Loading...
HomeMy WebLinkAbout2018-449-E Finance - Senior Care of Orange County outside agency agreementDocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77FFCCC2626B OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT, made and entered into the first day of July 2018, ( "Effective Date ") by and between the County of Orange, a political subdivision of the State of North Carolina, 200 South Cameron Street, Hillsborough, North Carolina, 27278, ( "County ") and Senior Care of Orange County, Inc, a not - for -profit corporation, located at 105 Meadowland Drive, Hillsborough, NC 27278 ( "Provider "). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners. NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth, the County and Senior Care of Orange County, Inc agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2018 to June 30, 2019. 2. Scope of Services. a. Provider will provide services, as outlined in the attached Outside Agency Funding Application and any amendments or revision thereto which is attached as Exhibit "A" and incorporated by reference, to the residents of Orange County. The Scope of Services and the Program Budget may be different from the original application based on County appropriation; however, any revisions or amendments to this Agreement must be approved in writing by the County and attached to this Agreement as Exhibit B. b. The Provider shall be solely responsible for the means, methods, techniques, sequence, safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. The County agrees to appropriate for the provision of services described in Exhibit A, Scope of Services and more particularly described in the Revised Program Budget, the maximum sum of $35,000. b. All funds appropriated shall be used for purposes described in Exhibit A. Any funds not used for the purposes stated shall be returned to the County. Any changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider. If the funds are expended not in accordance with the Scope of Services, at the discretion of the County the Provider may be required to repay the funds to the County. The Provider shall be paid in four equal installments in the amount of $8,750. The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. (Senior Care of Orange County, Inc) Orange County Outside Agency Performance Agreement Revised 712018 Page 1 of 9 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77FFCCC2626B e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later. £ The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 — December 31; January 1 — March 31 and April 1 - June 30. Reports are due on January 11, April 12, and July 12 of the program fiscal year. b. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services, upon reasonable notice during normal working hours. 5. Termination. a. In the event of any of the circumstances set forth below (hereinafter referred to as "default "), the County may immediately terminate this Agreement, in whole or in part, and from time to time. Notice of termination must be in writing, state the reason or reasons for the termination, and specify the effective date of the termination: i. In the event that Provider shall cease to exist as an organization or shall enter bankruptcy proceedings, be declared insolvent, or liquidate all or substantially all of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement; or ii. In the event that Provider shall fail to render a satisfactory accounting as provided section 4 above, the County may terminate this Agreement and Provider shall return all payments already made to it by the County for services which have not been provided or for which no satisfactory accounting has been rendered; or iii. In the event of any fraudulent representation by the Provider in an invoice or other verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. iv. Nonperformance, incomplete service or performance, or failure to satisfactorily perform any part of the work identified in the Scope of Services or to comply with any provision of this Agreement, as determined by the County in its sole discretion. v. Failure to adhere to the terms of applicable county, state or federal laws, regulations, or stated public policy. b. In the event of default by the Provider, the county may elect to terminate this Agreement, in whole or in part and/or require the Provider to repay the funds within ten (10) business days from written notice of default. The County may (but shall not be required to) grant the Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County's remedies in law or in equity. (Senior Care of Orange County, Inc) Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 7118 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77FFCCC2626B c. Notwithstanding the foregoing, either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain, during the period of performance of this Agreement, insurance: i. Worker's Compensation. For protection from claims under workers' or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof, iii. Comprehensive Automobile Liability Insurance, including hired and non -owned vehicles, if any, covering personal injury or death, and property damage; and iv. Professional Liability Insurance, covering personal injury, bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION • Worker's Compensation • Commercial General Liability • Automobile Liability • Professional Liability MINIMUM REQUIRED COVERAGE Limits for Coverage A - Statutory State NC & Coverage B - Employers Liability $500,000 each accident, disease policy limit and disease each employee $1,000,000 Each Occurrence $2,000,000 Aggregate $500,000 Combined Single Limit $1,000,000 Each Occurrence $2,000,000 Aggregate c. All insurance policies (with the exception of Worker's Compensation and Professional Liability) required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough, NC 27278 d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. (Senior Care of Orange County, Inc) Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 7118 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77FFCCC2626B 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County. 11. Indemnification. Provider 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 the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 12. Non - Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non - Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Non - discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. 14. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County's living wage is $ 14.25 per hour. To the extent possible, Orange County recommends that Senior Care of Orange County, Inc provide a living wage to its employees. 15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered, to the last known address shall constitute sufficient notice to the County and the Provider. All notices required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: (Senior Care of Orange County, Inc) Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 7118 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77FFCCC2626B County: Finance & Administrative Services Orange County Post Office Box 8181 Hillsborough, NC 27278 Provider: Senior Care of Orange County, Inc 105 Meadowland Drive Hillsborough, NC 27278 16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147 - 86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF, the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For OocuSignejby:'r " r eider � W&OUA.t. K%S�u C5B55FF72C3C4D2... For a ' Docusignedby "ounty Government -EE0637994B755E477... Bonnie Hammersley, County Manager (Senior Care of Orange County, Inc) Orange County Outside Agency Performance Agreement Rev. 7118 8/16/2018 Date 8/18/2018 Date Page S of 9 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: Senior Care of Orange County; Inc. Applicant Organization's Physical Address: 105 Meadowland Drive Hillsborough, NC 27278 Applicant Organization's Mailing Address: 105 Meadowland Drive Hillsborough, NC 27278 Applicant Organization's Web Address: soltysadultday.org Executive Director: Swayzene Rigssbee Telephone Number- 919 -245 -2017 E -Mail: sri sbee Oran ecount nc. ov Tax ID Number: 56- 2460614 b) Funding Request List all FY18 -19 Human Services (HS} Funding Being Requested — For All Programs) and the Proposed Use of Funds (2 -3 lines or less) Program Carrbora Chapel Oran.:de Total HS Hill - HS Count HS •.' The Adult Day Health Program Operations $1;500 $2 540 35,000 $39 000 programming supplies and the days of servlcds for alcl ant:who.atkends ;`ro rani..... Totals 411500 A $2,500 $35,000 $39,000 c) To the best of my knowledge and belief all information and data in this application is true and current The document has been duly authorized by the governing board of the applicant. Signature: E uti "ripctor li Date r Signature: _ � 1 K v Ll Board ai'person Date — - -- - - - -- .... ... .... ... ...-----— AGENCY INFO R ATION 1/23/2018 4:21:18 PM Page 8 of 25 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION d) DISCLOSURE OF (POTENTIAL CONFLICTS OF INTEREST AND NON DISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families, or their business associates... YES NO ❑ x❑ a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ❑ x❑ b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ❑ x❑ c) Current beneficiaries of the program for which funds are being requested? ❑ x❑ d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. NON - DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identitylexpression, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti - discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signatur - -E�c c Iv rector Date n Signature: - oar Chairperson D ate AGENCY INFORMATION 1/23/2018 4:21:18 PM P a g e 1 0 o f 2 5 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 2, AGENCY INFORMATION (Be Very Brief and Concise) Please provide the following information about your agency (2 pages OR LESS): a) Years in Operation, Date of Incorporation (Month/Year): Senior Care of Orange County incorporated March of 2004 with 14 years of operation. b) Agency's Purpose /Mission (no more than a few sentences): Florence Gray Soltys Adult Day Health Program mission is to provide health and social model to frail, disabled and isolated adults 18 years and older with special needs who will benefit from Adult Day Health programs. Program provides a friendly safe environment, daily stimulating activities, enriching programs, nutritious meals, and snacks as well as rehabilitative services. In addition, the program provides respite and education for family members and caregivers. The primary goal is to prevent or delay the onset of institutionalization of participants living in the community. The vision of Senior Care of Orange County, Inc. is to advocate, establish and operate programs that provide services for frail or disabled older adults to remain in the comfort of their homes with family as long as possible. The 65 and older adults are the fastest growing population segment. c) Types of Services the Agency Provides (bullet format): • Caregiver respite • Engaging and stimulating environment • Qualified nurses and therapist for health monitoring • Quality of life and meaningful /purposeful programs • Safe and friendly environment • Socialization to prevent isolation • Therapeutic programming d) Agency's History with Providing These Services: Over the past 14 years the need for Adult Day Health services continues to increase for participants living in Orange County communities and other surrounding areas. The continued growth of the area and cost of healthcare for seniors to attend our program remains a challenge to provide services to participants in need. Through the years, we've made great efforts in our recruitment process with the Department of Social Services (Medicaid CAPIDA), and Veterans Administration who financially support participants with low incomes and/ or medical needs to utilize the Adult Day Health program as an option to in- homecare services. This option will aid with social interaction of each participant enrolled in the program. In addition to the recruitment process, we applied to Triangle J. Council of Governments and are receiving funding to help support days of coverage for Adult Day Care and Health funding options. e) Other Pertinent Agency Information (Ex. Has the agency experienced any major changes in the past year? is there a new Executive Director? Are there new initiatives ?) Within the past year there continues to be an increase in the health component of the program due to the acuity levels of the participants requires more staffing to ensure participants need are safely being met. This increase has impacted the need for more 1:1 assistance which Agency Information 1/23/2018 4:21:18 PM Page 11 of 25 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION effects the pay scale supported by the revenue. As of July 2017, Swayzene Riggsbee accepted the role of Executive Director. f) Schedule of Positions (For Entire Agency) • Full Time Equivalent (FTE) staff will be noted as 1.00; half time as .50; quarter time as .25, etc. • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours = Volunteer FTE 2,080 # of FTE - Full -Time Paid Positions: 5 # of FTE - Paid Part -Time Positions: 13 # of Volunteers: 5 # of FTE - Volunteers:0 g) Living Wage Does this agency pay permanent employees a minimum living wade? (Yes /No) Yes If yes, is this agency an Orange County Living Wage Certified Employe ? No If no, please explain. This agency is not an Orange County Living Wage Certified Employer but would be interested in knowing more about it. Agency Information 1/23/2018 4:21:18 PM Page 12 of 25 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION h) Agency Budget Is your agency currently receiving and/or requesting other (non -Human Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) government funding? (Yes /No) No If yes, please list below: Include all programs that have funding requestslawardsltotals from Carrboro, Chapel HiII _ and Orange Count governments (other than Human Services). DO NOT include federal funding sources, such as CDBG and HOME. Program FY17 -18 I FYI 8-19 Source Award l Request *Add rows or attach additional page, if needed. ii. Submit your agency's budget. You may complete the provided template (separate xls file) or you may submit your own budget file (as long as it contains the same information, and in a similar format, as requested in the provided template). Agency Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: Revenues • Private Donations • Program Generated Revenue • Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other (DO NOT include CDBG funding here) • Orange County Human Services - - - -- Agency Information 1/23/2018 4:21:18 PM Page 13 of 25 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B iv. EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION ® Orange County Other (DO NOT Include HOME funding here) o Other Government Grants • Triangle United Way • State Government • Federal Government (CDBG /HOME /etc.) • Private Foundation Grants o Other Revenue Expenditures • Compensation • Rent & Utilities • Supplies & Equipment • Travel & Training • Other Expenses Does your agency budget show a Surplus or Deficit? Deficit Is there a significant change? Yes /No Yes Please provide a brief explanation for Surplus or Deficit, and significant changes. Senior Care of Orange County continues to deal with a significant change within the past fiscal year. The Florence Gray Soltys Adult Day Health Program has various third party payer sources which includes the Veterans Administration providing limited funding days of service for eligible Veterans. In the past, Veterans qualified for attendance in the program for up to five days per week, where now its three days. The increase in the cost of living wage, where the program cost per day of service has remain constant. Also, staff turnover remains a major issue due to limited wages and employees needing benefits. What is your agency's fiscal year? July 1, 2018 - June 30, 2019 Agency Information 1/23/2018 4:21:18 PM Page 14 of 25 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Agency Budget Operating Budget for Entire Agency AGENCY NAME: Senior Care of Orange Countv; Inc. AGENCY REVENUE Private Donations Agency Generated Revenue (fees) Local Government Grants: Human Services - Town of Carrboro Other - Town of Carrboro Human Services - Town of Chapel Hill Other - Town of Chapel Hill Human Services - Orange County Other - Orange County Other - Town of Hillsborough Other Government Grants Triangle United Way State Government Federal Government (CDBGIHOMEIetc.) Private Foundation Grants Other Revenue To tal Agency Revenue AGENCY EXPENSES Compensation Rent & Utilities Supplies & Equipment Travel & Training Other Expenses: Insurances 2t116 X17 Zt,'1.,.i't8 7n $ 20,125 $ 7,500 $ 500 -93% $ 239,767 $ 1,250 $ 265,000 $ 1,500 $ 275,000 $ 1,500 4% 0% $ - $ - $ - 0 $ 1,750 $ 2,500 $ 2,500 0% $ - $ - $ - 0 $ 21,250 $ 28,750 $ 35,000 22% $ - $ - $ - 0 $ - $ - $ - $ - $ - $ - 0 0 $ - $ - $ - 0 $ 54,086 $ 62,000 $ 62,000 $ - $ - $ 3 $ 338;231 $ 298,102 $ - $ - $ 367,250 $ 320,000 $ 376;500 $ 320,000 0 0 3% 0% $ 1 $ 1,560 $ 1,560 0% $ 22,820 $ 26,500 $ 27,000 2% $ 2,102 $ 1,900 $ 1,900 0% $ 15,566 $ 17,500 $ 18,000 3% FY 2015 -16 Comparative Agency Budget Revised 9129/2014 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION '3. P. ROGRAM.INFORMATION (Submit a se.pa.rate Section 3'for each program) Program Name: Florence Gray Soltys Adult Day Health Program Program Primary Contact and Title: Swayzene Riggsbee Telephone Number: 919 -245 -2417 E -Mail: sri sbee oran ecount nc. ov a) Indicate the type of Human Service Needs Priority, if program applicable: x❑ Priority Area #1: safety -net services for disadvantaged residents ❑ Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges x❑ Priority Area #3: programs aimed at improving health and nutrition of needy residents b) Indicate the type of program for which you are requesting funding c) Provide a bulleted list of other agencies, if any, with which your agency coordinates /collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, briefly describe the coordinated /collaborative efforts. • Orange County Department on Aging- Referrals to our program from OC Cares, Caregiver Respite Support, $25,000 in -kind donation for nutritious meals. • Orange County Department of Social Services- Referrals from adult division of DSS • Veterans Administration Services; provide federal contract for Adult Day Health qualified veterans. • Triangle J Council of Governments- (HCCBG) Home Community Care Block Grant Funding annually for adult day h ealth and social participants. Program Description (3 pages OR LESS) Please provide the following information about the proposed program: PROGRAM INFORMATION 1/23/2018 4.21:18 PM P a g e 15 of 2 5 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION d) Summarize the program services proposed and how the program will address a Town /County priority /goal? This is a request to continue with the financial support provided to Florence Gray Soltys Adult Day Health Program under the sponsorships of Senior Care of Orange County, Inc. This program initially started by the County Department on Aging as a major Master Aging Plan funded initiative. Both County and Town funds are vital for the continuation of this one of a kind program that serves severely frail elderlies and adults with special needs in the Orange County area. We continue to see growth from residents of Chapel Hill and Carrboro needing Adult Day Health services within the last four years. The program expanded on February 4, 2009 as a partnership with the county to continue to meet the goals of the Master Aging Plan of Orange County. The request for funding from each participating jurisdiction is an enormous priority with helping to delay and /or prevent institutionalization. This would allow the individual to remain within their home and community as statistics show that adults are living longer. Florence Gray Soltys adult Day Health Program will continue to serve individuals ages 18 and up with top quality of care, dignity and respect. (Please note that the average age is 80 years old.) e) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of Chapel Hill Council Goals, Carrboro Board Priorities, or other community priorities (i.e, Council /Board Goals). Reference local data (using the provided links, i.e. Chapel Hill Human Services Needs Assessment) to support the need for this program. Florence Gray Soltys Adult Day Health Program is a therapeutic, health focused program for adults and seniors that offer a variety of services in a home -like setting that is open from 7:30am to 5:30pm Monday thru Friday to accommodate caregivers who work outside the home. The substantial need for this program is growing rapidly as more seniors age in place with numerous diagnosis ranging from, but not limited to dementia, Parkinson, and diabetes. The program provides assurance to family members that their loved one is well taken care of each day they attend the program. Each year, the number of participants enrolled in program continues to grow which currently is averaging 21.4 with a capacity of 29 per day. The support from the County and the towns of Chapel Hill and Carrboro would continue to provide day health services for individuals in need in the community. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? Our targeted population is individuals 65 years of age and older. The need of this program continues to grow rapidly as more seniors age in place with numerous diagnosis ranging from, but not limited to dementia, Parkinson disease, CVA and diabetes (physical and cognitive related diagnoses) identifying and connecting this populations' needs would remain through the outside collaboration efforts with The Department on Aging, Triangle J Council of Governments, The local Veterans Affairs Officer, Physician /Provider Offices, Civic Groups, Churches Senior Advisory Committees, Social Media efforts and continued word of mouth through participants' family member and community. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) The credentials of the Program Director and other key staff must hold at minimum, a Bachelors Degree from an accredited University. The current Director has over 30 years of experience working within the senior population and has approximately one year managing and operating the PROGRAM INFORMATION 1/23/2018 4:21:15 PM Page 16 of 25 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION program. In addition, the support of other key staff is Social Worker, Recreational Therapist, and Healthcare Coordinators which includes Registered Nurses. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. The activities carried out for providing funding for adult day health services and continued program operations is ongoing and continues through the July 1, 2018 -- June 30th° 2019 fiscal year. The funding will assist with the continuation of services for families in need of the Adult Day Health Program, and additional days as needed along with program operations that would include but not Limited to medical office and activity supplies, food cost for am and pm snacks, employee retention, and training (i.e. staff development on a quarterly basis and new staff orientation.) The services for the participants would vary on each individual's need basis. (i.e. one — two days per week, short -term and/or long- term.) i) Why is funding this program a good investment for the community? How does funding this program add value to the community? (250 words OR LESS) This is a request to continue with the financial support provided to Florence Gray Soltys Adult Day Health Program under the sponsorships of Senior Care of Orange County, Inc. This program initially started by the County Department on Aging as a major Master Aging Plan funded initiative. Both County and Town funds are vital for the continuation of this one of a kind program that serves severely frail elderlies and adults with special needs in the Orange County area. We continue to see growth from residents of Chapel Hill and Carrboro needing Adult Day Health services within the last four years. The program expanded on February 4, 2009 as a partnership with the county to continue to meet the goals of the Master Aging Plan of Orange County. The request for funding from each participating jurisdiction is an enormous priority with helping to delay and /or prevent institutionalization. This would allow the individual to remain within their home and community as statistics show that adults are living longer and healthier lives. Florence Gray Soltys adult Day Health Program will continue to serve individuals ages 18 and up with top quality of care, dignity and respect. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. If funding was a reduced allocation; hopefully the program would continue to serve as many participants and their caregivers as possible which may reduce the daily average of individuals enrolled in the program due to limited funding sources. We would hate to fathom if funding was not awarded. If this scenario were to happen to Orange County's one of a kind Adult Day Health model; this would have a major impact for all the families that we serve. This unique program is committed to the health and well -being of adults with physical and mental deficiencies that come along with the aging process. As Orange County continues to grow, with the new UNC hospital and new residential communities this shows a great need of Adult Day Health services. As mentioned earlier, this program is able to provide engaging, stimulating, friendly safe environment to meet the quality of life for frail individuals who may need more of a structure in their day activities along with health care monitoring. If funding is not awarded would also impact working caregivers and veterans of Orange County. Working caregivers may be forced to retire early or leave a position to care for their loved ones and with the Veterans, unable to provide the contracted services for men and women who have served our country due to lack of financial sustainability. Our program fees are based on a sliding scale of the individual in need of our program. This program was designed to meet the needs of all families that we serve. Majority of our population (approximately 90 %) have at least a dementia diagnosis, who requires total supervision, which is growing rapidly in this age group and the need for Adult Day Health services. Without the towns and County support, our sustainability of the program would be a major challenge in continuing for more than PROGRAM INFORMATION 1/23/2018 4:21:18 PM P a g e 17 of 2 5 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION one or possibly two years. Please consider the continuation of funding to increase the quality of life for so many Orange County residents who need our services. k) What percentage of your target population is low - moderate income? In 2003, Central Orange Adult Day Health Program (formally) was under the auspicious of the Orange County Department on Aging. In 2004, the program assumed a non - profit 501 c -3 status under the Governing Board of Senior Care of Orange County; Inc. Through the years the operation remained adjacent to the Central Orange Senior Center and was licensed for 10 participants per day. As the need for adult day health services increased the program later expanded to hold a license of 29 participants per day on February 4th, 2009 as a partnership with the county to continue to work towards meeting the goals of the Master Aging Plan of Orange County. The Senior Care Board continues to work toward building stronger relationships with the Veterans Administration Community referral program, and establishing a partnership with the local Veterans Affairs Office, Discharge Planners at the local Hospitals, and Triangle Visions Optometry to support in the referral program. Additional in -kind support still remains from Carol Woods retirement Community with a representative which serves on the Senior Care Board of Directors. [) What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc. ?) Evaluation policy: A formal evaluation of the program is initiated annually, beginning the last quarter of the calendar year (October 31S) complied by November 30th, summarized by December 15th of the calendar year. A written report of the evaluation and its findings will be submitted to the Board in January of the next calendar year. Program Director keeps all information available on file. m) Include any other pertinent information. PROGRAM INFORMATION 1/23/2018 4:21:18 PM Page 18 of 25 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77FFCCC2626B EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Additional Program Information n) Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, Actual Estimated Projected 2016 -17 2017 -18 2018 -19 Lender Male 26 23 25 Female 22 26 25 Total 48 49 50 Etin�c African-American 19 24 23 American Indian or Alaska Native 0 0 0 Asian 2 0 2 Caucasian 27 25 25 Native Hawaiian or other Pacific Islander 0 0 0 Other: specify Latino 0 0 0 Total 48 49 50 Of the above, how many Hispanic/Latino 2 0 2 Of the above, how many non-Hispanic/Latino 46 49 48 Total 48 49 50 0 -5 years 6 -18 years 19 -50 years 1 2 3 51+ years 47 47 47 Total 48 49 50 � Geographllc Location ;.. -' Alamance County 1 4 5 Chatham County 1 2 2 Durham County 2 8 9 Wake County 0 0 0 Orange County Breakdown Chapel Hill Public Housing 0 Q 1 Town of Chapel :Hill (Non Public Housing) . 10 7 8 Town of Carrtoro 1 0 1 Town of Hillsborough 20.: 13 13 City of Mebane (Orange County) 6 7 5 OrangeCdunty (Outside Municipalities) 7 8 6 . Total 48 49 50 PROGRAM INFORMATION 112312018 4:21:18 PM P a g e 19 of 25 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement of Complete the Work Statement Chart to describe the work to be performed. This chart is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. Every program is required to have AT LEAST 9 Program Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and Time - bound. Click on SMART Goals to learn more. • Program Activities should outline major activities the agency implements to accomplish its program goals. (i.e. Deliver meals to elderly /disabled residents.) • Program Goal should explain what the program is trying to achieve /accomplish. Goals are statements about what the program should accomplish. (i.e. Deliver 900 meals per day, Monday - Friday.) • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. (i.e. Will track the number of meals delivered each day.) • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. (i.e. Delivered an average of 905 meals per day.) Work Statement Chart for Program: Florence Gray Soltys Adult Day Health Program Program Goal Maintain Adult Day Health Enrollment Census Performance Measures Increase marketing strategies and program awareness Previous Year Program Results 48 participants were enrolled Current Year Estimated Results 49 expected enrollment Next Year Projected Results 50 oroiected enrollment Program Goal Prevent and/or delay institutionalization Performance Measures To provide financial community resources to 80% of participants Previous Year Program Results Assist with supplemental funding for families in need - provided 80% and prevented or delayed institutionalization Current Year Estimated Results Continue to meet the 80% Next Year Projected Results I Continue to meet the 80% Program Goal Performance Measures Previous Year Program Results Current Year Estimated Results Next Year Projected Results Program Goal Performance Measures Previous Year Program Results Current Year Estimated Results Next Year Projected Results PROGRAM INFORMATION 1/23/2018 4:21:18 PM Page 20 of 25 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION p) Program Budget 1. Submit your program budget. You may complete the provided template (separate As file) or you may submit your own budget file (as long as it contains the same information, in the same format, as requested in the provided template). Program Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: Revenues • Private Donations • Program Generated Revenue • Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other (DO NOT include CDBG funding here) • Orange County Human Services • Orange County Other (DO NOT Include HOME funding here) • Other Government Grants • Triangle United Way • State Government • Federal Government (CDBG /HOMEletc.) • Private Foundation Grants o Other Revenue Expenditures • Compensation • Rent & Utilities • Supplies & Equipment • Travel & Training • Other Expenses 2. Program Budget Detail -- Provide description of "other" budget items, not defined. 3. This program budget represents what percent of the agency budget? % 4. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. N �.. -rte Total Cost of Program BAs �I;fi Total # of Individuals Cost Per Individual PROGRAM INFORMATION 1/23/2018 4.21:18 PM Page 22 of 25 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77FFCCC2626B Jul. 31. 2016 4:3PM .rl�• � Scope of Services — FY 2018 -19 Otrtside Agency Performance Agreement Agency Names Senior Care of Grange County Program Name., Florence Gray Soltys Adult Day Health Program Funding Award: $35,000.00 Outline how the agency will spend Orange Counry's funding award. No. 7419 P. 2 Expense Deseri tlon Amount Program supplies/snacks $6,200 Personnel Salaries FICA, and Rjn e Benefits $25,000 ) m to ee retention $2,600 Staff development trainin A $310 Acbyity Supplies S1.200 Program Seiwiees Outline the critical services (activities) the agency will employ to attain the .Anticipated Outcomes below, by June 30, 2419, + Continue to promote independence, a safe friendly environment health services, meals, and snack, socialization, respite support and stimulating activities Decrease isolation and provide an alternative to instThltivrral care within the commimity of Orange County area. + Support continuation of additional program supplies as censils increases. Anticipated Outcomes The Anticipated itcsults column must include quantifiable results in the form of number of personslanW Served within Orahze Colin (Y' ottlY [all Towns and municipalities). If you nse_pereentagios, you knust also provide the total number of par•ticinants within than measure's description or for ar, earlier erformance measure, l ?erfortrrarrct' 11xasures Anticipated Res-nits Prevent and /or prolong most participants with health conditions from becoming isolared and/or institutionalized within the community of Orange County area. 85 Continue to strive to increase and maintain an enrollment daily average census of 26 participants each 4M._ 75 To continue to provide essential amount of respite support for caregivers needing time to rest or leisure time to do other things outside of care ivin . 100 Cer1�*(?17C5B55FF72C3CA DocuSigned by WU,6,��u t, ri%sbt t, D Tile: 4 P-caIt Executive Director r Date: 8/16/2018 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77FFCCC2626B ATTACHMENT "A" Orange County Certifications — FY 2018 -19 Outside Agency Performance Agreement Chief Contact, Administrators, Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name, title, residential address; phone and email address and if possible, fax number. Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur. The list should be in writing, with the name, physical address, mailing address and if possible, phone, fax and email address. Budget Submission I certify that I have provided a budget for the period to be covered by funding Orange County, and that any substantive changes made to this budget have been in advance authorized in writing by Orange County. Annual Financial Review I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not, please explain on a separate sheet of paper. Alignment with Organization's Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. DGCU Signed by: Wainu t.t, K%S�t Certified by: c5B55FF72C3C4D2... Title: (Provider's Signature) Executive Director Date: 8/16/2018 (Senior Care of Orange County, Inc) Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 7118 DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B `JU 121, 2014 6: JOAM IV o, 7401 P. 2 Client#: 955852 04SE:NIOCARI ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE B lnnlnna (MMIDDIYYYY) nco THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE W5UING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) Enust have ADDITIONAL INSURED provlBlons or be andorsed. If SUBROGATION IS WAIVED, Subject to the tarty and conditions of the policy, certain pallciac may require an endorsemont. A statelrlsnt on this certificate does not confer any rights to the certificate holder in lieu of SUCK ondorsalnant(r). PROOVOrmR p�}7AC7 McGrlff Insurance Services RONE � E I; BSB 743y2217 VC yQ: $0198278861 494 Galllmore Dairy Road E-MA Suite F ADORES MEDEXP (Any otie ve A sS 00D Greensboro, NC 27409 INSORER(G) AFFORDING COVERAGE HAIC I INSURER A; CvR" *fin Imurerwe CampanY 35378 INSURED Orange Senior Dare of range County Inc B., llarlwllnrurancn Ccmpnny 38970 PERSONAL L ADV INJURY $1,000,1500 Attn nay Health Center INSURER C: - 105 Meadowlands Dr INSURER O: s3000000 INSURERS: Hillsborough, NC 27278 -8181 NOVRrR r. PRODUCTS - COMPIOPAGG GL]VLxAGES CERTIFICATE. PJIIMRF.R! OVIAM KI ►inaanea, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN I$SUEP TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CIF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDeo BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS Or $UGH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIR TYPE DP INSURANCE INSR UT POLICY NUMBER MMIDDMYYF MM1OtMO BXP LIMITS A 2t COMMLRCIALGENERA LIABILITY XI CLAIhrB -MADE CJCCUR x SM921051 7113/2018 071131201 rAACCHp�OCTCUR�RENCE $1000000 PREFAISE3 II.ET nce 450,0 0 7t MEDEXP (Any otie ve A sS 00D BI1PD Ded.5,000 PERSONAL L ADV INJURY $1,000,1500 GEN'LAGGREOATE41MI1 APPLIES PER: . PRO - POLICY D &01 F-1 LOC s3000000 GENEPALAGGArQATsz PRODUCTS - COMPIOPAGG t _ OTHER: AUTOMOBILE LIABILITY CoMew -e N LE umrr Es -- ,1 -desil BODILY INJURY (Per p4f59h) 1 ANY AUTO OW�EED BCHEDULED AUT 1 ONLY AUTOS HtREU NON -OWNED AUTOS ORLY AUTOS ONLY BODILY IN IURY Per aGCfdenl ( j PEIOPERTY DAMAGfi e e # 1,1101IR"LA61AD OCCUR EACi4=URR'FNCE # E XCESS LIAB CLAIM'�MADE ADORE ©AYE $ - aFD I I RU W-ON s S B WORKERRSCOMPrKAYMN AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOMPARTNERIEXECUTNE�r-y-�� OFFICERIMEMBER EXCLUDED? i r l NIA MWC010010202 2148/2099 021001201S pEft orH- E.L. EACH ACCIDENT $500 000 _ r.L. DISEASE -E0. EMPLOYEE $600,000 (MpndatoryInNH) If yy5 @, dowoe Uno4u OE9CRIPTIONOFOPERATiONSbe164 E.L,DISWr;- POLICYLIMIY' - �-- - $500,000 A Professional SM921059 0711312018 071IT20119 $1,000,000 each clalm Liability $3,+000,000 aggregate $5,000 died. DMSCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ArVRO 107, Addlllunel Renaults ashodulo, mey he attached Y nlarc aparo is requiradl Policy Includes endorsement that provides Additional Insured status for any Landlord, ownor, or Properly Manager- of the Designated Premises or any Tradeshow or Convention Sponsor or Operator or any Lessor of equipment. Professional Liability - POLO SM921051 (See Attached Descriptions) anon, 1r1U^1 e Orange County GlDvarnrnont 200 S Cameron Street Hillgbwough, NC 2727E ACORD 25 (2016103) 1 of 2 #S204711011M20467370 SHOULD ANY OF THE ABOVE DE°SCRISErb POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE VVILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE @ 1988 -2015 ACOkD CORPORATION. All rights reservers, The ACORD name and logo are roglaterad marks of ACORD L1111MA: DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B 'Ju - 27. 2418 8:31AM DESCRIPTIONS (Continued from Page 1) Professional Liability Limit #1: 1,000,000 bsd,#1: $5,000.00 Limit #2: 3,000,000 Retroactive Date: Juiy 13, 2005 for OL and PRO Sexual Acts Liability EndorsBment Limit 41: 1,000,000 All Claims Made by Each Claimant Limit #2: 2,000,400 All Claims under Coverage Sexual Abuse Liability 'Workers Comp information *i Other States Coverage ProprietorslPartners]Executive Officers /Members Excluded: Nancy Esparsen, Officer Ann Burton, Officer Dave Wilkerson, Officer -5,vQ1 i i A 4j.3 (ZOUHus) 2 of Z #3204-11 101/M20467370 No, 7441 P. 3