HomeMy WebLinkAbout20160651.tiff RESOLUTION
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's Assistance and Law Enforcement
(VALE) Grant Application for the Long Term Care Ombudsman Friendly Visitor Program from the
County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld
County, on behalf of the Department of Human Services, Area Agency on Aging, to the Victim's
Assistance and Law Enforcement Board,commencing July 1, 2016, and ending June 30, 2017,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's Assistance and Law Enforcement(VALE) Grant Application for
the Long Term Care Ombudsman Friendly Visitor Program from the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Department of Human Services, Area Agency on Aging, to the Victim's Assistance and Law
Enforcement Board, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said application.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 22nd day of February, A.D., 2016.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: `� � � r�..J-. L{, zee
-
j� �C�+�•K Mike Freeman, Chair
Weld County Clerk to the Board
a EXCUSED
n^n& Sean P. C may, Pro-Tem-) oaD,dt
aijlDe y Clerk to the Board
`ulie A. Cozad
AP' ' • D RM:i am i CUSED
rbar Kirkmeyer
• n Y orne tt ♦ �
Y
� ,, ' ,i►'�°3/9 Steve Moreno
9 Date of signature:
2016-0651
HSI-VCAYL I HR0087
r
MEMORANDUM •
DATE: February 5, 2016
Igo?.
T r E, ^ B1/4 TO: Board of County Commissioners—Pass-Around •
rFR: Judy A. Griego, Director, Human Services
• GOUNTY1
RE: Weld County Department of Human Services' Area
Agency on Aging 2016-2017 Victim's 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 of the Departments Area Agency on Aging 2016-2017 Victim's
Assistance& Law Enforcement (VALE) Grant Application.The Ombudsman Program has
received the VALE grant for the past 19 years since 1997. We are requesting$12,000 for the
July 2016 through June 2017 funding cycle. Through the years, the VALE grant has allowed
the Ombudsman Program to increase staff time to keep up with the increasing demand for
advocacy on behalf of this very vulnerable population. The funds have enabled the Program to
maintain an abuse education and awareness program aimed at educating direct caregivers who
work in long term care settings. The grant has also allowed the opportunity for the Ombudsman
Program to educate residents and staff about the Ombudsman Program,abuse issues and
resident rights. Continued funding will make it possible for the Ombudsman Program to serve
the increasing number of vulnerable long term care residents. We believe that our request for
the continuation of funding relates to the mandate of early crisis intervention and to provide
assistance and support to victims and their families.
I do not recommend a Work Session. I recommend approval of this Application.
Approve Request
BOCC A_•enda Work Session
Sean Conway l�
Steve Moreno
Barbara Kirkmeyer •
Mike Freeman
Julie Cozad
2016-0651
Pass-Around Memorandum; February 5, 2016—Contract ID 356 Page 1
2016-2017 VALE ASSISTANCE FUNDS
19th Judicial District, Weld County Application
REFER TO APPLICATION INSTRUCTIONS TO COMPLETE THIS APPLICATION CORRECTLY.
SECTION A - AGENCY INFORMATION: %yAlEusEoxtY`
1. APPLICANT AGENCY:
Grant# .// ✓"/ ✓ 'i i
Amoun4Requested ; 2 G
Program Name: Weld County Department of Human Services Amnunr'
',; `
Area Agency on Aging
Street Address(if not confidential): 315 C. North 11th Avenue
Greeley, Colorado 80631
Mailing Address (if different): Post Office Box 1805
Greeley, Colorado 80632
Phone: (970) 346-6950 extension 6128
Fax: (970) 346-6951
E-Mail: rmaldonado(a�weldgov.com
2. CONTACT PERSON: Raegan Maldonado
Title: Ombudsman Supervisor
Phone: (970)346-6950 extension 6128
Fax: (970) 346-6951
E-Mail: rmaldonado(a�weldaov.com
3. Agency Status ® governmental ❑private-non-profit ❑ 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 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: $12,000
® Victim Services $12,000 ❑ Equipment$
ITEMS 1 - 6 MUST REMAIN ON THIS PAGE
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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 25 Assisted Living Facilities in Weld
County. 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 that resident rights are being
respected and that quality care is being administered. In addition, our program focuses on the
importance of recognition and appropriate response to signs and symptoms of elder abuse and
neglect. Continued V.A.L.E. funding will make it possible for the Weld County Area Agency on Aging
Ombudsman Program to serve the increasing number of vulnerable long term care residents and
their families. 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.
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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 j
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 Robbery
vehicular homicide, DUI/DWI crashes or
careless driving resulting in death.
Domestic Violence Assault
10 Adult Sexual Assault Other violent crimes such as hate and
bias crime, gang violence (specify).
80 Elder Abuse(including economic Other, please specify
exploitation and fraud crimes)
TOTAL UNDUPLICATED VICTIMS ESTIMATED TO BE SERVED DURING THE 12-MONTH PERIOD 90
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OBJECTIVE 2 (standard): To provide the following types of services to the following estimated number of
unduplicated victims during the 12-month grant period.
Number of Victims Receiving Each Type of Service: Estimate the number of victims who will receive
each type of service during the grant period.A victim may receive the same type of service more than
once(i.e. counseling), but the type of service can be counted only once during the grant period. An
individual service category cannot exceed the total number of victims listed in table A.
EST. NO. EST. NO.
VICTIMS SERVICES VICTIMS SERVICES
50 Crisis/Counseling Intervention (in person) 90 Victim Compensation Assistance
(required)
40 Follow-up (includes crisis intervention by 70 Personal Advocacy
phone)
Therapy 40 Telephone contact
Group Treatment/Support Civil Legal Advocacy/Court
Accompaniment
Shelter/Safehouse Forensic Exam
50 Information/Referral (in person) Hospital/Clinic Response
Criminal Justice Support/ Language Services (interpretation)
Advocacy/Court Accompaniment
Transportation
Emergency Financial Assistance
Transitional Housing
Emergency Civil Legal Attorney
Assistance
Victim Rights Act Services
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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. 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 especially against at-risk adults. This education
will include information regarding Victim Rights and Victim Compensation.
Objective Intended Data Collection Timeframe
(list title of person -Outcome/Impact
responsible)
1 The LTC Ombudsman Residents in facilities Staff documentation in During the
and Ombudsman will have knowledge of database. 12-month
Supervisor will provide their rights, crimes grant period.
1:1 education to 20 long targeting at-risk adults,
term care residents per and victim rights and
quarter. victim compensation.
2 The LTC Ombudsman Residents will have an Staff documentation in During the
and Ombudsman opportunity to discuss database. 12-month
Supervisor will provide victim information in a grant period.
group education during 2 group setting. Involve
Resident Council facility staff in the
meetings per month. discussion.
3 The LTC Ombudsman Family members will Staff documentation in During the
and Ombudsman have the knowledge of database. 12-month
Supervisor will provide victim services, rights, grant period.
education during 4 crimes, and information
Family Council needed when applying
meetings. for victim
compensation.
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 Intended Data Collection Timeframe
(list title of person Outcome/Impact
responsible)
1 The LTC Ombudsman Nurse aide students will Staff documentation in During the 12
and Ombudsman be knowledgeable database. Training month grant
Supervisor will provide about elder abuse and evaluations. period.
education to 100-150 victims services before
nurse aide students. they begin their
employment at
facilities.
2 The LTC Ombudsman Direct care staff will be Staff documentation in During the 12
and Ombudsman informed about abuse database. Training month grant
Supervisor will provide detection and how to evaluations. period.
education to 50-100 respond, including
direct care staff. victim services.
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3 The LTC Ombudsman Agencies in the Staff documentation in During the 12
and Ombudsman Ombudsman network database. month grant
Supervisor will provide will be made aware of period.
victim rights and victim victim rights and victim
compensation compensation.
information to attendees
during 5-10 committee
meetings.
GOAL 4: The Weld County Long Term Care Ombudsman Program will collaborate with Adult Protective
Services when applicable.
Objective Intended Data Collection Timeframe
(list title of person Outcome/Impact
responsible)
1 The LTC Ombudsman Networking with other Number of cases During the 12
and Ombudsman entities involved with at- addressed during the month grant
Supervisor will attend risk adult cases. meetings. period.
10-12 Adult Protection Include information
Networking Group about victim rights and
Meetings. victim compensation.
2 The LTC Ombudsman Referrals to appropriate Number of case referrals. During the 12
and Ombudsman program. month grant
Supervisor will refer period.
cases to APS, and
receive cases from APS.
3 The LTC Ombudsman Combined Number of collaborated During the 12
and Ombudsman investigations will allow case investigations. month grant
Supervisor will combine for gathering necessary period.
efforts with APS when data at the same time.
appropriate.
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10. QUALITY ASSURANCE PLAN: Describe the approach for evaluating the project in response
to the stated objectives, intended outcomes/impact and data collection.
On a monthly basis, we will document all information in our database system, "Ombudsmanager." This
will allow us to track the type of meeting attended, education provided, and the number of individuals
present. We will also distribute training evaluations when education is provided to nurse aides and direct
care staff members. 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.
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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.
YES NO Services: C.R.S. 24-4.2-105 (4) (a—m)
V (a) Provision of services for early crisis intervention;
x (b) Provision of telephone lines for victims and witnesses
assistance;
V (c) Referral of victims to appropriate social service and victim
compensation programs and assistance in filling out forms for
compensation;
V (c.5) Assistance programs for victims and their families;
x (d) Education of victims and witnesses about the operation of the
criminal justice system;
x (e)Assistance in prompt return of the victims' property;
x (t)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.
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lib. For each YES listed in 13a), reference the Goal and Objective that relates to the service
provided with a brief explanation. DO NOT RESTATE THE GOAL OR OBJECTIVE.
a Goal 2 and Objectives 1, 2 and 3
Goal 3 and Objectives 1, 2 and 3
Goal 4 and Objectives 1, 2 and 3
Explanation: All of these goals and objectives focus on early crisis intervention through
education and collaboration of services.
c Goal 2 and Objectives 1, 2 and 3
Explanation: We will provide residents and family members with information regarding social
services contacts and Ombudsman contacts in case they are needing assistance with filling out
forms for compensation.
Goal 3 and Objectives 1, 2 and 3
Explanation: We will refer victims to APS, and collaborate efforts 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, 2 and 3
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 ®No
If yes,please answer the following:
Number of volunteers/interns which were utilized for last six months,July I, 2014
through December 31, 2014.
Number of volunteer/intern hours for the last six months, July 1, 2014 through
December 31, 2014.
In 2014, the total number of volunteers/interns was who provided hours
to the agency.
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SECTION D - SERVICE INFORMATION:
13. What is the population and geographic area targeted for service through this project?
a) How many crime victims have you served and will you serve?
VICTIMS SERVED VICTIMS SERVED PROJECTED VICTIMS PROJECTION OF
1 YEAR 1 YEAR SERVED VICTIMS TO SERVE
July 1, 2012 July 1, 2013 July 1, 2014 July 1, 2015
Through Through Through Through
June 30, 2013 June 30, 2014 June 30, 2015 June 30, 2016
82 90 90 90
b)What is the number of victims served July--1, 2015 through December 31, 2015?
c) Are there other community agencies currently providing like services to the targeted population?
There are no other community agencies that provide such services to long-term care residents.
If yes, explain how this project is not a duplication of services.
14. Document community support, coordination and networking by providing the following information:
a) List the top five agencies who your agency works most closely with in coordination and
provision of crime victim services and indicate how you work with them.
AGENCY HOW YOU COORDINATE
1 Home and Community Based Services SEP quarterly meeting, collaborate efforts if working with the same
resident/client. Information and referral regarding Weld County long
term care facilities.
2 Adult Protective Services APS monthly meeting, APS case staffing meeting, collaborate efforts
if working the same resident/client, together facilitate trainings to
groups. Referral of abuse and neglect cases that occur in Weld
County.
3 Disability Law Colorado Information, consultation and referral with State Ombudsman's
office.
4 Medicaid Technicians Refer residents and families when they are in need of applying for
Medicaid.
5 Weld skilled nursing and assisted living Advocating, consultation, and education.
facilities
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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 Quarterly Meetings, Victim Rights Day, Subcommittee as needed, Trainings
Ombudsman Supervisor
Teresa Hill Quarterly Meetings, Victim Rights Day, Subcommittee as needed, Trainings
Long Term Care Ombudsman
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 Monthly meetings, present Ombudsman perspective during case review,
Networking Meeting provide group with information regarding LTC, the Ombudsman Program and
Victim Services.
The Weld County Bio-Ethics Quarterly meetings and emergency meetings. Develop case studies for review.
Committee Provide education regarding LTC, the Ombudsman Program and Victim
Services.
ADRC (Aging and Disability Six meetings per year. Provide education regarding LTC, the Ombudsman
Resources for Colorado) Program and Victim Services.
Weld County Senior Support Attendance at meetings. Provide education regarding LTC, the Ombudsman
Network Program and Victim Services.
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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? We meet with residents, victims, family members and staff members 1:1 to provide them with
information regarding Victim Compensation and their rights. In addition, we inform people about Victim
Compensation during Ombudsman trainings and meetings. We also educate individuals via telephone
and email, when appropriate. We also inform them that we can assist them with the application process if
they would like us to do so.
b) Explain any major issues that hinder your agency in helping crime victims to understand Victim
Compensation eligibility requirements and to apply for benefits.
We have no major issues that hinder our agency in helping crime victims to understand Victim
Compensation eligibility requirements and to apply for benefits.
c) Date of the last Crime Victim Compensation training: Wednesday, July 16th, 2014
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.
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SECTION F- VICTIM RIGHTS ACT:
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
Z Yes ❑No
a) Briefly describe how your agency assures that all staff and volunteers are trained on VRA.
We require that the Ombudsman staff read, "Crime Victims Have Rights," on the DCJ website:
www.dcl.state.co.us, on a yearly basis. If we are able to recruit appropriate volunteers, we will
require that they review this information as part of their training.
b) Does your agency have a statutory mandate to notify victims about their rights under VRA?
n Yes ®No
c) Date of last VRA Training: October 3rd, 2014
d)Person who conducted the training: Ami Gerstner, COVA
2 Number of Staff and Volunteers in your agency providing services to crime victims.
1 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 information from, "Crime Victims
Have Rights,"from the DCJ website: www.dcl.state.co.us, when appropriate. We provide the large print
brochures to individuals who have visual impairments. We also have Ombudsman brochures that we
distribute that specifically explain Resident Rights when they live in an assisted living facility or nursing
home.
f) Does your agency have a brochure describing VRA? n Yes ® No
If"yes", list the languages in which your brochure is available. See SECTION I.ATTACHMENTS
g) If you agency does not have a brochure describing VRA, please indicate if your agency utilizes
brochures from other agencies. See SECTION I ATTACHMENTS VRA brochures SHOULD be
included in the application (all languages).
"Crime Victims Have Rights,"from DCJ website: www.dcl.state.co.us
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 received 19th JD VALE Funding for this project? ® Yes n No
GRANT YEAR AMOUNT AWARDED AMOUNT OF FUNDS RETURNED
( not used during grant cycle)
2015-2016 $9,000 0
2014-2015 $9,639 0
2013-2014 $12,000 0
2012-2013 $12,000 0
18. What is the projected cost per client served (cost/benefit ratio)?
Funds requested divided by number of victims projected to serve =cost per client
$12,000 divided by 90 = $133.33 cost per client.
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 (970) 346-6950 ejewell@weldgov.com
Head 6101
Raegan Ombudsman (970) 346-6950 raldonado@weldgov.com
Maldonado Supervisor 6128
b) Who (give name and title) in your agency is responsible for reviewing agency bank statements
against agency financial reports for accuracy of financial information?
Chris D'Ovidio County Accounting
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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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 1,2016 to June 30,2017
We hereby certify that the information contained herein is true and correct to the best of our
knowledge and belief. The following signatories understand and agree that any grant received as a
result of this application shall incorporate and be subject to the statements made within the above
described VALE Grant Application(The Application). Furthermore,the signatories certify that
they have each read The Application and are fully cognizant of their duties and responsibilities for
this project.
Original signatures of each party to this application(i.e.,Project Director,Financial Officer and
Authorized Official)are required. Please use BLUE INK to distinguish the original documents
from copies. Refer to Application Instructions for definitions for the signing authorities.
Project Director:
Name: Eva M.Jewell Position/Title: AAA Division Head
Agency(including Division or Unit): Weld County Department of Human Services,Area Agency on Aging
Mailing Address: Post Office Box 1805,Greeley,CO 80632
Phone: (970)346-6950 ext 6101 Fax: (970)346-6951 E-Mail:eiewell@weldgov.com
Signature: r ve"-YY1 9 `[-P Date: a - 3 — / e
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)352-1551 ext 6537 ax: (970)346-7691 E-Mail: lBottorff@weldgov.com
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Signature: Date: 2 LS// it
Authorized Official:
Name: Mike Freeman Position/Title: Chair
Agency(including Division or Unit): Weld County Board of Commissioners
Mailing Address: Post Office Box 758,Greeley.CO 80632
Phone: (970)336-7204 ext 4200 Fax: (970)352-0242 E-Mail:mfreeman@weldgov.com
Signature: T16-4G2-4 .o Date: FEB 2 2 2016
In accordance with the Colorado Revised Statutes 24-72-202.6,information supplied in this application is considered a public record.
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