HomeMy WebLinkAbout20140481.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, 2014, and ending June 30, 2015,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 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 19th day of February, A.D., 2014.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY COLORADO
ATTEST: U ,w1 ; /, U^ (: d
`tC� (•G ougla0 Rademac r, Chair
Weld County Clerk to the Board
pp x�� rarbara Kirkmey r, Pro-Te
BY: Q y al. c—,
Deput Clerk to the Board �-
Sean P. Conway
APPR D AS T RM: lu��
Mike Freeman
ountyAttorney 2
1 t\' E/14 m Garcia
Date of signature: "a & 'Iz/
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/tr ism
2014-0481
HR0085
MEMORANDUM
X861 ixgitDATE: February 13, 2014
V� TO: Douglas Rademacher, Chair, Board of County Commissioners
G o U N T 71 FROM: Judy A. Griego, Director, Human S rvices ��
RE: Weld County Department of Hu ervi s Area gent 3
on Aging's 2014-2015 Victim As is ance 'id Law
Enforcement (VALE) Grant Applib tion
Enclosed for Board approval is the Department's Area Agency on Aging's Victim Assistance and
Law Enforcement (VALE) Grant application. This Grant was reviewed by Pass-around
Memorandum dated January 30, 2014, and approved for placement on the Board's Agenda.
This grant will allow the Ombudsman program to provide elder abuse education programs to long
term care staff,continue the long term care friendly visitor program, and maintain and strengthen
the Volunteer Ombudsman program.
The amount being requested for the July 1, 2014 through June 30, 2015, funding cycle is
$12,000.00.
If you have any questions, give me a call at extension 6510.
2014-0481
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 I,2014 to June 30,2015
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 Agin°
Mailing Address: Post Office Box 1805, Greeley,CO 80632
Phone: (970)346-6950_ ext 6101 Fax: (970)346-6951 E-Mail: ejewell@weldgov.com
Signature: (i,L'r 64„.0 Date:
Financial Officer:
Name: Lennie L. Bottorff Position/Title: Fiscal and Budget Manager
Agency(including Division or Unit): Weld County Department of Human Services
Mailing Address: Post Office Box A, Greeley, CO 80632
Phone: 970)352-1551 ext.6537 Fax: (970)346-7691 E-Mail: lbott``orffi/2i weldgov.com
Signa ure: Date: 2/z/!/`/
Authorized Official:
Name: Doug Rademacher 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: dademacher@weldgov.com
Signature:(rocs np>>+ �i4 (M.x-" Date: FEB 1 9 2014
In accordance with the Colorado Revised Statutes 24-72-202.6,information supplied in this application is considered a public record.
ow/I-eV,/
2014-2015 VALE ASSISTANCE FUNDS
19th Judicial District, Weld County Application
SECTION A - AGENCY INFORMATION: VALE USE ONLY
1. APPLICANT AGENCY: Grant#:
Amount Requested:
Program Name: Weld County Department of Human Services Amount Funded:
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(u7a,weldgov.com
2. CONTACT PERSON: Raegan Maldonado
Title: Lead Lonq Term Care Ombudsman
Phone: (970) 346-6950 extension 6128 •
Fax: (970) 346-6951
E-Mail: rmaldonado(ffiweldgov.com
3. Agency Status (i.e., governmental, private-non-profit, or private-for-profit): Governmental
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 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 LTC Ombudsmen to
maintain a friendly visitor and awareness program.
6. FUNDS REQUESTED: $12,000
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 under the
umbrella of the Weld County Area Agency on Aging and the Weld County Department of Human
Services. The authority of the local Ombudsman Program comes from the Older American's Act,
Colorado Revised Statutes 25-11.5 and the Nursing Home Reform Law of 1987. The Weld County
Ombudsman acts as a consumer voice for the concerns of the elderly living in institutions, who may
have no one else to speak for them. The Ombudsman also receives and resolves questions, issues,
problems and complaints made by, for, or on behalf of residents of long term care facilities.
The purpose of the Weld County Long Term Care Ombudsman Program is to assist and empower
consumers of long term care services by providing information about these services and furnish
support in complaint resolution. These issues or complaints 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. The Long Term Care Ombudsman Program is a
resident/patient/consumer-centered advocacy program.
Long Term Care Ombudsmen have statutory status under the Older Americans'Act of 1965 as
amended and are required by federal and state law to visit every nursing home monthly and every
assisted living facility on a quarterly basis. They also receive, investigate and resolve complaints;
identify needs of long term care residents; and help establish programs to meet those needs. The
Ombudsmen also document and report problems of long term care and help to stimulate and
promote improvement of the system.
8. Brief Project Description for which the funds are being requested.
The V.A.L.E. grant has allowed the Ombudsman Program to maintain staff time to keep up with the
increasing demand for advocacy on behalf of this very vulnerable population. The funds have also
enabled the program to maintain an educational program aimed at educating residents, Certified
Nursing Assistants (C.N.A.'s), other long term care staff, and family members. 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 the 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.
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SECTION C - GOALS AND OBJECTIVES:
(Goal 1, objectives 1 and 2, are mandatory for all applicants.)
11. 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
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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.
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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
Other violent crimes such as hate and
10 Adult Sexual Assault 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
Civil Legal Advocacy/Court Individual Therapy
Accompaniment -
Civil Legal Attorney Assistance 50 Information / Referral (in person)
Criminal-Justice Support./----- - 10 —lnformatlon-/-Refer-Fal-(by phone)-- --
Advocacy/Court Accompaniment
50 Crisis/Counseling Intervention (in person) Language Services (interpretation)
40 Crisis/Counseling Intervention (by phone) Shelter/Safehouse -
Emergency Financial Assistance Transitional Housing
90 Follow-up (in person, by phone, or written) Transportation
Forensic Exam 90 Victim Compensation Assistance
(required)
Victim/Survivor Advocacy
Group Treatment/Support
Victim Rights Act Services
Hospital/Clinic Response
Note: The estimated number of victims who will receive each type of service will depend on the
cognition level of the victim. Many of the residents have dementia and may not be able to talk on the
telephone, and would be visited by the Ombudsman at the facility.
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PROJECT-SPECIFIC GOALS AND OBJECTIVES:
Add at least one more goal with objectives but no more than four additional goals with objectives.
Use format provided below. Goals should be clear, concise, broad statements that highlight what the project
intends to achieve. They should relate to the Project Description and Budget pages of the Application.
Objectives (no more than three per goal) should be specific and measureable-(i.e. a number can be attached)in
order to measure changes brought about by the project toward achieving each goal. Objectives state specifically
what will be done, by whom, and by when. Objectives should be related to the personal positions requested in the
budget. A timetable of projected achievement should be indicated in the Goals and Objectives.
Efficiency and Effectiveness are measured in Goals and Objectives and reported on in quarterly reports.
Efficiency: Were the project's proposed activities accomplished as projected?
Effectiveness: How will you determine that your project is effective or has made a difference to the victims served?
GOAL 2: The Assistant Ombudsman and the Lead Ombudsman will educate long term care residents
and their families about the Ombudsman Program, their Rights as Residents and crimes committed
especially against the elderly. This education will also include information regarding Victim Rights and
Victim Compensation.
Objective 1: Provide one-on-one education to 20 long term care residents per quarter.
Objective 2: Provide group education during 2 Resident Council meeting per month(6 per quarter)
during the funding cycle.
Objective 3: Provide education to 4 Family Councils by the end of the funding cycle, June 2015.
GOAL 3: Collaborate with Adult Protective Services when applicable.
Objective 1: Attend monthly Adult Protective Services meetings and provide information and
assistance, 10-12 by June 2015.
Objective 2: Refer cases to Adult Protective Services when the Ombudsman Program is notified of an
elder abuse crime that took place outside of the long term care facility, throughout the July 2014-June
2015 funding cycle. Examples include but are not limited to physical abuse, neglect of an at-risk adult,
and financial exploitation.
Objective 3: Combine efforts with Adult Protective Services when both programs are responding to a
case that took place in a Weld County long term care facility.
GOAL 4: The Assistant Ombudsman and the Lead Ombudsman will provide education regarding the
Ombudsman Program, Resident Rights and elder abuse detection and response topics. This education
will also include information regarding Victim Rights and Victim Compensation.
Objective 1: Schedule trainings with the Nurse Aide Coordinator at AIMS Community College (both
campuses, Fort Lupton and Greeley), 2-4 times a quarter during the funding cycle.
Objective 2: Educate 50-75 students from July to December 2014, and 50-75 students from January
to June 2015.
Objective 3: Provide education to 2-3 nurse aide high school classes during this funding cycle.
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• 12. Address what problems, if any, you anticipate in implementing your program's goals and objectives.
We do not anticipate any problems with implementing our program goals and objectives.
• How do you plan to resolve these problems?
N/A
13a. 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;
(b) Provision of telephone lines for victims and witnesses
x 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;
(f)Notification to the victim of the progress of the investigation,
x the defendant's arrest, subsequent bail determinations, and the •
status of the case;
(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;
(j) Coordination of efforts to assure that victims have a secure
place to wait before testifying;
(k)Provision of counseling or assistance during court appearances •
when appropriate;
(1)Protection from threats of harm and other forms of
.x 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.
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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.
13b. For each YES listed in 13 a), 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) List Goal and Objective(s) pertaining to the service provided in your GOALS and
which refers to OBJECTIVES.
question 13.a
Goal 2 and Objectives 1, 2 and 3 •
Goal 3 and Objectives 1, 2 and 3
a 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.
Goal 2 and Objectives 1, 2 and 3
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Explanation: We will provide residents and family members information regarding
the Victim Compensation program during one-on-one discussions and during
group meetings.
Goal 3 and Objectives 1, 2 and 3
c Explanation: The Ombudsmen 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 students with information regarding the Victim
Compensation program during our trainings.
Goal 2 and Objectives 1, 2 and 3
Explanation: The Ombudsmen will educate residents and their families about
c.5 assistance programs.
Goal 4 and Objectives 1, 2 and 3
Explanation: The Ombudsmen will educate students about assistance programs
for victims and their families.
14. Will this project utilize volunteers and or interns? No.
If yes,please answer the following:
0 Number of volunteers/interns which were utilized from July 1, 2013 through
December 31, 2013.
0 Number of volunteer/intern hours from July 1, 2013 through December 31, 2013.
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SECTION D - SERVICE INFORMATION:
15.What is the population and geographic area targeted for service through this project?
Populations targeted are older adults,age 60 plus, who reside in nursing homes and assisted living
facilities located in Weld County. This population is becoming more frail and at-risk for abuse or neglect.
Many of these individuals have a dementia diagnosis. These residents are often unable to speak for
themselves and rely on the Ombudsman Program and others (such as direct care staff) to speak on their
behalf. Currently there are approximately 1,500 Weld County residents who live in long term care
facilities, and an additional long term care facility is being built in the Windsor area. All of these residents
receive services through the Ombudsman Program, either directly with visitations and complaint
resolution, or indirectly thought training and technical assistance provided to staff to improve the quality of
care. By extension, the program may also represent the concerns of relatives and/or friends of long term
care residents, as long as the concern reflects the concerns of the resident. Continuation of support will
make it possible for the Area Agency on Aging Ombudsman Program to continue to serve all of the long
term care residents and their families with the same type an degree of services that we are currently
providing.
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, 2011 July 1, 2012 July 1, 2013 July 1, 2014
Through Through Through Through
June 30, 2012' June 30, 2013 June 30, 2014 June 30, 2015
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103 82 90 90
b)What is the number of victims served July 1, 2013 through December 31, 2013? 39
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. N/A
16.Document community support, coordination and networking by providing the following information:
a) List the top five agencies who your agency works most closely with in coordination and provision
of crime victim services and indicate how you work with them.
AGENCY HOW YOU COORDINATE
1 Home and Community Based 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 with the same resident/client, together facilitate trainings to
groups. Referral of abuse and neglect cases that occur in Weld county.
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3 Medicaid Technicians Refer residents and families when they are in need of applying for
Medicaid.
4 Victim Advocates Education, information and referral.
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5 SAVA Education, information and referral. Anticipate working together to
develop and provide education.
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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.
NAME OF MEMBER HOW THEY PARTICIPATE
Raegan Maldonado Quarterly Meetings, Victims Rights Day, Subcommittee as needed, Training
Kathleen Alvarado Quarterly Meetings, Victims Rights Day, Subcommittee as needed, Training
b) Briefly describe any other agency actions that demonstrate its high priority for developing
corrimunity support, coordination, networking, and cooperation.
The Ombudsman Program also participates in the following committees:
COMMITTEE HOW WE PARTICIPATE
APS Meeting Monthly meetings, present Ombudsman perspective during case review,
provide group with information regarding LTC and the.Ombudsman Program.
The Weld County Bio-Ethics Committee Attendance at quarterly meetings and emergency meetings. Develop case
studies for review. Provide education regarding LTC and the Ombudsman
Program.
The Weld County Functional Needs Participation in scheduled meetings and assist in marketing this committee.
Committee Ensure that facilities have an emergency plan including responses to sexual
assault and abuse.
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SECTION E -VICTIM COMPENSATION:
Provide the following information concerning your agency's involvement with the Crime Victim
Compensation Program: -
17. a) Does your agency regularly inform victims about Victim Compensation and help them to apply
when appropriate? Yes
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.
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b) Explain any major issues that hinder your agency in helping crime victims to understand Victim
Compensation eligibility requirements and to apply for benefits.
We have no major issues that hinder our agency in helping crime victims to understand Victim
Compensation eligibility requirements and to apply for benefits.
c) Does your agency regularly conduct/receive Victim Compensation training for direct services staff
and volunteers? Yes
Date of the last training: July 25th, 2012
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Person who conducted the training: Karol Patch •
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.
VALE USE ONLY
Reviewed Victim Compensation Coordinator
Comments:
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SECTION F - VICTIM RIGHTS ACT:
18. Has your agency taken steps to assure that all staff and volunteers have read and understand the
GUIDELINES FOR ASSURING THE RIGHTS OF VICTIMS OF AND WITNESSES TO CRIMES:
Rights afforded to crime victims - C.R.S. 24-4.1-302.5; Procedures for assuring rights of victims of
crimes; C.R.S. 24-4.1-303; and Child victim or witness—rights and services—C.R.S. 24-4.1-304
Yes
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.dci.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?
No
c) VRA Training:
Date of the last training: July 26th, 2012
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Person who conducted the training: Kelly Kissell
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.
d) How does your agency notify victims of their rights under VRA?
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We provide residents, family members and facility staff members with information from, "Crime Victims
Have Rights," from the DCJ website: www.dci.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 Residents Rights when they live in an assisted living facility or nursing
home.
e) Does your agency have a brochure describing VRA? No
If"yes", list the languages in which your brochure is available. See SECTION I. ATTACHMENTS
f) If you agency does not have a brochure describing VRA, please indicate if your agency utilizes
brochures from other agencies. See SECTION I ATTACHMENTS. DO NOT INCLUDE VICTIM
COMPENSATION BROCHURES TO YOUR APPLICATION. VRA brochures SHOULD be included
in the application (all languages).
"Crime Victims Have Rights," for DCJ website: www.dci.state.co.us
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SECTION G - EVALUATION:
How will you evaluate the effectiveness of this project?
(1) By reviewing whether or not we are meeting and/or exceeding our goals and objectives.
(2) With the use of our Ombudsman training evaluations and client satisfaction surveys.
19. If this is an application for continuing funding, how successful has this project been in the past in
accomplishing its proposed goals and objectives?
We have been very successful with meeting and/or exceeding our goals and objectives in the past, and
have accomplished all goals and objectives throughout the years.
20. 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
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SECTION H-BUDGETARY INFORMATION:
All Budget pages MUST be completed. All figures should be rounded to the nearest dollar.
21. RESPONSIBLE PARTIES:
(a) List the two individuals who are responsible for ensuring the grant is administrated as
proposed by the organization and approved by the VALE Board.
NAME TITLE PHONE EMAIL
Eva Jewell AAA Division Head (970) 346-6950 6101 ejewell@weldgov.com
Raegan Maldonado Lead LTC Ombudsman (970)346-6950 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 I County Accounting
•
22. 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. If you were asked to rewrite the answer to this question last year, be sure you are
using the updated language in this application.
Weld County has separate processes in place to order goods and services, authorize payment, approve
payment and write checks. Program personnel order goods or services with the assistance of the county
purchasing office. After the order is received, an invoice is sent to the departmental fiscal office where
the accounts payable staff verify the delivery of the item, obtain authorization for payment and dode 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.
•
23. What process does your agency have in place to reconcile financial information with the quarterly
VALE Financial Report?
The Lead Ombudsman submits a request to the Weld County Human Services fiscal department,
requesting that the fiscal department complete the required information/paperwork. The completed
information is then reviewed by the Lead Ombudsman, the MA Department Head and the Financial
Officer. The AAA Department Head and the Financial Officer sign the quarterly VALE reports.
13
SECTION I- ATTACHMENTS:
ATTACH WITH EACH COPY OF THE APPLICATION GRANT:
X blank Client Survey
X A list of ALL of your agency's board members which delineates the Board of Directors, (private
non-profit).
ATTACH ONLY WITH ORIGINAL APPLICATION:
X Your agency's VRA brochure OR the VRA brochure your agency utilizes (ALL languages)
DO NOT INCLUDE VICTIM COMPENSATION BROCHURES TO YOUR APPLICATION.
X A signed copy of the attached Grant Applicant Memorandum of Understanding Concerning the Rights
Afforded to Crime Victims.
X Include a copy of agency's most recent audit report or financial review. * If agency is not subject to
audit, explain how proper management and disbursement of funds is monitored. (Only one copy of the
audit or financial review is required.)
•
14
ATTACHMENT
VICTIM ASSISTANCE AND LAW ENFORCEMENT BOARD
GRANT APPLICANT MEMORANDUM OF UNDERSTANDING
CONCERNING THE RIGHTS AFFORDED TO CRIME VICTIMS
As provided in C.R.S. 24-4.2-105, (4.7), Colorado law requires the following:
A REQUESTING AGENCY OR PERSON SHALL ACKNOWLEDGE IN WRITING THAT SUCH AGENCY OR
PERSON HAS READ AND UNDERSTANDS THE RIGHTS AFFORDED TO CRIME VICTIMS PURSUANT TO
SECTION 24-4.1-302.5 AND THE SERVICES DELINEATED PURSUANT TO SECTION 24-4.1-303 AND 24-
4.1-304. SUCH WRITTEN ACKNOWLEDGMENT SHALL BE ATTACHED TO SUCH REQUESTING
AGENCY'S OR PERSON'S APPLICATION FOR MONEYS PURSUANT TO THIS SECTION. THE BOARD
SHALL NOT ACCEPT FOR EVALUATION ANY APPLICATION FOR A GRANT OF MONEYS PURSUANT TO
THIS SECTION UNTIL THE REQUESTING AGENCY OR PERSON PROVIDES THE BOARD WITH SUCH
WRITTEN ACKNOWLEDGMENT.
•
The prospective grantee certifies to the VALE Board, by submission of this completed Grant Applicant
Memorandum of Understanding Concerning the Rights Afforded to the Crime Victims, that the agency or person
described herein has read and understands the rights afforded to crime victims as required by C.R.S. 24-4.2-105,
(4.7).
•
PROJECT DIRECTOR: EVA JEWELL TITLE: WELD AAA DIRECTOR
PROJECT: WELD COUNTY LONG TERM CARE OMBUDSMAN ADVOCATE/FRIENDLY VISITOR
AGENCY: WELD COUNTY AREA AGENCY ON AGING
ADDRESS: 1551 NORTH 17TH AVENUE, POST OFFICE BOX 1805 GREELEY, CO 80632
SIGNATURE: ftU2"7'Yl. Lib aZ DATE:
COPIES OF THE STATUTES DESCRIBED ABOVE WILL BE PROVIDED TO PROSPECTIVE GRANT
RECIPIENTS UPON REQUEST.
Area Agency on Aging
Board Membership List
Bill Pike
Love Banghart Jerry Kearney .6915 W 22"d St
3530 W.Rangeview Rd 2110 28th Ave Apt A CO 80634
G• 50 3
Greeley, CO 80634 Greeley, CO 80634 Greeley
H: 970-330-5991 C: 970-518-9914 C: 970-396-3408
6-33434
Lkendr4300 a.aol.com tikearnev 19(a msn.com
Email
Susan Collins billdortCasi.com
.950 52"d Ave Ct Apt Q3
Greeley CO 80634 Wayne Wagner
H:970-506-1843 Will Kulp 1720 60th Ave#318
W: 970-351-2464 4117 W.20th Street Road Greeley, CO 80634
susan.collins s�unco.edu Greeley, CO 80634 H:970-352-7121
H: 970-330-7258 wavnea4(a�msn.com
Bruce Fitzgerald wkulps(a,gnail.com
6670 CR 21. Roy Wardell
Ft. Lupton,CO 80621 Sandy Magnuson 16512 Essex Rd
H: 303-857-2801 1508 Lakeside Drive Platteville, CO 80651
Fitzgerald.b(a�hotmaii.com Greeley,CO 80631 H-970-785-0145
H-970-336-9031 C: 970-396-1870
Sean Conway . Cell-970-381-4810 E-mail:
Commissioner sandv.magnuscau@ginail.com rwardell(a�what-«ire.cotru
W: 970-356-4000 ext
4206 Shirley Medbery Yamaguchi
sconwav anweldaov.com 1125 73rd Judy
Ave Judy 21
Greeley;CO 80634 1314Platteville, 80651
Ken Humphrey H:970-356-3001 Platteville,
ille, COC 09
2314 45th Avenue C:970-301-1288 C:970-576-6409m
Greeley,CO 80634 medbervshirlevna email.com
H:970-330-0590 r Alex Zaude
C: 970-381-5131 Ken Noreme
kshumphrev nvahoo.com 1508 Lakeside Drive 8615 W 18th St
Greeley, CO 80631 Greeley, CO 80634
Mary Jones H-970-336-9031 H:970-506-1521
5601 West 18th Street -ken.norem (@gmail.com anzh1(aa.com
#22
Greeley,80634
C: 970-381-8654
cmionesai),skvbeanm.com Revised 12/11/13
aaa
Asridnnce.Adrocact Anmerrc on Aging.
Weld County Arca Agency on Aging
February 4th, 2014
Department of Human Services
Dear ,
The Weld County Long Term Care Ombudsman Program is conducting a survey based upon customer
satisfaction. We are always endeavoring to improve the services that are provided to our customers. In
order to ensure this goal, it is necessary to have client feedback on the services we provide. Therefore,
we have enclosed a brief survey.
It is our hope that you will find time to complete this survey. The information that is gathered will allow
us to identify both our strengths and weaknesses; allowing us the opportunity to improve our program.
This survey is completely confidential. We wish to assure you that your identity will not be revealed. In
addition,the data collected from the survey will be used solely for the purpose of improving our
services.
Your completion of this survey is voluntary. If you choose to complete the questionnaire,thank you for
your participation. Please return the survey in the self addressed stamped envelope as soon as possible.
Once again, thank you for your participation.
Sincerely,
Raegan Maldonado, Long-Term Care Ombudsman
Kathleen Alvarado, Long-Term Care Ombudsman
Enclosures
WELD COUNTY Ombudsman Program
Customer Satisfaction Questionnaire 2014
We are always striving to improve service to our customers. Please take afew minutes to fill out
this questionnaire. It is important for us to know how you think we are doing. Thank you!
Please return survey to:PO Box 1805 315 North 11m Avenue,Building C, Greeley, CO 80632
Attn: Ombudsman Program.
Are you a:
resident family or friend facility staff _other
What was the main reason you contacted or visited with the Ombudsman?
E
o
5 n Z
1. Did the Ombudsman respond in a timely manner?
2. Was the Ombudsman courteous?
3. Did the Ombudsman help you achieve what you wanted?
4.. Were you satisfied with the amount of contact you had with the Ombudsman?
5. Were you satisfied with the services you received from the Ombudsman?
6. Was the information you received from the Ombudsman helpful and did you feel you had
more power as a consumer as a result?
If you need help in the future, would you call the Weld County Ombudsman
Program again? o Yes ❑ No
Was there anything else the Ombudsman could have done that would have helped?
Please share any other comments you may have about the Ombudsman
program.
Name (Optional):
Would you like a call back: EYes ❑No Phone
Ombudsman Program/Residents' Rights
Training Evaluation
Ensuring an Abuse Free Environment
We are very interested in having your feedback concerning the training and
would appreciate your time in completing this evaluation form. Thank you!
1. The length of the training program was:
1 Too long
2 Too short
3 Just right
2. The material presented was:
1 Easily understandable
2 Understandable
3 Somewhat difficult to understand -
4 Very difficult to understand
3. Opportunity given to ask questions or make comments was:
1 Not enough
2 Too much
3 Just right
4. How comfortable did you feel discussing the training topics?
1 Very comfortable
2 Somewhat comfortable
3 A little uneasy
4 Very uneasy
5. What is your overall opinion of this training program?
1 Excellent
2 Good
3 Average
4 Inadequate
6. What did you like BEST or LEAST about this training?
BEST: LEAST:
7. Would you recommend this training to other students?
1. Yes 2. No
8. Do you know how to contact the Weld County Ombudsman?
1. Yes 2. No
9. After this training, are you more familiar with residents' rights?
1. Yes 2. No
10. After receiving this training, are you familiar with the Victim
Compensation Program?
1. Yes 2. No
11. If additional training was offered, what topic(s) would be
the most beneficial to YOU?
12. Do you have any additional comments?
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