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HomeMy WebLinkAboutNYS Office for the Aging - Social Adult Day ServicesGeorge E. Pataki Governor Walter G. Hoefer Director New York (JFFICEfor * Two Empire State Plaza Albany, New York 12223-1251 NYSOFA@o fa.state.ny, us January 11, 2001 Jean W. Cochran, Supervisor Town of Southold Southold Town Hall P.O. Box 1169 Main Road Southold, NY 11971 Dear Ms. Cochran: We are pleased to enclose the official fully executed contract between our Office and Town of Southold under the Social Adult Day Services (SADS) program. The program period begins January 1, 2001. Shbrtly, we will be sending you additional information regarding your 25% advance payment, vouchering procedures and budget modification procedures. If you have any fiscal questions, please contact me at (518) 486-2725. If you have any programmatic questions, please contact Andrea Hoffman at (518) 474-0484. We convey our best wishes for a successful program. Sincerely, Stephen Francis Senior Accountant Enclosures cc: Andrea Hoffman PROMOTING INDEPENDENCE AND QUALITY OF LIFE FOR OLDER NEW YORKERS An Equal OppOrtttni~Employer STATE AGENCY (Name & Address) NEW YORK STATE OFFICE FOR THE AGING 2 Empire State Plaza Albany, NY 12223-1251 CONTRACTOR (Name & Address) Town of Southold 750 Pacific Street Box 85 Mattituck, NY 11952 CHARITIES REGISTRATION NUMBER: FEDERAL TAX IDENTIFICATION NUMBER: MUNICIPALITY NO.: (if applicable) 470379000-000 STATUS CONTRACTOR IS ( ) IS NOT (x) A SECTARIAN ENTITY CONTRACTOR IS ( ) IS NOT (~ A NOT FOR PROFIT ORGANIZATION NYS COMPTROLLER'S NUMBER C002905 ORIGINATING AGENCY CODE 01370 TYPE OF PROGRAM(S/: Social Adult Day Services Program INITIAL CONTRACT PERIOD FROM: 1/1/2001 TO: 12/31/2001 FUNDING AMOUNT FOR INITIAL PERIOD: $20,000 MULTI-YEAR TERM (if applicable) FROM: N/A TO: APPENDICES ATTACHED AND PART OF THIS AGREEMENT: _X APPENDIX A Standard Clauses as required by the Attorney General for ail State contracts, X APPENDIX A1 Agency-specific Clauses X APPENDIX B Budget X APPENDIX C Payment and Reporting Schedule X APPENDIX D Program Workplan _X APPENDIX X Modification Agreement Form (to accompany modified appendices for changes in term or consideration on an existing period or for renewal periods) __ OTHER (Identify) __ OTHER (identify) __ OTHER (identify) __ OTHER (Identify) IN WITNESS THEREOF, the parties hereto have executed or approved this AGREEMENT on the dates below their signatures. Contract No: c002905 CONTRACTOR STATE AGENCY Town of Southold New York State Office for the Aqinq Printed Name Jean W. Cochran Title: Director Printed Name Title: Southold Town Supervisor Date: 12/5/00 Date: State Agency Certification "In addition to the acoeptance of this contract, I also certify that original copies of this signature page will be attached to all other exact copies of this contract." STATE OF NEW YORK ) ) SS.: County of Suffolk ) On the 5th day of December ,2000 before me personally appeared Jean W. Cochran , to me known, who being by me duly sworn, did depose and say thatx¥~/she resides at 270 Boisseau Avenue, Southold, NY , thatxJ~she is the Supervisor of the Town of Southold , the corporation described herein which executed the foregoing instrument; and that,/she signed ~ii~/her name thereto by order of the b~ard of directors of said corporation. MELANIE DO~OSKI NOTARY m~UC, Sram ~ NY ATTORNEY GENERAL'S SIGNATURE STATE COMPTROLLER'S SIGNATURE APPROVED Date:,, Da~ ;: DEC 1 9 2000 STATE OF NE~ YORK &GREEMENT This AGREEMENT is hereby made by and between the State of New York agency (STATE) and the public or private agency (CONTRACTOR) identified on the face page hereof. NITNESSETH: WHEREAS, the STATE has the authority to regulate and provide funding for the establishment and operation of program services and desires to contract with skilled parties possessing the necessary resources to provide such services; and WHEREAS, the CONTRACTOR is ready, willing and able to provide such program services and possesses or can make available all necessary qualified personnel, licenses, facilities and expertise to perform or have performed the services required pursuant to the terms of this AGREEMENT; NOW THEREFORE, in consideration of the promises, responsibilities and covenants herein, the STATE and the CONTRACTOR agree as follows: I. Conditions of AGreement A. This AGREEMENT may consist of successive periods (PERIOD) as specified within the AGREEMENT or within a subsequent Modification Agreement(s) (Appendix X). Each additional or superseding PERIOD shall be on the forms specified by the particular State agency, and shall be incorporated into this AGREEMENT. B. Funding for the first PERIOD shall not exceed the funding amount specified on the face page hereof. Funding for each subsequent PERIOD, if any, shall not exceed the amount specified in the appropriate appendix for that PERIOD. C. This AGREEMENT incorporates the face pages attached and all of the marked appendices identified on the face page hereof. D. For each succeeding PERIOD of this AGREEMENT, the parties shall prepare new appendices, to the extent that any require modification, and a Modification Agreement (The attached Appendix X is the blank form to be used). Any terms of this AGREEMENT not modified shall remain in effect for each PERIOD of the AGREEMENT. To modify the AGREEMENT within an existing PERIOD, the parties shall revise or complete the appropriate appendix form(s). Any change in the amount of consideration to be paid, or change in the term, is subject to the approval of the office of the State Comptroller. Any other modifications shall be processed in accordance with agency guidelines as stated in Appendix Al. E. The CONTRACTOR shall perform all services to the satisfaction of the STATE. The CONTRACTOR shall provide services and meet the program objectives summarized in the Program Workplan (Appendix D) in accordance with: provisions of the AGREEMENT; relevant laws, rules and regulations, administrative and fiscal guidelines; and where applicable, operating certificates for facilities or licenses for an activity or program. F. If the CONTRACTOR enters into subcontracts for the performance of 'work pursuant to this AGREEMENT, the CONTRACTOR shall take full responsibility for the acts and omissions of its subcontractors. Nothing in the subcontract shall impair the rights of the STATE under this AGREEMENT. No contractual relationship shall be deemed to exist between the subcontractor and the STATE. G. Appendix A (Standard Clauses as required by the Attorney General for all State contracts) takes precedence over all other parts of the AGREEMENT. II. Payment and ReDortin~ A. The CONTRACTOR, to be eligible for payment, shall submit to the STATE's designated payment office (identified in Appendix C) any appropriate documentation as required by the Payment and Reporting Schedule (Appendix C) and by agency fiscal guidelines, in a manner acceptable to the STATE. B. The STATE shall make payments and any reconciliations in accordance with the Payment and Reporting Schedule (Appendix C). The STATE shall pay the CONTRACTOR, in consideration of contract services for a given PERIOD, a sum not to exceed the amount noted on the face page hereof or in the respective Appendix designating the payment amount for that given PERIOD. This sum shall not duplicate reimbursement from other sources for CONTRACTOR costs and services provided pursuant to this AGREEMENT. C. The CONTRACTOR shall meet the audit requirements specified by the STATE. 2 III. Terminations A. This AGREEMENT may be terminated at any time upon mutual written consent of the STATE and the CONTRACTOR. B. The STATE may terminate the AGREEMENT immediately, upon written notice of termination to the CONTRACTOR, if the CONTRACTOR fails to comply with the terms and conditions of this AGREEMENT and/or with any laws, rules, regulations, policies or procedures affecting this AGREEMENT. C. The STATE may also terminate this AGREEMENT for any reason in accordance with provisions set forth in Appendix Al. D. Written notice of termination, where required, shall be sent by personal messenger service or by certified mail, return receipt requested. The termination shall be effective in accordance with the terms of the notice. E. Upon receipt of notice of termination, the CONTRACTOR agrees to cancel, prior to the effective date of any prospective termination, as many outstanding obligations as possible, and agrees not to incur any new obligations after receipt of the notice without approval by the STATE. F. The STATE shall be responsible for payment on claims Pursuant to services provided and costs incurred pursuant to terms of the AGREEMENT. In no event shall the STATE be liable for expenses and obligations arising from the program(s) in this AGREEMENT after the termination date. IV. Indemnification A. The CONTRACTOR shall be solely responsible and answerable in damages for any and all accidents and/or injuries to persons (including death) or property arising out of or related to the services to be rendered by the CONTRACTOR or its subcontractors pursuant to this AGREEMENT. The CONTRACTOR shall indemnify and hold harmless the STATE and its officers and employees from claims, suits, actions, damages and costs of every nature arising out of the provision of services pursuant to this AGREEMENT. B. The CONTRACTOR is an independent contractor and may neither hold itself out nor claim to be an officer, employee or subdivision of the STATE nor make any claim, demand or application to or for any right based upon any different status. Property Any equipment, furniture, supplies or other property purchased pursuant to this AGREEMENT is deemed to be the property of the STATE except as may otherwise be governed by Federal or State laws, rules or regulations, or as stated in Appendix Al. VI. Safeguards for Services and Confidentiality A. Services performed pursuant to this AGREEMENT are secular in nature and shall be performed in a manner that does not discriminate on the basis of religious belief, or promote or discourage adherence to religion in general or particular religious beliefs. B. Funds provided pursuant to this AGREEMENT shall not be used for any partisan political activity, or for activities that may influence legislation or the election or defeat of any candidate for public office. C. Information relating to individuals who may receive services pursuant to this AGREEMENT shall be maintained and used only for the purposes intended under the contract and in conformity with applicable provisions of laws and regulations, or specified in Appendix Al. APPENDIX A STANDARD CLAUSES FOR ALL NEW YORK STATE CONTRACTS The parties to the attached con ract, cerise, lease, amendment or other agreement of an,/kind Coereinafter, "the contract" or "this contract") agree to be bound by the following clauses which are hereby made a pa~t of the contract (the word omrac or herein relers to any party other than the State, whether a contractor, licenser, licensee, lessor, lessee or any other party): l. EXECUTORY CLAUSE. In accordance with Section 41 of the State Finance Law, the State shall have no liability under this contract to the Contraclnr or to anyone else beyond funds appropriated and available for this contract. 2. NON~ASSIGNMEblT CLAUSE In accordance with Section 138 of the State Finahce Law, this contract may not be assigned by the Contractor or its tight, title or interest therein ~ssigned, transferred couveyed, sublet or otherwise disposed of without the previous consent, in writing, of the State and any attempts to assign the contract without the State's written consent are mdl and void rlh~ Con factor may, however, assign its right to receive payment without the State's prior written consent unless this contract concerns Certificates of Participation pursuant to Article 5-A of the State Finance law. · COMPTROLLER S APPROVAL th accordance with Section 112 of the State Finance Law (or, if this contract is with the State University or City University of New York, Section 355 or Section 621 g of the Education Law), if this contract exceeds $15,000 (or the ~rdnimum tlxresholds agreed to by the Office of the State Comptroller for certain S.U.N.Y. and C. U.N.Y. contracts), or if this is an amendment for any amount to a contract which, as so amended, exceeds said statutory amoun, or if, by this contract, the State agrees to give'something other than money when the value or reasonably estimated value of such consideration exceeds $15,00{), it shall not be valid, effec ye or binding upon the Slate until it has been approved by the State Comptroller and filed in his office. 4.WORKERS" COMPENSATION BENEFITS. In accordance with Section 142 of the State Finance Law, this contract shall be void and of no force and effect unless the Contractor shall provide and maintain coverage during the life of this cmltract for the benefit of such employees as are required to be covered by the provisions of tile Workers' Compensatthn Law. 5. NON-DISCRIMINATION REQUIREMENTS. In ancordance with Article 15 of the Executive Law (also known as the Human Rights Law) and all other State and Federal statutory and constitutional non-discrinfination provisions, [tie Contractor will not discriminate against any em, ployee or applicant for employmant because of race, creed, color, sex, n~.tioanl origin, age, disability or marital status. Furthermore, in accordance with Section 220-e of tile Labor Law, if this is a contract for the construction, aheratthn or repair of any public building or public work or for the manufacture, sale or distribution of materials, equipment or supplies, and to the extent that thts coutract shall be performed within the State of New York, Contractor agrees that neither it nor its subcontractors shall, by reason of race, creed, color, disability, sex, or national origin: (a) discriminate in hiring against any New York State citizen who is qualified m~d available to perform the work; or Co) discriminate against or intimidate any employee hired for the performance of work under this contract. If this is a building service contract as defined in Sectthn 230 of the Labor Law, then, m accordance with Section 239 thereof, Contractor agrees that neither it nor its subcontractors shall be reason of race, creed, color~ national origin, age, sex, or disability: (al discriminate in ttinng against any New York State citizen who is qualified and available to perform the work; or Co) discmninate aga/nst or intimidate m~y employee hired IBr the pe~a%rmance of work under this contract. Contractor is subject to fines of $50.00 per person per day for any violatmn of Section 220~e or Section 239 as well as possible termination of this contract and forfeiture of all moneys due bereander for a second or subsequent violation. 6. WAGE AND HOURS PROVISIONS· If this is a public work contract covered by Article 8 of the Labor Law or a building service contract covered by Article 9 thereof; neither Contractor's employees nor the employees of its subcontractors may be required or permitted to work more than the number of hours or days stated in said statutes, except as otherwise provided in the Labor law and as set forth in prevailing wage m~d supplement schedules issued by the State Labor Department. Furthermore, Contractor and its subcontractors tnust pay at least the prevailing wage rate and pay or provide the prevailing supplements, including the premmin rates for overtime pay, as determined by/he State Labor Deparlment in accordance with the Labor Law. 7. _NON-COLLUSIVE BIDDING REQI. flREMENT. In accordance with Section 139-d of the State Finance Law, if this contract was awmrded based upon the submission of bids, Contractor warrants, nnder penalty of perjuu, that its bid was arrived at thdependently and without collusion aimed at restricting competition. Contractor further warrants that, at the time Contractor submitted its bid, an authorized and responsible person executed and delivered to the State a non-collusive bidding certification on Contraclor's behalf. 8. INTERNATIONAL BOYCOT'F PROHIBITION. In accordance with Section 220-f of the Labor Law and Section 139-h of the State Fthance Law, if this contract exceeds $5.000, the Contractor agrees, as a material condition of the contract, that neither the Contractor nor any substantially owned or affiliated person, firm, partnership or corporation has participated, is participating, or shall participate in an intematiunal boycott in violation of the federal Export Administration Act of 1979 (50 USC App. Sections 2401 et seq.) or regulations thereunder. If such Contractor, or any of fire aforesaid affiliates of Contractor, is convicted or is otherwise found to have violated said laws or regulations upon the final determination of the United States Commerce Department or any other appropriate agency of the United States subsequent to the contractors execution, such contract, amendment or modification thereto shall be rendered forfeit and void. The Contractor shall so notify the State Comptroller within five (5) business days ut' such conviction, determination or disposition of appeal (2NYCRR 105.4). 9. SET-OFF RIGHTS. The State shall have all of ils commoll law, equitable and statutory rights of set-offi These rights shall include, but not be limited to, the State's option to withhold for the purposes of set-off any moneys due to the Contractor under this contract up to any ammmts due and owing to the State with regard to this contract, any other contract with any State department or agency, including a~y contract for a term conunencing prior to the term of this contract, plus any amounts due and owing to the State for any other reason including, without limi. tfition, tax delinquencies, fee delinquencies or monetary penalties relative thereto. The State shall exercise its set-off fights in accordance with nurnml State practices including, in cases of set-off pursuant to an audit, the finalization of such an~t by the State agency, its representatives, or the State Comptroller. 10. RECORDS, The Contractor shall establish and maintain complete and accurate books, records, documents, accounts and other evidence direedy pertinent to performance under this contract (hereinafter, collectively, "the Records"). The Records must be kept for the balance of the cglandar year in wlfich they were made and for six (6) additional years thereafier. The State Comptroller, the Attorney General and any other person or entity authorized to conduct an exaWanation, as well as the agency or agencies involved in this contract, shall have access to the Records during normal business hours at an office of the Contractor within the State of New York or, if no such office is available, at a mutually agreeable and reasonable venue within the State, for the term specified above for the purposes of inspection, auditing and copying. The State shall take reasonable steps to protect from public disclosure any of the Records widch are exempt from disclosure under Section 87 of the Public Officers Law (the "Statute") provided that: (i) the Contractor shall timely inform an app~-opriate State official, in writing, that said records should not be disclosed; and (ii) said records shall be sufficiently identified; and (iii) designation of said records as exempt under the Statute is reasonable. Nothing contained herein shall diminish, or in any way adversely affect, the State's right to discovery in any pending or future litigation. 11. IDENTIFYING INFORMATION AND PRIVACY NOTIFICATION. (A) FEDERAL EMPLOYER IDENTIFICATION NI[1MBER and/ur FEDERAL SOCIAL SECURITY NUMBER. All invoices or New York State standard vouchers submitted for payment for the sale of goods or services or the lease of real or pexsonal property to a New York State agency must include the payee's identification number, i.e., the seller's or lessor's identification number. The number is either the payee's Federal employer identification number or Federal social security number, or both such numbers when the payee has both such numbers. Failure to include this number or numbers max, delay payment. Where the payee does not have such number or numbers, the payee, on its invoice or New York State standard voucher, must give the remqon or reasons why the payee does not have such number or numbers. (B) PRIVACY NOTIFICATION. (1) The authority to request the above personal information from a seller of goods or services or a lessor of real or personal property, and the authority to maintain such information, is found in Section 5 of the State Tax Law. Disclosure of tlris information by the seller or lessor to the State is mandatory. 'Die principal purpose for which the information is collected is to enable the State to identify individuals, businesses and others who have been delinquent in filing tax returns or may have understated their tax liabilities and to generally identify persons affected by the taxes admiinstered by the Commissioner of Taxation and Finance. The information will be used for tax administration purpose and for any other purpose authorized by law. (2) The persona/information is requested by the purchasing unit of the agency contracting m purchase the goods or services or lease the real or personal property covered by tiffs contract or lease. The information is maintained in New York State's Central Accounting System by the Director of Aanountirtg Operations, Office of the State Comptroller, AESOB, Albany, New York 12236. 12. EQUAL EMPLOYMENT OPPORTUNITIES FOR MINORITIES AND WOMEN. In accordance with Section 312 of the Executive law, if this contract is: (i) a written agreement or pumhase order instrument, providing for a total expenditure in excess of $25,000.00, whereby a contracting agency is comnfitted to expend or does expend funds in return for labor, services, supplies, equipment, materials or any combination of the foregoing, to be performed for, or rendered or furnished to the contracting agency; or (ii) a written agreement in excess of $100,000.00 whereby a contracting agency is committed to expend or does expend funds for the acquisitior~, construction, demolition, replacement, major repair or renovation of real property and improvements thereon; or (iii) a written agreement in excess of $100,000.00 whereby die owner of a State assisted housing project is committed to expend or does expend funds for the acquisition, construction, demolition, replacement, major repair or renovation of real property and improvements thereon for such project, then: (a) The -2- Cgn!ractor will not discriminate against employees or applicants for employmem because of ~ ace, creed, color, national origin, sea, age, disability or marital stalus, and will undertake or continue existing programs of affirmative action to ensure that minority group members and women are afforded equal employment opportunities without discrimination. Affilrmative action shall mean recruitment, mt~ployment, lob assignment, promotinn, upgradings, demotion, transfer, layoff, or termination and rates of pay or other Inrn~s ol: compensmion; (b) at the reqnest of the contracting agency, the Contraclor shall request each employment agency, labor uninu, or authorized representative of workers with which it has a collective bargaining or other agreement or understanding, to himish s written statement that such emphiyment agency, labor union or representative will not discrimiffate on the basis of race, creed, color, national origin, sex, age, disability m- marital atoms and that such union or repmsemative will affirmatively cooperate in the implementation of the contractor's obligations herein; and (c) die Contractor shall state, iii all solicitations or advertisements for employees, that, in the performm~ce of the State contract, all qualified applicants will be afforded equal employment opportunhies without discrimination because of race, creed, color, national origin, sex, age, disability or marital status. Contractor will include the provisions of "a, "b", and "c" above, in every subcontract over $25,000.00 for the construction, demolition, replacement, major repair, renovatinn, planning or design of real property~and improvements thereon (the Work) except where the Work is for the beneficial use of the Contractor. Section 312 does not apply to: (i) work, goods or services unrelated to this contract; or (ii) employment outside New York State; or (iii) banking services, insurance policies or the sale of securities. The State shall consider compliartce by a contractor or subcontractor with the requirements of any federal law concerding equal emphiS, ment opportunity which effectuates the purpose of this section. The contracting agency shall determine whether the imposition of the ]requirements of the provisions hereof duplicate or conflict with any such federal law and if such duplication or conflict exists, the contracting agency shall waive the applicability of Section 312 to the extent of such duplicanon or conflict. Contractor will comply with all duly promalgated and lawful rilles and regulations of the Division of Minority and Women's Business Development pertaining hereto. 13. CONFLICTING TERMS. In the event of a conflict between the terms of the contract (including any and all attachments thereto and amendments thereof) and the terms of tiffs Appendix A, the terms of this Appendix A shall control. 14. GOVERNING LAW. This contract shall be governed by the laws of the State of New York except where the Federal supremacy clause requires otherwise 15. LATE PAYMENT. Timeliness of payment and any interest to be paid to Contractor for late paymeni shall be governed by Article XI-A of the State Finance Law to the extent required by law. 16. NO ARBITRATION. Disputes involving this contract, including the breach or alleged breach thereof, may not be submitted to binding arbitration (except where statatorily andmrized), but must, instead, be beard in a court of competent jurisdiction of the State of New York. 17. SERVICE OF PROCESS. In addition to the methods of service allowed by the State Civil Practice Law & Rules ("CPLR "), Contractor hereby consents to service of process upon it by registered or certified mall, return receipt requested. Service hereundar shall be complete upon Contractor's actual receipt of process or upon the State's receipt of the return thereof by the United States Postal Service as refl~sed or undeliverable. Contractor must promptly notify the State, in writing, of each and evew change of address to which service of process can be made. Service by the State to the last known address shall be sufficient. Contractor will have thiriy (30) calendar days after service hm-eunder is complete in which to respond. 18. PROHIBITION ON PURCHASE OF TROPICAL HARDWOODS._The Contractor certifies and warrants that all wood products to be used under this contract award will be in accordance with, but not limited to, the specifications and provisions of State Finance Law § 165. (Use of Tropical Hardwoods) which prohibits purchase and use of tropical hardwoods, unless specifically exempted, by the Slate or any governmental agency or political subdivision or public benefit corporation. Qualification for an exemption under this law will be the responsibility of the contraclor to establish to meet with the approval of the State. In addition, when any portion of this contract involving the use of woods, whether supply or installation, is to be performed by any subcontractor, the prime Contractor will indicate and certify in the submitted bid proposal that the subcontractor has been informed and is in complitmce with specifications m~d provisions regarding use of tropical hardwoods as detailed in §165 State Finmme Law. Any such use must meet with the approval of the State, otherwise, the bid may not be considered responsive. Under bidder certifications, proof of qualification for exemption will be the responsibility of the Contractor m meet with the approval of the State. 19. MACBRfl~E FAIR EMPLOYMENT PRINCIPLES. In accordance with the MacBride Fair Employment Principles (Chapter 807 of the Laws of 1992), the Contractor hereby stipulates that the Contractor eidier (a) has no business operations in Northern tm/and, or ~) shall take lawfid steps in good faith to condoct any business operations in Northern lrelm~d in accordance with the MacBfide Fair Employment Principles (as desefibed in Section 165 of the New York State Finfince Law), m~d shall permit independent moiuioring of compliance with such principles. 20. OMNIBUS PROCUREMENT ACT OF 1992 It is the policy of New Ym-k State to maximize opportunities for the -q- participation of New York State business enterprises, including minority and women-owned business enterprises as bidders, subconh~actors and suppliers on its procurement cootrants. Information on the availability of New York State subcontractors and suppliers is available from: Department of Economic Development Division for Small Business 30 South Pearl Street Albany, New York 12245 Tel. 518-292-5220 A directory of certified minority and women°owned business enterprises is available from: Department of Economic Development Minority and Women's Business Development Division 30 South Pearl Street Albany. New York 12245 www.empire, stale.ny.us The Onmibus Procurement Act of t992 requires that by signing this bid proposal or contract, as applicable, Contractors certify that whenever the total bid amount is greater than $1 milfion: (a) The Contractor has made reasonable efforts to encourage the participation of New York State Business Enterprises as suppliers and subcontractors~ including certified minority and women-owned business enterprises, on this project, and has retained the documentation of these efforts to be provided upon request to the State; (b) The Contractor has complied with the Federal Equal Opportunity Act of 1972 (P.L. 92~261), as amended: (c) The Contractor agrees to make reasonable efforts to provide notification to New York State residents of employment opportnnifies on this project through listing any such positions with the Job Service Division of the New York State Department of Labor, or providing such notification in such manner as is consistent with existing collective bargaining contracts or agreements. The Contractor agrees to document these efforts and to provide said documentation to the State upon request: m~d (d) The Contractor acknowledges notice that the State may seek to obtain offset credits from foreign countries as a result of this contract and agrees to cooperate with the State in these efforts. 21. RECIPROCITY AND SANCTIONS PROVISIONS. Bidders are hereby notified that if their principal place of business is located in a state that penalizes New York State vendors, and if the goods or services they offer will be substantially produced or performed outside New York State, the Omnibus Procurement Act 1994 amendments (Chapter 684, Laws of 1994) require that they be denied contracts which they would otherwise obtain. Contact the Department of Economic Development, Division for Small Business. 30 South Pearl Street; Albany New York 12245, for a current list of states subject to this provision. (Revised August, 2000) -4- APPENDIX A-1 AGENCY SPECIFIC CLAUSES SOCIAL ADULT DAY SERVICES PROGRAM (Please note that the order in which each part of this Appendix A-1 is set forth, corresponds directly to that of the State of New York Agreement {boilerplate}.) I. Conditions of Agreement The Contractor shall comply with all applicable State Laws, including Section 541a of Article 19-J of the Executive Law, and the State Finance Law of New York State, and with all applicable rules and regulations of the State and the New York State Office of the State Comptroller that are in effect or become effective during the term of this Agreement. The Contractor shall comply with Section 6654.20 of Title 9 of the New York Codes, Rules and Regulations and MDS requirement as established in NYSOFA Program Instruction ~97-PI-01. The Contractor shall comply with the registration and reporting provisions required of charitable organizations by Article 7-A of the New York State Executive Law. The Contractor shall comply with Titles VI and VII of the Civil Rights Act of 1964 (Public Law 38-352), and any amendment thereto, and all rules and regulations pertaining thereto promulgated by the United States Department of Health and Human Services that are in effect or become effective during the term of this Agreement. In addition to the above protections the Contractor shall comply with Titles I, II, and III of the Americans with Disabilities Act of 1990, and any amendment thereto, which protects qualified individuals with disabilities from discrimination in employment and provides access to public services. Reasonable accommodations must be made for any person with a disability desiring to participate in services funded under this agreement, no fees can be charged to the participant for such accommodation. The Contractor shall comply with the program management and assessment requirements of the State, including but not limited to announced and unannounced on-site visits by State staff, disclosure of all program files and related fiscal records and development of a corrective action plan if required by ~he State in a program assessment report. The Request for Proposals package issued by the State and the proposal submitted by the Contractor in response to the Request for Proposals are a part of this Agreement. The Program Workplan (Appendix D) shall not be modified without approval from the Sta~e. If modification to the Program Workplan is necessary, the Contractor must submit a written request to the State and await State approval before implementing such changes. The Contractor shall make expenditures only for authorized items of expense contained in the Budget (Appendix B). Cost overruns of up to $200 or 10% (whichever is greater) for an individual budget category for authorized items of expense will be allowed as long as the total costs do not exceed the total amount of the contract. If expenditures for other than authorized items become necessary, the Contractor shall submit a written request for approval from the State and await State approval before incurring such expenditures. Also, if costs for an individual budget category will exceed the budgeted amount by more than $200 or 10%, whichever is greater, a budget modification must be approved in writing by the State before these costs will be reimbursed. Budget modifications shall not result in an increase in the amount made available under this Agreement unless the State gives its express written consent. II. A. III . A. IV. A. Unless a waiver is requested and granted as provided for in legislation, the Contractor agrees and understands that any funds provided under this program shall not exceed 75% of the Total Budget Amount. The Contractor agrees that the Social Adult Day Services funding shall not supplant any existing public or ~rivate f~nding for social adult day services programs. The Contractor agrees that the Social Adult Day Services funding shall not be used for services provided to el~/erly persons who are eligible for or receiving comparable services pursuant to 7~itles XVIII, XIX or XX of the federal Social Security Act or any other government program. The Contractor may enter into subcontracts for the provision of some aspects of the program as described in the Program Workplan. All such subcontracts shall be written according to State and local standards and a copy of each executed subcontract shall be forwarded to the State prior to payment by the State for any expenditures incurred under such subcontract. The Contractor agrees that any public information materials or other printed or published materials will give due recognition to the fact that the program is supported with State Funds and such recognition will be in a form prescribed by the State. The Contractor shall work cooperatively with and consult with the area agencies on aging in the region to be served by this Agreement. The Contractor shall work cooperatively with public and private agencies, institutions, organizations, and associations within New York State and, where appropriate, with national organizations in the development of activities under this Agreement. Payment and Reporting The Contractor agrees that in the absence of new legislative authorization for the use of these State funds for the purpose described in this Agreement, the State may only be authorized to reimburse vouchered claims for payment for approved expenses incurred during the 2000-01 State Fiscal Year up to and including March 31, 2001. In the event that new legislative authorization permits the use of these State funds in subsequent State fiscal year(s), the State ,is authorized to reimburse vouchered claims for payment for approved expenses incurred by the ending date of the fiscal year for which authorization is received. The Contractor understands and agrees that all payments to be made hereunder, are subject to the availability of State funds and, the State shall have no liability to the Contractor beyond the amounts made available under the 2000-01 State Budget. Terminations The Contractor shall make a full and final accounting of all funds received under this Agreement within 60 days of receipt or issuance of a notice of termination. Indemnification The Contractor shall assume responsibility for recruitment, retention, and/or dismissal of all personnel to be employed in the conduct of this Agreement. The Contractor shall ensure that the personnel hired are qualified to carry out the activities outlined in this Agreement. VI. A. Property The Contractor agrees that all rights and title to any materials (manuals, tests, guides, audio or visual materials or devices) developed with funds under this Agreement shall become the property of the State. Reproduction, distribution, sale, release or other use of such material by the Contractor must be specifically requested in writing by the Contractor and must receive prior approval by the State. Safeguards for Services and Confidentiality The Contractor shall utilize these State funds to serve those aged (i.e., persons age 60 and older) individuals possessing functional impairments, whether due to physical or cognitive impairments, regardless of their membership status subject to the availability of funding. The Contractor shall serve any aged individual possessing functional impairments, whether due to physical or cognitive impairments, and assure equal access for participation, services, activities and informational and outreach sessions without regard to race, color, religion, sex, national origin, partisan affiliation or sexual orientation. The Contractor shall prevent the use of official authority, influence or coercion to interfere with or affect elections or nominations for public office. The Contractor shall assure there is neither coercion nor advice to other persons to contribute anything of value to a party, committee, organization, agency, or person for political purposes, nor engage in any other partisan activities. The Contractor shall use all cost sharing and participant contributions received for services funded under this Agreement to expand services under this Agreement and to incorporate them into the budget accordingly. The Contractor agrees to maintain the confidentiality of all personal information pertaining to senior citizens served under this Agreement, including contributions; disclosure of such information may be made only when necessary to the provision of services, unless the senior citizen or his/her, authorized representative gives his/her consent to disclose such information, disclosure is required by court order, or such information is provided in summary, statistical, or other form, which does not identify particular individuals. 3 Appendix B Budget Sununary ProDosing Organization Town of So'~lthold Contract Period:January 1, 2001 - ]0ecember 31, 2001 Budget Category Budget Amount 1. Personnel $ 19,581 2. Fringe Benefits 2,086 3. Maintenance and Operations 333 4. Other Expenses 0 5. Subcontractors and/or Consultants * 0 6. Total Budget 22,000 7. Less Program Income 2,000 8, Net Budget Expenses 20,000 9. Matching Funds 0 10. State Funds Requested ** $ 20,000 * For each anticipated subcontractor or consultant, Subcontractor/Consultant Budget must be completed and submitted. ** State Funds Requested must be a minimum of $20,000 and a maximum of $75,000. ~ame, ~cle ~oca~on tif hourly ra~e ~ ~loyme, cal=. Weeks HeMth, ,Aide ~ ~,38o 52 Sr. Adult Day Care Bruce Berger Massage Therapist ~o,6~ 52 Sr. Adu1t Day Care Lauren Como ~~ 100% Prograph 7380. 10,641. 1,560. 19,581. Soczal Securi:y $2¢98. ae:~r~m~n~ Hmalch I~surance S9__8. Disability 196. 2,086. 3. Maintenance and Operations: Rent/Utilities (if multiple locations, please attach additional copies): Location: O~er: Monthly Rental:S__ X %Chargeable X _ _ mos. = $ Utilities: $ Janitorial Services: $ Maintenance-in-lieu of rent: $ Briefly Describe Each Expense: Telephone: $. Postage: Supplies: Art supplies, paints, paper)large paper pads, $-- 333 massage gels, towels, cassettes, record books ma ic markersL etc. Printing/Photocopying: Equipment maintenance and repair: (describe equipment and list amount) $_ Meals: $-- 4. Other Expenses: ITEM: TOTAL List each item and its cost for all Other Expenses. $ AMOUNT $333 TOTAL S 0 Subcontractors/Consultants: List each organization's name, tlrpe of service and amount below. Include a budget for each subcontractor/consultant. Organization/Type of Service Program Income: List total amount anticipated: Participant Contributions: Cost Sharing: Other Income (specify source): TOTAL Amount O00 $ 0 9. Local Matching Cash: List sources and amounts of Local Matching Cash. Source: (/) if in-kind TOTAL 000 Amount $ $ 0 $ 20,000 APPENDIX C PAYMENT AND REPORTING SCHEDULE SOCIAL ADULT DAY SERVICES PROGRAM The Contractor shall submit appropriate State Vouchers for reimbursement of expenses incurred in the conduct of this Agreement on a monthly or quarterly basis in such form as required by the State and with the necessary documentation as specified in the Social Adult Day Services Program Vouchering Procedure. The Contractor may request an advance not to exceed 25% of the State funds awarded. The Contractor shall submit the final voucher for expenses incurred under this Agreement to the State within 90 days after the ending date of the Agreement (by March 31, 2002). State Vouchers must be submitted to: New York State Office for the Aging Attention: Bureau of Fiscal Operations 2 Empire State Plaza Albany, NY 12223-1251 If the Contractor is a not-for-profit organization, then subject to the submission of a properly completed advance voucher, the advance will be paid within 30 days of the starting date of this Agreement. If it is necessary for the State to suspend the Prompt Contracting Law time frames, under the circumstances provided for in that statute, this payment date will be adjusted accordingly. The Contractor shall submit to the State an interim program progress report as prescribed by the State. This report is due by July 30, 2001 for the period ending June 30, 2001. A final program progress report must be submitted no later than 30 days after the end of the contract period (by January 31, 2002). Program progress reports must be submitted to: Andrea Hoffman Division of Local Program Operations New York State Office for the Aging 2 Empire State Plaza Albany, NY 12223-1251 Program Workpl~n Appendix D Proposing Organization Southold Town~ Human Services Subpart I: F-~nsion of Existing Social Adult Day Sa=vices Program Section A. 1. Operating schedule and location(s) a. Current hours and days of operation and location(s) 5 days a week - Monday through Friday 9 a.m. - 4 p.m. Located at the Human Resource Center 750 Pacific St. (P.O. Box 85) Mattituck, NY 11952 Describe any anticipated changes in this program area if funds are awarded. Identify major benchmarks to be achieved and time frame for overall completion. If funds are available for our one year pilot program, we will expand Our catchment area to include Shelter Island Shelter Island has no Day Care at al! . a We have ca]is to utilize our Day Care Program, but we cannot accept them as we need another part time staff person in order to supervise, monitor, provide personal care, maintenance and the daily Iiving skills of the additional clients. The funds would allow us to utilize specialized aIternative approaches to enhance the environment and utilize ail the senses of our clients to instill a genera! sense of well being in the hope that through the techniques of massage therapy and music therapy we can calm our A]zheimer's clients so they can re]ax more, decrease pacing and wandering, promote more focus and lessen combativeness. We wi]! monitor the effects of the various methods on their behavior. It is our hope that utilizing these methods would en- able us to increase our ability to manage their behavior better and extend their time at home and in our program, thus deterring premature institution- alization. -cont. on next page- b. continued Many of our frail elderly c]ients suffer from depression. It is our hope that the touching techniques in combination with moving to music, and doing activities to music will stimulate more positive responses to the world around them, that they wi1! feel more empowered and part of a very special group of caring people. We want to produce overal! physical, mental and emotional benefits from this indiv- idualized two-pronged approach to enriching the lives of our participants. Hospitals are utilizing massage therapy to calm and relax pre-operative patients as we]] as post-operative massage to promote healing. Examples of some of the overall benefits of massage are: 1. Increases nourishment to muscles and organs. 2. Increases efficiency and performance of muscle cells. 3. Improves cardio-vascular system where the number of circulating red blood cells is increased leading to greater oxygen capacity being carried to the blood. 4. Stimulates the body's parasympathetic nervous system which helps to ]ower blood pressure. 5. Breathing becomes slower and fuller and thus more efficient due to greater pulmonary ventilation. 6. Skin will have increased secretions because of more blood flow to it which will cause more regeneration of new skin cells through mitosis (replication). 7. Stimulates and tonifies digestive organs. 8. Improves digestion and the absorption of more usable nutrition. 9. Causes the release of special pain killing neurotransmitters known as endorphins where an euphoric feeling can be felt. 10. Increase basal metabolic rate where every cel! does more than what it did before, burning more calories in the process. 11. Increases the elimination of toxins and waste products from the body ceils. 12. Aids the body's feeling of tactile sensation where there is numbness or tingling. Our goal is to utilize massage techniques, comparable with our clientele, as well as music therapy to improve the health and behavior of both the frail elderly and dementia clients. Our goal is to enrich their quality of life, improve wandering and/or pacing and combative behavior among some dementia and A]zheimer clients to enable them to utilize our program longer, make it easier for caregivers to manage their behavior at home thus deterring premature insti- tutionalization. Although we have sufficient staff, they have many duties. They must implement the individual care plans, attend to the client's personaI care, provide the individual help required for nutrition, supervision and monitoring. They are very busy with their overall duties. The two consultants would only plan and implement their specialties. Each one would provide a rich, unique array of activities, presented to our clients on a regular scheduled basis, an en- richment of the senses of each participant at the level of their ability to accept it. - cont. on next page - b. continued These are the special enhancements our budget cannot provide, but things that may increase the ability of our clients to enjoy more meaningful days. This one year pilot project wouId determine if this is possible. Major benchmarks would be recorded monthly as the program progressed. We would have a base line for each client and at the end of six months we would chart changes in behavior, such as depression, combativeness, wandering, pacing, anxiety levels and length of stay in Day Care. A limited day may be able to be expanded. There may be increased participation in activities, less care- giving stress for families, an increase in the general well-being of the client to allow them to remain at home and in our program and not be prematurely institutionalized.. 3 Program WorkDl=n Appendix D Southold Tow~, Human .Se~ri~ 2. Program participants: · Average % of participants/day KO n. · Unduplicated % of participants/month~O · Unduplicated % of participants in calendar year 1999 50 · A description of the program participants including the types and degree of their impairments 1. Cannot ambulate alone, grossiy'dnsteady, cane; possible hallucinations at home. 2. No problems with early dismissal. 3. No problems; needs assist due to blindness. 4. No problems here; can easily feel slighted and becomes angr 5. Less participation; no exercises; on list at Westhampton NH 6. Cannot ambulate alone; very unsteady; walker; forgetful. 7. Episode on 8/17; ? comonary involvement; to Urist on Friday blood work on Monday 8/21. Staff knows to observe closely. 8. Extremely rigid; has been on Exelon for one week (aricept discontinued)Exelon stopped on Friday 8/18; no med over the weekend and'to start Aricept on monday. Her behavior has become worse in most areas on the exeon. Husband to see Ickes on 8/30 and Valiicourt on 9/6. Difficult behavior at home. Appetite poor; Donna Z. to assist with diet. We en- courage or feed her; offer supplements and fluids; home at 1:30. (Alzheimer's Disease) continued next page b. Describe any anticipated changes in this program area if funds are awarded. Identify major benchmarks to be achieved and time frame for overall completion. An%ic~Dated changes iD Dr0gram area if fuuos are awarded would be to enhance and improve the behavioral management of clients, %o improve their physical, emotional and social well-being; to increase their ability to utilize our Day Care Program longer and to deter premature institutionalization. We would supervise and monitor clients as they participated in our enhanced program and noting any changes in behavior, length of daily attendance in program, caregivers opinions from interviews to determine change in behavior at home, and any n~ticeable physical, emotiona! and/or socia! ~mprovement. It is ~mportant that each client be prov!ded with the services and activities that are commensurate with their ability to participate with maximum benefit to their general well being - to reach out to al! their senses in order to )rovide meaningful opportunities to enjoy music, movement, touch and artistic expression to the highest personal level they can attain; to make joyful con- tact with the world around them. - cont. on next page - 4 a. continued 10. 11. 12. 13. 14. 15. 16 17. 18. 19. Slow to respond but doing well husband is trying to regulate. 12:30. on Exelon; constipation problem that We encourage extra fluids. °ere until Comes M-W-F; likes to help other clients; no problems Comes M-W-F, becoming more frail and unsteady ambulation when weather is humid; uses cane. Short of breath on exertion; extremely unsteady ambulation and needs one assit; uses walker; post stroke client. Becoming more frail; needs encouragement (Dementia) uses cane and cannot ambulate alone; unsteady; to eat; we give supplements and extra fluids. Quiet as usual; family away until next month and Jack is living with Nancy Lillis; right hand swollen; he declines to exercise with that arm; occasionally cough becomes loose and Nancy adds one more nebulizer treatment. No problems; needs guidance 'with ambulation; daughter concerned she will fall. No problems here; needs to walk more; wife overwhelmed at home with his ability to get "into everything". (Alzheimer's Disease) Started Jb Exelon Jn conjunction with Aricept on 8/15; already improve- ment noted in word retrieval thought processes. Needs to walk more; cannot sit too long or her feet and legs hurt. (Alzheimer's Dsease) Nicely managed at home and here on Seraquel. is coming M-W-F and staff knows to let Doris cannot find him. (Alzheimer's Disease) Needs to walk; husband color after lunch so she Becoming more incontinent at home. No problems here. Leaves at 1:30 (Alzheimer;s Disease) 5 b. continued Each client's chart would have a baseline of impairments, physical, mental and emotional. Changes would be noted each month. At the six month mark a chart of each client would be made showing progress, or no or little progress, in each area noted. This would be done each month with the final individual progress reports charted in December. 6 Proposing Organization: ~] ~ Program WorkDl~n A~Dsndix D Human Services 3. Staffing: List staff positions with their responsibilities, indicating whether paid or volunteer, indicating those with direct contact with participants and the nature of the contact and hours worked. For full time staff whose responsibilities are providing assistance to participants or supervising participant activities, list relevant training and experience. Complete a Biographical Sketch for the program director (Please be advised that the regulations include requirements in this Director: The Director of the Day Care Program is also the Director of Human Services for the Town of Southold. The Director has the authority, working with the Suffolk County Office for Aging and the Supervisor and Town Board of Southold Town to hire personnel, be responsible for policies and proced- ures, has the basic responsibility to manage and implement the program and to ensure that activities and services are provided appropriately and in accord- ance with participant's needs. This is a full time paid position. Adult Day Care Supervisor: This is a full time paid position. The Adult Day Care Supervisor directly implements compliance and conformity standards with local, State and Federal laws and regulations. The Day Care Super- visor submits program reports, does initial assessments, completes the PDS assessments, writes the individual care plans and implements them, provides at least six hours of in-service training annually to develop, review and expand skills and knowledge, provides annual training in the use of fire extinguishers, written procedures regarding evacuation and emergency sit- uations, emergency phone numbers, keeps open communications with famiIies of participants. Al] trainings are documented. - cont. on next page - b. Describe any anticipated changes in the program area if funds are awarded. Identify major benchmarks to be achieved and timeframe for overall completion. If funds are awarded 3 people will be added to the staff, a massage therapist, a music therapist and an aide who will do record keeping, assist the therapists, track client progress, carry out therapists assignments throughout the week. A data base will be established and precise tracking of progress will be essential to the project. The therapists will have to have job descriptions prepared, permission from the Supervisor a,d Town Board to establish the positions and all positions must be advertised. This process takes about 6-8 weeks. Staff are expe~ed to be on board by February 1. 7 a. continued Day Care Aide: This is a full time paid position. The current staff person in this position has been with the Day Care Program since its inception in 1985. She received a special 40 hour home heatth aide course through the Suffolk County Department of Health, specifically for the implementation of the new Day Care Program. She has received training from Dr. Lori Bright-Long and Dr. Alan Steinberg, co-founders of the Long Island A1zheimer's Assistance Center at Stony Brook Hospital. They are both Geriatric Psychiatrists who provided training for us in the initial years of our program. Dr. Jay Slotkin, a loca! Geriatrician, also has provided our aides with training. The Day Care Aide of course, takes part in all in-service trainings here at the Human Resource Center where our Day Care Program is located. Al! staff members have had ppd (Mantoux) skin tests as well as the Hepatitus A injection. All service staff members are certified home health aides, have had at least six hours of in-service train- ing annually, trained in the use of equipment, such as fire extinguishers, location of emergency numbers. Day Care Aide: This is a fulI time paid position. The current staff member has worked in our program since 1988 and is a certified home health aide. He has participated in all in-service trainings, has had his ppd skin test and Hepatitus A injection. As all our aides, he facilitates socialization through games, reorientation activities, while supervising and monitoring the behavior and personal needs of the participants. He leads exercise programs, field trips, does gardening with them, takes clients for walks, helps them with cutting food when necessary, serves snacks. He also conducts short quizzes with mind alert questions. All the aides are trained to help those who are functionally or mentally impaired to achieve as much as they are able to socially, intellectually, educationally and physically. Three Part Time Aides: These are ali paid positions. All are certified home health aides, all have had the ppd skin test and the Hepatitus A injection. All have participated in our in-service trainings. These aides add an extra feature of each leading a group of Day Care participants in activities appropriate to their leve! of ability, letting all participants use their individuaI abilities to the fullest. All service staff is responsible for carrying out the individual service plans for participants. Social Worker: This is a full time paid position with Southold Town Human Services, however, part of her time is utiIized for our Day Care Program. She is part of our admission and discharge committee, meets with our care- givers group and meets individually with families to do case management. Volunteer: Our volunteer is a retired psychiatrist who volunteers every Mon- day morning to do a variety of activities with our Day Care participants. She, too, has met all the requirements in regard to health status. If re- quired, this volunteer is ab!e to perform tasks related to the health, safety or welfare of the participants. Proposin~ Or~an{zation: Progr~mWor~)lan Appendix D Southold Town, Human Services 4. Relationship(s) With Other Organization(s): If the program is sponsored by or is part of another organization (e.g., a program within a YMCA or Senior Housing Complex), describe that organization, its involvement in serving the individuals in the con~nunity, especially older adults and its relationship with the program. Describe the program's relationship with other community organizations providing other services and supports that may be needed by program participants, e.g., referral mechanisms, case conferencing. In 1982 Dr. Jay Slotkin and I co-founded the Southold Town Geriatric Network. It has since been replicated throughout the county. Each month a group of health professionals from many disciplines meet on the last Wednesday of each month at 9:30 a.m. at the Human Resource Center. We have physicians, hospital discharge planners, nursing home social workers, home health care supervisors, community advocates from the Suffolk County Office for Aging, Assisted Living owners, Respite Care, Hospice, North Fork Counseling social workers and many others over' the years. We discuss overall health care changes, changes in health care on the east end of Long Island; we refer clients to other agencies, do case counseling and discuss many other issues. This meeting keeps us aware of other services that are available and our services receive support from the other agencies throughout Suffolk County. We have a long and outstanding relationship with other organizations in our area and throughout Suffolk County. Describe any anticipated changes in this program area if funds are awarded. Identify major benchraarks to be achieved and time frame for overall completion. No changes are anticipated. 9 Proposing Organization: Pro~ramWorkpl~n A~pendix D Southold Town Human Services Assessments and Care Planning: Describe the current process for conducting client assessments and developing participant care plans. Include a description of the instrument(s) used, the frequency for conducting assessments and developing care plans, where assessments are conducted and the staff who perform these functions. (Please be advised that there are program requirements for this area.) Upon admission into our Day Care Program the Supervisor of Day Care visits the home of the participant and completes a PDS assessment. There is an initial assessment and an individualized care plan is developed. There is a six month reassessment and after six months another annual. There are also episodic PDS assessments after a participant suffers a stroke or other serious illness and another care plan is developed. Describe any anticipated changes in this program,area if funds are awarded. Identify major benchmarks to be achieved and time frame for overall completion. There will be no changes in this policy. 10 Proposing Organization: Program Wor~lan A~pen~ix D Southold Town Human Services 6. Program Services and Activities: Describe the services and activities of the prograph. Include a schedule/calendar of a tYpical day/week for the program (the times and types of activities). Describe the level of assistance that is provided to participants, e.g., if needed by a participant the program provides supervision and cueing, as well as hands-on assistance ~uch as cutting food, opening containers and actual feeding. {Please be advised that the regulations include requirements in this area ~! If any aspect of the program is provided by an entity under a subcontract, please describe the entity and what it provides to the program. The Southold Town Day Care Program is a structured, comprehensive program which provides functionally impaired individuals with socialization, supervisl( and monitoring, personal care and nutrition. Monday through Friday, 9:00 a.m. to 4:00 p.m. We also offer additional services such as enhancement of daily living skills, transportation, caregiver assistance and case coordination and assistance. Clients are assisted as needed in such areas as eating, toileting transfer, and ambulation. Juice and snacks are served to all participants at appropriate times. All meals comply with the standards set forth for a nutrit2 program for the elderly site and as established by the New York Office for Aging and the Suffolk County Office for Aging. We also provide cueing, cutting food, opening containers and actual feeding. See Attachment #1 Describe any anticipated changes in this program area if funds are awarded. Identify major benchmarks to be achieved and time frame for overall com~letion. If any changes include subcontractors, it is recommended that letters of support from these entities be included. These standards will remain the same. 11 Proposing O~ga~£sa~£on: Program Workplan Appendix D Southold Town Human Services 7. Program Site: a. Describe the physical attributes of the sitels) where the program is located, including its (their) location in the community, the building(s) and room(s) where program activities take place, services are provided and that participants use, and any space shared with .other programs or services. In 1993 the Town of Southold purchased a bank mortgage center to utiliz~ as our Human Resource Center. They built an addition comprised of a large kitchen and two handicapped bathrooms. The building is located in the hamle~ of Mattituck in Southold Town. The Day Care Program occupies three rooms - an office for the superviso~ Day Care, a conference room and a large 30' x 50' room where program activites take place. Adjacent to this room is a 28' x 25' deck that was constructed for us as an Eagle Scout project and where clients can enjoy an outdoor picnic, games and refreshments under an umbrella. We do not share space with any other programs. bo Describe any anticipated ch~ges in this program area if funds are awarded. Identify benctunarks to be achieved and time frame for overall completion. No changes will be made in the building or Day Care area. of 12 Proposin~ Organization: Program Work Plan Appendix D Southold Town Human Services 8. Participant Cost Sharing: a. Is there a standard practice of requiring participants to pay for some/all of the cost of the program? If yes, describe how cost sharing determinations are made, what is considered for making a determination and how much a participant is required to pay. If a slidinu scale is used please include it. Also, please describe what happens if a person is unable to pay the cost share. Participants are given a brochure upon application to our program which states our policy of voluntary and anonymous contributions. The suggested voluntary contribution is $ 12.00 per day for the program and lunch, if a person utilizes our round trip bus services it is an additional voluntary and anonymous contribution of $2.00. Service will not be denied if a person is unable or unwilling to contribute. Describe any anticipated changes in this program area if funds are awarded. There will be no change in this policy if funds are awarded. 13 Proposing Orga~za~on~ Pro.ram Work Pls~n Appe~Lix D Southold Town ~uman Services Participant Contributions: ao Is there a standard process for providing participants with a voluntary opportunity to contribute toward the cost of the program? If yes, describe the process,, including how individuals are informed of this opportunity and the frequency. If there is a suggested contribution amount or a sliding scale please provide that information. Yes, we have a standard process for providing participants with a voluntary opportunity to contribute toward the cost of the program. Upon admission to our program participants and their families are given our brochure which states our policy. We also have an informational letter which informs families of the opportunity to contribute. This letter is sent monthly. ho Describe any anticipated changes in this program area if funds are awarded. There will be no change in this policy if funding is awarded. 14 Program Work, lan Appendix D Proposing Organization: Southold Town Human Services Section B. Rationale ama Justification for Program Cha~ges Sunm~arize the program expansion that will take place because ;of the additional funding and provide a rationale and justification for the expansion of =he existing program and an explanation of unme~ need that will be addressed. We serve approximately 20 participants daily in our Day Care Program. A] are functionally impaired. Six of our clients have been diagnosed with Alzheimer's Disease. Although we have a full day program for our Day Care members and provide many activities to maintain their abilities, we can do Our clients who have Alzheimer's Disease pace and wander. Some are combatant, while others find it difficult to stay the full day. This causes more stress on the caregivers, who truly need every moment of respite they can get from our program. Many of our frail elderly clients are depressed. They realize health changes that have occurred in their lives. Some have left their own homes to move in with family members. Others feel set aside from life and ne to be reassured that they are still important to those around them. It is difficult for our aides to devote the individual time needed to address these issues in a concentrated, comprehensive way. In order to address these issues positively and, as our regulations sugge to maintain the highest practicable physical, mental and psychosocial well-bei of the participant including independence and self care, w~ propose to hire as consultants a certified massage therapist and a music therapist. With these techniques we will encourage the clients to use their existing..capacities, develop new capacities and interests and compensate for existing or developing impairments in capacity. Through the use of massage and touch, concentrated weekly for one year, and with moving, painting, singing and listening to music we will encourage focus, calming, a general feeling of well-being, less anxiety and a decrease depression. This may contribute to a decrease in pacing, wandering, combativ. ness and lengthen the hours they can remain in our program each day. Improve- ment in managing the behavior o~ clients will releave stress at home and allo~ the caregivers to enjoy the full day of respite deterring premature institutionalization for our clients. We want to implement this one year pilot project and form an initial base line, monitor any changes in behavior of our clients on a monthly basis and at the end of six months we will chart the changes for each client to see if they benefitted from the program and identify those areas. A final report would be charted at the end of the project to see the results of our project. We would hope that, as stated in our regulations, we would encourage and stimulate the participant to interact with others and seek to establish, maintain or improve the client's sense of usefulness to self and others, the desire to use his or her physical and mental capabilities to the ~ullest extent, and his or her sense of self respect. The second goal of our proposal is to expand our catchment area to includ the Town of Shelter Island. Shelter Island has no Day Care Program and we get many requests for Shelter Island residents to utilize our Program. Although we have accepted some Shelter Island clients in the past, we don't have enough staff to meet the need. Therefore, I would like to add one part-time aide to our staff in order to include residents of Shelter Island in our program. 15 Program workplan Appendix D Proposin~ Org~nlsation: Southold Town Human Services Section C: Continuation of Program Expamsion Funding available under this grant was appropriatedon a one-time basis. Please explain how the program expansion described in this proposal will be continued when funds under this grant are no longer available. If our one year pilot project meets our expected goals I would want to continue it. When funds are no longer available we must first try to increase our budget through Town of Southold funding. Our second effort will be voluntary contributions for the service, although service will not be denies to anyone because of their inability or unwillingness to pay. Also, we will utilize our general voluntary contributions for the Day Care Program toward this program. Our estimated yearly and anonymous contributions are estimated at $ 25,000.00 per year. It is usually more than this estimate. Program Workplan Appendix 1) Proposing Organization Southold Town Human Services ATTACHMENTS VENETIA McKEIGHAN DIRECTOR Adult Day Care Schedule of Activities Daily schedule as follows : 8:30 9:30 a.m. 9:30 - 10:O0.a.m. 10:00- 10:30 a.m. 10:30 -11:00 a.m. 11:00-11:15 a.m. 11:15-11:45 a.m. 11:45 -1Z:15 p.m. 12:30- 1:30 p.m. 1:30- 2:00p.m. 2:00- 3:00 p.m. 3:00- 3:15 p.m. 3:15- 3:45 p.m. 3:45- 4:00 p.m. 4:00 p.m. Arrival by van or caregiver Breakfast Reality orientation; "Keep Mind Alert" Exercises, Range of Motion to music Juice or soup as appropriate Target game, Large motor activity, parachute, ball Dinner; all clients assisted and transfered Rest period, Video movie, table games, cards Ambulate as needed Table games, crafts, target games, word games Afternoon snack; all clients assisted Bingo or similar game Clients prepared for departure Dismissal; clients home by van or caregiver All clients are assisted as needed with feeding, toileting, ambulation In good weather, w~e walk outdoors and use our deck for snacks We maintain the window sill garden The men play pool 'or the ladies have manicures Music is a big part.of our day, singing, dancing, instruments, games A time for Reminisce/(i~"planned i~to each day. Families participate in holiday parties or programs Craft projects are done according to the various abilities Monthly blood pressures and weights are taken Family imput is always appreciated Agency Code 01370 SAMPLE FORM - DO NOT COMPLETE APPENDIX X Contract No. Period Funding Amount for Period This is an AGREEMENT between THE STATE OF NEW YORK, acting by and through the NEW YORK STATE OFFICE FOR THE AGING, having its principal office at 2 Empire State Praza, Albany, New York 12223- 1251 (hereinafter referred to as the STATE), and (hereinafter referred to as the CONTRACTOR), for modification of Contract Number C to extend the term of the Agreement through All other provisions of said AGREEMENT shall remain in full force and effect. IN WITNESS WblEREOF, the parties hereto have executed this AGREEMENT as of the dates appearing under their signatures. State Aqency Certification "in addition to the acceptance of this contract, I also certify that original copies of this signature page will be attached to all other exact copies of this contract." CONTRACTOR SIGNATURE STATE AGENCY SIGNATURE By: By: Printed Name Walter G. Hoefer Title: Title: Director Date: Date: STATE OF NEW YORK ) Countyof .) ) SS.: On the day of ,20 , before me personally appeared. , to me known, who being by me duly sworn, did depose and say that he/she resides at , that he/she is the of the , the corporation described herein which executed the foregoing instrument; and that he/she signed his/her name thereto by order of the board of directors of. said corporation. (Notary) STATE COMPTROLLER'S SIGNATURE Title: Date: