HomeMy WebLinkAbout20041774.tiff Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made thi day ot -4t, 2004 between the Board of Weld
County Commissioners, sitting as the Board of So al Services, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Third Way Center, PO Box
61385,Denver, CO 80206,hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services,hereinafter called "State
Department" is authorized to provide social services to individuals and families of individuals
through its agents, County Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under
State Department rules, and
WHEREAS, County wishes to provide these services by purchasing them from
Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings
County and Contractor agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which
are listed in this Agreement at a rate of$62.40 per day for children placed within the
Residential Child Care Facility identified as Provider ID#1507881. These services will
be for children who have been deemed eligible for social services under the statutes, rules
and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2004, until the end of the Colorado fiscal
year, June 30, 2005; or until the child is removed by the County; or if the child's behavior
would cause harm to himself or other children, and Contractor seeks approval from the
County and the County agrees, in writing, to terminate this Agreement, whichever event
occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as
this Agreement, signed by the authorized representatives of the parties. In addition to the
termination provisions in Paragraph 2 above, either party shall have the right to terminate
this contract by giving the other party thirty(30) days notice by registered mail,return
receipt requested. If notice is so given, this contract shall terminate on the expiration of
the thirty(30) days or until the eligible child can be placed elsewhere,whichever occurs
earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease, but the parties shall not be released from the duty
to perform their obligations up to the date of termination.
Agreement to Purchase 1
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
4. This Agreement is in lieu of and supersedes all prior agreements between the parties
hereto and relating to the care and services herein described.
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services
and may include, but are not limited to: Basic 24-hour care and child maintenance (food,
shelter, clothing, educational supplies and allowance), Direct Child Care, Transportation,
Administrative Overhead, Support Overhead, Therapeutic Recreation, Service delivery
Staff, Direct therapy and evaluation, which may include but are not limited to:
Psychological, Neurological Medication and follow-up, Family Therapy, Individual
Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender Treatment as
prescribed by the Sex Offender Management Board Policy, Polygraph, Plethysmograph,
Parent Training for Teens, Independent Living Training, Mentor/Advocate, and
Supervised Visitation.
2. Payment for a child's temporary absence from the facility, including absence due to
hospitalization, will be made in accordance with State Department rules in Staff Manual
Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and
Contractor's facility for the initial placement and return after the treatment plan is
completed. If the child runs away from the Contractor's facility, the County shall provide
transportation to either return the child to the facility or to other care as arranged by the
County. The County will make the decision to return the child to the facility, with input
from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be
provided by Contractor. Any transportation costs not covered or contemplated in the
original treatment plan must be negotiated between County and Contractor and are not
subject to reimbursement under this Agreement. However,provisions for payment of
other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by
persons or agencies which are not a party to this contract shall be specified in the
treatment/case plan, and those persons shall acknowledge their responsibility by signing
the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 1507881
Third Way Center
4821 S Bannock St
Englewood CO 80010
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any
sub-contracts without the express written approval of the Executive Director of the
Colorado Department of Social Services or his appointed designee.
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70,
2.710.71, 2.710.72, 2.710.73, 2.710.74) and Colorado Department of Human Services
Child Care Licensing Division policy(7.714.131), the contractor may obtain: 1) Ordinary
medical care, and 2) Emergency medical, surgical or dental care for said child after
making reasonable efforts to contact the County to obtain consent. Emergency care is
defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the
child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or
dental care will be made in a person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any
administration of emergency medical, surgical or dental services provided under this
authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services
being provided, authorization must be obtained from the assigned caseworker or
supervisor. If parental rights are intact, authorization or attempts to obtain authorization
from the parent(s) should also be documented. If the placement is made through a
voluntary placement agreement between the parent(s) and the County, the parent(s) must
be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental
services provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the
time of submittal of each progress report, including the discharge report at the time of the
child's termination from the care of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic
Screening, Diagnosis and Treatment Program.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
9. It is agreed and permission is granted for the child to participate in planned recreational
and social activities of Contractor, including supervised off grounds excursions and
extended trips within the State, provided that Contractor has written permission from
County and legal custodian for any trips out of Colorado for any reason and any planned
absence from the facility of over seven (7) days within a consecutive 30-day period. Such
written permission may be in the treatment/case plan. Further, Contractor and County
will also secure, where possible, permission from parents or guardians of the child placed
with the Contractor.
10. County and Contractor shall inform each other and the local school district of any
changes in parental residence affecting educational status, which comes to their attention.
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be
child specific and shall include the initial Treatment Plan that shall be goal oriented and
time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated
educational arrangement for the child upon completion. Also included will be the
anticipated date for discharge from treatment purchased as well as provisions concerning
the involvement of the child's family in treatment of the child.
3. County and Contractor agree and understand that the psychological (mental and
behavioral) or physical problems which necessitate purchasing services for this child are
specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and
Contractor and shall be reflected in the Attachment A.
5. At no longer than three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15)days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. Contractor shall participate in all
Foster Care Reviews as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of
Social Services, the State of Colorado and any federal laws and regulations, as such,
which may be amended from time to time, and shall be binding on Contractor and control
any disputes in this Agreement.
Agreement to Purchase 4
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of
1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act
of 1975 as revised, and provide confidentiality of information concerning the child and
the child's family.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. Maintain during the term of this Agreement a liability insurance policy of at least
$400,000 for property damage liability, $150,000 for injury and/or damage to any one
person, and $400,000 for total injuries arising from any one accident.
8. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2)
months gross receipts,whichever is greater, covering the activities of any of its officers,
agents or employees responsible for the implementation and/or administration of this
contract in order to make reparations for any wrongful acts, omissions, or any other
defalcations of the Contractor.
9. Indemnify County, the Colorado Department of Social Services and the State of Colorado
against any and loss against all claims and actions based upon or arising out of damage or
injury, including death, to persons or property caused or sustained in connection with the
performance of this contract or by conditions created thereby, or based upon any
violations of any statute, ordinance, or regulation and the defense of any such claims or
actions.
10. Maintain service program records, fiscal records, documentation and other records, which
will sufficiently and properly reflect all direct and indirect costs of any nature incurred in
the performance of this Agreement. The above shall be subject at all reasonable times to
inspection, review or audit by federal, State Department or county personnel, and other
persons authorized in writing by the Executive Director, Colorado Department of Social
Services.
11. Bill the County for services rendered, using the required Division of Child Welfare
Provider Roster. This roster is to be mailed to the County department by the last day of
the month of care. If Provider Rosters are not received, payments will be held until the
required paperwork is received.
12. Attend and participate in Foster Care Reviews for children in placement longer than 60
days, and any subsequent appeal process, for children in placement with the Contractor
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
pursuant to two (2)weeks written notice by the County. If the facility is in a different
part of the state from the county in which the review is held, participation may be by
teleconference.
• 13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. A full evaluation of an Individualized Educational Plan (IEP) for youth designated as a
Special Education Students will be conducted every 3 years and reviewed every year. If
the IEP is due while the child is in placement, the Contractor will complete or obtain a
completed IEP. A copy will then be forwarded to the County.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery,bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph(B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase 6
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal
system time frames for services purchased under this Agreement in accordance with the
established rate specified herein,when Provider Rosters are submitted as described in
Section IV,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services,
federal rules and regulations and the laws of the State of Colorado, any of which may be
amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements
of State Department Staff Manual, Volume VII, and provide consultation and/or technical
assistance to Contractor in relation to the services purchased under this Agreement.
6. Involve Contractor in planning for the child and give the Contractor a copy of the
Discrete Case Plan at time of placement or as soon as completed and when updated or
revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by
this Agreement is that of employer-independent contractor. No agent, employee, or
servant of Contractor shall be deemed to be an employee, agent, or servant of County.
Contractor will be solely and entirely responsible for its acts or of any agent, employee,
servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in
whole or in part, is subject to and contingent upon the continuing availability of State of
Colorado and federal funds for the purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard
and protect personal items brought to Contractor by the Child, Contractor will be released
from responsibility for loss or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the
parties. No prior or contemporaneous addition, deletion, or other amendment hereto shall
have any force or effect whatsoever, unless embodied herein in writing. No subsequent
notation, renewal, addition, deletion, or other amendment hereto shall have any force or
effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services and the County to
monitor the service program, fiscal books and other records sufficiently to assure the
purchase of services in this Agreement are carried out for the benefit of the
aforementioned child through program reports, on-site visits where applicable and other
contracts as deemed necessary. The Contractor understands that the Colorado
Department of Social Services will provide consultation and technical assistance to
Contractor to assure satisfactory performance in the provision of purchased services
under this Agreement.
Agreement to Purchase
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. In the event this contract is terminated, final payment to the Contractor may be withheld
at their discretion of the County until final audit. Incorrect payments to the Contractor
due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor
either by deduction from subsequent payments under this contract or other contracts
between the County and the Contractor or by the County, as a debt due to both the State
of Colorado, Colorado Department of Social Services and the County. The waiver of any
violation shall not be construed as a waiver of any other or subsequent violation of this
contract or appropriate statutes and regulations.
7. It is expressly understood and agreed that the enforcement of the terms and conditions of
this Agreement, and all rights of action relating to such enforcement, shall be strictly
reserved to the undersigned parties or their assignees, and nothing contained in this
Agreement shall give or allow any claim or right of action whatsoever by any other
person not included in this Agreement. It is the express intention of the undersigned
parties that any entity other than the undersigned parties or their assignees receiving
services or benefits under this Agreement shall be an incidental beneficiary only.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the
parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care,which did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
Agreement to Purchase
8
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? O Yes O No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
O In home services O Placement with Relative O Cty CC Foster Care O Shelter Care
❑ CORE Services ❑ Receiving Home O CPA ❑ Cty regul r Abuse r Care
aln,e,d
❑ Day Treatment O Kinship Care O RTC O regular foster
❑ Group Home ❑ Ind.Living O Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) O Secure O Other(Explain)
Appropriate Counseling:
❑ Individual O Family
O Group
Appropriate Treatment:
❑ Sex Offender O Aggressive/Violent O Substance Abuse
❑ Truancy O Victim Behavior ❑ Depression
❑ Other live ❑ Delinquency ❑ Special Medical Needs ❑ Behavior Modification ❑ Anger
El Other (Explain)
Management
Appropriate Educational Services:
El Special Ed. ❑ Public School ❑ Day Treatment
❑ On-grounds School O Additional Tutoring ❑ Independent Living Training O Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
El it has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date
Date
Agreement to Purchase
RCCF Services 9
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
• month, and year first above written.
. gal
ATTEST:
400.11"3/4. Weld County Clerk to the Board
ft\\,, E L®•,,
,•11WELD COUNTY BOARD OF SOCIAL
SERVICES,ON BEHALF OF THE
1861teLt.
rivriter
WELD COUNTY DEPARTMENT
'41•t 4all OF SOCIAL SERVICES
Parr' , VI Seenkftel 7 By: W3' k„
eputy Clerk to the Board Robert D. asden,Chair
JUN 2 8 2004
APPROVED AS TO FORM:
CONTRACTOR
C inty om y
Third Way Center
PO Box 61385
Denver, 0206
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
/
By: s Jilt`
LDire t r
Agreement to Purchase
RCCF Services 10
act'/-/297.
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this 6 day of 2004 between the Board of Weld
• County Commissioners, sitting as the Board of Soc. 1 Services, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and The University of Colorado
Health Sciences Center dba Synergy, 3738 W Princeton Cir, Denver, CO 80236, hereinafter
called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State
Department" is authorized to provide social services to individuals and families of individuals
through its agents, County Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under
State Department rules, and
WHEREAS, County wishes to provide these services by purchasing them from
Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings
County and Contractor agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which
are listed in this Agreement at a rate of$71.18 per day for children placed within the
Residential Child Care Facility identified as Provider ID#49488. These services will be
for children who have been deemed eligible for social services under the statutes, rules
and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2004, until the end of the Colorado fiscal
year, June 30, 2005; or until the child is removed by the County; or if the child's behavior
would cause harm to himself or other children, and Contractor seeks approval from the
County and the County agrees, in writing, to terminate this Agreement, whichever event
occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as
this Agreement, signed by the authorized representatives of the parties. In addition to the
termination provisions in Paragraph 2 above, either party shall have the right to terminate
this contract by giving the other party thirty(30) days notice by registered mail, return
receipt requested. If notice is so given, this contract shall terminate on the expiration of
the thirty(30) days or until the eligible child can be placed elsewhere, whichever occurs
earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease, but the parties shall not be released from the duty
to perform their obligations up to the date of termination.
Agreement to Purchase i
RCCF Services
:-cGcy/I%
Contract No.: PY 04/05-SS-23A-RCCF
4. This Agreement is in lieu of and supersedes all prior agreements between the parties
hereto and relating to the care and services herein described.
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services
and may include,but are not limited to: Basic 24-hour care and child maintenance (food,
shelter, clothing, educational supplies and allowance), Direct Child Care, Transportation,
Administrative Overhead, Support Overhead, Therapeutic Recreation, Service delivery
Staff, Direct therapy and evaluation, which may include but are not limited to:
Psychological, Neurological Medication and follow-up, Family Therapy, Individual
Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender Treatment as
prescribed by the Sex Offender Management Board Policy, Polygraph, Plethysmograph,
Parent Training for Teens, Independent Living Training, Mentor/Advocate, and
Supervised Visitation.
2. Payment for a child's temporary absence from the facility, including absence due to
hospitalization, will be made in accordance with State Department rules in Staff Manual
Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and
Contractor's facility for the initial placement and return after the treatment plan is
completed. If the child runs away from the Contractor's facility, the County shall provide
transportation to either return the child to the facility or to other care as arranged by the
County. The County will make the decision to return the child to the facility, with input
from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be
provided by Contractor. Any transportation costs not covered or contemplated in the
original treatment plan must be negotiated between County and Contractor and are not
subject to reimbursement under this Agreement. However, provisions for payment of
other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by
persons or agencies which are not a party to this contract shall be specified in the
treatment/case plan, and those persons shall acknowledge their responsibility by signing
the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 49488
Synergy
3660-80 W Princeton Cir
Denver CO 80236
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any
sub-contracts without the express written approval of the Executive Director of the
Colorado Department of Social Services or his appointed designee.
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70,
2.710.71, 2.710.72, 2.710.73, 2.710.74) and Colorado Department of Human Services
Child Care Licensing Division policy(7.714.131), the contractor may obtain: 1) Ordinary
medical care, and 2) Emergency medical, surgical or dental care for said child after
making reasonable efforts to contact the County to obtain consent. Emergency care is
defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the
child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or
dental care will be made in a person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any
administration of emergency medical, surgical or dental services provided under this
authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services
being provided, authorization must be obtained from the assigned caseworker or
supervisor. If parental rights are intact, authorization or attempts to obtain authorization
from the parent(s) should also be documented. If the placement is made through a
voluntary placement agreement between the parent(s) and the County, the parent(s) must
be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental
services provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the
time of submittal of each progress report, including the discharge report at the time of the
child's termination from the care of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic
Screening, Diagnosis and Treatment Program.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
9. It is agreed and permission is granted for the child to participate in planned recreational
and social activities of Contractor, including supervised off grounds excursions and
extended trips within the State, provided that Contractor has written permission from
County and legal custodian for any trips out of Colorado for any reason and any planned
absence from the facility of over seven (7) days within a consecutive 30-day period. Such
written permission may be in the treatment/case plan. Further, Contractor and County
will also secure,where possible, permission from parents or guardians of the child placed
with the Contractor.
10. County and Contractor shall inform each other and the local school district of any
changes in parental residence affecting educational status,which comes to their attention.
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be
child specific and shall include the initial Treatment Plan that shall be goal oriented and
time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated
educational arrangement for the child upon completion. Also included will be the
anticipated date for discharge from treatment purchased as well as provisions concerning
the involvement of the child's family in treatment of the child.
3. County and Contractor agree and understand that the psychological (mental and
behavioral) or physical problems which necessitate purchasing services for this child are
specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and
Contractor and shall be reflected in the Attachment A.
5. At no longer than three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. Contractor shall participate in all
Foster Care Reviews as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of
Social Services, the State of Colorado and any federal laws and regulations, as such,
which may be amended from time to time, and shall be binding on Contractor and control
any disputes in this Agreement.
Agreement to Purchase 4
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of
1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act
of 1975 as revised, and provide confidentiality of information concerning the child and
the child's family.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. Maintain during the term of this Agreement a liability insurance policy of at least
$400,000 for property damage liability, $150,000 for injury and/or damage to any one
person, and $400,000 for total injuries arising from any one accident.
8. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2)
months gross receipts, whichever is greater, covering the activities of any of its officers,
agents or employees responsible for the implementation and/or administration of this
contract in order to make reparations for any wrongful acts, omissions, or any other
defalcations of the Contractor.
9. Indemnif County, e Colo ado De/of of So al S rvic an he S to o olo do
"-,,, V
y and 1 ss agai t all ci s an actin bas up or 'sin out o dam or
\
10. Maintain service program records, fiscal records, documentation and other records,which
will sufficiently and properly reflect all direct and indirect costs of any nature incurred in
the performance of this Agreement. The above shall be subject at all reasonable times to
inspection, review or audit by federal, State Department or county personnel, and other
persons authorized in writing by the Executive Director, Colorado Department of Social
Services.
11. Bill the County for services rendered, using the required Division of Child Welfare
Provider Roster. This roster is to be mailed to the County department by the last day of
the month of care. If Provider Rosters are not received, payments will be held until the
required paperwork is received.
12. Attend and participate in Foster Care Reviews for children in placement longer than 60
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
days, and any subsequent appeal process, for children in placement with the Contractor
pursuant to two (2) weeks written notice by the County. If the facility is in a different
part of the state from the county in which the review is held, participation may be by
teleconference.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. A full evaluation of an Individualized Educational Plan (IEP) for youth designated as a
Special Education Students will be conducted every 3 years and reviewed every year. If
the IEP is due while the child is in placement, the Contractor will complete or obtain a
completed IEP. A copy will then be forwarded to the County.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
6
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal
system time frames for services purchased under this Agreement in accordance with the
established rate specified herein,when Provider Rosters are submitted as described in
Section IV,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services,
federal rules and regulations and the laws of the State of Colorado, any of which may be
amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements
of State Department Staff Manual, Volume VII, and provide consultation and/or technical
assistance to Contractor in relation to the services purchased under this Agreement.
6. Involve Contractor in planning for the child and give the Contractor a copy of the
Discrete Case Plan at time of placement or as soon as completed and when updated or
revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by
this Agreement is that of employer-independent contractor. No agent, employee, or
servant of Contractor shall be deemed to be an employee, agent, or servant of County.
Contractor will be solely and entirely responsible for its acts or of any agent, employee,
servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in
whole or in part, is subject to and contingent upon the continuing availability of State of
Colorado and federal funds for the purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard
and protect personal items brought to Contractor by the Child, Contractor will be released
from responsibility for loss or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the
parties. No prior or contemporaneous addition, deletion, or other amendment hereto shall
have any force or effect whatsoever, unless embodied herein in writing. No subsequent
notation, renewal, addition, deletion, or other amendment hereto shall have any force or
effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services and the County to
monitor the service program, fiscal books and other records sufficiently to assure the
purchase of services in this Agreement are carried out for the benefit of the
aforementioned child through program reports, on-site visits where applicable and other
contracts as deemed necessary. The Contractor understands that the Colorado
Department of Social Services will provide consultation and technical assistance to
Contractor to assure satisfactory performance in the provision of purchased services
under this Agreement.
Agreement to Purchase 7
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. In the event this contract is terminated, final payment to the Contractor may be withheld
at their discretion of the County until final audit. Incorrect payments to the Contractor
due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor
either by deduction from subsequent payments under this contract or other contracts
between the County and the Contractor or by the County, as a debt due to both the State
of Colorado, Colorado Department of Social Services and the County. The waiver of any
violation shall not be construed as a waiver of any other or subsequent violation of this
contract or appropriate statutes and regulations.
7. It is expressly understood and agreed that the enforcement of the terms and conditions of
this Agreement, and all rights of action relating to such enforcement, shall be strictly
reserved to the undersigned parties or their assignees, and nothing contained in this
Agreement shall give or allow any claim or right of action whatsoever by any other
person not included in this Agreement. It is the express intention of the undersigned
parties that any entity other than the undersigned parties or their assignees receiving
services or benefits under this Agreement shall be an incidental beneficiary only.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the
parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care,which did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
Agreement to Purchase 8
RCCF Services
•
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS •
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: Slate ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care
❑ CORE Services ❑ Receiving Home 0 CPA ❑ regular egul Abuse Treatment
0 Day Treatment ❑ RTC ❑ Cty r(Specify)
Foster Care
❑ Kinship Care ❑ Group Home ❑ Ind.Living ❑ Other S d
( l� Y)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) 0 Secure 0 Other(Explain)
Appropriate Counseling:
❑ Individual ❑ Family 0 Group
Appropriate Treatment:
0 Sex Offender ❑ AggressiveNiolent 0 Substance Abuse ❑ Truancy
Y 0 Victim Behavior 0 Depression
❑ Delinquency ❑ Special Medical Needs O Behavior Modification 0 Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. 0 Public School 0 Day Treatment
❑ On-grounds School 0 Additional Tutoring 0 Independent Living Training
❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes 0 No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
RCCF Services 9
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
• I0M4411//444
ATT�yce
I i '��,d County Clerk to the Board
J , WELD COUNTY BOARD OF SOCIAL
ft:irisell
� �` SERVICES,ON BEHALF OF THE
WELD COUNTY DEPARTMENT
J .
OF SOCIAL SERVICES
//// By: E &
:twp. l.L
C 0 eputy Clerk to the Board Robert D. Masden,Chair
JUN 2 8 2004
APPROVED AS TO FO �7
_ CONTRACTOR
Co ty A orney
The University of Colorado
Health Sciences Center
dba Synergy
3738 W Princeton Cir
Denver, CO 80236
By: i`Ctilljet '1' lW
WELD COUNTY DEPARTMENT Kristin O. Moyer
OF SOCIAL SERVICES Mannar IPra-Award
Grant3 nd Contracts
By: a
irecto
Agreement to Purchase 10
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
U
THIS AGREEMENT made thisc-9,Qaay ofg , 2004 between the Board of Weld
County Commissioners, sitting as the Board of So al Services, on behalf of the Weld County
Department of Social Services,hereinafter called "County" and Wingshadow, Inc., 1225
Redwood Street, Fort Collins, CO 80524,hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State
Department" is authorized to provide social services to individuals and families of individuals
through its agents, County Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under
State Department rules, and
WHEREAS, County wishes to provide these services by purchasing them from
Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings
County and Contractor agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which
are listed in this Agreement at a rate of$89.35 per day for children placed within the
Residential Child Care Facility identified as Provider ID#1516584. These services will
be for children who have been deemed eligible for social services under the statutes,rules
and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2004, until the end of the Colorado fiscal
year, June 30, 2005; or until the child is removed by the County; or if the child's behavior
would cause harm to himself or other children, and Contractor seeks approval from the
County and the County agrees, in writing, to terminate this Agreement, whichever event
. occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as
this Agreement, signed by the authorized representatives of the parties. In addition to the
termination provisions in Paragraph 2 above, either party shall have the right to terminate
this contract by giving the other party thirty(30) days notice by registered mail,return
receipt requested. If notice is so given,this contract shall terminate on the expiration of
the thirty(30)days or until the eligible child can be placed elsewhere,whichever occurs
earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease,but the parties shall not be released from the duty
to perform their obligations up to the date of termination.
Agreement to Purchase 1
RCCF Services
o7e115/-/-77Y
Contract No.: 1W 04/05-SS-23A-RCCF
4. This Agreement is in lieu of and supersedes all prior agreements between the parties
hereto and relating to the care and services herein described.
SECTION I. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services
and may include,but are not limited to: Basic 24-hour care and child maintenance(food,
shelter, clothing, educational supplies and allowance), Direct Child Care, Transportation,
Administrative Overhead, Support Overhead, Therapeutic Recreation, Service delivery
Staff, Direct therapy and evaluation,which may include but are not limited to:
Psychological,Neurological Medication and follow-up, Family Therapy,Individual
Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender Treatment as
prescribed by the Sex Offender Management Board Policy, Polygraph, Plethysmograph,
Parent Training for Teens, Independent Living Training, Mentor/Advocate, and
Supervised Visitation.
2. Payment for a child's temporary absence from the facility, including absence due to
hospitalization, will be made in accordance with State Department rules in Staff Manual
Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and
Contractor's facility for the initial placement and return after the treatment plan is
completed. If the child runs away from the Contractor's facility, the County shall provide
transportation to either return the child to the facility or to other care as arranged by the
County. The County will make the decision to return the child to the facility, with input
from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be
provided by Contractor. Any transportation costs not covered or contemplated in the
original treatment plan must be negotiated between County and Contractor and are not
subject to reimbursement under this Agreement. However,provisions for payment of
other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by
persons or agencies which are not a party to this contract shall be specified in the
treatment/case plan, and those persons shall acknowledge their responsibility by signing
the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 1516584
The Wing
1225 Redwood Street
Fort Collins CO 80524
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any
sub-contracts without the express written approval of the Executive Director of the
Colorado Department of Social Services or his appointed designee.
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70,
2.710.71, 2.710.72,2.710.73, 2.710.74)and Colorado Department of Human Services
Child Care Licensing Division policy(7.714.131), the contractor may obtain: 1) Ordinary
medical care, and 2) Emergency medical, surgical or dental care for said child after
making reasonable efforts to contact the County to obtain consent. Emergency care is
defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the
child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or
dental care will be made in a person-to-person communication,not through phone mail
messages.
3. During regular work hours,the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours,weekends and
holidays,the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any
administration of emergency medical, surgical or dental services provided under this
authorization.
5. Prior to any elective,non-routine or non-emergency medical, surgical or dental services
being provided, authorization must be obtained from the assigned caseworker or
supervisor. If parental rights are intact, authorization or attempts to obtain authorization
from the parent(s) should also be documented. If the placement is made through a
voluntary placement agreement between the parent(s) and the County, the parent(s)must
be contacted for authorization.
•
6. The Contractor is required to maintain a complete record of all medical, surgical or dental
services provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the
time of submittal of each progress report, including the discharge report at the time of the
child's termination from the care of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic
Screening, Diagnosis and Treatment Program.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
9. It is agreed and permission is granted for the child to participate in planned recreational
and social activities of Contractor, including supervised off grounds excursions and
extended trips within the State,provided that Contractor has written permission from
County and legal custodian for any trips out of Colorado for any reason and any planned
absence from the facility of over seven (7) days within a consecutive 30-day period. Such
written permission may be in the treatment/case plan. Further, Contractor and County
will also secure,where possible,permission from parents or guardians of the child placed
with the Contractor.
10. County and Contractor shall inform each other and the local school district of any
changes in parental residence affecting educational status, which comes to their attention.
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be
child specific and shall include the initial Treatment Plan that shall be goal oriented and
time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated
educational arrangement for the child upon completion.Also included will be the
anticipated date for discharge from treatment purchased as well as provisions concerning
the involvement of the child's family in treatment of the child.
3. County and Contractor agree and understand that the psychological (mental and
behavioral)or physical problems which necessitate purchasing services for this child are
specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and
Contractor and shall be reflected in the Attachment A.
5. At no longer than three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition,psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. Contractor shall participate in all
Foster Care Reviews as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of
Social Services,the State of Colorado and any federal laws and regulations, as such,
which may be amended from time to time, and shall be binding on Contractor and control
any disputes in this Agreement.
Agreement to Purchase 4
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not se assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of
1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act
of 1975 as revised, and provide confidentiality of information concerning the child and
the child's family.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90,regarding the use of restraints in an emergency situation.
7. Maintain during the term of this Agreement a liability insurance policy of at least
$400,000 for property damage liability, $150,000 for injury and/or damage to any one
person, and $400,000 for total injuries arising from any one accident.
8. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2)
months gross receipts,whichever is greater, covering the activities of any of its officers,
agents or employees responsible for the implementation and/or administration of this
contract in order to make reparations for any wrongful acts, omissions, or any other
defalcations of the Contractor.
9. Indemnify County, the Colorado Department of Social Services and the State of Colorado
against any and loss against all claims and actions based upon or arising out of damage or
injury, including death, to persons or property caused or sustained in connection with the
performance of this contract or by conditions created thereby, or based upon any
violations of any statute, ordinance, or regulation and the defense of any such claims or
actions.
10. Maintain service program records, fiscal records, documentation and other records,which
will sufficiently and properly reflect all direct and indirect costs of any nature incurred in •
the performance of this Agreement. The above shall be subject at all reasonable times to
inspection,review or audit by federal, State Department or county personnel, and other
persons authorized in writing by the Executive Director, Colorado Department of Social
Services.
11. Bill the County for services rendered, using the required Division of Child Welfare
Provider Roster. This roster is to be mailed to the County department by the last day of
the month of care. If Provider Rosters are not received, payments will be held until the
required paperwork is received.
12. Attend and participate in Foster Care Reviews for children in placement longer than 60
days, and any subsequent appeal process, for children in placement with the Contractor
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
pursuant to two (2)weeks written notice by the County. If the facility is in a different
part of the state from the county in which the review is held, participation may be by
teleconference.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. A full evaluation of an Individualized Educational Plan (IEP) for youth designated as a
Special Education Students will be conducted every 3 years and reviewed every year. If
the IEP is due while the child is in placement, the Contractor will complete or obtain a
completed IEP. A copy will then be forwarded to the County.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended,proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not,within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
6
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal
system time frames for services purchased under this Agreement in accordance with the
established rate specified herein, when Provider Rosters are submitted as described in
Section IV,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services,
federal rules and regulations and the laws of the State of Colorado, any of which may be
amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements
of State Department Staff Manual,Volume VII, and provide consultation and/or technical
assistance to Contractor in relation to the services purchased under this Agreement.
6. Involve Contractor in planning for the child and give the Contractor a copy of the
Discrete Case Plan at time of placement or as soon as completed and when updated or
revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by
this Agreement is that of employer-independent contractor. No agent, employee, or
servant of Contractor shall be deemed to be an employee, agent, or servant of County.
Contractor will be solely and entirely responsible for its acts or of any agent, employee,
servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds,whether in
whole or in part, is subject to and contingent upon the continuing availability of State of
Colorado and federal funds for the purpose thereof
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard
and protect personal items brought to Contractor by the Child, Contractor will be released
from responsibility for loss or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the
parties. No prior or contemporaneous addition, deletion, or other amendment hereto shall
have any force or effect whatsoever,unless embodied herein in writing. No subsequent
notation,renewal, addition, deletion, or other amendment hereto shall have any force or
effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services and the County to
monitor the service program, fiscal books and other records sufficiently to assure the
purchase of services in this Agreement are carried out for the benefit of the
aforementioned child through program reports, on-site visits where applicable and other
contracts as deemed necessary. The Contractor understands that the Colorado
Department of Social Services will provide consultation and technical assistance to
Contractor to assure satisfactory performance in the provision of purchased services
under this Agreement.
Agreement to Purchase
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. In the event this contract is terminated, final payment to the Contractor may be withheld
at their discretion of the County until fmal audit. Incorrect payments to the Contractor
due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor
either by deduction from subsequent payments under this contract or other contracts
between the County and the Contractor or by the County, as a debt due to both the State
of Colorado, Colorado Department of Social Services and the County. The waiver of any
violation shall not be construed as a waiver of any other or subsequent violation of this
contract or appropriate statutes and regulations.
7. It is expressly understood and agreed that the enforcement of the terms and conditions of
this Agreement, and all rights of action relating to such enforcement, shall be strictly
reserved to the undersigned parties or their assignees, and nothing contained in this
Agreement shall give or allow any claim or right of action whatsoever by any other
person not included in this Agreement. It is the express intention of the undersigned
parties that any entity other than the undersigned parties or their assignees receiving
services or benefits under this Agreement shall be an incidental beneficiary only.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the
parties or their officers or employees may possess,nor shall any portion of this
Agreement be deemed to have created a duty of care,which did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
Agreement to Purchase
RCCF Services 8
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? O Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services O Placement with Relative O Cty CC Foster Care
❑ CORE Services0 Shelter Care O ClySub regular gu Abuse TreatmentCare
O Receiving Home O CPA O RTC
❑ Day Treatment O Kinship Care O Group Home ❑ � e,)Fo Care
O Ind.Living O Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) O Secure O Other(Explain)
Appropriate Counseling:
O Individual O Family O GrWP
Appropriate Treatment: .
❑ Sex Offender ❑ Aggressive/Violent O Substance Abuse ❑ Truancy
❑ Self-destructive O Delin uenc Behavior
❑ Victim Behavior O Depression
q y ❑ Special Medical Needs ❑ Behavior Modification O Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. O Public School
O Inay dependent Treatment
O On-grounds School
O Additional Tutoring O Independent Living Training O Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
O It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) O Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
•
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Dt2. of o#a-r'ays
Gloria Romansik,Administrator Signature of Person Au Sign Agreement
s---
Date
Date
Agreement to Purchase
RCCF Services 9
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
iataleadejt
40,t,<:' / , Teld County Clerk to the Board
J
t �, WELD COUNTY BOARD OF SOCIAL
`,A Art.
1861 ( �� SERVICES,ON BEHALF OF THE
%i � T _ WELD COUNTY DEPARTMENT
ed
`r I/ - A Al OF SOCIAL SERVICES
Br• r 7i/ r, r �� By:
Deputy Clerk to a Board Robett kii\N\
asden,Chair
JUN 2 8 2004
APPROVED AS TO FORM:
CONTRACTOR
County A omey •
Wingshadow, Inc.
1225 Redwood Street
Fort Collins, CO 80524 �7
By: c ,,.t
PaarDlL OP Oft-f-A-na JS
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
Direct J
Agreement to Purchase
RCCF Services 10
• Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
net
THIS AGREEMENT made this 0,J day oQatu, 2004 between the Board of Weld
County Commissioners, sitting as the Board of Social Services, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Youth Emancipation & Services,
Inc., 1600 31st Ave, Greeley CO 80634, hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State
Department" is authorized to provide social services to individuals and families of individuals
through its agents, County Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under
State Department rules, and
WHEREAS, County wishes to provide these services by purchasing them from
Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings
County and Contractor agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which
are listed in this Agreement at a rate of$122.28 per day for children placed within the
Residential Child Care Facility identified as Provider ID#1513086. These services will
be for children who have been deemed eligible for social services under the statutes, rules
and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2004, until the end of the Colorado fiscal
year, June 30, 2005; or until the child is removed by the County; or if the child's behavior
would cause harm to himself or other children, and Contractor seeks approval from the
County and the County agrees, in writing, to terminate this Agreement, whichever event
occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as
this Agreement, signed by the authorized representatives of the parties. In addition to the
termination provisions in Paragraph 2 above, either party shall have the right to terminate
this contract by giving the other party thirty(30) days notice by registered mail, return
receipt requested. If notice is so given, this contract shall terminate on the expiration of
the thirty(30) days or until the eligible child can be placed elsewhere, whichever occurs
earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease, but the parties shall not be released from the duty
to perform their obligations up to the date of termination.
Agreement to Purchase 1
RCCF Services
ago i-/79q
Cohtract No.: PY 04/05-SS-23A-RCCF
4. This Agreement is in lieu of and supersedes all prior agreements between the parties
hereto and relating to the care and services herein described.
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services
and may include, but are not limited to: Basic 24-hour care and child maintenance (food,
shelter, clothing, educational supplies and allowance), Direct Child Care, Transportation,
Administrative Overhead, Support Overhead, Therapeutic Recreation, Service delivery
Staff, Direct therapy and evaluation, which may include but are not limited to:
Psychological, Neurological Medication and follow-up, Family Therapy, Individual
Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender Treatment as
prescribed by the Sex Offender Management Board Policy, Polygraph, Plethysmograph,
Parent Training for Teens, Independent Living Training, Mentor/Advocate, and
Supervised Visitation.
2. Payment for a child's temporary absence from the facility, including absence due to
hospitalization, will be made in accordance with State Department rules in Staff Manual
Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and
Contractor's facility for the initial placement and return after the treatment plan is
completed. If the child runs away from the Contractor's facility, the County shall provide
transportation to either return the child to the facility or to other care as arranged by the
County. The County will make the decision to return the child to the facility, with input
from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be
provided by Contractor. Any transportation costs not covered or contemplated in the
original treatment plan must be negotiated between County and Contractor and are not
subject to reimbursement under this Agreement. However, provisions for payment of
other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by
persons or agencies which are not a party to this contract shall be specified in the
treatment/case plan, and those persons shall acknowledge their responsibility by signing
the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 1513086
Youth Emancipation & Services, Inc.
1600 31st Ave
Greeley CO 80634
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any
sub-contracts without the express written approval of the Executive Director of the
Colorado Department of Social Services or his appointed designee.
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70,
2.710.71, 2.710.72, 2.710.73, 2.710.74) and Colorado Department of Human Services
Child Care Licensing Division policy(7.714.131), the contractor may obtain: 1) Ordinary
medical care, and 2) Emergency medical, surgical or dental care for said child after
making reasonable efforts to contact the County to obtain consent. Emergency care is
defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the
child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or
dental care will be made in a person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any
administration of emergency medical, surgical or dental services provided under this
authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services
being provided, authorization must be obtained from the assigned caseworker or
supervisor. If parental rights are intact, authorization or attempts to obtain authorization
from the parent(s) should also be documented. If the placement is made through a
voluntary placement agreement between the parent(s) and the County, the parent(s) must
be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental
services provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the
time of submittal of each progress report, including the discharge report at the time of the
child's termination from the care of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic
Screening, Diagnosis and Treatment Program.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
9. It is agreed and permission is granted for the child to participate in planned recreational
and social activities of Contractor, including supervised off grounds excursions and
extended trips within the State, provided that Contractor has written permission from
County and legal custodian for any trips out of Colorado for any reason and any planned
absence from the facility of over seven (7) days within a consecutive 30-day period. Such
written permission may be in the treatment/case plan. Further, Contractor and County
will also secure, where possible, permission from parents or guardians of the child placed
with the Contractor.
10. County and Contractor shall inform each other and the local school district of any
changes in parental residence affecting educational status, which comes to their attention.
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be
child specific and shall include the initial Treatment Plan that shall be goal oriented and
time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated
educational arrangement for the child upon completion. Also included will be the
anticipated date for discharge from treatment purchased as well as provisions concerning
the involvement of the child's family in treatment of the child.
3. County and Contractor agree and understand that the psychological (mental and
behavioral) or physical problems which necessitate purchasing services for this child are
specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and
Contractor and shall be reflected in the Attachment A.
5. At no longer than three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. Contractor shall participate in all
Foster Care Reviews as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of
Social Services, the State of Colorado and any federal laws and regulations, as such,
which may be amended from time to time, and shall be binding on Contractor and control
any disputes in this Agreement.
Agreement to Purchase 4
RCCF Services
• Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of
1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act
of 1975 as revised, and provide confidentiality of information concerning the child and
the child's family.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. Maintain during the term of this Agreement a liability insurance policy of at least
$400,000 for property damage liability, $150,000 for injury and/or damage to any one
person, and $400,000 for total injuries arising from any one accident.
8. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2)
months gross receipts, whichever is greater, covering the activities of any of its officers,
agents or employees responsible for the implementation and/or administration of this
contract in order to make reparations for any wrongful acts, omissions, or any other
defalcations of the Contractor.
9. Indemnify County, the Colorado Department of Social Services and the State of Colorado
against any and loss against all claims and actions based upon or arising out of damage or
injury, including death, to persons or property caused or sustained in connection with the
performance of this contract or by conditions created thereby, or based upon any
violations of any statute, ordinance, or regulation and the defense of any such claims or
actions.
10. Maintain service program records, fiscal records, documentation and other records, which
will sufficiently and properly reflect all direct and indirect costs of any nature incurred in
the performance of this Agreement. The above shall be subject at all reasonable times to
inspection, review or audit by federal, State Department or county personnel, and other
persons authorized in writing by the Executive Director, Colorado Department of Social
Services.
11. Bill the County for services rendered, using the required Division of Child Welfare
Provider Roster. This roster is to be mailed to the County department by the last day of
the month of care. If Provider Rosters are not received, payments will be held until the
required paperwork is received.
12. Attend and participate in Foster Care Reviews for children in placement longer than 60
days, and any subsequent appeal process, for children in placement with the Contractor
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
pursuant to two (2) weeks written notice by the County. If the facility is in a different
part of the state from the county in which the review is held, participation may be by
teleconference.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. A full evaluation of an Individualized Educational Plan (IEP) for youth designated as a
Special Education Students will be conducted every 3 years and reviewed every year. If
the IEP is due while the child is in placement, the Contractor will complete or obtain a
completed IEP. A copy will then be forwarded to the County.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
RCCF Services S
• Contract No.: PY 04/05-SS-23A-RCCF
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal
system time frames for services purchased under this Agreement in accordance with the
established rate specified herein, when Provider Rosters are submitted as described in
Section IV, Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services,
federal rules and regulations and the laws of the State of Colorado, any of which may be
amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements
of State Department Staff Manual, Volume VII, and provide consultation and/or technical
assistance to Contractor in relation to the services purchased under this Agreement.
6. Involve Contractor in planning for the child and give the Contractor a copy of the
Discrete Case Plan at time of placement or as soon as completed and when updated or
revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by
this Agreement is that of employer-independent contractor. No agent, employee, or
servant of Contractor shall be deemed to be an employee, agent, or servant of County.
Contractor will be solely and entirely responsible for its acts or of any agent, employee,
servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in
whole or in part, is subject to and contingent upon the continuing availability of State of
Colorado and federal funds for the purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard
and protect personal items brought to Contractor by the Child, Contractor will be released
from responsibility for loss or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the
parties. No prior or contemporaneous addition, deletion, or other amendment hereto shall
have any force or effect whatsoever, unless embodied herein in writing. No subsequent
notation, renewal, addition, deletion, or other amendment hereto shall have any force or
effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services and the County to
monitor the service program, fiscal books and other records sufficiently to assure the
purchase of services in this Agreement are carried out for the benefit of the
aforementioned child through program reports, on-site visits where applicable and other
contracts as deemed necessary. The Contractor understands that the Colorado
Department of Social Services will provide consultation and technical assistance to
Contractor to assure satisfactory performance in the provision of purchased services
under this Agreement.
Agreement to Purchase
RCCF Services
• Contract No.: PY 04/05-SS-23A-RCCF
6. In the event this contract is terminated, final payment to the Contractor maybe withheld
at their discretion of the County until final audit. Incorrect payments to the Contractor
due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor
either by deduction from subsequent payments under this contract or other contracts
between the County and the Contractor or by the County, as a debt due to both the State
of Colorado, Colorado Department of Social Services and the County. The waiver of any
violation shall not be construed as a waiver of any other or subsequent violation of this
contract or appropriate statutes and regulations.
7. It is expressly understood and agreed that the enforcement of the terms and conditions of
this Agreement, and all rights of action relating to such enforcement, shall be strictly
reserved to the undersigned parties or their assignees, and nothing contained in this
Agreement shall give or allow any claim or right of action whatsoever by any other
person not included in this Agreement. It is the express intention of the undersigned
parties that any entity other than the undersigned parties or their assignees receiving
services or benefits under this Agreement shall be an incidental beneficiary only.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the
parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care, which did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
Agreement to Purchase
8
RCCF Services
Contract No.:•PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
LI Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? 0 Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care
❑ CORE Services ❑ Shelter Care ❑ Cty Substance regular Fose Treatment
❑ Receiving Home ❑ CPA ❑ RTC
❑ Day Treatment ❑ Kinship Care ❑ Grou Home ❑ Oth (Sp Foster Care
Group ❑ Ind.Living LI Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual ❑ Family ❑ Group
Appropriate Treatment:
❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse ❑ Truancy
El Self-destructive ❑ Delinquency ❑ Victim Behavior ❑ Angers Management
y ❑ Special Medical Needs ❑ Behavior Modification
❑ Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. ❑ Public School
❑ On-grounds School ❑ Day epennt Treatment
8r ❑ Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature
City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
RCCF Services 9
Contract No::'PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
A
E1/4, n eld County Clerk to the o rd
WELD COUNTY BOARD OF SOCIAL
1861 ..q SERVICES,ON BEHALF OF THE
WELD COUNTY DEPARTMENT
Pr r OF SOCIAL SERVICES
__...__ 6�r By: c?„,ii.
.
Deputy Clerk to the Board Robert D.Masden,Chair
JUN 2 8 2004
APPROVED AS TO FORM:
CONTRACTOR
Countytorney
Youth Emancipation & Services, Mc.
1600 31st Ave
Greeley CO 80634
By:CJ� i i �J 42_ A /..QC--
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: i4cto( t
Agreement to Purchase
RCCF Services 1O
aerie,/— /729
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made thisc-' day o tnt, 2004 between the Board of Weld
County Commissioners, sitting as the Board of So ial Services, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Youthtrack, 10184 W Bellview
300,Littleton, CO 80127,hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State
Department" is authorized to provide social services to individuals and families of individuals
through its agents, County Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under
State Department rules, and
WHEREAS, County wishes to provide these services by purchasing them from
Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings
County and Contractor agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which
are listed in this Agreement at a rate of$67.22 per day for children placed within the
Residential Child Care Facility identified as Provider ID#11723. These services will be
for children who have been deemed eligible for social services under the statutes, rules
and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2004, until the end of the Colorado fiscal
year, June 30, 2005; or until the child is removed by the County; or if the child's behavior
would cause harm to himself or other children, and Contractor seeks approval from the
County and the County agrees, in writing, to terminate this Agreement,whichever event
occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as
this Agreement, signed by the authorized representatives of the parties. In addition to the
termination provisions in Paragraph 2 above, either party shall have the right to terminate
this contract by giving the other party thirty(30) days notice by registered mail, return
receipt requested. If notice is so given, this contract shall terminate on the expiration of
the thirty(30)days or until the eligible child can be placed elsewhere, whichever occurs
earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease, but the parties shall not be released from the duty
to perform their obligations up to the date of termination.
Agreement to Purchase 1
RCCF Services
awy—/»y
Contract No.: PY 04/o5-SS-23A-RCCF
4. This Agreement is in lieu of and supersedes all prior agreements between the parties
hereto and relating to the care and services herein described.
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services
and may include,but are not limited to: Basic 24-hour care and child maintenance(food,
shelter, clothing, educational supplies and allowance), Direct Child Care, Transportation,
Administrative Overhead, Support Overhead, Therapeutic Recreation, Service delivery
Staff, Direct therapy and evaluation, which may include but are not limited to:
Psychological,Neurological Medication and follow-up, Family Therapy, Individual
Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender Treatment as
prescribed by the Sex Offender Management Board Policy, Polygraph, Plethysmograph,
Parent Training for Teens, Independent Living Training, Mentor/Advocate, and
Supervised Visitation.
2. Payment for a child's temporary absence from the facility, including absence due to
hospitalization,will be made in accordance with State Department rules in Staff Manual
Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and
Contractor's facility for the initial placement and return after the treatment plan is
completed. If the child runs away from the Contractor's facility, the County shall provide
transportation to either return the child to the facility or to other care as arranged by the
County. The County will make the decision to return the child to the facility,with input
from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be
provided by Contractor. Any transportation costs not covered or contemplated in the
original treatment plan must be negotiated between County and Contractor and are not
subject to reimbursement under this Agreement. However,provisions for payment of
other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by
persons or agencies which are not.a party to this contract shall be specified in the
treatment/case plan, and those persons shall acknowledge their responsibility by signing
the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 11723
Youthtrack Excel
51 W 4th Ave
Denver CO 80223
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any
sub-contracts without the express written approval of the Executive Director of the
Colorado Department of Social Services or his appointed designee.
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70,
2.710.71, 2.710.72, 2.710.73, 2.710.74) and Colorado Department of Human Services
Child Care Licensing Division policy(7.714.131), the contractor may obtain: 1) Ordinary
medical care, and 2)Emergency medical, surgical or dental care for said child after
making reasonable efforts to contact the County to obtain consent. Emergency care is
defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the
child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or
dental care will be made in a person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any
administration of emergency medical, surgical or dental services provided under this
authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services
being provided, authorization must be obtained from the assigned caseworker or
supervisor. If parental rights are intact, authorization or attempts to obtain authorization
from the parent(s) should also be documented. If the placement is made through a
voluntary placement agreement between the parent(s) and the County, the parent(s) must
be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental
services provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the
time of submittal of each progress report, including the discharge report at the time of the
child's termination from the care of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic
Screening, Diagnosis and Treatment Program.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
9. It is agreed and permission is granted for the child to participate in planned recreational
and social activities of Contractor, including supervised off grounds excursions and
extended trips within the State, provided that Contractor has written permission from
County and legal custodian for any trips out of Colorado for any reason and any planned
absence from the facility of over seven (7) days within a consecutive 30-day period. Such
written permission may be in the treatment/case plan. Further, Contractor and County
will also secure,where possible, permission from parents or guardians of the child placed
with the Contractor.
10. County and Contractor shall inform each other and the local school district of any
changes in parental residence affecting educational status,which comes to their attention.
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be
child specific and shall include the initial Treatment Plan that shall be goal oriented and
time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated
educational arrangement for the child upon completion. Also included will be the
anticipated date for discharge from treatment purchased as well as provisions concerning
the involvement of the child's family in treatment of the child.
3. County and Contractor agree and understand that the psychological (mental and •
behavioral) or physical problems which necessitate purchasing services for this child are
specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and
Contractor and shall be reflected in the Attachment A.
5. At no longer than three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. Contractor shall participate in all
Foster Care Reviews as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of
Social Services, the State of Colorado and any federal laws and regulations, as such,
which may be amended from time to time, and shall be binding on Contractor and control
any disputes in this Agreement.
Agreement to Purchase 4
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of
1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act
of 1975 as revised, and provide confidentiality of information concerning the child and
the child's family.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. Maintain during the term of this Agreement a liability insurance policy of at least
$400,000 for property damage liability, $150,000 for injury and/or damage to any one
person, and $400,000 for total injuries arising from any one accident.
8. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2)
months gross receipts, whichever is greater, covering the activities of any of its officers,
agents or employees responsible for the implementation and/or administration of this
contract in order to make reparations for any wrongful acts, omissions, or any other
defalcations of the Contractor.
9. Indemnify County, the Colorado Department of Social Services and the State of Colorado
against any and loss against all claims and actions based upon or arising out of damage or
injury, including death,to persons or property caused or sustained in connection with the
performance of this contract or by conditions created thereby, or based upon any
violations of any statute, ordinance, or regulation and the defense of any such claims or
actions.
10. Maintain service program records, fiscal records, documentation and other records,which
will sufficiently and properly reflect all direct and indirect costs of any nature incurred in
the performance of this Agreement. The above shall be subject at all reasonable times to
inspection, review or audit by federal, State Department or county personnel, and other
persons authorized in writing by the Executive Director, Colorado Department of Social
Services.
11. Bill the County for services rendered, using the required Division of Child Welfare
Provider Roster. This roster is to be mailed to the County department by the last day of
the month of care. If Provider Rosters are not received, payments will be held until the
required paperwork is received.
12. Attend and participate in Foster Care Reviews for children in placement longer than 60
days, and any subsequent appeal process, for children in placement with the Contractor
Agreement to Purchase
S
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
pursuant to two (2)weeks written notice by the County. If the facility is in a different
part of the state from the county in which the review is held,participation may be by
teleconference.
• 13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. A full evaluation of an Individualized Educational Plan (IEP)for youth designated as a
Special Education Students will be conducted every 3 years and reviewed every year. If
the IEP is due while the child is in placement, the Contractor will complete or obtain a
completed IEP. A copy will then be forwarded to the County.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement,been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local)transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery,bribery, falsification or destruction of records,making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions(federal, state, and local)terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
RCCF Services 6
Contract No.: PY 04/05-SS-23A-RCCF
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal
system time frames for services purchased under this Agreement in accordance with the
established rate specified herein,when Provider Rosters are submitted as described in
Section IV, Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services,
federal rules and regulations and the laws of the State of Colorado, any of which may be
amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements
of State Department Staff Manual, Volume VII, and provide consultation and/or technical
assistance to Contractor in relation to the services purchased under this Agreement.
6. Involve Contractor in planning for the child and give the Contractor a copy of the
Discrete Case Plan at time of placement or as soon as completed and when updated or
revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by
this Agreement is that of employer-independent contractor. No agent, employee, or
servant of Contractor shall be deemed to be an employee, agent, or servant of County.
Contractor will be solely and entirely responsible for its acts or of any agent, employee,
servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in
whole or in part, is subject to and contingent upon the continuing availability of State of
Colorado and federal funds for the purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard
and protect personal items brought to Contractor by the Child, Contractor will be released
from responsibility for loss or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the
parties. No prior or contemporaneous addition, deletion, or other amendment hereto shall
have any force or effect whatsoever, unless embodied herein in writing. No subsequent
notation, renewal, addition, deletion, or other amendment hereto shall have any force or
effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services and the County to
monitor the service program, fiscal books and other records sufficiently to assure the
purchase of services in this Agreement are carried out for the benefit of the
aforementioned child through program reports, on-site visits where applicable and other
contracts as deemed necessary. The Contractor understands that the Colorado
Department of Social Services will provide consultation and technical assistance to
Contractor to assure satisfactory performance in the provision of purchased services
under this Agreement.
Agreement to Purchase
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. In the event this contract is terminated, final payment to the Contractor may be withheld
at their discretion of the County until final audit. Incorrect payments to the Contractor
due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor
either by deduction from subsequent payments under this contract or other contracts
between the County and the Contractor or by the County, as a debt due to both the State
of Colorado, Colorado Department of Social Services and the County. The waiver of any
violation shall not be construed as a waiver of any other or subsequent violation of this
contract or appropriate statutes and regulations.
7. It is expressly understood and agreed that the enforcement of the terms and conditions of
this Agreement, and all rights of action relating to such enforcement, shall be strictly
reserved to the undersigned parties or their assignees, and nothing contained in this
Agreement shall give or allow any claim or right of action whatsoever by any other
person not included in this Agreement. It is the express intention of the undersigned
parties that any entity other than the undersigned parties or their assignees receiving
services or benefits under this Agreement shall be an incidental beneficiary only.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the
parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care, which did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
•
immunities.
Agreement to Purchase
RCCF Services 8
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? O Yes O No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative O CtyCC Foster Care
O Shelter Care O Substance l r Abuse Treatment
O CORE Services O Receiving Home O CPA ❑ RTC
O Day Treatment O Kinship Care O Group Home ❑ Cty regular Foster Care
O Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
O Therapeutic(Behavior Modification) ❑ Secure O Other(Explain)
Appropriate Counseling:
O Individual ❑ Family ❑ Group
Appropriate Treatment:
❑ Sex Offender ❑ Aggressive/Violent O Substance Abuse ❑ Truancy O Victim Behavior O Depression
❑ Self-destructive O Delinquency ry O Special Medical Needs O Behavior Modification
O Other (Explain) ❑ Anger Management
Appropriate Educational Services:
O Special Ed. O Public School
❑ O Day Treatment
On-grounds School
❑ Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
O It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) O Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Sodal Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
RCCF Services 9
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
A ` 1 �' ^f ��'(�U (
I. ! eld County Clerk to the Board
J
see
� WELD COUNTY BOARD OF SOCIAL
186! . ! .% SERVICES,ON BEHALF OF THE
%l:�':s WELD COUNTY DEPARTMENT
�.iu�•
rPrr
OF SOCIAL SERVICES
By Vim L r y, By:
'ISeputy Clerk to the oard Robert D.Masden,Chair
JUN 2 8 2004
APPROVED AS TO FORM:
CONTRACTOR County A [omey
Youthtrack
10184 W Bellview 300
Littleto CO 80127
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: V
Dlrecto
Agreement to Purchase
RCCF Services 1O
0700/-/77/
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this-?day o ,Otx, 2004 between the Board of Weld
County Commissioners, sitting as the Board of So al Services, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Youthtrack, 10184 W Bellview
300, Littleton, CO 80127, hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State
Department" is authorized to provide social services to individuals and families of individuals
through its agents, County Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under
State Department rules, and
WHEREAS, County wishes to provide these services by purchasing them from
Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings
County and Contractor agree as follows:
•
1. County agrees to purchase and Contractor agrees to provide the care and services which
are listed in this Agreement at a rate of$71.64 per day for children placed within the
Residential Child Care Facility identified as Provider ID#11724. These services will be
for children who have been deemed eligible for social services under the statutes, rules
and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2004, until the end of the Colorado fiscal
year, June 30, 2005; or until the child is removed by the County; or if the child's behavior
would cause harm to himself or other children, and Contractor seeks approval from the
County and the County agrees, in writing, to terminate this Agreement,whichever event
occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as
this Agreement, signed by the authorized representatives of the parties. In addition to the
termination provisions in Paragraph 2 above, either party shall have the right to terminate
this contract by giving the other party thirty(30) days notice by registered mail, return
receipt requested. If notice is so given, this contract shall terminate on the expiration of
the thirty(30) days or until the eligible child can be placed elsewhere, whichever occurs
earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease,but the parties shall not be released from the duty
to perform their obligations up to the date of termination.
Agreement to Purchase 1
RCCF Services ,ROC,y_/79 V
Contract No.: PY 04/05-SS-23A-RCCF
4. This Agreement is in lieu of and supersedes all prior agreements between the parties
hereto and relating to the care and services herein described.
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services
and may include, but are not limited to: Basic 24-hour care and child maintenance (food,
shelter, clothing, educational supplies and allowance), Direct Child Care, Transportation,
Administrative Overhead, Support Overhead, Therapeutic Recreation, Service delivery
Staff, Direct therapy and evaluation, which may include but are not limited to:
Psychological,Neurological Medication and follow-up, Family Therapy, Individual
Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender Treatment as
prescribed by the Sex Offender Management Board Policy, Polygraph, Plethysmograph,
Parent Training for Teens, Independent Living Training, Mentor/Advocate, and
Supervised Visitation.
2. Payment for a child's temporary absence from the facility, including absence due to
hospitalization, will be made in accordance with State Department rules in Staff Manual
Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and
Contractor's facility for the initial placement and return after the treatment plan is
completed. If the child runs away from the Contractor's facility, the County shall provide
transportation to either return the child to the facility or to other care as arranged by the
County. The County will make the decision to return the child to the facility, with input
from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be
provided by Contractor. Any transportation costs not covered or contemplated in the
original treatment plan must be negotiated between County and Contractor and are not
subject to reimbursement under this Agreement. However, provisions for payment of
other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by
persons or agencies which are not a party to this contract shall be specified in the
treatment/case plan, and those persons shall acknowledge their responsibility by signing
the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 11724
Youthtrack Jeffco
5924 Hwy 285
Morrison CO 80465
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any
sub-contracts without the express written approval of the Executive Director of the
Colorado Department of Social Services or his appointed designee.
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70,
2.710.71, 2.710.72, 2.710.73, 2.710.74) and Colorado Department of Human Services
Child Care Licensing Division policy(7.714.131), the contractor may obtain: 1) Ordinary
medical care, and 2) Emergency medical, surgical or dental care for said child after
making reasonable efforts to contact the County to obtain consent. Emergency care is
defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the
child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or
dental care will be made in a person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours,weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any
administration of emergency medical, surgical or dental services provided under this
authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services
being provided, authorization must be obtained from the assigned caseworker or
supervisor. If parental rights are intact, authorization or attempts to obtain authorization
from the parent(s) should also be documented. If the placement is made through a
voluntary placement agreement between the parent(s) and the County, the parent(s)must
be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental
services provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the
time of submittal of each progress report, including the discharge report at the time of the
child's termination from the care of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic
Screening, Diagnosis and Treatment Program.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
9. It is agreed and permission is granted for the child to participate in planned recreational
and social activities of Contractor, including supervised off grounds excursions and
extended trips within the State, provided that Contractor has written permission from
County and legal custodian for any trips out of Colorado for any reason and any planned
absence from the facility of over seven (7) days within a consecutive 30-day period. Such
written permission may be in the treatment/case plan. Further, Contractor and County
will also secure, where possible, permission from parents or guardians of the child placed
with the Contractor.
10. County and Contractor shall inform each other and the local school district of any
changes in parental residence affecting educational status, which comes to their attention.
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be
child specific and shall include the initial Treatment Plan that shall be goal oriented and
time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated
educational arrangement for the child upon completion. Also included will be the
anticipated date for discharge from treatment purchased as well as provisions concerning
the involvement of the child's family in treatment of the child.
3. County and Contractor agree and understand that the psychological (mental and
behavioral) or physical problems which necessitate purchasing services for this child are
specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and
Contractor and shall be reflected in the Attachment A.
5. At no longer than three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. Contractor shall participate in all
Foster Care Reviews as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of
Social Services, the State of Colorado and any federal laws and regulations, as such,
which may be amended from time to time, and shall be binding on Contractor and control
any disputes in this Agreement.
Agreement to Purchase 4
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of
1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act
of 1975 as revised, and provide confidentiality of information concerning the child and
the child's family.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. Maintain during the term of this Agreement a liability insurance policy of at least
$400,000 for property damage liability, $150,000 for injury and/or damage to any one
person, and $400,000 for total injuries arising from any one accident.
8. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2)
months gross receipts, whichever is greater, covering the activities of any of its officers,
agents or employees responsible for the implementation and/or administration of this
contract in order to make reparations for any wrongful acts, omissions, or any other
defalcations of the Contractor.
9. Indemnify County, the Colorado Department of Social Services and the State of Colorado
against any and loss against all claims and actions based upon or arising out of damage or
injury, including death, to persons or property caused or sustained in connection with the
performance of this contract or by conditions created thereby, or based upon any
violations of any statute, ordinance, or regulation and the defense of any such claims or
actions.
10. Maintain service program records, fiscal records, documentation and other records,which
will sufficiently and properly reflect all direct and indirect costs of any nature incurred in
the performance of this Agreement. The above shall be subject at all reasonable times to
inspection, review or audit by federal, State Department or county personnel, and other
persons authorized in writing by the Executive Director, Colorado Department of Social
Services.
11. Bill the County for services rendered, using the required Division of Child Welfare
Provider Roster. This roster is to be mailed to the County department by the last day of
the month of care. If Provider Rosters are not received, payments will be held until the
required paperwork is received.
12. Attend and participate in Foster Care Reviews for children in placement longer than 60
days, and any subsequent appeal process, for children in placement with the Contractor
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
pursuant to two (2)weeks written notice by the County. If the facility is in a different
part of the state from the county in which the review is held, participation may be by
teleconference.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. A full evaluation of an Individualized Educational Plan (IEP) for youth designated as a
Special Education Students will be conducted every 3 years and reviewed every year. If
the IEP is due while the child is in placement, the Contractor will complete or obtain a
completed IEP. A copy will then be forwarded to the County.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
6
RCCF Services
Contract No.: PY 04/OS-SS-23A-RCCF
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal
system time frames for services purchased under this Agreement in accordance with the
established rate specified herein, when Provider Rosters are submitted as described in
Section IV, Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services,
federal rules and regulations and the laws of the State of Colorado, any of which may be
amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements
of State Department Staff Manual, Volume VII, and provide consultation and/or technical
assistance to Contractor in relation to the services purchased under this Agreement.
6. Involve Contractor in planning for the child and give the Contractor a copy of the
Discrete Case Plan at time of placement or as soon as completed and when updated or
revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by
this Agreement is that of employer-independent contractor. No agent, employee, or
servant of Contractor shall be deemed to be an employee, agent, or servant of County.
Contractor will be solely and entirely responsible for its acts or of any agent, employee,
servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in
whole or in part, is subject to and contingent upon the continuing availability of State of
Colorado and federal funds for the purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard
and protect personal items brought to Contractor by the Child, Contractor will be released
from responsibility for loss or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the
parties. No prior or contemporaneous addition, deletion, or other amendment hereto shall
•have any force or effect whatsoever, unless embodied herein in writing. No subsequent
notation, renewal, addition, deletion, or other amendment hereto shall have any force or
effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services and the County to
monitor the service program, fiscal books and other records sufficiently to assure the
purchase of services in this Agreement are carried out for the benefit of the
aforementioned child through program reports, on-site visits where applicable and other
contracts as deemed necessary. The Contractor understands that the Colorado
Department of Social Services will provide consultation and technical assistance to
Contractor to assure satisfactory performance in the provision of purchased services
under this Agreement.
Agreement to Purchase
RCCF Services
Contract No.: IT 04/05-SS-23A-RCCF
6. In the event this contract is terminated, final payment to the Contractor may be withheld
at their discretion of the County until final audit. Incorrect payments to the Contractor
due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor
either by deduction from subsequent payments under this contract or other contracts
between the County and the Contractor or by the County, as a debt due to both the State
of Colorado, Colorado Department of Social Services and the County. The waiver of any
violation shall not be construed as a waiver of any other or subsequent violation of this
contract or appropriate statutes and regulations.
7. It is expressly understood and agreed that the enforcement of the terms and conditions of
this Agreement, and all rights of action relating to such enforcement, shall be strictly
reserved to the undersigned parties or their assignees, and nothing contained in this
Agreement shall give or allow any claim or right of action whatsoever by any other
person not included in this Agreement. It is the express intention of the undersigned
parties that any entity other than the undersigned parties or their assignees receiving
services or benefits under this Agreement shall be an incidental beneficiary only.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the
parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care, which did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
Agreement to Purchase
RCCF Services 8
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
I. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care
❑ CORE Services ❑ Receiving Home ❑ CPA ❑ Cty Substance regular Fose Treatment
❑ Da Treatment ❑ RTC ❑ Oty (Spec y) Care
Day ❑ Kinship Care ❑ Group Home ❑ Ind.Living
0 Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual 0 Family ❑ Group
Appropriate Treatment:
❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse ❑ Truancy CI Victim Behavior El Depression
❑ Self-destructive 0 Delinquency y ❑ Special Medical Needs ❑ Behavior Modification ❑ Anger Management
❑ Other (Explain)
Appropriate Educational Services:
0 Special Ed. ❑ Public School 0 Day Treatment
❑ On-grounds School ❑ Additional Tutoring
❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
RCCF Services 9
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
ATTEST: ,,�,���/
mss` Weld�Clerk� to the Board
,,�) I 4• WELD COUNTY BOARD OF SOCIAL
I .` SERVICES,ON BEHALF OF THE
•P 1861 ? AA,- . WELD COUNTY DEPARTMENT
''' _ � OF SOCIAL SERVICES
4.46; ; �jI<« ,., � By:
�`% ..tety Clerk to the Bild Robert D.Masden, Chair
JUN 2 8 2004
APPROVED AS TO FORM:
CONTRACTOR
County Attorney
Youthtrack
10184 W Bellview 300
Littleto CO 80127
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: 1 iir_,
�irectoim
Agreement to Purchase
RCCF Services 10
&0DV- /7J5'
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made thiQg day off_ t,a'.2004 between the Board of Weld
County Commissioners, sitting as the Board of So 'al Services, on behalf of the Weld County
Department of Social Services,hereinafter called "County" and Youthtrack, 10184 W Bellview
300, Littleton, CO 80127, hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services,hereinafter called "State
Department" is authorized to provide social services to individuals and families of individuals
through its agents, County Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under
State Department rules, and
WHEREAS, County wishes to provide these services by purchasing them from
Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings
County and Contractor agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which
are listed in this Agreement at a rate of$66.47 per day for children placed within the
Residential Child Care Facility identified as Provider ID#11725. These services will be
for children who have been deemed eligible for social services under the statutes, rules
and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2004,until the end of the Colorado fiscal
year, June 30, 2005; or until the child is removed by the County; or if the child's behavior
would cause harm to himself or other children, and Contractor seeks approval from the
County and the County agrees, in writing, to terminate this Agreement,whichever event
occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as
this Agreement, signed by the authorized representatives of the parties. In addition to the
termination provisions in Paragraph 2 above, either party shall have the right to terminate
this contract by giving the other party thirty(30) days notice by registered mail,return
receipt requested. If notice is so given,this contract shall terminate on the expiration of
the thirty(30) days or until the eligible child can be placed elsewhere, whichever occurs
earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease,but the parties shall not be released from the duty
to perform their obligations up to the date of termination.
Agreement to Purchase 1
RCCF Services aery /7O1
Contract No.: PY 04/05-SS-23A-RCCF
4. This Agreement is in lieu of and supersedes all prior agreements between the parties
hereto and relating to the care and services herein described.
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services
and may include,but are not limited to: Basic 24-hour care and child maintenance(food,
shelter, clothing, educational supplies and allowance), Direct Child Care, Transportation,
Administrative Overhead, Support Overhead, Therapeutic Recreation, Service delivery
Staff, Direct therapy and evaluation, which may include but are not limited to:
Psychological, Neurological Medication and follow-up, Family Therapy, Individual
Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender Treatment as
prescribed by the Sex Offender Management Board Policy, Polygraph, Plethysmograph,
Parent Training for Teens, Independent Living Training, Mentor/Advocate, and
Supervised Visitation.
2. Payment for a child's temporary absence from the facility, including absence due to
hospitalization, will be made in accordance with State Department rules in Staff Manual
Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and
Contractor's facility for the initial placement and return after the treatment plan is
completed. If the child runs away from the Contractor's facility, the County shall provide
transportation to either return the child to the facility or to other care as arranged by the
County. The County will make the decision to return the child to the facility, with input
from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be
provided by Contractor. Any transportation costs not covered or contemplated in the
original treatment plan must be negotiated between County and Contractor and are not
subject to reimbursement under this Agreement. However, provisions for payment of
other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by
persons or agencies which are not a party to this contract shall be specified in the
treatment/case plan, and those persons shall acknowledge their responsibility by signing
the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 11725
Youthtrack San Luis Valley
1317 17 St#8
Alamosa CO 81101
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any
sub-contracts without the express written approval of the Executive Director of the
Colorado Department of Social Services or his appointed designee.
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70,
2.710.71, 2.710.72, 2.710.73, 2.710.74) and Colorado Department of Human Services
Child Care Licensing Division policy(7.714.131), the contractor may obtain: 1) Ordinary
medical care, and 2) Emergency medical, surgical or dental care for said child after
making reasonable efforts to contact the County to obtain consent. Emergency care is
defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the
child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or
dental care will be made in a person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970)350-8389.
4. The County will be notified by the facility no later than the following working day of any
administration of emergency medical, surgical or dental services provided under this
authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services
being provided, authorization must be obtained from the assigned caseworker or
supervisor. If parental rights are intact, authorization or attempts to obtain authorization
from the parent(s) should also be documented. If the placement is made through a
voluntary placement agreement between the parent(s) and the County, the parent(s) must
be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental
services provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the
time of submittal of each progress report, including the discharge report at the time of the
child's termination from the care of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic
Screening, Diagnosis and Treatment Program.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
9. It is agreed and permission is granted for the child to participate in planned recreational
and social activities of Contractor, including supervised off grounds excursions and
extended trips within the State, provided that Contractor has written permission from
County and legal custodian for any trips out of Colorado for any reason and any planned
absence from the facility of over seven(7) days within a consecutive 30-day period. Such
written permission may be in the treatment/case plan. Further, Contractor and County
will also secure,where possible, permission from parents or guardians of the child placed
with the Contractor.
10. County and Contractor shall inform each other and the local school district of any
changes in parental residence affecting educational status, which comes to their attention.
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be
child specific and shall include the initial Treatment Plan that shall be goal oriented and
time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated
educational arrangement for the child upon completion. Also included will be the
anticipated date for discharge from treatment purchased as well as provisions concerning
the involvement of the child's family in treatment of the child.
3. County and Contractor agree and understand that the psychological (mental and
behavioral) or physical problems which necessitate purchasing services for this child are
specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and
Contractor and shall be reflected in the Attachment A.
5. At no longer than three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition,psychological and social
functioning,the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15)days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. Contractor shall participate in all
Foster Care Reviews as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of
Social Services, the State of Colorado and any federal laws and regulations, as such,
which may be amended from time to time, and shall be binding on Contractor and control
any disputes in this Agreement.
Agreement to Purchase 4
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of
1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act
of 1975 as revised, and provide confidentiality of information concerning the child and
the child's family.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. Maintain during the term of this Agreement a liability insurance policy of at least
$400,000 for property damage liability, $150,000 for injury and/or damage to any one
person, and $400,000 for total injuries arising from any one accident.
8. Maintain during the terms of this Agreement a fidelity bond of at least$25,000 or two (2)
months gross receipts,whichever is greater, covering the activities of any of its officers,
agents or employees responsible for the implementation and/or administration of this
contract in order to make reparations for any wrongful acts, omissions, or any other
defalcations of the Contractor.
9. Indemnify County, the Colorado Department of Social Services and the State of Colorado
against any and loss against all claims and actions based upon or arising out of damage or
injury, including death, to persons or property caused or sustained in connection with the
performance of this contract or by conditions created thereby, or based upon any
violations of any statute, ordinance, or regulation and the defense of any such claims or
actions.
10. Maintain service program records, fiscal records, documentation and other records, which
will sufficiently and properly reflect all direct and indirect costs of any nature incurred in
the performance of this Agreement. The above shall be subject at all reasonable times to
inspection, review or audit by federal, State Department or county personnel, and other
persons authorized in writing by the Executive Director, Colorado Department of Social
Services.
11. Bill the County for services rendered, using the required Division of Child Welfare
Provider Roster. This roster is to be mailed to the County department by the last day of
the month of care. If Provider Rosters are not received,payments will be held until the
required paperwork is received.
12. Attend and participate in Foster Care Reviews for children in placement longer than 60
days, and any subsequent appeal process, for children in placement with the Contractor
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
pursuant to two (2)weeks written notice by the County. If the facility is in a different
part of the state from the county in which the review is held,participation may be by
teleconference.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. A full evaluation of an Individualized Educational Plan (IEP) for youth designated as a
Special Education Students will be conducted every 3 years and reviewed every year. If
the IEP is due while the child is in placement, the Contractor will complete or obtain a
completed IEP. A copy will then be forwarded to the County.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local)terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
RCCF Services 6
Contract No.: PY 04/05-SS-23A-RCCF
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal
system time frames for services purchased under this Agreement in accordance with the
established rate specified herein,when Provider Rosters are submitted as described in
Section IV, Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services,
federal rules and regulations and the laws of the State of Colorado, any of which may be
amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements
of State Department Staff Manual, Volume VII, and provide consultation and/or technical
assistance to Contractor in relation to the services purchased under this Agreement.
6. Involve Contractor in planning for the child and give the Contractor a copy of the
Discrete Case Plan at time of placement or as soon as completed and when updated or
revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by
this Agreement is that of employer-independent contractor. No agent, employee, or
servant of Contractor shall be deemed to be an employee, agent, or servant of County.
Contractor will be solely and entirely responsible for its acts or of any agent, employee,
servants and sub-contractors during the performance of this Agreement. •
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds,whether in
whole or in part, is subject to and contingent upon the continuing availability of State of
Colorado and federal funds for the purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard
and protect personal items brought to Contractor by the Child, Contractor will be released
from responsibility for loss or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the
parties. No prior or contemporaneous addition, deletion, or other amendment hereto shall
have any force or effect whatsoever, unless embodied herein in writing. No subsequent
notation, renewal, addition, deletion, or other amendment hereto shall have any force or
effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services and the County to
monitor the service program, fiscal books and other records sufficiently to assure the
purchase of services in this Agreement are carried out for the benefit of the
aforementioned child through program reports, on-site visits where applicable and other
contracts as deemed necessary. The Contractor understands that the Colorado
Department of Social Services will provide consultation and technical assistance to
Contractor to assure satisfactory performance in the provision of purchased services
under this Agreement.
Agreement to Purchase
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. In the event this contract is terminated, final payment to the Contractor may be withheld
at their discretion of the County until final audit. Incorrect payments to the Contractor
due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor
either by deduction from subsequent payments under this contract or other contracts
between the County and the Contractor or by the County, as a debt due to both the State
of Colorado, Colorado Department of Social Services and the County. The waiver of any
violation shall not be construed as a waiver of any other or subsequent violation of this
contract or appropriate statutes and regulations.
7. It is expressly understood and agreed that the enforcement of the terms and conditions of
this Agreement, and all rights of action relating to such enforcement, shall be strictly
reserved to the undersigned parties or their assignees, and nothing contained in this
Agreement shall give or allow any claim or right of action whatsoever by any other
person not included in this Agreement. It is the express intention of the undersigned
parties that any entity other than the undersigned parties or their assignees receiving
services or benefits under this Agreement shall be an incidental beneficiary only.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the
parties or their officers or employees may possess,nor shall any portion of this
Agreement be deemed to have created a duty of care, which did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
Agreement to Purchase
RCCF Services 8
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
I. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
O Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? O Yes O No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services O Placement with Relative O Cty CC Foster Care O Shelter Care
❑ CORE Services O Receiving Home O CPA O RTC O Substance l r Abuse Treatment
O Day Treatment ❑ Kinship Care O Group Home0 Cty regular Foster Care
O Ind.[wing O Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) O Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual O Family O Group
Appropriate Treatment:
O Sex Offender ❑ Aggressive/Violent O Substance Abuse O Truancy
uenBehavior
❑ Victim Behavior O Depression
O Self-destructive O Delinquency ty O Special Medical Needs O Behavior Modification O Anger Management
❑ Other (Explain)
Appropriate Educational Services:
O Special Ed. O Public School
El On-groundsSchoolO Day Treatment
O Additional Tutoring O Independent Living Training O Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
O It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) O Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
•
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plait
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature
City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
RCCF Services 9
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
AT ii•
LUM
�IlWeld County Clerk to the Board
I `g l 4
0 - ' WELD COUNTY BOARD OF SOCIAL
, �.�4q . SERVICES,ON BEHALF OF THE
c WELD COUNTY DEPARTMENT
.5 -$
OF SOCIAL SERVICES Ikr( Pyre
Calk.!\�.►� By: ,r
-- —--beputy Clerk to the Board Robert D.Masden,Chair
JUN 2 8 2004
APPROVED AS TO FORM.
CONTRACTOR
Coun orney
Youthtrack
10184 W Bellview 300
Littleton CO 80127
r
By:46?“,
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
Director
Agreement to Purchase
RCCF Services 10
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made thia day o4 ', 2004 between the Board of Weld
County Commissioners, sitting as the Board of So al Services, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Youthtrack, 10184 W Bellview
300, Littleton, CO 80127,hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State
Department" is authorized to provide social services to individuals and families of individuals
through its agents, County Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under
State Department rules, and
WHEREAS, County wishes to provide these services by purchasing them from
Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings
County and Contractor agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which
are listed in this Agreement at a rate of$72.64 per day for children placed within the
Residential Child Care Facility identified as Provider ID#11727. These services will be
for children who have been deemed eligible for social services under the statutes, rules
and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2004, until the end of the Colorado fiscal
year, June 30, 2005; or until the child is removed by the County; or if the child's behavior
would cause harm to himself or other children, and Contractor seeks approval from the
County and the County agrees, in writing, to terminate this Agreement, whichever event
occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as
this Agreement, signed by the authorized representatives of the parties. In addition to the
termination provisions in Paragraph 2 above, either party shall have the right to terminate
this contract by giving the other party thirty(30) days notice by registered mail, return
receipt requested. If notice is so given, this contract shall terminate on the expiration of
the thirty(30) days or until the eligible child can be placed elsewhere, whichever occurs
earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease,but the parties shall not be released from the duty
to perform their obligations up to the date of termination.
Agreement to Purchase 1
RCCF Services
aDOy-/777
Contract No.: PY 04/05-SS-23A-RCCF
4. This Agreement is in lieu of and supersedes all prior agreements between the parties
hereto and relating to the care and services herein described.
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services
and may include, but are not limited to: Basic 24-hour care and child maintenance (food,
shelter, clothing, educational supplies and allowance), Direct Child Care, Transportation,
Administrative Overhead, Support Overhead, Therapeutic Recreation, Service delivery
Staff, Direct therapy and evaluation, which may include but are not limited to:
Psychological,Neurological Medication and follow-up, Family Therapy, Individual
Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender Treatment as
prescribed by the Sex Offender Management Board Policy, Polygraph, Plethysmograph,
Parent Training for Teens, Independent Living Training, Mentor/Advocate, and
Supervised Visitation.
2. Payment for a child's temporary absence from the facility, including absence due to
hospitalization,will be made in accordance with State Department rules in Staff Manual
Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and
Contractor's facility for the initial placement and return after the treatment plan is
completed. If the child runs away from the Contractor's facility, the County shall provide
transportation to either return the child to the facility or to other care as arranged by the
County. The County will make the decision to return the child to the facility, with input
from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be
provided by Contractor. Any transportation costs not covered or contemplated in the
original treatment plan must be negotiated between County and Contractor and are not
subject to reimbursement under this Agreement. However, provisions for payment of
other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by
persons or agencies which are not a party to this contract shall be specified in the
treatment/case plan, and those persons shall acknowledge their responsibility by signing
the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 11727
Youthtrack Grand Ave
1020 Grand Ave
Grand Junction CO 81501
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any
sub-contracts without the express written approval of the Executive Director of the
Colorado Department of Social Services or his appointed designee.
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies(2.710.70,
2.710.71, 2.710.72, 2.710.73, 2.710.74) and Colorado Department of Human Services
Child Care Licensing Division policy(7.714.131), the contractor may obtain: 1) Ordinary
medical care, and 2)Emergency medical, surgical or dental care for said child after
making reasonable efforts to contact the County to obtain consent. Emergency care is
defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the
child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or
dental care will be made in a person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any
administration of emergency medical, surgical or dental services provided under this
authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services
being provided, authorization must be obtained from the assigned caseworker or
supervisor. If parental rights are intact, authorization or attempts to obtain authorization
from the parent(s) should also be documented. If the placement is made through a
voluntary placement agreement between the parent(s) and the County, the parent(s)must
be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental
services provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the
time of submittal of each progress report, including the discharge report at the time of the
child's termination from the care of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic
Screening, Diagnosis and Treatment Program.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
9. It is agreed and permission is granted for the child to participate in planned recreational
and social activities of Contractor, including supervised off grounds excursions and
extended trips within the State,provided that Contractor has written permission from
County and legal custodian for any trips out of Colorado for any reason and any planned
absence from the facility of over seven (7) days within a consecutive 30-day period. Such
written permission maybe in the treatment/case plan. Further, Contractor and County
will also secure, where possible,permission from parents or guardians of the child placed
with the Contractor.
10. County and Contractor shall inform each other and the local school district of any
changes in parental residence affecting educational status, which comes to their attention.
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be
child specific and shall include the initial Treatment Plan that shall be goal oriented and
time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated
educational arrangement for the child upon completion. Also included will be the
anticipated date for discharge from treatment purchased as well as provisions concerning
the involvement of the child's family in treatment of the child.
3. County and Contractor agree and understand that the psychological (mental and
behavioral) or physical problems which necessitate purchasing services for this child are
specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and
Contractor and shall be reflected in the Attachment A.
5. At no longer than three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. Contractor shall participate in all
Foster Care Reviews as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of
Social Services, the State of Colorado and any federal laws and regulations, as such,
which may be amended from time to time, and shall be binding on Contractor and control
any disputes in this Agreement.
Agreement to Purchase 4
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of
1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act
of 1975 as revised, and provide confidentiality of information concerning the child and
the child's family.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. Maintain during the term of this Agreement a liability insurance policy of at least
$400,000 for property damage liability, $150,000 for injury and/or damage to any one
person, and $400,000 for total injuries arising from any one accident.
8. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2)
months gross receipts, whichever is greater, covering the activities of any of its officers,
agents or employees responsible for the implementation and/or administration of this
contract in order to make reparations for any wrongful acts, omissions, or any other
defalcations of the Contractor.
9. Indemnify County, the Colorado Department of Social Services and the State of Colorado
against any and loss against all claims and actions based upon or arising out of damage or
injury, including death, to persons or property caused or sustained in connection with the
performance of this contract or by conditions created thereby, or based upon any
violations of any statute, ordinance, or regulation and the defense of any such claims or
actions.
10. Maintain service program records, fiscal records, documentation and other records,which
will sufficiently and properly reflect all direct and indirect costs of any nature incurred in
the performance of this Agreement. The above shall be subject at all reasonable times to
inspection,review or audit by federal, State Department or county personnel, and other
persons authorized in writing by the Executive Director, Colorado Department of Social
Services.
11. Bill the County for services rendered, using the required Division of Child Welfare
Provider Roster. This roster is to be mailed to the County department by the last day of
the month of care. If Provider Rosters are not received, payments will be held until the
required paperwork is received.
12. Attend and participate in Foster Care Reviews for children in placement longer than 60
days, and any subsequent appeal process, for children in placement with the Contractor
Agreement to Purchase
RCCF Services 5
Contract No.: PY 04/05-SS-23A-RCCF
pursuant to two (2)weeks written notice by the County. If the facility is in a different
part of the state from the county in which the review is held, participation may be by
teleconference.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. A full evaluation of an Individualized Educational Plan(IEP) for youth designated as a
Special Education Students will be conducted every 3 years and reviewed every year. If
the IEP is due while the child is in placement, the Contractor will complete or obtain a
completed IEP. A copy will then be forwarded to the County.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended,proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not,within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery,bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph(B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
6
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal
system time frames for services purchased under this Agreement in accordance with the
established rate specified herein, when Provider Rosters are submitted as described in
Section IV,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services,
federal rules and regulations and the laws of the State of Colorado, any of which may be
amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements
of State Department Staff Manual, Volume VII, and provide consultation and/or technical
assistance to Contractor in relation to the services purchased under this Agreement.
6. Involve Contractor in planning for the child and give the Contractor a copy of the
Discrete Case Plan at time of placement or as soon as completed and when updated or
revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by
this Agreement is that of employer-independent contractor. No agent, employee, or
servant of Contractor shall be deemed to be an employee, agent, or servant of County.
Contractor will be solely and entirely responsible for its acts or of any agent, employee,
servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in
whole or in part, is subject to and contingent upon the continuing availability of State of
Colorado and federal funds for the purpose thereof
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard
and protect personal items brought to Contractor by the Child, Contractor will be released
from responsibility for loss or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the
parties. No prior or contemporaneous addition, deletion, or other amendment hereto shall
have any force or effect whatsoever, unless embodied herein in writing. No subsequent
notation, renewal, addition, deletion, or other amendment hereto shall have any force or
effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services and the County to
monitor the service program, fiscal books and other records sufficiently to assure the
purchase of services in this Agreement are carried out for the benefit of the
aforementioned child through program reports, on-site visits where applicable and other
contracts as deemed necessary. The Contractor understands that the Colorado
Department of Social Services will provide consultation and technical assistance to
Contractor to assure satisfactory performance in the provision of purchased services
under this Agreement.
Agreement to Purchase
RCCF Services 7
Contract No.: PY 04/05-SS-23A-RCCF
6. In the event this contract is terminated, final payment to the Contractor may be withheld
at their discretion of the County until final audit. Incorrect payments to the Contractor
due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor
•
either by deduction from subsequent payments under this contract or other contracts
between the County and the Contractor or by the County, as a debt due to both the State
of Colorado, Colorado Department of Social Services and the County. The waiver of any
violation shall not be construed as a waiver of any other or subsequent violation of this
contract or appropriate statutes and regulations.
7. It is expressly understood and agreed that the enforcement of the terms and conditions of
this Agreement, and all rights of action relating to such enforcement, shall be strictly
reserved to the undersigned parties or their assignees, and nothing contained in this
Agreement shall give or allow any claim or right of action whatsoever by any other
person not included in this Agreement. It is the express intention of the undersigned
parties that any entity other than the undersigned parties or their assignees receiving
services or benefits under this Agreement shall be an incidental beneficiary only.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the
parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care,which did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
•
Agreement to Purchase
RCCF Services 8
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative
❑ CORE Services 0 Cty CC Foster Care 0 Shelter Care ❑ CtySubstuncel r Abuse r C Treatment
❑ Receiving Home ❑ CPA 0 RTC 0 Cty regular Foster Can❑ Day Treatment ❑ Kinship Care ❑ Group Home 0 Ind.Living 0 Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual ❑ Family ❑ Group
Appropriate Treatment:
❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse ❑ Truancy
❑ Self-destructive o ❑ Victim Behavior 0 Dtg Man
❑ Delinquency ❑ Special Medical Needs ❑ Behavior Modification ❑ Anger Mana rant
❑ Other (Explain) �'
Appropriate Educational Services:
O Special Ed. ❑ Public School
❑ On-grounds School ❑ Day endtn Lt
❑ Additional Tutoring ❑ Independent Living Training 0 Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan. •
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
RCCF Services 9
Contract No.: IT 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
•
gditilj
�� eld County Clerk to the Board
+p WELD COUNTY BOARD OF SOCIAL
SERVICES, ON BEHALF OF THE
WELD COUNTY DEPARTMENT
11 P. fir- OF SOCIAL SERVICES
G
•
B�r.�IS, tzz z� j;-4,1C, By:
iak
Deputy Clerk to the Board Robert D. asden,Chair
JUN 2 8 2004
APPROVED AS TO FORM:
CONTRACTOR
County A omey
Youthtrack
10184 W Bellview 300
Little
By.
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: trbQALr
Agreement to Purchase
RCCF Services 10
af)oy-1799
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