGHTS
AFFORDED TO CRIME VICTIMS PURSUANT TO SECTION 24-4.1-302.5 AND THE
SERVICES DELINEATED PURSUANT TO SECTION 24-4.1-303 AND 24-4.1-304.
SUCH WRITTEN ACKNOWLEDGMENT SHALL BE ATTACHED TO SUCH
REQUESTING AGENCY'S OR PERSON'S APPLICATION FOR MONEYS PURSUANT
TO THIS SECTION. THE BOARD SHALL NOT ACCEPT FOR EVALUATION ANY
APPLICATION FOR A GRANT OF MONEYS PURSUANT TO THIS SECTION UNTIL
THE REQUESTING AGENCY OR PERSON PROVIDES THE BOARD WITH SUCH
WRITTEN ACKNOWLEDGMENT.
The prospective grantee certifies to the VALE Board, by submission of this completed Grant
Applicant Memorandum of Understanding Concerning the Rights Afforded to Crime Victims,
that the agency or person described herein has read and understands the rights afforded to crime
victims as required by C.R.S. 24-4.2-105 (4.7).
PROJECT DIRECTOR: Eva M. Jewell
TITLE: Weld County Area Agency on Aging Division Head
PROJECT: Weld County Long Term Care Ombudsman Advocate/Friendly Visitor
AGENCY: Weld County Department of Human Services, Area Agency on Aging
ADDRESS: 315 North 11`h Avenue, Bldg C, Post Office Box 1805, Greeley, CO 80632
SIGNATURE: e-- > G< DATE: 2: - 7 i.,�_
1
COPIES OF THE STATUTES DESCRIBED WILL BE PROVIDED TO PROSPECTIVE
GRANT RECIPIENTS UPON REQUEST.
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