ATTACHMENT B, RFP 9879 Area Agency on Aging, as Amended January 26, 2006
GRANT PROPOSAL CONTENT
Sections I through VIII (and Section IX. for certain services) and Section X. Please use the following format. To ensure cCompleteness of Pproposal--Please fill out the Grant Proposal Check-Off List, Attachment E, to assure that all documents have been submitted.
SECTIONS I through VII:
GRANT PROPOSAL
All agencies submitting proposals must submit Sections I through VII. It is anticipated that Sections I through VII will be (5) five to ten (10) pages in length.
Section I. AGENCY INFORMATION
1. Title of Program:
2. Name of Applicant Agency:
3. Name of Executive Director:
4. Name of Program Manager (if different from Executive Director):
5. Name of Chair/President of Governing Board:
Telephone Number:
6. Program Area(s) in which you are applying:
7. Date of Incorporation of Agency:
8. Geographic Service Area (including primary target areas, e.g. Monterey Peninsula, South County, etc.)
SECTION II. FISCAL INFORMATION
1. Total Agency Budget for (2005-2006):
2. Total Program Budget for (2005-2006):
3. Did you receive funds from other sources in (2005-2006): Yes_____ No ____
If so, from whom, and how much:
Other Funding Sources Amount
______
4. Total Agency Budget Anticipated for (2006-2007):
5. Total Program Budget Anticipated for (2006-2007):
6. Amount Older Americans Act Funds Requested for (2006-2007):
7. Amount Older Californians Act Funds Requested for (2006-2007):
8. Percentage of requested Older Americans Act Funds in relation to program’s total budget, e.g.
$30,000 OAA funds = $30,000 divided by $70,000 program budget = 43%
SECTION III. PROGRAM INFORMATION
1. Briefly describe the services to be provided:
2. List goals and objectives for the program:
3. Discuss the accessibility of program services:
· Is public/specialized transportation available?
· Can mobility impaired seniors be accommodated?
· Can language barriers be overcome?
· Can visually impaired individuals be accommodated?
· Are services provided in an appropriate location for seniors?
4. Estimate the total number of unduplicated persons to be served: ______
5. Estimate the total number of service units to be provided by the program in fiscal year 2006-2007:
6. Estimate the total number of service units that will be provided this year, fiscal year 2005-2006, if you are currently providing the service:
7. Is the service:
New ( ) Expanded ( ) Continued ( )
8. Describe how you will monitor and evaluate the effectiveness of the service:
9. Describe your system to accept voluntary contributions from clients:
10. Describe plans for serving low-income minorities, rural residents, and older adults with disabilities.
11. What enhancements/changes to program would agency make if additional funds were available?
SECTION IV. FISCAL CRITERIA ON WHICH AWARD WILL BE BASED
1. Does your agency have sufficient financial resources to ensure stable programming?
If so, describe:
If not, explain how this will be remedied:
2. Does your agency have a ready source of internal cash, or access to cash, available in times of shortfalls? If so, describe:
If not, explain how this will be remedied:
3. Did your agency retain a positive cash fund balance at the end of fiscal year 2004-2005? No____ Yes______
If yes, amount: $______
4. Is it anticipated that there will be a positive cash balance at the end of this fiscal year? No____Yes____
5. Did your agency have a cash deficit at the end of fiscal year 2004-2005? No____Yes____
If yes, amount $______
If yes, how has the deficit been resolved?
6. Does your agency have an established operating reserve to finance cash shortfalls and program growth? Yes______No______
If not, explain:
7. How do your board and management maintain accountability for the financial stability of the organization?
8. How does the agency raise funds? Who is primarily responsible for raising funds?
9. Does the agency have an annual plan for raising funds? If yes, please describe
If not, explain:
10. Please furnish a copy of your most recent independent audit. If your audit does not cover the period July 2004 through June 2005, a copy of your financial statements for that time period will also need to be furnished.
SECTION V. PROGRAM CRITERIA
1. Describe how you market and advertise your services.
2. Does your agency have community support? If you are a new applicant, please include three letters of support from clients or agencies. Mark them Appendix B.
3. Does your service have a waiting list? If so, describe the length of the wait, how the waiting list is handled in general, the policy of the organization regarding waiting lists.
4. Describe how your agency fits into the continuum of home care and community-based long term care services.
5. Describe how your agency coordinates services/planning activities with other community agencies.
6. Describe how your program serves those in greatest economic need.
7. Describe how your program serves those in greatest social need.
8. Describe how your program serves ethnic minorities.
9. Please enclose any brochures that your agency/program distributes. Be sure to furnish brochures in languages other than English. Mark them Appendix C.
10. Describe your recruitment of minority and older persons for staff positions.
11. Describe your training of cultural competency for staff positions.
12. Do you have staff who are fluent in a language other than English? If so, describe the number of staff, the language(s), their duties, etc.
13. Are volunteers an important component in this service? If so, how?
If not, explain:
14. Describe your agency's ability to recruit/train/retain/recognize volunteers.
15. Do you have volunteers who are fluent in a language other than English? If so, describe the number of volunteers, the language(s), their duties, etc.
16. Does your agency have a written policy and procedures for operations during a natural disaster? If so, describe. If not, describe your plan to have one in place by December 31, 2006.
SECTION VI. ORGANIZATIONAL CRITERIA
This Section may be submitted in any of the following formats:
1. One hard copy and two copies on CD,
2. Three hard copies,
3. Any combination of hard copies and CD that provides three copies of all the required information.
The location of the required information shall be clearly identified in the proposal.
1. Furnish the agency's Articles of Incorporation. Mark them Appendix D
2. Furnish a copy of your organization's IRS tax status. Mark it Appendix E
3. Furnish a copy of your agency's Organizational Chart. Mark it Appendix F
4. Furnish a copy of your Board of Director’s Roster, including names, geographic location of members and ethnicity and whether agency consumers are Board members. Mark it Appendix G.
5. Furnish a copy of your Corporate Bylaws. Mark them Appendix H.
6. Furnish a copy of your Personnel Policies. Mark them Appendix I.
7. Furnish a copy of all of the Job Descriptions of the positions in your program. Mark them Appendix J.
8. Furnish a copy of your agency's Affirmative Action Policies. Mark them
Appendix K.
9. Furnish a copy of your agency's salary scales and steps. Mark them Appendix L.
10. Furnish a copy of your program's commitmentagency’s to staff development and training plan. Please include budgetary considerations, e.g. out-of-town meetings that will be attended etc. Mark it Appendix M.
11. Furnish a copy of your agency's Nondiscrimination and Sexual Harassment Policy. Mark it Appendix N.
12. Furnish a copy of your agency's Grievance Procedures. Mark it Appendix O.
13. List your professional or statewide affiliations. Mark it Appendix P.
14. Furnish a copy of your agency's Certificates of Insurance for: (a) Comprehensive General Liability Insurance with liability limits of not less than $1,000,000; (b) Professional Liability Insurance if rendering any professional services such as medical or legal services for which errors and omissions insurance is necessary with liability limits of not less than $1,000,000; (c) Motor Vehicle Insurance covering all motor vehicles (including owned and non-owned) used in providing services with a combined single limit of not less than $1,000,000; and (d) Workers Compensation Insurance in the amount of $1,000,000 covering all of its employees. Mark these Appendix Q.
SECTION VII. BUDGET
Please complete the appropriate Budget (see Attachments C-1 through C-5) and mark it Appendix R. The following budget formats are:
A) SUPPORTIVE SERVICES/ PREVENTIVE HEALTH/ ELDER ABUSE PREVENTION :
Adult Day Care / Rehabilitation and EducationHealth Promotion/Disease Prevention / Senior Center Management
Information and Assistance / Senior Employment Services
Legal ServicesAssistance / Senior Food Bag
Medication Management / Senior Peer Counseling
Ombudsman / Shared Housing
Personal Care/Homemaker: Note, these services are provided on an hourly basis and service and billing are based on an hourly rate.
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ATTACHMENT B, RFP 9879 Area Agency on Aging, as Amended January 26, 2006
B) NUTRITION SERVICES BUDGET:
Nutrition (Congregate meals)Services for congregate site
Home delivered meals: City and RuralNSIP/Congregate
C) COMMUNITY BASED SERVICES PROGRAM
Alzheimer’s Day Care Resource Center (ADCRC)
D) HEALTH INSURANCE AND COUNSELING ADVOCACY PROGRAM (HICAP)
E) FAMILY CAREGIVER SUPPORTIVE SERVICES
SECTIONS VIII through X
SUPPLEMENTAL INFORMATION
Complete Sections IXVIII through XI in addition to I though VIII only if you are applying for funds for the following services:
i. Congregate Meals: Central Kitchen/Caterer
ii. Congregate Nutrition: Senior Dining Centers
iii. Home-Delivered Meals:
VIII CONGREGATE MEALS: CENTRAL KITCHEN/CATERER
Describe the type of menu your agency uses and why.
- Explain the process your agency uses in the development of menus. Include the individuals responsible for development of menus,and how often the process is repeated., and how nutritional analysis of menus is performed.
- Describe how changes are made to the approved menu and how they are reported and documented. for thee AAA’s review.
- Describe the process for evaluation of the menus, from both staff and clients perspectives.
- Which of the following types of diets will your agency be able to serve? Please explain.
· Regular
· Carbohydrate modified
· Protein modified
· Fat modified
· Consistency modified
· Mineral modified
· Other
- If a referral of a client with one or more of the above restrictions was received and the program did not contract for and/or it could not provide the diet, how would the project handle the situation?
6. How are meal temperatures monitored, include who performs the task, documentation and verification procedures.?
- Describe your program's quality assurance and how compliance with safe food handling standards is met; include plans for staff certification in food preparation, storage, and handling practices. Include Describe your program's quality assurance and how it interfaces with the other two components of congregate nutrition (congregate dining sites and nutrition education). Include outline of staff who are responsible management and or oversight of dining.
- Explain how meal costs are set and evaluated.
- Provide training plan for staff and volunteers.
How would the central kitchen benefit in shared resources (e.g. food, equipment, personnel) to improve the quality and quantity of meals provided?
Describe the role of the central kitchen in the event of an earthquake or other natural disaster.
10. Describe staff responsibilities at each site. Include whether the manager/coordinators do outreach I&R, food-service activities, etc.
IX CONGREGATE NUTRITION: SENIOR DINING CENTERS
1. Do the sites have a menu review committee? Please describe. If not, explain
2. Does the center have an advisory group made up of participants? If yes, describe duties and responsibilities of the advisory group and its charter if any.
3. Outline how center staff will coordinate with the other components of congregate nutrition and social service agencies to provide sufficient services to participants.
4. Describe the role of the Dining Center in the event of an earthquake or other natural disaster
5. Describe how staff and volunteers will assist in maintaining the quality and safety of the meals and activities at the Centers.
6. Describe the process for non-seniors to participate in the program. How are fees determined? What percentage of participants are non-seniors?List categories of non-seniors (for example, disabled, guests...) and their participation in the site activities.
7. Describe the contribution system for seniors and non-seniors and how your agency ensures that it is a confidential and voluntary donation. Please provide copy of donation solicitation statement, submit as Appendix S.
8. Explain how nutrition education services are provided to recipients of services.
9. Does your program accept Food Stamps? Yes_____ No___
X HOME-DELIVERED MEALS
1. Explain the process your agency uses in the development of menus. Include the individuals responsible for development of menus, how often the process is repeated, and how nutritional analysis of menus is performed.
2. Describe how changes are made to the approved menu and how they are reported and documented.
- Describe the process for evaluation of the menus, from both staff and clients' perspectives.
4. Which of the following types of diets will your agency be able to serve? Please explain.
· Regular
· Carbohydrate modified
· Protein modified
· Fat modified
· Consistency modified
· Mineral modified
· Other
5. If a referral of a client with one or more of the above restrictions was received and the program did not contract for and/or it could not provide the diet, how would the project handle the situation?
6. How are meal temperatures monitored, include who performs the task, documentation and verification procedures.
- Describe your program's quality assurance and how compliance with safe food handling standards is met; include plans for staff certification in food preparation, storage, and handling practices.
8. Explain how nutrition education services are provided to recipients of services.
9. Explain how meal costs are set and evaluated.
- Provide training plan for staff and volunteers.
- Describe the process for non-seniors to participate in the program. How are fees determined? What percentage of participants are non-seniors?
- Describe the voluntary contribution system for seniors and non-seniors and how your agency ensures that it is a confidential donation. Please provide a copy of donation solicitation documents, submit as Appendix S1.
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