HomeMy WebLinkAbout20180442.tiffRESOLUTION
RE: APPROVE VICTIM ASSISTANCE AND LAW ENFORCEMENT (VALE) GRANT
APPLICATION FOR LONG TERM CARE OMBUDSMAN FRIENDLY VISITOR PROGRAM
AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Victim Assistance and Law Enforcement
(VALE) Grant Application for the Long Term Care Ombudsman Friendly Visitor Program from the
County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld
County, on behalf of the Department of Human Services, Area Agency on Aging, to the Victim
Assistance and Law Enforcement Board, commencing July 1, 2018, and ending June 30, 2019, with
further terms and conditions being as stated in said application, and
WHEREAS, after review, the Board deems it advisable to approve said application, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Victim Assistance and Law Enforcement (VALE) Grant Application for the
Long Term Care Ombudsman Friendly Visitor Program from the County of Weld, State of Colorado,
by and through the Board of County Commissioners of Weld County, on behalf of the Department of
Human Services, Area Agency on Aging, to the Victim Assistance and Law Enforcement Board, be,
and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said application.
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D3-2-'1-18
2018-0442
HR0089
RE: VICTIM ASSISTANCE AND LAW ENFORCEMENT (VALE) GRANT APPLICATION FOR
LONG TERM CARE OMBUDSMAN FRIENDLY VISITOR PROGRAM
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 12th day of February, A.D., 2018.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: day JC eo4k,
Weld County Clerk to the Board
unty Attorney
Date of signature: 08-7-1
Steve Moreno, Chair
arbara Kirkmeyery Pro-Tem
Sean P. Conway
Julie A. Cozad
Mike Freeman
2018-0442
HR0089
PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: January 26, 2018
TO: Board of County Commissioners — Pass -Around
FR: Judy A. Griego, Director, Human Services
RE: Weld County Department of Human Services Victim
Assistance Law Enforcement (VALE) Grant Application
Please review and indicate if you would like a work session prior to placing this item on the Board's agenda.
Request Board Approval to submit Department's 2018-2019 Victim Assistance Law Enforcement
(VALE) Grant Application. The Department is requesting $10,000.00 in VALE grant funds for the July 2018
through June 2019 funding cycle. VALE grant funds have been used for the past 21 years, since 1997, for the
Ombudsman Program. This grant has allowed the program to increase staff time for advocacy on behalf of a
very vulnerable population, to educate direct long-term caregivers regarding abuse and awareness, and to
educate residents and staff about the Ombudsman Program, abuse issues and resident rights.
Continued funding through this grant will enable the Ombudsman Program to serve the increasing number of
vulnerable long-term care residents, allow for mandated early crisis intervention, and provide assistance and
support to victims and their families.
I do not recommend a Work Session. I recommend approval to submit this Application.
Sean P. Conway
Julie A. Cozad
Mike Freeman
Barbara Kirkmeyer, Pro-tem
Steve Moreno, Chair
Approve Schedule
Recommendation Work Session
Other/Comments:
2018-0442
Pass -Around Memorandum; January 26, 2018 — CMS [D — not in CMS
2/5/18
Jacquie,
Here are the 3 VALE Grant Signature Pages that need to be signed by the Chair of Commissioners. I will
need all 3 of them back after signature. I would like to pick them up directly from the Clerk to the
Board. I will contact them and request that they notify me when the signature is complete.
If you have any questions, please call me at 6128.
Thank you,
Raegan Maldonado
rmaldonado@weldgov.com
VALE Grant Application Signature Page
Applicant Agency: Weld County Department of Human Services, Area Agency on Aging
Project Title: Weld County Long Term Care Ombudsman/Friendly Visitor Program
Grant Period: July 1, 2018 to June 30, 2019
We hereby certify that the information contained herein is true and correct to the best of our
knowledge and belief. The following signatories understand and agree that any grant received as a
result of this application shall incorporate and be subject to the statements made within the above
described VALE Grant Application (The Application). Furthermore, the signatories certify that
they have each read The Application and are fully cognizant of their duties and responsibilities for
this project.
Original signatures of each party to this application (i.e., Project Director, Financial Officer and
Authorized Official) are required. Please use BLUE INK to distinguish the original documents
from copies. Refer to Application Instructions for definitions for the signing authorities.
Project Director:
Name: Eva M. Jewell
Position/Title: AAA Division Head
Agency (including Division or Unit): Weld County Department of Human Services, Area Agency on Aging
Mailing Address: Post Office Box 1805, Greeley, CO 80632
Phone: (970) 400-6101 Fax: (970) 346-6951 E -Mail: ejewell@weldgov.com
Signature: ( G' Uo ��N - Date: j 21--/a9
Financial Officer:
Name: Leonard L. Bottorff Position/Title: Fiscal and Budget Manager
Agency (including Division or Unit): Weld County Department of Human Services
Mailing Address: Post Office Box A, Greeley, CO 80632
Phone: (970) 400-6537 Fax: (970) 346-7691 E -Mail: lbottorff@weldgov.com
/20r
Signature: f��'�% Date: / 8
Authorized Official:
Name: Steve Moreno
Position/Title: Chair
Agency (including Division or Unit): Weld County Board of Commissioners
Mailing Address: Post Office Box 758, Greeley, CO 80632
Phone: (970) 400-4207
Signature:
Fax: (970) 336-7233 E -Mail: smoreno@weldgov.com
Date: FEB 12 2018
In accordance with the Colorado Revised Statutes 24-72-202.6, information supplied in this application is considered a public record.
19
Q01(6- Of -141O)
2018-2019 VALE ASSISTANCE FUNDS
19th Judicial District, Weld County Application
July 1, 2018 through June 30, 2019
IMPORTANT: Refer to the APPLICATION INSTRUCTIONS TO COMPLETE CORRECTLY.
SECTION A - AGENCY INFORMATION:
1. APPLICANT AGENCY: Weld County Department of Human Services
Program Name: Weld County Long Term Care Ombudsman Program
Street Address (if not confidential): 315 N 11th Ave., Bldg C.
Greeley, Colorado 80631
Mailing Address (if different): Post Office Box 1805
Greeley, Colorado 80632
Phone: (970) 400-6128
Fax: (970) 346-6951
E -Mail: rmaldonadoa,weldgov.com
2. CONTACT PERSON: Raegan Maldonado
Title: Ombudsman Supervisor
Phone: (970) 400-6128
Fax: (970) 346-6951
E -Mail: rmaldonadoa,weldgov.com
Grant #:
VALE USE ONLY
Amount Requested:
Amount Funded:
3. Agency Status ® governmental nprivate-non-profit n private -for-profit
84-6000813 Non -Profit agencies include their TAX ID Number here.
NOTE: If you are claiming non-profit status and if you have not previously provided documentation supporting this claim
to the VALE Board, then you must provide sufficient documentation concerning your agency's non-profit status with this
application.
4. PROJECT TITLE: Weld County Long Term Care Ombudsman Friendly Visitor and Awareness
Program
5. Give a problem statement that is specific to the community the project will serve: The at -risk adult
population is growing rapidly. The funding will allow the Ombudsman Program to have a consistent
presence in Weld County long term care settings, allowing for advocacy and education. The funding
will enable the Long Term Care Ombudsmen to maintain a friendly visitor and awareness program.
6. FUNDS REQUESTED TOTAL: $10,000
ITEMS 1 - 6 MUST REMAIN ON THIS PAGE
1
SECTION B - NARRATIVE SUMMARY
7. Agency description: The Weld County Long Term Care Ombudsman Program is housed within the
Weld County Area Agency on Aging, and is funded by Federal and State grants. The authority of the
local Ombudsman Program comes from the Older American's Act, Colorado Revised Statutes 25-
11.5, and the Federal Nursing Home Reform Law/OBRA. Long Term Care Ombudsmen have
statutory status under the Older Americans' Act of 1965 as amended, and are required by federal
and state law to visit every nursing home monthly and every assisted living facility on a quarterly
basis. There are currently 8 Long Term Care Facilities and 23 Assisted Living Facilities and one
Residential Treatment Facility in Weld County. In addition, a 65 bed Secure Assisted Living Memory
Care facility is scheduled to open in Greeley in May 2018. There are also plans to build an additional
assisted living facility in the Windsor area. The Long Term Care Ombudsman Program is a
resident/patient/consumer-centered advocacy program.
The purpose of the Weld County Long Term Care Ombudsman Program is to assist and empower
consumers of long term care services by providing information about these services and furnish
support in complaint resolution. The Weld County Ombudsman acts as a consumer voice for the
concerns of the at -risk adults living in institutions, who may have no one else to speak for them. The
Ombudsman also investigates and resolves questions, issues, problems and complaints made by,
for, or on behalf of residents of long term care facilities. These issues or complaints may include, but
are not limited to access to long term care services, redress of neglectful or abusive care, and
information and assistance with civil and human rights. In addition, the Ombudsman documents and
reports problems of long term care, helps establish programs to meet residents' needs, and
stimulates and promotes improvement of the system.
8. Project Description for which the funds are being requested.
The V.A.L.E. Assistance Funds have allowed the Ombudsman Program to maintain staff time to keep
up with the increasing demand for advocacy on behalf of this very vulnerable population. The funds
have also enabled the program to maintain an educational program aimed at educating residents,
Certified Nursing Assistants (C.N.A.'s), other long term care staff, and family members. Education
material includes, but is not limited to: information about the Long Term Care Ombudsman Program,
Resident Rights, Elder Abuse and Neglect, and Victim Compensation. The Ombudsman's role,
through observation and a frequent presence in facilities, is to insure resident rights are being
respected and that quality care is being administered. In addition, our program focuses on the
importance of recognition and appropriate response to signs and symptoms of elder abuse and
neglect. Continued V.A.L.E. funding will make it possible for the Weld County Area Agency on Aging
Ombudsman Program to serve the increasing number of vulnerable long term care residents and
their families. The Long Term Care Ombudsman Program has been very fortunate to have this
partnership with Victim Services. Being involved with CCVC and other networking groups involving
Victim Services, has strengthened and enhanced our ability to address the needs of at -risk adults in
Weld County.
2
SECTION C - GOALS AND OBJECTIVES:
(Goal 1, objectives 1 and 2, are mandatory for all applicants.)
9. GOAL 1 (standard): This project will provide direct services that assist crime victims with emotional
and physical needs to stabilize their lives, provide a measure of safety and security, and/or enhance
victims' experience with the criminal justice system.
OBJECTIVE 1 (standard): To provide services to the following estimated unduplicated number of crime
victims during the 12 -month grant period.
Although a person may be a victim of multiple crimes in one criminal episode, they can be counted
only once using the predominant crime.
Definitions:
Victims: primary and secondary victims
Primary victim: The person against whom the crime was committed, except in the case of homicide, and DUI/DWI
deaths where the primary victims are the survivors of the victim. In domestic violence crimes, children of the primary
victims (who are receiving services) are also considered to be primary victims.
Secondary Victims: Persons other than primary victims receiving services because of their own reaction or needs
resulting from a crime.
Unduplicated Count: New and continuing victims served by the project . Continuing victim is a person served in the
prior grant year who is continuing to receive services in the new grant year.
EST. NO.
EST. NO.
VICTIMS
TYPE OF CRIME
VICTIMS
TYPE OF CRIME
Child Physical Abuse
Adults Molested as Children
Child Sexual Abuse
Survivors of Homicide
DUI/DWI - Victims of vehicular assault or
vehicular homicide, DUI/DWI crashes or
careless driving resulting in death.
Robbery
Domestic Violence
Assault
10
Adult Sexual Assault
Other violent crimes such as hate and
bias crime, gang violence (specify).
90
Elder Abuse (including economic
exploitation and fraud crimes)
Other, please specify
TOTAL UNDUPLICATED VICTIMS ESTIMATED TO BE SERVED DURING THE 12 -MONTH PERIOD
100
3
OBJECTIVE 2 (standard): To provide the following types of services to the following estimated number of
unduplicated victims during the 12 -month grant period.
Number of Victims Receiving Each Type of Service: Estimate the number of victims who will receive
each type of service during the grant period.
INDICATE HOW YOU ARE COUNTING SERVICES: (check one box)
n A victim may receive the same type of service more than once (i.e. information) but the type of
service can be counted only once during the grant period. An individual service category cannot
exceed the total number of victims listed in table A.
® A victim may receive the same type of service more than once (i.e. information) and the service is
counted every time during the grant period. An individual service category can exceed the total number
of victims listed in table A.
EST. NO.
EST. NO.
VICTIMS
SERVICES
VICTIMS
SERVICES
60
Crisis/Counseling Intervention (in person)
100
Victim Compensation Assistance
(required)
50
Follow-up (includes crisis intervention by
phone)
80
Personal Advocacy
Therapy
50
Telephone contact
Group Treatment / Support
Civil Legal Advocacy/Court
Accompaniment
Shelter / Safehouse
Forensic Exam
60
Information / Referral (in person)
Hospital/Clinic Response
Criminal Justice Support /
Advocacy/Court Accompaniment
Language Services (interpretation)
Emergency Financial Assistance
Emergency Civil Legal Attorney
Assistance
OTHER (specify)
Transportation
Transitional Housing
Victim Rights Act Services
4
PROJECT -SPECIFIC GOALS AND OBJECTIVES:
Add at least one more goal with objectives but no more than three additional goals with no more
than three objectives per goal. Objectives must be measurable and specific. Refer to Application
Instructions, use format provided below.
GOAL 2: The Weld County Long Term Care Ombudsman Program will educate long term care residents
and their families about their rights and crimes committed against at -risk adults. This education will
include information regarding Victim Rights and Victim Compensation.
Objective
(list title of person
responsible)
Intended
Outcome/Impact
Data Collection
Timeframe
1
The LTC Ombudsman
and Ombudsman
Supervisor will provide
1:1 education to 20 long
term care residents per
quarter.
Residents in facilities
will have knowledge of
their rights, crimes
targeting at -risk adults,
and victim rights and
victim compensation.
Staff documentation in
database.
During the
12 -month
grant period.
2
The LTC Ombudsman
and Ombudsman
Supervisor will provide
group education during 2
Resident Council
meetings per month.
Residents will have an
opportunity to discuss
victim information in a
group setting. Involve
facility staff in the
discussion.
Staff documentation in
database
During the
12 -month
grant period.
3
The LTC Ombudsman
and Ombudsman
Supervisor with discuss
potential Family Council
meetings with 1 long
term care facility and 1
assisted living facility per
quarter.
Families will have an
opportunity to discuss
victim information in a
group setting. Involve
facility staff in the
discussion.
Staff documentation in
database.
During the
12 -month
grant period.
GOAL 3: The Weld County Long Term Care Ombudsman Program will provide group education about
resident rights, and elder abuse detection and response topics. This education will include information
regarding Victim Rights and Victim Compensation.
Objective
(list title of person
responsible)
Intended
Outcome/Impact
Data Collection
Timeframe
1
The LTC Ombudsman
and Ombudsman
Supervisor will provide
education to 100-150
nurse aide students.
Nurse aide students will
be knowledgeable
about elder abuse and
victim services before
they begin their
employment at
facilities.
Staff documentation in
database. Training
evaluations.
During the 12
month grant
period.
5
2
The LTC Ombudsman
Direct care staff will be
Staff documentation in
During the 12
and Ombudsman
Supervisor will provide
education to 50-100
direct care staff.
informed about abuse
detection and how to
respond, including
victim services.
database.
month grant
period.
3
The LTC Ombudsman
Agencies in the
Staff documentation in
During the 12
and Ombudsman
Supervisor will provide
victim rights and
compensation
information during 5-10
committee meetings.
Ombudsman network
will be made aware of
victim rights and victim
compensation.
database.
month grant
period.
GOAL 4: The Weld County Long Term Care Ombudsman Program will collaborate with Adult Protective
Services with applicable.
Objective
(list title of person
responsible)
Intended
Outcome/Impact
Data Collection
Timeframe
1
The LTC Ombudsman
and Ombudsman
Supervisor will attend
Adult Protection
Networking Group
Meetings.
Networking with other
entities involved with at-
risk adult cases.
Include information
about victim rights and
victim compensation.
Number of cases
addressed during the
meetings.
During the 12
month grant
period.
2
The LTC Ombudsman
and Ombudsman
Supervisor will refer
cases to APS, and
receive cases from APS.
Referrals to appropriate
program.
Number of case referrals.
During the 12
month grant
period.
3
The LTC Ombudsman
and Ombudsman
Supervisor will combine
efforts with APS when
appropriate.
Combined
investigations will allow
for gathering necessary
data at the same time.
Number of collaborated
case investigations.
During the 12
month grant
period.
6
10. QUALITY ASSURANCE PLAN: Describe the approach for evaluating the project in response
to the stated objectives, intended outcomes/impact and data collection.
We will track the type of meeting attended, education provided, and the number of individuals present.
We will also distribute training evaluations when appropriate. The evaluations will include questions
regarding knowledge of victim rights and victim compensation. We will document cases in our database
in order to keep track of our collaboration with Adult Protective Services. All pertinent information will be
documented in our quarterly VALE reports. The long term care community is a population that no other
entity has access to like the Ombudsman Program. We intend to ensure that this population is made
aware of victim rights and victim compensation.
7
11a. Services as defined in the V.A.L.E. statute, 24-4.2-105 (4) (a — m) C.R.S.
Indicate YES for services which are indicated in the Goals and Objectives of this application, and
NO for services NOT indicated in the Goals and Objectives of this application. If your grant request
does not have at least ONE of the services below, then the project is not eligible for VALE Grant
funding.
YES
NO
Services: C.R.S. 24-4.2-105 (4) (a — m)
✓
(a) Provision of services for early crisis intervention;
x
(b) Provision of telephone lines for victims and witnesses
assistance;
,/
(c) Referral of victims to appropriate social service and victim
compensation programs and assistance in filling out forms for
compensation;
✓
(c.5) Assistance programs for victims and their families;
x
(d) Education of victims and witnesses about the operation of the
criminal justice system;
x
(e) Assistance in prompt return of the victims' property;
x
(f) Notification to the victim of the progress of the investigation,
the defendant's arrest, subsequent bail determinations, and the
status of the case;
x
(g) Intercession with the employers or creditors of victims or
witnesses;
x
(h) Assistance to the elderly and to persons with disabilities in
arranging transportation to and from court;
x
(i) Provision of translator services;
x
(j) Coordination of efforts to assure that victims have a secure
place to wait before testifying;
x
k) Provision of counseling or assistance during court appearances
when appropriate;
x
(1) Protection from threats of harm and other forms of
intimidation;
x
(m) Special advocate services
(7) (b) "Special advocate services" means the services offered to aid victims
who are children, including, but not limited to, court -appointed special advocate
(CASA) programs, sexual assault treatment and prevention programs,
community -based youth and family servicing programs, gang alternative
programs, school -based intervention and prevention programs, big brother and
big sister programs offering aid to children who are victims, restitution
programs, partners programs offering aid to children who are victims, and child
abuse treatment programs.
Only grants submitted by the Court Administrator's Office would check (2.5) (a) (I) below.
(2.5) (a) (I) The court administrator of each judicial district may apply for grants of moneys for the
purpose of collecting all moneys assessed by the courts, including moneys owed pursuant to this article, and
collecting and disbursing restitution owed to victims of crime;
Only grants submitted by the local Probation Department would check (2.5) (a) (II) below.
(2.5) (a) (I) The local probation department may apply for grants of moneys for the purpose of
implementing the right of victims.
8
11b. For each YES listed in 1 la), reference the Goal and Objective that relates to the service
provided with a brief explanation. DO NOT RESTATE THE GOAL OR OBJECTIVE.
List letter (a — m)
which refers to
question 13.a
List Goal and Objective(s) pertaining to the service provided in your GOALS and
OBJECTIVES.
a
Goal 2 and Objectives 1 and 2
Goal 3 and Objectives 1, 2 and 3
Goal 4 and Objectives 1, 2 and 3
Explanation: All of these goals and objectives focus on early crisis intervention
through education and collaboration of services
c
Goal 2 and Objectives 1 and 2
Explanation: We will provide residents and family members with information
regarding social services contacts and Ombudsman contacts in case they are in
need of assistance with filling out forms for compensation.
Goal 3 and Objectives 1, 2 and 3
Explanation: We will refer victims to APS, and collaborate with APS, when
appropriate. We will provide individuals with information regarding the Victim
Compensation Program and assist them as needed.
Goal 4 and Objectives 1, 2 and 3
Explanation: We will provide information regarding the Victim Compensation
Program during our trainings.
c.5
Goal 2 and Objectives 1 and 2
Explanation: We will educate residents and their families about assistance
programs.
Goal 3 and Objectives 1, 2 and 3
Explanation: We will provide education about assistance programs for victims
and their families.
12. Will this project utilize volunteers and or interns? n Yes N No
If yes, please answer the following:
Number of volunteers/interns which were utilized for last six months, July 1, 2017
through December 31, 2017.
In 2017, the total number of volunteers/interns was who provided hours
to the agency.
9
SECTION D - SERVICE INFORMATION:
for service through this project?
and will you serve?
figures from the Quarter 41FINAL report for
13. What is the population and geographic area targeted
a) How many crime victims have you served
Continuing Applicants should obtain these
each grant cycle.
VICTIMS SERVED
1 YEAR
July 1, 2015
Through
June 30, 2016
VICTIMS SERVED
1 YEAR
July 1, 2016
Through
June 30, 2017
PROJECTED VICTIMS
SERVED
July 1, 2017
Through
June 30, 2018
PROJECTION OF
VICTIMS TO SERVE
July 1, 2018
Through
June 30, 2019
60
89
90
100
b) What is the number
c) Are there other community
There are no other community
If yes, explain how this
14. Document community
a) List the to • five
of victims served July 1, 2017 through December 31, 2017? 49
agencies currently providing like services to the targeted population?
agencies that provide such series to long term care residents.
project is not a duplication of services.
support, coordination and networking by providing the following information:
agencies who your agency works most closely with in coordination and
victim services and indicate how you work with them.
provision of crime
AGENCY
HOW YOU COORDINATE
1 Home and Community Based Services
Collaborate efforts if working with the same resident/client.
Information and referral regarding Weld County long term care
facilities. SEP meetings when appropriate.
2 Adult Protective Services
Attend APS meetings. Collaborate efforts if working with the same
resident/client. Referral of abuse and neglect cases that occur in
Weld County.
3 Disability Law Colorado
Information, consultation and referral with CO State Ombudsman's
office.
4 Weld skilled nursing and assisted livings
Advocating, consultation, and education.
5 Medicaid Technicians
Refer residents and families when they are in need of applying for
Medicaid, or have questions regarding the process.
10
b) Is your agency an active participant in Weld County's Coordinating Committee for Victims of Crime
(CCVC)? If "yes," provide the name(s) and position(s) of the CCVC participant(s) and their level of
involvement in that group. Yes
NAME OF MEMBER
HOW THEY PARTICIPATE
Raegan Maldonado
Ombudsman Supervisor
Quarterly Meetings, Victim Rights Day, Trainings, Subcommittees when
appropriate.
Teresa Hill
Long Term Care Ombudsman
Quarterly Meetings, Victim Rights Day, Trainings, Subcommittees when
appropriate.
c) Briefly describe any other agency actions that demonstrate its high priority for developing
community support, coordination, networking, and cooperation.
COMMITTEE
HOW WE PARTICIPATE
Adult Protective Services
Networking Meeting
APS meetings. Present Ombudsman perspective during case review, provide
group with information regarding LTC, the Ombudsman Program and Victim
Services.
The Weld County Bio-Ethics
Committee
Quarterly meetings and emergency meetings. Develop case studies for review.
Provide education regarding LTC, the Ombudsman Program and Victim
Services.
ADRC (Aging and Disability
Resources for Colorado)
ADRC meetings. Provide education regarding LTC, the Ombudsman Program
and Victim Services.
Weld County Senior Support
Network
Attendance at meetings. Provide education regarding LTC, the Ombudsman
Program and Victim Services.
11
SECTION E - VICTIM COMPENSATION:
Provide the following information concerning your agency's involvement with the Crime Victim
Compensation Program:
15. a) Does your agency regularly inform victims about Victim Compensation and help them to apply
when appropriate? ® Yes n No
How?
b) Explain any major issues that hinder your agency in helping crime victims to understand Victim
Compensation eligibility requirements and to apply for benefits.
c) Date of the last 19th JD Crime Victim Compensation training: Thursday, September 28th, 2017
d) Person who conducted the training: Fawn Harmon
2 Number of Staff and Volunteers in your agency providing services to crime victims.
2 Number of Staff and Volunteers who attended the last Victim Compensation Training.
DO NOT INCLUDE VICTIM COMPENSATION BROCHURES WITH YOUR APPLICATION.
12
SECTION F - VICTIM RIGHTS CONSTITUTIONAL AMENDMENT:
16. Has your agency taken steps to assure that all staff and volunteers have read and understand the
GUIDELINES FOR ASSURING THE RIGHTS OF VICTIMS OF AND WITNESSES TO CRIMES:
Rights afforded to crime victims - C.R.S. 24-4.1-302.5; Procedures for assuring rights of victims of
crimes; C.R.S. 24-4.1-303; and Child victim or witness — rights and services — C.R.S. 24-4.1-304
® Yes ❑ No
a) Briefly describe how your agency assures that all staff and volunteers are trained on VRA.
We require that the Ombudsman staff review "Crime Victims Have Rights," on the DCJ website:
https://www.colorado.gov/dcj/ovp, on a yearly basis. We also review, "The Rights of Crime
Victims," on the Weld Sheriff's website:
https://www.weldsheriff.com/divisions/administration/victim services unit/.
b) Does your agency have a statutory mandate to notify victims about their rights under VRA?
❑ Yes ® No
c) Date of last VRA Training: June 28th, 2016
d) Person who conducted the training: Ami Gerstner, COVA
2 Number of Staff and Volunteers in your agency providing services to crime victims.
2 Number of Staff and Volunteers who attended the VRA Training.
e) How does your agency notify victims of their rights under VRA?
We provide residents, family members and facility staff members with, "The Rights of Crime Victims,"
brochures from the Weld County Sherriff's website:
https://www.weldsheriff.com/divisions/administration/victim services unit/. We also provide the large
print brochures from the DCJ website:
https://cdpsdocs.state.co.us/ovp/VRA/Crime Victims Rights Iargeprint22016.pdf, to individuals who have
visual impairments. In addition, we explain Resident Rights when individuals live in assisted living
facilities and nursing homes.
f) Does your agency have a brochure describing VRA? ❑ Yes ® No
If "yes", list the languages in which your brochure is available. See SECTION I. ATTACHMENTS
g) If your agency does not have a brochure describing VRA, please indicate if your agency utilizes
brochures from other agencies. See SECTION H. ATTACHMENTS. VRA brochures SHOULD be
included in the application (all languages).
Weld Sherriffs Department:
https://www.weldsheriff.com/divisions/administration/victim services unit/.
DCJ: https://cdpsdocs.state.co.us/ovpNRA/Crime Victims Rights largeprint22016.pdf
DO NOT INCLUDE VICTIM COMPENSATION BROCHURES TO YOUR APPLICATION.
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SECTION G - BUDGETARY INFORMATION: All Budget pages MUST be completed. All
figures should be rounded to the nearest dollar.
17. Have you previously received 19th JD VALE Funding for this project? ® Yes n No
GRANT YEAR
2017-2018
2016-2017
AMOUNT AWARDED
$10,000
$10,000
AMOUNT OF FUNDS RETURNED
( not used durin • • rant cycle)
-0-
2015-2016
$9,000
-0-
2014-2015
$9639
-0-
18. What is the projected cost per client served (cost/benefit ratio)?
FORMULA: Funds requested divided by number of victims projected to serve = cost per client
$10,000 divided by 100 = $100 cost per client.
19. RESPONSIBLE PARTIES:
a) List the two individuals who are responsible for ensuring the grant is
administrated as proposed by the organization and approved by the VALE Board.
NAME
TITLE
PHONE
EMAIL
Eva Jewell
AAA Division
Head
(970) 400-6101
ejewell@weldgov.com
Raegan Maldonado
Ombudsman
Supervisor
(970) 400-6128
rmaldonado@weldgov.com
b) Who (give name and title) in your agency is responsible for reviewing agency bank statements
against agency financial reports for accuracy of financial information?
Chris D'Ovidio
County Accounting
20. What controls and processes does your agency have in place for writing checks? The answer should
include information including: who in the agency is authorized to request a check, who is authorized to
write a check, who is authorized to sign a check, whether or not dual signatures are required on any
checks, and whether or not a person authorized to write a check could sign a check to themselves.
Weld County has separate processes in place to order goods and services, authorize payment, approve
payment and write checks. Program personnel order goods and services with the assistance of the
county purchasing office. After the order is received, an invoice is sent to the department fiscal office
where the accounts payable staff verify the delivery of the item, obtain authorization for payment and
code the payment in the accounting system. Approval of the payment is completed by a departmental
accounting supervisor and the central county accounting office verifies the approval and writes the check.
The system of internal control ensures that authorization, approval and disbursement are done by
different offices; no checks are authorized and written by the same individual.
21. What process does your agency have in place to reconcile financial information with the quarterly
VALE Financial Report?
The Ombudsman Supervisor submits a request to the Weld County Human Services fiscal department,
requesting that the fiscal department complete the required information/paperwork. The completed
information is then reviewed by the Ombudsman Supervisor, the AAA Department Head, and the
Financial Officer. The AAA Department Head and the Financial Officer sign the quarterly VALE financial
reports.
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TOTAL
This page recaps your entire
picture of your agency's
Application.
Please indicate the
services.
FUNDING
AMOUNT
BUDGET
AGENCY
Victim Service Agency
funding sources and
sources for ALL
INFORMATION
VICTIM SERVICES
Budget. This recap provides an overall
percentage of funding being requested in the VALE
funding your agency receives for victim
START DATE END DATE
Month/Day/Year Month/Day/Year
VALE Grant (if applicable)
$10,000
07/01/17
06/30/18
DCJ (Ex: VOCA, VAWA)
01/01/18
12/31/18
Other Victim Services
/ /
/ /
Grants received from other
VALE Judicial Districts
Other Grants
/ /
/ /
Other — Federal Funds
$68,933
07/01/17
06/30/18
Other - State
$98,197
07/01/17
06/30/18
TOTAL
$177,130
Please specify the source of "Other" funds (other grants, government funds,
city funds, donations, fund-raising, etc.) "Other" funds should reflect hard
dollars and NOT in -kind contributions (office space, phones, etc)
HOW WILL FUTURE FUNDING NEEDS BE MET?
Other -Federal Funds listed above, refers to the Older American's Act funds that support
the Long Term Care Ombudsman Program. Weld County Area Agency on Aging
programs are funded through the Older American's Act and other grants designated for
specific programs. The Ombudsman Program will continue to be funded by the Older
American's Act and other designated grants.
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VALE PROJECT BUDGET
PROJECT FUNDS REQUESTED BUDGET:
Continuation Applicants fill out Columns 1, 2, and 3.
New Applicants fill out Column 2 only.
INFORMATION
ROUND TO NEAREST DOLLAR
Continuation Applicants
ALL APPLICANTS
Continuation
(Column 1)
2017 - 2018
(Column 2)
2018 - 2019
Applicants
(Column 3)
Current Grant Award
Requested Budget
Increase or
Decrease
PERSONNEL
PERSONNEL
(+ / -)
Job Position
Job Position/NAME
Teresa Hill
5650
Teresa Hill
5929
+279
LTC Ombudsman
LTC Ombudsman
Raegan Maldonado
729
Raegan Maldonado
1046
+317
Ombudsman Supervisor
Ombudsman Supervisor
Fringe Benefits
2921
Fringe Benefits
2325
-596
Subtotal
I 9300
Subtotal
9300
-0-
EQUIPMENT
EQUIPMENT
(+1 -)
Subtotal
Subtotal
SUPPLIES AND OPERATING
EXPENSES
SUPPLIES & OPERATING EXPENSES
(+ / -)
Training Materials
200
Training Materials
200
-0-
Subtotal
200
Subtotal
200
-0-
IN-STATE TRAVEL
IN -STATE TRAVEL
(+ / -)
Mileage
500
Mileage
500
-0-
Subtotal
500
Subtotal
500
-0-
PROFESSIONAL SERVICES
PROFESSIONAL SERVICES
(+ / -)
Subtotal
Subtotal
TOTAL FUNDS: 10,000
TOTAL FUNDS REQUESTED: 10,000
-0-
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VALE PROJECT
BUDGET DETAIL AND JUSTIFICATION
A. PERSONNEL:
List each job position, include the name of the employee, if available. If two individuals have the
same job title, list it twice.
Indicate FTE of individual (EX: 1 FTE; .5 FTE; .75 FTE)
TOTAL COST - Show the total amount of salary and fringe benefits of the position
(SALARY and FRINGE BENEFITS are to be shown separately.)
VALE % - Show the VALE percent requested for the total cost of the position
VALE Funding - Calculate the VALE funding request based on the TOTAL COST and VALE %.
Other Funding Source(s) - Indicate how the position is paid for other than VALE funding. If the
position cannot be funded (because 100% VALE Funding) indicate this.
Title of Job Position\Name
FTE
Total
Cost
VALE
%
Requested
VALE
Funding
Request
ed
If THIS grant funding will not pay for the
entire position, what other SOURCE will be
used to pay for the rest of the position
Teresa Hill
LTC Ombudsman (S)
1
$46,014
13%
$5,929
Older Americans Act -Federal and State
Teresa Hill
LTC Ombudsman (F)
$25,345
8%
$1,977
Older Americans Act -Federal and State
Raegan Maldonado
Ombudsman Supervisor (S)
1
$65,880
2%
$1,046
Older Americans Act -Federal and State
Raegan Maldonado
Ombudsman Supervisor (F)
$21,808
2%
$348
Older Americans Act -Federal and State
Name of person and their Title: Teresa Hill, Long Term Care Ombudsman
VALE Cost: $5929 + $1,977 = $7,906
Name of person and their Title: Raegan Maldonado, Ombudsman Supervisor
VALE Cost: $1,046 + $348 = $1,394
B. EQUIPMENT REQUEST: Refer to Application Instructions to complete this section
correctly.
None
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C. SUPPLIES AND OPERATING REQUEST: All supplies and operating requests must be
specific, itemized costs related to victim services.
We are requesting $200 to purchase additional supplies, i.e. training materials, DVD's, etc.
D. IN -STATE TRAVEL REQUEST: Itemize travel expenses of project personnel by purpose
We are requesting $500 for mileage reimbursement for travel to and from long term care facilities
in Weld County, and for travel to and from training events.
E. PROFESSIONAL SERVICES REQUEST: List consultants or independent contractors who
will provide victim services under the grant.
F. DIFFERENCES FROM LAST YEAR'S REQUEST: Continuation Applicants only for
Victim Services requests: If this is an application for continuing funding, explain any changes
from last year's awarded funding for Victim Services requests and this proposed funding.
We requested and were granted $10,000 during the 2017-2018 funding cycle. We are
requesting the continuation of $10,000 during the 2018-2019 funding cycle. The Long Term
Care Ombudsman Program is solely funded by state and federal grants, and additional
funding from Weld County Government is not a viable option.
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