HomeMy WebLinkAbout2010-054 DSS- Flaircare, Inc. dba Homewatch Caregivers of the Triangle - Renewal of Agreements for in-home aid services Contract#68-2011
Flaircare,Inc.
CONTRACT# 68-2011 Fiscal Year Begins Julyl,2010 Ends June 30,2011
NORTH CAROLINA
ORANGE COUNTY
IN-HOME AIDE PROVIDER SERVICES AGREEMENT
THIS AGREEMENT, is made and entered into this 7-3 day of ,c--+Q , 2010 by
and between Orange County,North Carolina for and on behalf of the Orange County Department
of Social Services and the Orange County Department of Aging (the "County"); and Flaircare,
Inc. dba Homewatch Caregivers of the Tr (t "Contractor") whose federal tax
identification number or Social Security Number is: 26-0076-
244
WITNESSETH:
For the purpose and subject to the terms and conditions hereinafter set forth,the County
hereby contracts for the services of the Contractor,and the Contractor agrees to provide the
services to the County in accordance with the terms of this Agreement.
1. Contract Documents: This Agreement consists of this document as well as each of the
documents listed below as indicated(collectively referred to as the"Contract Documents"). If
the word"Yes"appears beside the title of the contract document at the time both parties execute
this Agreement,then that document is included as part of this Agreement. If the word"No"
appears beside the title of the contract document at the time both parties execute this Agreement,
then that document is not included as part of this Agreement. Each of the Contract Documents
made part hereof are attached hereto and incorporated herein by reference to the same:
TITLE OF CONTRACT DOCUMENT YES/NO
(1) The General Terms and Conditions(Attachment A) YES
(2) The Scope of Work,services,and rate(Attachment B) YES
(3) Federal Drug Free Workplace Certification(Attachment C) YES
(4) Conflict of Interest Policy(Attachment D) YES
(5) No Overdue Taxes Certification(Attachment E) YES
(6) Certification Regarding Lobbying(Attachment G) YES
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Flaircare,Inc.
(7) Certification Regarding Debarment(Attachment H) YES
(8) Business Associate Addendum(Attachment I) YES
(9) Certification Regarding Transportation(Attachment J) YES
(10) Outcomes&Reporting(Attachment N) YES
2. Precedence Amone Contract Documents: In the event of a conflict between or among
the terms of the Contract Documents and this Agreement,the terms of this Agreement shall
control. In the event of a conflict between or among the terms of the Contract Documents,then
the Contract Documents with the highest relative precedence shall prevail. The order of
precedence shall be the order of documents as listed in Section 1,above,with Attachment A
having precedence over Attachment B and so forth. If there are multiple Contract Amendments,
the most recent amendment shall have the highest precedence and the oldest amendment shall
have the lowest precedence.
3. Effective Period: This Agreement shall be effective from July 1,2010 through June 30,
2011.
4. Contractor's Duties: The Contractor shall provide the services to the County described
in Attachment B in accordance with the approved rate as described in Attachment B,Scope of
Work,and shall meet the requirements set forth in Attachment N,Outcomes and Reporting.
5. County's Duties: The County shall pay the Contractor in the manner and in the
amounts specified in the Contract Documents.
(a) The total amount paid by the County to the Contractor under this Agreement for
the provision of services to the Department of Social Services shall not exceed:$415,647. This
amount consists of$415,647 in Federal,State and County funds(CFDA# ),
$0(source of other funds if applicable).
(b) The total amount paid by the County to the Contractor under this Agreement for
the provision of services to the Department on Aging shall not exceed:$50,000. This amount
consists of$50,000 in Federal,State and County funds(CFDA# ),so
(source of other funds if applicable).
[X] (c) There are no matching requirements from the Contractor under this Agreement for
the provision of services to the Department of Social Services.
[ ] (d) The Contractor's matching requirement is$ ,which shall consist of:
[ ] In-kind [ ] Cash
[ ] Cash and In-kind [ ] Cash and/or In-kind
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Flaircare,Inc.
The contributions from the Contractor for matching requirements for the provision of
services to the Department of Social Services shall be sourced from non-federal funds.
6. Reportiniz Requirements: Contractor shall comply with audit requirements as
described in N.C.G.S. § 143-6.2 and OMB Circular A-133.
7. Payment Provisions: Payment shall be made in accordance with the Contract
Documents as described in the Scope of Work,Attachment B.
8. Contract Administrators: All notices permitted or required to be given by one Party
to the other and all questions about the contract from one Party to the other shall be addressed
and delivered to the other Party's Contract Administrator. The name,post office address,street
address,telephone number,fax number,and email address of the Parties'respective initial
Contract Administrators are set out below. Either party may change the name,post office
address,street address,telephone number,fax number,or email address of its Contract
Administrator by giving timely written notice to the other Party.
For Services Performed on Behalf of the Department of Social Services:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS!
Renee Bynum,Adult Services Supervisor Renee Bynum,Adult Services Supervisor
Orange County Department of Social Services Orange County Department of Social Services
P.O.Box 8181 113 Mayo Street
Hillsborough,NC 27278 Hillsborough,NC 27278
(919)245-2881
(919)644-3005
bynum@co.gLtn_ge.nc.us
For Services Performed on Behalf of the Department on Aainz
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS;
Kate Barrett,Aging Transitions Administrator Kate Barrett,Aging Transitions Administrator
Orange County Department on Aging Orange County Department on Aging
2551 Homestead Road 2551 Homestead Road
Chapel Hill,NC 27516 Chapel Hill,NC 27516
(919)968-2085
kbarrettn.co.oran e.nc.us
Contract#68-2011
Flaircare,Inc.
For the Contractor:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANSI
Stephanie Wright or Anzor Gachechiladze Stephanie Wright or Anzor Gachechiladze
Flaircare,Inc. Flaircare,Inc. p�
Chapel Hill,NC 2751k-4- Chapel Hill,NC 2751K.}
t I-V a W M OLC444 ca.v-n al, eJA_4rJ► tooq Mows t vr�l e4 � l ZJ --AA* '3 �.►d'�.t.c o H
Adt-
(919)960-6038
9. No Assignment or Sub-Contract: Contractor shall not sub-contract out any of the
services provided for in this Agreement or make any assignment of this Agreement(including
rights to payments)without the prior written Consent of the County as specified more fully in
Attachment A,General Terms and Conditions.
10. Relationship of the Parties: Contractor is an independent contractor of the County.
Contractor represents that it has or will secure, at its own expense, all personnel required in
performing the services under this Agreement. Such personnel shall not be employees of or have
any contractual relationship with the County. All personnel engaged in work under this
Agreement shall be fully qualified and shall be authorized or permitted under state and local law
to perform such services. It is further agreed by Contractor that it shall obey all State and
Federal statutes, rules and regulations which are applicable to provisions of the services called
for herein. Neither Contractor nor any employee of the Contractor shall be deemed an officer,
employee or agent of the County.
11. Termination: This Agreement may be terminated as specified in Attachment A,General
Terms And Conditions.
12. Insurance Requirements: Contractor shall obtain, at its sole expense,all insurance as
required in Attachment A,General Terms And Conditions.
13. Indemnification: Contractor agrees to defend, indemnify, and hold harmless the
County, for all loss, liability, claims or expense (including reasonable attorney's fees) arising
from bodily injury, including death or property damage, to any person or persons caused in
whole or in part by Contractor in accordance with Attachment A, General Terms And
Conditions. It is the intent of this Section that Contractor indemnify County to the full extent
permitted by law.
14. Entire Agreement: The parties have read this Agreement, including the Contract
Documents, and agree to be bound by all of its terms, and further agree that it constitutes the
complete and exclusive statement of the Agreement between the parties.
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15. Interpretation: When the context in which words are used in this Agreement indicates
that such is the intent,words shall in the singular number shall include the plural and vice versa.
The masculine gender shall include the feminine and neuter.
IN WITNESS WHEREOF,the County and the Contractor have been first duly
authorized,have executed and entered into this Agreement as of the day and year first above
written.
FLAIRCARE,INC.DBA H MEWATCH CAREGIVERS OF THE TRIANGLE
By a. 6-24-(C__
Signature Date
Ak a C)' /
Printed Name Title
ORANGE �/� T_,NO RO A
By: (�X.t,__ /v
Chair,Bokfd of County Commissl ers Date
County Risk Ma r
NAME OF SUPERVISING DEPARTMENTS
N-3o-16
D artment Di ctor Signature Date
Department Director Signature Date
This instrument has been pre-audited in the manner required by the Local Government Budget
and Fiscal Control AP ct.
et".1t, • A�
Signature of County Finance Officer Date
Thi 4aas been approved as to form and legal sufficiency.
Sign ture of&ounty Attorney Date
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Flaircare,Inc.
ATTACHMENT A
GENERAL TERMS AND CONDITIONS
Orange County Department of Social Services and Orange County Department on Aging
Relationships of the Parties respective successors.It is expressly understood and
agreed that the enforcement of the terms and
Independent Contractor: The Contractor is and conditions of this contract, and all rights of action
shall be deemed to be an independent contractor in the relating to such enforcement,shall be strictly reserved
performance of this contract and as such shall be to the County and the named Contractor. Nothing
wholly responsible for the work to be performed and contained in this document shall give or allow any
for the supervision of its employees. The Contractor claim or right of action whatsoever by any other third
represents that it has, or shall secure at its own person. It is the express intention of the County and
expense, all personnel required in performing the Contractor that any such person or entity, other than
services under this agreement. Such employees shall the County or the Contractor, receiving services or
not be employees of, or have any individual benefits under this contract shall be deemed an
contractual relationship with the County. incidental beneficiary only.
Subcontracting: The Contractor shall not
subcontract any of the work contemplated under this Indemnity and Insurance
contract without prior written approval from the
County. Any approved subcontract shall be subject to Indemnification: The Contractor agrees to
all conditions of this contract.Only the subcontractors indemnify and hold harmless the County and any of
specified in the contract documents are to be their officers,agents and employees,from any claims
considered approved upon award of the contract. The of third parties arising out or any act or omission of
County shall not be obligated to pay for any work the Contractor in connection with the performance of
performed by any unapproved subcontractor. The this contract.
Contractor shall be responsible for the performance of
all of its subcontractors. Insurance: During the term of the contract, the
Contractor at its sole cost and expense shall provide
Assignment: No assignment of the Contractor's commercial insurance of such type and with such
obligations or the Contractor's right to receive terms and limits as may be reasonably associated with
payment hereunder shall be permitted.However,upon the contract. As a minimum, the Contractor shall
written request approved by the issuing purchasing provide and maintain the following coverage and
authority,the County may: limits:
(a) Forward the Contractor's payment check(s) (a) Worker's Compensation - The contractor
directly to any person or entity designated by shall provide and maintain Worker's
the Contractor, or Compensation Insurance as required by the
(b) Include any person or entity designated by laws of North Carolina,as well as employer's
Contractor as a joint payee on the Contractor's liability coverage with minimum limits of
payment check(s). $500,000.00, covering all of Contractor's
In no event shall such approval and action obligate the employees who are engaged in any work
County to anyone other than the Contractor and the under the contract. If any work is sublet,the
Contractor shall remain responsible for fulfillment of Contractor shall require the subcontractor to
all contract obligations. provide the same coverage for any of his
employees engaged in any work under the
Beneficiaries: Except as herein specifically provided contract.
otherwise, this contract shall inure to the benefit of (b) Commercial General Liability - General
and be binding upon the parties hereto and their Liability Coverage on a Comprehensive Broad
General Terms and Conditions—(06/04) Page 1 of 5
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Form on an occurrence basis in the minimum contract in a timely and proper manner, the County
amount of $1,000,000.00 Combined Single shall have the right to terminate this contract by
Limit. (Defense cost shall be in excess of the giving written notice to the Contractor and specifying
limit of liability.) the effective date thereof. In that event,all finished or
(c) Automobile-Automobile Liability Insurance, unfinished deliverable items prepared by the
to include liability coverage, covering all Contractor under this contract shall, at the option of
owned,hired and non-owned vehicles used in the County, become its property and the Contractor
performance of the contract. The minimum shall be entitled to receive just and equitable
combined single limit shall be $500,000.00 compensation for any satisfactory work completed on
bodily injury and property damage; such materials, minus any payment or compensation
$500,000.00 uninsuredfunder insured previously made. Notwithstanding the foregoing
motorist; and $25,000.00 medical payment. provision, the Contractor shall not be relieved of
Providing and maintaining adequate insurance liability to the County for damages sustained by the
coverage is a material obligation of the Contractor County by virtue of the Contractor's breach of this
and is of the essence of this contract. The Contractor agreement, and the County may withhold any
may meet its requirements of maintaining specified payment due the Contractor for the purpose of setoff
coverage and limits by demonstrating to the County until such time as the exact amount of damages due
that there is in force insurance with equivalent the County from such breach can be determined. In
coverage and limits that will offer at least the same case of default by the Contractor,without limiting any
protection to the County. All such insurance shall other remedies for breach available to it the County
P tY
meet all laws of the State of North Carolina. Such may procure the contract services from other sources
insurance coverage shall be obtained from companies and hold the Contractor responsible for any excess
that are authorized to provide such coverage and that cost occasioned thereby. The filing of a petition for
are authorized by the Commissioner of Insurance to bankruptcy by the Contractor shall be an act of default
do business in North Carolina. The Contractor shall under this contract,
at all times comply with the terms of such insurance
policies,and all requirements of the insurer under any Waiver of Default: Waiver by the County of any
such insurance policies, except as they may conflict default or breach in compliance with the terms of this
with existing North Carolina laws or this contract. contract by the Provider shall not be deemed a waiver
The limits of coverage under each insurance policy of any subsequent default or breach and shall not be
maintained by the Contractor shall not be interpreted construed to be modification of the terms of this
as limiting the contractor's liability and obligations contract unless stated to be such in writing,signed by
under the contract. an authorized representative of the County and the
Contractor and attached to the contract.
Default and Termination
Availability of Funds: The parties to this contract
Termination Without Cause: The County may agree and understand that the payment of the sums
terminate this contract without cause by giving 30 specified in this contract is dependent and contingent
days written notice to the Contractor. In that event, upon and subject to the appropriation,allocation,and
all finished or unfinished deliverable items prepared availability of funds for this purpose to the County.
by the Contractor under this contract shall, at the
option of the County, become its property and the Force Majeure:Neither party shall be deemed to be
Contractor shall be entitled to receive just and in default of its obligations hereunder if and so long
equitable compensation for any satisfactory work as it is prevented from performing such obligations by
completed on such materials, minus any payment or any act of war, hostile foreign action, nuclear
compensation previously made. explosion,riot,strikes,civil insurrection,earthquake,
hurricane,tornado,or other catastrophic natural event
Termination for Cause: If, through any cause, the or act of God.
Contractor shall fail to fulfill its obligations under this
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Survival of Promises: All promises, requirements, Confidentiality: Any information,data,instruments,
terms, conditions, provisions, representations, documents, studies or reports given to or prepared or
guarantees, and warranties contained herein shall assembled by the Contractor under this agreement
survive the contract expiration or termination date shall be kept as confidential and not divulged or made
unless specifically provided otherwise herein, or available to any individual or organization without the
unless superseded by applicable Federal or State prior written approval of the County.The Contractor
statutes of limitation. acknowledges that in receiving,storing,processing or
otherwise dealing with any confidential information it
Intellectual Property Rights will safeguard and not further disclose the information
except as otherwise provided in this contract.
Copyrights and Ownership of Deliverables: All
deliverable items produced pursuant to this contract Oversight
are the exclusive property of the County. The
Contractor shall not assert a claim of copyright or Access to Persons and Records: The State Auditor
other property interest in such deliverables. shall have access to persons and records as a result of
all contracts or grants entered into by State agencies
Federal Intellectual Property Bankruptcy or political subdivisions in accordance with General
Protection Act: The Parties agree that the County Statute 147-64.7. Additionally, as the State funding
shall be entitled to all rights and benefits of the authority, the Department of Health and Human
Federal Intellectual Property Bankruptcy Protection Services shall have access to persons and records as a
Act, Public Law 100-506, codified at 11 U.S.C. 365 result of all contracts or grants entered into by State
(n) and any amendments thereto. agencies or political subdivisions.
Compliance with Applicable Laws Record Retention: Records shall not be destroyed,
purged or disposed of without the express written
Compliance with Laws: The Contractor shall consent of the County.The Department of Health and
comply with all laws, ordinances, codes, rules, Human Services' basic records retention policy
regulations, and licensing requirements that are requires all records to be retained for a minimum of
applicable to the conduct of its business, including three years following completion or termination of the
those of federal, state, and local agencies having contract. If the contract is subject to Federal policy
jurisdiction and/or authority. and regulations, record retention will normally be
longer than three years since records must be retained
Equal Employment Opportunity: The Contractor for a period of three years following submission of the
shall comply with all federal and State laws relating to final Federal Financial Status Report,if applicable,or
equal employment opportunity. three years following the submission of a revised final
Federal Financial Status Report. Also, if any
Health Insurance Portability and Accountability litigation, claim, negotiation, audit, disallowance
Act(HIPAA): The Contractor agrees that, if the action,or other action involving this contract has been
County determines that some or all of the activities started before expiration of the three year retention
within the scope of this contract are subject to the period described above,the records must be retained
Health Insurance Portability and Accountability Act until completion of the action and resolution of all
of 1996, P.L. 104-91, as amended ("HIPAA"), or its issues which arise from it, or until the end of the
implementing regulations, it will comply with the regular three year period described above,whichever
HIPAA requirements and will execute such is later.
agreements and practices as the County may require
to ensure compliance. Warranties and Certifications
Confidentiality Date and Time Warranty: The Contractor warrants
that the product(s) and service(s) furnished pursuant
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to this contract ("product" includes, without Severability: In the event that a court of competent
limitation, any piece of equipment, hardware, jurisdiction holds that a provision or requirement of
firmware, middleware, custom or commercial this contract violates any applicable law, each such
software, or internal components, subroutines, and provision or requirement shall continue to be enforced
interfaces therein)that perform any date and/or time to the extent it is not in violation of law or is not
data recognition function,calculation, or sequencing otherwise unenforceable and all other provisions and
will support a four digit year format and will provide requirements of this contract shall remain in full force
accurate date/time data and leap year calculations. and effect.
This warranty shall survive the termination or
expiration of this contract. Headings: The Section and Paragraph headings in
these General Terms and Conditions are not material
Certification Regarding Collection of Taxes: G.S. parts of the agreement and should not be used to
143-59.1 bars the Secretary of Administration from construe the meaning thereof.
entering into contracts with vendors that meet one of
the conditions of G.S. 105-164.8(b)and yet refuse to Time of the Essence: Time is of the essence in the
collect use taxes on sales of tangible personal performance of this contract.
property to purchasers in North Carolina. The
conditions include: (a) maintenance of a retail Key Personnel: The Contractor shall not replace any
establishment or office; (b) presence of of the key personnel assigned to the performance of
representatives in the State that solicit sales or this contract without the prior written approval of the
transact business on behalf of the vendor; and (c) County. The term"key personnel" includes any and
systematic exploitation of the market by media- all persons identified as such in the contract
assisted,media-facilitated,or media-solicited means. documents and any other persons subsequently
The Contractor certifies that it and all of its affiliates identified as key personnel by the written agreement
(if any) collect all required taxes. of the parties.
Miscellaneous Care of Property: The Contractor agrees that it shall
be responsible for the proper custody and care of any
Choice of Law: The validity of this contract and any property furnished to it for use in connection with the
of its terms or provisions, as well as the rights and performance of this contract and will reimburse the
duties of the parties to this contract, are governed by County for loss of, or damage to, such property. At
the laws of North Carolina. The Contractor, by the termination of this contract, the Contractor shall
signing this contract, agrees and submits, solely for contact the County for instructions as to the
matters concerning this Contract, to the exclusive disposition of such property and shall comply with
jurisdiction of the courts of North Carolina and these instructions.
agrees, solely for such purpose, that the exclusive
venue for any legal proceedings shall be Wake Travel Expenses: Reimbursement to the Contractor
County, North Carolina. The place of this contract for travel mileage, meals, lodging and other travel
and all transactions and agreements relating to it,and expenses incurred in the performance of this contract
their situs and forum, shall be Wake County, North shall not exceed the rates established in County
Carolina, where all matters, whether sounding in policy.
contract or tort, relating to the validity, construction,
interpretation, and enforcement shall be determined. Sales/Use Tax Refunds: If eligible, the Contractor
and all subcontractors shall: (a) ask the North
Amendment: This contract may not be amended Carolina Department of Revenue for a refund of all
orally or by performance. Any amendment must be sales and use taxes paid by them in the performance
made in written form and executed by duly authorized of this contract,pursuant to G.S. 105-164.14;and(b)
representatives of the County and the Contractor. exclude all refundable sales and use taxes from all
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reportable expenditures before the expenses are wage and encourages agencies to which it provides
entered in their reimbursement reports. funding to pursue the same goal. The County's living
wage hourly standard, as adopted by the Orange
Advertising: The Contractor shall not use the award County Board of County Commissioners annually,
of this contract as a part of any news release or can be found in the Orange County Budget
commercial advertising. Ordinance. To the extent possible, Orange County
recommends that the Contractor and all
Orange County Living Wage: Orange County is subcontractors provide a living wage, as defined in
committed to providing its employees with a living this section,to their employees.
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ATTACHMENT B
SCOPE OF WORK
Orange County Department of Social Serv nge County Department on Aging
Federal Tax Id. or SSN 26-0076-244
Contract# 68-2011
A. CONTRACTOR INFORMATION
1. Contractor Agency Name:Flaircare Inc.
2. If different from Contract Administrator Information in General Contract:
Address
Telephone Number:' Fax Number: Email:
3. Name of Program(s): In-Home Services
4. Status: ( )Public ( )Private,Not for Profit (X)Private,For Profit
5. Contractor's Financial Reporting Year July 1, 2010 through June 30, 2011
B. Explanation of Services to be provided and to whom(include SIS Service Code):
The Contractor will provide emplo ey es to perform in-home services for the
Department of Social Services' clients and the Department on Aging's clients, at the
level amount and frequency specified by the social worker in the In-Home Aide Services
Plan (SIS Code 042) The Contractor will provide Level II Home Management and
Level III Personal Care The Contractor is required to meet all goals and outcomes listed
in Attachment N.
C. Rate per unit of Service(define the unit):
1. If Standard Fixed Rate,Maximum Allowable, (See Rates for Services Chart)
$14 40/hour
2.Negotiated County Rate.
D.Number of units to be provided:
E.Details of Billing process and Time Frames;The Coun&will reimburse the Contractor
for services described in this contract up to the budgetary limits of the contract allotment.
The County will reimburse the Contractor at a rate of$14.40/hour for approved services
provided For reimbursement the Contractor must submit an original and two copies of
an invoice by the fifth of the month for the preceding month's expenditures to the
designated County Administrator. All invoices for the provision of services to the
Department of Social Services shall be submitted to the Administrator for said
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Department. All invoices for the provision of services to the Department on Aging shall
be submitted to the Administrator for said Department. The County will reimburse the
Contractor monthly upon receipt of a complete and correctly filed report.
F. Area to be served/Delivery site(s): Orange County
(Signature of C tractor)
(Signa re of Vpartment Director)
me`30 10 (Date Submitted)
(Date Submitted)
(Signature of Department Director)
(Date Submitted)
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ATTACHMENT C
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
Orange County Department of Social Services and Orange County Department on Aging
I. By execution of this Agreement the Contractor certifies that it will provide a drug-free
workplace by:
A. Publishing a statement notifying employees that the unlawful manufacture, distribution,
dispensing,possession or use of a controlled substance is prohibited in the Contractor's
workplace and specifying the actions that will be taken against employees for violation of
such prohibition;
B. Establishing a drug-free awareness program to inform employees about:
(1)The dangers of drug abuse in the workplace;
(2)The Contractor's policy of maintaining a drug-free workplace;
(3)Any available drug counseling, rehabilitation, and employee assistance programs; and
(4)The penalties that may be imposed upon employees for drug abuse violations
occurring in the workplace;
C. Making it a requirement that each employee be engaged in the performance of the
agreement be given a copy of the statement required by paragraph(A);
D. Notifying the employee in the statement'required by paragraph(A)that, as a condition of
employment under the agreement,the employee will:
(1)Abide by the terms of the statement; and
(2)Notify the employer of any criminal drug statute conviction for a violation occurring
in the workplace no later than five days after such conviction;
E. Notifying the County within ten days after receiving notice under subparagraph (D)(2)
from an employee or otherwise receiving actual notice of such conviction;
F. Taking one of the following actions,within 30 days of receiving notice under
subparagraph(D)(2),with respect to any employee who is so convicted:
(1)Taking appropriate personnel action against such an employee, up to and including
termination; or
(2)Requiring such employee to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a Federal, State, or local health,
law enforcement,or other appropriate agency; and
Making a good faith effort to continue to maintain a drug-free workplace through
implementation of paragraphs (A), (B), (C), (D), (E), and(F).
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II. The site(s) for the performance of work done in connection with the specific agreement are
listed below: l
1 toot A m� 'a,� Cad
(Street address)
(City, county, state, zip code)
2.
(Street address)
(City, county, state,zip code)
Contractor will inform the County of any additional sites for performance of work under this
agreement.
False certification or violation of the certification shall be grounds for suspension of payment,
suspension or termination of grants, or government-wide Federal suspension or debarment
(Section 4 CFR Part 85, Section 85.615 and 86.620).
a ,w 06� 26( —10
Signature Title
Agc ency//Organizatio4LA ,T,r, Date
(Certification signature should be same as Contract signature.)
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ATTACHMENT D
CONFLICT OF INTEREST POLICY
Orange County Department of Social Services and Orange County Department on Aging
Conflict of Interest Defined:
A conflict of interest is defined as an actual or perceived interest by a(Contractor/staff
member/Board member) in an action that results in, or has the appearance of resulting in,
personal, organizational, or professional gain. A conflict of interest occurs when an
employee/Contractor/Board member has a direct or fiduciary interest in another
relationship. A conflict of interest could include:
➢ Ownership with a member of the Board of Directors/Trustees or an employee
where one or the other has supervisory authority over the other or with a client
who receives services.
➢ Employment of or by a member of the Board of Directors/Trustees or an
employee where one or the other has supervisory authority over the other or
with a client who receives services.
➢ Contractual relationship with a member of the Board of Directors/Trustees or
an employee where one or the other has supervisory authority over the other or
with a client who receives services.
➢ Creditor or debtor to a member of the Board of Directors/Trustees or an
employee where one or the other has supervisory authority over the other or
with a client who receives services.
➢ Consultative or consumer relationship with a member of the Board of
Directors/Trustees or an employee where one or the other has supervisory
authority over the other or with a client who receives services.
The definition of conflict of interest includes any bias or the appearance of bias in a
decision-making process that would reflect a dual role played by a member of the
organization or group. An example, for instance, might involve a person who is an
employee and a Board member, or a person who is an employee and who hires
family members as consultants.
Employee/Contractor/Board Member Responsibilities:
It is in the interest of the organization, individual staff, and Board members to strengthen
trust and confidence in each other,to expedite resolution of problems,to mitigate the
effect and to minimize organizational and individual stress that can be caused by a
conflict of interest.
Employees are to avoid any conflict of interest, even the appearance of a conflict of
interest. This organization serves the community as a whole rather than only serving a
special interest group. The appearance of a conflict of interest can cause embarrassment
to the organization and jeopardize the credibility of the organization. Any conflict of
interest, potential conflict of interest, or the appearance of a conflict of interest is to be
reported to your supervisor immediately. Employees are to maintain independence and
objectivity with clients, the community, and organization. Employees are called to
Conflict of Interest Policy(06/04) Page 1 of 3
Flaircare,Inc.
maintain a sense.of fairness, civility, ethics and personal integrity even though law,
regulation, or custom does not require them.
Acceptance of Gifts:
Employees,members of employee's immediate family, and members of the Board are
prohibited from accepting gifts,money or gratuities from the following:
a. Persons receiving benefits or services from the organization;
b. Any person or organization performing or seeking to perform services under
contract with the organization; and
c. Persons who are otherwise in a position to benefit from the actions of any
employee of the organization.
Employees may, with the prior written approval of their supervisor, receive honoraria for
lectures and other such activities while on personal days, compensatory time, annual
leave, or leave without pay. If the employee is acting in any official capacity, honoraria
received by an employee in connection with activities relating to employment with the
organization are to be paid to the organization.
NOTARIZED CONFLICT OF INTEREST POLICY
State of North Carolina
County of Orange
1, a ftrkc, l.3 "--N r ,Notary Public for said County and State,
certify NN-Lw (jrC_�„;kAZe, personally appeared before me this day and
acknowledged that he/she is �vtS c of
and by that authority duly given and as the act of the corporation, affirmed that the
foregoing Conflict of Interest Policy was adopted by the Board of Directors in a meeting
held on the aq day of n a01 0
Sworn to and subscribed before me this XA day of St.xne, , a
Conflict of Interest Policy(06/04) Page 2 of 3
Flaircare,Inc.
(Official Seal)
Notary Public
My Commission expires 10-D-a"10 -, 20
�rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■
Attached is the Conflict of terest Policy for: Flaircare, Inc.
c
Signature of rpor ti n Official
Conflict of Interest Policy(06/04) Page 3 of 3
Flaircare,Inc.
ATTACHMENT E
OVERDUE TAXES
Orange County Department of Social Services and Orange County Department on Aging
2,4 , 2010
To: Orange County Department of Social Services and Orange County Department on
Aging
Certification:
I certify that Flaircare, Inc. does not have any overdue tax debts, as defined by N.C.G.S.
105-243.1, at the federal, State, or local level. I further understand that any person who
makes a false statement in violation of N.C.G.S. 143-6.2(b2)is guilty of a criminal
offense punishable as provided by N.C.G.S. 143-34(b).
Sworn Statement:
��or c ��crZ.,e— , being duly sworn, say that I am the �j sss7� of
Flaircare, Inc. of in the State of North Carolina; and that the foregoing certification is
true, accurate and complete to the best of my knowledge and was made and subscribed by
me. I also acknowledge and understand that any misuse of State funds will be reported to
the appropriate authoritie for further action.
a
Directo
Sworn to and subscribed before me on the day of the date of said certification.
My Commission Expires: 10' a 1
(Notary Signature and Seal)
Overdue Taxes—(06/04) Page 1 of 1
Contract#68-2011
Flaircare,Inc.
ATTACHMENT G
CERTIFICATION REGARDING LOBBYING
Orange County Department of Social Services and Orange County Department on Aging
The undersigned certifies,to the best of his or her knowledge and belief,that:
1.No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned,
to any person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress,an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract,continuation, renewal,
amendment,or modification of any Federal contract, grant, loan, or cooperative agreement.
2. If any funds other than Federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with this Federally funded contract, grant, loan,or cooperative agreement,the
undersigned shall complete and submit Standard Form SF-LLL, "Disclosure of
Lobbying Activities," in accordance with its instructions.
3. The undersigned shall require that the language of this certification be included in the award
document for subawards at all tiers(including subcontracts, subgrants, and contracts under grants,
loans, and cooperative agreements)who receive federal funds of$100,000.00 or more and that all
subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by Section 1352,Title 31, U.S. Code. Any person who
fails to file the required certification shall be subject to a civil penalty of not less than$10,000.00
and not more than$100,000.00 for each such failure.
a,, OG- Z r{- /0
Signature Title
H&Zy- 4,r-e. 1w.c. 460, (�oht�� 06 -ZY - 10
Agency/Organization T _ Date 44Z
(Certification signature should be same as Contract signature.)
Federal Certification—Lobbying(06/04) Page 1 of 1
Contract#68-2011
Flaircare,Inc.
ATTACHMENT H
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION-LOWER TIER COVERED TRANSACTIONS
Orange County Department of Social Services and Orange County Department on Aging
Instructions for Certification
1. By signing and submitting this proposal,the prospective lower tier participant is
providing the certification set out below.
2. The certification in this clause is a material representation of the fact upon which
reliance was placed when this transaction was entered into. If it is later determined that
the prospective lower tier participant knowingly rendered an erroneous certification, in
addition to other remedies available to the Federal Government,the department or
agency with which this transaction originated may pursue available remedies, including
suspension and/or debarment.
3. The prospective lower tier participant will provide immediate written notice to the
person to which the proposal is submitted if at any time the prospective lower tier
participant learns that its certification was erroneous when submitted or has become
erroneous by reason of changed circumstances.
4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier
covered transaction," "participant," "person," "primary covered transaction," "principal,"
"proposal," and "voluntarily excluded," as used in this clause, have the meanings set out
in the Definitions and Coverage sections of rules implementing Executive Order 12549.
You may contact the person to which this proposal is submitted for assistance in
obtaining a copy of those regulations.
5. The prospective lower tier participant agrees by submitting this proposal that, should
the proposed covered transaction be entered into, it shall not knowingly enter any lower
tier covered transaction with a person who is debarred, suspended, determined ineligible
or voluntarily excluded from participation in this covered transaction unless authorized
by the department or agency with which this transaction originated.
6. The prospective lower tier participant further agrees by submitting this proposal that
it will include this clause titled "Certification Regarding Debarment, Suspension,
Ineligibility and Voluntary Exclusion- Lower Tier Covered Transaction," without
modification, in all lower tier covered transactions and in all solicitations for lower tier
covered transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective
participant in a lower tier covered transaction that it is not debarred, suspended,
ineligible, or voluntarily excluded from covered transaction, unless it knows that the
certification is erroneous. A participant may decide the method and frequency of which
it determines the eligibility of its principals. Each participant may, but is not required to,
check the Nonprocurement List.
Federal Certification-Debarment(06/04) Page 1 of 2
Contract#68-2011
Flaircare,Inc.
8. Nothing contained in the foregoing shall be construed to require establishment of a
system of records in order to render in good faith the certification required by this clause.
The knowledge and information of a participant is not required to exceed that which is
normally possessed by a prudent person in the ordinary course of business dealings.
9. Except for transactions authorized in paragraph 5 of these instructions, if a
participant in a covered transaction knowingly enters into a lower tier covered transaction
with a person who is suspended, debarred, ineligible, or voluntarily excluded from
participation in this transaction, in addition to other remedies available to the Federal
Government,the department or agency with which this transaction originated may pursue
available remedies, including suspension, and/or debarment.
Certification Regarding Debarment, Suspension,Ineligibility and Voluntary Exclusion-
Lower Tier Covered Transactions
(1) The prospective lower tier participant certifies,by submission of this proposal,that
neither it nor its principals is presently debarred, suspended,proposed for debarment,
declared ineligible,or voluntarily excluded from participation in this transaction by any
Federal department or agency.
(2) Where the prospective lower tier participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation to
this proposal.
06
Signature Title
gacc;�-� I.P. J6&k CMG-'2Y-ao
Agency/Organization Date
Cs ` - Tk
(Certification signature should be same as Contract signature.)
Federal Certification-Debarment(06/04) Page 2 of 2
Contract 968-2011
Flaircare,Inc.
ATTACHMENT I
BUSINESS ASSOCIATE ADDENDUM
Orange County Department of Social Services and Orange County Department on Aging
This Agreement is made effective the ZA_day of Sc.—,e_ , 2040 1 by and between Orange
County ("Covered Entity") and Flaircare, Inc. ("Business Associate") (collectively the
"Parties").
1. BACKGROUND
a. Covered Entity and Business Associate are parties to a contract entitled 468-2011 (the
"Contract"), whereby Business Associate agrees to perform certain services for or on
behalf of Covered Entity.
b. Covered Entity is an organizational unit of Orange County (the "County") that has been
designated in whole or in part by the County as a health care component for purposes of
the HIPAA Privacy Rule.
c. The relationship between Covered Entity and Business Associate is such that the Parties
believe Business Associate is or may be a"business associate"within the meaning of the
HIPAA Privacy Rule.
d. The Parties enter into this Business Associate Addendum to the Contract with the
intention of complying with the HIPAA Privacy Rule provision that a covered entity may
disclose protected health information to a business associate, and may allow a business
associate to create or receive protected heath information on its behalf, if the covered
entity obtains satisfactory assurances that the business associate will appropriately
safeguard the information.
2. DEFINITIONS
Unless some other meaning is clearly indicated by the context,the following terms shall have the
following meaning in this Agreement:
a. "HIPAA" means the Administrative Simplification Provisions, Sections 261 through 264,
of the federal Health Insurance Portability and Accountability Act of 1996, Public Law
104-191.
b. "Individual" shall have the same meaning as the term"individual" in 45 CFR160.103 and
shall include a person who qualifies as a personal representative in accordance with 45
CFR 164.502(g).
c. "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable Health
Information at 45 CFR part 160 and part 164, subparts A and E.
d. "Protected Health Information" shall have the same meaning as the term "protected
health information" in 45 CFR 160.103, limited to the information created or received by
Business Associate from or on behalf of Covered Entity.
e. "Required By Law" shall have the same meaning as the term "required by law" in 45
CFR 164.103.
Contract-HIPAA(06/04) Page 1 of 4
Contract#68-2011
Flaircare,Inc.
f. Unless otherwise defined in this Agreement, terms used herein shall have the same
meaning as those terms have in the Privacy Rule.
3. OBLIGATIONS OF BUSINESS ASSOCIATE
a. Business Associate agrees to not use or disclose Protected Health Information other than
as permitted or required by this Agreement or as Required By Law.
b. Business Associate agrees to use appropriate safeguards to prevent use or disclosure of
the Protected Health Information other than as provided for by this Agreement.
c. Business Associate agrees to mitigate,to the extent practicable, any harmful effect that is
known to Business Associate of a use or disclosure of Protected Health Information by
Business Associate in violation of the requirements of this Agreement.
d. Business Associate agrees to report to Covered Entity any use or disclosure of the
Protected Health Information not provided for by this Agreement of which it becomes
aware.
e. Business Associate agrees to ensure that any agent, including a subcontractor,to whom it
provides Protected Health Information received from, or created or received by Business
Associate on behalf of Covered Entity agrees to the same restrictions and.conditions that
apply through this Agreement to Business Associate with respect to such information.
f. Business Associate agrees to provide access, at the request of Covered Entity, to
Protected Health Information in a Designated Record Set to Covered Entity or, as
directed by Covered Entity, to an Individual in order to meet the requirements under 45
CFR 164.524.
g. Business Associate agrees, at the request of the Covered Entity, to make any
amendment(s) to Protected Health Information in a Designated Record Set that the
Covered Entity directs or agrees to pursuant to 45 CFR 164.526.
h. Unless otherwise prohibited by law,Business Associate agrees to make internal practices,
books, and records, including policies and procedures and Protected Health Information,
relating to the use and disclosure of Protected Health Information received from, or
created or received by Business Associate on behalf of Covered Entity, available to the
Covered Entity, for purposes of determining Covered Entity's compliance with the
Privacy Rule.
i. Business Associate agrees to document such disclosures of Protected Health Information
and information related to such disclosures as would be required for Covered Entity to
respond to a request by an Individual for an accounting of disclosures of Protected Health
Information in accordance with 45 CFR 164.528, and to provide this information to
Covered Entity or an Individual to permit such a response.
Contract-HIPAA(06/04) Page 2 of 4
Contract 468-2011
Flaircare,Inc.
4. PERMITTED USES AND DISCLOSURES
a. Except as otherwise limited in this Agreement or by other applicable law or agreement, if
the Contract permits, Business Associate may use or disclose Protected Health
Information to perform functions, activities, or services for, or on behalf of, Covered
Entity as specified in the Contract,provided that such use or disclosure:
1) would not violate the Privacy Rule if done by Covered Entity; or
2) would not violate the minimum necessary policies and procedures of the Covered
Entity.
b. Except as otherwise limited in this Agreement or by other applicable law or agreements,
if the Contract permits, Business Associate may use Protected Health Information as
necessary for the proper management and administration of the Business Associate or to
carry out the legal responsibilities of the Business Associate.
c. Except as otherwise limited in this Agreement or by other applicable law or agreements,
if the Contract permits, Business Associate may disclose Protected Health Information
for the proper management and administration of the Business Associate,provided that:
1) disclosures are Required By Law; or
2) Business Associate obtains reasonable assurances from the person to whom the
information is disclosed that it will remain confidential and will be used or further
disclosed only as Required By Law or for the purpose for which it was disclosed to
the person, and the person notifies the Business Associate of any instances of which
it is aware in which the confidentiality of the information has been breached.
d. Except as otherwise limited in this Agreement or by other applicable law or agreements,
if the Contract permits, Business Associate may use Protected Health Information to
provide data aggregation services to Covered Entity as permitted by 45 CFR
164.504(e)(2)(i)(B).
e. Notwithstanding the foregoing provisions, Business Associate may not use or disclose
Protected Health Information if the use or disclosure would violate any term of the
Contract or other applicable law or agreements.
5. TERM AND TERMINATION
a. Term. This Agreement shall be effective as of the effective date stated above and shall
terminate when the Contract terminates.
b. Termination for Cause. Upon Covered Entity's knowledge of a material breach by
Business Associate, Covered Entity may, at its option:
1) Provide an opportunity for Business Associate to cure the breach or end the
violation, and terminate this Agreement and services provided by Business
Associate, to the extent permissible by law, if Business Associate does not cure the
breach or end the violation within the time specified by Covered Entity;
2) Immediately terminate this Agreement and services provided by Business Associate,
to the extent permissible by law; or
Contract-l-PAA(06/04) Page 3 of 4
Contract 968-2011
Flaircare,Inc.
3) If neither termination nor cure is feasible, report the violation to the Secretary as
provided in the Privacy Rule.
c. Effect of Termination.
1) Except as provided in paragraph (2) of this section or in the Contract or by other
applicable law or agreements, upon termination of this Agreement and services
provided by Business Associate, for any reason, Business Associate shall return or
destroy all Protected Health Information received from Covered Entity, or created or
received by Business Associate on behalf of Covered Entity. This provision shall
apply to Protected Health Information that is in the possession of subcontractors or
agents of Business Associate. Business Associate shall retain no copies of the
Protected Health Information.
2) In the event that Business Associate determines that returning or destroying the
Protected Health Information is not feasible, Business Associate shall provide to
Covered Entity notification of the conditions that make return or destruction not
feasible. Business Associate shall extend the protections of this Agreement to such
Protected Health Information and limit further uses and disclosures of such
Protected Health Information to those purposes that make the return or destruction
infeasible, for so long as Business Associate maintains such Protected Health
Information.
6. GENERAL TERMS AND CONDITIONS
a. This Agreement amends and is part of the Contract.
b. Except as provided in this Agreement, all terms and conditions of the Contract shall
remain in force and shall apply to this Agreement as if set forth fully herein.
c. In the event of a conflict in terms between this Agreement and the Contract, the
interpretation that is in accordance with the Privacy Rule shall prevail. In the event that a
conflict then remains, the Contract terms shall prevail so long as they are in accordance
with the Privacy Rule.
d. A breach of this Agreement by Business Associate shall be considered sufficient basis for
Covered Entity to terminate the Contract for cause.
at 06- 2(f
Signature Title
Agency/Organization ! _ Date
(Certification signature should be same as Contract signature.)
Contract-HIPAA(06/04) Page 4 of 4
Contract#68-2011
Flaircare,Inc.
ATTACHMENT J
CERTIFICATION REGARDING TRANSPORTATION
Orange County Department of Social Services and Orange County Department on Aging
By execution of this Agreement the Contractor certifies that it will provide safe client
transportation by:
I. Insuring that all drivers(including employees, contractors, contractor's employees,and
volunteers) shall be at least 18 years of age;
2. Insuring that all drivers (including employees, contractors,contractor's employees, and
volunteers) shall be licensed to operate the specific vehicle used in transporting clients in
accordance with Chapter 20-7 of the General Statutes of North Carolina and the Division
of Motor Vehicle requirements;
I
3. Insuring that all vehicles used to transport clients shall have valid State registrations and
State inspection stickers;
4. Insuring that all vehicles transporting clients shall have at least the minimum level of
liability insurance appropriate for the type of vehicle;
5. Insuring that the contractor shall have written policies and procedures regarding how
drivers handle and report client emergencies and/or vehicle crashes involving clients to
contractor and how contractor notifies the Orange County Department of Social Services
Q - Z
Signature T U Title
F 6,�,rcaw-e- Z,'c., Cf—<o
Agency/Organization Date
4
(Certification signature should be same as Contract signature.)
Transportation Certification(03/06) Page I of 1
Contract#68-2011
Flaircare,Inc.
ATTACHMENT N
OUTCOMES AND REPORTING
Orange County Department of Social Services and Orange County Department on Aging
By signing and submitting this document,the Contractor certifies that it agrees to the following:
1. The Contractor agrees to participate in program, fiscal and administrative monitoring and/or
audits,making records and staff time available to Federal, State and County staff.
2. The Contractor agrees to take necessary steps for corrective action, as negotiated within a
corrective action plan, for any items found to be out of compliance with Federal, State, and County
laws, regulations, standards and/or terms of the Contract.
3. The Contractor agrees that continuation of and/or renewal of this Contract is contingent on
meeting the following requirements. The Contractor agrees to:
A. Provide employees to perform in-home services for the County's clients, at the level,
amount and frequency specified by the social worker in the.In-Home Aide Service Plan.
B. Provide verification,upon request,that the selected employee has been properly
licensed and trained and is qualified to perform assigned tasks.
C. Assign employees to clients according to the clients' needs and the employees' abilities
and experience.
D. In a timely manner,provide the County with information on significant changes in the
clients' conditions or situations.
E. Assure that the client is treated with dignity and respect,assist in protecting the client's
assets and possessions, and assure confidentiality of client's circumstances.
F. Allow aides to provide transportation,within reason, for both medical and personal
reasons.
G. Provide care at Level II as appropriate to the needs of the client.
H. Maintain all financial and program records for a period of three years from the date of
final payment under this agreement for inspection by the County,the Area Agency on
Aging and the Comptroller General of the United States, or any of their duly authorized
representatives. If any claim, litigation,negotiation, audit or other action involving the
Contractor's records has been started before the expiration of the three-year period,the
records must be retained until completion of the action and resolution of all issues that
arise from it.
I. Protective Service In-Home Aide requests are to be staffed within 24 hours and the
hours to be worked are to be strictly adhered to. Referral acceptance by the Contractor
is conditional on worker availability. The Contractor will notify the County within two
hours if the request cannot be honored.
J. High Risk In-Home Aide Service requests are to be staffed within five days. All other
requests are to be filled within ten working days of the request.
K. Changes in the service hours are to be made by the County. Requests for changes may
be made by the Contractor,but are not finalized until notification is given by the
County.
Outcomes (06/04) Page 1 of 2
Contract#68-2011
Flaircare,Inc.
L. The Contractor will immediately notify the County when Protective Services Cases are
not staffed,when In-Home Aide workers are absent, and/or when any of the following
occur:
a. The client dies.
b. The client enters a rest home,nursing home, or hospital.
c. The client moves from the original address on the request.
d. The client refuses to accept the services or to comply with care requirements.
e. There are significant factors that affect the client or significant changes in a
client's situation.
G
Signature Title
[�lar.�=✓�.-Ex a.e LOC. r O�h a, 40 tx�c" c:�G to
Agency/Organization #.,A- Date
�&%�S � 7- --e_
(Certification signature should be same as Contract signature.)
Outcomes (06/04) Page 2 of 2