Agenda packet — City Council and Authorities Concurrent, October 10, 2023 (part 3 of 5)

Second Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara
FY2020
Agency: City of Santa Clara
Program Name: Senior Nutrition Program Congregate Meals This is a contract between the County of Santa Clara (COUNTY) and the (CONTRACTOR) for the purpose of providing meals for persons 60 years of age and older, which is funded, authorized by, and to be performed in accordance with the Older Americans Act of 1965, as amended, P.L. 89-73, U.S.C. Section 3000 et seq., and all amendments, rules, and regulations pertaining thereto.

1. TERM OF CONTRACT
The term begins on July 1, 2019, and expires on June 30, 2022, unless terminated earlier or otherwise amended; with two one-year extension options.

2. MAXIMUM FINANCIAL OBLIGATION
COUNTY will reimburse CONTRACTOR actual allowable expenditures subject to the provisions of this Contract, for a total not to exceed $129,631.65 in FY2019- 2020, not to exceed $110,774.16 in FY2020-2021, and not to exceed $121,324.08 in FY2021-2022, for a total not to exceed $361,729.89.

3. BUDGET CONTINGENCY
This Contract is contingent upon the appropriation of sufficient funding by the COUNTY for the services covered by this Contract. Notwithstanding the termination provisions set forth herein, if funding is reduced or depleted by the County for services covered by this Contract, the COUNTY has the option to either terminate this Contract without notice (except that is necessary to transition clients in the discretion of the County) and with no liability occurring to the County, or to offer an amendment to this Contract indicating the reduced amount.

4. FEE FOR SERVICE CONTRACT
a. CONTRACTOR will be paid by COUNTY in accordance with Exhibit A-2:

Program Provisions, Exhibit B-2: Program Plan & Requirements, Exhibit C-3:

Budget, and Exhibit D-2: Logic Model, for the performance of services as outlined in this Contract up to the maximum compensation. i. For Non-Profit Agencies, OMB Circular A-122.
ii. For Local Governments, OMB Circular A-87.
iii. For Public and Nonprofit Institutions of Higher Education, OMB Circular A-121.
iv. For Profit Making Organization, 41 CFR Part 1.
b. If CONTRACTOR provides any tasks, deliverables, goods, services, or other work, other than as specified in this Contract, the same will be deemed to be a gratuitous effort on the part of the CONTRACTOR, and the CONTRACTOR will have no claim whatsoever against COUNTY.
c. CONTRACTOR must participate in a quarterly reconciliation process. During the reconciliation process all funds awarded to CONTRACTOR must be reconciled to the costs incurred and to the remaining cash, if any. Quarterly reconciliations must be submitted with the corresponding monthly invoice.

DocuSign Envelope ID: 2DAB8AFF-AA81-40D2-8D5F-CFA236756B1A Exhibit A-2: Program Provisions

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Second Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara
FY2020
During each reconciliation, all funds paid to CONTRACTOR under its fee for service claims must be reconciled to the actual costs incurred by the contractor and the remaining cash, if any. This provision survives the termination of this Contract.
d. CONTRACTOR must participate in a closeout period at the end of the COUNTY funding period. During the closeout period all funds awarded to CONTRACTOR must be reconciled to the costs incurred and to the remaining cash, if any. A closeout packet will be provided to CONTRACTOR by COUNTY at the end of the funding period and is due within forty-five (45) days thereafter.

If actual cost of providing services based on Unit Cost per meal is less than the amount reimbursed by COUNTY, CONTRACTORS final reimbursement will be reduced by the overpayment received from COUNTY. This provision survives the termination of this Contract.

5. PARTICIPANT CONTRIBUTIONS
a. CONTRACTOR will submit participant contributions on a monthly basis with the monthly expense claims.
b. CONTRACTOR will deposit all participant contributions in a bank account maintained for the Senior Nutrition Program (SNP). All deposits, withdrawals, and balances for the Senior Nutrition Program must be separately identified.

COUNTY has the right to review all financial records and bank accounts for audit purposes. Participants contributions will be collected, counted, and recorded daily by CONTRACTOR. Two persons designated by CONTRACTOR will co-verify the collection and count of participant contributions daily by their signature and date on a participant contribution accounting record. Participant contributions are to be deposited daily when possible, but no less frequently than on a weekly basis. Participant contributions are to be kept in a secure locked location and at night locking in a safe, pending deposit into the Senior Nutrition Program bank account.

6. ADVANCE PAYMENTS
a. Notwithstanding Section 4 above, COUNTY, at its discretion may make advance payments under this contract to CONTRACTOR up to a maximum of 25% of the total contract amount and under conditions as the COUNTY may specify. Such advance payments will in no way increase the total maximum financial obligation specified under this contract.
b. CONTRACTOR must meet fidelity bond requirements as specified in Article V F. of this contract prior to receiving advance payment. c. All advance payments require full repayment prior to the expiration of the contract. COUNTY will specify repayment method of the advance payment amount by deducting an agreed upon monthly amount from the outstanding balance of the contract until the repayment obligation is fulfilled, or; deducting the advance payment amount in a lump sum from the remaining contract balance.

7. COMPENSATION
CONTRACTOR must submit to COUNTY an invoice in a form approved by DocuSign Envelope ID: 2DAB8AFF-AA81-40D2-8D5F-CFA236756B1A Exhibit A-2: Program Provisions

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Second Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara
FY2020
COUNTY, by the tenth (10th) calendar day of each month for the month just preceding in which services were performed. The CONTRACTOR will get paid on a monthly basis upon receiving an accurate account and invoice for services rendered, as well as payment for participant and guest contributions as outlined in Exhibit B-2: Program Plan & Requirements.
a. Prior to submittal, invoices and reconciliations must be certified and signed by a responsible officer of CONTRACTOR with authority to certify that the information submitted by CONTRACTOR is accurate and CONTRACTOR is entitled to payment under the terms of the Contract. COUNTY may rely on said certification in making payment, but this payment will not constitute a waiver of any of COUNTY's legal rights or objections.
b. In order to ensure continuation of service, CONTRACTOR will not be paid for meals in excess of the number of year-to-date meals listed in the Service Delivery Plan in Exhibit C-3: Budget. Meals that are provided but not reimbursed in a particular month may be reimbursed if claimed on later invoice so long as CONTRACTOR has offered the agreed upon services continuously. c. If the invoice is in proper form and the items billed are payable under this Contract, COUNTY will make payment to CONTRACTOR.
d. COUNTY will not be required to make payment if the amount claimed is not in accordance with the provisions of this Contract. All payments under this Contract will be made directly to CONTRACTOR as a corporate entity. Under no circumstances will COUNTY be required to make payments in any amount pursuant to this Contract to any other parties, including individual employees or creditors of CONTRACTOR.
e. COUNTY is not obligated to reimburse CONTRACTOR for any service or expenditure not reported to COUNTY within sixty (60) calendar days after the end of the last month of the Contract term.

8. SERVICE PROVIDED
a. CONTRACTOR must inform COUNTY of services and activities performed under this Contract and accept appropriately referred clients from the COUNTY for contract services as part of CONTRACTORs client base. b. CONTRACTOR must coordinate services with other organizations providing similar services in order to foster community cooperation and avoid unnecessary duplication of services.
c. CONTRACTOR must assist in the coordination of and verification of eligibility for mobility management services for participants who use CONTRACTORs site as a home meal site.

9. CONTRACT REPRESENTATIVES
a. CONTRACTOR designates City Manager as CONTRACTORs representative for the purpose of performing the services as required by this Contract. Unless DocuSign Envelope ID: 2DAB8AFF-AA81-40D2-8D5F-CFA236756B1A Exhibit A-2: Program Provisions

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Second Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara
FY2020
otherwise indicated in writing, the above-named person has the primary authority and responsibility to carry out this Contract. b. COUNTY designates the Senior Nutrition Program Manager as its representative for the purpose of managing the services performed pursuant to this Contract.

10. ADJUSTMENT TO EXHIBIT B-2: PROGRAM PLAN & REQUIREMENTS A written adjustment to the Program Plan & Requirements may be approved by the COUNTY Representative, or designee, identified in this Exhibit, without a contract amendment as long as the adjustment reflects approved original program provisions and both parties are notified at least 10 days before the adjusted Work Plan begins.

11. ADJUSTMENT TO EXHIBIT C-3: BUDGET
A budget adjustment can be made without a contract amendment if Contractor submits a written budget adjustment request to the COUNTY Contract Representative, or designee, and the request is approved by the COUNTY in writing. A budget adjustment must not increase the maximum financial obligation of this Contract.

CONTRACTOR may request a budget revision by submitting the COUNTYs Budget Revision Request form to the COUNTYs designated contract/program monitor. The Budget Revision Request must include a statement explaining the impact that the budget revision, if approved, would have on the program/service delivery. Upon approval of the CONTRACTORs Budget Revision Request, COUNTY will forward an approved copy of the Budget Revision Request form to the CONTRACTOR.

12. ADJUSTMENT TO EXHIBIT D-2: LOGIC MODEL
A written adjustment to the Logic Model may be approved by the COUNTY Representative, or designee, identified in this Exhibit, without a contract amendment as long as the adjustment reflects approved original program provisions and both parties are notified at least 10 days before the adjusted Logic Model begins.

To COUNTY: Social Services Agency, Director
CC: Senior Nutrition Program Manager
353 West Julian Street, 4th Floor
San Jose, California 95110-2335
To CONTRACTOR: Deanna J. Santana
City Manager
1500 Warburton Avenue
DocuSign Envelope ID: 2DAB8AFF-AA81-40D2-8D5F-CFA236756B1A Exhibit A-2: Program Provisions

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Second Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara
FY2020
Santa Clara, CA 95050

11. COUNTYS CONTRACT TRANSITION PROCESS
CONTRACTOR agrees to provide all information deemed necessary by the County for use in subsequent procurement cycles.

DocuSign Envelope ID: 2DAB8AFF-AA81-40D2-8D5F-CFA236756B1A Exhibit B-2: Program Plan & Requirements

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Second Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara
FY2020
Agency: City of Santa Clara (CONTRACTOR)
Program Name: Senior Nutrition Program Congregate Meals (PROGRAM)

1. SERVICE DESCRIPTION & EXPECTED OUTCOME
CONTRACTOR will work with the Social Services Agency Senior Nutrition Program (COUNTY) and other community partners to ensure that the seniors receive nutritious and healthy meals at CONTRACTORs nutrition site(s). The PROGRAM provides seniors and older adults of Santa Clara County access to healthy, nutritious meals and the opportunity to socialize, take classes, and access other services. CONTRACTOR will perform services in compliance with the Senior Nutrition Program, Congregate Policy & Procedures Manual, and any updates thereto.

2. PERMITS AND LICENSES
CONTRACTOR will obtain all permits and licenses necessary to the performance of this contract will assure that its subcontractors obtain the same. The CONTRACTOR will pay all normal fees for permits, licenses, inspections or any other certification or service required in the performance of this contract.

3. ELIGIBLE INDIVIDUALS
Persons who are eligible for meals and services under this contract are those persons who are 60 years of age or older or who are spouses of persons who are 60 years of age or older. Meals may be made available to handicapped or disabled individuals who have not attained 60 years of age but who reside in housing facilities occupied primarily by the elderly at which congregate nutrition services are provided, or individuals with disabilities who reside at home with and accompany older individuals who are eligible for services. Priority will be given to those older persons in greatest social and economic need with particular attention to seniors who are age 75 or older, low-income, living alone, and/or minorities as defined by the Older Americans Act of 1965.

4. MEALS
a. Meals served by CONTRACTOR must provide at least one-third (1/3rd) of the current recommended dietary allowance specified by the Food and Nutrition Board of the National Academy of Sciences National Research Council. b. Menus will be planned by CONTRACTOR in cycles, the minimum period being five (5) weeks. Such menus must be planned in accordance with COUNTY requirements. Such menus will be submitted to COUNY three (3) weeks prior to initial use. Menus will be posted in a conspicuous location at the meal site at least one (1) week in advance of use.
c. Table settings will be of reasonable quality. If disposable dinnerware is used, it will be of sturdy quality.

5. CONGREGATE MEAL SITES
a. CONTRACTOR will provide congregate meals at the meal site(s), days, and times indicated in Exhibit C-3: Budget. Notwithstanding, CONTRACTOR may make minor changes to the service days and times listed in Exhibit C-3 with prior written approval of COUNTY.
b. CONTRACTOR may not relocate the meal site or add a meal site without prior notification, inspection, and approval by COUNTY. Relocation or addition of a meal site without the prior approval of the COUNTY may be considered a DocuSign Envelope ID: 2DAB8AFF-AA81-40D2-8D5F-CFA236756B1A Exhibit B-2: Program Plan & Requirements

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Second Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara
FY2020
breach of the provisions of this contract. COUNTY may suspend or withhold payments, or terminate the contract if the relocation affects any of the provisions of the contract including, but not limited to the following:
i. The relocation or addition reduces or terminates the provision of services to seniors in the geographic area served by this contract. ii. The relocation or addition changes the service area served by this contract. iii. The relocation or addition does not serve or give priority to older persons in the greatest social or economic need as defined by the Older Americans Act of 1965 as amended.
c. The site must have adequate lighting and ventilation and must meet all applicable health, fire, safety and sanitation regulations. CONTRACTOR must obtain current certificates from appropriate public officials indicating the site is in compliance with health and fire regulations.
d. CONTRACTOR ensures that a pleasant dining atmosphere is maintained and that there is adequate space for the equipment of participants, such as canes, crutches and wheelchairs.
e. There will be no architectural barriers which would prevent an eligible individual from having access to the meal site facility.
f. Innovative services may added to the PROGRAM during the term of this contract, or upon an extension of this contract, upon written approval of the COUNTY.
g. Notwithstanding a designation as a catered site in Exhibit C-3: Budget, upon written approval from COUNTY and upon obtaining all required governmental approvals, CONTRACTOR may switch to being a cook on site location. In the event of this switch, CONTRACTORs per-meal rate will be changed to the standard cook on site per-meal rate if different than the catered meal rate.

6. NUMBER OF MEALS, SERVING DAYS, AND HOLIDAYS
a. CONTRACTOR will provide the number of hot meals as specified in Exhibit C3: Budget. If demand by eligible individuals in the first six (6) months of this Contract does not result in CONTRACTOR providing the average number of meals per day specified in Exhibit C-3: Budget, COUNTY may terminate this Contract. Prior to termination, COUNTY and CONTRACTOR may attempt to renegotiate this Contract to allow CONTRACTOR to reduce the average number of meals to be provided per day. If CONTRACTOR provides additional meals and such additional meals will cause CONTRACTOR to exceed the Maximum Financial Obligation of this Contract, such additional costs will be the sole expense of CONTRACTOR, unless the parties agree and execute a Contract Amendment.
b. CONTRACTOR will be paid for the number of meals served at a meal site, not the number of meals prepared. COUNTY will not reimburse meals served that do not meet the dietary requirements in Section 4(a).

CONTRACTOR must open its Nutrition Site(s) for the number of service days specified in Exhibit C-3: Budget. CONTRACTOR must open its Nutrition Site(s) at minimum the number of serving days indicated each week except for holidays. Should CONTRACTOR close its Nutrition Site(s) due to unforeseen circumstances, CONTRACTOR will notify COUNTY immediately and work collaboratively to reschedule the day(s) that the Nutrition Site(s) was closed.

Should CONTRACTOR close their Nutrition Site(s) due to foreseen circumstances and not be able to reschedule the day(s) of services, DocuSign Envelope ID: 2DAB8AFF-AA81-40D2-8D5F-CFA236756B1A Exhibit B-2: Program Plan & Requirements

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Second Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara
FY2020
CONTRACTOR will not be reimbursed for the number of meals allocated to the serving day(s) that the Nutrition Site(s) was closed.

7. ADVISORY COUNCIL
CONTRACTOR will ensure that an election is held to elect a participant to represent the nutrition site on the countywide program Advisory Council. It will be the responsibility of the program Advisory Council to advise the COUNTY on policy matters relating to the delivery of the congregate nutrition services throughout the COUNTY program area.

8. SUPPORTIVE SERVICES
a. CONTRACTOR will provide supportive services, to the extent that such services are needed and are not already available from third parties and accessible to individuals participating in the Congregate Meals Program.

Supportive services may include:
i. Transportation of eligible individuals to and from congregate meal sites so that nutrition and other services will be accessible to those eligible individuals living within the program area who, because of lack of mobility or physical or mental handicap, would otherwise be unable to participate in the program;
ii. Information and referral services designed to provide eligible individuals with current information of, and referral to, all appropriate services to meet their needs;
iii. Health and welfare counseling services designed to assist eligible individuals in dealing with the problems and stresses that interfere with normal health and social functioning. CONTRACTOR may provide such services through person-to-person assistance from trained counselors or referrals to other resources;
iv. Nutrition education through a formal program of regularly scheduled meetings to make available pertinent facts related to nutritional need; v. Recreation activities designed to foster the health and social well-being of program participants through social interaction and satisfying use of free time;
vi. Outreach activities to assure maximum participation of hard to reach and other eligible individuals.
b. CONTRACTOR will report the supportive services provided at its meal site(s) to the COUNTY in the format requested by the COUNTY and whether the service is provided by CONTRACTOR or another entity at least annually, or more often, as requested by the COUNTY. COUNTY may request this information from CONTRACTOR up to once per quarter.

9. FOOD INVENTORY
CONTRACTOR will develop a written plan for conducting food inventories. The plan will include the procedures for conducting food inventories, identify persons responsible for conducting the inventory, and set the schedule for completing the inventories. The plan will also include a description of the "First-in-First Out" food rotation system that will be used to ensure stored goods are rotated to prevent deterioration. CONTRACTOR will provide COUNTY with a copy of its food inventory plan and completed food inventories, upon request.

DocuSign Envelope ID: 2DAB8AFF-AA81-40D2-8D5F-CFA236756B1A Exhibit B-2: Program Plan & Requirements

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Second Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara
FY2020

10. PEST CONTROL
CONTRACTOR is required to follow the pest control requirements in the current Senior Nutrition Program, Congregate Policy & Procedures Manual. In addition, if a pest issue is identified. COUNTY reserves the right to require CONTRACTOR to take corrective action to remedy the issue or require any other action from CONTRACTOR necessary to protect the health and welfare of participants.

11. DATA COLLECTION AND PRIVACY
a. At intervals prescribed by the COUNTY and, on forms provided by COUNTY, CONTRACTOR will collect program data and information relating to nutrition risk assessments, registered site participants, meals, use of services and program contributions. CONTRACTOR will also be required to collect program data through the use of electronic collection methods. Such methods may include the use of computers, scanners, or other means. CONTRACTOR must comply with collection requirements as directed by COUNTY. Unless otherwise specified, COUNTY will provide CONTRACTOR with the equipment needed to collect data by electronic means. COUNTY will be considered legal owner of all equipment provided to CONTRACTOR for this purpose. Such equipment is considered Non-Expendable property as described in Section 16 of this Exhibit. b. CONTRACTOR must submit a completed and signed Santa Clara Senior Nutrition Program Monthly Report for the prior month by the fourth (4th) working day of the current month to their assigned registered dietitian. c. No later than the second time an eligible participant attends a congregate meal site operated by CONTRACTOR, CONTRACTOR must have the participant complete a registration form with participants information. Registration forms must be submitted to the designated COUNTY staff person at least monthly for registrants from the prior month along with the Monthly Report. CONTRACTOR must submit any new monthly registrations prior to the fifth (5th) working day of every month.
d. CONTRACTOR must submit their electronic participant demographic scanner data and related documents for the prior month by the fifth (5th) working day of every month to the Senior Nutrition Program.
e. Quarterly Report. Quarterly Reports with output and outcome data must be turned in with September, December, March, and July invoices. Quarterly Reports must be prepared on the form provided by the COUNTY. Submission of the Quarterly Report is required before the corresponding monthly invoice can be paid.
f. Within 30 days of executing this agreement, and annually thereafter if the term of this agreement is extended, all employees, volunteers, subcontractors, or agents of CONTRACTOR who handle confidential client information, including but not limited to registration forms, must complete the information security and privacy presentation online training provided by the California Department of Aging (currently available at:
https://www.aging.ca.gov/ProgramsProviders/Information_Security_and_Priv acy/Presentation/index.html). Upon completion, evidence must be submitted to COUNTY to provide to Sourcewise.

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Second Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara
FY2020
congregate meals is $3.00 per meal. If CONTRACTOR also provides home delivered meals, the suggested contribution is $3.00 per day. Contributions are confidential. CONTRACTOR will not disclose records of the amount of contribution received or the name of contributor to third parties without written permission of the contributor. COUNTY has the right to review CONTRACTOR'S contribution records for audit purposes. Payment of the suggested contribution is not a condition for the receipt of meals. b. CONTRACTOR will submit participant contributions on a monthly basis to be included with the monthly reimbursement claims. One hundred percent of these contributions must be submitted to COUNTY.

CONTRACTOR must record the number of volunteer meals served.

CONTRACTOR will be reimbursed for volunteer meals provided. b. Guest Meals: A guest under the age of 60 may be offered a meal during meal hours if doing so will not deprive an older individual of a meal or add to the cost of meals prepared. A guest must pay a fee of at least $8.00 or up to the actual cost of the meal served, as specified in Exhibit C-3: Budget. CONTRACTOR must record the number of guest meals served and keep guest fees separate from participant contributions. CONTRACTOR may keep guest fees received.

The cost of providing guest meals may not be included in the quarterly reconciliation.
c. Staff Meals: Nutrition services staff under the age of 60 may receive a meal if doing so will not deprive an older individual of a meal or add to the cost of meals prepared. CONTRACTOR must record the number of nutrition services staff meals served. The cost of providing staff meals may not be included in the quarterly reconciliation.

14. MANDATORY ATTENDANCE
CONTRACTOR must have a representative attend every required training and meeting offered by the COUNTY that is specific to the Senior Nutrition, Congregate Meals Program.

15. PURCHASES
COUNTY may require CONTRACTOR, by written notice, to obtain approval of COUNTY for all purchases of food and materials. Approval will not be withheld by COUNTY except for good cause.

16. NON-EXPENDABLE PROPERTY
Any acquisition by CONTRACTOR of non-expendable property with a retail purchase price in excess of five- hundred dollars ($500.00), that is required by CONTRACTOR for performance of this Contract, must require prior written approval of COUNTY.

COUNTY will be the legal owner of all equipment that is purchased with COUNTY funds. COUNTY may take possession of its equipment if it is not being used primarily for program purposes and will determine disposition of that equipment upon expiration or termination of this contract.

DocuSign Envelope ID: 2DAB8AFF-AA81-40D2-8D5F-CFA236756B1A Exhibit B-2: Program Plan & Requirements

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Second Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara
FY2020

17. COMPETITIVE BID REQUIREMENTS
a. All equipment purchases by the CONTRACTOR exceeding five-hundred dollars ($500.00) must be procured through a competitive process in compliance with Sourcewises bidding procedures unless services or materials can be obtained only from a single source. Any procurement exceeding tenthousand dollars ($10,000.00) must also comply with the requirements of Office of Management and Budget Circular Uniform Guidance.
b. Unless CONTRACTOR uses the COUNTYs designated vendor, prior to making any equipment purchase that has a value of five-hundred dollars ($500) or more, CONTRACTOR will submit to COUNTY evidence that it has received a minimum of three (3) bids for such subcontract and justification for selection of the successful bidder or submit documentation to support the use of the sole supplier. Record shall be maintained by CONTRACTOR showing the parties solicited and the bids submitted.

18. OVERTIME WORK
Overtime work expenditures that are incurred by the CONTRACTOR will not be paid by reducing services or meals under this contract.

19. RESTRICTION OF DISCLOSURES
Any reports, analysis, studies, drawings, information or data generated as a result of this contract are to be provided to COUNTY prior to public dissemination.

20. CARE ACCESS ERROR RATE REQUIREMENT
Federal regulations pursuant to Title III of the Older Americans Act of 1965 (OAA) establish procedures for allocating money to states for various senior services. States have established allocation mechanisms to award monies to their Area Agencies on Aging (AAA). These AAAs in turn, award monies via contracts or grants to carry out the mission of the OAA.

Sourcewise, the County of Santa Claras designated AAA, allocates money for the provision of the Congregate Meals Program by reimbursing the County based on the number of meals served to seniors each month. This data is tracked through Sourcewises Care Access Database. When there is a discrepancy between the paper total (signatures of SNP participants) and scanner total (scanned barcodes of SNP participants), an error rate arises. Currently, if the total combined error rate of all Senior Nutrition Meal Sites exceeds five percent (5%), the County will not be reimbursed by Sourcewise. Therefore, CONTRACTORs data that is imported into Sourcewises Care Access Database must not exceed an error rate of 5%.

If CONTRACTORs imported data exceeds an error rate of 5%, COUNTY will withhold a percentage of CONTRACTORs invoice equivalent to the percentage of the error rate exceeding the 5% threshold. For example, if CONTRACTOR has an error rate of 23%, COUNTY will withhold 18% (23% - 5%) of CONTRACTORs invoice for that month.

Should Sourcewise decide to reimburse the County regardless of the combined error rate of all Senior Nutrition Meal Sites, then the County will not withhold any percentage of CONTRACTORs invoice regardless of CONTRACTORs error rate for that month.

DocuSign Envelope ID: 2DAB8AFF-AA81-40D2-8D5F-CFA236756B1A Exhibit B-2: Program Plan & Requirements

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Second Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara
FY2020

21. GRIEVANCE POLICY
a. CONTRACTOR must establish a written grievance process for reviewing and attempting to resolve complaints of older individuals receiving services funded by this Contract which complies with Sourcewises requirements and the Older Americans Act, Section 315(b)(4). At a minimum, the process shall include all of the following:
i. Time frames within which a complaint will be acted upon. ii. Written notification to the complainant of the results of the review, including a statement that the complainant may appeal to Sourcewise if dissatisfied with the results of CONTRACTORs review.
iii. Confidentiality provisions to protect the complainants rights to privacy.

Only information relevant to the complaint may be released to the responding party without the older individuals consent. b. CONTRACTOR shall notify older individuals of the grievance process available to them by:
i. Posting notification of the process in visible and accessible areas, such as the bulletin boards in multipurpose senior centers or areas in which there are a substantial number of older adults. For individuals are non-English speaking, the notification shall also be posted in the primary language of a significant number of older individuals.
ii. Advising homebound older individuals of the process either orally or in writing upon CONTRACTORs contact with the individuals. c. Complaints may involve, but not be limited to, any or all of the following:
i. Amount or duration of a service.
ii. Denial or discontinuance of a service.
iii. Dissatisfaction with the service being provided or with the service provider. If the complaint involves an issue of professional conduct that is under the jurisdiction of another entity, such as the California Medical Board or the State Bar Association, the complainant shall be referred to the proper entity.
iv. Failure of the service provider to comply with any of the requirements set forth in California Department of Aging regulations or in your contract with Sourcewise.
d. Nothing in this Grievance policy shall be construed as prohibiting older individuals from seeking other available remedies, such as presenting their complaints at an open meeting of CONTRACTORs governing board. e. Notify Sourcewise in writing within ten working days after statement has been issues to complainant detailing the complaint, resolution and a copy of the statement sent to complainant. The address for mailing is 3100 De La Cruz Blvd., Suite 310, Santa Clara, CA, 95054.

22. FISCAL YEAR CLOSEOUT SUBMISSION
Due to fiscal reporting deadlines imposed by the California Department of Aging and Sourcewise, CONTRACTOR must submit requested fiscal year-end closeout documents to COUNTY accounting staff by July 6, 2022.

DocuSign Envelope ID: 2DAB8AFF-AA81-40D2-8D5F-CFA236756B1A DocuSign Envelope ID: 2DAB8AFF-AA81-40D2-8D5F-CFA236756B1A County of Santa Clara
Social Services Agency
Agency Name: City of Santa Clara
Site: Santa Clara Senior Center
A B C
#of #of
Budget Daily Meals Serving Days
Per Meal Reimbursement Rate* 69 248
Grand Total
FY 2021-22
D E
Annual Units Rate
17,112 $7.09
Service
F
Total Contract
Amount**
$121,324.08
$121,324.08
Exhibit C-3
Site 1 - Service Plan & Budget
Weekly Service Plan Mon Tues Weds Thurs Fri Sat Sun Days Site Preparation Type Service Start 11:30AM 11:30AM 11:30AM 11:30AM 11:30AM N/A N/A Catered Service End 12:30 PM 12:30 PM 12:30 PM 12:30 PM 12:30 PM N/A N/A !Total Hours I 1.00 I 1.00 I 1.00 I 1.00 I 1.00 I N/A I N/A II 5 I Monthly Service Delivery Plan Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Total Possible Serving Days 22 22 22 21 22 23 21 20 23 21 22 22 261 Unpaid Days Off 0 0 0 0 0 0 0 0 0 0 0 0 0
Holidays 1 0 2 1 3 2 1 1 0 1 1 0 13
Actual Serving Days 21 22 20 20 19 21 20 19 23 20 21 22 248 Budgeted Monthly Meals 1449 1518 1380 1380 1311 1449 1380 1311 1587 1380 1449 1518 17112 (Serving Davs x # of Dailv Meals) YTD Budgeted Meals** 1449 2967 4347 5727 7038 8487 9867 11178 12765 14145 15594 17112 *Only meals provided to eligible participants which meet dietary requirements will be reimbursed. The maximum number of meals reimbursed by the County will not exceed the YTD number of budgeted meals based on County-approved holiday schedule. Meals provided in a previous month but not reimbursed may be billed in a subsequent month. **Food costs must equal at least 25% less $.25 of the Total Contract Amount. Meals that are unserved will not be reimbursed.

Second Amendment to the Contract between the County of Santa Clara Social services Agency and City of Santa Clara FY2020 Page 1 of 3
DocuSign Envelope ID: 2DAB8AFF-AA81-40D2-8D5F-CFA236756B1A County of Santa Clara
Social Services Agency
Agency Name: City of Santa Clara
Site: Santa Clara Senior Center
69 248 17,112
# of Daily Serving Days Annual Meals
Meals
Paid Hours*

A B C D
Paid Time
Off
(Days)
Daily Do not include
Job Title Hours Hourly Rate Holidays
Site Manager 5.00 $19.74 33.40
Kitchen Aide 4.00 $15.05 33.40
Tota 9.00
Unp_aid Volunteer Hours
A B
Daily
Volunteer Hours Hours
Registration Staff 3.00
Server 1 3.00
Server 2 2.00
Server 3 2.00
Server 4 2.00
Tota 12.00
FY 2021-22
13 Paid Holidays
E
Salaries
$ 25,761 $
$ 15,712 $
$ - $
$ - $
$ - $
s - s
$ - $
s - s ~ 41,473 ~

1.45%
Payroll
Tax Rate
F
Payroll
Taxes
374
228
-
-
-
-
-
-
602
G
Retirement
Contribution
~ -
H I
Other
Health Fringe
Insurance Benefits
$ 659
$ 503
~ - ~ 1,162
Exhibit C-3
Site 1 - Staffing Plan
J
Total per
Employee
$ 26,794
$ 16,443
$ -
$ -
$ -
s -
$ -
s -
~ 43,237
*All personnel costs in the Staffing Plan are built into the per meal rate listed in Exhibit C-3: Budget, Service Plan & Budget.

Second Amendment to the Contract between the County of Santa Clara Social services Agency and City of Santa Clara FY2020 Page 2 of 3
DocuSign Envelope ID: 2DAB8AFF-AA81-40D2-8D5F-CFA236756B1A County of Santa Clara
Social Services Agency
FY 2021-22
Agency Name: City of Santa Clara
Program: SNP Congregate Meals

A B C D
Source of Funds FY22Amount %ofTotal Commitment Code
Resources Provided by County
Santa Clara County Senior Nutrition
Program (This Contract) $ 121,324.08 54.0%
Resources Provided by Agency (Match)
In-Kind Resources
Volunteer Hours* $75,324.00 33.5%
Cash Resources
Agency General Fund $3,445.00 1.5%
CDBG $24,000.00 10.7%
Non-senior contributions $500.00 0.2%
Total Program Cost $ 224,593.08 99.9%
Actual Meal Cost
Total Per Meal Match sec Rate (Match + sec Rate)
$6.03 $7.09 $13.12
Commitment Code
1 Firm Commitment-Already have an agreement or letter confirming funding 2 Anticipated Renewal of Existing Funding-Continuation of current year funding 3 Anticipated Resource-Projection of previous fees or donations 4 Application Pending-Application has been submitted, no confirmation at this time 5 Pre-Application-Not yet submitted
* Volunteer Hours are valued by the County as: Living Wage * Hours Per Day * Serving Days Second Amendment to the Contract between the County of Santa Clara Social services Agency and City of Santa Clara FY2020
1 3
1 1
3 Exhibit C-3
Resource Table

Page 3 of 3 ends

DocuSign Envelope ID: 2DAB8AFF-AA81-40D2-8D5F-CFA236756B1A Santa Clara County FY 2021-2022 Exhibit D-2: Logic Model Social Services Agency
Logic Model -
A. Contract Goal:

B. Situation
Lack of food access,
~nancial instability, and
social isolation are pervasive
issues among the older adult
community. In order to meet
~he needs of this community
services need to include
ethnically diverse cuisine
served in locations in
proximity to low-income
neighborhoods, innovative
service models that bring the
~ood to the people, ~ransportation options, and
additional safety net
resources. These services
are a vital component to
keeping people healthy and
living independently.

Congregate Meals Agency Name: City of Santa Clara
Provide nutritious meals, opportunities to socialize, transportation, and resources to older adults across Santa Clara County.

C. Activities/Services
Provide training to meal site
1volunteers on food safety topics.

D1. # of
unduplicated
clients/families
served per FY
12 D2. #of
Outputs
per FY
--
6 D3. Output
Volunteer Trainings
E. Short/Long Term
Outcome Measures
By June 30, 2022, at least 75% of eligible older adult
congregate meal participants will have participated in at least one other service offered at the meal site.

Second Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara FY2020 Page 1 of 1

Page 1 of 2 ends

Third Amendment to the Contract between the County of Santa Clara and City of Santa Clara

THIRD AMENDMENT TO THE CONTRACT BETWEEN THE COUNTY OF SANTA CLARA AND CITY OF SANTA CLARA – CONGREGATE MEALS
This is the Third Amendment to the Contract between the County of Santa Clara (COUNTY) and City of Santa Clara (CONTRACTOR) entered into on July 1, 2019, for the provision of Congregate Meal Services. The original contract was approved by the Board on June 18, 2019.

This Contract is amended as follows:

Effective July 1, 2022, the parties agree to comply with the provisions contained in the following exhibits and article, which are either attached hereto or stated below, and incorporated herein by this reference and made a part of the Contract.

1. Add Exhibit A-3: Program Provisions, which is attached hereto and incorporated by this reference.

2. Add Exhibit B-3: Program Plan & Requirements, which is attached hereto and incorporated by this reference.

3. Add Exhibit C-4: Budget Plan, which is attached hereto and incorporated by this reference.

4. Add Exhibit D-3: Logic Model, which is attached hereto and incorporated by this reference.

5. Add Article IV, Statutes, Regulations, and Polices, #16. COVID -19 REQUIREMENTS

16. COVID -19 REQUIREMENTS
CONTRACTOR shall comply with all COUNTY requirements relating to COVID-19 for persons who routinely perform services for the COUNTY onsite and share airspace with or proximity to other people at a COUNTY facility as part of their services for the COUNTY (“County’s COVID-19 Requirements”), including but not limited to vaccination, as applicable and periodically updated, and available at
https://procurement.sccgov.org/doing-business-county/contractor-vaccinations and incorporated herein by this reference.

If CONTRACTOR is providing in-person services to community members (“Direct Client Services”) under this Agreement, all references in the COUNTY’s COVID-19 Requirements and below referenced Certification to “onsite” and “County facility” shall be deemed to also refer to any indoor location where Direct Client Services are provided, including when services are provided at non-County facilities. Accordingly, such CONTRACTOR’s shall comply with the COUNTY’s COVID-19 Requirements when providing Direct Client Services indoor at any location. Any reporting pursuant to the Certification of CONTRACTOR’s personnel who are not fully vaccinated and up-to-date on boosters for which they are eligible and who are providing Direct Client Services at non-County facilities shall be to the COVID-19 Designee for the COUNTY department that manages this Agreement.

DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672

Page 2 of 2 ends

Third Amendment to the Contract between the County of Santa Clara and City of Santa Clara
If applicable, CONTRACTOR shall complete the Contractor Certification of Compliance with COVID-19 Vaccine Requirements (“Certification”), attached hereto as Exhibit E.

CONTRACTOR shall comply with the requirements of this Section for the entire term of this Agreement.

CONTRACTOR shall comply with all reasonable requests by COUNTY for documentation demonstrating CONTRACTOR’s compliance with this Section. Failure by CONTRACTOR to comply with any of the requirements of this Section (including but not limited to vaccination and masking requirements and completion and submittal of the Certification) is a material breach of this Agreement, and the COUNTY may, in its sole discretion terminate this Agreement immediately or take other action as the COUNTY may determine to be appropriate.

All other terms and conditions of the Contract remain in full force and effect. In the event of a conflict between the original Contract and this Amendment, this Amendment controls.

IN WITNESS WHEREOF, COUNTY and CONTRACTOR hereby agree to the terms of this Amendment to the Contract.

COUNTY OF SANTA CLARA CONTRACTOR
Miguel Márquez, Chief Operating Officer Office of City Manager Date: __________ Date: __________
ATTEST __________________________ ___________________________ John P. Mills, Deputy County Executive Assistant City Clerk Date: Date: __________

APPROVED AS TO FORM AND LEGALITY APPROVED AS TO FORM
Deputy County Counsel Office of the City Attorney
Date: __________ Date: __________
DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 7/1/2022 6/24/2022
I.DocuSigned by:
~~ ~::~
6/30/2022 6/29/2022
6/23/2022 6/30/2022
Exhibit A-3 Program Provisions

_________________________________________________________________________________________________ Page 1 of 5 Third Amendment to the Contract Between the County of Santa Clara and City of Santa Clara
CONTRACTOR: City of Santa Clara
PROGRAM/PROJECT NAME: Senior Nutrition Program – Congregate Meals This is a contract between the County of Santa Clara (COUNTY) and the (CONTRACTOR) for the purpose of providing meals for persons 60 years of age and older, which is funded, authorized by, and to be performed in accordance with the Older Americans Act of 1965, as amended, P.L. 89-73, U.S.C. Section 3000 et seq., and all amendments, rules, and regulations pertaining thereto.

1. CONDITIONAL AMENDMENTS
The County Executive, or designee, received delegation of authority from the Board of Supervisors on May 3, 2022, to negotiate, execute, amend, and terminate the scope of services, the term, new or revised contracting requirements, maximum financial obligation and budget of this Contract through June 30, 2023 based upon the following conditions:
a. COUNTY has appropriated sufficient funds for the modification of this Contract, b. CONTRACTOR is meeting the performance requirements for this contract, c. County Counsel has reviewed and approved the amendment as to form and legality, and
d. County Executive has approved the amendment.

2. TERM OF CONTRACT
The term begins on July 1, 2019, and expires on June 30, 2023, unless terminated earlier or otherwise amended.

3. MAXIMUM FINANCIAL OBLIGATION
COUNTY will reimburse CONTRACTOR actual allowable expenditures subject to the provisions of this Contract, for a total not to exceed $129,631.65 in FY2019-2020, $110,774.16 in FY2020-2021, $121,324.08 in FY2021-2022, and $124,917.60 in FY2022- 2023 for a total not to exceed $486,647.49.

4. BUDGET CONTINGENCY
This Contract is contingent upon the appropriation of sufficient funding by the County for the services covered by this Contract. Notwithstanding the termination provisions set forth herein, if funding is reduced or depleted by the County for services covered by this Contract, the County has the option to either terminate this Contract without notice (except that necessary to transition clients in the discretion of the County) and with no liability occurring to the County, or to offer an amendment to this Contract indicating the reduced amount.

5. COMPENSATION TO CONTRACTOR
a. FEE FOR SERVICE CONTRACT
i. CONTRACTOR will be paid by COUNTY in accordance with Exhibit A-3 Program Provisions, Exhibit B-3: Program Plan & Requirements, Exhibit C-4: Budget, and Exhibit D-3: Logic Model, for the performance of services as outlined in this Contract up to the maximum compensation. These costs will also be in DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 Exhibit A-3 Program Provisions

_________________________________________________________________________________________________ Page 2 of 5 Third Amendment to the Contract Between the County of Santa Clara and City of Santa Clara
accordance with current cost principles and with all other requirements of this contract:

1. For Non-Profit Agencies, OMB Circular A-122.

2. For Local Governments, OMB Circular A-87.

3. For Public and Nonprofit Institutions of Higher Education, OMB Circular A121.

4. For Profit Making Organization, 41 CFR Part 1.
i. If CONTRACTOR provides any tasks, deliverables, goods, services, or other work, other than as specified in this Contract, the same will be deemed to be a gratuitous effort on the part of the CONTRACTOR, and the CONTRACTOR will have no claim whatsoever against COUNTY.
ii. CONTRACTOR must participate in a quarterly reconciliation process. During the reconciliation process all funds awarded to CONTRACTOR must be reconciled to the costs incurred and to the remaining cash, if any. Quarterly reconciliations must be submitted with the corresponding monthly invoice. During each reconciliation, all funds paid to CONTRACTOR under its fee for service claims must be reconciled to the actual costs incurred by the contractor and the remaining cash, if any. This provision survives the termination of this Contract. iii. CONTRACTOR must participate in a closeout period at the end of the COUNTY funding period. During the closeout period all funds awarded to CONTRACTOR must be reconciled to the costs incurred and to the remaining cash, if any. A closeout packet will be provided to CONTRACTOR by COUNTY at the end of the funding period and is due within forty-five (45) days thereafter. If actual cost of providing services base on Unit Cost per meal is less than the amount reimbursed by COUNTY, CONTRACTOR’S final reimbursement will be reduced by the overpayment received from COUNTY. This provision survives the termination of this Contract.
b. COMPENSATION
CONTRACTOR must submit to COUNTY an invoice in a form approved by COUNTY, by the tenth (10th) calendar day of each month for the month just preceding in which services were performed. The CONTRACTOR will get paid on a monthly basis upon receiving an accurate account and invoice for services rendered, as well as payment for participant and guest contributions as outlined in Exhibit B-3: Program Plan & Requirements.
(i) Prior to submittal, invoices must be certified and signed by a responsible officer of CONTRACTOR with authority to certify that the information submitted by CONTRACTOR is accurate and CONTRACTOR is entitled to payment under the terms of the Contract. COUNTY may rely on said certification in making payment, but this payment will not constitute a waiver of any of COUNTY's legal rights or objections.

DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 Exhibit A-3 Program Provisions

_________________________________________________________________________________________________ Page 3 of 5 Third Amendment to the Contract Between the County of Santa Clara and City of Santa Clara
(ii) In order to ensure continuation of service, CONTRACTOR will not be paid for meals in excess of the number of year-to-date meals listed in the Service Delivery Plan in Exhibit C-4: Budget. Meals that are provided but not reimbursed in a particular month may be reimbursed if claimed on later invoice so long as CONTRACTOR has offered the agreed upon services continuously. (iii) If the invoice is in proper form and the items billed are payable under this Contract, COUNTY will make payment to CONTRACTOR.
(iv) COUNTY will not be required to make payment if the amount claimed is not in accordance with the provisions of this Contract. All payments under this Contract will be made directly to CONTRACTOR as a corporate entity. Under no circumstances will COUNTY be required to make payments in any amount pursuant to this Contract to any other parties, including individual employees or creditors of CONTRACTOR.
(v) COUNTY is not obligated to reimburse CONTRACTOR for any expenditure not reported to COUNTY within sixty (60) calendar days after the end of the last month of the Contract term.

6. PARTICIPANT CONTRIBUTIONS
a. CONTRACTOR will submit participant contributions on a monthly basis with the monthly expense claims.
b. CONTRACTOR will deposit all participant contributions in a bank account maintained for the Senior Nutrition Program (SNP). All deposits, withdrawals, and balances for the Senior Nutrition Program must be separately identified. COUNTY has the right to review all financial records and bank accounts for audit purposes. Participants’ contributions will be collected, counted, and recorded daily by CONTRACTOR. Two persons designated by CONTRACTOR will co-verify the collection and count of participant contributions daily by their signature and date on a participant contribution accounting record. Participant contributions are to be deposited daily when possible, but no less frequently than on a weekly basis. Participant contributions are to be kept in a secure locked location and at night locking in a safe, pending deposit into the Senior Nutrition Program bank account.

7. ADVANCE PAYMENTS
a. COUNTY, at its discretion may make advance payments under this contract to CONTRACTOR up to a maximum of 25% of the total contract amount and under conditions as the COUNTY may specify. Such advance payments will in no way increase the total maximum financial obligation specified under this contract. b. CONTRACTOR must meet fidelity bond requirements as specified in Article V F. of this contract prior to receiving advance payment.
c. All advance payments require full repayment prior to the expiration of the contract.

COUNTY will specify repayment method of the advance payment amount by DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 Exhibit A-3 Program Provisions

_________________________________________________________________________________________________ Page 4 of 5 Third Amendment to the Contract Between the County of Santa Clara and City of Santa Clara
deducting an agreed upon monthly amount from the outstanding balance of the contract until the repayment obligation is fulfilled, or; deducting the advance payment amount in a lump sum from the remaining contract balance.

8. ADJUSTMENT TO EXHIBIT B-3: PROGRAM PLAN & REQUIREMENTS A written adjustment to the Scope of Service/Staffing Plan may be approved by the COUNTY Representative, or designee, identified in this Exhibit, without a contract amendment as long as the adjustment reflects approved original program provisions and both parties are notified at least 10 days before the adjusted Scope of Service/Staffing Plan begins.

9. ADJUSTMENT TO EXHIBIT C-4: BUDGET
A budget adjustment can be made without a contract amendment if Contractor submits a written budget adjustment request to the COUNTY Contract Representative, or designee, and the request is approved by the COUNTY in writing. A budget adjustment must not increase the maximum financial obligation of this Contract.

CONTRACTOR may request a budget revision by submitting the COUNTY’s Budget Revision Request form to the COUNTY’s designated contract/program monitor. The Budget Revision Request must include a statement explaining the impact that the budget revision, if approved, would have on the program/service delivery. Upon approval of the CONTRACTOR’s Budget Revision Request, COUNTY will forward an approved copy of the Budget Revision Request form to the CONTRACTOR.

10. ADJUSTMENT TO EXHIBIT D-3: LOGIC MODEL
A written adjustment to the Logic Model may be approved by the COUNTY Representative, or designee, identified in this Exhibit, without a contract amendment as long as the adjustment reflects approved original program provisions and both parties are notified at least 10 days before the adjusted Logic Model begins.

11. SERVICE PROVIDED
a. CONTRACTOR must inform COUNTY of services and activities performed under this Contract and accept appropriately referred clients from the COUNTY for contract services as part of CONTRACTOR’s client base.
b. CONTRACTOR must coordinate services with other organizations providing similar services in order to foster community cooperation and avoid unnecessary duplication of services.
c. CONTRACTOR must assist in the coordination of and verification of eligibility for mobility management services for participants who use CONTRACTOR’S site as a home meal site.

12. CONTRACT REPRESENTATIVES
a. CONTRACTOR designates Rajeev Batra, City Manager as CONTRACTOR’s representative for the purpose of performing the services as required by this Contract.

DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 Exhibit A-3 Program Provisions

_________________________________________________________________________________________________ Page 5 of 5 Third Amendment to the Contract Between the County of Santa Clara and City of Santa Clara
Unless otherwise indicated in writing, the above named person has the primary authority and responsibility to carry out this Contract. b. COUNTY designates the Director of Social Services Agency, or designee, as its representative for the purpose of managing the services performed pursuant to this Contract.

13. NOTICES
All notices prescribed by this Contract will be in writing and deemed effective if sent by certified mail or registered mail and properly deposited with the United States Postal Service, postage prepaid with return receipt requested and addressed as follows:
a. To COUNTY: Social Services Agency
Office of Contracts Management
333 West Julian Street
San Jose, California 95110-2335
b. To CONTRACTOR: City of Santa Clara
Rajeev Batra, City Manager
1500 Warburton Avenue
Santa Clara, CA 95050

14. COUNTY’S CONTRACT TRANSITION PROCESS
CONTRACTOR agrees to provide all information deemed necessary by the County for use in subsequent procurement cycles.

DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 Exhibit B-3: Program Plan & Requirements

Page 1 of 8 ends

Third Amendment to the Contract between the County of Santa Clara Agency and City of Santa Clara
Agency: City of Santa Clara (CONTRACTOR)
Program Name: Senior Nutrition Program – Congregate Meals (PROGRAM)

1. SERVICE DESCRIPTION & EXPECTED OUTCOME
CONTRACTOR will work with the Social Services Agency – Senior Nutrition Program (COUNTY) and other community partners to ensure that the seniors receive nutritious and healthy meals at CONTRACTOR’s nutrition site(s). The PROGRAM provides seniors and older adults of Santa Clara County access to healthy, nutritious meals and the opportunity to socialize, take classes, and access other services. CONTRACTOR will perform services in compliance with the Senior Nutrition Program, Congregate Policy & Procedures Manual, and any updates thereto.

4. MEALS
a. Meals served by CONTRACTOR must provide at least one-third (1/3rd) of the current recommended dietary allowance specified by the Food and Nutrition Board of the National Academy of Sciences – National Research Council. b. Menus will be planned by CONTRACTOR in cycles, the minimum period being five (5) weeks. Such menus must be planned in accordance with COUNTY requirements. Such menus will be submitted to COUNTY three (3) weeks prior to initial use. Menus will be posted in a conspicuous location at the meal site at least one (1) week in advance of use.
c. Table settings will be of reasonable quality. If disposable dinnerware is used, it will be of sturdy quality.

5. CONGREGATE MEAL SITES
a. CONTRACTOR will provide congregate meals at the meal site(s), days, and times indicated in Exhibit C-4: Budget. Notwithstanding, CONTRACTOR may make minor changes to the service days and times listed in Exhibit C-4 with prior written approval of COUNTY.

DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 Exhibit B-3: Program Plan & Requirements

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Third Amendment to the Contract between the County of Santa Clara Agency and City of Santa Clara
b. CONTRACTOR may not relocate the meal site or add a meal site without prior notification, inspection, and approval by COUNTY. Relocation or addition of a meal site without the prior approval of the COUNTY may be considered a breach of the provisions of this contract. COUNTY may suspend or withhold payments, or terminate the contract if the relocation affects any of the provisions of the contract including, but not limited to the following:
i. The relocation or addition reduces or terminates the provision of services to seniors in the geographic area served by this contract. ii. The relocation or addition changes the service area served by this contract. iii. The relocation or addition does not serve or give priority to older persons in the greatest social or economic need as defined by the Older Americans Act of 1965 as amended.
c. The site must have adequate lighting and ventilation and must meet all applicable health, fire, safety and sanitation regulations. CONTRACTOR must obtain current certificates from appropriate public officials indicating the site is in compliance with health and fire regulations.
d. CONTRACTOR ensures that a pleasant dining atmosphere is maintained and that there is adequate space for the equipment of participants, such as canes, crutches and wheelchairs.
e. There will be no architectural barriers which would prevent an eligible individual from having access to the meal site facility.
f. Innovative services may added to the PROGRAM during the term of this contract, or upon an extension of this contract, upon written approval of the COUNTY.
g. If a site is designated as a catered site in Exhibit C-4: Budget, upon written approval from COUNTY and upon obtaining all required governmental approvals, CONTRACTOR may switch to being a cook on site location. In the event of this switch, CONTRACTOR’s per-meal rate will be changed to the standard cook on site per-meal rate if different than the catered meal rate.

6. NUMBER OF MEALS, SERVING DAYS, AND HOLIDAYS
a. CONTRACTOR will provide the number of hot meals as specified in Exhibit C4: Budget. If demand by eligible individuals in the first six (6) months of this Contract does not result in CONTRACTOR providing the average number of meals per day specified in Exhibit C-4: Budget, COUNTY may terminate this Contract. Prior to termination, COUNTY and CONTRACTOR may attempt to renegotiate this Contract to allow CONTRACTOR to reduce the average number of meals to be provided per day. If CONTRACTOR provides additional meals and such additional meals will cause CONTRACTOR to exceed the Maximum Financial Obligation of this Contract, such additional costs will be the sole expense of CONTRACTOR, unless the parties agree and execute a Contract Amendment.

DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 Exhibit B-3: Program Plan & Requirements

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Third Amendment to the Contract between the County of Santa Clara Agency and City of Santa Clara
b. CONTRACTOR will be paid for the number of meals served at a meal site, not the number of meals prepared. COUNTY will not reimburse meals served that do not meet the dietary requirements in Section 4(a).
c. CONTRACTOR must open its Nutrition Site(s) for the number of service days specified in Exhibit C-4: Budget. CONTRACTOR must open its Nutrition Site(s) at minimum the number of serving days indicated each week except for holidays. Should CONTRACTOR close its Nutrition Site(s) due to unforeseen circumstances, CONTRACTOR will notify COUNTY immediately and work collaboratively to reschedule the day(s) that the Nutrition Site(s) was closed.

Should CONTRACTOR close their Nutrition Site(s) due to foreseen circumstances and not be able to reschedule the day(s) of services, CONTRACTOR will not be reimbursed for the number of meals allocated to the serving day(s) that the Nutrition Site(s) was closed.

Supportive services may include:
i. Transportation of eligible individuals to and from congregate meal sites so that nutrition and other services will be accessible to those eligible individuals living within the program area who, because of lack of mobility or physical or mental handicap, would otherwise be unable to participate in the program;
ii. Information and referral services designed to provide eligible individuals with current information of, and referral to, all appropriate services to meet their needs;
iii. Health and welfare counseling services designed to assist eligible individuals in dealing with the problems and stresses that interfere with normal health and social functioning. CONTRACTOR may provide such services through person-to-person assistance from trained counselors or referrals to other resources;
iv. Nutrition education through a formal program of regularly scheduled meetings to make available pertinent facts related to nutritional need; v. Recreation activities designed to foster the health and social well-being of program participants through social interaction and satisfying use of free time;
DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 Exhibit B-3: Program Plan & Requirements

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Third Amendment to the Contract between the County of Santa Clara Agency and City of Santa Clara
vi. Outreach activities to assure maximum participation of hard to reach and other eligible individuals.
b. CONTRACTOR will report the supportive services provided at its meal site(s) to the COUNTY in the format requested by the COUNTY and whether the service is provided by CONTRACTOR or another entity at least annually, or more often, as requested by the COUNTY. COUNTY may request this information from CONTRACTOR up to once per quarter.

DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 Exhibit B-3: Program Plan & Requirements

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Third Amendment to the Contract between the County of Santa Clara Agency and City of Santa Clara
d. CONTRACTOR must submit their electronic participant demographic scanner data and related documents for the prior month by the fifth (5th) working day of every month to the Senior Nutrition Program.
e. Quarterly Report. Quarterly Reports with output and outcome data must be turned in with September, December, March, and July invoices. Quarterly Reports must be prepared on the form provided by the COUNTY. Submission of the Quarterly Report is required before the corresponding monthly invoice can be paid.
f. Within 30 days of executing this agreement, and annually thereafter if the term of this agreement is extended, all employees, volunteers, subcontractors, or agents of CONTRACTOR who handle confidential client information, including but not limited to registration forms, must complete the information security and privacy presentation online training provided by the California Department of Aging (currently available at:
https://www.aging.ca.gov/ProgramsProviders/Information_Security_and_Privac y/Presentation/index.html). Upon completion, evidence must be submitted to COUNTY to provide to Sourcewise.

12. PARTICIPANT CONTRIBUTION PRINCIPLES
a. CONTRACTOR will provide meals to eligible individuals regardless of their ability to pay for all or part of their meals. Recipients are requested to make a financial contribution to offset the cost of the meals. Suggested contribution for congregate meals is $3.00 per meal. If CONTRACTOR also provides home delivered meals, the suggested contribution is $3.00 per day. Contributions are confidential. CONTRACTOR will not disclose records of the amount of contribution received or the name of contributor to third parties without written permission of the contributor. COUNTY has the right to review CONTRACTOR'S contribution records for audit purposes. Payment of the suggested contribution is not a condition for the receipt of meals.
b. CONTRACTOR will submit participant contributions on a monthly basis to be included with the monthly reimbursement claims. One hundred percent of these contributions must be submitted to COUNTY.

13. VOLUNTEER, GUEST, AND STAFF MEALS
a. Volunteer Meals: A volunteer under the age of 60 who provides services during meal hours may be offered a meal, if doing so will not deprive an older individual of a meal. Volunteers under age 60 who receive a full meal that meets the requirements in Section 4 must pay a $3.00 fee and the fee must be included with the participant contributions and returned to the COUNTY. CONTRACTOR must record the number of volunteer meals served. CONTRACTOR will be reimbursed for volunteer meals provided.
c. Guest Meals: A guest under the age of 60 may be offered a meal during meal hours if doing so will not deprive an older individual of a meal or add to the cost of meals prepared. A guest must pay a fee of at least $8.00 or up to the actual cost of the meal served, as specified in Exhibit C-4: Budget. CONTRACTOR must record the number of guest meals served and keep guest fees separate DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 Exhibit B-3: Program Plan & Requirements

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Third Amendment to the Contract between the County of Santa Clara Agency and City of Santa Clara
from participant contributions. CONTRACTOR may keep guest fees received.

The cost of providing guest meals may not be included in the quarterly reconciliation.
d. Staff Meals: Nutrition services staff under the age of 60 may receive a meal if doing so will not deprive an older individual of a meal or add to the cost of meals prepared. CONTRACTOR must record the number of nutrition services staff meals served. The cost of providing staff meals may not be included in the quarterly reconciliation.

14. MANDATORY ATTENDANCE
CONTRACTOR must have a representative attend every required training and meeting offered by the COUNTY that is specific to the Senior Nutrition, Congregate Meals Program.

15. PURCHASES
COUNTY may require CONTRACTOR, by written notice, to obtain approval of COUNTY for all purchases of food and materials. Approval will not be withheld by COUNTY except for good cause.

17. COMPETITIVE BID REQUIREMENTS
a. All equipment purchases by the CONTRACTOR exceeding five-hundred dollars ($500.00) must be procured through a competitive process in compliance with Sourcewise’s bidding procedures unless services or materials can be obtained only from a single source. Any procurement exceeding ten-thousand dollars ($10,000.00) must also comply with the requirements of Office of Management and Budget Circular Uniform Guidance.
b. Unless CONTRACTOR uses the COUNTY’s designated vendor, prior to making any equipment purchase that has a value of five-hundred dollars ($500) or more, CONTRACTOR will submit to COUNTY evidence that it has received a minimum of three (3) bids for such subcontract and justification for selection of the successful bidder or submit documentation to support the use of the sole supplier. Record shall be maintained by CONTRACTOR showing the parties solicited and the bids submitted.

18. OVERTIME WORK
Overtime work expenditures that are incurred by the CONTRACTOR will not be paid by reducing services or meals under this contract.

DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 Exhibit B-3: Program Plan & Requirements

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Third Amendment to the Contract between the County of Santa Clara Agency and City of Santa Clara

19. RESTRICTION OF DISCLOSURES
Any reports, analysis, studies, drawings, information or data generated as a result of this contract are to be provided to COUNTY prior to public dissemination.

Sourcewise, the County of Santa Clara’s designated AAA, allocates money for the provision of the Congregate Meals Program by reimbursing the County based on the number of meals served to seniors each month. This data is tracked through Sourcewise’s Care Access Database. When there is a discrepancy between the paper total (signatures of SNP participants) and scanner total (scanned barcodes of SNP participants), an error rate arises. Currently, if the total combined error rate of all Senior Nutrition Meal Sites exceeds five percent (5%), the County will not be reimbursed by Sourcewise. Therefore, CONTRACTOR’s data that is imported into Sourcewise’s Care Access Database must not exceed an error rate of 5%.

If CONTRACTOR’s imported data exceeds an error rate of 5%, COUNTY will withhold a percentage of CONTRACTOR’s invoice equivalent to the percentage of the error rate exceeding the 5% threshold. For example, if CONTRACTOR has an error rate of 23%, COUNTY will withhold 18% (23% - 5%) of CONTRACTOR’s invoice for that month.

Should Sourcewise decide to reimburse the County regardless of the combined error rate of all Senior Nutrition Meal Sites, then the County will not withhold any percentage of CONTRACTOR’s invoice regardless of CONTRACTOR’s error rate for that month.

21. GRIEVANCE POLICY
a. CONTRACTOR must establish a written grievance process for reviewing and attempting to resolve complaints of older individuals receiving services funded by this Contract which complies with Sourcewise’s requirements and the Older Americans Act, Section 315(b)(4). At a minimum, the process shall include all of the following:
i. Time frames within which a complaint will be acted upon. ii. Written notification to the complainant of the results of the review, including a statement that the complainant may appeal to Sourcewise if dissatisfied with the results of CONTRACTOR’s review.
iii. Confidentiality provisions to protect the complainant’s rights to privacy. Only information relevant to the complaint may be released to the responding party without the older individual’s consent.
b. CONTRACTOR shall notify older individuals of the grievance process available to them by:

DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 Exhibit B-3: Program Plan & Requirements

Page 8 of 8 ends

Third Amendment to the Contract between the County of Santa Clara Agency and City of Santa Clara
i. Posting notification of the process in visible and accessible areas, such as the bulletin boards in multipurpose senior centers or areas in which there are a substantial number of older adults. For individuals are non-English speaking, the notification shall also be posted in the primary language of a significant number of older individuals.
ii. Advising homebound older individuals of the process either orally or in writing upon CONTRACTOR’s contact with the individuals. c. Complaints may involve, but not be limited to, any or all of the following:
i. Amount or duration of a service.
ii. Denial or discontinuance of a service.
iii. Dissatisfaction with the service being provided or with the service provider.

If the complaint involves an issue of professional conduct that is under the jurisdiction of another entity, such as the California Medical Board or the State Bar Association, the complainant shall be referred to the proper entity. iv. Failure of the service provider to comply with any of the requirements set forth in California Department of Aging regulations or in your contract with Sourcewise.
d. Nothing in this Grievance policy shall be construed as prohibiting older individuals from seeking other available remedies, such as presenting their complaints at an open meeting of CONTRACTOR’s governing board. e. Notify Sourcewise in writing within ten working days after statement has been issues to complainant detailing the complaint, resolution and a copy of the statement sent to complainant. The address for mailing is 3100 De La Cruz Blvd., Suite 310, Santa Clara, CA, 95054.

DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 County of Santa Clara
Social Services Agency
Agency Name: City of Santa Clara
Site: Santa Clara Senior Center
A
Budget
Per Meal Reimbursement Rate*
Grand Total
Weekly Service Plan
Service Start
Service End
fTotal Hours
Monthly Service Delivery Plan
Possible Serving Days
Unpaid Days Off
Holidays
Actual Serving Days
Budgeted Monthly Meals
'Servine: Davs x # of Dailv Meals)
YTD Budgeted Meals**
I
B
#of
Daily Meals
69 Mon Tues
11:30AM 11:30AM
12:30 PM 12:30 PM

1.00 I 1.00
Jul Aug
21 23
0 0
1 0
20 23
1380 1587
1380 2967
I
C
#of
Serving Days
248
Weds Thurs
11:30AM 11:30AM
12:30 PM 12:30 PM

1.00 I 1.00
Sep Oct
22 21
0 0
2 1
20 20
1380 1380
4347 5727
I
FY 2022-23
D E
Annual Units Rate
17,112 $7.30
Fri Sat Sun
11:30AM N/A N/A
12:30 PM N/A N/A

1.00 I N/A I N/A
Nov Dec Jan Feb
22 22 22 20
0 0 0 0
3 1 2 1
19 21 20 19
1311 1449 1380 1311
7038 8487 9867 11178
F
Total Contract
Amount**
$124,917.60
$124,917.60
ExhibitC-4
Site 1 - Service Plan & Budget
Site Preparation Type
Catered
Mar Apr May Jun Total
23 20 23 22 261
0 0 0 0 0
0 1 1 0 13
23 19 22 22 248
1587 1311 1518 1518 17112
12765 14076 15594 17112
*Only meals provided to eligible participants which meet dietary requirements will be reimbursed. The maximum number of meals reimbursed by the County will not exceed the YTD number of budgeted meals based on County-approved holiday schedule. Meals provided in a previous month but not reimbursed may be billed in a subsequent month. **Food costs must equal at least 25% less $.25 of the Total Contract Amount. Meals that are unserved will not be reimbursed.

Third Amendment to the Contract between the County of Santa Clara Social services Agency and City of Santa Clara Page 1 of 3 DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 County of Santa Clara
Social Services Agency
Agency Name: City of Santa Clara
Site: Santa Clara Senior Center
69 248 17,112
# of Daily Serving Days Annual Meals
Meals
Paid Hours*

A B C D
Paid Time
Off
(Days)
Daily Do not include
Job Title Hours Hourly Rate Holidays
Site Manager 5.00 $19.93 33.40
Kitchen Aide 4.00 $20.79 33.40
Total 9.00
Unp_aid Volunteer Hours
A B
Daily
Volunteer Hours Hours
Server 1 2.00
Server 2 2.00
Check-in 1 2.00
Check-in 2 2.00
Total 8.00
FY 2022-23
13 Paid Holidays
E
Salaries
$ 26,009 $
$ 21,705 $
$ - $
$ - $
$ - $
$ - $
$ 47,714 $

1.45%
Payroll
Tax Rate
F
Payroll
Taxes
377
315
-
-
-
-
692
G
Retirement
Contribution
$ -
H
Health
Insurance
$
$
$ - $
Exhibit C-4
Site 1 - Staffing Plan
I J
Other
Fringe Total per
Benefits Employee
659 $ 27,045
503 $ 22,523
$ -
$ -
$ -
$ -
1,162 $ 49,568
*All personnel costs in the Staffing Plan are built into the per meal rate listed in Exhibit C-4: Budget, Service Plan & Budget.

Third Amendment to the Contract between the County of Santa Clara Social services Agency and City of Santa Clara Page 2 of 3 DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 County of Santa Clara
Social Services Agency
FY 2022-23
Agency Name: City of Santa Clara
Program: SNP Congregate Meals
A
Source of Funds
Resources Provided by County
Santa Clara County Senior Nutrition
Program (This Contract)
Resources Provided by Agency (Match)
In-Kind Resources
Volunteer Hours*
Cash Resources
Agency General Fund
CDBG
Non-senior contributions
Total Program Cost
Total Per Meal Match
$4.54
Commitment Code
1 2
3 4
5 B C D
FV23Amount % of Total Commitment Code
$ 124,917.60 61.7%
$50,216.00 I 24.8%1
$3,445.00 1.7%
$24,000.00 11.8%
$0.00 0.0%
$ 202,578.60 100.0%
Actual Meal Cost
sec Rate (Match+ sec Rate)
$7.30 $11.84
Firm Commitment-Already have an agreement or letter confirming funding Anticipated Renewal of Existing Funding-Continuation of current year funding Anticipated Resource-Projection of previous fees or donations Application Pending-Application has been submitted, no confirmation at this time Pre-Application-Not yet submitted
* Volunteer Hours are valued by the County as: Living Wage* Hours Per Day* Serving Days Third Amendment to the Contract between the County of Santa Clara Social services Agency and City of Santa Clara Exhibit C-4
Resource Table
1 3
1 1
3

Page 3 of 3 ends

DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 Santa Clara County Social Services Agency
Logic Model - Congregate Meals
FY 2022-2023 Exhibit D-3: Logic Model
Agency Name: City of Santa Clara
A. Contract Goal: Provide nutritious meals, opportunities to socialize, transportation, and resources to older adults across Santa Clara County.

8. Situation
Lack of food access,
!financial instability, and
social isolation are
pervasive issues among the
older adult community. In
order to meet the needs of
lthis community services
need to include ethnically
diverse cuisine served in
locations in proximity to lowincome neighborhoods,
innovative service models
lthat bring the food to the
people, transportation
options, and additional
safety net resources. These
services are a vital
component to keeping
people healthy and living
independently.

C. Activities/Services
Provide training to meal site
volunteers on food safety topics.

Provide training to meal site
participants on food safety topics.

D1. # of
unduplicated
clients/families
served per FY
12 200
D2. #of
Outputs
per FY
6 4
D3. Output
Volunteer Trainings
Informational
handouts
E. Short/Long Term
Outcome Measures
By June 30, 2023, at least 75% of eligible older adult
congregate meal participants will have participated in at least one other service offered at the meal site.

Third Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara Page 1 of 1

CONTRACTOR CERTIFICATION OF COMPLIANCE WITH
COVID-19 VACCINE REQUIREMENTS
(Version Effective April 1, 2022)
Contractor Information:

Contractor name: Name of Contractor representative:

Contractor phone number: Contractor email address:

Contractor Certification. On behalf of Contractor, I hereby certify that:

1. Contractor has reviewed and is in compliance with all current County requirements regarding COVID-19 vaccination applicable to contractor’s employees working at County facilities, including but not limited to the requirements in the County’s memorandum regarding COVID19 Vaccine Requirement for County Personnel (“County Vaccine Policy”), the County’s memorandum regarding Application of COVID-19 Vaccination Requirement to County Contractors, Interns, and Volunteers, all current State and County Health Officer orders, and any other County requirements. These memoranda and current County policies are accessible at <https://procurement.sccgov.org/doing-business-county/contractor-vaccinations>.

Contractor understands that it is responsible for reviewing and maintaining compliance with all subsequent revisions or amendments to State and County orders and requirements regarding COVID-19.

2. As of the date signed below:
a. Contractor understands that it must confirm, and has confirmed, that all of contractor’s workers (including any subcontractor workers) who routinely perform services for the County onsite and share airspace with or proximity to other people at a County facility as part of their services for the County1
are:
i. Fully vaccinated against COVID-19 and up-to-date on any boosters for which they are eligible as defined and required in the County Vaccine Policy; or ii. Have a legally sufficient and approved medical, disability, or religious exemption from vaccination that has been granted by contractor. 1 As established in the County’s Memorandum Regarding Application of COVID-19 Vaccination Requirement to County Contractors, Interns, and Volunteers, contractors performing work at closed construction sites are not required to comply with the County’s vaccination requirements, but must comply with all applicable federal, state, and local public health laws, including but not limited to vaccination, testing, and masking requirements.

EXHIBIT E: COVID-19 Contractor Certification
DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 City of Santa Clara Rajeev Batra
(408) 615-2210 [email protected]
b. Contractor has verified and will continue to verify the vaccination status of all staff working on site at any County facility, and has obtained proof of vaccination from its staff in a form consistent with the California Department of Public Health’s Vaccine Records Guidelines and Standards.

3. If contractor seeks to send any workers who are not fully vaccinated and up-to-date on boosters for which they are eligible to work indoors at any County facility because the contractor has granted them an exemption, contractor shall notify the County in writing by providing a list of any such workers to the COVID-19 Designee for the department that manages the facility where the contractor personnel will be working at least 96 hours in advance of any such worker arriving onsite so that the department has sufficient time to determine whether it will approve the contractor’s requests that its personnel work onsite and, if approved, can ensure that the contractor has complied with all applicable COVID-19 safety requirements for unvaccinated individuals, including, where appliable, regular testing and the use of a fit-tested N95 mask.2 Notice must be separately provided to each department that manages a facility where contractor seeks to assign personnel to work onsite. Regardless of exemption status, personnel who are not fully vaccinated and up-to-date on boosters for which they are eligible may not work in high-risk roles at County facilities.

4. If any of contractor’s workers are noncompliant with vaccination or testing requirements, contractor will notify the County Department for which they are providing services immediately and will not permit those workers to go onsite at a County facility without express written permission from the County.

5. Contractor will comply with all reasonable requests by the County for documentation demonstrating the contractor’s compliance with this Certification.

I verify the truth and accuracy of the statements in this Certification under penalty of perjury under the laws of the State of California. _____________________________________ Name of authorized representative of Contractor ________________________________ Title _____________________________________ Signature ________________________________ Date 2 If contractor sends workers who are not fully vaccinated and up-to-date on boosters for which they are eligible, it is contractor’s obligation to ensure that it has any necessary authorization under the California Confidentiality of Medical Information Act, Cal. Civ. Code §§ 56 et. seq., and under any other laws to share this information with the County.

EXHIBIT E: COVID-19 Contractor Certification
DocuSign Envelope ID: 02615A6E-6851-41D7-93E2-293ABF334672 Rajeev Batra Interim City Manager
6/24/2022
Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 1 of 2 ends

FOURTH AMENDMENT TO THE CONTRACT BETWEEN THE COUNTY OF SANTA CLARA AND CITY OF SANTA CLARA – CONGREGATE MEALS
This is the Fourth Amendment to the Contract between the County of Santa Clara (COUNTY) and City of Santa Clara (CONTRACTOR) entered into on July 1, 2019, for the provision of Congregate Meal Services. The original contract was approved by the Board on June 18, 2019.

This Contract is amended as follows:

Effective upon execution, the parties agree to comply with the provisions contained in the following exhibits, which are either attached hereto or stated below, and incorporated herein by this reference and made a part of the Contract.

1. Add Attachment A: List of Programs which is attached hereto and incorporated by this reference.

2. Replace Exhibit A-3: Program Provisions with Exhibit A-4: Program Provisions, which is attached hereto and incorporated by this reference.

3. Add Exhibit A-4.1: Program Provisions, which is attached hereto and incorporated by this reference.

4. Replace Exhibit B-3: Program Plan & Requirements with Exhibit B-4: Program Plan & Requirements, which is attached hereto and incorporated by this reference.

5. Add Exhibit B-4.1: Program Plan & Requirements, which is attached hereto and incorporated by this reference.

6. Replace Exhibit C-4: Budget Plan with Exhibit C-5: Budget Plan, which is attached hereto and incorporated by this reference.

7. Add Exhibit C-5.1: Budget, which is attached hereto and incorporated by this reference.

8. Replace Exhibit D-3: Logic Model with Exhibit D-4: Logic Model, which is attached hereto and incorporated by this reference.

9. Add Exhibit D-4.1: Logic Model/Purchase report, which is attached hereto and incorporated by this reference.

All other terms and conditions of the Contract remain in full force and effect. In the event of a conflict between the original Contract and this Amendment, this Amendment controls.

IN WITNESS WHEREOF, COUNTY and CONTRACTOR hereby agree to the terms of this Amendment to the Contract.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 2 of 2 ends

COUNTY OF SANTA CLARA CONTRACTOR
Jeffrey Smith M.D., J.D., County Executive Office of City Manager Date: __________ Date: __________
ATTEST __________________________ ___________________________ , D Assistant City Clerk
Date: Date: __________

APPROVED AS TO FORM AND LEGALITY APPROVED AS TO FORM
Deputy County Counsel Office of the City Attorney
Date: __________ Date: __________
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 7/3/2023
In DocuSigned by:

L£ ~0~~ Daniel Little irector
6/30/2023
6/14/2023
6/29/2023
6/29/2023
6/29/2023
Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 1 of 1 ends

Attachment A
List of Programs
Each program listed on this Attachment will have a corresponding set of Exhibits to specify the program terms and conditions. All Exhibits are attached hereto and incorporated herein by this reference.

1. Congregate Meals
Exhibit A-4: Program Provisions
Exhibit B-4: Program Plan Requirements
Exhibit C-5: Budget Plan
Exhibit D-4: Logic Model

2. Home and Community Based Services (HCBS) Senior Nutrition Infrastructure Funding Exhibit A-4.1: Program Provisions
Exhibit B-4.1: Program Plan Requirements
Exhibit C-5.1: Budget
Exhibit D-4.1: Logic Model/Purchase Report
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit A-4 Program Provisions

_________________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 1 of 5 ends

CONTRACTOR: City of Santa Clara
PROGRAM/PROJECT NAME: Senior Nutrition Program – Congregate Meals This is a contract between the County of Santa Clara (COUNTY) and the (CONTRACTOR) for the purpose of providing meals for persons 60 years of age and older, which is funded, authorized by, and to be performed in accordance with the Older Americans Act of 1965, as amended, P.L. 89-73, U.S.C. Section 3000 et seq., and all amendments, rules, and regulations pertaining thereto.

1. CONDITIONAL AMENDMENTS
The County Executive, or designee, received delegation of authority from the Board of Supervisors on December 6, 2022, to negotiate, execute, amend, and terminate the scope of services, the term, new or revised contracting requirements, maximum financial obligation and budget of this Contract through June 30, 2023 based upon the following conditions:
a. COUNTY has appropriated sufficient funds for the modification of this Contract, b. CONTRACTOR is meeting the performance requirements for this contract, c. County Counsel has reviewed and approved the amendment as to form and legality, and
d. County Executive has approved the amendment.

2. TERM OF CONTRACT
The term begins on July 1, 2019, and expires on June 30, 2023, unless terminated earlier or otherwise amended.

3. MAXIMUM FINANCIAL OBLIGATION
COUNTY will reimburse CONTRACTOR actual allowable expenditures subject to the provisions of this Contract, for a total not to exceed $129,631.65 in FY2019-2020, $110,774.16 in FY2020-2021, $121,324.08 in FY2021-2022, and $135,780.00 in FY2022- 2023 for a total not to exceed $497,509.89.

5. COMPENSATION TO CONTRACTOR
a. FEE FOR SERVICE CONTRACT
i. CONTRACTOR will be paid by COUNTY in accordance with Exhibit A-4 Program Provisions, Exhibit B-4: Program Plan & Requirements, Exhibit C-5: Budget, and Exhibit D-4: Logic Model, for the performance of services as outlined in this Contract up to the maximum compensation. These costs will also be in DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit A-4 Program Provisions

_________________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 2 of 5 ends

accordance with current cost principles and with all other requirements of this contract:

1. For Non-Profit Agencies, OMB Circular A-122.

2. For Local Governments, OMB Circular A-87.

3. For Public and Nonprofit Institutions of Higher Education, OMB Circular A121.

4. For Profit Making Organization, 41 CFR Part 1.
i. If CONTRACTOR provides any tasks, deliverables, goods, services, or other work, other than as specified in this Contract, the same will be deemed to be a gratuitous effort on the part of the CONTRACTOR, and the CONTRACTOR will have no claim whatsoever against COUNTY.
ii. CONTRACTOR must participate in a quarterly reconciliation process. During the reconciliation process all funds awarded to CONTRACTOR must be reconciled to the costs incurred and to the remaining cash, if any. Quarterly reconciliations must be submitted with the corresponding monthly invoice. During each reconciliation, all funds paid to CONTRACTOR under its fee for service claims must be reconciled to the actual costs incurred by the contractor and the remaining cash, if any. This provision survives the termination of this Contract. iii. CONTRACTOR must participate in a closeout period at the end of the COUNTY funding period. During the closeout period all funds awarded to CONTRACTOR must be reconciled to the costs incurred and to the remaining cash, if any. A closeout packet will be provided to CONTRACTOR by COUNTY at the end of the funding period and is due within forty-five (45) days thereafter. If actual cost of providing services base on Unit Cost per meal is less than the amount reimbursed by COUNTY, CONTRACTOR’S final reimbursement will be reduced by the overpayment received from COUNTY. This provision survives the termination of this Contract.
b. COMPENSATION
CONTRACTOR must submit to COUNTY an invoice in a form approved by COUNTY, by the tenth (10th) calendar day of each month for the month just preceding in which services were performed. The CONTRACTOR will get paid on a monthly basis upon receiving an accurate account and invoice for services rendered, as well as payment for participant and guest contributions as outlined in Exhibit B-4: Program Plan & Requirements.
(i) Prior to submittal, invoices must be certified and signed by a responsible officer of CONTRACTOR with authority to certify that the information submitted by CONTRACTOR is accurate and CONTRACTOR is entitled to payment under the terms of the Contract. COUNTY may rely on said certification in making payment, but this payment will not constitute a waiver of any of COUNTY's legal rights or objections.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit A-4 Program Provisions

_________________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 3 of 5 ends

(ii) In order to ensure continuation of service, CONTRACTOR will not be paid for meals in excess of the number of year-to-date meals listed in the Service Delivery Plan in Exhibit C-5: Budget. Meals that are provided but not reimbursed in a particular month may be reimbursed if claimed on later invoice so long as CONTRACTOR has offered the agreed upon services continuously. (iii) If the invoice is in proper form and the items billed are payable under this Contract, COUNTY will make payment to CONTRACTOR.
(iv) COUNTY will not be required to make payment if the amount claimed is not in accordance with the provisions of this Contract. All payments under this Contract will be made directly to CONTRACTOR as a corporate entity. Under no circumstances will COUNTY be required to make payments in any amount pursuant to this Contract to any other parties, including individual employees or creditors of CONTRACTOR.
(v) COUNTY is not obligated to reimburse CONTRACTOR for any expenditure not reported to COUNTY within sixty (60) calendar days after the end of the last month of the Contract term.

COUNTY will specify repayment method of the advance payment amount by deducting an agreed upon monthly amount from the outstanding balance of the DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit A-4 Program Provisions
_________________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 4 of 5 ends

contract until the repayment obligation is fulfilled, or; deducting the advance payment amount in a lump sum from the remaining contract balance.

8. ADJUSTMENT TO EXHIBIT B-4: PROGRAM PLAN & REQUIREMENTS A written adjustment to the Scope of Service/Staffing Plan may be approved by the COUNTY Representative, or designee, identified in this Exhibit, without a contract amendment as long as the adjustment reflects approved original program provisions and both parties are notified at least 10 days before the adjusted Scope of Service/Staffing Plan begins.

9. ADJUSTMENT TO EXHIBIT C-5: BUDGET
A budget adjustment can be made without a contract amendment if Contractor submits a written budget adjustment request to the COUNTY Contract Representative, or designee, and the request is approved by the COUNTY in writing. A budget adjustment must not increase the maximum financial obligation of this Contract.

10. ADJUSTMENT TO EXHIBIT D-4: LOGIC MODEL
A written adjustment to the Logic Model may be approved by the COUNTY Representative, or designee, identified in this Exhibit, without a contract amendment as long as the adjustment reflects approved original program provisions and both parties are notified at least 10 days before the adjusted Logic Model begins.

SERVICE PROVIDED
CONTRACTOR must inform COUNTY of services and activities performed under this Contract and accept appropriately referred clients from the COUNTY for contract services as part of CONTRACTOR’s client base.

CONTRACTOR must coordinate services with other organizations providing similar services in order to foster community cooperation and avoid unnecessary duplication of services.

CONTRACTOR must assist in the coordination of and verification of eligibility for mobility management services for participants who use CONTRACTOR’S site as a home meal site.

CONTRACT REPRESENTATIVES
CONTRACTOR designates , Manager CONTRACTOR’s
representative for the purpose of performing the services as required by this Contract.

Unless otherwise indicated in writing, the above named person has the primary authority and responsibility to carry out this Contract.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947

11. a.
b.

12. a. Jovan Grogan City as
Exhibit A-4 Program Provisions
_________________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 5 of 5 ends

b. COUNTY designates the Director of Social Services Agency, or designee, as its representative for the purpose of managing the services performed pursuant to this Contract.

13. NOTICES
All notices prescribed by this Contract will be in writing and deemed effective if sent by certified mail or registered mail and properly deposited with the United States Postal Service, postage prepaid with return receipt requested and addressed as follows:
a. To COUNTY: Social Services Agency
Office of Contracts Management
333 West Julian Street
San Jose, California 95110-2335
b. To CONTRACTOR: City of Santa Clara
, City Manager
1500 Warburton Avenue
Santa Clara, CA 95050

14. COUNTY’S CONTRACT TRANSITION PROCESS
CONTRACTOR agrees to provide all information deemed necessary by the County for use in subsequent procurement cycles.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Jovan Grogan
Exhibit A-4.1: Program Provisions
_____________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 1 of 4 ends

AGENCY: City of Santa Clara
PROGRAM NAME: Senior Nutrition Program – Congregate Meals – Home and Community Based Services Infrastructure Funding (HCBS Infrastructure Funding)

1. SERVICE DESCRIPTION
This is a contract between the County of Santa Clara (COUNTY) and City of Santa Clara (CONTRACTOR) for the purpose of purchasing, upgrading, or refurbishing infrastructure for the production and distribution of congregate or home-delivered meals provided through the regular Congregate Meals program, which is funded, authorized by, and to be performed in accordance with the Older Americans Act of 1965, as amended, P.L. 89-73, U.S.C. Section 3000 et seq., and all amendments, rules, and regulations pertaining thereto.

2. CONDITIONAL AMENDMENTS
The County Executive, or designee, received delegation of authority from the Board of Supervisors on December 6, 2022, to negotiate, execute, amend, and terminate the scope of services, the term, new or revised contracting requirements, maximum financial obligation and budget of this Contract through June 30, 2023, based upon the following conditions:
a. COUNTY has appropriated sufficient funds for the modification of this Contract, b. CONTRACTOR is meeting the performance requirements for this contract, c. County Counsel has reviewed and approved the amendment as to form and legality, and
d. County Executive has approved the amendment.

3. TERM OF CONTRACT
The term begins on July 1, 2019, and expires on June 30, 2023, unless terminated earlier or otherwise amended.

4. MAXIMUM FINANCIAL OBLIGATION
COUNTY will reimburse CONTRACTOR actual allowable expenditures subject to the provisions of this Contract, for a total not to exceed $27,022.00 in FY2022-2023.

5. BUDGET CONTINGENCY
This Contract is contingent upon the appropriation of sufficient funding by the County for the services covered by this Contract. Notwithstanding the termination provisions set forth herein, if funding is reduced or depleted by the County for services covered by this Contract, the County has the option to either terminate this Contract without notice (except that necessary to transition clients in the discretion of the County) and with no liability occurring to the County, or to offer an amendment to this Contract indicating the reduced amount.

6. COMPENSATION TO CONTRACTOR
a. COST REIMBURSEMENT CONTRACT
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit A-4.1: Program Provisions
_____________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 2 of 4 ends

i. CONTRACTOR will be reimbursed by COUNTY for its actual, reasonable, necessary, and allowed costs incurred up to the maximum compensation, for the performance of services as specified in this contract. These costs will also be in accordance with current cost principles and with all other requirements of this contract:

1. For Non-Profit Agencies, OMB Circular A-122.

2. For Local Governments, OMB Circular A-87.

3. For Public and Nonprofit Institutions of Higher Education, OMB Circular A-121.

4. For Profit Making Organization, 41 CFR Part 1.
ii. If CONTRACTOR provides any tasks, deliverables, goods, services, or other work, other than as specified in this Contract, the same will be deemed to be a gratuitous effort on the part of the CONTRACTOR, and the CONTRACTOR will have no claim whatsoever against COUNTY. iii. CONTRACTOR must participate in a closeout period at the end of the COUNTY funding period. During the closeout period all funds awarded to CONTRACTOR must be reconciled to the costs incurred and to the remaining cash, if any. A closeout packet will be provided to CONTRACTOR by COUNTY at the end of the funding period and is due within forty-five (45) days thereafter. This provision survives the termination of this Contract.
b. COST REIMBURSEMENT CLAIM
CONTRACTOR must submit to COUNTY a cost reimbursement claim in a form approved by COUNTY, by the tenth (10th) working day of each month for services performed during the preceding month.
i. Prior to submittal, cost reimbursement claims must be certified and signed by a responsible officer of CONTRACTOR with authority to certify that the information submitted by CONTRACTOR is accurate and CONTRACTOR is entitled to payment under the terms of the Contract.

COUNTY may rely on said certification in making payment, but this payment will not constitute a waiver of any of COUNTY's legal rights or objections.
ii. If the cost reimbursement claim is in proper form and the items billed are payable under this contract, COUNTY will make payment to CONTRACTOR within twenty-one (21) working days after receipt of the cost reimbursement claim.
iii. COUNTY will not be required to make payment if the amount claimed is not in accordance with the provisions of this Contract. All payments under this Contract will be made directly to CONTRACTOR as a corporate entity. Under no circumstances will COUNTY be required to make payments in any amount pursuant to this Contract to any other parties, including individual employees or creditors of CONTRACTOR.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit A-4.1: Program Provisions
_____________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 3 of 4 ends

iv. COUNTY is not obligated to reimburse CONTRACTOR for any expenditure not reported to COUNTY within sixty (60) calendar days after the end of the last month of the Contract term.

7. PURCHASE REPORTING
This contract requires SSA’s purchase reporting. CONTRACTOR shall monitor and report the purchases outlined in Exhibit D: Logic Model/Purchase Report.

CONTRACTOR must submit to COUNTY a report in a form approved by COUNTY, by the tenth (10th) working day of each month, accompanied with the monthly cost reimbursement claim.

8. ADJUSTMENT TO EXHIBIT B-4.1: PROGRAM PLAN & REQUIREMENTS A written adjustment to the Program Plan & Requirements may be approved by the COUNTY Representative, or designee, identified in this Exhibit, without a contract amendment as long as the adjustment reflects approved original program provisions and both parties are notified at least 10 days before the adjusted Program Plan & Requirements begins.

9. ADJUSTMENT TO EXHIBIT C-5.1: BUDGET
A budget adjustment can be made without a contract amendment if Contractor submits a written budget adjustment request to the COUNTY Contract Representative, or designee, and the request is approved by the COUNTY in writing. A budget adjustment must not increase the maximum financial obligation of this Contract.

10. ADJUSTMENT TO EXHIBIT D-4.1: LOGIC MODEL/PURCHASE REPORT A written adjustment to the Logic Model/Purchase Report may be approved by the COUNTY Representative, or designee, identified in this Exhibit, without a contract amendment as long as the adjustment reflects approved original program provisions and both parties are notified at least 10 days before the adjusted Logic Model begins.

12. CONTRACT REPRESENTATIVES
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit A-4.1: Program Provisions
_____________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 4 of 4 ends

CONTRACTOR designates , City Manager as CONTRACTOR’s
representative for the purpose of performing the services as required by this Contract. Unless otherwise indicated in writing, the above named person has the primary authority and responsibility to carry out this Contract.

COUNTY designates the Director of Social Services Agency, or designee, as its representative for the purpose of managing the services performed pursuant to this Contract.

13. NOTICES
All notices prescribed by this Contract will be in writing and deemed effective if sent by certified mail or registered mail and properly deposited with the United States Postal Service, postage prepaid with return receipt requested and addressed as follows:
a. To COUNTY: Social Services Agency
Office of Contracts Management
333 West Julian Street
San Jose, California 95110-2335
b. To CONTRACTOR: City of Santa Clara
, City Manager
1500 Warburton Avenue
Santa Clara, CA 95050

14. COUNTY’S CONTRACT TRANSITION PROCESS
CONTRACTOR agrees to provide all information deemed necessary by the County for use in subsequent procurement cycles.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 a. Jovan Grogan
b.

Jovan Grogan
Exhibit B-4: Program Plan & Requirements
_____________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 1 of 9 ends

CONTRACTOR: City of Santa Clara
PROGRAM NAME: Senior Nutrition Program – Home and Community Based Services (HCBS) Senior Nutrition Infrastructure Funding

4. MEALS
a. Meals served by CONTRACTOR must provide at least one-third (1/3rd) of the current recommended dietary allowance specified by the Food and Nutrition Board of the National Academy of Sciences – National Research Council. b. Menus will be planned by CONTRACTOR in cycles, the minimum period being five (5) weeks. Such menus must be planned in accordance with COUNTY requirements. Such menus will be submitted to COUNTY three (3) weeks prior to initial use. Menus will be posted in a conspicuous location at the meal site at least one (1) week in advance of use.
c. Table settings will be of reasonable quality. If disposable dinnerware is used, it will be of sturdy quality.

5. CONGREGATE MEAL SITES
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit B-4: Program Plan & Requirements
_____________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 2 of 9 ends

a. CONTRACTOR will provide congregate meals at the meal site(s), days, and times indicated in Exhibit C-5: Budget. Notwithstanding, CONTRACTOR may make minor changes to the service days and times listed in Exhibit C-5 with prior written approval of COUNTY.
b. CONTRACTOR may not relocate the meal site or add a meal site without prior notification, inspection, and approval by COUNTY. Relocation or addition of a meal site without the prior approval of the COUNTY may be considered a breach of the provisions of this contract. COUNTY may suspend or withhold payments, or terminate the contract if the relocation affects any of the provisions of the contract including, but not limited to the following:
i. The relocation or addition reduces or terminates the provision of services to seniors in the geographic area served by this contract. ii. The relocation or addition changes the service area served by this contract. iii. The relocation or addition does not serve or give priority to older persons in the greatest social or economic need as defined by the Older Americans Act of 1965 as amended.
c. The site must have adequate lighting and ventilation and must meet all applicable health, fire, safety and sanitation regulations. CONTRACTOR must obtain current certificates from appropriate public officials indicating the site is in compliance with health and fire regulations.
d. CONTRACTOR ensures that a pleasant dining atmosphere is maintained and that there is adequate space for the equipment of participants, such as canes, crutches and wheelchairs.
e. There will be no architectural barriers which would prevent an eligible individual from having access to the meal site facility.
f. Innovative services may added to the PROGRAM during the term of this contract, or upon an extension of this contract, upon written approval of the COUNTY.
g. If a site is designated as a catered site in Exhibit C-5: Budget, upon written approval from COUNTY and upon obtaining all required governmental approvals, CONTRACTOR may switch to being a cook on site location. In the event of this switch, CONTRACTOR’s per-meal rate will be changed to the standard cook on site per-meal rate if different than the catered meal rate.

6. NUMBER OF MEALS, SERVING DAYS, AND HOLIDAYS
a. CONTRACTOR will provide the number of hot meals as specified in Exhibit C5: Budget. If demand by eligible individuals in the first six (6) months of this Contract does not result in CONTRACTOR providing the average number of meals per day specified in Exhibit C-5: Budget, COUNTY may terminate this Contract. Prior to termination, COUNTY and CONTRACTOR may attempt to renegotiate this Contract to allow CONTRACTOR to reduce the average number of meals to be provided per day. If CONTRACTOR provides additional DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit B-4: Program Plan & Requirements
_____________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 3 of 9 ends

meals and such additional meals will cause CONTRACTOR to exceed the Maximum Financial Obligation of this Contract, such additional costs will be the sole expense of CONTRACTOR, unless the parties agree and execute a Contract Amendment.
b. CONTRACTOR will be paid for the number of meals served at a meal site, not the number of meals prepared. COUNTY will not reimburse meals served that do not meet the dietary requirements in Section 4(a).
c. CONTRACTOR must open its Nutrition Site(s) for the number of service days specified in Exhibit C-5: Budget. CONTRACTOR must open its Nutrition Site(s) at minimum the number of serving days indicated each week except for holidays. Should CONTRACTOR close its Nutrition Site(s) due to unforeseen circumstances, CONTRACTOR will notify COUNTY immediately and work collaboratively to reschedule the day(s) that the Nutrition Site(s) was closed.

Supportive services may include:
i. Transportation of eligible individuals to and from congregate meal sites so that nutrition and other services will be accessible to those eligible individuals living within the program area who, because of lack of mobility or physical or mental handicap, would otherwise be unable to participate in the program;
ii. Information and referral services designed to provide eligible individuals with current information of, and referral to, all appropriate services to meet their needs;
iii. Health and welfare counseling services designed to assist eligible individuals in dealing with the problems and stresses that interfere with normal health and social functioning. CONTRACTOR may provide such services through person-to-person assistance from trained counselors or referrals to other resources;
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit B-4: Program Plan & Requirements
_____________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 4 of 9 ends

iv. Nutrition education through a formal program of regularly scheduled meetings to make available pertinent facts related to nutritional need; v. Recreation activities designed to foster the health and social well-being of program participants through social interaction and satisfying use of free time;
vi. Outreach activities to assure maximum participation of hard to reach and other eligible individuals.
b. CONTRACTOR will report the supportive services provided at its meal site(s) to the COUNTY in the format requested by the COUNTY and whether the service is provided by CONTRACTOR or another entity at least annually, or more often, as requested by the COUNTY. COUNTY may request this information from CONTRACTOR up to once per quarter.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit B-4: Program Plan & Requirements
_____________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 5 of 9 ends

c. No later than the second time an eligible participant attends a congregate meal site operated by CONTRACTOR, CONTRACTOR must have the participant complete a registration form with participant’s information. Registration forms must be submitted to the designated COUNTY staff person at least monthly for registrants from the prior month along with the Monthly Report. CONTRACTOR must submit any new monthly registrations prior to the fifth (5th) working day of every month.
d. CONTRACTOR must complete their monthly scanning for the prior month by the first (1st) working day of the month immediately following. e. Quarterly Report. Quarterly Reports with output and outcome data must be turned in with September, December, March, and July invoices. Quarterly Reports must be prepared on the form provided by the COUNTY. Submission of the Quarterly Report is required before the corresponding monthly invoice can be paid.
f. Within 30 days of executing this agreement, and annually thereafter if the term of this agreement is extended, all employees, volunteers, subcontractors, or agents of CONTRACTOR who handle confidential client information, including but not limited to registration forms, must complete the information security and privacy presentation online training provided by the California Department of Aging (currently available at:
https://www.aging.ca.gov/ProgramsProviders/Information_Security_and_Privac y/Presentation/index.html). Upon completion, evidence must be submitted to COUNTY to provide to Sourcewise.

Page 6 of 9 ends

must record the number of volunteer meals served. CONTRACTOR will be reimbursed for volunteer meals provided.
c. Guest Meals: A guest under the age of 60 may be offered a meal during meal hours if doing so will not deprive an older individual of a meal or add to the cost of meals prepared. A guest must pay a fee of at least $8.00 or up to the actual cost of the meal served, as specified in Exhibit C-5: Budget. CONTRACTOR must record the number of guest meals served and keep guest fees separate from participant contributions. CONTRACTOR may keep guest fees received.

14. MANDATORY ATTENDANCE
CONTRACTOR must have a representative attend every required training and meeting offered by the COUNTY that is specific to the Senior Nutrition, Congregate Meals Program.

15. PURCHASES
COUNTY may require CONTRACTOR, by written notice, to obtain approval of COUNTY for all purchases of food and materials. Approval will not be withheld by COUNTY except for good cause.

17. COMPETITIVE BID REQUIREMENTS
a. All equipment purchases by the CONTRACTOR exceeding five-hundred dollars ($500.00) must be procured through a competitive process in compliance with Sourcewise’s bidding procedures unless services or materials can be obtained only from a single source. Any procurement exceeding ten-thousand dollars ($10,000.00) must also comply with the requirements of Office of Management and Budget Circular Uniform Guidance.
b. Unless CONTRACTOR uses the COUNTY’s designated vendor, prior to making any equipment purchase that has a value of five-hundred dollars ($500) or more, CONTRACTOR will submit to COUNTY evidence that it has received a minimum of three (3) bids for such subcontract and justification for selection of the DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit B-4: Program Plan & Requirements
_____________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 7 of 9 ends

successful bidder or submit documentation to support the use of the sole supplier. Record shall be maintained by CONTRACTOR showing the parties solicited and the bids submitted.

18. OVERTIME WORK
Overtime work expenditures that are incurred by the CONTRACTOR will not be paid by reducing services or meals under this contract.

19. RESTRICTION OF DISCLOSURES
Any reports, analysis, studies, drawings, information or data generated as a result of this contract are to be provided to COUNTY prior to public dissemination.

Should Sourcewise decide to reimburse the County regardless of the combined error rate of all Senior Nutrition Meal Sites, then the County will not withhold any percentage of CONTRACTOR’s invoice regardless of CONTRACTOR’s error rate for that month.

Page 8 of 9 ends

ii. Written notification to the complainant of the results of the review, including a statement that the complainant may appeal to Sourcewise if dissatisfied with the results of CONTRACTOR’s review.
iii. Confidentiality provisions to protect the complainant’s rights to privacy. Only information relevant to the complaint may be released to the responding party without the older individual’s consent.
b. CONTRACTOR shall notify older individuals of the grievance process available to them by:
i. Posting notification of the process in visible and accessible areas, such as the bulletin boards in multipurpose senior centers or areas in which there are a substantial number of older adults. For individuals are non-English speaking, the notification shall also be posted in the primary language of a significant number of older individuals.
ii. Advising homebound older individuals of the process either orally or in writing upon CONTRACTOR’s contact with the individuals. c. Complaints may involve, but not be limited to, any or all of the following:
i. Amount or duration of a service.
ii. Denial or discontinuance of a service.
iii. Dissatisfaction with the service being provided or with the service provider.

22. FISCAL YEAR CLOSEOUT SUBMISSION
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit B-4: Program Plan & Requirements
_____________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 9 of 9 ends

Due to fiscal reporting deadlines imposed by the California Department of Aging and Sourcewise, CONTRACTOR must submit requested fiscal year-end closeout documents to COUNTY accounting staff by July 5, 2023.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit B-4.1: Program Plan & Requirements
_____________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 1 of 3 ends

CONTRACTOR: City of Santa Clara
PROGRAM NAME: Senior Nutrition Program – Home and Community Based Services (HCBS) Senior Nutrition Infrastructure Funding

1. SERVICE DESCRIPTION & EXPECTED OUTCOME
The Social Services Agency – Senior Nutrition Program (COUNTY) is contracted to receive Home and Community Based Services (HCBS) Senior Nutrition Infrastructure grant revenue from Sourcewise, the local Area Agency on Aging, to pass through to designated subcontractors (including CONTRACTOR) that provide Title III congregate meals or home-delivered meals services. The pass-through funding will reimburse only for Sourcewise-approved infrastructure items and items on the California Department of Aging’s Title IIIC Capital Expenditure Approved List, CDA 7038 (REV 03/2022), attached as Exhibit E.

CONTRACTOR will work with the Social Services Agency – Senior Nutrition Program (COUNTY) to purchase, upgrade, or refurbish infrastructure to enhance production and distribution of congregate or home-delivered meals in compliance with HCBS funding rules.

2. POLICIES & PROCEDURES
CONTRACTOR will perform services in compliance with the Senior Nutrition Program, Congregate Policy & Procedures Manual, and any updates thereto as well as the Sourcewise Provider Manual equipment disposal procedures, attached as Exhibit F.

3. INTENT
During Spring 2021, Meals on Wheels submitted an Advocacy Proposal to the Legislature, requesting $40 million to support the capacity and infrastructure improvement grants for senior nutrition programs. The HCBS Senior Nutrition Infrastructure Funding resulted from that proposal. Statewide, this funding will provide $38 million to enhance, expand, and increase senior nutrition infrastructure. The intent of this funding opportunity is to add capacity and make infrastructure improvement grants to senior nutrition programs under the Mello-Granlund Older Californians Act.

4. BACKGROUND
The specific items and prices listed in Exhibit C-5.1: Budget have been pre-approved for purchase with the funds in the agreement by Sourcewise and the California Department of Aging.

5. PERMITS AND LICENSES
CONTRACTOR will obtain all permits and licenses necessary to the performance of this contract will assure that its subcontractors obtain the same. The CONTRACTOR will pay all normal fees for permits, licenses, inspections or any other certification or service required in the performance of this contract.

6. PURCHASES
CONTRACTOR must complete purchases in their entirety prior to June 30, 2023. Any change to the items in Exhibit C-5.1: Budget, including increased price or specification change, must be pre-approved in writing by the COUNTY Senior Nutrition Program DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit B-4.1: Program Plan & Requirements
_____________________________________________________________________________________________ Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 2 of 3 ends

Manager and Sourcewise (who will also get approval from the California Department of Aging) prior to purchase. CONTRACTOR may not be reimbursed without written preapproval.

7. PURCHASES
CONTRACTOR must complete purchases in their entirety prior to June 30, 2023.

8. PURCHASING RESTRICTIONS
This funding shall not be used to make additions, improvements, modifications, replacements, rearrangements, reinstallations, renovations, or alterations to capital assets that materially increase their value or useful life. This includes any equipment that is permanently affixed to a building such as non-portable generators, walk-in refrigerators, and walk-in freezers.

9. NON-EXPENDABLE PROPERTY
Any acquisition by CONTRACTOR of non-expendable property with a retail purchase price in excess of five-thousand dollars ($5,000.00), requires prior written approval of COUNTY.

10. COMPETITIVE BID REQUIREMENTS
a. All equipment purchases by the CONTRACTOR exceeding five-thousand dollars ($5,000.00) must be procured through a competitive process in compliance with Sourcewise’s bidding procedures unless services or materials can be obtained only from a single source. Any procurement exceeding tenthousand dollars ($10,000.00) must also comply with the requirements of Office of Management and Budget Circular Uniform Guidance.
b. Unless CONTRACTOR uses the COUNTY’s designated vendor, prior to making any equipment purchase that has a value of five-thousand dollars ($5,000) or more, CONTRACTOR will submit to COUNTY evidence that it has received a minimum of three (3) bids for such subcontract and justification for selection of the successful bidder or submit documentation to support the use of the sole supplier. Record shall be maintained by CONTRACTOR showing the parties solicited and the bids submitted.

11. EQUIPMENT TRACKING
Property acquired under this agreement that has a normal useful life of at least one year and has a unit acquisition cost of at least $5,000 (a desktop or laptop setup, is considered a unit, if purchased as a unit), all computing devices, regardless of cost (including, but not limited to: workstations, servers, laptops, personal digital assistants, notebook computers, tablets, smartphones, and cellphones) and all portable electronic storage media, regardless of cost (including, but not limited to: thumb/flash drives and portable hard drives) must be reported to COUNTY, which will be reported to Sourcewise and the California Department of Aging, on the Equipment Request Justification Form (CDA 7037), attached as Exhibit G, for approval and tracked on an annual basis. In addition, the equipment purchased with this funding may be monitored by Sourcewise, the state government, and federal government based on equipment purchasing requirements.

Page 3 of 3 ends

All prior equipment/property purchased by CONTRACTOR will remain on the Sourcewise Program Property Inventory List. CONTRACTOR will submit the following to COUNTY in the month of June:
a. List of equipment and the condition of the item;
b. Location of the equipment;
c. Picture of the equipment including Sourcewise tag number.

12. EQUIPMENT DISPOSAL
CONTRACTOR may only dispose of equipment purchased under this agreement in compliance with the Senior Nutrition Program, Congregate Policy & Procedures Manual, and any updates thereto, as well as the Sourcewise Provider Manual equipment disposal procedures, attached as Exhibit F.

CONTRACTOR will submit an Equipment/Property Disposal Form to COUNTY for submittal to Sourcewise prior to disposal of the equipment/property that is no longer needed, defective, and/or stolen.

Equipment/property remaining on the Program Property Inventory List that is less than five-thousand dollars ($5,000.00) and does not meet the criteria for a computing device or portable electronic storage, will still require approval for disposal prior to removal from the inventory.

13. AUDIT
This funding could be subject to audits by the COUNTY, Sourcewise, the state government, and federal government.

14. RESTRICTION OF DISCLOSURES
Any reports, analysis, studies, drawings, information, or data generated as a result of this contract are to be provided to COUNTY prior to public dissemination.

15. FISCAL YEAR CLOSEOUT SUBMISSION
Due to fiscal reporting deadlines, CONTRACTOR must submit requested fiscal yearend closeout documents to COUNTY accounting staff by July 5, 2023.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 DocuSign Envelope ID: FDC119A5-43CA-4631 -9D5C-479C0FA6B947 County of Santa Clara
Social Services Agency
FY 2022-2023
Agency Name: City of Santa Clara
Program: SNP Congregate Meals
A B
Budget Annual Units
Per Meal Reimbursement Rate 18,600
Contract Total
C D
Rate Total
$7.30 $135,780.00
$135,780.00
Fourth Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara Exhibit C-5
Master Budget

Page 1 of 4 ends

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA6B947 County of Santa Clara
Social Services Agency
Agency Name: City of Santa Clara
Site: Santa Clara Senior Center
A
Budget
Per Meal Reimbursement Rate*
Grand Total
Weekly Service Plan
Service Start
Service End
fTotal Hours
Monthly Service Delivery Plan
Possible Serving Days
Unpaid Days Off
Holidays
Actual Serving Days
Budgeted Monthly Meals
(Servine: Davs x # of Dailv Meals)
YTD Budgeted Meals**
I
B
#of
Daily Meals
75 Mon Tues
11:30AM 11:30AM
12:30 PM 12:30 PM

1.00 I 1.00
Jul Aug
21 23
0 0
1 0
20 23
1500 1725
1500 3225
I
C
#of
Serving Days
248
Weds Thurs
11:30AM 11:30AM
12:30 PM 12:30 PM

1.00 I 1.00
Sep Oct
22 21
0 0
2 1
20 20
1500 1500
4725 6225
I
FY 2022-2023
D E
Annual Units Rate
18,600 $7.30
Fri Sat Sun
11:30AM N/A N/A
12:30 PM N/A N/A

1.00 I N/A I N/A
Nov Dec Jan Feb
22 22 22 20
0 0 0 0
3 1 2 1
19 21 20 19
1425 1575 1500 1425
7650 9225 10725 12150
F
Total Contract
Amount**
$135,780.00
$135,780.00
ExhibitC-5
Site 1 - Service Plan & Budget
Site Preparation Type
Catered
Mar Apr May Jun Total
23 20 23 22 261
0 0 0 0 0
0 1 1 0 13
23 19 22 22 248
1725 1425 1650 1650 18600
13875 15300 16950 18600
*Only meals provided to eligible participants which meet dietary requirements will be reimbursed. The maximum number of meals reimbursed by the County will not exceed the YTD number of budgeted meals based on County-approved holiday schedule. Meals provided in a previous month but not reimbursed may be billed in a subsequent month. **Food costs must equal at least 25% less $.25 of the Total Contract Amount. Meals that are unserved will not be reimbursed.

Fourth Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara Page 2 of 4 DocuSign Envelope ID: FDC119A5-43CA-4631 -9D5C-479C0FA6B947 County of Santa Clara FY 2022-2023 Exhibit C-5
Social Services Agency Site 1 - Staffing Plan
Agency Name: City of Santa Clara
Site: Santa Clara Senior Center
75 248 18,600
# of Daily Serving Days Annual Meals
Meals
Paid Hours*

A B C D
Paid Time
Off
(Days)
Daily Do not include
Job Title Hours Hourly Rate Holidays
Site Manager 5.00 $19.93 33.40
Kitchen Aide 4.00 $20.79 33.40
Total 9.00
Un_eaid Volunteer Hours
A B
Daily
Volunteer Hours Hours
Server 1 2.00
Server 2 2.00
Check-in 1 2.00
Check-in 2 2.00
Total 8.00
13 Paid Holidays
E
Salaries
$ 26,009
$ 21,705
$ -
$ -
$ -
$ -
$ 47,714
$
$
$
$
$
$
$

1.45%
Payroll
Tax Rate
F
Payroll
Taxes
377
315
-
-
-
-
692
G H I
Other
Retirement Health Fringe
Contribution Insurance Benefits
$ 659
$ 503
$ - $ - $ 1,162
*All personnel costs in the Staffing Plan are built into the per meal rate listed in Exhibit C-5: Budget, Service Plan & Budget.

Fourth Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara Page 3 of 4 DocuSign Envelope ID: FDC119A5-43CA-4631 -9D5C-479C0FA6B947 County of Santa Clara
Social Services Agency
FY 2022-2023
Agency Name: City of Santa Clara
Program: SNP Congregate Meals
A
Source of Funds
Resources Provided by County
Santa Clara County Senior Nutrition
Program (This Contract)
Resources Provided by Agency (Match)
In-Kind Resources
Volunteer Hours*
Cash Resources
Agency General Fund
CDBG
Non-senior contributions
Total Program Cost
Total Per Meal Match
$4.18
Commitment Code
1 2
3 4
5 B C D
FV23Amount % of Total Commitment Code
$ 135,780.00 64%
$50,216.00 I 24%1
$3,445.00 2%
$24,000.00 11%
$0.00 0%
$ 213,441.00 100%
Actual Meal Cost
sec Rate (Match+ sec Rate)
$7.30 $11.48
Firm Commitment-Already have an agreement or letter confirming funding Anticipated Renewal of Existing Funding-Continuation of current year funding Anticipated Resource-Projection of previous fees or donations Application Pending-Application has been submitted, no confirmation at this time Pre-Application-Not yet submitted
* Volunteer Hours are valued by the County as: Living Wage* Hours Per Day* Serving Days Fourth Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara Exhibit C-5
Resource Table
1 3
1 1
3

Page 4 of 4 ends

Santa Clara County
Social Services Agency
FY 2022 - 2023 Exhibit C-5.1: BUDGET
Resource Table
1 of 3
Agency Name: City of Santa Clara
Contract Period: December 6, 2022 - June 30, 2023
Project Name: Senior Nutrition Program - Congregate Meals - Home and Community Based Services Infrastructure Funding (HCBS Infrastructure Funding)

A B C D
Source of Funds FY22-23 Amount
% of Total
Funding Commitment Code
Social Services Agency (SSA)* $ 27,022.00 100% 1
Other Funding Sources:
0%
0%
0%
0%
0%
0%
Total Funding Resources** $ 27,022.00 100%
Commitment Code
1 2
3 4
5 * The SSA line in FY 22-23 Amount, Column "B" should equal the Grand Total of Column "B" in the Budget Detail. ** The Total Funding Resources in Column "B" should equal the Grand Total of Column "D" in the Budget Detail.

Firm Commitment-Already have an agreement or letter confirming funding
Anticipated Renewal of Existing Funding-Continuation of current year funding
Anticipated Resource-Projection of previous fees or donations Application Pending-Application has been submitted, no
confirmation at this time
Pre-Application-Not yet submitted and expect funding
Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 1 of 3 ends

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Santa Clara County
Social Services Agency
FY 2022 - 2023 Exhibit C-5.1: BUDGET
Resource Table
2 of 3
Agency Name: City of Santa Clara
Contract Period: December 6, 2022 - June 30, 2023
Project Name: Senior Nutrition Program - Congregate Meals - Home and Community Based Services Infrastructure Funding (HCBS Infrastructure Funding)

A B C D
Operating Expenses** Contract Amount Other Funding Total 2 Door Reach-In Refrigerator 5,815.00 5,815.00
Cold Food Drop In Unit 3,838.00 3,838.00
Hot Food Drop In Well Unit 3,287.00 3,287.00
Milk Cooler 3,800.00 3,800.00
Roll-In Refrigerator 6,758.00 6,758.00
Inflation 3,524.00 3,524.00
Subtotal Operating Expenses 27,022.00 - 27,022.00
Grand Total*** 27,022.00 - 27,022.00
*Direct Costs are those costs for activities or services that benefit “specific projects” and are usually charged directly to projects on an item-by item basis. **These expense accounts are examples only. Vendors are not required to use these. ***The Grand Total for Column "D" should equal Total Funding Resources of Column "B" in the Resource Table.

If there are any budget changes in certain line item expenses during the course of FY23, contractor must submit to the County a budget revision request form.

Direct Costs *
Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 2 of 3 ends

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Santa Clara County
Social Services Agency
FY 2022 - 2023 Exhibit C-5.1: BUDGET
Resource Table
3 of 3
Agency Name: City of Santa Clara
Contract Period: December 6, 2022 - June 30, 2023
Project Name: Senior Nutrition Program - Congregate Meals - Home and Community Based Services Infrastructure Funding (HCBS Infrastructure Funding) Please provide an explanation for each line item. Narrative should be consistent with budget. 2 Door Reach-In Refrigerator
True TS-35-HC 39 1/2" Two Section Reach In Refrigerator, (2) Left/Right Hinge Solid Doors, 115v
Cold Food Drop In Unit
Cold Food Drop-In Unit, refrigerated, 2-pan size, self- contained refrigeration, insu Code: ATL-WCM-2
Hot Food Drop In Well Unit
Hot Food Drop-In Well Unit, electric, 3-well, individual pan design, wet or dry oper Code: ATL-WIH-3
Milk Cooler
True TMC-34-S-HC Milk Cooler w/ Top & Side Access - (512) Half Pint Carton Capacity, 115v
Roll-In Refrigerator
Turbo Air PRO-26R-RI-N 34" One Section Roll In Refrigerator, (1) Right Hinge Solid Door, 115v
Inflation
This item is included to capture cost increases that occur after the execution of the agreement.

Operating Expenses
Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara

Page 3 of 3 ends

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA6B947 Santa Clara County Social Services Agency
Logic Model - SNP - Congregate Meals
FY 2022-2023 Exhibit D-4: Logic Model
Agency Name: City of Santa Clara
A. Contract Goal: Provide nutritious meals, opportunities to socialize, transportation, and resources to older adults across Santa Clara County.

C. Activities/Services
By June 30, 2023, City of Santa
Clara will have provided 18,600
meals over 248 lunch meal service
days to at least (# of unduplicated
seniors) unduplicated seniors.

Provide training to meal site
volunteers on food safety topics.

Provide training to meal site
participants on food safety topics.

D1. # of
unduplicated
clients/families
served per FY
275
12 200
D2. #of
Outputs
per FY
18,600
6 4
D3. Output
Meals
Volunteer Trainings
Informational
Handouts
E. Short/Long Term
Outcome Measures
By June 30, 2023, at least 75% of eligible older adult
congregate meal participants will have participated in at least one other service offered at the meal site.

Fourth Amendment to the Contract between the County of Santa Clara Social Services Agency and City of Santa Clara Page 3 of 3 DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA6B947 Santa Clara County FY 2022 - 2023 Exhibit D-4.1: LOGIC MODEL/PURCHASE REPORT Social Services Agency lofl Agency Name:

Contract Period:

Project Name:

Item*
Item
*Provide invoice and proof of payment
City of Santa Clara
October 20, 2022 - June 30, 2023
Senior Nutrition Program - Congregate Meals - Home and Community Based Services Infrastructure Funding (HCBS Infrastructure Funding) Narrative
Narrative
Date of Purchase
mm/dd/yyyyy
Fourth Amendment to the Contract Between the County of Santa Clara and City of Santa Clara Cl HCBS

Page 1 of 1 ends

Total
$0.00
Title IIIC Capital Expenditure Approved List
Instructions: The list of equipment below are approved to be purchased using the Home and Community Based Services (HCBS) Senior Nutrition Infrastructure Grant for the Title IIIC Older Californians Nutrition Program (OCNP) only. No written justification or CDA approval is required.

Type of Equipment: Oven/Range/Stove,
Steamer, Gas or Electric
Categories: Combi
Convection
Conventional
Conveyor
Countertop
Double Stack
Griddle
Heat-n-Hold
Holding Unit
Induction Cooktop
Range Top
Reel
Rotating Rack
Type of Equipment: Cart/Cabinet, Hot or Cold
Categories: Beverage Service
Buffet
Holding
Mobile
Proofing Retherm
Rolling
Self-Serve
Serving
Warming
Type of Equipment: Hood
Categories: Exhaust
Condensate
Type of Equipment: Mixer
Categories: Countertop
Floor
Type of Equipment: Kitchen Sink
Categories: Compartment
Hand
Utility
Type of Equipment: Refrigerator and Freezer
Categories: Blast Chiller
Cam chiller
Side by Side
Glass Door
Ice Chest
Milk Cooler
Mobile
Reach-In
Roll-In
Undercounter
Work-top
(Walk-in refrigerators and walk-in freezers are
excluded.)
Exhibit E: Title IIIC Capital Expenditure Approved List DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 *If the equipment requested is not listed below the AAA will need to submit a completed Equipment Justification Form CDA 7037 with their proposal to the CDA for review and approval.

Please note walk-in refrigerators and freezers are not allowable.

Individual Equipment Items
Barbecue (allowable when serving meals
to older adults in OCNP)
Bagging Machine
Braising Pan
Broiler
Cold Pan Serving Counter
Cook/Chill System
Depositor and Filling Machine Dishwasher
Dough Divider
Drawer Warmer
Food Display (Hot or Cold)
Food Processor
Food Slicer, Chopper, Dicer, etc.

Menu Boards (Kitchen/Serving Area)
Microwave
Plate/Tray Dispenser
Produce Washers
Salad Bar
Serving Equipment
Serving Line System (Hot or Cold)
Shrink Wrapper Machine
Tray Sealer Machine
Speed Line (Hot or Cold) Stainless
Steel Work Tables Steam Table
Styrofoam Recycling Machine Tilt Skillet
* Per Program Memo No: 20-05 Equipment/Property Justification and Reporting Threshold.

CDA has adjusted the requirement for reporting equipment/property purchased as a part of one of the above referenced contracts to $5,000 per unit cost. All computing devices, regardless of cost (including, but not limited to: workstations, servers, laptops, personal digital assistants, notebook computers, tablets, smartphones, and cellphones) and all portable electronic storage media, regardless of cost (including, but not limited to: thumb/ flash drives and portable hard drives) must still be reported. * Per Title 2, Code of Federal Regulations, Section 200.439: "Capital expenditures for special purpose equipment are allowable as direct costs, provided that items with a unit cost of $5,000 or more have the prior written approval of the Federal awarding agency or passthrough entity." * Require CDA approval
Exhibit E: Title IIIC Capital Expenditure Approved List DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Griddle
Fryer

SOURCEWISE PROVIDER MANUAL,
PLANNING SERVICE AREA, 10

SANTA CLARA COUNTY
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Last updated: 08/2022
FY 2022-2023

PROVIDER MANUAL TABLE OF CONTENTS
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 SECTION 1: INTRODUCTION ......................................................................................................................................... 5 Overview .......................................................................................................................................................................... 5 Who should read the Provider Manual?. ............................................................................................................... 5 SECTION 2: GENERAL INFORMATION, REQUIREMENTS, & DUE DATES .................................................. 6 Funding Sources .......................................................................................................................................................... 6 Service Type and Program Definition ................................................................................................................... 7 Timeline and Due Dates throughout the fiscal year ....................................................................................... 10 SECTION 3: SERVICE & CONTRACT COMPLIANCE REQUIREMENTS ....................................................... 12 Contract Requirements & Certifications ............................................................................................................. 12 California Civil Rights Law Certification ............................................................................................................. 12 Certification regarding Lobbying .......................................................................................................................... 12 Information Integrity & Security ............................................................................................................................ 13 Data Security Policy & Procedure ......................................................................................................................... 13 Security Awareness Training .................................................................................................................................. 13 Transition Plan ............................................................................................................................................................. 13 Grievance Procedure ................................................................................................................................................. 14 Insurance ....................................................................................................................................................................... 15 120 Day Contract Compliance Requirement and Guidance ........................................................................ 15 SECTION 4: GENERAL OLDER AMERICAN ACT PROGRAM REQUIREMENTS & LOCAL REQUIREMENTS ............................................................................................................................................................. 17 Goals & Objectives ..................................................................................................................................................... 17 Target Population - Title Ill B, C, D, and Title VII services ........................................................................... 17 Target Population - Title Ill E services ................................................................................................................ 18 Staffing and Volunteers - Title Ill B, C, D, E, and Title VII services ........................................................... 18 Coordination ................................................................................................................................................................. 18 Public Information ...................................................................................................................................................... 18 Client Input ................................................................................................................................................................... 18 Client Contribution ..................................................................................................................................................... 18 SECTION 5: SERVICE PERFORMANCE ................................................................................................................... 19 Service Performance Requirements .................................................................................................................... 19 Requesting Technical Assistance .......................................................................................................................... 19 SECTION 6: DATA & PROGRAM REPORTING ..................................................................................................... 20 Data Management Overview ................................................................................................................................. 20 Data Collection - Service Units ............................................................................................................................ 20 Data Collection - Assessments .............................................................................................................................. 21 Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Data Verification and Monitoring of Service Units .......................................................................................... 21 Data Performance Management Process ........................................................................................................... 21 Registered Service Required Client Fields and Data Elements: Title Ill B & C ..................................... 22 Registered Service Required Client Fields and Data Elements: Title Ill E ............................................. 23 Non-Registered Service Requirements: Title Ill B & C. ................................................................................. 25 Non-Registered Service Requirements: Title Ill E .......................................................................................... 25 Restrictive Service Requirements: Title Ill B .................................................................................................... 25 Database Requirements for Registered, Non-Registered, and Restrictive Services: ........................ 26 SECTION 7: FISCAL, ACCOUNTING, RECORDKEEPING & AUDITS ............................................................ 27 Monthly Expenditure Request for Funds: ......................................................................................................... 27 Quarterly Expenditure Request for Funds: ....................................................................................................... 27 Sourcewise Internal Review and Corrective Action for Request for Funds .......................................... 27 Matching requirements: ........................................................................................................................................... 28 In-Kind Revenues and Expenses: ......................................................................................................................... 28 Indirect Costs .............................................................................................................................................................. 29 Qualifications and exceptions: .............................................................................................................................. 30 Non-Utilization of Federal Funds for Local Match: ........................................................................................ 30 Accounting Records, Recordkeeping & Retention: ....................................................................................... 30 Audits and Financial Closeouts ............................................................................................................................. 31 Funding Sources ......................................................................................................................................................... 31 Audited Financials and Single Audit Requirement ........................................................................................ 33 Closeout Report ......................................................................................................................................................... 33 Contract Resolution .................................................................................................................................................. 34 SECTION 8: PROGRAM MONITORING ................................................................................................................... 34 Monitoring Schedule Requirements .................................................................................................................... 34 Notification of In-Person Monitoring .................................................................................................................. 34 Pre-Program and Pre-Fiscal Monitoring ............................................................................................................ 35 Program Monitoring Only ....................................................................................................................................... 35 Program & Fiscal Monitoring ................................................................................................................................. 35 Site Visit and Accommodations ........................................................................................................................... 35 Post-Program and Post-Fiscal Monitoring ........................................................................................................ 35 Corrective Action Plan ............................................................................................................................................. 35 SECTION 9: GRANT MODIFICATIONS ................................................................................................................... 36 Contract Modifications ............................................................................................................................................ 36 Requested by Contractor ....................................................................................................................................... 36 Amendments to Service Agreement .................................................................................................................. 36 Budget Modifications and Revisions ................................................................................................................... 36 SECTION 10: EQUIPMENT ........................................................................................................................................... 37 Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Equipment/Property is defined by CDA as: ..................................................................................................... 37 Equipment/Property Approval Process ............................................................................................................ 37 Equipment Disposal Process ................................................................................................................................. 37 Equipment/Property Maintenance ...................................................................................................................... 38 SECTION 11: CO-BRANDING AND MEDIA ............................................................................................................. 39 SECTION 12: CONTRACTED SERVICES GRIEVANCE PROCEDURE & POLICY ....................................... 39 SECTION 13: GLOSSARY OF TERMS ...................................................................................................................... 40 OAA Title Ill & Title VII Program Eligible Population and Program Definitions .................................. .40 Supplement Glossary of Terms ............................................................................................................................. 42 SECTION 14: DATA & FISCAL TEMPLATES ......................................................................................................... 45 SECTION 1: INTRODUCTION
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Overview
Sourcewise has prepared this Provider Manual to assist the contracted organization's (aka service provider) administrative, fiscal and program staff to successfully manage their grant funded programs. The manual contains the most frequently utilized procedures required to maintain contractor compliance with federal, state, and Sourcewise regulations and policies that govern the grant funded programs and services.

We look forward to working with you to deliver quality services for older adults in Santa Clara County.

Who should read the Provider Manual?
Within each contracted organization, the below individuals should read, in detail, this PROVIDER MANUAL and the fully executed service agreement for the applicable fiscal year.

Position/Title Responsibilities
Program Manager Person(s) is responsible for administering/managing the Sourcewise/OAA grant funded program
Data Manager Person(s) responsible for collecting client level data and entering into the respective program (Q Database System or other database)
Fiscal Manager Person(s) responsible for the fiscal aspect (budgets, reporting expenditures, etc.) of the Sourcewise/OAA grant-funded program.

Operations Manager/Site Person(s) responsible for day-to-day operations of the program if Coordinators different from the program manager.
*This manual replaces all previous Sourcewise provider manuals. However, it is not a replacement for program-specific manuals and regulations issued by the State of California such as the LongTerm Care Ombudsman Program manual or California Statewide Guidelines for Legal Assistance manuals, etc.
**NOTE Contractor, contractor, subcontractor, service provider, and grantee may be used interchangeably throughout the manual. The terms have the same meaning regardless of how the term is used
SECTION 2: GENERAL INFORMATION, REQUIREMENTS, & DUE DATES Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Funding Sources
It is important for all contractors and their team to understand the dollar amount, source of funds and the match requirement for your grant. Older American Act program funding is federal funding unless otherwise identified by the AAA to the contracted service provider. Additional funding may include State General Fund or one-time only initiatives.

Older American Act (OAA) Federal Funding Sources with Descriptions and Minimum Required In-Kind or Cash-Match
OAA Funding Description Minimum Match
Source In-Kind or Cash
Title Ill B Adult Day Care/Health Center; Legal Services; L TC-OMB; 11.11% Case Management; Transportation; Senior Center Activities; Ombudsman Program
Title Ill C Nutrition Services; Congregate Meal (C-1); Home Delivered 11.11% Meals (C-2)
Title Ill D Health Promotion - Evidence-Based 0%
Title Ill E Family Caregiver Support Programs (Caregivers of Older 35% Adults & Older Adult Relative Caregivers)
Title VII A Prevention of Elder Abuse - Ombudsman Program 0% Title VII B Prevention of Elder Abuse, Neglect and Exploitation 0% State LTCOMB Ombudsman Program 0%
NSIP Nutrition Services Incentive Program (NSIP); United States 0% Department of Agriculture (ASDA)
The funding source for Families First Coronavirus Response Act (FFCRA) & Coronavirus Aid, Relief and Economic Security (CARES) Act, Consolidated Appropriation Act (CAA), and American Rescue Plan Act (ARPA) program funding and CDFA number is listed below for you to reference.

Emergency funding awarded to Title Ill and Title VII services started in March 2020 in response to the Coronavirus Disease (COVID19).

Families First Coronavirus Response Act (FFCRA) & Coronavirus Aid, Relief and Economic Security (CARES) Act, Consolidated Appropriation Act (CAA), and American Rescue Plan Act (ARPA) Federal Funding Sources with Description and Minimum Required In-Kind or Cash-Match
FFCRA/ CARES Funding
Act Source
CARES Title Ill B
FFCRA Title Ill C,
Part 1
FFCRA Title Ill C,
Part 2
CARES Title Ill C,
Part 2
CARES Title Ill E
CARES Title VII
Description
Special Programs for the Aging, Title 111,
Part B, Grants for Supportive Services
Nutrition Services; Congregate Meal (C1); Home Delivered Meals (C-2) Nutrition Services; Congregate Meal (C1); Home Delivered Meals (C-2) Nutrition Services; Congregate Meal (C1); Home Delivered Meals (C-2) Family Caregiver Support Programs
Prevention of Elder Abuse -
Ombudsman Program
Minimum
Match InKind or
Cash
0%
0%
0%
0%
0%
0%
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 CAA Title Ill C, Nutrition Services; Congregate Meal (C- 0% Part 1 1); Home Delivered Meals (C-2) CAA Title Ill C, Nutrition Services; Congregate Meal (C- 0% Part 2 1); Home Delivered Meals (C-2) ARPA Title Ill B Special Programs for the Aging, Title Ill, 15% Part B, Grants for Supportive Services ARPA Title Ill C, Nutrition Services; Congregate Meal (C- 15% Part 1 1); Home Delivered Meals (C-2) ARPA Title Ill C, Nutrition Services; Congregate Meal (C- 15% Part 2 1); Home Delivered Meals (C-2) ARPA Title Ill D Health Promotion - Evidence-Based 0%
ARPA Title Ill E Family Caregiver Support Programs 35%
ARPA Title VII Prevention of Elder Abuse - 0% Ombudsman Program Service Type and Program Definition
To help each contractor and their teams successfully administer their Title Ill or Title VII program, it is important to understand the unique program or service definition of the Older American Act (OAA) Title Ill or Title VII Program, the type of unit for measurement and the type of funding (registered v. non-registered).

Outlined in Appendix Bis the California Department of Aging (CDA) Service Categories and Data Dictionary. You can also find the below list of the Service Categories and Data Dictionary components for contracted services funded by Sourcewise.

Service
Category
Adult Day
Care/Health
Case
Management
Definition
CDA Data Service Cateories & Definitions
Unit of
Measure
Personal care for dependent elders in a 1 hour
supervised, protective, and congregate
setting during some portion of a day.

Services offered in conjunction with adult
day care/adult day health typically include
social and recreational activities, training,
counseling, and services such as
rehabilitation, medications assistance and
home health aide services for adult day
health.

Assistance either in the form of access 1 hour
coordination in circumstances where the
older person is experiencing diminished
functioning capacities, personal conditions
or other characteristics which require the
provision of services by formal service
providers or family caregivers. Activities of
case management include such practices
as assessing needs, developing care plans,
authorizing and coordinating services
Registered
v Nonregistered
Funding
Type
Registered Title Ill B
Registered Title Ill B
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 among providers, and providing follow-up
and reassessment, as required.

Transportation Transportation from one location to 1 way Non- Title Ill B another. Does not include any other trip registered
activity. May include travel vouchers and
transit passes.

Legal Legal advice, counseling and/or 1 hour Non- Title Ill B Assistance representation by an attorney or other registered person acting under the supervision of an
attorney.

Senior Center Services designed to enable older 1 hour Non- Title Ill B Activities individuals to attain and/or maintain registered physical and mental well-being such as
recreation, music, creative arts, physical
activity, education, leadership
development and other supportive
services not covered under other service
categories. Development and provision of
new volunteer opportunities and services,
and creation of additional services and
programs to remedy gaps and deficiencies
in existing services. Entertainment costs
such as tickets to shows or sporting
events, meals, lodging, rentals,
transportation and gratuities, are not
allowable.

Telephone Telephone a client to provide contact and 1 contact Non- Title Ill B Reassurance safety checks to reassure and support registered older individuals.

Congregate A meal provided to an eligible individual in 1 meal Registered Title Ill Meals a congregate group setting, that meets all C-1
of the requirements of the Older
Americans Act and State/Local laws, and
assures a minimum one-third of the Dietary
Reference Intake, and shall comply with
Dietary Guidelines for Americans.

Home A meal provided to an eligible individual in 1 meal Registered Title Ill Delivered his or her place of residence, that meets all C-2 Meals of the requirements of the Older
Americans Act and State/Local laws,
assures a minimum one-third of the current
Dietary Reference Intake, and shall comply
with Dietary Guidelines for Americans.

Health An evidence-based health promotion 1 contact Non- Title Ill D Promotion program, including programs related to the registered Evidence- prevention and mitigation of the effects of
Based chronic disease (including, but not limited
to, osteoporosis, obesity, diabetes, and
cardiovascular disease), alcohol and
substance abuse reduction, smoking
cessation, weight loss and control, stress
management, falls prevention, physical
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 activity, and improved nutrition. For a list
of ACL approved Evidence-Based
programs, please visit the National Council
on Aging website at
https://www.ncoa.org/resources/ebpchart.

Caregiver An FCSP Support Service consisting of 1 hour Registered Title Ill E Training workshops or one-on-one individually
(Caregiver of tailored sessions, conducted either in
an Older person or electronically by a skilled and
Adult) knowledgeable individual, to assist
caregivers in developing the skills and
gaining the knowledge necessary to fulfill
their caregiving responsibilities; and
address the areas of health, nutrition, and
financial literacy.

Caregiver An FCSP Support Service provided by a 1 hour Registered Title Ill E Case person who is trained and experienced in
Management the skills that are required to coordinate
(Caregiver of and monitor the provision of formal
an Older caregiver-related services in circumstances
Adult) where caregivers are experiencing
diminished capacities due to mental
impairment or temporary severe stress
and/or depression.

Caregiver An FCSP Respite Care service that includes 1 hour Registered Title Ill E Respite In- the provision of care receiver day and/or
Home overnight supervision and friendly visiting
(Caregiver of by an appropriately skilled provider or
an Older volunteer in order to prevent wandering
Adult) and health or safety incidents.

Caregiver An FCSP Respite Care service where the 1 hour Registered Title Ill E Respite Out- care receiver attends a
of-Home Day supervised/protective, congregate setting
Care during some portion of a day, and includes
(Caregiver of assess to social and recreational activities. an Older
Adult)
Community An FCSP Information Service designed to 1 Activity Non- Title Ill E Education on educate groups of current or potential registered Caregiving caregivers and those who may provide
(Caregiver of them with assistance about available FCSP an Older and other caregiver support resources and
Adult) services (e.g., booth at a health fair).

Caregiver An FCSP Support Service provided by a 1 hour Registered Title Ill E Case person who is trained and experienced in
Management the skills that are required to coordinate
(Older Adult and monitor the provision of formal
Relative caregiver-related services in circumstances
Caregiver) where caregivers are experiencing
diminished capacities due to mental
impairment or temporary severe stress
and/or depression.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Elder Abuse Public education and training of 1 Session Non- Title VIIPrevention, professionals to develop, strengthen, and registered B Education & carry out programs for the prevention,
Training detection, assessment, and treatment of,
intervention in, investigation of, and
response to elder abuse, neglect, and
exploitation (including financial
exploitation). This includes training for Title
Ill E caregivers.

Elder Abuse Educational materials and guidance kits 1 Non- Title VIIPrevention distributed for the prevention, detection, Product registered B Education assessment, and treatment of, intervention
Materials in, investigation of, and response to elder
abuse, neglect, and exploitation (including
financial exploitation).

Timeline and Due Dates throughout the fiscal year
Set forth below are due dates which do not change throughout the year, and it is expected that the contracted service provider submits the required information by the due dates outlined below.

Dates are subject to change depending on unique requests received from the State. These updates will be communicated by email to the contracted service contact person and provide as much time available to complete the request.

GENERAL DUE DATES/TIMELINE*
Topic Due Date Submit to/Contact Information
CDA Security Awareness Training 31st of July [email protected] 120 days of the [email protected] Full Contract Compliance start of the contract
Audited financials including Single ist day of February [email protected] Audit of the following
year
Financial Closeout Report 15th day of July [email protected] Program & Fiscal Monitoring** August - June Sourcewise Planner Analyst will schedule/arrange
* Annual program monitoring is required for all Title Ill C Nutrition Service Programs; Every two years a program & fiscal monitoring is required for all Title Ill and Title VII programs & services. *includes emergency funding through FFCRA, CARES Act, CAA, and ARPA.

NON-REGISTERED TITLE Ill or TITLE VII SERVICES
Topic Due Date Submit to/Contact Information
Title Ill or Title VII Registered Service 10th day of the following month unit reports after the quarter*
Quarter 1 (July 01 - September October 10th
30) [email protected] Quarter 2 (October 01 -
December 31) January 10th
Quarter 3 (January 01 - March April 10th
31)
Quarter 4 (April 01 - June 30) July 10th
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 15th day of the
Request for Funds Invoices following month [email protected] after the quarter **
Closeout Report 15th day of July [email protected] * If the 10th day of the month is on a weekend date, the non-registered service unit report is due the Friday before the 10th day of the month.
** If the 15th day of the month is on a weekend date, the request for funds is due the Friday before the 15th day of the month.

REGISTERED TITLE Ill SERVICES
Topic Due Date Submit to/Contact Information
Title Ill or Title VII Registered Service 10th day of the [email protected] unit reports following month* Request for Funds Invoices 15th day of the [email protected] following month** 10 working days
Ql Demographic & Data Check from September
3Qth
10 working days
Q2 Demographic & Data Check from December [email protected] 3pt Q3 Demographic & Data Check 10 working days
from March 31 st
Q4 Demographic & Data Check 10 working days
from June 30th
Closeout Report 15th day of July [email protected] * If the 10th day of the month is on a weekend date, the registered service unit report is due the Friday before the 10th day of the month.
** If the 15th day of the month is on a weekend date, the request for funds is due the Friday before the 15th day of the month.
***or designated Q Database Administrator of Sourcewise EMERGENCY FUNDED TITLE Ill & TITLE VII SERVICES*
Topic Due Date Submit to/Contact Information
Title Ill or Title VII Registered Service 10th day of the [email protected] unit reports following month** Request for Funds Invoices 15th day of the [email protected] following month*** Closeout Report 15th day of [email protected] October * Includes FFCRA, CARES Act, CAA, ARPA by reference and also outlined in Section 2 of the service provider manual and executed service agreement.
** If the 10th day of the month is on a weekend date, the registered service unit report is due the Friday before the 10th day of the month.
*** If the 15th day of the month is on a weekend date, the request for funds is due the Friday before the 15th day of the month.
***or designated Q Database Administrator of Sourcewise SECTION 3: SERVICE & CONTRACT COMPLIANCE REQUIREMENTS
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Contract Requirements & Certifications
The below sub-list of contract requirements and certifications is not inclusive of all compliance requirements and the contractor is responsible for thoroughly reviewing the fully executed contract agreement to ensure all requirements are adhered to.

California Civil Rights Law Certification
Contractor with which the award for the Title Ill or Title VII program(s) is at or more than $100,000 is required to sign a separate certification along with the fiscal year service agreement.

Pursuant to Public Contract Code section 2010, a person that submits a bid or proposal to, or otherwise proposes to enter into or renew a contract with respect to any contract in the amount of $100,000 or above shall certify, under penalty of perjury, at the time the bid or proposal is submitted or the contract is renewed, all of the following:
■ California Civil Rights Laws: For contracts executed or renewed after January 1, 2017, the contractor certifies compliance with the Unruh Civil Rights Act (Section 51 of the Civil Code) and the Fair Employment and Housing Act (Section 12960 of the Government Code); and
■ Employer Discriminatory Policies: For contracts executed or renewed after January 1, 2017,if a Contractor has an internal policy against a sovereign nation or peoples recognized by the United States government, the Contractor certifies that such policies are not used in violation of the Unruh Civil Rights Act (Section 51 of the Civil Code) or the Fair Employment and Housing Act (Section 12960 of the Government Code).

Certification regarding Lobbying
All contractors are required to sign a separate certification along with the fiscal year service agreement for the Title Ill or Title VII program regardless of the contract amount. (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency; a Member of Congress; an officer of employee of Congress; or an employee of a Member of Congress in connection with the awarding of any federal grant; the making of any federal loan; the entering into any cooperative agreement; and the extension, continuation, renewal, amendment or modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard For-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents and all sub-awards at all tiers (including subcontractors, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly.
(4)Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, United States Code. Any person who fails to file the Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 required certification shall be subject to a civil penalty of no less than $10,000 and no more than $100,000 for each such failure.

Information Integrity & Security
All contractors are required to sign a separate certification along with the fiscal year service agreement for the Title Ill or Title VII program regardless of the contract amount.

Data Security Policy & Procedure
Each contractor and its subcontractors/vendors, shall have in place operational policies, procedures, and practices to protect State information assets, including those assets used to store or access Personal Health Information (PHI), Personal Information (Pl) and any information protected under the Health Insurance Portability and Accountability Act (HIPAA), (i.e., public, confidential, sensitive and/or personal identifying information) herein referred to as Personal, Sensitive and Confidential Information (PSCI) as specified in the State Administrative Manual, 5300 to 5365.3; Cal. Gov. Code § 11019.9, DGS Management Memo 06-12; DOF Budget Letter 06- 34; and CDA Program Memorandum 07-18 Protection of Information Assets and the Statewide Health Information Policy Manual. Information assets may be in hard copy or electronic format and may include but is not limited to:
i. Reports
ii. Notes
iii. Forms
iv. Computers, laptops, cellphones, printers, scanners
v. Networks (LAN, WAN, WIFI) servers, switches, routers vi. Storage, media, hard drives, flash drives, cloud storage vii. Data, applications, database
Security Awareness Training
The contractor employees, subcontractors/vendors, and volunteers handling PSCI must complete the required CDA Security Awareness Training module located at https://aqinq.ca.qov/lnformation security/ within thirty (30) days of the start date of the Contract/ Agreement, within thirty (30) days of the start date of any new employee, Subcontractor, Vendor or volunteer's employment and annually thereafter. Contractor must maintain certificates of completion on file and provide to Sourcewise upon request.

Template Security Awareness Training Certificate located in Appendix A.

Transition Plan
In the RFP OAA Application, the contractor is required to submit a transition plan to assist the contractor with developing an initial plan for situations that may require Sourcewise and/or the contractor to transfer or terminate the funded service at any time during the contract period. a. The contractor shall submit a transition plan to the Sourcewise within 15 days of delivery of a written Notice of Termination of a program funded either by Title Ill or Title VII. The transition plan must be approved by the AREA AGENCY and shall at a minimum include the following:
i. Description of how clients will be notified about the change in their service provider.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ii. A plan to communicate with other organizations that can assist in locating alternative services.
iii. A plan to inform community referral sources of the pending termination of the service and what alternatives, if any, exist for future referrals. iv. A plan to evaluate clients in order to assure appropriate placement. v. A plan to transfer any confidential medical and client records to a new contractor. vi. A plan to dispose of confidential records in accordance with applicable laws and regulations.
vii. A plan for adequate staff to provide continued care through the term of the contract.
viii. A full inventory and plan to dispose or, transfer, or return to the AREA AGENCY all equipment purchased during the entire operation of the contract. ix. Additional information as necessary to affect a safe transition of clients to other community service providers.
b. The Contractor shall implement the transition plan as approved by the Sourcewise. Sourcewise and will monitor the contractors progress in carrying out all elements of the transition plan. c. If the contractor fails to provide and implement a transition plan as required by this Agreement, the contractor will implement a transition plan submitted by Sourcewise to the contractor following the Notice of Termination.

Grievance Procedure
The contractor shall establish and maintain a written grievance process for reviewing and attempting to resolve complaints of older individuals or caregivers. Contractor is required to post the grievance procedure in a visible and accessible area. At a minimum, the process shall include all of the following:
i. Ten day time frames within which a complaint will be acted upon. ii. Written notification to the complainant of the results of the review, including a statement that the complainant may appeal to the AREA AGENCY if dissatisfied with the results of the Contractor's review.
iii. Confidentiality provisions to protect the complainant's rights to privacy. Only information relevant to the complaint may be released to the responding party without the older individual's consent.
iv. The Contractor shall notify older individuals of the grievance process available to them by:
a. Posting notification of the process in visible and accessible areas, such as the bulletin boards in multipurpose senior centers. For areas in which a substantial number of older
* For individuals are non-English speaking, the notification shall also be posted in the primary language of a significant number of older individuals. b. Advising homebound older individuals of the process either orally or in writing upon the Contractor's contact with the individuals.
v. Complaints may involve, but not be limited to, any or all of the following:
a. Amount or duration of a service.
b. Denial or discontinuance of a service.
c. Dissatisfaction with the service being provided or with the service provider. *If the complaint involves an issue of professional conduct that is under the jurisdiction of another entity, such as the California Medical Board or the State Bar Association, the complainant shall be referred to the proper entity.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 vi. Failure of the service provider to comply with any of the requirements set forth in CDA regulations or in your contract with Sourcewise.
*It is imperative to note that nothing in the Grievance policy shall be construed as prohibiting older individuals from seeking other available remedies, such as presenting their complaints at an open meeting of the Contractor's governing board
The contractor shall ensure within the Grievance procedure that they will notify the Chief Executive Officer of the AREA AGENCY in writing within ten working days after a statement has been issued to complainant detailing the complaint, resolution and a copy of statement sent to complainant.

All grievances should be mailed to the following address:

Attn: Chief Executive Officer
3100 De La Cruz Blvd, Suite 310
Santa Clara, CA 95054
Insurance
Contractor shall provide Sourcewise Planner Analyst at the start of the fiscal year, the active/ current insurance:
i. General liability of not less than $1,000,000 per occurrence for bodily injury and property damage combined. Higher limits may be required by the State in cases of higher than usual risks.
ii. Automobile liability including non-owned auto liability, of not less than $1,000,000 for volunteers and paid employees providing services supported by this AGREEMENT. iii. If applicable, or unless otherwise amended by future regulation, the CONTRACTOR and subcontractors shall comply with the Public Utilities Commission General Order No. 115-F which requires higher levels of insurance for charter-party carriers of passengers and is based on seating capacity as follows:
a. $750,000 if seating capacity is under 8
b. $1,500,000 if seating capacity is 8 - 15
c. $5,000,000 if seating capacity is over 15
iv. Professional liability of not less than $1,000,000 as it appropriately relates to the services rendered. Coverage shall include medical malpractice cost with the AREA AGENCY named as an additional insured on the policy.
120 Day Contract Compliance Requirement and Guidance
Each contracted service provider of OAA Title Ill or Title VII program regardless of funding source shall ensure full contract compliance 120 days from the contract start date. Full compliance will be verified by the grant administer (or Sourcewise) between day 60 -100 to ensure that by 120 days the elements below are accomplished by the contracted service provider.

The following checklist was constructed to support contracted service providers achieve 120 day compliance. It highlights key elements or procedures to ensure contract compliance for the OAA Title Ill or Title VII service agreement and program administration.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Data Security Policy & Procedure -Sourcewise OAA Service Agreement, Section 5.q & Section 15 Contractor should have procedures available that identify the following:
□ All access codes which allow access to confidential information are properly safeguarded. □ Personal, Confidential or Sensitive Information (PSCI) shall be protected from disclosure in accordance with all applicable laws, regulations, and policies. □ PSCI data shall be protected by authorized access using the principles of least privilege. □ Outline how staff and volunteers may ensure the protection of PSCI information by:
- Accessing, inspecting, using, disclosing, or modifying PSCI information only for the purpose of performing official duties.

Never accessing, inspecting, using, disclosing, or modifying PSCI information for curiosity, personal gain, or any non-business-related reason. - Securing PSCI information in approved locations.

Never removing PSCI information from the work site without authorization.

Grievance Procedure - 22 CCR§ 7400; 22 CCR§ 7500; 45 CFR 1321.65; Sourcewise OAA Service Agreement Section 17
□ A written a grievance process is established for reviewing and attempting to resolve complaints of older individuals receiving services funded by this agreement. □ Includes a 10-day time frame within which complaints will be acted upon by the service provider at each level of resolution. Note: the AAA is expected to respond to the complainant within 10-day timeframe and it should be included in the Grievance Policy & Procedure. □ Written notification to the complainant of the results of the review includes a statement that the complainant may appeal to the AAA if dissatisfied with results of contractor's review. □ Confidentiality provisions to protect the complainant's rights to privacy. "Only information relevant to the complaint may be released to the responding party without the older individual's consent."
Grievance Policy - 22 CCR § 7400; 22 CCR§ 7500; 45 CFR 1321.65; Sourcewise OAA Service Agreement Section 17
The service provider shall notify older individuals of the grievance process available to them by:
□ Posting notification of the process in visible and accessible areas, such as the bulletin boards in multipurpose senior centers.
□ For individuals non-English speaking, notification is posted in primary language of significant number of older individuals.
□ Advising homebound older individuals of the process either orally or in writing upon the Contractor's contact with the individuals.
□ Ensure within the Grievance procedure that they will notify the CEO of AAA in writing within ten working days after a statement has been issued to complainant detailing the complaint, resolution and a copy of a statement sent to complainant.

Voluntary Contributions Request - 22 CCR § 7500; 45 CFR 1321.67 □ Service provider offers clients with opportunity to provide voluntary contributions confidentially to support the cost of the Title Ill/VII OAA program. □ Service Provider refers to contributions solicited and received from Title Ill/VII participants as voluntary contributions and not donations or other.
□ Includes the amount of suggested client contribution, if defined.

Voluntary Contributions Policy & Procedure - 22 CCR § 7500; 45 CFR 1321.67 □ PROVIDER has written policy and procedure for collecting voluntary contributions INCLUDING:

SECTION 4: GENERAL OLDER AMERICAN ACT PROGRAM REQUIREMENTS & LOCAL

REQUIREMENTS
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □ How clients will be informed of the opportunity to contribute to the cost of service. □ The amount of suggested client contribution and how it was determined. □ The method used to collect and record client contributions to ensure confidentiality.

Grantee Public Information & Outreach Materials developed to promote Sourcewise OAA Title Ill or Title VII Grant Funded Programs - Sourcewise OAA Service Agreement, Section 32 □ Public Information or promotional materials in use to promote the program within the targeted geographic region to target population
□ Public Information or promotional materials acknowledges Sourcewise as the funder □ Public Information or promotional materials uses appropriate branding, logo and messaging as suggested per Sourcewise Style Guide guidelines available on the Sourcewise website at, https://mysourcewise.com/about/media-center/.
□ If #3 is not accomplished, funding agency name included on public information or promotional materials is included.

The authorizing Federal and State statutes governing Sourcewise as an Area Agency on Aging are found in the Older Americans Act as amended in 2020, Title 22 of the California Code of Regulations, and Division 8.5 of the California Welfare and Institutions Code.

Contracted service providers are required as a part of the Invitation for Bid (IFB) or Request for Proposal (RFP) procedure to ensure the minimum requirements per the funding specifications are upheld. The contractor defines the specific and measurable objectives to satisfy each goal requirement in the submitted proposal and annual renewal application using the defined Sourcewise application template provided by the Sourcewise Planner Analyst. Contractors are unable to modify the requirements; these requirements become a condition of any contract awarded for the service. Sourcewise may negotiate modifications after the bid/proposal and/or renewal application is submitted to assure that all necessary program requirements are met and coordinated prior to continuation. The awarded proposal and/or renewal application becomes a part of the contract agreement for services and monitored throughout the year by Sourcewise to ensure the minimum requirements for the award are satisfied.

Goals & Objectives
Goals and Objectives must be specific, measurable, and attainable.

Target Population - Title Ill B, C, D, and Title VII services Service provider must have established methods, other than use of means testing to provide services to all eligible older individuals 60 and older. Programs, services, and activities must be very specific and explicit about the communities they are attempting to address gaps in service delivery.

Additionally, demonstrate serving the target population (at-risk socially/economically), keeping in line with the intent of the Older Americans Act.

Service providers must show intent and methodology to serve the needs of caregivers and care recipients:
■ Age 75+
■ Low Income (federal poverty)
■ Minority
■ Living Alone
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Target Population - Title Ill E services
Service provider must have established methods, other than use of means testing to provide services to all eligible older individuals 60 and older and their informal caregivers aged 18 and older. Programs, services, and activities must be very specific and explicit about the communities they are attempting to address gaps in service delivery.

Additionally, demonstrate serving the target population (at-risk socially/economically), keeping in line with the intent of the Older Americans Act.

Service providers must show intent and methodology to serve the needs of caregivers and care recipients:
■ Age 75+
■ Low Income (federal poverty)
■ Minority
■ Living Alone
■ Individuals with disabilities
Staffing and Volunteers - Title Ill B, C, D, E, and Title VII services Service provider must demonstrate recruitment and training of staff & volunteers to support the program.

Staffing and Volunteers goal must describe specifically how many staff and volunteers will be required to support the Older Americans Act program and the kinds of tasks that will be performed by volunteers to further expand the provision of the Title Ill or Title VII program.

Coordination
Service provider shall form and administer cooperative agreements with other community-based agencies to demonstrate appropriate agency linkages and coordination to ensure comprehensive service delivery and avoid unnecessary duplication of services.

Public Information
Service provider must have planned information and outreach activities, including distribution printed materials co-branded with funding agency (Sourcewise) to promote services to target populations and geographic region in the community.

Service provider must ensure that programs and services are available to all older adults regardless of sexual orientation and gender identity. Evaluation of outreach efforts to gay, lesbian, bisexual, and transgender older adults will be included in the contract monitoring requirements.

Client Input
Service provider must have procedures in place for obtaining the views of the participants of the service being provided, including a written and distributed client grievance procedure.

Describe the annual process by which regular client input is received and areas that are monitored for quality service.

Client Contribution
Service provider must have provided clients with the opportunity to provide voluntary contributions confidentially to support the cost of the Title Ill/VII OAA program.

SECTION 5: SERVICE PERFORMANCE
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service provider shall describe the process for collecting voluntary client contributions including (a) how clients will be informed of the opportunity to contribute to the cost of the service, (b) the amount of suggested client contribution and how it was determined, and (c) the method used to collect and record client contributions to ensure confidentiality.

Service Performance Requirements
These requirements are included in the service agreement. Contracted service providers are expected to meet the minimum 8.33% of service unit delivery (or one-twelfth the total contract amount) on a monthly basis for registered services and 3% of service units delivered on a quarterly basis for non-registered services in order to meet the contracted service unit goal for the fiscal year beginning on July 01 through June 30.

When the monthly/quarterly request for funds is submitted to Sourcewise and is accompanied by the month/quarterly service unit report Sourcewise will review and respond directly to those service providers which are not meeting the expected minimum level of service. The Sourcewise team urges our service providers to initiate contact if there are unforeseen changes or obstacles presented which are inhibiting your organization from meeting the expected service units for that month so Sourcewise may assist with finding a workable solution.

Requesting Technical Assistance
Contractors are expected to communication problems, successes, issues, etc. with the Sourcewise Planner Analyst and Sourcewise. Contractors should request technical assistance for program, fiscal, or data matters whenever needed. Sourcewise is available and willing to provide technical assistance to service providers who request such assistance.

Technical assistance may also be provided by Sourcewise, when Sourcewise determines that the service provider needs assistance in a particular area. Examples of technical assistance include, but are not limited to:
(a) Assistance with financial or program reporting
(b) Clarification of service definitions
(c) Improving quality of service delivery
(d)Assistance in complying with Sourcewise assessment recommendations (e) Assistance in meeting the objectives of the contract Contractors have an opportunity to request technical assistance at any time, by submitting an email request to the Planner Analyst at Sourcewise by email.

SECTION 6: DATA & PROGRAM REPORTING
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Data Management Overview
The Older American Act (OAA) requires a report of statistical data reflecting the number of service units provided and number of registered clients or the estimated clients/audience reached.

The data and information created from data elements contribute to valuable knowledge about service use and client demographics. It is a source for Area Agencies on Aging (AAA), California Department of Aging (CDA), and U.S. Administration for Community Living (ACL) performance measures.

Contractors are required to submit all Sourcewise requested reports in a timely manner including monthly program and fiscal, quarterly data verification, client surveys, self-assessments, and yearend closeout reports, and, if applicable to enter required data into AssureCare Q Database in a timely manner. Failure of a Contractor to provide timely and accurate reports and data entry is sanctionable under the Sourcewise policies.

Sourcewise contracted service providers are categories under two types of services delivered:
- Registered Services: Means data collection and reporting requirements include unduplicated client counts by characteristic, units of service, including in some cases ADLs/lADLs and Nutrition Risk assessment. Registered Services are client specific data using participant identification numbers for each client and include required client demographic elements for targeting and/or reporting purposes.

Required registered client level detail include participant ID to determine unduplicated count, birth date, zip code, rural designation, gender, sex at birth, sexual orientation or gender identity, race, ethnicity, poverty status, and living arrangement. - Non-registered Services: Are those services where it is not practical to collect client specific information or where requiring the client to register may serve as a barrier to receiving a service. Reports include an estimated total client/audience reached by each service within each quarter of the fiscal year and is reported on a quarterly basis. - Restrictive Services: Is a service provided using Older Americans Act funds in whole or in part for which demographic and consumer characteristics are reported in aggregate, and personal identifying information (PII) related to clients is not shared or recorded beyond the provider level.

Data Collection - Service Units
Contracted service providers must comply with the record keeping procedures required by Sourcewise, which are dictated by CDA and the National Aging Program Information System (NAPIS). Requirements include the following:
(a) The collection of all input units of service must be recorded and retained by the contractor. (b)Services, as reported, must comply with the requirements in the grant contract which will be consistent with the service/program definition contained in the original request for proposal or invitation for bid process and the contractors grant application.

Contractors entering data into the Q Database are expected to complete all entries by the 10th day of the following month of service. Reference the Q User Guide, Appendix C, for further instructions on how to do this.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Data Collection - Assessments
Contracted service providers which the grant funded program or service requires select assessments including but not limited to ADL/IADL, Nutrition Risk Assessment, Employment Assessment, or Caregiver Relationship file must be included and updated annually during the contracted fiscal year by the contracted service provider at minimum.

Data Verification and Monitoring of Service Units
Each contracted service provider is responsible for ensuring that all of the required data elements, assessments, care plans and service units are completed and input into the required database system (Q Database) on or before the 10th day of the following month for the most recent month.

Contracted service providers are primarily responsible for upholding the integrity of the grant funded program or service to ensure the program requirements are satisfied.

Client profiles shall be updated with the most accurate and up to date information on an ongoing basis or as received but at least one time within the fiscal year.

On a quarterly basis, the Sourcewise Q Database Administrator will complete a quarterly demographic data and assessment monitoring for all registered contracted services during the last month of the fiscal quarter. The Database Administrator will contact the contracted service provider contact person securely to share the questionable, outdated or null demographics or assessments to be updated within 10 working days or before the fiscal quarter concludes to ensure the quarterly data submission to the State is submitted on time and is approved.

Data Performance Management Process
The below table describes the entity and their role to ensure that the required statistical information is captured based on the type of Title Ill or Title VII program and services.

Entity Role
Service Provider or AAA
AAA
■ Collects and tracks client/user information and service units
■ Collects and manages the client required assessments
for the Title Ill program and service
■ Reports service utilization units, consumer
demographics and expenditures
■ Maintains records to uphold accuracy of data
■ Plans and administers OAA data management
system(s)
■ Implements CDA data reporting requirements
■ Develops and maintains written procedures
■ Analyzes, corrects, and verifies data
■ Monitors and evaluates local services
■ Trains staff and provides technical assistance to the providers, clients, and caregivers
■ Reports data to CDA via the statewide California Aging Reporting System (CARS)
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Registered Service Required Client Fields and Data Elements: Title Ill B & C Specifically related to Title Ill Band C required registered client fields, use the below table to identify what must be obtained upon initial intake and enrollment in the Title Ill B or C program.

Service Category Service Unit Registered ADL/IADL Nutrition Funding Client Risk Source
Personal Care X HOUR X X Title Ill B
Homemaker X HOUR X X Title Ill B
Chore X HOUR X X Title Ill B
Adult Day Care/Health X HOUR X X Title Ill B
Case Management X HOUR X X Title Ill B
Congregate Meal X MEAL X X Title Ill C
Home Delivered Meals X MEAL X X X Title Ill C
Nutrition Counseling X Session per X X Title Ill C
participant
Assisted Transportation X One-way trip X Title Ill B
(X) required elements
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Registered Service Required Client Fields and Data Elements: Title Ill E Specifically related to Title Ill E Family Caregiver Support Program services required registered caregiver and care recipient client fields, use the below table to identify what must be obtained upon initial intake and enrollment in the Title Ill E services for Caregivers of Older Adults & Older Adult Relative Caregiver.

CAREGIVER REQUIRED FIELDS (
Service Category Service Unit Registered Employment Caregiver )
Caregiver Status Relationship
Assessments X HOUR X X X
Counseling X HOUR X X X
Peer Counseling X HOUR X X X
Support Group X HOUR X X X
Training X HOUR X X X
Case Management X HOUR X X X
In-Home Supervision X HOUR X X X
Homemaker X HOUR X X X Assistance
In-home Personal Care X HOUR X X X
Home Chore X HOUR X X X
Out-of-Home Day Care X HOUR X X X
Out-of-Home X HOUR X X X Overnight Care
Assisted Devices X Device/Occurrence X X X
Home Adaptation X Modification/Occurrence X X X
Registry X Hour/Occurrence X X X
Emergency X Assistance/Occurrence X X X Cash/Material Aid (X) required elements
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947

CARE RECIPIENT REQUIRED FIELDS (
)
Service Category Registered Care Receiver ADL & IADL *
Assessments X X
Counseling X X
Peer Counseling X X
Support Group X X
Training X X
Case Management X X
In-Home Supervision X X
Homemaker Assistance X X
In-home Personal Care X X
Home Chore X X
Out-of-Home Day Care X X
Out-of-Home Overnight Care X X
Assisted Devices X X
Home Adaptation X X
Registry X X
Emergency Cash/Material Aid X X
(X) required elements
* There are NO ADL and IADL data collection requirements for Care Receivers in FCSP Caring for Child Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Non-Registered Service Requirements: Title Ill B & C
Specifically related to Title Ill Band C non-registered services, use the below table to identify what must be obtained upon initial intake and enrollment in the non-registered Title Ill B, C, D program.

Service Category Service Unit Estimated Funding
Clients/ Audience Source
Nutrition Education X Session per X Title Ill C
participant
Information & Assistance X Contact X Title Ill B
Health Promotion - Evidence X Contact X Title Ill D
Based
Elder Abuse Prevention and X Session X Title VII
Training
Elder Abuse Prevention & 1 Material X Title VII
Education Materials
Other* X -- --
(X) Required elements
* (Community Education, Disaster Preparedness Materials, etc.) Reference the Title Ill Intake and Assessment Guide Non-Registered Service Requirements: Title Ill E
Specifically related to Title Ill Enon-registered services, use the below table to identify what must be obtained upon initial intake and enrollment in the non-registered Title Ill E program.

Service Category Service Unit Estimated Funding
Clients/ Audience Source
Outreach X Contact X Title Ill E
Information & Assistance X Contact X Title Ill E
Interpretation/Translation X Contact X Title Ill E
Legal Resources X Contact X Title Ill E
Public Information X Activity X Title Ill E
Community Education X Activity X Title Ill E
(X) Required elements
Restrictive Service Requirements: Title /II B
Specifically related to Title Ill B, Legal Assistance restrictive services, use the below table to identify what must be obtained upon initial intake and enrollment in the restrictive Title Ill B program.

Service Category Service Unit Client Case Level Funding Source Level Data Data
Legal Assistance X HOUR X X Title Ill B
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Database Requirements for Registered, Non-Registered, and Restrictive Services:

Type of Service Database Database Description
Requirement
For registered services client/user information
including demographics, health/client
assessments, and service unit reporting are
required to be uploaded and managed in the
Q System Database and due monthly.

Registered Services (Title Ill YES B/C/E) Reference the Q User Guide (Appendix C) for additional information on how to use the
application for tracking client/user
demographic information, health/client
assessments, and service units.

Requires only aggregate quarterly service unit
Non-Registered Services (Title Ill NO reports is submitted to the AAA (Sourcewise) B/C/D/E) on a predefined template on a quarterly basis.

For restrictive services client/case level-data
including demographics (not including name) and
service unit reporting are required to be
submitted to Sourcewise on a quarterly basis to
be uploaded to the CARS.

Legal assistance providers will produce a report
containing aggregated and de-identified data for
each of the required SPR data elements. Legal
assistance data reported to AAAs/SUAs must be
Restrictive Service (Title Ill B) YES aggregated and de-identified to ensure there is no disclosure of personally identifiable client
information. This is required to preserve client
confidentiality in accordance with legal rules of
ethics.

Further, legal assistance is categorized as a
"restricted service" in OAAPS, which ensures that
legal assistance data will not be improperly
combined with data associated with other Title Ill,
VI, or VII SPR services.

Further guidance on the required data and assessments for each type of service may be found in the Title Ill Intake and Assessments Guide, Appendix D, which is a tool for contracted service providers to and AAA staff identify the required ACL and CDA Title Ill data elements and implement into the administration of the contracted service. If there are further clarification and/ or assistance, please contact the Sourcewise Planner Analyst by email or phone to further discuss the situation so we may find a solution.

SECTION 7: FISCAL, ACCOUNTING, RECORDKEEPING & AUDITS
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Contract awards include a performance standard clause with a specific, negotiated per unit cost reimbursement rate and remedies if performance (quality or quantity) falls below a specified level in a specified period of time.

Monthly Expenditure Request for Funds:

Monthly program expenditures excel workbooks and Request for Funds templates are emailed to each registered Title 111, Title VII, or special reporting service providers* at the start of the fiscal year, along with instructions for completing and submitting the monthly request for funds.

Contractors are required to prepare and submit a Report of Expenditure Request and Request for Funds (RFF) and attach proof of expenditures by the 15th day of the following month. All costs presented on a monthly request for funds must be supported by financial documentation, regardless of if classified as grant costs, in-kind, match, non-match, income and allowable as outlined in Office of Management and Budget (0MB) circulars.

The following documents must accompany the Monthly Request for Funds:
■ Monthly Request for Funds Invoice
■ Monthly Program Expenditures Report (excel spreadsheet) ■ Sub grantees Income Statement (their financial report) ■ Sub grantees Matching Contributions Report (outlining matching contributions source, nonfederal matching contribution) ■ Monthly Q Units Report (for monthly registered services) Quarterly Expenditure Request for Funds:

Quarterly Program Expenditures excel workbooks and Request for Funds templates are emailed to each non-registered Title Ill, Title VII or special reporting service providers* at the start of the fiscal year, along with instructions for completing and submitting the monthly request for funds.

Contractors are required to prepare and submit a Quarterly Report of Expenditure Request and Request for Funds (RFF) and attach proof of expenditures by the 15th day of the following month after the end of the fiscal quarter. All costs presented on a quarterly request for funds must be supported by financial documentation, regardless of if classified as grant costs, in-kind, match, non-match, income and allowable as outlined in Office of Management and Budget (0MB) circulars.

The following documents must accompany the Quarterly Request for Funds:
■ Monthly Request for Funds Invoice
■ Monthly Program Expenditures Report (excel spreadsheet) ■ Sub grantees Income Statement (their financial report) ■ Sub grantees Matching Contributions Report (outlining matching contributions source, nonfederal matching contribution) ■ Quarterly Non-Registered Services Report (quarterly invoice) *Note: The type of service provided is outlined within the RFP documentation and CDA Data Dictionary for contracted service team to ensure that they are in compliance with the expenditure reporting requirements of the Title Ill or Title VII service.

Sourcewise Internal Review and Corrective Action for Request for Funds The Planner Analyst will review and approve all RFF(s). If there is a discrepancy in reporting, the Planner Analyst notifies the service provider of the discrepancy and requests a corrected invoice be resubmitted in a timely manner -within 1 business day. Once all calculations and details have been reviewed and approved by the Planner Analyst, the approved invoice accompanied with the Monthly Program
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Expenditures Report, service provider financial report and service units report is forwarded to the Sourcewise Finance Team for payment processing.

Matching requirements:

Each contractor is required to provide local match which is detailed in your approved budget and contract. The matching requirements are calculated on net costs, which are total costs less program income, and non-matching contributions. The local match requirement may be met either by allowable costs (non-federal matching contribution) or third-party in-kind contributions.

Allowable matching contributions are non-federal matching contributions; these are local cash and/or in-kind contributions that are not associated with federal funds/costs. ■ Title Ill B/C : 11.11%
■ Title Ill E: 35%
In-Kind Revenues and Expenses:

In-Kind contributions represent the value of third-party contributions of goods, services other than personnel, and personal services used by the Agency to achieve matching requirements. In addition, the In-Kind is identified as either a "match" or a "non-match" donation.

The California Department of Aging, Audit Department, has provided specific rules to follow in identifying what products and services, from which group of individuals, we can use in the match or non-match categories.

In-Kind Match: Contributions of property, equipment, or services by a non-federally funded third party. Examples are:
■ Contributions from local city governments, county governments, businesses and private individuals and foundations.
■ Contributions, other than services, from the Board of Directors.

In-Kind Non-Match: Contributions of property, equipment, or services from federally funded third party. Examples are:
■ Contributions from federally funded employees
The value attached to the In-Kind donations is based on the value the Agency would have to pay for those goods or services if purchased and must be fair and reasonable. The following values are used by this Agency:
■ Training based on the trainer's hourly rate.
■ Supervision based on the supervisor's hourly rate.
■ Professional services based on an estimated value.
■ Volunteer services based on the minimum wage rate.
■ Private automobile travel is reimbursed at the rate approved by the California Department of Aging. Actual odometer readings or standard mileage figures may be used for trips between cities. For trips within the city, only actual odometer readings may be accepted. ■ Equipment use based on an estimated value.
■ Supply items/food based on an estimated value.
■ Space based on an estimated value.
■ Other items based on an estimated value.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Indirect Costs
Indirect costs are costs incurred for a common or joint purpose benefiting more than one cost objective and not readily assignable to the cost objective specifically benefiting the Project, without effort disproportionate to the results achieved. The maximum reimbursement amount allowable for indirect costs is ten percent (10%) of the contractors Modified Total Direct Costs (MTDC), excluding in-kind contributions and nonexpendable equipment.

Amount Contractors may request on a Monthly/Quarterly basis:

Contractors may request up to the maximum one-twelfth of the authorized total budget each month during the contract period. The OAA Title Ill, Title VII, or special reporting funding is performance based, thus the total number of units provided each month or quarter is associated with the maximum request for funds a contractor may request.

If contractor exceeds the monthly target unit, the contractor can claim up to an additional 5% of the one-twelfth maximum request available.

If the contract does not meet the one-twelfth monthly/quarterly target units, the contractor may only request costs/expenditures which equal the total monthly percent of units provided. To identify the maximum request when a contractor does not meet the monthly target units, take the unit percentage and multiply it against the maximum request amount to get the maximum available request for funds.

Contractors are urged to closely monitor the pace of how many service units are being provided and the dollars being spent. The below shown chart can be used as a rule of thumb in monitoring units and expenditures.

Portion of Fiscal Year Target Percentages of the Number of Completed Month Service Units to be Provided and Grant
Funds to be Expended
1/12 July 8% FY
2/12 August 16% FY
3/12 September (end Ql) 25% FY
4/12 October 33% FY
5/12 November 42% FY
6/12 December (end Q2) 50% FY
7/12 January 58% FY
8/12 February 67% FY
9/12 March (end Q3) 75% FY
10/12 April 83% FY
11/12 May 92% FY
12/12 June (end Q4) 100% FY
NOTE: If there is an increase of 10% or decrease of 10% (for expenditures or service units being provided), immediate action must be taken to correct the problem. An excessive demand for services may require a Contractor to develop a waiting list as outlined in the executed service agreement.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Qualifications and exceptions:

Exceptions as provided by federal statute; the Local Match requirement may not be met by costs borne by another federal grant. Current federal statute allows the use of General Revenue Sharing funds to count towards satisfying the Local Match requirement.

Neither costs nor the values of cash and/or in-kind contributions may count toward satisfying the Local Match requirement if they have or will be counted toward satisfying a Local Match requirement of another federal grant or contract, or any other federal funds.

Cash and/or in-kind contributions counting towards satisfying a matching requirement must be verifiable from the records of the Contractor. These records must show how the value placed on matching contributions was determined.

To the extent feasible, volunteer services shall be supported by the same methods that the organization uses to support the allow-ability of its regular personnel costs.

In-kind contributions shall count towards satisfying a Local Match requirement only where if the Contractor receives the contributions.

Non-Utilization of Federal Funds for Local Match:

Non-federal resources used to match other federal grants or contracts may not be used to match Title Ill funds.

Federal cash or in-kind resources acquired during current or prior years may not be used to match funds provided under Title Ill unless otherwise specifically authorized by federal statute.

Non-federal resources shall be accepted as part of the Contractor match or cost sharing only when they are not borne by the federal government directly or indirectly under any other program.

Accounting Records, Recordkeeping & Retention:

The Contractor must maintain complete records which shall include, but not be limited to, accounting records, contracts, agreements, a reconciliation of the "Financial Closeout Report" to the audited financial statements, single audit report, and general ledgers, and a summary worksheet identifying the results of performing an audit resolution. This includes the following: Letters of Agreement, insurance documentation, memorandums and/or Letters of Understanding, patient or client records, and electronic files of its activities and expenditures hereunder in a form satisfactory to Sourcewise and the California Department of Aging in compliance with the laws and regulations of the State of California. All records pertaining must be made available for inspection and audit by the State at any time during normal business hours.

All such records, including confidential records, must be maintained and made available by the contractor: (1) until an audit has occurred and an audit resolution has been issued or unless otherwise authorized in writing, (2) shall retain said records for a minimum of four (4) years or for such longer period, if any, as is required by applicable statute, by any other clause of this AGREEMENT, or by A and C of this section.

If the contract is completely or partially terminated, the records relating to the work terminated shall be preserved and made available for the same periods as specified above. The contractor shall ensure that any resource directories and all client records remain the property of Sourcewise upon termination of and are returned to or transferred to another contractor as instructed by Sourcewise.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 All records containing confidential information shall be handled in a confidential manner in accordance with the requirements for information integrity and security, and in accordance with guidelines set forth in the contract service agreement, and Section 5(q). & 15. After the authorized period has expired, confidential records shall be shredded and disposed of in a manner that will maintain confidentiality.

The contractor shall maintain accounting records for funds received under the terms and conditions of your contract with Sourcewise. These records shall be separate from those for any other funds administered by the and shall be maintained in accordance with Generally Accepted Accounting Principles and Procedures and the Office of Management and Budget's (0MB) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. [2 CFR 200] [ 45 CFR 75]
Audits and Financial Closeouts
Funding Sources
It is important for all contractors and their team to understand the dollar amount, source of funds and the match requirement for your grant. This also includes the Catalog of Federal Domestic Assistance (CDFA) Number.

The funding source (Federal Grantor) for the following programs is the U.S. Department of Health and Human Services, Administration for Community Living. The passthrough is Sourcewise.

The funding source for OAA program funding and CDFA number is listed below for you to reference.

Older American Act (OAA) Federal Funding Sources with Descriptions, CDFA Numbers and Minimum Required In-Kind or Cash-Match
OAA Funding Description CDFA No. Minimum Match
Source In-Kind or Cash
Title Ill B Adult Day Care/Health Center; Legal 93.044 11.11% Services; L TC-OMB; Case Management;
Transportation; Senior Center Activities;
Ombudsman Program
Title Ill C Nutrition Services; Congregate Meal (C-1); 93.045 11.11% Home Delivered Meals (C-2)
Title Ill D Disease Prevention & Health Promotion 93.043 0% Title Ill E 93.052 35%
Family Caregiver Support Programs
Title VII A Prevention of Elder Abuse - Ombudsman 93.042 0% Program
Title VII B Prevention of Elder Abuse, Neglect and 93.041 0% Exploitation
State L TCOMB 0%
NSIP Nutrition Services Incentive Program (NSIP); 93.053 0% United States Department of Agriculture
(USDA)
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 The funding source for Families First Coronavirus Response Act (FFCRA) & Coronavirus Aid, Relief and Economic Security (CARES) Act, Consolidated Appropriates Act (CAA), Title XX Elder Justice, and American Rescue Plan Act (ARPA) program funding and CDFA number is listed below for you to reference. Emergency funding awarded to Title Ill and Title VII services started in March 2020 in response to the Coronavirus Disease (COVID19).

Families First Coronavirus Response Act (FFCRA) & Coronavirus Aid, Relief and Economic Security (CARES) Act, Consolidated Appropriates Act (CAA), Title XX Elder Justice, and American Rescue Plan Act (ARPA) Federal Funding Sources with Descriptions, CDFA Numbers and Minimum Required In-Kind or Cash-Match
Emergency
Funding
Name/Type
CARES
FFCRA
FFCRA
CARES
CARES
CARES
CAA
CAA
ARPA
ARPA
ARPA
ARPA
Funding
Source
Title Ill B
Title Ill C,
Part 1
Title Ill C,
Part 2
Title Ill C,
Part 2
Title Ill E
Title VII
Title Ill C,
Part 1
Title Ill C,
Part 2
Title Ill B
Title Ill C,
Part 1
Title Ill C,
Part 2
Title Ill D
Description
Special Programs for the Aging, Title 111,
Part B, Grants for Supportive Services
Nutrition Services; Congregate Meal (C1); Home Delivered Meals (C-2) Nutrition Services; Congregate Meal (C1); Home Delivered Meals (C-2) Nutrition Services; Congregate Meal (C1); Home Delivered Meals (C-2) Family Caregiver Support Programs
Prevention of Elder Abuse -
Ombudsman Program
Consolidated Appropriations Act,
2021, Nutrition Services; Congregate
Meal (C-1); Home Delivered Meals (C-2)
Consolidated Appropriations Act,
2021, Nutrition Services; Congregate
Meal (C-1); Home Delivered Meals (C-2)
American Rescue Plan, 2021, Special
Programs for the Aging, Title 111, Part B,
Grants for Supportive Services
American Rescue Plan, 2021, Nutrition
Services; Congregate Meal (C-1); Home
Delivered Meals (C-2)
American Rescue Plan, 2021, Nutrition
Services; Congregate Meal (C-1); Home
Delivered Meals (C-2)
American Rescue Plan, 2021, Health
Promotion - Evidence-Based
CDFA No.

93.044

93.045

93.052

93.042

93.045

93.044

93.045

93.043
Minimum
Match InKind or
Cash
0%
0%
0%
0%
0%
0%
0%
0%
15%
15%
15%
0%
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ARPA Title Ill E American Rescue Plan, 2021, Family 93.052 35% Caregiver Support Programs American Rescue Plan, 2021,
ARPA Title VII Prevention of Elder Abuse - 93.042 0%
Ombudsman Program
Audited Financials and Single Audit Requirement
Contractors expending less than $750,000 in total federal funds (from all sources) are exempt from federal audit requirements, but records must be available for review. Sourcewise reserves the right to determine whether the Contractor expended the funds provided under their contract in accordance with applicable laws and regulations. This may be accomplished by reviewing an audit of the Contractor or through other means (e.g., monitoring reviews) if the Contractor has not had an audit.

Any Contractor receiving $750,000 or more in total federal funds must comply with the requirements of the Single Audit Act (0MB Circular A-133) and all applicable audit requirements.

The Contractor shall permit independent auditors to have access to the records and financial statements as necessary for the Contractor to comply with 0MB Circular A-133. A copy of the audit must be provided to Sourcewise by February pt of the following year.

Contractors who expend $750,000 or more in Federal Awards shall arrange for an audit to be performed as required by the Single Audit Act of 1984, Public Law 98-502, Single Audit Act Amendments of 1996, Public Law 104-156, and Office of Management and Budget (0MB) Circular A-133. Contractor shall permit independent auditors to have access to records and financial statements as necessary for Contractor to comply with 0MB Circular A-133.

The Contractor shall ensure that Federal-Funded expenditures are displayed discretely in the single audit report's "Schedule of Expenditures of Federal Awards" (SEFA) under the appropriate Catalog of Federal Domestic Assistance (CFDA) number along with the related State-Funded expenditures. The Contractor shall ensure that the State-funded expenditures are discretely identified in the SEFA by the appropriate program name, identifying grant/contract number, and as passed-through Sourcewise.

The Contractor shall identify the CFDA titles and numbers to the independent auditor conducting the organization's single audit. The funding source (Federal Grantor) for the following programs is the U.S. Department of Health and Human Services. CFDA numbers are listed in Section 7 under Audits and Financial Closeout.

Any money obligated under the grant (even if in the possession of Contractor) but not needed to meet incurred obligations shall be returned with the Closeout Financial Report to Sourcewise.

There is no provision to carryover unexpended grant funds at the end of the fiscal year.

Any money obligated under the grant (even if in the possession of Contractor) but not needed to meet incurred obligations shall be returned with the Closeout Financial Report to Sourcewise. There is no provision to carryover unexpended grant funds at the end of the fiscal year.

Closeout Report
Contractors shall comply with all program and fiscal reporting requirements set forth by Sourcewise. To complete the required fiscal year closeout report, the contractor will be supplied SECTION 8: PROGRAM MONITORING
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 the necessary templates by no later than June 20. The annual fiscal year closeout due date is outlined in the fully executed service agreement and usually between the 15th and 20th day of July.

Contract Resolution
Within thirty (30) days after the project period has ended or when requested by Sourcewise (whichever comes earlier), the Contractor must provide ending Closeout Fiscal Report signed by the Contractor's authorized signer.

Contractors must provide the following items:

1. Subrecipient Audited Financial Report.

2. Program Statement of Revenue & Expenditures or a Program Functional Expense Matrix.

3. Subrecipient Fiscal Closeout Report.

If the contract resolution finds that payment is due to the subrecipient, payment should be initiated by the Planner Analyst and issued within 30 days from the date of the audit resolution letter to the subrecipient.

If recoveries are requested, a demand for payment is included as part of the audit resolution letter.

Follow-up invoices should be sent monthly, and if payment has not been received within 60 days, the Area Agency Chief Executive Officer should be notified to discuss further progressive action.

Sourcewise is required to conduct annual monitoring of local Older American Act, Title Ill and Title VII contracted agencies. This requirement is governed by both the California Code of Regulation 22 CCR§ 7250(b)(2), 7400, 7500, 7630-7638.13 and California Department of Aging, The monitoring visit is not intended to be punitive. There are three primary purposes for monitoring:

1. To ensure each service provider is following the requirements of the Older Americans Act and the California Code of Regulations.

2. To ensure each service provider is meeting the goals defined in their contract with Sourcewise.

3. To ensure each service provider is meeting the HIPAA Compliance regulations.

Monitoring Schedule Requirements
Type of Program Frequency & Type of Monitoring
Title Ill B, D, E & Title VII A, B
Title Ill C
Notification of In-Person Monitoring
Program & Fiscal Monitoring every 2 years
Program monitoring annually
Fiscal monitoring every 2 years
At least -4 -6 weeks in advance, the Sourcewise Planner Analyst will prepare two -three different dates which the contractor may select from to complete the required program and/or fiscal monitoring of the grant funded program. The fiscal year of focus will be identified in the email.

One an agreed upon date is selected, the Planner Analyst will send a Outlook calendar invitation to the Program Manager of the grant funded service to reserve the date and time of the monitoring.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Pre-Program and Pre-Fiscal Monitoring
At least 4 weeks in advance, to prepare the contractor for the on-site program and/or fiscal monitoring visit, the Planner Analyst will share the below documents to begin preparation of the monitoring visit. All completed documents are due at least 2 weeks or 10 business days in advance to the Sourcewise Planner Analyst by email.

Program Monitoring Only
■ Program Monitoring Contractor Checklist
Program & Fiscal Monitoring
■ AAA Program Monitoring Contractor Checklist
■ AAA Fiscal Monitoring Contractor Checklist
■ AAA Internal Controls Questionnaire
■ AAA Fiscal Monitoring Questionnaire
Site Visit and Accommodations
On the date of the site visit, the contractor shall supply Sourcewise a private/secure area on-site for the time period outlined to review and hold interviews with necessary personnel and/or volunteers.

The Contractor is expected to cooperate fully with the Sourcewise Planner Analyst during the scheduled evaluations of the program. The Contractor will collect and make available all pertinent project information as needed and/or required and participate in any project site visits made by Sourcewise.

Post-Program and Post-Fiscal Monitoring
Once the program and/or fiscal monitoring concludes, the Sourcewise Planner Analyst and monitoring team will require at least 10 -12 weeks to prepare a monitoring report draft based on the program questionnaires, staff interviews, and program documentation provided by the contractor.

To receive a copy of the Title Ill or Title VII Program or Fiscal Monitoring Report template, please contact the Sourcewise Planner Analyst by email and the requested templates will be supplied.

Corrective Action Plan
The draft monitoring report will be accompanied by a corrective action plan which the contractor must outline the due date which the item will be revised, sign the document and submit back to Sourcewise. Essentially the corrective action plan is meant to improve performance and/or reduce risk to ensure services are within compliance.

Failure to comply with an agreed-upon plan can result in suspension or termination of funding. If a contractor entity fails to comply with federal, state statutes & regulations, or the terms and conditions of a Sourcewise grants, Sourcewise may impose additional conditions, as described in § 75.207. If Sourcewise monitor determines that noncompliance cannot be remedied by imposing additional conditions, Sourcewise may take one or more of the following actions, as appropriate in the circumstances:
■ Temporarily withhold cash payments pending correction of the deficiency. ■ Disallow (that is, deny both use of funds and any applicable matching credit for) all or part of the cost of the activity or action not in compliance. ■ Wholly or partly suspend (suspension of award activities) or terminate grant.

SECTION 9: GRANT MODIFICATIONS
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ■ Withhold further grants for the project or program.
■ Take other remedies that may be legally available.

To ensure that contracted service providers receive the necessary support required to provide the service outlined in the scope of work in the fully executed service agreement, the contractor has the ability to request modifications to the contracted units of service and the budget with prior approval by Sourcewise. The fully executed service agreement outlines in detail all required timelines and due dates for specific modifications to the project.

If the contractor does not identify the required steps to follow in the fully executed agreement or within this manual, the contractor is encouraged to contact the Sourcewise Planner Analyst to discuss their unique situation.

Contract Modifications
Requested by Contractor
The contractor agrees and understands that the units of service provided are subject to modifications only upon written authorization from the CEO of Sourcewise.

The contractor shall submit a written justification outlining the reasoning and rationale for the modification to be approved no later than 15 days from the requested date of modification.

Amendments to Service Agreement
Throughout the contract period, Sourcewise may deliver a contract amendment to ensure that the terms of the existing agreement are up to date and formally acknowledged by both parties.

Sourcewise will administer contract amendments for service agreements when there is a proposed increase or decrease in service units, grant fund award, or revisions/updates to the contract language outlined in the agreement. The Amendment will outline the specific increase or revision/update and require the contractor and Sourcewise to sign the amendment to be formally adopted.

No oral understanding or agreement not set forth herein shall be binding on any of the parties hereto.

Budget Modifications and Revisions
The RFP OAA Application budget and/or renewal application budget is approved by Sourcewise prior to the start of the new contract period. Based on the approved budget submitted, it is not considered allowable for the contractor to alter, make variations or deviate from any budget items/categories described without prior approval from the Sourcewise CEO.

If the contractor budgeted items/categories deviate or vary+ 10% of the approved allocation, the contractor is required to submit a budget revision to Sourcewise at least 15 days prior to the upcoming monthly/quarterly request for funds.

The contractor shall submit an updated Program budget template with the new program category/item allocation and a written justification outlining the cause/reasoning for the revision to the Sourcewise Planner Analyst. The Sourcewise Planner Analyst may request additional information prior to submitting for approval. Once approved the Planner Analyst will provide the contractor with an updated monthly expenditure excel workbook to prepare the upcoming monthly/ quarterly
SECTION 10: EQUIPMENT
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 request for fund. The approved budget revision will be amended to the application/service agreement.

Older Americans Act (OAA) funds can only be used toward the contractual service.

All equipment/property with a per unit cost of $5,000 or more requires justification and approval from the California Department of Aging (CDA) PRIOR to purchase.

Equipment/Property is defined by CDA as:

1. Has a normal useful life of at least one (1) year. Item such as computer, monitor, printer, fax, telephone, furniture and lighting. (A desktop or laptop setup is considered a unit, if purchased as a unit).

2. All computing devices, regardless of cost (including, but not limited to: workstations, servers, laptops, personal digital assistants, notebook computers, tablets, smartphones, and cellphones.)

3. All portable electronic storage media regardless of cost (including, but not limited to:
thumb/flash drives and portable hard drives.)
Equipment/Property Approval Process

1. Equipment purchases must be included in the service providers approved budget. If the equipment purchase is not included, contact Planner Analyst, Raul Corral at [email protected]. Please note, planned equipment purchases not included in the program budget may result in delays in the approval process.

2. Fill out an Equipment Request Justification Form (Equipment purchase of $5,000 or more.)

3. Submit the Equipment Justification Form to the Planner Analyst, Raul Corral at [email protected].

4. The Planner Analyst will review the Equipment Justification Form for completion. Once complete, the Planner Analyst will forward the request to CDA.

5. CDA will review the Equipment Justification Form. When the Planner Analyst receives a response from CDA, the Planner will contact you to provide a decision on the equipment request.

6. When approved, the equipment/property purchased using OAA funding is required to be tagged with a Sourcewise asset tag.

Equipment Disposal Process
Equipment that is no longer needed, defective, and/or stolen will require your organization to submit an Equipment/Property Disposal Form.

Prior to disposal of the equipment/property, the Equipment/Property Disposal Form needs to be submitted to CDA and approved by CDA.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947

1. To receive the Equipment/Property Disposal Form, contact Planner Analyst, Raul Corral at [email protected].

2. Complete the Equipment/Property Disposal Form.

3. Print the completed form, an authorized signer of the organization needs to sign the Disposal Form with ink.

4. Submit the completed Disposal Form to Sourcewise, 3100 De La Cruz Blvd, Suite 310 Santa Clara, CA 95054 and the equipment must be present at the time of the disposal.

5. Once Sourcewise received a response from CDA that the equipment/property is approved to be disposed, the Planner Analyst will contact your organization to notify you.

Equipment/property remaining on the Sourcewise Program Property Inventory List that is less than $5,000 and does not meet the criteria for a computing device or portable electronic storage, will still require CDA approval for disposal prior to removal from the inventory.

Equipment/Property Maintenance
All prior equipment/property purchased by the service provider and/or subcontractors of the service provider with funds from any prior Older American Act, Title Ill or Title VII Agreement will remain on the Sourcewise Program Property Inventory List managed by Sourcewise.

Each year, the Sourcewise Planner Analyst will survey the equipment/property Inventory List in the month of June. The equipment/property inventory will require the contracted service provider to submit:

1. List of equipment and the condition of the item to Sourcewise

2. Location of the equipment

3. Picture of the equipment including the Sourcewise tag number Any questions, about equipment purchases, disposal and/or management of equipment can be sent directly to Raul Corral, Planner Analyst at [email protected].

SECTION 11: CO-BRANDING AND MEDIA
SECTION 12: CONTRACTED SERVICES GRIEVANCE PROCEDURE & POLICY Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Our partnership to deliver essential supportive OAA services to Santa Clara County highlights the importance of community partnerships. As a contracted service, the program agrees to acknowledge the receipt of all funding support from Sourcewise in news releases (radio, television, and newspaper); printed materials such as brochures, pamphlets, newsletters; the contractors website; and any other printed documents. Such acknowledgement shall make accurate reference to the service for which funding is provided, in whole or in part, by Sourcewise.

Each contractor has access to download a full-color and black and white Sourcewise Logo via Dropbox.

Download by clicking here.

For branding guidelines on how to best utilize brand
elements, the contractor may access the Sourcewise
Style Guide on our website at:
https://www.mysourcewise.com/about/mediacenter/.

This program is partially or fully funded by

SOURCEWISE

COMMUN IT Y RESO UR CE SOLUT I ONS
This program is partially or fully funded by

SOURCEWISE

COMMUN I TY RESOURCE SOLUT I O NS
The materials published or transferred by the contractor and financed with funds under this agreement shall state:
(a) "The materials or product were a result of a project funded by Sourcewise and the California Department of
Aging."
(b) Name of the entity
(c) Include the following statement: "The conclusions and opinions expressed may not be those of the Area Agency/Sourcewise and/or California Department of Aging and this publication may not be based upon or inclusive of raw data." Each contractor shall provide a copy of all products and materials developed in whole or in part with the funded service to Sourcewise for file.

It is the responsibility of the contractor to initiate and obtain approval of all products and materials where the Sourcewise logo is used prior to distribution. Providers can send final proofs to Sourcewise by emailing [email protected] or the Sourcewise Planner Analyst.

Proofs will be returned within 5 business days with a note of approval or recommendations to edit.

A contracted service provider or potential provider of services has the right to appeal an adverse determination made by the Sourcewise (Area Agency on Aging). Reference Sourcewise Service Provider Grievance Policy, Appendix F, to view the Contracted Services Grievance Procedure.

Note: The Contracted Services Grievance Procedure is a unique procedure for contracted and potential service providers to follow and NOT the public facing grievance policy for individuals who have received services to submit a complaint or grievance. For the public facing grievance policy for community members reference Section 3 of this Provider Manual.

SECTION 13: GLOSSARY OF TERMS
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 OAA Title Ill & Title VII Program Eligible Population and Program Definitions Eligible Service Population for Title Ill Band D means individuals sixty (60) years of age or older, with emphasis on those in greatest economic and social need with particular attention to lowincome minority older individuals, older individuals with Limited English Proficiency (LEP), and older individuals residing in rural areas. [OAA § 305 (a)(2)(E); 22 CCR 7119, 7125, 7127, 7130, 7135 and 7638.7]
Eligible Service Population for Title Ill C-1 and C-2 means individuals sixty (60) years of age or older, with emphasis on those in greatest economic and social need with particular attention to low-income minority older individuals, older individuals with LEP, and older individuals residing in rural areas. [OAA § 305 (a)(2)(E); 22 CCR 7125, 7127, 7130, 7135] Individuals eligible to receive a meal at a congregate nutrition site are:
i. Any older individual.
ii. The spouse of any older individual
iii. A person with a disability, under age sixty (60) who resides in a housing facility occupied primarily by older individuals at which congregate nutrition services are provided. iv. A volunteer under age sixty (60), if doing so will not deprive an older individual sixty (60) or older of a meal. [CCR 7636.9(b)(3); CCR 7638.7(b) and OAA 339(H)J Individuals eligible to receive a home-delivered meal are individuals who are:
i. Frail as defined by 22 CCR 7119, homebound by reason of illness or disability, or otherwise isolated. (These individuals shall be given priority in the delivery of services.) [ 45 CFR 1321.69(a)J.
ii. A spouse of a person in 22 CCR 7638.7(c)(2), regardless of age or condition, if an assessment concludes that is in the best interest of the homebound older individual at discretion of AREA AGENCY with CONTRACTOR.
iii. An individual with a disability who resides at home with older individuals, if an assessment concludes that it is in the best interest of the homebound older individual who participates in the program at discretion of AREA AGENCY with CONTRACTOR.

Eligible Service Population for Title Ill E means an adult family member, or another individual, who is an informal provider of in-home and community care to an older individual or to an individual of any age with Alzheimer's disease or a related disorder with neurological and organic brain dysfunction. [OAA § 302(3)]
i. Older relative caregiver means a caregiver who is -
■ Is age 55 or older; and
■ Lives with, is the informal provider of in-home and community care to, and is the primary caregiver for, a child or an individual with a disability. ii. In the case of a caregiver for a child -
■ Is the grandparent, step grandparent, or other relative (other than the parent) by blood, marriage, or adoption, of the child;
■ Is the primary caregiver of the child because the biological or adoptive parents are unable or unwilling to serve as the primary caregivers of the child; and ■ Has a legal relationship to the child, such as legal custody, adoption, or guardianship, or is raising the child informally
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ■ In the case of a caregiver for an individual with a disability, is the parent, grandparent, or other relative by blood, marriage, or adoption, of the individual with a disability. [OAA § 372(a)(3)]
iii. Individual with a disability The term "individual with a disability" means an individual with a disability, as defined in Section 3 of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102), who is not less than age 18 and not more than age 59. [OAA § 372(a)(2)] iv. Nutrition Services Incentive Program (NSIP) means the program whose purpose is to provide incentives to encourage and reward effective performance by AAAs in the efficient delivery of nutritious meals to older individuals. The program consists of a cash allotment based on the ratio of the number of meals served by each Planning and Service Area (PSA) compared to the total number of meals served in the State in the prior-prior federal fiscal year.
v. One-Time-Only Funds means Titles Ill and VII federal funds allocated to the AAA in a State fiscal year that are not expended or encumbered for services and administration provided by June 30 of that fiscal year. [22 CCR 7314(a)(6)]
vi. Priority Services for Title 111 B means those services associated with access to services (transportation, outreach, information and assistance, and case management); in-home services including supportive services such as respite and visiting, for families of older individuals who are victims of Alzheimer's disease and related disorders with neurological and organic brain dysfunction; and legal assistance.
vii. Priority Services for Title Ill E means services provided to:
■ Caregivers who are older individuals with greatest social need, and older individuals with greatest economic need (with particular attention to low-income older individuals)
■ Older relative caregivers of children with severe disabilities, or individuals with disabilities who have severe disabilities. [OAA§373(c)(2)(A-B)J ■ Family caregivers who provide care for individuals with Alzheimer's disease and related disorders with neurological and organic brain dysfunction. [OAA § 372(b)J viii. Program Development means activities that either establish a new service or expand or integrate existing services.
ix. Program Requirements means Title Ill program requirements found in the OAA [42 USC 3001-3058]; the Code of Federal Regulations [ 45 CFR 1321]; the California Code of Regulations [22 CCR 7000 et seq.]; and CDA Program Memoranda, and California Retail Food Code (CRFC).
x. "Subcontractor" means the legal entity that receives funds from the CONTRACTOR to carry out part of the AREA AGENCY federal award identified in this Agreement with CONTRACTOR .
xi. "Subcontract" means any form of legal agreement between the CONTRACTOR and the Subcontractor, including an agreement that the AREA AGENCY considers a contract, including vendor type Agreements for providing goods or services under this Agreement. xii. Title Ill B (Supportive Services) means a variety of services including, but not limited to:
personal care, homemaker, chore, adult day health care, case management, assisted Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 transportation, transportation, legal assistance, information and assistance, outreach, services that promote or support social connectedness and reduce negative health effects associated with social isolation, and long-term care ombudsman advocacy, as defined in the National Aging Programs Information Systems (NAPIS) categories and the National Ombudsman Reporting System (NORS). [OAA § 321(a)J
xiii. Title Ill C-1 (Congregate Nutrition Services) means nutrition services for older individuals in a congregate setting. Services include meals, nutrition education, health promotion programs, nutrition risk screening, and opportunities for socialization. Each meal shall provide one-third (1/3) of the Dietary Reference Intakes (DRI) and comply with the most current Dietary Guidelines for Americans (DGA). To be an eligible Title Ill C-1 congregate nutrition site, the site must meet all of the following criteria: [22 CCR 7638.?(a)J ■ Be open to the public. [ 45 CFR 1321.53(b)(3)]
■ Not means test. [OAA § 315(b)(3)]
■ Not receive funds from another source for the cost of the same meal, equipment, or services. [2 CFR 200.403(f)J[ 45 CFR 75.403(f)J
xiv. Title Ill C-2 (Home-Delivered Nutrition Services) means nutrition services provided to homebound older individuals including meals, nutrition education, and nutrition risk screening. Each meal shall provide one-third (1/3) of the DRI and comply with the most current Dietary Guidelines for Americans. [22 CCR 7135, 22 CCR 7638.?(c)J xv. Title Ill D (Health Promotion - Evidence Based) means disease prevention and health promotion programs that are based on scientific evidence and demonstrated through rigorous evaluation to be effective in improving the health of older adults. Title Ill D evidence-based health promotion programs include programs related to the prevention and mitigation of the effects of chronic diseases (including osteoporosis, hypertension, obesity, diabetes, and cardiovascular disease), infectious disease, and vaccine-preventable disease, and prevention of sexually transmitted diseases. Evidence-based services also include programs focused on alcohol and substance abuse reduction, chronic pain management, smoking cessation, weight loss and control, stress management, falls prevention, physical activity, and improved nutrition. [OAA 102 (14)(D)J
xvi. Title Ill E Family Caregiver Support Program (FCSP) Categories are:
■ Information Services
■ Access Assistance
■ Support Services
■ Respite Care
■ Supplemental Services
[OAA 373(b)(1)(2)(3)(4)(5)J
xvii. "Vendor" means an entity selling goods or services to the Contractor or Subcontractor during the Contractor or Subcontractor's performance of the Agreement. ■
Supplement Glossary of Terms
xviii. AAA: Area Agency on Aging is an identifiable private nonprofit or public agency designated by the Department of Aging which works for the interest of older Californians within the PSA (Planning and Service Area). This agency engages in community planning, coordination, and program development, and, through contractual arrangements, provides Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 a broad array of social and nutritional services. Sourcewise is the designated AAA in Santa Clara County.
xix. CDA: California Department of Aging
xx. Focal Point: A designated senior center that provides a broad spectrum of senior services. xxi. Greatest Economic Need: Having an income at or below the federal official poverty line defined by the federal Bureau of the Census and published annually by the Department of Health and Human Services.
xxii. Greatest Social Need: The need caused by noneconomic factors which include any of the following:
a. Physical and mental disabilities.
b. Language barriers.
c. Cultural, social, or geographical isolation, including isolation caused by racial or ethnic status, HIV status, sexual orientation, gender identity, or gender expression that does the following:
i. Restricts the ability of an individual to perform normal daily tasks. ii. Threatens the capacity of an individual to live independently. xxiii. Matching Contributions: The cash and/or in-kind contribution made by the bidding organization that qualifies as match for the applicable Title Ill service and outlined in the program standard. OAA is federal funding. Matching contributions for OAA may not include other federal funding it should be non-federal.
xxiv. Minority Provider: A nonprofit organization whose controlling board is comprised of at least 51% minority individuals who are African American, Hispanic, American Indian/Native Alaskan/Native Hawaiian, and/or Asian American/Pacific Islander. xxv. Minority: A person of color who is any of the following:

Black/ African American: a person having origins in any of the Black racial groups of Africa.

Hispanic: a person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish or Portuguese culture or origin regardless of race. Asian/Pacific Islander: a person whose origins are from India, Pakistan or Bangladesh, Japan, China, Taiwan, Korea, Vietnam, Laos, Cambodia, the Philippines, Samoa, Guam, or the United states Trust Territories of the Pacific including the Northern Marianas. American Indian/ Alaskan Native: an American Indian, Eskimo, Aleut, or Native Hawaiian.
xxvi. Non-Profit: Any agency, institution, or organization that has been granted tax-exempt status by the Internal Revenue Service.
xxvii. Non-registered Services: Are those services where it is not practical to collect client specific information or when requiring the client to register may serve as a barrier to receiving service.
xxviii. Older Americans Act: The federal funding source for supportive service programs funded under this Request for Proposal.
xxix. Older Californians Act: The state funding source for Community-Based Services Programs.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 xxx. Open and Competitive Process: The formal Sourcewise process followed to solicit proposals for the provision of services.
xxxi. PSA: Planning and Service Area (PSA). PSA defines the geographic region which the AAA encompasses.
xxxii. Registered Services: Means data collection and reporting requirements including unduplicated client counts by characteristics, units of service, including in some cases ADLs/lADLs. Registered Services are client specific data using participant identification numbers for each client.
xxxiii. Request for Proposal (RFP): An official document that requests community organizations to respond to a formal invitation to provide a specific program of services. It contains the terms and conditions an operating organization must comply with in order to fulfill its contract with Sourcewise.
xxxiv. Unit of service: The activity which describes the type of service to be contracted for; all Sourcewise funded programs must provide a required number of units for the specific program area of interest.
xxxv. Unduplicated Persons Count: Unique count of clients who receive services between July 1st and June 30th . Bidders submitting proposals are required to include an unduplicated person count to provide services. Reporting requirements are described and nonnegotiable for registered and nonregistered Older American Act funded services. xxxvi. Voluntary Contributions: Providing clients with the opportunity to contribute monetarily to the cost of the service/program provided by the successful bidder. The successful bidder should (a) inform the client of the opportunity to voluntarily contribute to the cost of service, including but not limited to the cost-of-service delivery, related activities to facilitate access to meals, and/or supportive services of the service (b) describe the amount of suggested client contribution and how it was determined, and (c) explain the method used to collect and record client contributions.

SECTION 14: DATA & FISCAL TEMPLATES
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 At least 2 -4 weeks prior to the start of the contracted fiscal year, the Sourcewise Planner Analyst will provide all the required data and fiscal reporting templates to the contracted agency.

Throughout the contract period, all contractors may request copies of the data and/or fiscal templates at any time by email.

To receive expenditure or monthly request for funds templates, please email [email protected]
To receive data reporting templates, please email [email protected] For Q Database assistance, please email [email protected] Certificate of Completion Name:________________ This document certifies that the mentioned has completed CDA’s Privacy and Information Security Awareness TrainingDate Training Completed: _____________________ Employee Signature: _________________________ Exhibit F: Sourcewise Provider Manual DocuSign Envelope ID: FDC119A5-43CA-4631 -9D5C-479C0FA6B947 CAUFORNIA PEPARTMENTOF "\_JING Print Company/Agency: _________ _ above individual and understands his or her responsibility for protecting CDA information assets.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 California Department of Aging (CDA)
CDA Service Categories and Data Dictionary
Revised July 2018
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit F: Sourcewise Provider Manual
AAA Activities and CARS Reporting
Definition/ Primary Registered Service Unit Definitions Reporting Requirements NAPIS Historical Funding Priority or Category Measure 1 Reference Reference 2 Source Service Non- Registered 3 Cluster 1 service: Reporting
Personal assistance, stand-by assistance, supervision or cues. (such as requirements include NAPIS Personal Care 1 Hour with eating, bathing, toileting, transferring in/out of bed/chair, walking, unduplicated client counts by NAPIS 1 Div4000 Title Ill B Yes Registered dressing, grooming). characteristic, ADLs/lADLs and Unit 20 service units.

Cluster 1 service: Reporting
Assistance such as preparing meals, shopping for personal and household requirements include NAPIS Homemaker 1 Hour unduplicated client counts by NAPIS 2 Div4000 Title Ill B Yes Registered items, managing money, using the telephone or doing light housework. characteristic, ADLs/lADLs and Unit 50, Unit 27 service units.

Cluster 1 service: Reporting
Assistance such as heavy housework, yard work or sidewalk and other requirements include NAPIS Chore 1 Hour unduplicated client counts by NAPIS 3 Title Ill B Yes Registered home maintenance for a person. characteristic, ADLs/lADLs and Div 4000 Unit 5 service units.

A meal provided to an eligible individual in his or her place of residence, Cluster 1 service: Reporting Home-Delivered that meets all of the requirements of the Older Americans Act and requirements include NAPIS Title Ill CMeals 1 Meal State/Local laws, assures a minimum one-third of the current Dietary unduplicated client counts by NAPIS4 Div4000 2 No Registered characteristic, ADLs/lADLs and Unit 51 Reference Intake, and shall comply with Dietary Guidelines for Americans. service units.

Personal care for dependent elders in a supervised, protective, and Cluster 1 service: Reporting congregate setting during some portion of a day. Services offered in NAPIS Adult Day Care/ conjunction with adult day care/adult day health typically include social requirements include Div4000 1 Hour unduplicated client counts by NAPIS 5 Title Ill B Yes Registered Adult Day Health and recreational activities, training, counseling, and services such as characteristic, ADLs/lADLs and Pr 5, Pr 11, rehabilitation, medications assistance and home health aide services for service units. Pr 17 adult day health.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479COFA68947 Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered Service Unit Definitions Reporting Requirements NAPIS Historical Funding Priority or Category Measure 1 Reference Reference 2 Source Service Non- Registered 3 Assistance either in the form of access coordination in circumstances where the older person is experiencing diminished functioning capacities, Cluster 1 service: Reporting personal conditions or other characteristics which require the provision requirements include NAPIS Case Management 1 Hour of services by formal service providers or family caregivers. Activities of unduplicated client counts by NAPIS 6 Div4000 Pr 3 Title Ill B Yes Registered case management include such practices as assessing needs, developing characteristic, ADLs/lADLs and care plans, authorizing and coordinating services among providers, and service units. providing follow-up and reassessment, as required.

Cluster 2 services:

Reporting requirements
include unduplicated client
1 One Way Assistance and transportation, including escort, to a person who has counts by characteristic and NAPIS Assisted Transportation Trip difficulties (physical or cognitive) using regular vehicular transportation. service units. For FCSP, NAPIS 7 Div4000 Title Ill B No Registered ADL/IADL information is Unit 10 required for Care Receivers
served in "Caregiver Caring
for Elderly" component only
Cluster 2 services:

Reporting requirements
A meal provided to an eligible individual in a congregate group setting, include unduplicated client that meets all of the requirements of the Older Americans Act and counts by characteristic and NAPIS Title Ill C- Congregate Meals 1 Meal State/Local laws, and assures a minimum one-third of the Dietary service units. For FCSP, NAPIS 8 Div 4000 Pr 20 1 No Registered ADL/IADL information is Reference Intake, and shall comply with Dietary Guidelines for Americans. required for Care Receivers served in "Caregiver Caring
for Elderly" component only
Cluster 2 services:

Individualized guidance to individuals who are at nutritional risk because Reporting requirements of their health or nutrition history, dietary intake, chronic illnesses, or include unduplicated client 1 Session Per medications use, or to caregivers. Counseling is provided one-on-one by counts by characteristic and NAPISDiv Title Ill CNutrition Counseling Participant a registered dietitian, and addresses the options and methods for service units. For FCSP, NAPIS 9 4000Unit 53 lTitle Ill No Registered improving nutrition status. Nutrition counseling may be made either in ADL/IADL information is C-2 person or by any other means deemed appropriate (e.g., telephone, required for Care Receivers emails, etc.) served in "Caregiver Caring
for Elderly" component only
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered Service Unit Definitions Reporting Requirements NAPIS Historical Funding Priority or Category Measure 1 Reference Reference 2 Source Service Non- Registered 3 Non-Registered services:
1 One Way Transportation from one location to another. Does not include any other Reporting requirements NAPIS Non- Transportation Trip activity. May include travel vouchers and transit passes. include estimated NAPIS 10 Div 4000 Pr 12 Title Ill B Yes Registered unduplicated client counts and service units.

Non-Registered services:

Legal advice, counseling and/or representation by an attorney or other Reporting requirements NAPIS Non- Legal Assistance 1 Hour person acting under the supervision of an attorney. include estimated NAPIS 11 Div 4000 Pr 14 Title Ill B Yes Registered unduplicated client counts and service units.

A program to promote better health by providing accurate and culturally sensitive nutrition, physical fitness, or health (as it relates to nutrition) information and instruction to participants, caregivers, or participants in a Non-Registered services: Title Ill C1 Session Per group or individual setting overseen by a dietitian or individual of Reporting requirements NAPIS 1 Non- Nutrition Education Participant comparable expertise. Methods of education may include include estimated NAPIS 12 Div4000 Title Ill C- No Registered demonstrations, audio-visual presentations, or small group discussions unduplicated client counts Unit 52 for congregate program participants. Handout materials may be used, and service units. 2 but not limited to, as the sole education component for home-delivered meal program participants.

A service that: (A) provides individuals with information on services available within the communities; (B) links individuals to the services and Non-Registered services:

Information opportunities that are available within the communities; (C) to the Reporting requirements and 1 Contact maximum extent practicable, establishes adequate follow-up procedures. include estimated NAPIS 13 NAPIS Title Ill B Yes NonAssistance Internet web site "hits" are to be counted only if information is requested unduplicated client counts Div 4000 Pr 1 Registered and supplied, and (C) is satisfied. Maximum extent practicable includes and service units. offering a follow-up call to all individuals who were linked to a service.

Individuals can remain anonymous and refuse a follow-up call.

Interventions (one-on-one contacts) with individuals initiated by an Non-Registered services:
agency or provider for the purpose of identifying potential clients (or Reporting requirements NAPIS Non- Outreach 1 Contact include estimated NAPIS 14 Div4000 Title Ill B Yes their age 60+ caregivers) and encouraging their use of existing services unduplicated client counts Unit 19 Registered and benefits. and service units.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered Service Unit Definitions Reporting Requirements NAPIS Historical Funding Priority or Category Measure 1 Reference Reference 2 Source Service Non- Registered 3 An evidence-based health promotion program, including programs related to the prevention and mitigation of the effects of chronic disease Non-Registered services: (including, but not limited to, osteoporosis, obesity, diabetes, and Reporting requirements NAPIS 16- Older 1 Contact cardiovascular disease), alcohol and substance abuse reduction, smoking include estimated Heath Americans Act Title Ill D 3 No NonHealth Promotion cessation, weight loss and control, stress management, falls prevention, unduplicated client counts Promotion Sec 102 {14) Registered physical activity, and improved nutrition. For a list of ACL approved and service units. Evidence-Based programs, please visit the National Council on Aging website at https://www.ncoa.org/resources/ebpchart.

Non-Registered services:

Alzheimer'sDay Care 1 Day of Day of attendance (four hours minimum) at a licensed Adult Day Care or Reporting requirements NAPIS 15- NonServices Attendance Adult Day Health Care Center that provides Alzheimer's or dementia include estimated Other Div4000 Pr6 Title Ill B Yes Registered services. unduplicated client counts and service units.

Non-Registered services:

Arrange for and provide assistance to participants in the form of Reporting requirements NAPIS 15 - Div4000 NonCash / Material Aid 1 Assistance commodities, surplus food distribution, emergency cash assistance, and include estimated Other Unit 15 Title Ill B No Registered vouchers. unduplicated client counts and service units.

Educating groups of older persons, their families, friends, and community Non-Registered services:

Community organizations/facility staff on rights, benefits, entitlements, and health Reporting requirements NAPIS 15 - NonEducation 1 Activity and wellness information for older persons either residing at home or in include estimated Other Div 4000 Unit 9 Title Ill B No Registered an institutional setting. unduplicated client counts and service units.

Evaluating a person's physical, psychological, and social needs, financial Non-Registered services:

Comprehensive
resources, and the strengths and weaknesses of their informal support Reporting requirements NAPIS 15 - Div4000 NonAssessment 1 Hour system and the immediate environment as a basis for determining include estimated Other Unit 32 Title Ill B Yes Registered current functional ability and potential improvement in order to develop unduplicated client counts CCR 7112 the appropriate services needed to maximize functional independence. and service units.

Non-Registered services:

Disaster Assemble and distribute disaster preparedness materials such as File of Reporting requirements NAPIS 15 - NonPreparedness 1 Product Life or preparedness kits that will assist seniors in the event of an include estimated Other No reference Title Ill B No Registered Materials emergency. unduplicated client counts and service units.

Education carry out programs for the prevention, detection, assessment, and Reporting requirements NAPIS 15- Nonand 1 Session treatment of, intervention in, investigation of, and response to elder include estimated Other Div 4000 Pr 22 Title VII B No Registered abuse, neglect, and exploitation (including financial exploitation). unduplicated client counts Training This includes training for Title Ill E caregivers. and service units.

Elder Abuse Educational materials and guidance kits distributed for the prevention, Non-Registered services:

Prevention detection, assessment, and treatment of, intervention in, investigation of, Reporting requirements NAPIS 15- Non- 1 Product include estimated Div 4000 Pr 22 Title VII B No Educational and response to elder abuse, neglect, and exploitation (including financial unduplicated client counts Other Registered Materials exploitation). and service units.

Activities designed to maintain or obtain part-time/full-time employment Non-Registered services:
for older persons or to assist them in selecting and entering into a second Reporting requirements NAPIS 15 - Non- Employment 1 Activity career. This can be accomplished through activities including but not include estimated Other Div 4000 Pr 15 Title Ill B No Registered limited to career counseling, recruitment, assessment, training, job club, unduplicated client counts and job development. and service units.

Activities such as, non-evidence-based medication management, health screening, physical fitness, therapy, and hospice to assist older individuals to improve or maintain physical health and secure necessary medical, preventive health, or health maintenance services. Health screening, therapy, and hospice must be provided by a licensed health professional Non-Registered services: or by a paraprofessional supervised by a licensed health professional. Div 4000 Pr 9, Does not include services covered by Medicare, Medi-Cal, or other health Reporting requirements NAPIS 15 - Unit 13, Unit Non- Health 1 Hour include estimated Title Ill B Yes insurance. Medication management means activities that facilitate safe unduplicated client counts Other 21, Unit 29, Registered and effective use of prescription and over-the-counter drugs. These and service units. Unit 37 activities may include medication screening and education to an individual and/or the caregiver to prevent incorrect medication administration and adverse drug reaction. Primary activities are normally on a one-to-one basis; if done as a group activity, each participant shall be counted as one contact unit.

Non-Registered services:

Reporting requirements NAPIS 15 - Non- Housing 1 Hour Assistance in locating adequate housing through referral or placement. include estimated Other Div4000 Pr4 Title Ill B No Registered unduplicated client counts and service units.

Interpretation/ Provide interpretation/translation services for older individuals and their Reporting requirements NAPIS 15- Non- 1 Contact include estimated Div 4000 Unit 4 Title Ill B No Translation caregivers. unduplicated client counts Other Registered and service units.

Activities related to increasing transportation and mobility options for Non-Registered services:

Mobility older adults by providing assistance, information, travel training, trip Reporting requirements NAPIS 15 - Non- Management 1 Hour planning, coordination of service public or private transit operators, include estimated Other Title Ill B No Registered Activities scheduling, access to transit information, creation of new models of unduplicated client counts service such as volunteer driver programs and shuttles. and service units.

Provide services such as screening, assessment, therapy, counseling, Non-Registered services: follow-up, and referral to maintain or improve the mental health of older individuals. Mental Health services must be provided by a licensed health Reporting requirements NAPIS 15 - Div 4000 Pr 10, Non- Mental Health 1 Hour professional or by a paraprofessional supervised by a licensed health include estimated Other Unit 11, Title Ill B Yes Registered professional. Does not include services covered by Medicare, Medi-Cal, unduplicated client counts Unit 23, Unit 29 or other health insurance. and service units.

Use the skills and/or life experiences of trained volunteers, under Non-Registered services:
qualified supervision, to provide advice, guidance, and support in a self- Reporting requirements NAPIS 15 - Non- Peer Counseling 1 Hour help approach in order to enhance well-being and enable clients to make include estimated Other Div 4000 Unit 7 Title Ill B No Registered informed choices. unduplicated client counts and service units.

Non-Registered services:

Personal Affairs Provide assistance in writing letters and with the completion of financial Reporting requirements NAPIS 15 - Div 4000 Unit Non- 1 Contact include estimated Title Ill B No Assistance forms, including tax forms, and other written or electronic documents. unduplicated client counts Other 12, Pr 16 Registered and service units.

Services for the security and safety of their home environment, by Non-Registered services:

Personal /Home providing safety features such as: medical alert, alarms, assistive devices Reporting requirements NAPIS 15 - Non- 1 Product include estimated Div4000 Pr7 Title Ill B No Security {including provision of assistive technology services and assistive unduplicated client counts Other Registered technology devices). and service units.

Non-Registered services:

Public Contact with multiple current or potential clients or caregivers through Reporting requirements NAPIS 15 - NonInformation 1 Activity publications, publicity campaigns, and other mass media campaigns include estimated Other NAPIS Title Ill B Yes Registered including Internet websites. unduplicated client counts and service units.

Recruit workers, maintain a current list of qualified workers, refer Reporting requirements NAPIS 15- Div4000 Non- Registry 1 Hour workers to clients or clients to workers, and follow-up to assure that include estimated Other Unit 41 Title Ill B No Registered service was received. unduplicated client counts and service units.

Residential modifications of homes that are necessary to facilitate the Non-Registered services:

Residential Repairs / 1 ability of older individuals to remain at home and that are not available Reporting requirements NAPIS 15 - Div4000 Non- include estimated Title Ill B Yes Modifications Modification under other programs. Includes minor repairs/renovations in order to unduplicated client counts Other Unit 1, Unit 48 Registered meet safety, health issues, and code standards. and service units.

Arrange for relief of the relatives or other caregivers of the frail elderly Non-Registered services:
living at home by the coordination or direct provision of supportive Reporting requirements NAPIS 15 - Div 4000 Pr 18, Non- Respite Care 1 Hour services to the older person(s) while the primary caregiver is temporarily include estimated Other Unit45 Title Ill B Yes Registered absent (includes Adult Day Care as a respite service for families). unduplicated client counts and service units.

Services designed to enable older individuals to attain and/or maintain physical and mental well-being such as recreation, music, creative arts, physical activity, education, leadership development and other Non-Registered services:

Senior Center supportive services not covered under other service categories. Reporting requirements NAPIS 15- Div 4000 Pr 13 NonActivities 1 Hour Development and provision of new volunteer opportunities and services, include estimated Other OMBA-87 Title Ill B No Registered and creation of additional services and programs to remedy gaps and unduplicated client counts deficiencies in existing services. Entertainment costs such as tickets to and service units. shows or sporting events, meals, lodging, rentals, transportation and gratuities, are not allowable.

Non-Registered services:

Telephone Telephone a client to provide contact and safety checks to reassure and Reporting requirements NAPIS 15 - Div4000 Non- 1 Contact include estimated Title Ill B Yes Reassurance support older individuals. unduplicated client counts Other Unit 28 Registered and service units.

Non-Registered services:

Visit a client to provide contact and safety checks to reassure and support Reporting requirements NAPIS 15- Div4000 Non- Visiting 1 Hour older individuals. include estimated Other Unit 31 Title Ill B Yes Registered unduplicated client counts and service units.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Caregiver Assessment 1 Hour (Caring for Elderly)
Caregiver Counseling
(Caring for Elderly) 1 Hour
Caregiver Peer
Counseling 1 Hour
(Caring for Elderly)
FCSP - Caregiver Caring for Elderly
Support Services
Definitions Reporting Requirements
An FCSP Support Service conducted by persons trained and experienced in FCSP Registered services: the skills required to deliver the service that should result in a plan that includes emergency back-up provisions and is periodically updated; and Reporting requirements will explore options and courses of action for caregivers by identifying include unduplicated client their: (A) willingness to provide care; (B) duration and care frequency counts by characteristic and service units for Caregivers. preferences; (C) caregiving abilities; (D) physical health, psychological, ADL/IADL information is social support, and training needs; (E) financial resources relative for required for Care Receivers caregiving; and (F) strengths and weaknesses within the immediate served in "Caregiver Caring caregiving environment and (caregiver's) extended informal support for Elderly" component only. system.

FCSP Registered services:

An FCSP Support Service provided to a caregiver by a person appropriately Reporting requirements trained and experienced in the skills required to deliver the level of include unduplicated client support needed for stress, depression, and loss as a result of caregiving counts by characteristic and responsibilities. This service (A) may involve his or her informal support service units for Caregivers. system; (B) may be individual direct sessions and/or telephone ADL/IADL information is consultations, and (C) may address caregiving-related financial and long- required for Care Receivers term care placement responsibilities. served in "Caregiver Caring for Elderly" component only.

FCSP Registered services:

Reporting requirements
include unduplicated client
An FCSP Support Service provided by experienced volunteers on the counts by characteristic and condition that appropriate training and qualified supervision protocols are service units for Caregivers. in place. ADL/IADL information is
required for Care Receivers
served in "Caregiver Caring
for Elderly" component only.

Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered NAPIS Historical Funding Priority or Reference Reference 2 Source Service Non- Registered 3 OAA 373(b)(3) NAPIS NAPIS FCSP 1 Title Ill E N/A Registered Support Svs CDAFCSP Service Matrix
OAA 373(b)(3) NAPIS NAPIS FCSP 1 CDAFCSP Title Ill E N/A Registered Support Svs Service Matrix OAA 373(b)(3) NAPIS NAPIS FCSP 1 CDAFCSP Title Ill E N/A Registered Support Svs Service Matrix DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered Service Unit Definitions Reporting Requirements NAPIS Historical Funding Priority or Category Measure 1 Reference Reference 2 Source Service Non- Registered 3 FCSP Registered services:

An FCSP Support Service provided to a group of 3 - 12 caregivers that is led Reporting requirements by a competent facilitator; conducted at least monthly within a supportive include unduplicated client OAA 373(b)(3) Caregiver setting or via a controlled access, moderated on line or teleconference counts by characteristic and NAPIS NAPIS Support Group 1 Hour service units for Caregivers. FCSP 1 Title Ill E N/A Registered (Caring for Elderly) approach; for the purpose of sharing experiences and ideas to ease the ADL/IADL information is Support Svs CDAFCSP stress of caregiving, and to improve decision-making and problem-solving required for Care Receivers Service Matrix skills related to their caregiving responsibilities. served in "Caregiver Caring for Elderly" component only.

FCSP Registered services:

An FCSP Support Service consisting of workshops or one-on-one Reporting requirements individually tailored sessions, conducted either in person or electronically include unduplicated client OAA 373(b)(3) counts by characteristic and NAPIS Caregiver Training 1 Hour by a skilled and knowledgeable individual, to assist caregivers in service units for Caregivers. FCSP 1 NAPIS Title Ill E N/A Registered (Caring for Elderly) developing the skills and gaining the knowledge necessary to fulfill their ADL/IADL information is Support Svs CDAFCSP caregiving responsibilities; and address the areas of health, nutrition, and required for Care Receivers Service Matrix financial literacy. served in "Caregiver Caring for Elderly" component only.

FCSP Registered services:

Reporting requirements
An FCSP Support Service provided by a person who is trained and include unduplicated client Caregiver Case experienced in the skills that are required to coordinate and monitor the counts by characteristic and NAPISFCSP OAA 373(b)(3) Management 1 Hour provision of formal caregiver-related services in circumstances where service units for Caregivers. lSupport Svs NAPISCDA FCSP Title Ill E N/A Registered (Caring for Elderly) caregivers are experiencing diminished capacities due to mental ADL/IADL information is Service Matrix impairment or temporary severe stress and/or depression. required for Care Receivers served in "Caregiver Caring
for Elderly" component only.

Reporting requirements include
An FCSP Respite Care service that includes the provision of unduplicated client counts by care receiver day and/or overnight supervision and friendly characteristic and service units for visiting by an appropriately skilled provider or volunteer in Caregivers. ADL/IADL information is order to prevent wandering and health or safety incidents. required for Care Receivers served in "Caregiver Caring for Elderly" component
only.

FCSP Registered services:

An FCSP Respite Care service that includes the provision of Reporting requirements include care receiver assistance with meal preparation, medication unduplicated client counts by characteristic and service units for management, using the phone, and or light housework (along Caregivers. ADL/IADL information is with care receiver supervision) by an appropriately skilled required for Care Receivers served in provider or volunteer. "Caregiver Caring for Elderly" component only.

FCSP Registered services:

An FCSP Respite Care service that includes the provision of Reporting requirements include care receiver assistance with eating, bathing, toileting, unduplicated client counts by characteristic and service units for transferring, and or dressing (along with care receiver Caregivers. ADL/IADL information is supervision and related homemaker assistance) by an appropriately skilled provider. required for Care Receivers served in "Caregiver Caring for Elderly" component only.

FCSP Registered services:

An FCSP Respite Care service that includes an appropriately Reporting requirements include skilled provider or volunteer assisting a caregiver with heavy unduplicated client counts by characteristic and service units for housework, yard work, and or sidewalk and other routine Caregivers. ADL/IADL information is home maintenance (but not structural repairs) associated with required for Care Receivers served in caregiving responsibilities. "Caregiver Caring for Elderly" component only.

Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered NAPIS
Historical Funding Priority or Reference Reference 2 Source Service NonRegistered 3 NAPIS OAA 373(b)(4)
FCSP 2 NAPIS Title Ill E N/A Registered
Respite Care CDAFCSP Service Matrix
NAPIS OAA 373(b)(4) NAPIS FCSP 2 CDAFCSP Title Ill E N/A Registered Respite Care Service Matrix NAPIS OAA 373(b)(4)
NAPIS FCSP 2

CDAFCSP
Title Ill E N/A Registered
Respite Care Service Matrix
NAPIS OAA 373(b)(4) NAPIS FCSP 2 CDAFCSP Title Ill E N/A Registered Respite Care Service Matrix DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Caregiver Respite
Out-of-Home 1 Hour
Day Care
(Caring for Elderly)
Caregiver Respite
Out-of-Home
1 Hour Overnight Care
(Caring for Elderly)
Service Unit
Category Measure 1
Assistive Devices 1 Device
for Caregiving is 1
(Caring for Elderly) Occurrence
Definitions Reporting Requirements
FCSP Registered services:

Reporting requirements include
An FCSP Respite Care service where the care receiver attends unduplicated client counts by a supervised/protective, congregate setting during some characteristic and service units for portion of a day, and includes assess to social and recreational Caregivers. ADL/IADL information is activities. required for Care Receivers served in
"Caregiver Caring for Elderly" component
only.

FCSP Registered services:

Reporting requirements include
An FCSP Respite Care service where the care receiver is unduplicated client counts by temporarily placed in a supervised/protective, residential characteristic and service units for setting for one or more nights, and may include access to Caregivers. ADL/IADL information is nursing and personal care. required for Care Receivers served in "Caregiver Caring for Elderly" component
only.

FCSP - Caregiver Caring for Elderly
Supplemental Services
Definitions Reporting Requirements
FCSP Registered services:

An FCSP Supplemental Service that involves the purchase, Reporting requirements include rental and/or service fee of any equipment or product system unduplicated client counts by (ranging from a lift chair or bathtub transfer bench to an characteristic and service units for electronic pill dispenser or emergency alert fall prevention Caregivers. ADL/IADL information is device) in order to facilitate and fulfill caregiving required for Care Receivers served in responsibilities. "Caregiver Caring for Elderly"
component only.

Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered NAPIS
Historical Funding Priority or Reference Reference 2 Source Service Non- Registered 3 NAPIS OAA 373(b)(4)
FCSP 2 NAPIS Title Ill E N/A Registered CDAFCSP Respite Care Service Matrix NAPIS OAA 373(b)(4)
FCSP 2
NAPIS
Title Ill E N/A Registered CDAFCSP Respite Care Service Matrix Definition/ Primary Registered NAPIS Priority or
Reference Historical Funding Service Non- Reference 2 Source Registered 3
NAPIS OAA 373(b)(S)
FCSP 3 NAPIS Title Ill E N/A Registered Supplemental CDA FCSP Svs Service Matrix
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ... ..
--- ···-
Service Unit Definition/ Primary Registered
Category Measure 1
Definitions NAPIS Priority Reporting Requirements Historical Funding or Reference Service Non- Reference 2 Source Registered 3 FCSP Registered services:
1 An FCSP Supplemental Service that makes any minor or major Reporting requirements include Home Adaptations Modification physical change to the home (ranging from installation of grab unduplicated client counts by NAPIS OAA 373(b)(S) for Caregiving is 1 bars or replacement of door handles to construction of an characteristic and service units for FCSP 3 NAPIS (Caring for Elderly) entrance ramp or roll-in shower) in order to fulfill caregiving Caregivers. ADL/IADL information is Supplemental CDA FCSP Title Ill E N/A Registered Occurrence responsibilities. required for Care Receivers served in Svs Service Matrix "Caregiver Caring for Elderly" component only.

An FCSP Supplemental Service that recruits, screens, and FCSP Registered services: maintains a listing of dependable, qualified self-employed homemaker or respite care workers who may be matched with Reporting requirements include Caregiving Services 1 Hour is 1 caregivers willing to use personal resources to pay for unduplicated client counts by NAPIS OAA 373(b)(S) Registry Occurrence assistance with their caregiving responsibilities. Both the characteristic and service units for FCSP 3 NAPIS (Caring for Elderly) caregiver and the self-employed worker will be: (A) advised Caregivers. ADL/IADL information is Supplemental CDA FCSP Title Ill E N/A Registered about appropriate compensation and workplace performance required for Care Receivers served in Svs Service Matrix expectations; and (B) provided with follow-up to ensure the "Caregiver Caring for Elderly" match is functioning effectively. component only.

FCSP Registered services:

An FCSP Supplemental Service that arranges for and provides Reporting requirements include Caregiving Emergency 1 Assista nee assistance to caregivers in the form of commodities, surplus unduplicated client counts by NAPIS OAA 373(b)(S) Cash / Material Aid is 1 food, emergency cash, transit passes, meals, and vouchers that characteristic and service units for FCSP 3 NAPIS
(Caring for Elderly) Occurrence will help meet identified needs associated with an individual Caregivers. ADL/IADL information is Supplemental CDA FCSP Title Ill E N/A Registered caregiver's responsibilities. required for Care Receivers served in Svs Service Matrix "Caregiver Caring for Elderly" component only.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Caregiver Outreach
(Caring for Elderly) 1 Contact
Caregiving Information
and Assistance 1 Contact
(Caring for Elderly)
Caregiver Interpretation
/ Translation 1 Contact
(Caring for Elderly)
Caregiver Legal
Resources 1 Contact
(Caring for Elderly)
FCSP - Caregiver Caring for Elderly
Access Assistance
Reporting Requirements
Definitions
An FCSP Access Assistance service involving interventions (one-on-one Non-Registered services:
contacts with individuals) initiated by an agency or provider for the purpose Reporting requirements of identifying caregivers and encouraging their use of existing caregiver include estimated support services (e.g., Caregiver lnfoVan staff contacts outside of local unduplicated client counts market). and service units.

An FCSP Access Assistances service that: (A) provides caregivers with information on services available within the communities, including Non-Registered services: caregiving information related to assistive technology and caring for older Reporting requirements individuals at risk for institutional placement; (B) links caregivers to the include estimated services and opportunities that are available within the communities; (C) to unduplicated client counts the maximum extent practicable, establishes adequate follow-up and service units. procedures (caregiver may remain anonymous and refuse follow-up contact).

An FCSP Access Assistance Service for the provision of bilingual Non-Registered services:
communication assistance to a caregiver in order to access assistance and Reporting requirements receive support for his or her caregiving responsibilities (e.g., staff include estimated interpreting dialogue between caregiver and care consultant staff unduplicated client counts translating an eider's prescription drug label for his caregiver). and service units.

An FCSP Access Assistance Service involving one-to-one guidance provided Non-Registered services:
by an attorney (or person under the supervision of an attorney) in the use Reporting requirements of legal resources and services when assisting a caregiver with caregiving- include estimated unduplicated client counts related legal issues. and service units.

Exhibit F: Sourcewise Provider Manual
Definition/ Registered NAPIS Primary Priority or
Reference Historical Funding Service Non- Reference 2 Source Registered 3 NAPIS OAA 373(b)(2)
FCSP4 NAPIS NonAccess CDAFCSP Title Ill E N/A Registered Assistance Service Matrix
NAPIS OAA 373(b)(2)
FCSP4 NAPIS Title Ill E N/A Non- Access CDAFCSP Registered Assistance Service Matrix
NAPIS OAA 373(b)(2)
FCSP4 NAPIS Title Ill E N/A Non- Access CDAFCSP Registered Assistance Service Matrix
NAPIS OAA 373(b)(2)
FCSP4 NAPIS NonAccess CDAFCSP Title Ill E N/A Registered Assistance Service Matrix
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Public Information
on Caregiving 1 Activity
(Caring for Elderly)
Community
Education
on Caregiving 1 Activity
(Caring for Elderly)
Service Unit
Category Measure 1
Caregiver Assessment 1 Hour (Caring for Child)
Caregiver Counseling
(Caring for Child)
1 Hour
FCSP - Caregiver Caring for Elderly
Information Services
Definitions Reporting Requirements
An FCSP Information Service designed to provide information about Non-Registered services:
available FCSP and other caregiver support resources and services by Reporting requirements disseminating publications, conducting media campaigns, and maintaining include estimated electronic information systems (e.g., quarterly newsletter). unduplicated client counts and service units.

An FCSP Information Service designed to educate groups of current or Non-Registered services:
potential caregivers and those who may provide them with assistance about Reporting requirements available FCSP and other caregiver support resources and services (e.g., include estimated booth at a health fair). unduplicated client counts and service units.

FCSP - Grandparent Caring for Child
Support Services
Definitions Reporting Requirements
An FCSP Support Service provided to a caregiver by a person appropriately trained and experienced in the skills required to deliver the level of FCSP Registered services:
counseling service, which may range from guidance with caregiving Reporting requirements responsibilities to therapy for stress, depression, and loss; and (A) may include unduplicated client involve his or her informal support system; (B) may be individual direct counts by characteristic and sessions and/or telephone consultations, and (C) may address caregiving- service units for Caregivers. related financial and long-term care placement responsibilities.

An FCSP Support Service provided to a caregiver by a person appropriately FCSP Registered services:
trained and experienced in the skills required to deliver the level of support Reporting requirements needed for stress, depression, and loss as a result of caregiving include unduplicated client responsibilities. This service (A) may involve his or her informal support counts by characteristic and system; (B) may be individual direct sessions and/or telephone service units for Caregivers.

FCSP Registered services: OAA 373(b)(3) Caregiver Peer An FCSP Support Service provided by experienced volunteers on the Reporting requirements NAPIS NAPIS Counseling 1 Hour condition that appropriate training and qualified supervision protocols are include unduplicated client FCSP 1 CDAFCSP Title Ill E N/A Registered (Caring for Child) in place. counts by characteristic and Support Svs Service Matrix service units for Caregivers.

An FCSP Support Service provided to a group of 3 - 12 caregivers that is led FCSP Registered services:

Caregiver by a competent facilitator; conducted at least monthly within a supportive Reporting requirements NAPIS OAA 373(b)(3) Support Group 1 Hour setting or via a controlled access, moderated on line or teleconference include unduplicated client FCSP 1 NAPIS Title Ill E N/A Registered (Caring for Child) approach; for the purpose of sharing experiences and ideas to ease the counts by characteristic and Support Svs CDAFCSP stress of caregiving, and to improve decision-making and problem-solving Service Matrix skills related to their caregiving responsibilities. service units for Caregivers.

An FCSP Support Service consisting of workshops or one-on-one individually FCSP Registered services: tailored sessions, conducted either in person or electronically by a skilled OAA 373(b)(3) Caregiver Training and knowledgeable individual, to assist caregivers in developing the skills Reporting requirements NAPIS NAPIS (Caring for Child)
1 Hour and gaining the knowledge necessary to fulfill their caregiving include unduplicated client FCSP 1 CDAFCSP Title Ill E N/A Registered responsibilities; and shall address the areas of health, nutrition, and counts by characteristic and Support Svs Service Matrix financial literacy. service units for Caregivers.

An FCSP Support Service provided by a person who is trained and FCSP Registered services:

CaregiverCase experienced in the skills that are required to coordinate and monitor the Reporting requirements NAPISFCSP OAA 373(b)(3) Management 1 Hour provision of formal caregiver-related services in circumstances where include unduplicated client !Support Svs NAPISCDA FCSP Title Ill E N/A Registered (Caring for Child) caregivers are experiencing diminished capacities due to mental counts by characteristic and Service Matrix impairment or temporary severe stress and/or depression. service units for Caregivers.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Caregiver Respite
In-Home Supervision 1 Hour
(Caring for Child)
Caregiver Respite
Homemaker Assistance 1 Hour
(Caring for Child)
Caregiver Respite
In-Home Personal Care 1 Hour
(Caring for Child)
Caregiver Respite
Home Chore 1 Hour
(Caring for Child)
Caregiver Respite
Out-of-Home
Day Care 1 Hour
(Caring for Child)
Caregiver Respite
Out-of-Home
Overnight Care
1 Hour
(Caring for Child)
FCSP - Grandparent Caring for Child
Respite Care
Definitions Reporting Requirements
An FCSP Respite Care service that includes the provision of care receiver day FCSP Registered services:
and/or overnight supervision and friendly visiting by an appropriately skilled Reporting requirements provider or volunteer in order to prevent wandering and health or safety include unduplicated client incidents. counts by characteristic and service units for Caregivers.

An FCSP Respite Care service that includes the provision of care receiver FCSP Registered services:
assistance with meal preparation, medication management, using the Reporting requirements phone, and or light housework (along with care receiver supervision) by an include unduplicated client appropriately skilled provider or volunteer. counts by characteristic and service units for Caregivers.

An FCSP Respite Care service that includes the provision of care receiver FCSP Registered services:
assistance with eating, bathing, toileting, transferring, and or dressing Reporting requirements (along with care receiver supervision and related homemaker assistance) by include unduplicated client an appropriately skilled provider. counts by characteristic and service units for Caregivers.

An FCSP Respite Care service that includes an appropriately skilled provider FCSP Registered services: Reporting requirements or volunteer assisting a caregiver with heavy housework, yard work, and or include unduplicated client sidewalk and other routine home maintenance (but not structural repairs) counts by characteristic and associated with caregiving responsibilities. service units for Caregivers.

FCSP Registered services:

An FCSP Respite Care service where the care receiver attends a Reporting requirements supervised/protective, congregate setting during some portion of a day, and include unduplicated client includes assess to social and recreational activities. counts by characteristic and service units for Caregivers.

FCSP Registered services:

An FCSP Respite Care service where the care receiver is temporarily placed Reporting requirements in a supervised/protective, residential setting for one or more nights, and include unduplicated client may include access to nursing and personal care. counts by characteristic and service units for Caregivers.

Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered NAPIS
Historical Funding Priority or Reference Reference 2 Source Service NonRegistered 3 OAA 373(b)(4) NAPIS NAPIS FCSP 2 CDAFCSP Title Ill E N/A Registered Respite Care Service Matrix OAA 373(b)(4) NAPIS NAPIS FCSP 2 CDAFCSP Title Ill E N/A Registered Respite Care Service Matrix OAA 373(b)(4) NAPIS NAPIS FCSP 2 CDAFCSP Title Ill E N/A Registered Respite Care Service Matrix OAA 373(b)(4) NAPIS FCSP 2
NAPIS
Title Ill E N/A Registered
Respite Care CDAFCSP Service Matrix
OAA 373(b)(4) NAPIS NAPIS FCSP 2 CDAFCSP Title Ill E N/A Registered Respite Care Service Matrix OAA 373(b)(4) NAPIS NAPIS FCSP 2 CDAFCSP Title Ill E N/A Registered Respite Care Service Matrix DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Assistive Devices
for Caregiving 1 Device is 1
(Caring for Child) Occurrence
Home Adaptations for 1
Caregiving Modification
(Caring for Child) is 1 Occurrence
Caregiving Services 1 Hour is 1 Registry Occurrence (Caring for Child) Caregiving
Emergency 1 Assistance is
Cash / Material Aid 1 Occurrence
(Caring for Child)
FCSP - Grandparent Caring for Child
Supplemental Services
Definitions Reporting Requirements
An FCSP Supplemental Service that involves the purchase, rental and/or FCSP Registered services:
service fee of any equipment or product system (ranging from a lift chair or Reporting requirements bathtub transfer bench to an electronic pill dispenser or emergency alert include unduplicated fall prevention device) in order to facilitate and fulfill the caregiving client counts by characteristic and service responsibilities. units for Caregivers.

FCSP Registered services:

An FCSP Supplemental Service that makes any minor or major physical Reporting requirements change to the home (ranging from installation of grab bars or replacement include unduplicated of door handles to construction of an entrance ramp or roll-in shower) in client counts by order to facilitate and fulfill caregiving responsibilities. characteristic and service units for Caregivers.

An FCSP Supplemental Service that recruits, screens, and maintains a listing FCSP Registered services: of dependable, qualified self-employed homemaker or respite care workers Reporting requirements who may be matched with caregivers willing to use personal resources to include unduplicated pay for assistance with their caregiving responsibilities. Both the caregiver client counts by and the self-employed worker will be: (A) advised about appropriate characteristic and service compensation and workplace performance expectations; and (B) provided units for Caregivers. with follow-up to ensure the match is functioning effectively.

FCSP Registered services:

An FCSP Supplemental Service that arranges for and provides assistance to Reporting requirements caregivers in the form of commodities, surplus food, emergency cash, include unduplicated transit passes, meals, and vouchers that will help meet identified needs client counts by associated with an individual caregiver's responsibilities. characteristic and service units for Caregivers.

Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered NAPIS Historical Funding Priority or Reference Reference 2 Source Service Non- Registered 3 NAPIS OAA 373(b)(S)
FCSP 3 NAPIS Title Ill E N/A Registered Supplemental CDA FCSP Svs Service Matrix
NAPIS OAA 373(b)(S)
FCSP 3 NAPIS Title Ill E N/A Registered Supplemental CDA FCSP Svs Service Matrix
NAPIS OAA 373(b)(S)
FCSP 3 NAPIS
Supplemental CDA FCSP Title Ill E N/A Registered
Svs Service Matrix
NAPIS OAA 373(b)(S)
FCSP 3 NAPIS Title Ill E N/A Registered Supplemental CDA FCSP Svs Service Matrix
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Caregiver Outreach
(Caring for Child) 1 Contact
Caregiving Information
and Assistance 1 Contact
(Caring for Child)
Caregiver Interpretation
/ Translation 1 Contact
(Caring for Child)
Caregiver Legal
Resources 1 Contact
(Caring for Child)
FCSP - Grandparent Caring for Child
Access Assistance
Definitions Reporting Requirements
An FCSP Access Assistance service involving interventions (one-on-one Non-Registered services: contacts with individuals) initiated by an agency or provider for the Reporting requirements include purpose of identifying caregivers and encouraging their use of existing estimated unduplicated client caregiver support services (e.g., Caregiver lnfoVan staff contacts counts and service units. outside of local market). An FCSP Access Assistance service that: (A) provides caregivers with information on services available within the communities, including caregiving information related to assistive technology and caring for Non-Registered services:
older individuals at risk for institutional placement; (B) links caregivers Reporting requirements include to the services and opportunities that are available within the estimated unduplicated client communities; (C) to the maximum extent practicable, establishes counts and service units. adequate follow-up procedures (caregiver may remain anonymous and refuse follow-up contact).

An FCSP Access Assistance service for the provision of bilingual Non-Registered services: communication assistance to a caregiver in order to access assistance and receive support for his or her caregiving responsibilities (e.g., staff Reporting requirements include estimated unduplicated client interpreting dialogue between caregiver and care consultant staff counts and service units. translating an eider's prescription drug label for his caregiver).

An FCSP Access Assistance service involving one-to-one guidance Non-Registered services:
provided by an attorney (or person under the supervision of an Reporting requirements include attorney) in the use of legal resources and services when assisting a estimated unduplicated client caregiver with caregiving-related legal issues. counts and service units.

Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered NAPIS
Historical Funding Priority or Reference Reference 2 Source Service NonRegistered 3 NAPIS OAA 373(b)(2)
FCSP4 NAPIS NonAccess CDAFCSP Title Ill E N/A Registered Assistance Service Matrix
NAPIS OAA 373(b)(2)
FCSP4 NAPIS Title Ill E N/A Non- Access CDAFCSP Registered Assistance Service Matrix
NAPIS OAA 373(b)(2)
FCSP4 NAPIS Title Ill E N/A Non- Access CDAFCSP Registered Assistance Service Matrix
NAPIS OAA 373(b)(2)
FCSP4 NAPIS Title Ill E N/A Non- Access CDAFCSP Registered Assistance Service Matrix
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Public Information
on Caregiving 1 Activity
(Caring for Child)
Community Education
on Caregiving 1 Activity
(Caring for Child)
Service Unit
Category Measure 1
Program N/A Development
Coordination N/A
CARS/ Data N/A
Reporting Systems
FCSP - Grandparent Caring for Child
Information Services
Definitions Reporting Requirements
An FCSP Information Service designed to provide information about Non-Registered services:
available FCSP and other caregiver support resources and services by Reporting requirements include disseminating publications, conducting media campaigns, and estimated unduplicated client maintaining electronic information systems (e.g., quarterly newsletter). counts and service units.

An FCSP Information Service designed to educate groups of current or Non-Registered services:
potential caregivers and those who may provide them with assistance Reporting requirements include about available FCSP and other caregiver support resources and estimated unduplicated client services (e.g., booth at a health fair). counts and service units.

Fiscally Allowable Administrative Activities
Definitions NAPIS Reference
Activities that either establish a new service or expand or integrate existing services. Non-NAPIS Activities that involve the active participation of the AAA staff to include liaison with non-OAA funded agencies and organizations for the purpose of avoiding duplication, Non-NAPIS improving services, resolving problems related to service delivery, and addressing the service needs of the eligible service population.

The purchase, development, and maintenance of software designed to meet the requirements of the California Aging Reporting System (CARS). Maintenance includes Non-NAPIS system patches and upgrades. Activities include training staff on data collection and systems.

Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered NAPIS
Historical Funding Priority or Reference Reference 2 Source Service NonRegistered 3 NAPIS OAA 373(b)(l)
FCSP 5 NAPIS Title Ill E N/A Non- Information CDAFCSP Registered Svs Service Matrix
NAPIS OAA 373(b)(l)
FCSP 5 NAPIS Title Ill E N/A Non- Information CDAFCSP Registered Svs Service Matrix
Definition / Primary Registered Reporting Historical Funding Priority or Requirements Reference 2 Source Service Non- Registered 3 Fiscally CDA Standard allowable Agreement Title Ill B No N/A administrative Exhibit A activities Fiscally CDA Standard allowable Agreement Title Ill B No N/A administrative Exhibit A activities Fiscally allowable Title Ill B No N/A administrative
activities
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit F: Sourcewise Provider Manual
Definition / Primary Registered Service Unit Definitions NAPIS Reporting Historical Funding Priority or Category Measure 1 Reference Requirements Reference 2 Source Service Non- Registered 3 Fiscally
Emergency N/A Develop long-term emergency plans. Non-NAPIS allowable Title Ill B No N/A Preparedness administrative activities
Assist with the operation of the multipurpose senior center by meeting all or part of Fiscally Senior Center allowable Div4000 Staffing N/A the costs of compensating professional and technical personnel required for the Non-NAPIS administrative Unit 42 Title Ill B No N/A operation of the center. activities 1 AAAs must track the actual time services provided in their local database (i.e. minutes, fractions). All service units that are measured in hours must be reported as whole numbers (no fractions/partial units can be reported).

When exporting this data to the California Aging Reporting System (CARS) the AAA's software system must round total service units for each client by month and by service category to the nearest integer (i.e. can round up or down)). This should not affect the actual data in the AAA database, only the service unit totals in the CARS export files. Due to rounding, CDA expects minor service unit discrepancies (not to exceed 10 percent) between the AAA database and CARS. Also see "CARS Overview and Guidance" document. 2 All references to Division 4000 and CDA FCSP Service Matrix are for historical reference only. 3 In addition to reporting service units, AAAs must also report unduplicated client enrollments/estimated audience size (see the color key above for further information).

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit F: Sourcewise Provider Manual
Service Categories and Data Dictionary:

Glossary of Terms and Acronyms
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit F: Sourcewise Provider Manual
AAA: Area Agency on Aging ADL: Activities of Daily Living IADL: Instrumental Activities of Daily Living
AoA: United States Administration on Aging http://www.aoa.gov/ CARS: A multi-phased, multi-year project started in June 2007 which will transform the existing Older Americans Act (OAA) and Older Californians Act (OCA) aggregate reporting system into a new web-based system capable of providing the State with client-level data from the Aging Services network.

The complete project envisions web-based access to one common database (standardized data specification across programs) on OAA and OCA fiscal, program performance (utilization), and client-level demographic profile data (Registered services only; a number of Non-Registered services remaining are aggregated data).

It will allow the California Department of Aging (CDA) to compare data across all programs, as opposed to having silos of data that are not comparable to one another.

CCR: California Code of Regulations http://www.oal.ca.gov/ccr.htm CDA: California Department of Aging http://www.aging.ca.gov/ DIV: Division (as in a section of law) Division 4000: Division 4000 is used to specify the Other Title Ill Band Title Ill D services not defined in NAPIS, as well as elder abuse prevention activities related to Title VII. With the implementation of the Service Category and Data Dictionary Matrix, definitions from this source will no longer be used.

Estimated Unduplicated Client Count: The Administration on Aging has not provided a method to estimate an Unduplicated Count of Clients. Each AAA must supply its own methodology.

FCSP: Family Caregiver Support Program -- same as Title Ill E. FCSP provides support to (1) unpaid family caregivers of older adults and (2) grandparents or other older relatives with primary caregiving responsibilities for a child through five broad categories of services (see FCSP 1-5) FCSP 1: Support Services means the provision of caregiver assessment, caregiver counseling, caregiver peer counseling, caregiver support groups, caregiver training, and (if necessary) caregiver case management.

FCSP 2: Respite Care means a brief period of relief or rest from caregiving responsibilities, and is provided to caregivers on an intermittent, occasional, or emergency basis in a manner that responds to the individual needs and preferences of the caregivers and their care receivers, rather than a pre-established set amount offered on a "first come, first served" waiting list basis.

FCSP 3: Supplemental Services means caregiver-centered assistance offered on a limited basis to support and strengthen the caregiving efforts. FCSP 4: Access Assistance means the provision of caregiving information and assistance, caregiver outreach, caregiver interpretation/translation, and caregiver legal resources; and links caregivers to the opportunities and services that are available.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit F: Sourcewise Provider Manual
FCSP 5: Information Services means the provision of public information on caregiving and/or community education on caregiving, including information about available services. lnfoVan: A specialized vehicle used by Area Agencies on Aging and their providers for outreach and education on services and information via oral communication and written information such as flyers, brochures, etc. http://www.cda.ca.gov/aaa/reporting_instructions/info_van.asp NAPIS: The National Aging Program Information System (NAPIS) through which the State Program Report (SPR) is reported annually. The report contains statistical compilation of performance data and expenditures for programs administered by CDA with OAA Title Ill and Title VII funds. The data is collected and reported by service providers, AAAs, and State Units on Aging (for California, CDA) (for State on quarterly basis) on an annual basis in CARS. Statistical data is reported to AoA per federal guidelines by January 31 of each year by CDA.

Non Registered Services: Non-registered services are those services where it is not practical to collect client specific information or where requiring the client to register may serve as a barrier to receiving a service (see Service Categories and Data Dictionary document).

OAA: The Federal Older Americans Act: Congress enacted in 1965 to promote and provide assistance in the development of programs of benefit to the elderly and to provide funding for such programs through State Units and Area Agencies on Aging. http://www.aoa.gov/ AoARoot/ AoA_Programs/OAA/index.aspx OCA: In 1974, the Burton Act established the California Department of Aging (CDA) as a department within the Health and Welfare Agency. Initially the CDA was known as the Office on Aging.

The Burton Act also established the California Commission on Aging (CCoA) as an advisory body to the Governor, Legislature, Department of Aging and other state departments, as well as provided funding and staffing. Pr: Refers to "Program" type under Division 4000 Registered Services: Means data collection and reporting requirements include unduplicated client counts by characteristic, units of service, including in some cases ADLs/lADLs (see Service Categories and Data Dictionary document). Registered Services are client specific data using participant identification numbers for each client.

Service Categories and Data Dictionary: See Service Categories and Data Dictionary section.

Title Ill B: Title Ill B of the Older Americans Act that provides funding for supportive services such as, but not limited to, Information and Referral Services, In-home Services, Legal Services, Outreach, Respite Care/Respite Care Registries, and Transportation.

Title Ill C-1: Title Ill C-1 of the Older Americans Act that provides funding for the provision of Congregate Meals. Title Ill C-2: Title Ill C-2 of the Older Americans Act that provides funding for the provision of Home Delivered Meals. Title Ill D: Title Ill D of the Older Americans Act that provides funding for the provision of Disease Prevention and Health Promotion Services. Title Ill E: See FCSP Title VII B: Elder Abuse Prevention DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit F: Sourcewise Provider Manual
Service Categories and Data Dictionary:

Summary of Changes
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit F: Sourcewise Provider Manual
AAA Activities and CARS Reporting
Definition/ Primary Registered Service Unit Definitions NAPIS Historical Funding Priority or Summary of Changes Category Measure 1 Reference Reference 2 Source Service Non- Registered 3 Personal assistance, stand-by assistance, supervision or cues. (such NAPIS Personal Care 1 Hour as with eating, bathing, toileting, transferring in/out of bed/chair, NAPIS 1 Div4000 Title Ill B Yes Registered No Changes walking, dressing, grooming). Unit 20
Assistance such as preparing meals, shopping for personal and NAPIS Homemaker 1 Hour household items, managing money, using the telephone or doing NAPIS 2 Div4000 Title Ill B Yes Registered No Changes light housework. Unit SO, Unit 27
Chore 1 Hour Assistance such as heavy housework, yard work or sidewalk and NAPIS 3 NAPIS Title Ill B Yes Registered No Changes other home maintenance for a person. Div 4000 Unit 5 A meal provided to an eligible individual in his or her place of Home-Delivered residence, that meets all of the requirements of the Older NAPIS Title Ill CMeals 1 Meal Americans Act and State/Local laws, assures a minimum one-third NAPIS4 Div4000 2 No Registered No Changes of the current Dietary Reference Intake, and shall comply with Unit 51 Dietary Guidelines for Americans.

Personal care for dependent elders in a supervised, protective, and congregate setting during some portion of a day. Services offered NAPIS Adult Day Care/ 1 Hour in conjunction with adult day care/adult day health typically include NAPIS 5 Div4000 Title Ill B Yes Registered No Changes Adult Day Health social and recreational activities, training, counseling, and services Pr 5, Pr 11, such as rehabilitation, medications assistance and home health aide Pr 17 services for adult day health.

Assistance either in the form of access coordination in circumstances where the older person is experiencing diminished functioning capacities, personal conditions or other characteristics Case Management 1 Hour which require the provision of services by formal service providers NAPIS 6 NAPIS Title Ill B Yes Registered No Changes or family caregivers. Activities of case management include such Div4000 Pr 3 practices as assessing needs, developing care plans, authorizing and coordinating services among providers, and providing follow-up and reassessment, as required .

Individualized guidance to individuals who are at nutritional risk because of their health or nutrition history, dietary intake, chronic 1 Session Per illnesses, or medications use, or to caregivers. Counseling is NAPISDiv Title Ill C- Nutrition Counseling Participant provided one-on-one by a registered dietitian, and addresses the NAPIS 9 4000Unit 53 1Title Ill No Registered No Changes options and methods for improving nutrition status. Nutrition C-2 counseling may be made either in person or by any other means deemed appropriate (e.g., telephone, emails, etc.)
Transportation 1 One Way Trip Transportation from one location to another. Does not include any NAPIS 10 NAPIS Title Ill B Yes Non- No Changes other activity. May include travel vouchers and transit passes. Div 4000 Pr 12 Registered Legal Assistance 1 Hour Legal advice, counseling and/or representation by an attorney or NAPIS 11 NAPIS Title Ill B Yes Non- No Changes other person acting under the supervision of an attorney. Div 4000 Pr 14 Registered A program to promote better health by providing accurate and culturally sensitive nutrition, physical fitness, or health (as it relates to nutrition) information and instruction to participants, caregivers, Title Ill Cor participants in a group or individual setting overseen by a NAPIS 1 Nutrition Education
1 Session Per dietitian or individual of comparable expertise. Methods of NAPIS 12 Div4000 Title Ill C- No Non- No Changes Participant education may include demonstrations, audio-visual presentations, Unit 52 2 Registered or small group discussions for congregate program participants. Title Ill D 4 Handout materials may be used, but not limited to, as the sole education component for home-delivered meal program
participants.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479COFA68947 Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered Service Unit Definitions NAPIS Historical Funding Priority or Summary of Changes Category Measure 1 Reference Reference 2 Source Service Non- Registered 3 A service that: (A) provides individuals with information on services available within the communities; (B) links individuals to the services and opportunities that are available within the Information communities; (C) to the maximum extent practicable, establishes NAPIS Nonand 1 Contact adequate follow-up procedures. Internet web site "hits" are to be NAPIS 13 Div 4000 Pr 1 Title Ill B Yes Registered No Changes Assistance counted only if information is requested and supplied, and (C) is satisfied. Maximum extent practicable includes offering a follow-up call to all individuals who were linked to a service. Individuals can remain anonymous and refuse a follow-up call.

Interventions (one-on-one contacts) with individuals initiated by an NAPIS Outreach 1 Contact agency or provider for the purpose of identifying potential clients NAPIS 14 Div4000 Title Ill B Yes Non- No Changes (or their age 60+ caregivers) and encouraging their use of existing Registered services and benefits. Unit 19
An evidence-based health promotion program, including programs related to the prevention and mitigation of the effects of chronic disease (including, but not limited to, osteoporosis, obesity, diabetes, and cardiovascular disease), alcohol and substance abuse NAPIS 16- Older Americans Non- Health Promotion 1 Contact reduction, smoking cessation, weight loss and control, stress Heath Act Sec 102 (14) Title Ill D 3 No Registered No Changes management, falls prevention, physical activity, and improved Promotion nutrition. For a list of ACL approved Evidence-Based programs, please visit the National Council on Aging website at
https://www.ncoa.org/resources/ebpchart.

Alzheimer's 1 Day of Day of attendance (four hours minimum) at a licensed Adult Day NAPIS 15- NonDay Care Services Attendance Care or Adult Day Health Care Center that provides Alzheimer's or Other Div4000 Pr6 Title Ill B Yes Registered No Changes dementia services.

Arrange for and provide assistance to participants in the form of NAPIS 15 - Div4000 NonCash / Material Aid 1 Assistance commodities, surplus food distribution, emergency cash assistance, Other Unit 15 Title Ill B No Registered No Changes and vouchers.

Evaluating a person's physical, psychological, and social needs, financial resources, and the strengths and weaknesses of their Div4000 Comprehensive 1 Hour informal support system and the immediate environment as a basis NAPIS 15- Unit 32 Title Ill B Yes Non- No Changes Assessment for determining current functional ability and potential Other Registered improvement in order to develop the appropriate services needed CCR 7112 to maximize functional independence.

Disaster Assemble and distribute disaster preparedness materials such as NAPIS 15- NonPreparedness 1 Product File of Life or preparedness kits that will assist seniors in the event Other No reference Title Ill B No Registered No Changes Materials of an emergency.

Public education and training of professionals to develop, Elder Abuse Prevention, strengthen, and carry out programs for the prevention, detection, NAPIS 15- NonEducation and Training 1 Session assessment, and treatment of, intervention in, investigation of, and Other Div 4000 Pr 22 Title VII B No Registered No Changes response to elder abuse, neglect, and exploitation (including financial exploitation).This includes training for Title Ill E caregivers.

Elder Abuse Educational materials and guidance kits distributed for the Prevention 1 Product prevention, detection, assessment, and treatment of, intervention NAPIS 15- Div 4000 Pr 22 Title VII B No Non- No Changes Educational in, investigation of, and response to elder abuse, neglect, and Other Registered Materials exploitation (including financial exploitation).

Activities designed to maintain or obtain part-time/full-time employment for older persons or to assist them in selecting and NAPIS 15- NonEmployment 1 Activity entering into a second career. This can be accomplished through Other Div 4000 Pr 15 Title Ill B No Registered No Changes activities including but not limited to career counseling, recruitment, assessment, training, job club, and job development.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered Service Unit Definitions NAPIS Historical Funding Priority or Summary of Changes Category Measure 1 Reference Reference 2 Source Service Non- Registered 3 Activities such as non-evidence-based medication management, health screening, physical fitness, therapy, and hospice to assist older individuals to improve or maintain physical health and secure necessary medical, preventive health, or health maintenance services. Health screening, therapy, and hospice must be provided by a licensed health professional or by a paraprofessional supervised by a licensed health professional. Does not include NAPIS 15 - Div 4000 Pr 9, Non- Health 1 Hour services covered by Medicare, Medi-Cal, or other health insurance. Other Unit 13, Unit 21, Title Ill B Yes Registered No Changes Medication management means activities that facilitate safe and Unit 29, Unit 37 effective use of prescription and over-the-counter drugs. These activities may include medication screening and education to an individual and/or the caregiver to prevent incorrect medication administration and adverse drug reaction . Primary activities are normally on a one-to-one basis; if done as a group activity, each participant shall be counted as one contact unit.

Housing 1 Hour Assistance in locating adequate housing through referral or NAPIS 15 - Div4000 Pr4 Title Ill B No Non- No Changes placement. Other Registered Interpretation/ 1 Contact Provide interpretation/translation services for older individuals and NAPIS 15 - Div 4000 Unit 4 Title Ill B No Non- No Changes Translation their caregivers. Other Registered Activities related to increasing transportation and mobility options for older adults by providing assistance, information, travel training, Mobility Management 1 Hour trip planning, coordination of service public or private transit NAPIS 15 - Title Ill B No Non- No Changes Activities operators, scheduling, access to transit information, creation of Other Registered new models of service such as volunteer driver programs and shuttles.

Provide services such as screening, assessment, therapy, counseling, follow-up, and referral to maintain or improve the Div 4000 Pr 10, Mental Health 1 Hour mental health of older individuals. Mental Health services must be NAPIS 15- Unit 11, Title Ill B Yes Non- No Changes provided by a licensed health professional or by a paraprofessional Other Registered supervised by a licensed health professional. Does not include Unit 23, Unit 29 services covered by Medicare, Medi-Cal, or other health insurance.

Personal Affairs Provide assistance in writing letters and with the completion of NAPIS 15 - Div 4000 Unit 12, NonAssistance 1 Contact financial forms, including tax forms, and other written or electronic Other Pr16 Title Ill B No Registered No Changes documents.

Services for the security and safety of their home environment, by Personal/ 1 Product providing safety features such as: medical alert, alarms, assistive NAPIS 15- Div4000 Pr7 Title Ill B No Non- No Changes Home Security devices (including provision of assistive technology services and Other Registered assistive technology devices).

Public Contact with multiple current or potential clients or caregivers NAPIS 15- NonInformation 1 Activity through publications, publicity campaigns, and other mass media Other NAPIS Title Ill B Yes Registered No Changes campaigns including Internet websites.

Recruit workers, maintain a current list of qualified workers, refer NAPIS 15- Div4000 Non- Registry 1 Hour workers to clients or clients to workers, and follow-up to assure Other Unit 41 Title Ill B No Registered No Changes that service was received.

Residential modifications of homes that are necessary to facilitate Residential Repairs/
the ability of older individuals to remain at home and that are not NAPIS 15- Div4000 Non- 1 Modification available under other programs. Includes minor Title Ill B Yes No Changes Modifications repairs/renovations in order to meet safety, health issues, and code Other Unit 1, Unit 48 Registered standards.

Arrange for relief of the relatives or other caregivers of the frail elderly living at home by the coordination or direct provision of NAPIS 15 - Div 4000 Pr 18, Non- Respite Care 1 Hour supportive services to the older person(s) while the primary Other Unit 45 Title Ill B Yes Registered No Changes caregiver is temporarily absent (includes Adult Day Care as a respite service for families).

Entertainment costs such as tickets to shows or sporting events, meals, lodging, rentals, transportation and gratuities, are not allowable.

Telephone 1 Contact Telephone a client to provide contact and safety checks to reassure NAPIS 15- Div4000 Title Ill B Yes Non- No Changes Reassurance and support older individuals. Other Unit 28 Registered Visiting 1 Hour Visit a client to provide contact and safety checks to reassure and NAPIS 15 - Div4000 Title Ill B Yes Non- No Changes support older individuals. Other Unit 31 Registered DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Caregiver Assessment 1 Hour (Caring for Elderly)
Caregiver Counseling 1 Hour (Caring for Elderly)
Caregiver Peer Counseling 1 Hour (Caring for Elderly)
Caregiver
Support Group 1 Hour
(Caring for Elderly)
FCSP - Caregiver Caring for Elderly
Support Services
Definition/
Definitions NAPIS Historical Reference Reference 2
An FCSP Support Service conducted by persons trained and experienced in the skills required to deliver the service that should result in a plan that includes emergency back-up provisions and is periodically updated; and will explore options and courses of action NAPIS OAA 373(b)(3) for caregivers by identifying their: (A) willingness to provide care; FCSP 1 NAPIS (B) duration and care frequency preferences; (C) caregiving abilities; CDA FCSP Service (D) physical health, psychological, social support, and training Support Svs Matrix needs; (E) financial resources relative for caregiving; and (F) strengths and weaknesses within the immediate caregiving environment and (caregiver's) extended informal support system.

An FCSP Support Service provided to a caregiver by a person appropriately trained and experienced in the skills required to deliver the level of support needed for stress, depression, and loss NAPISFCSP OAA 373(b)(3) as a result of caregiving responsibilities. This service (A) may involve 1Support NAPISCDA FCSP his or her informal support system; (B) may be individual direct sessions and/or telephone consultations, and (C) may address Svs Service Matrix caregiving-related financial and long-term care placement responsibilities.

An FCSP Support Service provided by experienced volunteers on the NAPIS OAA 373(b)(3) condition that appropriate training and qualified supervision FCSP 1 NAPIS protocols are in place. Support Svs CDA FCSP Service Matrix An FCSP Support Service provided to a group of 3 - 12 caregivers that is led by a competent facilitator; conducted at least monthly OAA 373(b)(3) within a supportive setting or via a controlled access, moderated NAPIS NAPIS on line or teleconference approach; for the purpose of sharing FCSP 1 CDA FCSP Service experiences and ideas to ease the stress of caregiving, and to Support Svs Matrix improve decision-making and problem-solving skills related to their caregiving responsibilities.

Exhibit F: Sourcewise Provider Manual
Primary Registered
Funding Priority or Summary of Changes
Source Service Non- Registered 3
Title Ill E N/A Registered No Changes
Title Ill E N/A Registered No Changes Title Ill E N/A Registered No Changes Title Ill E N/A Registered No Changes DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered Service Unit Definitions NAPIS Historical Funding Priority or Summary of Changes Category Measure 1 Reference Reference 2 Source Service Non- Registered 3 An FCSP Support Service consisting of workshops or one-on-one individually tailored sessions, conducted either in person or NAPIS OAA 373(b)(3) Caregiver Training 1 Hour electronically by a skilled and knowledgeable individual, to assist FCSP 1 NAPIS Title Ill E N/A Registered No Changes (Caring for Elderly) caregivers in developing the skills and gaining the knowledge CDA FCSP Service necessary to fulfill their caregiving responsibilities; and address the Support Svs Matrix areas of health, nutrition, and financial literacy.

An FCSP Support Service provided by a person who is trained and Caregiver experienced in the skills that are required to coordinate and NAPIS OAA 373(b)(3) Case Management 1 Hour monitor the provision of formal caregiver-related services in FCSP 1 NAPIS Title Ill E N/A Registered No Changes (Caring for Elderly) circumstances where caregivers are experiencing diminished Support Svs CDA FCSP Service capacities due to mental impairment or temporary severe stress Matrix and/or depression.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Caregiver Respite
In-Home Supervision 1 Hour
(Caring for Elderly)
Caregiver Respite
Homemaker Assistance 1 Hour
(Caring for Elderly)
Caregiver Respite
In-Home 1 Hour Personal Care
(Caring for Elderly)
Caregiver Respite
Home Chore 1 Hour
(Caring for Elderly)
Caregiver Respite
Out-of-Home
Day Care 1 Hour
(Caring for Elderly)
Caregiver Respite
Out-of-Home
Overnight Care 1 Hour
(Caring for Elderly)
FCSP - Caregiver Caring for Elderly
Respite Care
Definition/
Definitions NAPIS Historical Reference Reference 2
An FCSP Respite Care service that includes the provision of care NAPIS OAA 373(b)(4) receiver day and/or overnight supervision and friendly visiting by an FCSP 2 NAPIS appropriately skilled provider or volunteer in order to prevent Respite Care CDA FCSP Service wandering and health or safety incidents. Matrix An FCSP Respite Care service that includes the provision of care OAA 373(b){4) receiver assistance with meal preparation, medication NAPIS management, using the phone, and or light housework (along with FCSP 2 NAPIS CDA FCSP Service care receiver supervision) by an appropriately skilled provider or Respite Care Matrix volunteer.

An FCSP Respite Care service that includes the provision of care NAPIS OAA 373(b)(4) receiver assistance with eating, bathing, toileting, transferring, and FCSP 2 NAPIS or dressing (along with care receiver supervision and related CDA FCSP Service homemaker assistance) by an appropriately skilled provider. Respite Care Matrix An FCSP Respite Care service that includes an appropriately skilled OAA 373(b){4) provider or volunteer assisting a caregiver with heavy housework, NAPIS NAPIS yard work, and or sidewalk and other routine home maintenance FCSP 2 CDA FCSP Service (but not structural repairs) associated with caregiving Respite Care Matrix responsibilities. An FCSP Respite Care service where the care receiver attends a NAPIS OAA 373(b){4) NAPIS supervised/protective, congregate setting during some portion of a FCSP 2 CDA FCSP Service day, and includes assess to social and recreational activities. Respite Care Matrix An FCSP Respite Care service where the care receiver is temporarily NAPIS OAA 373(b)(4) NAPIS placed in a supervised/protective, residential setting for one or FCSP 2 CDA FCSP Service more nights, and may include access to nursing and personal care. Respite Care Matrix Exhibit F: Sourcewise Provider Manual
Primary Registered
Funding Priority or Summary of Changes
Source Service Non- Registered 3
Title Ill E N/A Registered No Changes
Title Ill E N/A Registered No Changes Title Ill E N/A Registered No Changes Title Ill E N/A Registered No Changes Title Ill E N/A Registered No Changes Title Ill E N/A Registered No Changes DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Assistive Devices 1 Device is 1 for Caregiving Occurrence (Caring for Elderly) Home Adaptationsfor
Caregiving(Caring for 1 Modification
Elderly) is 1 Occurrence
caregiving Services
Registry 1 Hour is 1 Occurrence (Caring for Elderly)
Caregiving
Emergency 1 Assistance is 1
Cash / Material Aid Occurrence
(Caring for Elderly)
FCSP - Caregiver Caring for Elderly
Supplemental Services
Definition/
Definitions NAPIS Historical Reference Reference 2
An FCSP Supplemental Service that involves the purchase, rental NAPIS OAA 373(b)(5) and/or service fee of any equipment or product system (ranging FCSP 3 NAPIS from a lift chair or bathtub transfer bench to an electronic pill Supplement CDA FCSP Service dispenser or emergency alert fall prevention device) in order to al Svs Matrix facilitate and fulfill caregiving responsibilities. An FCSP Supplemental Service that makes any minor or major NAPISFCSP OAA 373(b)(S) physical change to the home (ranging from installation of grab bars 3Supplemen NAPISCDA FCSP or replacement of door handles to construction of an entrance tal Svs Service Matrix ramp or roll-in shower) in order to fulfill caregiving responsibilities.

An FCSP Supplemental Service that recruits, screens, and maintains a listing of dependable, qualified self-employed homemaker or respite care workers who may be matched with caregivers willing to NAPIS OAA 373(b){S) use personal resources to pay for assistance with their caregiving FCSP 3 NAPIS responsibilities. Both the caregiver and the self-employed worker Supplement CDA FCSP Service will be: (A) advised about appropriate compensation and al Svs Matrix workplace performance expectations; and (B) provided with followup to ensure the match is functioning effectively.

An FCSP Supplemental Service that arranges for and provides NAPIS OAA 373(b)(S) assistance to caregivers in the form of commodities, surplus food, FCSP 3 NAPIS emergency cash, transit passes, meals, and vouchers that will help Supplement CDA FCSP Service meet identified needs associated with an individual caregiver's responsibilities. al Svs Matrix
Exhibit F: Sourcewise Provider Manual
Primary Registered
Funding Priority or Summary of Changes
Source Service Non- Registered 3
Title Ill E N/A Registered No Changes
Title Ill E N/A Registered No Changes Title Ill E N/A Registered No Changes Title Ill E N/A Registered No Changes DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Caregiver Outreach
(Caring for Elderly) 1 Contact
Caregiving Information
and 1 Contact Assistance
(Caring for Elderly)
Caregiver Interpretation
/Translation(Caring for 1 Contact
Elderly)
Caregiver Legal Resources 1 Contact (Caring for Elderly) FCSP - Caregiver Caring for Elderly
Access Assistance
Definition/
Definitions NAPIS Historical Reference Reference 2
An FCSP Access Assistance service involving interventions (one-on- NAPIS OAA 373{b)(2) one contacts with individuals) initiated by an agency or provider for FCSP4 NAPIS the purpose of identifying caregivers and encouraging their use of Access CDA FCSP Service existing caregiver support services (e.g., Caregiver lnfoVan staff contacts outside of local market). Assistance Matrix
An FCSP Access Assistances service that: {A) provides caregivers with information on services available within the communities, including caregiving information related to assistive technology and NAPIS OAA 373{b)(2) caring for older individuals at risk for institutional placement; {B) FCSP4 NAPIS links caregivers to the services and opportunities that are available Access CDA FCSP Service within the communities; (C) to the maximum extent practicable, Assistance Matrix establishes adequate follow-up procedures (caregiver may remain anonymous and refuse follow-up contact).

An FCSP Access Assistance Service for the provision of bilingual communication assistance to a caregiver in order to access NAPISFCSP OAA 373{b)(2) assistance and receive support for his or her caregiving 4Access NAPISCDA FCSP responsibilities (e.g., staff interpreting dialogue between caregiver Assistance Service Matrix and care consultant staff translating an eider's prescription drug label for his caregiver).

An FCSP Access Assistance Service involving one-to-one guidance NAPIS OAA 373(b)(2) provided by an attorney (or person under the supervision of an FCSP4 NAPIS attorney) in the use of legal resources and services when assisting a Access CDA FCSP Service caregiver with caregiving-related legal issues. Assistance Matrix Exhibit F: Sourcewise Provider Manual
Primary Registered
Funding Priority or Summary of Changes
Source Service NonRegistered 3
NonTitle Ill E N/A Registered No Changes
Title Ill E N/A Non- No Changes Registered
Title Ill E N/A Non- No Changes Registered Title 111 E N/A Non- No Changes Registered DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Public Information
on
Caregiving 1 Activity
(Caring for Elderly)
Community Education
on 1 Activity Caregiving
(Caring for Elderly)
Service Unit
Category Measure 1
Caregiver Assessment 1 Hour (Caring for Child)
FCSP - Caregiver Caring for Elderly
Information Services
Definition/
Definitions NAPIS Historical Reference Reference 2
An FCSP Information Service designed to provide information about NAPIS OAA373(b)(1) available FCSP and other caregiver support resources and services FCSP 5 NAPIS by disseminating publications, conducting media campaigns, and Information CDA FCSP Service maintaining electronic information systems (e.g., quarterly Svs Matrix newsletter). An FCSP Information Service designed to educate groups of current NAPIS OAA 373(b)(1) or potential caregivers and those who may provide them with FCSP 5 NAPIS assistance about available FCSP and other caregiver support Information CDA FCSP Service resources and services (e.g., booth at a health fair). Svs Matrix FCSP - Grandparent Caring for Child
Support Services
Definition/ NAPIS Definitions Reference Historical Reference 2 An FCSP Support Service provided to a caregiver by a person appropriately trained and experienced in the skills required to deliver the level of counseling service, which may range from NAPIS OAA 373(b)(3) guidance with caregiving responsibilities to therapy for stress, FCSP 1 NAPIS depression, and loss; and (A) may involve his or her informal CDA FCSP Service support system; (B) may be individual direct sessions and/or Support Svs Matrix telephone consultations, and (C) may address caregiving-related financial and long-term care placement responsibilities.

Exhibit F: Sourcewise Provider Manual
Primary Registered
Funding Priority or Summary of Changes
Source Service Non- Registered 3
NonTitle Ill E N/A Registered No Changes
Title Ill E N/A Non- No Changes Registered
Primary Registered Priority or Funding Service Non- Summary of Changes Source Registered 3 Title Ill E N/A Registered No Changes
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered Service Unit Definitions NAPIS Historical Funding Priority or Summary of Changes Category Measure 1 Reference Reference 2 Source Service Non- Registered 3 An FCSP Support Service provided to a caregiver by a person appropriately trained and experienced in the skills required to deliver the level of support needed for stress, depression, and loss NAPISFCSP OAA 373(b)(3) Caregiver Counseling 1 Hour as a result of caregiving responsibilities. This service (A) may involve 1Support NAPISCDA FCSP Title Ill E N/A Registered No Changes (Caring for Child) his or her informal support system; (B) may be individual direct sessions and/or telephone consultations, and (C) may address Svs Service Matrix caregiving-related financial and long-term care placement responsibilities.

An FCSP Support Service provided by experienced volunteers on the NAPIS OAA 373(b)(3) Caregiver Peer Counseling 1 Hour condition that appropriate training and qualified supervision FCSP 1 NAPIS Title Ill E N/A Registered No Changes (Caring for Child) protocols are in place. Support Svs CDA FCSP Service Matrix An FCSP Support Service provided to a group of 3 - 12 caregivers that is led by a competent facilitator; conducted at least monthly OAA 373(b)(3) Caregiver within a supportive setting or via a controlled access, moderated NAPIS NAPIS Support Group 1 Hour on line or teleconference approach; for the purpose of sharing FCSP 1 CDA FCSP Service Title Ill E N/A Registered No Changes (Caring for Child) experiences and ideas to ease the stress of caregiving, and to Support Svs Matrix improve decision-making and problem-solving skills related to their caregiving responsibilities.

An FCSP Support Service consisting of workshops or one-on-one individually tailored sessions, conducted either in person or NAPIS OAA 373(b)(3) Caregiver Training 1 Hour electronically by a skilled and knowledgeable individual, to assist FCSP 1 NAPIS Title Ill E N/A Registered No Changes (Caring for Child) caregivers in developing the skills and gaining the knowledge CDA FCSP Service necessary to fulfill their caregiving responsibilities; and shall address Support Svs Matrix the areas of health, nutrition, and financial literacy.

An FCSP Support Service provided by a person who is trained and Caregiver experienced in the skills that are required to coordinate and NAPIS OAA 373(b)(3) Case Management 1 Hour monitor the provision of formal caregiver-related services in FCSP 1 NAPIS Title Ill E N/A Registered No Changes (Caring for Child) circumstances where caregivers are experiencing diminished Support Svs CDA FCSP Service capacities due to mental impairment or temporary severe stress Matrix and/or depression.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Caregiver Respite
In-Home Supervision 1 Hour
(Caring for Child)
Caregiver Respite
Homemaker Assistance 1 Hour
(Caring for Child)
Caregiver Respite
In-Home 1 Hour Personal Care
(Caring for Child)
Caregiver Respite
Home Chore 1 Hour
(Caring for Child)
Caregiver Respite
Out-of-Home 1 Hour Day Care
(Caring for Child)
Caregiver Respite
Out-of-Home
Overnight Care 1 Hour
(Caring for Child)
FCSP - Grandparent Caring for Child
Respite Care
Definition/
Definitions NAPIS Historical Reference Reference 2
An FCSP Respite Care service that includes the provision of care NAPIS OAA 373(b)(4) receiver day and/or overnight supervision and friendly visiting by an NAPIS appropriately skilled provider or volunteer in order to prevent FCSP 2 CDA FCSP Service wandering and health or safety incidents. Respite Care Matrix An FCSP Respite Care service that includes the provision of care receiver assistance with meal preparation, medication NAPISFCSP OAA 373(b)(4) management, using the phone, and or light housework (along with 2Respite NAPISCDA FCSP care receiver supervision) by an appropriately skilled provider or Care Service Matrix volunteer.

An FCSP Respite Care service that includes the provision of care NAPIS OAA 373(b)(4) receiver assistance with eating, bathing, toileting, transferring, and FCSP 2 NAPIS or dressing (along with care receiver supervision and related CDA FCSP Service homemaker assistance) by an appropriately skilled provider. Respite Care Matrix An FCSP Respite Care service that includes an appropriately skilled OAA 373(b)(4) provider or volunteer assisting a caregiver with heavy housework, NAPIS NAPIS yard work, and or sidewalk and other routine home maintenance FCSP 2 CDA FCSP Service (but not structural repairs) associated with caregiving Respite Care Matrix responsibilities. An FCSP Respite Care service where the care receiver attends a NAPIS OAA 373(b)(4) supervised/protective, congregate setting during some portion of a FCSP 2 NAPIS CDA FCSP Service day, and includes assess to social and recreational activities. Respite Care Matrix An FCSP Respite Care service where the care receiver is temporarily NAPIS OAA 373(b)(4) NAPIS placed in a supervised/protective, residential setting for one or FCSP 2 CDA FCSP Service more nights, and may include access to nursing and personal care. Respite Care Matrix Exhibit F: Sourcewise Provider Manual
Primary Registered
Funding Priority or Summary of Changes
Source Service Non- Registered 3
Title Ill E N/A Registered No Changes
Title Ill E N/A Registered No Changes Title Ill E N/A Registered No Changes Title Ill E N/A Registered No Changes Title Ill E N/A Registered No Changes Title Ill E N/A Registered No Changes DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Assistive Devices 1 Device is 1 for Caregiving Occurrence (Caring for Child) Home Adaptations for 1 Modification Caregiving is 1 Occurrence (Caring for Child) Caregiving Services
Registry 1 Hour is 1
(Caring for Child) Occurrence
Caregiving Emergency 1 Assistance is 1 Cash / Material Aid Occurrence (Caring for Child) FCSP - Grandparent Caring for Child
Supplemental Services
Definition/
Definitions NAPIS Historical Reference Reference 2
An FCSP Supplemental Service that involves the purchase, rental NAPIS OAA 373(b)(S) and/or service fee of any equipment or product system (ranging FCSP 3 NAPIS from a lift chair or bathtub transfer bench to an electronic pill Supplement CDA FCSP Service dispenser or emergency alert fall prevention device) in order to al Svs Matrix facilitate and fulfill the caregiving responsibilities. An FCSP Supplemental Service that makes any minor or major NAPIS OAA 373(b)(S) physical change to the home (ranging from installation of grab bars FCSP 3 NAPIS or replacement of door handles to construction of an entrance Supplement CDA FCSP Service ramp or roll-in shower) in order to facilitate and fulfill caregiving responsibilities. al Svs Matrix
An FCSP Supplemental Service that recruits, screens, and maintains a listing of dependable, qualified self-employed homemaker or respite care workers who may be matched with caregivers willing to NAPISFCSP OAA 373(b)(S) use personal resources to pay for assistance with their caregiving 3Supplemen NAPISCDA FCSP responsibilities. Both the caregiver and the self-employed worker tal Svs Service Matrix will be: (A) advised about appropriate compensation and workplace performance expectations; and (B) provided with followup to ensure the match is functioning effectively.

An FCSP Supplemental Service that arranges for and provides NAPIS OAA 373(b)(S) assistance to caregivers in the form of commodities, surplus food, FCSP 3 NAPIS emergency cash, transit passes, meals, and vouchers that will help Supplement CDA FCSP Service meet identified needs associated with an individual caregiver's responsibilities. al Svs Matrix
Exhibit F: Sourcewise Provider Manual
Primary Registered
Funding Priority or Summary of Changes
Source Service Non- Registered 3
Title Ill E N/A Registered No Changes
Title Ill E N/A Registered No Changes Title Ill E N/A Registered No Changes Title Ill E N/A Registered No Changes DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Caregiver Outreach
(Caring for Child) 1 Contact
Caregiving Information
and Assistance 1 Contact
(Caring for Child)
Caregiver Interpretation/
Translation 1 Contact
(Caring for Child)
Caregiver Legal Resources 1 Contact (Caring for Child)
FCSP - Grandparent Caring for Child
Access Assistance
Definition/
Definitions NAPIS Historical Reference Reference 2
An FCSP Access Assistance service involving interventions (one-on- NAPIS OAA 373{b)(2) one contacts with individuals) initiated by an agency or provider for FCSP4 NAPIS the purpose of identifying caregivers and encouraging their use of Access CDA FCSP Service existing caregiver support services (e.g., Caregiver lnfoVan staff contacts outside of local market). Assistance Matrix
An FCSP Access Assistance service that: (A) provides caregivers with information on services available within the communities, including caregiving information related to assistive technology and caring for NAPIS OAA 373{b)(2) older individuals at risk for institutional placement; (B) links FCSP4 NAPIS caregivers to the services and opportunities that are available Access CDA FCSP Service within the communities; (C) to the maximum extent practicable, Assistance Matrix establishes adequate follow-up procedures (caregiver may remain anonymous and refuse follow-up contact).

An FCSP Access Assistance service for the provision of bilingual communication assistance to a caregiver in order to access NAPIS OAA 373(b)(2) assistance and receive support for his or her caregiving FCSP4 NAPIS responsibilities (e.g., staff interpreting dialogue between caregiver Access CDA FCSP Service and care consultant staff translating an eider's prescription drug Assistance Matrix label for his caregiver).

An FCSP Access Assistance service involving one-to-one guidance NAPIS OAA 373(b)(2) provided by an attorney (or person under the supervision of an FCSP4 NAPIS attorney) in the use of legal resources and services when assisting a Access CDA FCSP Service caregiver with caregiving-related legal issues. Assistance Matrix Exhibit F: Sourcewise Provider Manual
Primary Registered
Funding Priority or Summary of Changes
Source Service Non- Registered 3
NonTitle Ill E N/A Registered No Changes
Title Ill E N/A
NonNo Changes Registered NonTitle Ill E N/A Registered No Changes Title Ill E N/A Non- No Changes Registered
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Service Unit
Category Measure 1
Public Information
on Caregiving 1 Activity
(Caring for Child)
Community Education
on Caregiving 1 Activity
(Caring for Child)
Service Unit
Category Measure 1
Program N/A Development
Coordination N/A
FCSP - Grandparent Caring for Child
Information Services
Definition/
Definitions NAPIS Historical Reference Reference 2
An FCSP Information Service designed to provide information about NAPIS OAA373(b)(1) available FCSP and other caregiver support resources and services FCSP 5 NAPIS by disseminating publications, conducting media campaigns, and Information CDA FCSP Service maintaining electronic information systems (e.g., quarterly newsletter). Svs Matrix
An FCSP Information Service designed to educate groups of current NAPIS OAA 373(b)(1) or potential caregivers and those who may provide them with FCSP 5 NAPIS assistance about available FCSP and other caregiver support Information CDA FCSP Service resources and services (e.g., booth at a health fair). Svs Matrix Fiscally Allowable Administrative Activities
Definition/
Definitions NAPIS Historical Reference Reference 2
Activities that either establish a new service or expand or integrate CDA Standard Non-NAPIS Agreement existing services. Exhibit A Activities that involve the active participation of the AAA staff to include liaison with non-OAA funded agencies and organizations for CDA Standard the purpose of avoiding duplication, improving services, resolving Non-NAPIS Agreement problems related to service delivery, and addressing the service Exhibit A needs of the eligible service population.

Exhibit F: Sourcewise Provider Manual
Primary Registered
Funding Priority or Summary of Changes
Source Service Non- Registered 3
NonTitle Ill E N/A Registered No Changes
Title Ill E N/A
NonNo Changes Registered
Primary Registered
Funding Priority or Summary of Changes
Source Service Non- Registered 3
Title Ill B No N/A No Changes
Title Ill B No N/A No Changes
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit F: Sourcewise Provider Manual
Definition/ Primary Registered Service Unit Definitions NAPIS Historical Funding Priority or Summary of Changes Category Measure 1 Reference Reference 2 Source Service Non- Registered 3 New definition: the definition
was revised to specify
The purchase, development, and maintenance of software designed allowable activities for staff CARS/ Data to meet the requirements of the California Aging Reporting System training on data collection N/A Non-NAPIS Title Ill B No N/A and systems for AB 959 and Reporting Systems (CARS). Maintenance includes system patches and upgrades. other topics. The definition Activities include training staff on data collection and systems. also clarifies that maintenance includes system
patches and upgrades.

Emergency N/A Develop long-term emergency plans. Non-NAPIS Title Ill B No N/A No Changes Preparedness Senior Center Assist with the operation of the multipurpose senior center by Div4000 Staffing
N/A meeting all or part of the costs of compensating professional and Non-NAPIS Unit 42 Title 111 B No N/A No Changes technical personnel required for the operation of the center.

For ADA compliance, additional notes for reporting requirements have been moved into a column titled "Reporting Requirements" as needed for each service category, instead of the color coordinated sections as follows:
• Light Blue: Denotes Cluster 1 services. Reporting requirements include unduplicated client counts by characteristic, ADLs/lADLs and service units. • Dark Blue: Denotes Cluster 2 services. Reporting requirements include unduplicated client counts by characteristic and service units. For FCSP, ADL/IADL information is required for Care Receivers served in "Caregiver Caring for Elderly" component only.
• White: Denotes Non-Registered services. Reporting requirements include estimated unduplicated client counts and service units. • Yellow: Denotes FCSP Registered services. Reporting requirements include unduplicated client counts by characteristic and service units for Caregivers. ADL/IADL information is required for Care Receivers served in "Caregiver Caring for Elderly" component only.
• Green: Denotes fiscally allowable administrative activities. 1 AAAs must track the actual time services provided in their local database (i.e. minutes, fractions). All service units that are measured in hours must be reported as whole numbers (no fractions/partial units can be reported).

Opening IE Mode in Microsoft Edge

1. Download the most current version of Edge.

2. In Edge, go to Settings, select Default browser, change the "Allow sites to be reloaded in Internet Explorer mode" setting to "Allow".

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 o X
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3. After selecting ‘Allow’ from the dropdown menu, click ‘Add’ within the row labeled ‘Internet Explorer mode pages’.

Exhibit F: Sourcewise Provider Manual
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4. Enter the Q Portal address. (https://qhost.assurecare.com/RDWeb) . Click ‘Add’

5. Close the Edge window and then reopen Microsoft Edge.

6. Enter the Q Portal address. (https://qhost.assurecare.com/RDWeb)

7. The Q Portal Log-in webpage should load. If it does not follow steps #8 and #11.

8. Click the ... (elipsis) button in the upper right corner of the Edge screen.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Internet Explor r: comoatihitL·-·---------
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9. Select "Reload in Internet Explorer mode".

10. Log in to the Q Portal and then into Q like normal.

Exhibit F: Sourcewise Provider Manual
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11. You might get this window:

I recommend clicking on the blue button so it knows to open this page in IE mode.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 This page is open in Internet Explorer
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AAA Provider Workbook
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 CareAccess

Q SYSTEM
2 CareAccess

ALL RIGHTS RESERVED
This material contains proprietary and confidential information and is protected by copyright and trade secret laws. Unauthorized reproduction, distribution, or transfer of this material, or any portion of it, is strictly prohibited and may result in civil and criminal penalties. Known violators will be prosecuted to the maximum extent possible under the law.

DISCLAIMER
CareAccess Incorporated has taken care in preparing this material. Nothing contained in this material alters in any way the terms and conditions of the license agreement by which the product was acquired, nor increases in any way CareAccess Incorporated liability to the user.

The text discussed in the guide is the Q System's default settings. Please see your System administrator for any questions that might arise.

Note: The pages in this document were formatted so that the document can be printed as a two-sided document. The blank pages in this document are intentional in order to maintain a format conducive to printing in such a manner.

Document revision date 5/11/2016
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 AAA Provider Workbook 3

TABLE OF CONTENTS
Lesson 1: Discovering Q Features
Understanding the Q database ...................................................................................................... 7 About the Q database system ..................................................................................................... 7 Q database model ...................................................................................................................... 7 Transacional processing vs. analytical processing ...................................................................... 8 Business intelligence .................................................................................................................. 8 Starting a Q database session ....................................................................................................... 9 Do it! Start Q database session .................................................................................................. 9 Install the client software ............................................................................................................ 9 Start Q demo database session ................................................................................................ 10 Lesson 2: Exploring the Q Workspace
Q workspace components ........................................................................................................ 11 Lesson 3: Navigating with Q Grids
Exploring the launcher ................................................................................................................. 13 Overview .................................................................................................................................. 13 Displaying the launcher: two views ........................................................................................... 13 Opening the launcher ............................................................................................................... 14 Command buttons in launcher .................................................................................................. 14 Objects ..................................................................................................................................... 14 Exploring Q grids ......................................................................................................................... 15 Locating objects in a grid .......................................................................................................... 15 The scroll bar ............................................................................................................................ 15 Quick jump ............................................................................................................................... 15 The Find command ................................................................................................................... 15 Do it! Open an object's grid ....................................................................................................... 16 The Client's Query .................................................................................................................... 16 Use the Process Center............................................................................................................ 16 Navigating through records in a grid ......................................................................................... 16 The Close button ...................................................................................................................... 17 The toolbar navigation buttons .................................................................................................. 17 Opening a new window............................................................................................................. 17 Grid toolbar ............................................................................................................................... 17 Customizing grids ........................................................................................................................ 17 Customizing Options ................................................................................................................. 17 Do it! Add and remove columns in a grid .................................................................................. 18 Re-arranging columns............................................................................................................... 19 Re-sizing columns .................................................................................................................... 19 Remove a column..................................................................................................................... 19 Do it! Sort and group your grid .................................................................................................. 19 Simple sorting ........................................................................................................................... 19 Complex sorting ........................................................................................................................ 20 Grouping .................................................................................................................................. 20 Lesson 4: The Client Record
Unique client record .................................................................................................................. 23 Do it! Search for a client ........................................................................................................... 23 Do It! Search the inactive clients list ......................................................................................... 23 Do It! Reactivate a client record ................................................................................................ 23 Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 4 CareAccess
Do It! Create a new client record ............................................................................................... 24 Client Main Demographic Screen (MDS) ...................................................................................24 Do It! Enter client demographics ................................................................................................ 25 Annotations ............................................................................................................................... 25 Lesson 5: Client Assessments
Overview ................................................................................................................................... 27 Do it! Enter assessment information .......................................................................................... 27 ADLs/IADLS Assessment screen .............................................................................................. 27 Making changes ........................................................................................................................ 28 Lesson 6: Client Service Plans
Overview ................................................................................................................................... 29 Do it! Create a Personal Care Service Plan ............................................................................... 29 Lesson 7: Entering Authorized & Delivered Units
Do it! Create a weekly authorization schedule ........................................................................... 31 Do it! Enter delivered units ........................................................................................................ 32 Service units monthly calendar .................................................................................................. 32 Lesson 8: Other Service Unit Entry Methods
Service Unit Entry .........................................................................................................................35 Overview ................................................................................................................................... 35 Do it! Query for service recipients ............................................................................................. 35 Do It! Service Unit Entry ............................................................................................................ 35 Service Unit Logging ....................................................................................................................36 Do it! Query for an Agency's clients ........................................................................................... 36 Service Unit Logging Query....................................................................................................... 36 Do it! Log personal care units .................................................................................................... 37 Commit all units ........................................................................................................................ 37 Verify your work ........................................................................................................................ 37 Lesson 9: Disenrolling and Deactivating Clients
Overview ................................................................................................................................... 39 Do It! Disenroll a client .............................................................................................................. 39 Client care plans grid ................................................................................................................ 39 Do It! Disenroll multiple clients................................................................................................... 40 Do It! Deactivate a client............................................................................................................ 40 Lesson 10: Common Queries
Overview ................................................................................................................................... 41 Clients with Active Care Plans .....................................................................................................42 Overview ................................................................................................................................... 42 Common use(s): ....................................................................................................................... 42 Query criteria: ........................................................................................................................... 42 Results: ..................................................................................................................................... 42 Clients with Service Units by time interval .................................................................................43 Overview ................................................................................................................................... 43 Common use(s): ....................................................................................................................... 43 Query criteria: ........................................................................................................................... 43 Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 AAA Provider Workbook 5
Results: ..................................................................................................................................... 43 :

Clients Receiving Service (Detailed) ............................................................................................44 Overview ................................................................................................................................... 44 Common use(s): ....................................................................................................................... 44 Query criteria: ........................................................................................................................... 44 Results: ..................................................................................................................................... 44 Service Units Entered vs. Authorized ..........................................................................................45 Overview ................................................................................................................................... 45 Common use(s): ....................................................................................................................... 45 Query criteria: ........................................................................................................................... 45 Results: ..................................................................................................................................... 45 Service Units in a Date Range ......................................................................................................46 Overview ................................................................................................................................... 46 Common use(s): ....................................................................................................................... 46 Query criteria: ........................................................................................................................... 46 Results: ..................................................................................................................................... 46 Lesson 11: Advanced Queries: QBE & Ad Hoc
Overview ................................................................................................................................... 47 QBE .......................................................................................................................................... 47 Ad Hoc ...................................................................................................................................... 47 How to run these queries .......................................................................................................... 47 Do it! Run a QBE search ........................................................................................................... 48 Lesson 12: Printing Reports
Print Preview Window Toolbar .................................................................................................. 49 Using the Copy Command ........................................................................................................ 50 Using the Export Command ...................................................................................................... 50 Exporting a Report .................................................................................................................... 51 Lesson 13: Customizing and Saving Reports
Customizing Reports ....................................................................................................................53 Overview ................................................................................................................................... 53 Run a query .............................................................................................................................. 53 Do It! Generate the print preview ............................................................................................... 53 Do It! Adjust the report layout .................................................................................................... 54 The Layout tab .......................................................................................................................... 54 Hiding record detail ................................................................................................................... 54 Column headings ...................................................................................................................... 54 Attributes tab ............................................................................................................................. 55 Do It! Modify the report attributes .............................................................................................. 55 Creating Report Column Settings .............................................................................................. 56 Lesson 14: The Waiting Room
Overview ................................................................................................................................... 57 Do it! Add a client record to your waiting room .......................................................................... 57 Re-name a waiting room icon .................................................................................................... 57 Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 6 CareAccess
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 AAA Provider Workbook 7
Lesson 15: Q Extras
Q Links ..........................................................................................................................................59 Overview ................................................................................................................................... 59 To-Do Lists ....................................................................................................................................59 Do it! Create a To-Do List .......................................................................................................... 59 Q E-Mail .........................................................................................................................................60 Overview ................................................................................................................................... 60 Do it! Check your e-mail ............................................................................................................ 60 Create a new e-mail folder ........................................................................................................ 60 Move your message .................................................................................................................. 60 Do it! Send a Q e-mail with a link .............................................................................................. 61 Lesson 16: Videx Bar Code Scanner
Printing a Service Roster for Scanning .......................................................................................63 Printing a Monthly Service Roster ...............................................................................................66 Printing Client Bar Code Labels ...................................................................................................69 Q ScanMate Utility ........................................................................................................................74 Downloading data from Scanner ............................................................................................... 74 Scanned Data Service Unit Import ...............................................................................................74 Importing Data into Q ................................................................................................................ 74 Import Service Units .....................................................................................................................77 Import Errors ................................................................................................................................. 78 Units Imported ..............................................................................................................................79 Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Lesson 1: Discovering Q Features
AAA Provider Workbook 7
LESSON 1: Discovering Q Features
Understanding the Q database
About the Q
database system
Q database
model
The CareAccess Portal is comprised of the Q Continuum Database software, the portal session, and the site database itself. Q Continuum is the database that stores and organizes information. The CareAccess application portal provides communication between the Q database session and the end user.

Q is built on SQL Server 2000 technology. Q combines the best characteristics of both traditional relational and multidimensional data models. The Q relational database contains several features for the design and maintenance of data warehouse style applications, such as the application you'll be using, CareAccess.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479COFA68947 Multideminsional database
Supports online analytical processing (OLAP)
Provides multideminsional view of data
Finds answers to complex questions about the organization Traditional relational database
Supports online transactional processing (OL TP)
Provides two-dimensional view of data
Finds answers to simple questions about the organization Lesson 1: Discovering Q Features
8 CareAccess
Transacional
processing vs.
analytical
processing
The traditional relational database structure is based on a two-dimensional model of data organized in rows and columns. This structure lends itself well to online transactional processing (OLTP), but is too inflexible for complex data analysis.

OLTP provides answers to simple questions, such as "What was the total expenditure for all services in May 2005?"
Business
intelligence
A multidimensional database supports online analytical processing (OLAP) through data mining. You can explore and analyze large quantities of data in order to discover meaningful patterns and trends using ad hoc queries. For example, you can find answers to complex, multi-layered questions, such as "Who are all clients over the age of 64 who have received a unit of waived services in January 2009?
You see the answer is four clients over the age of 64 have received a unit of waived services in January 2009. The answer is indicated where the dimensions intersect on the data cube. While a three-dimensional cube is often used to graphically represent multidimensional data, the total number of dimensions is not limited to three!
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Time
Jan 2009
4 Service
Senior Daycare
j
-
Client personal data
Joseph IV1ore\le
Sara Douglas
Karin Lang
Cathyrn Gonzolez
Lesson 1: Discovering Q Features
AAA Provider Workbook 9
Starting a Q database session
Do it! Start Q
database
session
After the client software is installed, you are ready to start a Q database session.

The CareAccess Application Portal available on the internet. So you can access the Q database using a web browser, such as Internet Explorer.

To begin a Q database session using Internet Explorer:

1. Click the Internet Explorer icon on your desktop. The browser is opened.

2. In the Address field, type https://www.careaccess-ca.com and click the Go button.

The CareAccess portal site is displayed. The CareAccess Application Portal login fields are located in the upper left of the browser window.

3. Type your user name in the User name field. Click Tab to advance to the Password field.

4. Type your password in the Password field, and click the sign in button.

The CareAccess "Member Area" is displayed.

Install the client
software
You install the client software one time only. To install the client software on your workstation:

1. Click the "Download the Citrix Presentation Server Client for 32-bit Windows" link.

2. When the File Download dialog box is displayed, click Run, and follow the directions to install the client.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Address https: //www . careaccess·-ca, com
Log in ~
User name:

I I Password:

I I
AdvantE! d Options>>:>
~
If y ou wish to use the latest Citrix Presentation Server Client, you can install it. After installation, y ou must restart your brow ser.

Download the Citri x Presentation Server Client for 32- bit Window s Lesson 1: Discovering Q Features
10 CareAccess
Start Q demo
database
session
To start Q demo database session after the client is installed:

1. In the Application Portal, click your site's Q icon. (This icon will be labeled with your site name or county.)

2. The Q Login screen is displayed.

3. Type your user name in the User ID field. Notice that the system forces your user name to all upper case. Click Tab to advance to the Password field.

4. Type your password in the Password field, and click OK The Q demo database session is started. The Q workspace with the Open Launcher is displayed.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Applications [l, 11/' rij f;)
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AAA Provider Workbook 11
Lesson 2: Exploring the Q Workspace
LESSON 2: Exploring the Q Workspace
Q workspace
components
The Q workspace includes the following components:

Menu bar Contains command options for accessing files, views, data, tools, opened windows, and help.

Toolbar Provides quick access to commonly used commands. To display or hide the Toolbar, click the View menu.

Launcher Lists objects that are in the Q database.

Process Center Lists any opened objects in hierarchical navigation list. To display or hide the Process Center, click the View menu.

Waiting Room Lets you create links to frequently used information. To display or hide the Waiting Room, click the View menu. To add items to your waiting room, right-click on the Title Bar and choose Send To>Waiting Room from the popup menu.

Status Bar Identifies information about the current Q database session. To display or hide the Status Bar, click the View menu.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 II Q Training Database
Menu Bar -----File Edit View Da~a Tools- Winaow Heli;;, Tool Bar
Process Center I X
Launcher
(in Tab View)
Process Center __ .....,. __
Waiting Room
t"."."' Open
Main I Referrals I Accounting J System (
Caregiver /Care Recipients
!l Caregivers
f.!) CARs Services
I ntl !l Clients Assigned to SSP Case Manager
!l 1nactive Clients
Logged Calls
'-' To Do Items
r il'i?W items ~s .a list (;: !:L!splay whe
Waiting Room ---.,!:! cu,m, cwrtoey ccuemJ
Status Bar ____ ,.._ _ _ ~, Q- _-T_R_N-_U- S-,E-R_(_S_yst - em_ A_tl_m_in-ist_r_at_o_r @_ A_r_e_a_A_g-er 12 CareAccess
Lesson 2: Exploring the Q Workspace
This page intentionally left blank.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 AAA Provider Workbook 13
Lesson 3: Navigating with Q Grids
LESSON 3: Navigating with Q Grids
Exploring the launcher
Overview In a database, records are stored in lists or "tables." These tables can include agencies, clients, service unit records, care plans, etc. In Q we call these tables "grids." This lesson will cover how to work with grids.

Displaying the
launcher: two
views
The Launcher is the most important grid in the Q system. This is the starting point for the work you will be doing in the system. The Launcher is a list of all of the grids, queries and functions in the system.

There are two ways to view objects in the Launcher: List view and Tab view.

By default, Q is displayed in tab view the first time you log in.

To switch to list view (alphabetical) click the "Show items as a list" checkbox in the lower left corner of the Launcher.

In this workbook we will use the Launcher in list view.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
•
,..... Open ..

Descriptiqn
Abbreviations Qpen
Accounting Events
Accounting Periods
ADCRC ·Annual Client Export (102) E'_rint
ADCRC Annual Client Report (1 02) QBE
ADCRC .Guarterly R·eporting (101)
Additional Units Authorized (One-Month)

8.d hoc
Additional Units Authorized (Permanent)
Adjustments
ADUADL Updater (Calif. MSSP !NAP.IS to NAPIS-only)
ADLsMDLs
ADLsMDLs Care Plan Codes
Agencies
Agencies/Services
Agency Clients by Age Range
Agency Clients Report
Agency Contracts
Agency Services Condensed
Agency /Clients
Aggregate Service Unit Entries by Agency L:J I Record: ~6To1 387 cription· ~lose IP: i how iter:n; •as lay when system starts
Lesson 3: Navigating with Q Grids
14 CareAccess
Opening the
launcher
Once you double-click on one of the Launcher items, the Launcher will disappear.

If you need to open the Launcher to access a new item, simply open it up! Click the Open button on the toolbar
Click File > Open from the Q menu bar.

With your keyboard, enter CTRL + O
Command
buttons in
launcher
When you select an object in the launcher list, there are up to six command buttons available, depending on the type of object selected.

Displays either a grid list of items or a query dialog box to search for items to include in a grid.

Opens a dialog box to create a new record for the selected object. The New button is disabled for report objects.

Opens either a formatted document or a query dialog box to search for items to include in a formatted document.

Opens the query by example (QBE) dialog box to display records or sets of records that match criteria that you specify.

Opens the ad hoc query dialog box. Similar to QBE, with more control. Ad hoc queries answer questions, such as: "Who are all clients born July 20, non-minority, female, widowed, with an annual income less than $10,000 living in Zip Code 12345?" Also you can query for Null values using the Ad hoc dialog box.

Not used in our version of Q.

Objects When a database session is communicating with Q, you use the application to view, modify, create, and deleted objects.

There are several different types of objects in Q, each with a different purpose.

Tables are objects in the relational database that actually store the data.

Grids display lists of Q objects. Double-click any object in the list to display its dialog box
Dialog boxes (sometimes called data input screens) are used to created objects and input data values and information into objects.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ...... •
•
•
_Erint
Q_BE :::,
Lesson 3: Navigating with Q Grids
AAA Provider Workbook 15
Code tables assign data validation values to fields in dialog boxes to ensure that users input the correct data in the right fields. They also populate drop-down lists with data values so users can easily select data instead of typing it.

Query screens are dialog boxes used to search for specified information stored in tables.

Exploring Q grids
Locating objects
in a grid
The Launcher itself is a grid. Every table in Q is displayed in a grid view which resembles a spreadsheet. In some smaller grids, it may be easy to locate the item you desire. Other times you may want to use other methods to find items.

There are three ways to locate an item on a grid:

The scroll bar Use the scroll bar on the right side to locate the item. In the Launcher's list view, the objects are always listed alphabetically. In other grids, the items may be sorted by other columns, such as Date or ID number.

Quick jump For grids that are sorted alphabetically, quickly type the first three letters of the item you are looking for. Q will search the first column for items that begin with those first three letters and "jump" there.

The Find
command
Use the Find function:

1. Click Edit > Find in the Menu bar.

2. The Find in Grid dialog box is displayed. Enter a description of what you are looking for in the "Find What" field.

3. Click the Find button.

4. Q will find all items that match the text. You may need to click "Find" multiple times before Q locates the item you are looking for.

5. When Q finds the item you are looking for, click the Close button on the "Find in Grid" dialog box.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 .==-------i'~-i'-
r"-~c==~--.d
.d
: , ', Find in Grid El
Find Ylhat: I Units
CQlumn: ... [A .... 11 _____ fj_,
r Match Entire Field f7 Search using wildcard characters(; and?) r MatchCase
.Eind
Lesson 3: Navigating with Q Grids
16 CareAccess
Do it! Open an
object's grid
You can open the grid associated with an object by double-clicking the object name in the Launcher. When you double-click some objects a grid is displayed, while double-clicking other objects opens a query dialog box. When a query dialog box is displayed, you can type a search string in any of the text fields to retrieve a specific record, or simply click the Query button to fetch all records.

The Client's
Query
To view the grid for the Clients object:

1. If necessary, click the Open button in the workspace toolbar to display the Open Launcher.

2. In the Open Launcher, locate and double-click the Clients object. The Clients query dialog box is displayed.

3. Leave the fields blank, and click the Query button. Leaving the fields blank will list all active clients in the table.

Use the Process
Center
Notice that the clients grid is displayed and the objects are also listed on the left, in the Process Center.

Navigating
through records
in a grid

4. Double-click on one of the clients listed in the Process Center.

5. When the client record is opened, the preceding Clients grid is no longer visible. However, there are two ways of navigating through the client list from here:

Double-click on a client record in the Process Center.

Use the buttons on the toolbar: . 6. Close the record by clicking the Close button located at the bottom right. You will be returned to the list of clients.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC1 19A5-43CA-4631-9D5C-479C0FA68947 II Q Training Database
File Edit View Data T cols Window Help
List of Clients
!·····!i Abase, Dannie (#191)
:-----!/ African , Lily (#192)
!·····~ Andrews, Julie (#56)
:-----!/ Aranda , David (#325)
L_ ___ rf} 113 Clients (Asner, Ed (#20) - Yan, Cindy (#266)) •
•
1 xi
SSN
African, Lily (#192) 192 4123/1921 111 -35-6890
Andrews, Julie (#56) 56 10/1/1935
Aranda, David (#325) 325 718/1937
Asner, Ed (#20) 20 1rnst1929
Beatty, Warren (#32) 32 3/3011937
Becall , Lauren (#22) 22 9/16/1924
Bennett, Tony (#60) 60 8/3/1926
Blythe, Sheila (#245) 245 6!611970
Bono, Chast!y (#99) 99 3/411969 ..=J l Record: 1 of 117 Selected Records: 1 Sorted by: Name Qose /4
►
Lesson 3: Navigating with Q Grids
AAA Provider Workbook 17
The Close button Pressing the Close button will close the record and return to the grid.

If you click the button, Q will close the current record and the preceding Clients grid in one step, and return you to the Launcher.

The toolbar
navigation
buttons
You can also press the "up" button on the toolbar to go up one level, which would return you to the grid that you started with.

Opening a new
window
Notice that when you open a record in a grid, the grid window disappears. If you would like to keep the grid window open when the selected record is opened, hold down the SHIFT key before opening the object.

Grid toolbar When you open a Q object, a small toolbar is displayed at the top-left of the grid window. After selecting an object in the grid list, you can click the toolbar buttons to perform the following tasks:

Displays the New dialog box for adding new records to the selected object.

Displays the Open dialog box for editing existing records in the selected object.

Deletes the selected object.

Copies the selected object.

Customizing grids
Customizing
Options
You can right-click in a grid list to display the menu options for the grid. The menu options may vary depending on the grid displayed, but the typical menu options always include options to change the appearance of the grid, such as adding and removing columns in the grid.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Lesson 3: Navigating with Q Grids
18 CareAccess
Do it! Add and
remove columns
in a grid
To change the appearance of a grid, add columns that are displayed:

1. Right-click in the list area of the Clients grid. The grid's popup menu options are displayed.

2. Click the Add Columns popup menu option. The Add Columns dialog box is displayed.

3. Click the check box for Age, Living Status, Poverty Status, Race, and Sex.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 # List of Clients
Cl x~
Name
•
Andrews ; Julie
Aranda, David
Asner, Ed
Beatty, Warren
Becall, Lauren
Bennett, Tony
Blythe, Sheila
Bono, Chastity
Brimley, Wlforci
Brooks, Mel
Brown, Anna
Brown, John
Browne, Matha
""'··-···-- ••:.1, _ I Record: 1 of 115 s
Birth Date SSN
Care Plan Ma?s Creation
Client Statemenes.

Generate·Client Bar Code,Label(s)
Client Demographic Report
New Client
Open Client
Delete <Elient
Copy Glient
Deactivate Client
Calendar View
~alendar Report
Check Out Client
Card View
Grouping Display Area
Collapse All
§::piand AIT
Add CollJmns ... :ctrl+-D
t Add Columns to Clients List El
=i
: .. ·{ ] II in household
: D Active
~ .. -0 Activity Assessment
·D Address (Billing Information)
.. ~ Age
·D Birth Date
-0 By
It] ·0 California AD Ls/lAD Ls
~ .. -0 Care Plan Headers
It] ·D Caregiver
: ..... 0 Change Agency
~ .. □ Change Agency • I
r Show Qnly Selected Columns
1ave
II Eind .

II Qefault
" ·£ancel
.::J
[;;,lose
Lesson 3: Navigating with Q Grids
AAA Provider Workbook 19

4. Click the Save button. The columns you checked are added to the grid.

Re-arranging
columns

5. Notice that the columns appear in the same order that you checked them.

Change the order by dragging and dropping the Race column next to the Name column so that it appears as the second column on the grid.

Re-sizing
columns
Remove a
column

6. Click and drag the vertical line divider between the Name and Race columns to make the Name column wider.

7. Right-click and select Add Columns from the popup menu.

8. Clear the checkbox next to SSN and Birthdate to remove these columns.

Do it! Sort and
group your grid
Q allows you to sort by any field displayed on the grid. You can do a simple sort by just one column, or set up a sorting hierarchy of two or more columns.

In addition to sorting, you can also group records by one of the columns.

Grouping allows you to collapse and expand a large list for easier navigation.

Grouping also allows you to display the number of records in each group (subtotal.)
Simple sorting To sort the grid by one column (simple sort):

1. Click on the Age column header to sort by that column. Notice that Q sorts it an ascending order first.

2. Click on Age again to change the sort order from ascending to descending.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Name Birth Date SSN Age Living P0verty status Race status .. Andrews, Julie 10/1/1935 74
7~M "=l?7' 8t n .. 1-.-.], ,o '""lf"IO~._ - p: ' 'I " :I # List of Clients
Lesson 3: Navigating with Q Grids
20 CareAccess
Complex sorting To sort the grid by two or more columns (complex sort):

1. Right-click in the grid and select Sorting and Grouping from the popup menu.

2. Click the button to move everything (Age) from the Selected box to the Available box.

3. Select Race and click to move it from Available to Selected.

4. Repeat for the Sex column and then the Name column.

5. Click the OK button to save settings and return to the grid.

The grid is displayed sorted first by race, then sex, and then name.

Grouping Turn on grouping by Race:

1. Right-click in the grid and choose Sorting and Grouping from the menu.

2. Click the word Off in the top line until it turns into On.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 II Sorting and Grouping
Available: Selected:. ~o~.: O.ro_ui:iing;
Living. Status ........................ ...! --------- Age Descending ff Poverty
Name
Status ~
Race <-
Sex
l
Johnson, Gloria
Freeman, Morgan
Huxtable, Clifford
P,:,itier, Sidney
~
~
Black or African American
Black or A fricarr American
Black or African American
Black or A fricarr American
~ort: I ::~rng: Ascending On
Asceridln,:;i
Ascending OH
QK I, ~ancel
5/25/1944
111 /1945
7112/1937 555-44-3333
212011927
66 .65
72 .8~
Ncr
AAA Provider Workbook 21
Lesson 3: Navigating with Q Grids

3. Click the OK button to save settings and return to the grid.

The grid is displayed with groups by Race. Within the Race groups, the records are sorted first by sex and then by name.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 # List of Clients -
x ~
Name Race l Age Liv.Ing, poverty Se :Status status
~ Black or A fr-ican American
Dee, Rubie· (#31) Black or African Am ... 85 Fe
Freeman, Morgan (#119) Black or African Am .. . 65 Mc
Poitier; Sidney (#23) Black or African Am ... 83 - Mc
~ Hawa_iian
Client, Courtney (#331 ) Hawaiian 70 Alone Above 100 ... Fe ::.I Multiple, Race
Jane, CareReceiver (#314),. Multiple Race 68 Not Alone Abo·ie 100 .... Fe John, Caregiver (#313) Multiple Race 28 Not Alone Above 1 00 ... Mc Lesson 3: Navigating with Q Grids
22 CareAccess
This page intentionally left blank.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 AAA Provider Workbook 23
Lesson 4: The Client Record
LESSON 4: The Client Record
Unique client
record
In Q every client has a unique client record. No matter how many case managers the client has, or how many services he is receiving, he will only have one Q client record. Case managers, fiscal staff and providers will all work with the same client record. Client assessments, case notes and care plans are accessible by first opening the client record. (You will work with these in later lessons.) Do it! Search for
a client
Remember that in Q there are thousands of clients already in the database.

Before creating a new client record, you should always query for the client to see if he or she already has been entered into the database.

To search for a client:

1. Display the Launcher in List view.

2. Locate and double-click Clients. The clients query screen is displayed.

3. Enter "D" in the Last Name field of the query box.

4. Press the Query button. Q displays all of the active clients whose last names begin with "D."
Do It! Search the
inactive clients
list
But Wait! Let's assume that you do not see your client in this list. There is one more place to check!
To search for the client in the Inactive Clients list:

1. Without closing the current List of Clients, click the Open button in the workspace toolbar to display the Launcher.

2. Locate and double-click the "Inactive Clients" object on the Launcher.

3. Enter "D" in the Last Name field of the query box.

4. Press the Query button. Q displays all of the inactive clients whose last names begin with "D."
Do It! Reactivate
a client record
If your client is in the inactive clients list, you should re-activate his or her record.

To re-activate a client record:

1. Right-click on the client record and select Activate Inactive Client. 2. Click the Close button at the bottom of the List of Inactive Clients.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 # Clients - [Query] Ef
ID SSN Birth Dale
J Last Name First Name Ml
I Case Ma nag er
..J Case Man ager U nil
..J
_Query I C)ear !;ancel
24 CareAccess
Lesson 4: The Client Record
Do It! Create a
new client record
Client Main
Demographic
Screen (MDS)
Let's assume that you did not find your client in the list of active or inactive clients.

In this case, you will create a new client record:

1. Click the New button in the grid toolbar to create a new Client record:

A new client record is displayed in Edit mode:

The client record has many different types of input fields:

Text fields Enter text or numbers in these fields. Examples: First Name, Street/Address and Directions.

Date fields Date fields can be entered in MMDDYYYY format, or you can use the pop-up calendar next to it. Do not type in slash (/) marks when entering dates with your keyboard.

Drop-down fields In these fields, choose from one of the options in the list.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 # New Client - [Add]
Client Data ] ConfidentialttyA3illing J Programs J Physicians I Miscellaneous J Client Information -------------------
Last Name First Name Ml Intake Date
--------.--------r= jos/23/2010 .:J First Name Last Moved Date .:J F aciltty •Name F aciltty Type
..:] Street/Address
Zip
Directions I Identifiers County of Permanent Residence
..:] F aciltty County
l
Personal Information ----------
Phone 1 Phone 2 F aciltty Phone
I -- I - - L-- Birth Date Age Sex Other (Sex)
.r-,--1 --,3·1r--- Marttal Status If widowed, since when? .----------,..:] ~ Race .-------3 ..... Elhnictty
3 Other (Race)
SSN SSN (#2) Medicare
I -- I -- Medi-Cal CIN# Medicaid County of Origin
Client Profile ----------------------------------------~ #. in household
Functionally Impaired
Female Head of Household
Language
Rural 3 Receives Medicaid
iJ Poverty Status ;;:..- ==--3-."" Receives SSI/SSP
,----3--,· Li~ing Status ..:] Disaster Registry
d Needs Translation ,-----3-. ..,, Other (Language) ;.....--===---- Interpreter ,---___:===::= Ag_dress History I 8_ddttional Client Info I Assessments I, Care !:Jan ! , E:amily I, !jistory I ~ave i]
s;_ancel
AAA Provider Workbook 25
Lesson 4: The Client Record
Do It! Enter
client
demographics

1. Enter information into all required fields:

First & Last Name
Address, City, and Zip
Birth Date (to calculate age)
Sex
Race
Ethnicity
SSN (if available)
Marital Status
Rural Status
Poverty Status
Living Status

2. Click the Save button at the bottom of the client demographic screen (MDS.) Do not close the client record!
Annotations When working with client data, you can place a comment on almost any field.

This function is called , and it is accessed from the right-click shortcut menu of a field. Annotate enables you to leave reminders about work that needs to be completed or to make comments intended to be read by others working with the client. After you create the annotation, a flag denotes that there is a comment attached to the field; this flag is circled in the example below.

Note: If a field is a read-only field, you will not be able to enter an annotation for that field. If you feel you should have access to a read-only field, contact your system administrator.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
•
•
•
•
•
Annotate ...

I Cllont, Courtnoy (Cllont) - (Viow Only)
Clet1 I eontld«t v.e.no I ProgrewM I Ph'fslcl!Jn.s I ~lt!OU, I Cllenl Wonnallon
La Name Frsl Name Ml ir.ateOllle
------.. -----r· 1010912010
A J<.A. Flrsl t-lame Ml Les!Name Lest Mo\led Dale
F ,.9Clltv __ Neme ________ Fr-ectt - y_T_ype _______ _ Slreel/A!b ess
Slele
P'
Client Profile
, fl hou$ehol(I R1.nl
fl6ldJcnllly .,.,.ad
Female Head of ~ehold l
Language r-------
Pov y .etus
LIW'lg Sletus
Neech Tramtatlon
00,e, ~)
•
•
•
•
•
PMSONI Worfflllllon
Phone 1 Phone 2 FaclltyPhone
F~,2 ---- I
erth Dale Aoe SelC Olher (Sex)
r10-7/04- -~940 --· ..... erne1e
Elhricty
SSN Medcare
Med.Qi! Medicaid Colny ot Origin
I
Plaiceofe.1h Veter... ~Oate
R
100-.. F Receives SSIISSP
Olsa~er Registry
Qose
26 CareAccess
Lesson 4: The Client Record
This page intentionally left blank.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 AAA Provider Workbook 27
LESSON 5: Client Assessments
Lesson 5: Client Assessments
Overview The California Department on Aging requires that providers collect assessment information on clients depending on the service provided: These assessments must be updated once per fiscal year:

Service ADLs/IADLs Nutrition Risk
Personal Care
Homemaker
Chore
Home Delivered Meals
ADC/H
Case Management
Congregate Meals
Nutritional Counseling
Do it! Enter
assessment
information
To enter ADLs and IADLs:

1. Click the Assessments button at the bottom of the client demographic screen.

2. Locate and double-click California ADLs and IADLs to open the assessment.

3. Click the Edit button located in the lower right of the dialog box.

Notice when you click Edit that today's date is automatically filled in the "Last Updated" field. Only assessments updated within the fiscal year will be reported on that year's annual client report.

For example, let's imagine that Tony Curtis' record was updated on May 12, 2006.

That date is within FY 05-06, so the ADL and IADL counts will be properly reported on the FY 05-06 annual reports. However, if the assessment was not updated between July 1, 2006 and June 30, 2007, this client will be reported as having MISSING ADLs on the FY 06-07 annual reports.

ADLs/IADLS
Assessment
screen
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
28 CareAccess
Lesson 5: Client Assessments

4. For the Eating ADL, select Some Human Help from the Safe Functioning Level drop-down list.

5. Skip the other checkboxes and drop-down lists.

6. Continue filling in the Safe Functioning Levels for the remaining ADLs.

7. Click the IADLs (Part 1) tab and fill in the Safe Functioning Levels for the IADL information.

8. Click the IADLs (Part 2) tab and fill in the Safe Functioning Levels for the IADLs.

9. Click the Save button. The Providers of Care tab is not required.

Making changes In Q, to update the assessment you will simply return to the form and make changes to the existing information. There is no need to start from scratch every time you make a change!

1. Click the Edit button at the bottom of the California ADLs/IADLs assessment.

Notice that Q populates the "Last Updated" field with today's date.

2. For the Eating ADL, select Independent from the Safe Functioning drop-down list.

3. Click the Save button.

4. Click the History button. The History grid is displayed. Notice that there is a record displayed for every instance that this assessment was changed.

5. Double-click on the last row in the grid.

Notice that Q uses yellow to highlight the changes that were made to the record.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 AAA Provider Workbook 29
Lesson 6: Client Service Plans
LESSON 6: Client Service Plans
Overview Your clients will have an individual service plan for every service that they receive from your agency. The service plan will serve as the placeholder for all information about the provider, service, rate, authorization and delivered units.

For example, the client will only have one Assisted Transportation service plan for his/her entire enrollment period. You will simply add information to it on a monthly basis.

This is also called client service "enrollment."
Do it! Create a
Personal Care
Service Plan
Open the client's care plan:

1. Display the Process Center (if necessary) by clicking on the View menu and clicking on Process Center until it is checked.

2. Use the Process Center scroll bar to find the "Care Plan" section of your client's record:

3. Click on "Care Plan." The first tab of the care plan is the Service Plan tab where you will add services.

4. Click the New button to create a new service plan.

5. Select Assisted Transportation from the Service drop-down list. *The Unit of Measure is auto-populated! This is not related to Title III Service.

6. Skip the Social Service Program drop-down list.

7. Select Title IIIB from the Funding Source drop-down list.

8. Select Custom Transports from the Agency drop-down list.

9. Enter 09/01/2009 in the Start Date field. (Leave the End Date empty!)

10. Press the Save button.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 $··~ Care Plan
: $ ···~ Service Plan
: i····© Current Problems
i····© Resolved Problems
~-- jp, History
30 CareAccess
Lesson 6: Client Service Plans
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Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Lesson 7: Entering Authorized & Delivered Units
AAA Provider Workbook 31
LESSON 7: Entering Authorized & Delivered Units
Do it! Create a
weekly
authorization
schedule
Now that we have created the basic service plan, we will enter a weekly authorization schedule. This client receives service every Tuesday and Thursday.

Once we set up this schedule, Q will calculate the number of authorized units based on the number of Tuesdays and Thursdays every month. This will repeat every month until the care plan is disenrolled.

1. Click the New button to create a new service plan.

2. Select Personal Care from the Service drop-down list.

3. Select Title IIIB from the Funding Source drop-down list.

4. Select Home Care Specialists from the Agency drop-down list.

5. Select Min. 2 hours from the Rate Condition drop-down list.

6. Enter 09/01/2009 in the Start Date field. (Leave the End Date empty!)

7. Press the Save button.

To enter a weekly authorization schedule for personal care:

1. Click on the Schedules tab of the care plan.

2. Click the New button to create a new schedule.

3. Select Weekly from the Frequency drop-down list.

4. Double-click on the Tuesday row.

5. Enter 4 in the Units field.

6. Click the Save button. You will be returned to the previous screen.

7. Double-click on the Thursday row.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 [QI
I.Xltt C0n'rnelU
o,-.,,._,....c.-.

Unh ,~--.-COI..NsH!nh Oroup e
·.,-----34- 9 I
:J---
Reite
Condition
Lesson 7: Entering Authorized & Delivered Units
32 CareAccess

8. Enter 4 in the Units field.

9. Click the Save button. You will be returned to the weekly screen.

10. Click the Save button to save the new schedule. Note that the "Units/Month" field has now been populated.

11. Click the Close button to return to the service plan.

Do it! Enter
delivered units
Service units
monthly
calendar
In Q, all delivered service units must be entered manually. In this exercise we will practice entering units directly on the client service plan. However, in a later lesson we will learn how to log units for all clients at once.

To enter delivered personal care units on the client care plan:

1. Click on the Service Units tab of the care plan:

2. Click the New button to create a new service unit month record.

3. Select September from the Month drop-down list.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ~ tit"" Care Plt1n Schedule • RSPIMJt!CS
Frequency ErledweDllte
FcJtr 31011)1/2008
RIil$
COldJoo
5'Jncl&')I
Monday 711<4/2008 ,. 7116/2008
,, 7118f2008
7119/2008
~ ~ ~ I #.
-,v RSPIN/HCS (Care Plan Service) - Curtis, Jamie Lee - [View Only] Care Plan ttem ----------------------------------~
Service
!Respite In-Home
Agency
!Home Care Specia~sts
status Disposition
Unit o1 Measure Social Service Program
IHR
start Dote End Dote
107!0112008 .------ r Unmet
Case Manager other
!Provided .------- !other .------ ..-
Q.eneral J Scb,edules J S!:!spensionslOverrides J C~se Recording J B,eason 1or Service ) ~
Funding Source
ITltlelll-E
Rate Condition
IMin . 2 hours
Cost!Jnlt
$21 .50
Average Cost
I $000
Lesson 7: Entering Authorized & Delivered Units
AAA Provider Workbook 33

4. Select 2009 from the Year drop-down list.

Notice that all of the Tuesdays and Thursdays are emboldened!

5. Enter 4 in the date box for September 1st, 3rd, 8th, & 10th.

6. Click the Save button.

7. Click the in the upper corner of the care plan service window to close the client's record completely.

You are now finished with creating a service plan, authorizing units, and logging delivered service units!
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 '11" New Service Unit Month - ~ PIN/HCS 1 xi
Service Units -------------------~
Agency Service
1,-H-om_e_C_a_re- Sp_e_c-ia-list_s ______ lRespne In-Home Month Year Authorized Entered
!July ..:J j2008 ..:.II 40.00 1 o.oo 1
Frequency Schedule Summary
f,,veekly JTu-4, Th-4
(7 Calendar View
r--su;;--~n;;;-JWed~Jfrif""""s,rt""
2 3 4 5
r-ii-r--r-- 6 7 8 9 10 11 12
r--i-i-i-i-i13 14 15 16 17 18 19 r-i-r-r--=i-rll W ~ ~ ~ i-r-r-r-r----= Schei;!ules I Service Unn History I ~ave <;:.ancel
Lesson 7: Entering Authorized & Delivered Units
34 CareAccess
This page intentionally left blank.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 AAA Provider Workbook 35
Lesson 8: Other Service Unit Entry Methods
LESSON 8: Other Service Unit Entry Methods
Service Unit Entry
Overview Use this service unit entry method for entering units for the same agency, but (possibly) different services and different dates.

In this exercise you will use a query to find all clients who receive service from Home Care Specialists, and access their service plans directly from the grid. This will make the monthly service entry much quicker!
Do it! Query for
service
recipients
Do It! Service
Unit Entry
To find clients who receive service from the same agency:

1. Display the Launcher in list mode.

2. Double-click Service Unit Entry.

3. Select Home Care Specialists from the Agency drop-down list.

4. Enter 09/2009 in the Month/Year field.

5. Click the Query button. You will be presented with a list of client care plan records which match the criteria you entered in the query.

1. Double-click on the care plan record for your client. You will be presented with the September 2009 service month record, ready for data entry!

2. If you do not see the calendar view, click the Calendar View checkbox.

3. Click the Edit button.

4. Click in the 09/15/09 date box.

5. Enter 4. 6. Click the Save button.

7. Click the Close button to return to the list of other Service Entry records.

8. Click the Close button again.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 . Smvlc:u lJntl [nlr:, (Oul!ryJ 1!!1~13
Cle«
36 CareAccess
Lesson 8: Other Service Unit Entry Methods
Service Unit Logging
Do it! Query for
an Agency's
clients
Service Unit
Logging Query
Use this service unit entry method for entering units for the same agency, same service and same date.

In this exercise you will use a query to find all active Personal Care clients and log all service units at the same time!
To query for all active clients for September 2009:

1. Display the Launcher in list mode.

2. Locate and double-click Service Unit Logging to open the Service Unit Logging query dialog box.

3. Select Home Care Specialists from the Agency drop-down list.

4. Select Personal Care from the Service drop-down list.

5. Enter today's date in the Date field (or hit the space bar).

6. Select All Clients Receiving Service from the Clients to Select field.

7. Check the Fill in new Service checkbox.

8. Enter 4 in the Units field since most clients receive 4 hours per day.

9. Select Default from Care Plan from the Funding Source drop-down list.

10. Press the Query button. The service unit logging grid is displayed.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 00 S.ervico Unit togging • [Query]
1N9 ~ianalbws 1he .ray 01 seM:e lff&S IOI partlC\W agency, ttrYICe, Ind e 6fltJl'CY
Ser
----~3 cl
fll In New Set.ice Unite With the fo9owlng
F•fl,_ Ulllslor r
Clens "" h the 10IO'IWlg
l'llor
Units ...
:lgj~
J
0" Service Unit Logging Agency: Home Care Specialists·Se/0,cji1 l?ersonal Care Name
Personal Care 8/1 8!2010 4,00
AAA Provider Workbook 37
Lesson 8: Other Service Unit Entry Methods
Do it! Log
personal care
units
Q has now displayed the full list of clients who can receive service and has prepopulated the grid with four (4) units for every client. Now you are ready to log the delivered units with one click!
But wait! Let's imagine that Elizabeth Taylor is listed on the service unit logging grid, but she should NOT receive a unit today. To make an adjustment to Ms.

Taylor's record:

1. Double-click on the row for Ms. Taylor.

2. Use the delete key to clear out the quantity field.

3. Use the delete key to clear out the funding source field until it is blank.

4. Press the Save button. Q will return you to the service unit logging grid.

Commit all units Now that you have made the necessary adjustments, commit (log) the units!

1. Click the Commit button in the lower left corner.
* Notice that the hourglass will appear while Q is committing units.

2. Click the Close button.

Verify your work That's it! You have logged units for all clients. To verify that the units have been committed:

1. Display the Open Launcher in list mode.

2. Locate and double-click Service Units in a Date Range

3. Select Home Care Specialists from the Agency drop-down list.

4. Enter Personal Care in the Services field.

5. Enter today's date in the Start Date and End Date fields.

6. Click the Query button. The report shows the units that you committed by doing service unit logging.

7. Click the Close button to return to the launcher.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 <>0 Taylor, Elizabeth (Service Unit Logging).·= [Edit]
Displayed Columns·==--------------------------,
Q.ate of Service jos1181201 o ·j
Quar,irty ~
CQsl, ~
Eunding Source :,....... lnie ___ Ill B
________________ _ f]
Max Unrts Authorized I
Additional Columns (in Alphabetical Order) -------------------~ !;l,illed r
Error Message
B,oute
Service ~ctivrty
Service l;!nrt Entry Type
S~e
C2.mmit
38 CareAccess
Lesson 8: Other Service Unit Entry Methods
This page intentionally left blank.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 AAA Provider Workbook 39
Lesson 9: Disenrolling and Deactivating Clients
LESSON 9: Disenrolling and Deactivating Clients
Overview When a client is no longer receiving service from your agency, you will disenroll the client by putting an end date on the care plan. You can either do this by:

Opening the client's record and navigating to the specific service plan or Querying for a list of all clients who are receiving service.

To use the second method, it is ideal to use a report which will allow us to access the client's care plan just by double-clicking. Therefore, we will use the query called "Clients Receiving Service (Detailed.)"
Do It! Disenroll a
client
To disenroll a client from a list:

1. Display the Launcher, if necessary.

2. Locate and double-click Clients Receiving Service (Detailed)

3. Enter Personal Care in the Services field.

4. Enter Home Care Specialists in the Agencies field.

5. Click the space bar in the Start Date field to auto-enter today's date.

6. Repeat in the End Date field.

7. Click the Query button.

Client care plans
grid
Q displays a row for every care plan record found. If the client has two care plans for the same service, you will see a row for each.

8. Double-click on the row for your client. Q will display his/her care plan.

9. Click the Edit button.

10. Enter yesterday's date in the End Date field.

11. Click the Save button.

12. Click the Close button to return to the grid. The client is no longer listed.

You have now disenrolled the client, and he will no longer appear on your service roster, list of active clients, or the service unit logging list.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
•
.l_ll Clients Receiving Services Services: Home Delivered Meals From Agencies: Meals 0 Service/ Average
Agency Client: Name Start Dale Route End Date Monthly
Units
04HDM/MOW Asner, Ed 12/5/2005 60.88
04HDM/MOW B ecall Lauren 12/16/2005 60.88
40 CareAccess
Lesson 9: Disenrolling and Deactivating Clients
Do It! Disenroll
multiple clients
But wait! What if you need to disenroll multiple clients at once? You will use the "Mass Disenroll" option:

To disenroll multiple clients:

1. Open the list of Clients Receiving Service (Detailed) if necessary.

2. Highlight the service plan records that need to be disenrolled. *Tip: Hold down your CTRL key to select more than one row!

3. Place your mouse over one of the highlighted rows and right-click.

4. Select "Mass Disenroll."

5. Enter an appropriate End Date. Do It! Deactivate
a client
If the client is still alive and living in the county, DO NOT deactivate the client.

Other providers in the county may still be serving this client.

However, IF the client is deceased, moved out of county, or institutionalized, you should DEACTIVE his/her record after disenrolling the care plan.

To deactivate a client:

1. Query for the client's record.

2. When the client's record is displayed, click the Edit button.

3. Enter the date, your name and a brief description of why you are deactivating the client in the Directions/Identifiers field.

4. Click the Save button.

5. Right-click on the blue title bar and select Deactivate Client.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Lesson 10: Common Queries
AAA Provider Workbook 41
LESSON 10: Common Queries
Overview Q has many different reports that you can use for different tasks. In order to get the results that you want, it is important to start with the right report. Here is a brief explanation of the different reports:

Report Name Results Unduplicated
clients?
Care
plan
details?
Inactive
clients?
Clients with
Active Care
Plans
List of client records
for clients who have
active care plans
matching the query
criteria
Yes No No
Clients with
Service Units
by Time
Interval
List of client records
for clients who have
one or more delivered service units
matching the query
criteria
Yes No Yes
Clients
Receiving Service (Detailed)
List of service plan
records matching
the query criteria
No Yes No
Service Units
Entered vs.

Authorized
List of service plan
records matching
the query criteria
and an aggregate
total of authorized
and delivered units
for the month
No Yes Yes
Service Units
in a Date
Range
List of service unit
records matching
the query criteria
No Yes Yes
Details on each of these reports are included in the following pages.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Lesson 10: Common Queries
42 CareAccess
Clients with Active Care Plans
Overview Q queries for active clients who have a care (service) plans that match the criteria entered. The results will be a list of unduplicated client records.

Common use(s): Reporting client demographics for clients who are receiving particular service(s).

Reviewing active "roster" and removing clients from it.

Query criteria:
(required fields are marked with an asterisk *)
In the example above, Q will find any client who has a care plan for personal care OR chore OR homemaker services from Home Care Specialists agency. Q filters the results by care plan dates; Clients whose care plan start date is AFTER 7/1/06 or whose end date is BEFORE 7/1/06 will be filtered out.

Results:

Grace Jones appears once even though she has two matching care plans for Home Care Specialists: one for Personal Care and one for Chore.

Accessible table(s): Client record (Double-click) No automatic access to service plans.

Special Functions: Care Plan Mass Creation.

Q: Why can't I see the matching service plans that Q found? A: The purpose of this report is to display an unduplicated list of clients. Since one client may have many matching care plans, Q is unable to display care plan details for care plans without listing the client more than once. To view service plan details, open the client record (double-click) and click his/her care plan button. Consider using the "Clients Receiving Service (Detailed)" query if you would like to view care plan details such as Start Date and End Date.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
•
i.i Clients with Active Care Plans · [ ... l!lliJf:I
Services Personal Care; Chore; Homemaker ~ Services (one / many / all) Agencies I Home Care Specialists Agencies (one/ many / all) As Of lo?/01/2006 J As Of (Date)·
Case Managers I Case Man~gers (one / many / all)
.Q.uery C]ear J;;ancel /4
Name Age Race Sex Low Lives Alone Income
Jones, Grace 83 African American Female Yes
Taylor. Elizabeth 74 White Yes Yes
Eastwood, Clint 76 White Male Yes Yes
Lesson 10: Common Queries
AAA Provider Workbook 43
Clients with Service Units by time interval
Overview Q queries for clients (active, inactive or both) who have at least one (delivered) service unit record that matches the criteria entered. The results will be a list of unduplicated client records.

Common use(s): Verifying client totals on quarterly (SPR) reports.

Reporting unduplicated client demographics for a particular service category.

Query criteria:
(required fields are marked with an asterisk *)
In the example above, Q will look for all clients who have at least one unit of delivered congregate meals recorded on his/her care plan with service dates between 7/1/06 and 6/30/07. (Please note that you may enter a future date.) It will not filter by agency or funding source or meal site.

Results:

Accessible table(s): Client record (Double-click) No automatic access to service plans.

Special Functions: Care Plan Mass Creation.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
•
1:111 Clients wit h Service Units by Time Interval ... l!llill:f Services I Congregate Meals ~ Services (one I many I all) Agene1es ~ Agencies (one/ many I all)
Stail Dale Start Date & End Date•: Service unit I 0710112006 J End Date J 06/30/2007 "Date of Service" must fall between these two dates. Acbve Active and I naclive
Funding Sources Active•: client record status: active,
inactive or both. S~es Funding Sources (one/ many I all) (Meal) Sites (one / many I all)
1rJ1uery __ -I CJear ~eel /4
I:] Clients Receiving Service Units Services: Congregate Meal cil~x l~I
Name Month of Birth11r Race Low Income Ag;
Beatty, Warren March Whire No 69
Becall, Lauren September Whire Yes 82
Lesson 10: Common Queries
44 CareAccess
Clients Receiving Service (Detailed)
Overview Q queries for care (service) plans for active clients that match the criteria entered. The results will be one row for every matching care plan. This is NOT an unduplicated clients query.

Common use(s): Viewing current service "roster."
Disenrolling all care plans at once.

Query criteria:
(required fields are marked with an asterisk *)
In the example above, Q will find any care plan where the service is Personal Care OR Chore OR Homemaker. It will NOT filter by agency or funding source. It will only find care plans that were active at least one day in the first quarter of FY06-07.

Results: Accessible table(s): Service plan record (Double-click) and Client record (rightclick on name).

Special Functions: Mass Disenroll and Mass Copy.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
•
!fa Clients Receiving Service (Detailed) - ... l!llif
Services Personal Care; Chore; Homemaker •·· •◄-- Services (one/ many / all) Agencies ◄ Agencies (one / many / all)
Funding Sources ◄ Funding Sources (one / many/ all)
Start Date I 0110, 12006
~ ◄ Start Date & End Date•: The care
End Date I os13012006 plan must have been active at least one day in this date range
.Query Cjear bancel - - -
Lesson 10: Common Queries
AAA Provider Workbook 45
Service Units Entered vs. Authorized
Overview Q queries for care plans that match the criteria entered for active and inactive clients. One row will be displayed for each active care plan found, even if there are zero authorized and zero delivered. It displays the total number of service units entered and authorized recorded on each care plan.

Common use(s): Reporting monthly service unit totals for a particular agency in a single month.

Identifying clients who are on a roster, but NOT receiving service.

Query criteria:
(required fields are marked with an asterisk *)
In the example above, Q will find all care plans for Home Care Specialist agency that were active during at least one day in the month of July 2006 and display the total number of units authorized and total units delivered for the month. If the client is receiving two different services from this agency, Q will display a row for both.

Results:

Accessible table(s): Service plan record (Double-click) and Client record (rightclick on name) Special Functions: None (However, you can mass disenroll by using the "Open Multiple Service Units Entered vs. Authorized" and changing the End Date for all).

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 I
•
•
1:81 S()rvice Units [ntcred ~- Authorized £Query] l!llif £1 rho n::po~ ndciites la tl-e rnarth ontep:,d tl-e m.,rbe, of mb otthairod lD the cli=nt fDI lhot rnmh lbaoad on eilha, the t4oo1Hy Amc<.nts function or the ccl-e:lula in eff~ I on Iha la.sl day cl the rnarth) eornpaecfto the "n uml:s of i.nh actual~ deli-leie:l to l~e dienl, Aoen::p
S"ervic:e.

MonlhfYea
Furdrg Scu,ce,
Home Ca,e SP3cialsl•
II
jo712oos July, 2006
r
4 Agency (one or all}
Service (one or all)
Month/Year'
Funding Sources
(one I many I all)
l::i Service Unit Entered vs. Authorized Report-Agency: Home Care S Units Wnits
Units
[;liet:1t:; Name . Service Start Date Authorized Delivered Authorized · Units
Montalban, Ricardo Personal Care 7/1/2005 0.00 0.00 0.00 Montalban, Ricardo Homemaker 11/1/2005 15.00 1.00 14.00 Lesson 10: Common Queries
46 CareAccess
Service Units in a Date Range
Overview Q queries for service unit records matching the criteria entered for active and inactive clients. One row will be displayed for each service unit record found.

Records with negative quantities will also be displayed.

Common use(s): Reporting service unit totals and/or costs for specific services or agencies.

Query criteria:
(required fields are marked with an asterisk *)
In the example above, Q will look for all service unit records (delivered units) entered for Home Care Specialist agency for Personal Care OR Chore OR Homemaker service with service dates between 7/1/06 and 9/30/06.

Results: Accessible table(s): Service Unit record (Double-click) and Client record (rightclick on name).

Special Functions: None
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
Ths r8port ,howa al oero,i:,90 unl.quanbtta•, toget/",91 Nth their casl:s, that flay9 l:Je,a,i "1i!in a gr,en dale ran~ - -
Agenc,y ~ Ca,e S peciah,<e
Fundng Scuee
I Per,ona Ca1e; Ch:ue; Homemaker:
) 07tU1 1£006
03/3)/2006 j
Agency (one or all)
Funding Sources (one / many/ atl)
Services {one / many I all)
.,. __ .,.,tart Date & End Date•: ·oate of
Service" mus fall be reen these bNo
dates.
(Meal) Sites (one I many/ all
I i ____ !ilel.Y J C_e.c
AAA Provider Workbook 47
Lesson 11: Advanced Queries: QBE & Ad Hoc
LESSON 11: Advanced Queries: QBE & Ad Hoc
Overview Standard client searches allow users to query for all clients by ID number, SSN, Birth Date, Name (or partial name), Phone, or Case Manager. Using the five common Q queries, you can also query for clients who receive certain services.

However, you can build more complex queries using the Query By Example (QBE) and ad-hoc functions in Q.

QBE The QBE query allows users to pull up a sample Client Main Demographic Screen (MDS) and fill in what they are looking for. Users are limited to fields from the main tab Client MDS. Users can fill in ONE value in each field, but can fill in multiple fields.

Use QBE for the following types of client queries:

Clients whose age = 65
Clients whose race = "African-American"
Clients whose race = "African-American" and City= "San Jose" Clients whose City = "San Jose" and rural = "Yes"
Ad Hoc The ad-hoc query function allows users to query on almost all fields in the database, including assessment fields, SSP enrollment fields and demographic fields. It also allows users to search for information in a range, multiple values for the same field and also missing (null) data. Use the ad-hoc method to perform the following types of queries:

Clients whose age > 65 AND < 85
Clients whose race = "African-American" OR "Asian-American" Clients whose race = "African-American" OR "Asian-American" AND City = "San Jose" OR "Palo Alto"
Clients whose rural status = "Yes" and "NAPIS ADL Count >= 3 Clients whose race = NULL (missing) OR age = NULL (missing) How to run these
queries
To run one of these advanced queries, you will use a basic Q query and combine it with the QBE or Ad Hoc function.

Identify the basic client population that you want to find and then choose a basic query to work with. For example:

All active clients: use the basic Clients query
MSSP clients: use the "Clients Assigned to SSP Case Manager" query MOW recipients: use the "Clients with Service Units by Time Interval." You will use this basic query in combination with the QBE or Ad Hoc function.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
•
•
•
•
•
•
•
•
•
•
•
48 CareAccess
Lesson 11: Advanced Queries: QBE & Ad Hoc
Do it! Run a QBE
search
Query 1: All female, African-American clients who received Home Delivered Meals since the beginning of the fiscal year.

This query requires that the database search for one value in the "Race" field and one value in the "Sex" field. The QBE query can be used to provide this information. The QBE will be used in combination with the "Clients with Service Units by Time Interval" report.

1. Highlight "Clients with Service Units by Time Interval" on the Launcher. Click the "QBE" button in the upper-right. A sample Client MDS screen will be presented.

2. Select Black African-American from the Race drop-down list

3. Select Female from the Sex drop-down list.

4. Press "Query." You will be presented with a standard "Clients with Service Units by Time Interval" query window.

5. Fill in service, start date, end date, active status and funding source.

6. Click the Query button.

Q will present a list of all African-American female clients who received a Home Delivered Meal funded by Title IIIC2 between 7/01/2004 and 3/31/05.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 $~ IHomc Odiwctcd Me.lb
~
D~ I 01 lill /2004 ~
I 0Jn112Cffi :I
I tlelll C2
1- Clients Receiving Service Units Services: Horne Deliv X ~
Active· ID Race· Sex Service
Units
X 1216257409 African-American Female 14.00
X 1222259121 African-American Female 14.00
1399935618 African-Ameri an.~ Female 14.00
"•<1 ~1 4136121 Africa ··, -f.~male 14.00 ~- ·-J~
.iJ
Lesson 12: Printing Reports
AAA Provider Workbook 49
LESSON 12: Printing Reports
Print Preview
Window Toolbar
The table below describes the functions of the commands displayed in the Print Preview window toolbar.

Icon Command Function
Table of
Contents
When grouping columns together, this
tool allows you to quickly navigate to a
particular group in your list.

Print This command sends the document to
your default printer.

Copy This command copies the report so
that it can be pasted into another
application such as MS Word or MS
Excel.

Find This command opens the familiar Find
window which you can use to locate
key words within the report.

Single Page This command is used to change the
display from a multiple sheet preview
to a single sheet preview.

Multiple Pages This command is used to change the
display from a single sheet preview to
a multiple sheet preview.

Zoom This command is used to make the
preview image larger or smaller.

Page Up/Down These commands allow you to scroll
through the pages of the report.

Navigation
Arrows
These commands allow you to move
back and forth through the pages of
the report.

Export This command enables the export
function described later in this section.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 E'.r1nt. - I
00 [Q]
.:l I
1211
~ack I
FQrwardl
Lesson 12: Printing Reports
50 CareAccess
Using the Copy
Command
Located within the print preview window toolbar, the Copy command can be helpful in copying a report from Q to another application. The steps below describe how to copy a report from Q to MS Word document.

1. Print the list of data using one of the Q system print options.

2. Click in the print preview window toolbar.

3. With Q still open, open the other application (MS Word) where you want to copy the Q report.

4. With your new MS Word document open, click or click Edit in the menu bar and select Paste. Using the Export
Command
The Export command found in the Q print preview window toolbar enables you to export the data of the report to create:

A MS Excel document
An HTML document
An RTF (rich-text) or Text file that can then be imported into other applications.

A read-only PDF document others can view using Adobe Reader.

A TIFF file that can be inserted into a MS Word or MS PowerPoint document.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
•
•
•
•
Lesson 12: Printing Reports
AAA Provider Workbook 51
Exporting a
Report
Despite the many different uses for all of these export types, the Export command itself is very straight-forward. The steps below explain how to export a report from the Q system.

1. Print the list of data using one of the Q system print options.

2. Click in the print preview toolbar.

3. Select the format in which you want the resulting export.

4. Click . 5. In the Save As window that opens, use the Save In: field to locate the correct drive where your file will be saved.

NOTE: Your C drive is listed as C$. Normal file order is shown to navigate to the user's Desktop.

6. Enter the name of your new document in the File Name: field.

7. Click .

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Save As Excel
My Documents
Administrator on COACTX1 5
~ Local Disk (C:)
~ DATA (D l
XenS erver Tools (E:)
E$ on 'Client' (T :)
D$ on 'Client' (U:)
C$ on 'Client'(\/:)
Documents and Settings
IC) Administrator
Inn
My Network Places
L
Save ·as type:
dave
Save7
Cancel
Lesson 12: Printing Reports
52 CareAccess
This page intentionally left blank.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Lesson 13: Customizing and Saving Reports
AAA Provider Workbook 53
LESSON 13: Customizing and Saving Reports
Customizing Reports
Overview Q allows users to customize (printed) grid reports by adding or removing columns, adding summary information and updating the formats.

Run a query 1. Display the Open Launcher in list mode.

2. Locate and double-click Service Units in a Date Range on the Launcher to open the Service Units in a Date Range Query dialog box.

3. Enter City Senior Center in the Agencies field.

4. Enter Title III C1 in the Funding Sources field.

5. Enter Congregate Meals in the Services field.

6. Enter Start Date of 07/01/2005 and an End Date of 06/30/2006. 7. Click the Query button. The Service Units in a Date Range grid is presented.

Do It! Generate
the print preview
To display the print preview, right-click and select Print Report. The print preview window also has buttons in the lower left corner for adjusting the columns (Add Columns button) Sorting and Grouping, Formatting, and Column Settings.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 .8.~r.k ~ FQrw-'fd El!port
., . ., .. ·$ .,
Service Units for Agency: City Senior Center
Funding Sources: Title Ill C1 Services: Congregate Meals From 07/0112005 to 06/3012006 All Meal Sites (SIS)
Service
Agency Tot•ICost CitySeriorCenter
Client Beatty ,Warren
CongregeteMeals
CongregeleMeals
Congregate Meals
Total:

Avenge:

Nun1>er of records in sec1ion: 3
Agency Tot•ICost CitySerioreente.-
Client Becell,Lauren
CongregeleMeals
Congregate Meals
Totiil:

Average:

Nurrber ofrecords insectim :

Agency Tot•ICost CitySe riorCenter
Client Broolr:s,Mel
CongregeleMeals
Congregele Meals
Congregate Meals
CongregeleMeals
CongregeleMeals
CongregeteMeals
Congregate Meals
Congregate Meals
Tolill:

Auerage:

Nuni>e r of records in section:

AgencyTot•ICoflt CttySeriorCenter
Client Connery, Sean
r'N>IW',.,_H,.M,.,.J,.

Service Clieri
Add Colt.rms ... 1 Sort and Q.(oo..., -1 [ormat ... I Column Settings . ] Sorted by: Age ncy Tota l Cost, Cli ent
Fun dirG Source Date Service QUlntity
TklellC1 12131'2005 22.00
Tftle II C1 3/7/2006 1.00
Tille II C1 'lfl]/2006 1.00

24.00 ...

Tkle II C1 10l31f2005 21 .00
TklellC1 11130!2005 22.00

43.00 21.50
me II C1 8/31/2005 18.00
Tftle Ml C1 9/30/2005 19.00
Tltle II C1 10/31/2005 17 .00
Tftle II C1 11130/2005 22.00
Tftle II C1 12/31'2005 16.00
TftlellC1 3/7/2006 1.00
Tltle II C1 'lf21/2006 1.00
Tltle NI C1 7(.31/2005 21 .00
11 5.00

14.38 Quem!Ky
Ag,rcy
Tobil CORI
$40.70
$1,85
$1 .85
$44.<G
$14.80
$38.85
$40.70
$79.55
$39.78
$33.30
$35.15
$31.45
$40.70
$29.60
$1.85
$1 .85
$38 .85
$212.75
$26.59
Agency
ToteilCost
Lesson 13: Customizing and Saving Reports
54 CareAccess
Do It! Adjust the
report layout
In this exercise, you will be adjusting your own column settings.

1. Click the button on the lower left.

2. Following steps from Lesson 3 (page 19), sort and group the grid by Client. The Layout tab The first tab that you will be presened with is the Layout tab where you can adjust the overall layout of the report, including orientation, margins and column detail.

To adjust the report layout:

1. If necessary, return to the print preview window by right-clicking in your grid and selecting Print Report from the popup menu.

2. Click the Format button in the lower left corner.

3. Select Landscape from the Orientation drop-down list.

4. Check the Show Number of Records, Show Totals, and Show Averages checkboxes.

Hiding record
detail
To hide the record details and only view the number of records in each group:

5. Check the Show Only Group Headers checkbox* in the Miscellaneous box shown above.
*This checkbox is only available if your report has grouping applied. If the checkbox is unavailable, return to the print preview and turn on grouping by client! The grid is displayed with only the Group Headers and the totals.

Column
headings
To alter the name of the "Agency Total Cost" column to simply read "Cost:"

6. Highlight the "Agency Total Cost" column on the left

7. Enter Cost in the Column Title field on the right.

8. Check the Bold checkbox to enbolden the entire Cost column.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 (fJ Report Format 13
!,ayout J e,ttributes j
Orientation -----~ Margins
jAutomatic ci Left
Right
~
Top
~
Bottom["""""6:5a
~
inches
inches
inches
inches
Miscellaneous -----~
JZ Show Number of Records
17 Show Totals
17 Show Aver ages
17 Show Only Group Headers
r Start New Page for Each Group
Attributes of Individual Columns ---------------------, Agency
Service
Client
Funding Source
Date Service
Quantity
II
r Bold
r /tali,
r Underline
Column Title (if different from title on left)
ICosi I _JJ
Lesson 13: Customizing and Saving Reports
AAA Provider Workbook 55
Attributes tab 1. Click the Attributes tab.

Do It! Modify the
report attributes

2. Select Column Detail from the Element to Modify drop-down list or click on the column detail on the report preview image.

3. Select Verdana from the Font drop-down list.

4. Select Blue from the Foreground drop-down list.

5. Click the OK button. The Print preview is displayed as below:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ~ Report Format El
l,ayout e,ttributes ]
fl estore Defaults
L~<-f Cff«rla
,wlt'llby.NrM"
Element to Modify
I Column Detail
Caption
_J
Font Alignment
_IVerdana 3 JLeft
Font Size r Bold Foreground
~ jBlue 3 r /ta#,, Background
r Underline !White .:J Sample
ABC ... XYZ
abc ... xyz
123 ... 890
?!@ #$% " &*()!
r Banding
r Solid background I on data items)
Qk .[;ancel
service Units for Agency: City senior Center - Funding
sou re es: Title IIIC 1 Services: Congregate Meals From o 7/01 /2 005 to 06/30/2006 A II Meal sites
~ency SeMce
Cliert : Asner, Ed
Tota :

Number of reoords in section: 7
Cliert : Bancroft, Mne
Tota :

Number of reoordsin section: 7
Cliert : Beatty,Watren
Tota:
····'>Qer
Sorted by: Client
Fundng
Source ~ency
Q.Jantny Tota cost
144.00 $000
144.00 $000
144.00 $000 ·, , __ __,,.......

Lesson 13: Customizing and Saving Reports
56 CareAccess
Creating Report
Column Settings
Once you have changed the formatting for a report, you may save the changes.

Users may save as many report column settings as desired-or use settings that the System Administrator has made accessible to all.

1. Click the Column Settings button on the print preview window to open your column settings.

2. Click on the New icon

3. Enter a name for your Column setting in the Description field

4. Click on Save and then Close.

5. Click on the Close button to close the Column Settings window.

Note: The Column Settings command button is available when you initiate a report using the print command found in the Q toolbar ( ) or when using the right click menu print options.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Record: 1 of 1
~ New Column Setting - [Add]
~ """'"'"" Colum. ns
Q_escription I
~ Additional Columns (in Alphabetical Order)
Ct;eator
~ubhc r
AQPly to Print
Preview
S1,ve from Print
Preview
<;;ancel
[i]
~ ancel
AAA Provider Workbook 57
LESSON 14: The Waiting Room
Lesson 14: The Waiting Room
Overview The Waiting Room is a part of the Q workspace where you can keep shortcuts to objects in Q that you access frequently. Any object can be added to the waiting room. Here are some examples:

Client Smith's Nutritional Risk assessment
A full list of your current clients
A query box for running a report
Do it! Add a
client record to
your waiting
room
Re-name a
waiting room
icon
Let's imagine that you would like a quick way of accessing a client's record.

To add a shortcut to your client record to your waiting room:

1. Display your Waiting Room if necessary by clicking on the View menu and clicking on Waiting Room until it is checked.

2. Place your mouse on the blue title bar at the top of the client record.

3. Right-click and select Send To> Waiting Room from the popup menu.

Q has now added an icon to your waiting room:

Re-name the waiting room icon:

1. Right-click on the icon that was just placed in your waiting room and select Rename from the popup menu.

2. Enter your client's name in Last, First format in the text box.

3. Click away from the text box to save it.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
•
•
Authorizations ... -------------re Close
Send To ►
Web Links
Mail Merge
'f2 Taylor, Elizabeth (Client)
Veteran
Medicare
58 CareAccess
Lesson 14: The Waiting Room
This page intentionally left blank.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Lesson 15: Q Extras
AAA Provider Workbook 59
LESSON 15: Q Extras
Q Links
Overview In Lesson 14, you learned how to add shortcuts to your Waiting Room for quick access. These shortcuts can also be called "Links" in the Q system. There are other places in the system where you can add links:

Client MDS (Confidentiality/Billing tab)
Case Notes
Q E-Mail Messages
To-Do Items
There are four ways to add a link to one of these records:

1. Click on the gray area of any form and drag it into a Links field.

Example: Click on the gray area of a client assessment form and drag into the Links field of a To-Do Item.
*Note: This does not work for grids!

2. Right-click on the title bar of any window and select Send and then Waiting Room, To-Do Item, or Message Recipient.

3. Right-click in the Links field and click on the name of any open window.

4. Drag a link from one record (including the waiting room) to another.

Example: Create a new mail message and drag a waiting room shortcut into the "Links" field of the message.

To-Do Lists
Do it! Create a
To-Do List
In Q you can create a to-do list, and be reminded when those items become overdue!
To create a to-do item:

1. Display the Launcher.

2. Locate and double-click To Do Items. 3. Click the new icon to create a new To Do Item.

4. Enter yesterday's date in both of the Date fields.

5. Enter Follow-Up Call in the Narrative field.

6. Drag the waiting room item for your client into the Links field.

7. Click the Save button.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
•
•
•
1 New·To Do Item
2 Open
3 Client, Courtney ( Client)
~
To ...

Lesson 15: Q Extras
60 CareAccess
Q E-Mail

8. Click the Close button to return to the To Do List.

Notice that Q is now displaying a warning message about your overdue item! Overview You can send e-mails to other Q users through the Q system. This is a safe, confidential way of sharing client information. You can create a message on the fly with a link to the form you are working with, or send a message from your Inbox.

Do it! Check
your e-mail
To open your Inbox:

1. Turn on your Process Center using the View menu.

2. Click on the Tools Menu and select Messages. Q will display your Q Inbox.

3. Double-click the new message you have received!

4. Forward this message to another recipient by clicking on the "Forward" icon:

Notice your other options for reply, reply to all, print, flag or delete the message! To create a new folder and move the message there:

Create a new email folder5. Right-click on the Inbox folder in your Process Center and select New Folder.

6. Enter Saved Messages as the new folder name.

7. Click the Save button.

Move your
message

8. Highlight the original message you received by clicking on it with your mouse.

9. Click the move to folder icon.

10. Click on the Saved Messages folder.

11. Click the Move button.

The message has now been moved to your Saved Messages folder! Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 0 ~ overdue item
liJ Move to Folder J:f
Lesson 15: Q Extras
AAA Provider Workbook 61
Do it! Send a Q
e-mail with a link
To create a new Q E-Mail message:

1. Click the button in the Inbox toolbar.

2. Click the ellipse button to the right of the To: field. Select a user from the list.

3. Enter Please review this client record in the Subject field.

4. Enter See attached in the message field.

5. Click and drag a Waiting Room link into the Links field of the message.

6. Click the Send button.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Lesson 15: Q Extras
6 CareAccess
This page intentionally left blank.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Lesson 16: Videx Bar Code Scanner
AAA Provider Workbook 63
LESSON 16: Videx Bar Code Scanner
Printing a Service Roster for Scanning
This report is intended to be used for logging service units for clients schedule to receive a service.

1. From the Launcher, open the object labeled Service Roster for Scanning.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ,- Open
Des-cii tion
Remove Unnecessary Tables
R,emove U hreachable Letters
Repair Direct Referrals
R,epair .Referrals
Save Settings Privately
Scanned D al a •S elVice Unit Import Batches
SCC Annual Client Export (102)
S ll'.C Annual· Client R el)ort (1 02
sec Quarterly Reporting (101 I
Schedule Frequencies
Service Activities
--------~
S elVice !Eernponent ~-·------------ s
Service Entry Methods
·Service Roster for Scanning
Service Types
Eritry
Service Unit Entry Types
I! Unit I mptirt B ati::he.s' __________ ...J
Service Unit Logging
I§ rovid .

Service Units Entered vs. Authorized
Lesson 16: Videx Bar Code Scanner
64 CareAccess
The following screen will appear:

2. Choose the appropriate selections in each of the fields:

Agency - Select the Service Provider
Service - Select the service being provided
Route - Select the Home Delivered Meals route.

Site - Select the Congregate meal site(s).

Combined Roster for all Routes/Sites - Check this box if a single roster is to be produced combining the scheduled clients for all the selected routes or sites. If not selected, separate rosters are printed for each route/ site. The check box is only available when routes or sites are selected in the above fields.

Roster Type - Select the type of roster (All Active Clients, Daily, or Weekly).

Date - Select the date of service or start of the week. This field is only enabled if the roster type is or
Include section with unscheduled clients - Select whether an additional section of the roster is needed to list all active clients not scheduled to receive service on the selected day or during the selected week.

Unit Quantities for Scanning - Enter the option(s) that should appear in the heading of the first page to be scanned for the quantity of units. A comma or semicolon should separate the numbers between 1 and 9.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 i:.i.l Service Roster for Scanning
•
•
•
•
•
•
•
•
•
Agency
Service(s)
Route(s)
Site(s)
Combined &oster ior all
Rocrtes tsites·
Roster Type
Date of s·ervice
Include section with
,unscheduled crn~nts
llriit"Quantities f@r- Scanning
11 EJ :--============== I llLJ
---~.

Query ~ancel
"multiple"
"Daily" "Weekly".
roster's
Lesson 16: Videx Bar Code Scanner
AAA Provider Workbook 65
An example of a completed query screen is shown below:

3. When finished completing the desired fields, click on the button.

An example of a roster is below:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 i:.i.l Service Roster for Scanning
Agency
Service(s)
Route(s)
Sile(s)
Icily Senior Center
!Congregate Meals;
Combined Roster tor all C
Rocrtestsiles·
Roster Type jAII Active Cl~ents
Date ofS'ervice '--~ ,
Include section with
,Lmsctieduled (lli~nts
llriit 'Quantilies f@r- Scanning E_2,3,4,5,6
I Query I ~ancel I
Q Roster for Scanning Unit Scan: 1 111111111111111111111111111111 2 111111111111111111111111111111
Provide r: City Senior Center
3 111111111111111111111111111111 Service: Congregate Meals Units: 4 111111111111111111111111111111 Period: 8/20/2010 5 111111111111111111111111111111
6 111111111111111111111111111111
Identifier Initials/Name Name Units
11111111111111111 11111111111111 1111
Andrews, Julie
56 D 11111111111111111 111111111111111111
Beatty , Warren
32 D 11111111111111111 11111111111111 1111
Bennett, Tony
60 D
Lesson 16: Videx Bar Code Scanner
66 CareAccess
Printing a Monthly Service Roster
This report is intended to be used for logging service units for clients scheduled to receive a service.

This roster can be used for manual entry at time of service with the intention of manipulating the data once it is imported into Q.

From the Launcher, open the object labeled Monthly Service Roster.

The next screen will appear:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ~ . Open
'Desoiption
Meal Routes
Meal Siles (SIS)
'Monthly Service Roster
Past Due Notice Messages
Physicians
Service Roster for Scanning
Service Unit Entry
Service Unit Logging
Service Unit Summary by Pro.vider !Service
Service Units Entered vs. Authorized
0i;i Monthly Service Roster
Agency 11
Services) I
Route(s·),
Sile({ )
Combined Roster to All [j
RoutestSites
Roster Type ·
Date (Month/Year.)
loc lude sectio.n with □ uosehedu.led :Clii~r:ifs.
~ ... Qpen
!1~
Jj;fnt,
@E'

8.li1 hoo
ent.
_31
Query 11 ~ancel
Lesson 16: Videx Bar Code Scanner
AAA Provider Workbook 67
Choose the appropriate selections in each of the fields:

Agency - Select the Service Provider
Service - Select the service being provided
Route - Select the Home Delivered Meals route.

Site - Select the Congregate site(s).

Roster Type - Select the type of roster (All Active Clients, or Monthly).

Date - Select the month and year of service.

Include section with unscheduled clients - Select whether an additional section of the roster is needed to list all active clients not scheduled to receive service on the selected day or during the selected week.

An example of a completed query screen is shown below:

When finished completing the desired fields, click on the button.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
•
•
•
•
•
•
•
0i;i Monthly Service Roster
Agency
Service(s)
Route(s)
Sile(s)
Combined Roster for All
R o_utes/Siles
Roster Type
Date (MonthN ear.)
Inc lude section with
.UIJSCl'leduled :Cli~nts,
"multiple"
Icily Senior Center
!Congregate Meals; I
IAn Active Clients
J 08/201 0 August, 201 0
C
Query II ~ancel
Q.u_e(y
Lesson 16: Videx Bar Code Scanner
68 CareAccess
An example of a roster is below:

Q Monthly Service Roster (8 1/2 x 14)
Provider: City Senior Center Service: Congregate Meals
August 2010: Fi
Client 1 2 3 4 5 6 7 8 9 10 1
111111111111 11111111111111111111111 Andrews,Julie
56 111111111111 11111111111111111111111 Beatty, Warren
32 111111111111111111111 11111111 Bennett, Tony
60 11111111111111111111111111111111111 Brooks, Mel 15
Illl IIIllllllllllllllllllllll
Connery, Sean
27 Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Lesson 16: Videx Bar Code Scanner
AAA Provider Workbook 69
Printing Client Bar Code Labels
This report is intended to be used to produce labels for Client ID cards. The labels will include the client name, Q ID number, and a bar code (for scanning) of the Q ID number.

The format for output will be identical to the Avery 5160 laser printer labels. by 2
There are two ways to print labels:

1. Using the right click menu off a client record or a list of clients. See Figures below
Using right click menu from a list of clients
Using right click menu off the individual client record Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 (1"h 5/B"h)
Connery, Sean
Cruz, Tom
Curtis , Jamie Lee
Curtis, Tony
8/2511930
411511967
11 /2211958
6/311925
Care Plan Mass Creation
E:fient Statements
Ei&EMMIE&ilil..., CITpnt D~roQgi:'apt-ilJ Re Ori;
Client Data -I Contidentialily/Billing I Programs I Phys C]~n $t~m~t$ I Client Information Last Name First Name
.-C-lie_nt ______ __, lcourtney
Generate Client Bar Code Label(s)
eJ;lt'IDemog aphf R~pp;):

Lesson 16: Videx Bar Code Scanner
70 CareAccess

2. Using the Client Bar Code Label object off the Launcher. See below.

To use the above object off the Launcher, follow these steps:

1. Open the object from the Launcher. The
following window will be presented:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ~ . Open
'Description
Agencies
Agency /Clients
Aggregate Service Unit Entries by Agency
Care Rian Dispositions
:client Bar Code Labels
Clients
Clients Receiving Service (Detailed)
Clients with Active Care Plans
Clients with Service Units By Time Interval
E-Mail
Inactive Clients
lr.iactive Insurance Plans
Mail Merge Documents
Meal Routes
Meal Siles (SIS)
Monthly Service Roster
J Record: 5 of 33 ,_S°"rted .bY: Description
JZ ihow items as .a list JZ Q_isplay when system starts 0111 Client Bar Code Labels
Agency 11
Service(_s)
Route(s)
Site(s
start Date I .d ' Er.id Date I .:3
'.Clier;rts. Scheduled Ir
OR
'.Clier;rts. Served n
~ ... Qpen
[ieyit
~rt
Q.BE'
8,~hw
~ent
B
□
Query II ~ancel
Lesson 16: Videx Bar Code Scanner
AAA Provider Workbook 71

2. Fill out the desired fields.

Agency - Select the Service Provider
Service - Select the service being provided
Route -Select the Home Delivered Meals route.

Site - Select the Congregate site(s).

Date - Select the Start & End date of the service.

Clients Scheduled or Served - Indicate whether clients are to be retrieved based on being scheduled to receive service beginning during the date range, or clients with their initial billing (first unit billed for the service) during the date range.

The following is an example of a completed query:

3. Click on Query when finished filling out the screen.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
•
•
•
•
•
0" Client Bar Code Labels
Agency !city Senior Center E]I
Service(s) !Congregate Meals; IU
l
R,oute(s)
lJ Site(s.) ISan Jose Charities
j
Start Date lo1i01t20os ,3
End Date I ost1 mo1 o ,3
Clier,ils Sch,edulef r
OR
j~ ) Query ~ancel
Lesson 16: Videx Bar Code Scanner
72 CareAccess
You will be presented with a list of clients that meet the entered criteria:

4. From this list, select all the clients for which a label is to be printed. Use the right click menu to access the printout. See Example below:

5. Choose where the labels are to start printing.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 El
Connery, Sean (#27) 8l25i'1930
Curtis, Tony (#34) 61311925 555-55-5555
Douglas, Kirk (#1.9) 12!9i'1916
Douglas, Michael (#16) 11111940
Eastwood, Clint (#28) 5l31i'1930
Sorted. by: Name
Qose ]
Car~ Piao Mass .Creation
~nt sta!:.e[nf; s
Generate Client Bar Code Label(s)
Client Demographic Repo"rt
New Client
Open Multiple Clients
I Report Configuration· I!!]
The Cl!eot Bar Code Labels report require~ Avery 5160
labels. If you are printing on a partially used sheet of labels, you can enter the Row aod Column where you
wish to begitrpricrting .' To prim on a full sheet er.rter 1 for bo.th the Row a1:1d Cofutnn fields.

Lesson 16: Videx Bar Code Scanner
AAA Provider Workbook 73
After saving the window, users are presented with the labels in print preview mode:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Beatty, Warren 32 Connery, Sean 27 Curtis, Tony 34
1111111 1111111111 11111111 11 1111 1111 111111 111111111111111111111 11111111 111111 11 11111111111111 1111111111111 Douglas, Kirk 19 Douqlas, Michael 16 EastV1<>od, Clint 28 11111111 1111 11111 11 1111111111111111 111111111111 11111111111111111111111 111111111111 111111111111111 11111111 Lesson 16: Videx Bar Code Scanner
74 CareAccess
Q ScanMate Utility
Downloading
data from
Scanner
This utility is used to import the information from the scanner into your hard drive.

Users will then download the file into Q.

Make sure the scanner is connected to the computer you are using to download the data into.

Turn the scanner on when ready to download the data.

1. When you are ready to download the scanner information, you will need to run the utility located in Start Programs Q ScanMate Utility VxComm.

2. When the first window appears, click on Tools, Transfer Applicaton.

3. You will be presented with a window. The options you should select are as follows:

Base Station
COMM1

4. After making sure the proper selections are chosen, click on Transfer Application.

5. Once the application has completed its transfer, all windows will disappear from your monitor.

6. You can then locate the file in your C:\Windows folder. The name of the file will be QscanMate.txt. At this point, the data contained in the scanner is cleared.

NOTE: it is advisable to change the name of the QscanMate.txt file to one that is descriptive of the Agency/Meal Site/ Date for historical purposes. An example is 13street98012010.txt.

Scanned Data Service Unit Import
Importing Data
into Q
The data collected and stored in the Videx Laserlite scanners are currently programmed and extracted using the VXCOMM utility.

The service unit import format and contents are described in detail in documentation. The file must contain sufficient information to identify the client, provider agency, service, and unit provision information. Specifically, the provider agency code, service code, date of service, quantity of units, unit cost, last name, and social security number or Q ID number must be included.

To import your data from the file you created previously into Q, follow these steps:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 file's Q's
client's
client's
Lesson 16: Videx Bar Code Scanner
AAA Provider Workbook 75

1. From the Launcher, open the utility labeled, Import Videx Scanner Data.

2. Choose the Agency from the query window.

3. You will be presented with a list of service units to be imported. **NOTE**: Once imported, unit information can be reviewed and revised using standard manual entry functions (including Service Unit Entry and Service Unit Logging). Additionally, batches and their accompanying units can be completely deleted and resubmitted until the units are posted for accounting purposes (an administrative function within Q necessary for billing processes, typically occurring on a monthly cycle). After posting occurs, the units are locked down and can be adjusted only via the manual entry functions and only if the appropriate authorization has been granted to the user.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ,-. Open
Qpen
Ue,w
Inactive ADLsilADLs
Inactive Agencies
E.riht
Inactive APS Workers
Inactive Assessment Reasons
Inactive Caregivers
..,...J Q.BE
6dhoc
Inactive CARs Services frei;;ent
Inactive Cities in County
Inactive Client Benefit statuses
Inactive Client Bene.tits
Inactive Clients
Inactive Conservatorship
Inactive Custom Messages
I Recor;~i: 143 of. 387 Sqrted by~ Descrip:tiqn ~lose
IZ g1:iow items as a iist IZ Q_isplay when.s,ystetn starts • Import Videx Scanner Data - [Que_r,'y]
fill.ency
Query I. C[ear· [.ancel l
- ~
Q's
Lesson 16: Videx Bar Code Scanner
76 CareAccess

4. After being presented with the table and list of units to be imported, You can right click, or double click on the record, and choose the appropriate selection as described in this chapter.

Right click view.

Double click view
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 I Record: 1 of 1
2/10/2010 (Scanned Data Service Uriit:lm'ilOrt Batcti)
Displayed.Columns
~ency Icily Senior Center
Q.ate Createa 1211 0!201 0 at 02: 55 PM
RecQrd.s lmpoi:;tea I 8
~ecords Reje_cted I 0
iotal.!Jnils lmportea I 8.00
IotaH.)nils Rejeetea I 0.00
Created ~Y !system Administrator
[mportea ✓
Import Errors
Units Impofted
Additional Columns (in Alphabetical Order.- -------------------~ Sile
!Jnils lmporteq I l: ...... fiew ....... :I. ~lose 1 ~
Lesson 16: Videx Bar Code Scanner
AAA Provider Workbook 77
Import Service Units
When selecting Import Service Units, you will be presented with another window as seen below:

File to Import - Specify where the file is located to be imported. Clicking on the ellipses button allows users to browse their PC for the desired file.

Service - Select the service. The choices offered reflect the services provided by the Agency that was chosen in Step 2 of this Lesson.

Funding Source - Select the funding source for the Service Unit records to be created. Combo box allowing only one selection, containing the option from Care (which is the default selection) as well as any funding sources for the selected agency/service combination that has the Schedule Cap option enabled (i.e. the Title III
funding sources.)
Date of Service - Enter the service unit delivery date. Date control. The user must indicate the date for which units are to be entered/edited. If the service is a simplified entry service entry method, only the month and year of the date supplied are consulted.

Unit Cost - Enter the unit cost for the Service Unit records to be created.

Numeric text control for currency entry; not enabled if the service is a cost entered at billing time service entry method.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 [ Addtt"'"81 Columns. (in Alphabetical Order)
Sile l1 3th street Inn
I[ ltnPort -S.er.vice Units I [mport Errors I !Jroiils lmt1orted I • Im po rt Service Units -
Fil.e to import
Set:vice I
E_undin Sour.~~ I
(late of Service I
i,,lnit Cost I
Meal Sile
11 •
•
•
"Default
"Suppress
•
•
I~
Plan"
Enforcement"
~
El
I
a ~
a
Lesson 16: Videx Bar Code Scanner
78 CareAccess
Import Errors

5. Click to start the import process. The process is complete when the query window disappears and the record has an X in the Imported column as seen below.

This function allows you to view any errors in the import process.

After selecting this item from the right click menu, you will be presented with another window as seen below. Any errors will show up as rows in this table.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ~ave I
Date Created
Record: 1 of 1 Selected Records: 1
Records
Imported
Records· Total Units
Rejected Imported
Records· Total Units
Rejected Imported
lmport Service Units
Import Errors
Units Imported
There are no items to show in this view
[ Reco~d: None Selected Recortls: 0
Total Units Created by
Rejected
Total Units
Rejected Created bY,
~lose 1
Imp
Lesson 16: Videx Bar Code Scanner
AAA Provider Workbook 79
Units Imported
This item off the right click menu will allow you to view a table of all imported service units.

A window similar to the one below will be presented. Open each record by double clicking on the row to view the details of the import.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Agency Date Created Records
Imported
Records Total Untts T ota.1 Untts Created by In,
Rejected Imported Rejected
Import Service Units
Import Errors
Units Imported
0111 Units Imported (Scanned Data Service U1iit lrhpo'h;Batcti) ~ .

Beatty. Warren
Bennett. Tony (#60) City Senior.. Congregate Meals 211 0/201 0 1 .00 Brooks . Mel (#15) Cit'y Senior.. . Congregate Meals 211 ·ot201 0 1.00 Douglas. Michael (#16) City Senior . . Congregate Meals 211 0/201 0 1.00 I Record: 1 of 5
~lose
CareAccess
www.careaccess-ca.com
[email protected]
877-262-9322
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Caregivers & Care Receivers in Q
Quick Reference Guide
You can think of the process of entering Caregiver and Care Receiver/Recipient information in Q as a 5-step process with a 6th step that s highly recommended:

1. Find/Create a Client record for the caregiver, and enter an Employment Assessment

2. Find/Create a Client record for the care receiver, and enter an ADL/IADL Assessment

3. Find/Create a Caregiver record

4. 5. Link the Caregiver record to the care receiver.

6. Highly Recommended: Create Dummy Care Plan for Care Receiver This guide will give you a quick reference for each step.

Updated: 8/6/18
STEP 1
Client record
for the
Caregiver
STEP 2
Client
record for
the Care
Receiver
STEP 3
Caregiver
Record
STEP 4
Synchronize
the records
STEP 5
Link the
records
STEP 6 (Recmnd)
Dummy Care plan
for Care Receiver
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Synchronize the Caregiver record with the caregiver's Client record Caregiver Quick Reference Page 2
Step 1
Client Record for the Caregiver
Create a new Client record for the Caregiver. Enter information in the following fields highlighted in yellow:

Name
Address, City, State,
and Zip
Birth date
Race
Ethnicity
Marital Status
Sex at Birth
Gender
Sexual Orientation
Rural
Poverty Status
Living Status
Caregivers require an Employment Assessment. Click the Assessments button in the lower left, double click on the Employment Data Assessment, enter a Status, then click Save:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 -
•
•
•
•
•
•
•
•
•
•
•
•
,!J New [hent - [Add] l!lliJ Ei
Client Data ) Confidentiality !Billing J Programs J Physicians J Miscellaneous J Client Information ----------------~ Personal Information --------- Last Name First Name Ml tntake Date Phone 1 Phone 2 Facility Phone F acilily Name
street/Address
Directions / Identifiers
.-------, jorn3r201s .:J
3 Facility Type
Cly
I
i"3
SI
Last Moved Date
r:J
Zip
County of Permanent Residence
I 3
Facility County
I ..

Age Race
r--- 1,---~3
Ethnicil
3 If widowed, since when?
3 .:l SSN (#2) Medicare
I -- Medicaid County of Origin
Veteran Reassessment Date
i---::] .:l
Sexual Orientation and Gender Identification -------------------------~ Sex at Birth Gender Other (Gender) Sexual Orientation other (Sexual Orientation) 3 3 3
Client Profile ----~:_:_:_:_-_-_-_---------------------~:_:_:_:_:_:_:_:_:_:_:_-:,---, # in household Rural ...:J Receives Medicaid ..:J Functionally Impaired ..:J Poverty status .-------3-~"' Receives SSlf.SSP i.] Female Head o1 Household .----3-, Living status ..:J Disaster Registry i.] Language !English iJ Needs Translation .-------3-."' other (Language) ~------ Interpreter ~1--------- I AQ.dress History I Additional Client [nfo I Assessment Snapshots I Cat:_egivers I Assessments I Care £,Ian I Clinic ~isits I Medical Authori~ations I HH~ I Case NQtes I E.amily I t:!istory I ~ Assessn1ents -
Filter b):' snapshot type:
·Status
11 El'
Description
Busi1:1ess
ADLsllADLs Declined to State
California ADLs/lADLs City Fulltime California NAPIS-only ADLs/ Missing Cognrtive Consent.iF Part-Time ile stora~e Gurrer:it Posit Contacts Retired Custom Fields Unemploved ~ ............ -.,1.~. _ ... ;...:

Caregiver Quick Reference Page 3
Step 2
Client Record for the Care Recipient
Create a new Client record for the Care Recipient. Enter information in the following fields highlighted in yellow:

Name
Address, City, State,
and Zip
Birth date
Race
Ethnicity
Marital Status
Sex at Birth
Gender
Sexual Orientation
Rural
Poverty Status
Living Status
Care Recipients require an ADL/IADL Assessment. Click the Assessments button in the lower left, double click on California ADLs/IADLs, enter the Safe Functioning Levels on all tabs, then click Save:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC1 19A5-43CA-4631-9D5C-479C0FA68947 •
•
•
•
•
•
•
•
•
•
•
•
-
;tj New Chent - [Add] l!lliJ f3
Client Data ) Confidentiality !Billing I Programs J Physicians I Miscellaneous J Client Information -----------------, Personal Information ------------,.

Last Name First Name Ml Intake Date Phone 1 Phone 2 Facility Phone .--------,------, lorn3r201s .:J ,-----.-----
Last Moved Date Age Race
.:l .:r-, .----.:1 Facility Name Facility Type Ethnicit .:l .:l Street/Address Cty If widowed, since when?
.:l .:l state Zip
13 SSN (#2) Medicare
Directions / Identifiers County of Permanent Residence Medicaid County of Origin .:l
Facility County Veteran Reassessment Date
SeKual Orientation and Gender Identification -------------------------~ Sex at Birth Gender other (Gender)
.:l .:l
Client Profile
# in household Rural
Functionally Impaired .:l Poverty Status
Female Head of Household .:l Living status
Language JEnglish .:l Needs Translation
other (Language) Interpreter
I AQ.dress History I Additional Client [nfo I Assessment Snapshots I Cat:_egivers I Assessments I Care !:,Ian I Clinic Y)sits I Medical Authori~ations I~ Case NQ1:es j E.amily I t:!istory I lm Assessments -
Sexual Orientation other (Sexual Orientation)
.:l
..:J Receives Medicaid
~----3-.~ Receives SSIISSP
i.J Disaster Registry
.----a ...
.!jg California ADLs/lADLs (Assessment Fo
Filter by snapshot type:

ADLs I IADLs (Part 1) I 1ADLs (Part 2) I Provider
Eating
Dressin9
Safe Functioning Level
11 Independent
5 Dependent
.:l
.:l
.:l
Caregiver Quick Reference Page 4
Step 3
Caregiver record
The Caregiver record is completely different Client record. You need to create both.

1. From the Launcher, open the Caregivers query.

2. Leave all the fields blank and click on the Query button.

A list of all the current Caregivers is displayed.

3. Check the list for your new Caregiver to ensure they are not already in the list.

4. Assuming they are not a Caregiver, Click the New button.

The new Caregiver window is displayed.

5. have to fill in address, DOB, or other fields. You will synchronize this record with this Client record.

Click the Save button to save the record, but do not close the record.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 _________ from the caregiver's
# New Caregiver - [Add] El Client Information Personal Information Firsl Name Ml Lasl Name Phone SSN
1 [
street/Address Ctty Date of Birth Age
L -'~ [ state Zip Gender Marttal status Language:
~I ill ...:::.J !English
Education
Setting Location
V\lhat is the highesl level of education?
:±11 :!] ~
Employment-------------------------------------
Are you currently employed?
8 Has your employment slatus changed because of care giving duties? r No change
r Cbanged Jobs
r Family/medical leave
r Leave of absence
r Increased hours
r Decreased hours
r Early retirement
r Began working
r Qu~job
Laid off
r other
~ancel I ,, I //,
Fill in the First and Last name, gender, setting, and location. These are required fields. You don't caregiver's existing __ _
Caregiver Quick Reference Page 5
Step 4
Synchronize the Records
This step allows our Caregiver record to talk to our caregiver Client record.

1. Right-click on the title bar of the caregiver record.

2. Click on the Synchronize Caregiver with a Client option.

3. Enter the name of the caregiver and press the Save button.

4. Click the Save button (a second time).

Notice that the DOB, age, gender, and other fields are now populated in the Caregiver record. Leave the Caregiver record open.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 I Client Information
First Name
street/Address
Synchronize Caregiver with a Client
New Caregiver
Delete Caregiver
Copy Caregi_ver
The Caregiver's name will populate the Select Client field. e
Caregiver Quick Reference Page 6
Step 5
Link the Caregiver and Care Receiver
The next step of the process is to link the Caregiver and Care Receiver in Q, using the Care Recipients button:

1. On the Caregiver record, click the Care Recipients button.

2. Click the New button.

The New Caregiver/Care Receiver Relationship & Assessments dialog box appears.

3. Click on the Ellipse button next to the Care Recipient field to search the Client list.

4. Enter the first and last name of the Care Recipient and click the Query button.

5. Highlight the correct Client and click the Apply button.

6. Choose a relationship from the Caregiver Relationship drop-down list.

7. Click the Save button.

Now that you have completed the Caregiver Process you can generate the Care Plan for the FCSP Service(s) for the Caregiver. Step 6 (Highly Recommended) Dummy Care Plan for Care Receiver/Recipient
It is highly recommended that you Care Recipient. This will allow you to manage your Care Recipients as a group and find missing demographic and assessment data easily and quickly. The Service is called .

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 LJ ,, ... ,. _ , , ,, ,_ ........ ·-··
Care B.ec.,lenls Assess!l)_em !:!ls1ory ,;;_ancel
□
CG/CR Relationship ----------------------------~
\fl/hat is your relationship to the CR?
How long ago did you begin helping CR do things that he/she was no Ion (lndicate ·number of years, For !Hose (ess than a year, indicate number o Daughter In-Law check the Months·checkbox) Grandparent
Are you currently paid for providing-care to your (Relationship)? Non- Family
other Family
generate a "Dummy" Care Plan for the _____ _
FCSP-Care Recipient
Caregiver Quick Reference Page 7
Troubleshooting
If you find a Client has FCSP Service units (Title IIIE) but are missing some portion of the Caregiver Process, check the following:

See if there is a Caregiver Record. This is the most common problem. The user forgot to add a Caregiver Record (Step 3).

If there is a Caregiver Record, make sure it is synchronized to the correct Caregiver Client Record (Step 4).

If there is a Caregiver Record and it is synchronized
the problem must be with the Association of the Caregiver Record with the Care Recipient (Step 5).

Is the Care plan for a Title III E service in the Care Receiver Client Record? If so, you must delete/remove the care plan from the Care Receiver along with all service units and enter allowed, but no service units are ever entered.)
All problems must be one (or more) of those listed. Correcting the problem will allow the CARs submission to be accepted.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
•
• to that Caregiver's Client record, then
•
this information in the Caregiver's Client Record. (Dummy Care Recipient care plans are Q Reports Guide 1
rev 1/07 ME
Q Reports Guide
Overview Q has many different reports that you can use for different tasks. In order to get the results that you want, it is important to start with the right report.

Here is a brief explanation of the different reports:

Report Name Results Unduplicated
clients?
Care plan
details?
Inactive
clients?
Clients with Active Care
Plans
List of client records for clients who have
active care plans matching the query criteria
Yes No No
Clients with Service
Units by Time Interval
List of client records for clients who have one
or more delivered service units matching the
query criteria
Yes No Yes
Clients Receiving
Service (Detailed)
List of service plan records matching the
query criteria
No Yes No
Service Units Entered vs.

Authorized
List of service plan records matching the
query criteria and an aggregate total of
authorized and delivered units for the month
No Yes Yes
Service Units in a Date
Range
List of service unit records matching the query
criteria
No Yes Yes
Details on each of these reports are included in the following pages.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Clients with Active Care Plans
Overview Q queries for active clients who have a care (service) plans that match the criteria entered. The results will be a list of unduplicated client records.

Common use(s) Reporting client demographics for clients who are receiving particular service(s.) Reviewing active “roster” and removing clients from it.

Query criteria
Services (one / many / all)
Agencies (one / many / all)
As Of (Date) *
Case Managers (one / many / all)
Required fields are marked with an (*) asterisk.

In the example above, Q will find any client who has a care plan for personal care OR chore OR homemaker services from Home Care Specialists agency. Q filters the results by care plan dates; Clients whose care plan start date is AFTER 7/1/06 or whose end date is BEFORE 7/1/06 will be filtered out.

Results
Grace Jones appears once even though she has two matching care plans for Home Care Specialists: one for Personal Care and one for Chore.

Accessible table(s): Client record (No automatic access to service plans.) Special Functions: Care Plan Mass Creation
Q: Why can’t I see the matching service plans that Q found? A: The purpose of this report is to display an unduplicated list of clients. Since one client may have many matching care plans, Q is unable to display care plan details for care plans without listing the client more than once. To view service plan details, open the client record (double-click) and click his/her care plan button. Consider using the “Clients Receiving Service (Detailed)” query if you would like to view care plan details such as Start Date and End Date. 2 Q System Administrator Workbook
rev 1/07 ME
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
•
f'ersonal Care; Chore; Homemaker □
·f Horne Care Special~8ts
As Of- .[ 07 /01 ~?-99~ :I
J_
.Query
Name Age Race Sex Low Live_s·Alone Income
Jones, Grace 83 African American Female Yes
Taylor, Elizabeth 74 White Yes Yes
Eastwood, Clint 76 White Male Yes Yes
Clients with Service Units by Time Interval
Overview Q queries for clients (active, inactive or both) who have at least one (delivered) service unit record that matches the criteria entered. The results will be a list of unduplicated client records.

Common use(s) Verifying client totals on quarterly (SPR) reports Reporting unduplicated client demographics for a particular service category.

Query criteria
Services (one / many / all)
Agencies (one / many / all)
Start Date & End Date*: Service unit
“Date of Service” must fall between
these two dates.

Active*: client record status: active,
inactive or both.

Funding Sources (one / many / all)
(Meal) Sites (one / many / all)
Required fields are marked with an (*) asterisk.

In the example above, Q will look for all clients who have at least one unit of delivered congregate meals recorded on his/her care plan with service dates between 7/1/06 and 6/30/07. (Please note that you may enter a future date.) It will not filter by agency or funding source or meal site.

Results
Accessible table(s): Client record (No automatic access to service plans.) Special Functions: Care Plan Mass Creation
Q Reports Guide 3
rev 1/07 ME
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ®mrn~ ~ @rnufillrnrn rnrn~ Gm 'OTI[Il]® owmo
•
•
la! Clients with Service Units by Time Interval - .. . l!lliJl3 Services Congregate Meals l.il
Agencies 1;:l
Start Date I 07101 1200s ~ End Date. I o~no1?007 ,j
Active Active and Inactive
Funding _Sources I
_
Sites
I [ _.Q.uer.v J C]ear
l::i Clients Receiving Service Units Services: Congregate Meal Dl~xl~1
Name.' Mor.ith·of-BirHi Race Lbw Income Age
Beatty, Warren March White No 69
B ecall, Lauren September White Yes 82
Clients Receiving Service (Detailed)
Overview Q queries for care (service) plans for active clients that match the criteria entered.

The results will be one row for every matching care plan. This is NOT an unduplicated clients query.

Common use(s) Viewing current service “roster.”
Disenrolling all care plans at once
Query criteria
Services (one / many / all)
Agencies (one / many / all)
Funding Sources (one / many / all)
Start Date & End Date*: The care
plan must have been active at least
one day in this date range
Required fields are marked with an (*) asterisk.

In the example above, Q will find any care plan where the service is Personal Care OR Chore OR Homemaker. It will NOT filter by agency or funding source. It will only find care plans that were active at least one day in the first quarter of FY06-07.

Results
Accessible table(s): Service plan record and Client record (right-click on name) Special Functions: Mass Disenroll and Mass Copy
4 Q System Administrator Workbook
rev 1/07 ME
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ®mm~ rnrnrnrn[mjrnrn ~rnuillJrnrn []l]rnoomrn[([]
•
•
!m Clients Receiving Service (Detailed) - ... Rlif
Service'.s f'ersonal Care; Chore; Homemaker I .. ,
Agencies
Funding Source
SJart Da.te [ 07/07/2005 j
End Dale I 09/30/2005 ':]
_Query a
----'---
◄
◄
Qa11cel
l.m Clients Receiving Services Services: Personal Care, Chore, Homemak I , I'
~gebcy Service ll~lient: Name Start Date End Date
Home Care Specialists Homemaker Montalban, Ricardo 7 7/1/2005 7/5/2005 A Warm Embrace Personal Care Montalban, Ricardo 9/30/2005 Service Units Entered vs. Authorized
Overview Q queries for care plans that match the criteria entered for active and inactive clients. One row will be displayed for each active care plan found, even if there are zero authorized and zero delivered. It displays the total number of service units entered and authorized recorded on each care plan.

Common use(s) Reporting monthly service unit totals for a particular agency in a single month.

Identifying clients who are on a roster, but NOT receiving service Query criteria
Agency (one or all)
Service (one or all)
Month/Year*
Funding Sources
(one / many / all)
Required fields are marked with an (*) asterisk.

In the example above, Q will find all care plans for Home Care Specialist agency that were active during at least one day in the month of July 2006 and display the total number of units authorized and total units delivered for the month. If the client is receiving two different services from this agency, Q will display a row for both.

Results
Accessible table(s): Service plan record (Double-click) and Client record (rightclick on name) Special Functions: None (However, you can mass disenroll by using the “Open Multiple Service Units Entered vs. Authorized” and changing the End Date for all.) Q Reports Guide 5
rev 1/07 ME
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ~ufill@rn rnrnrrni ~oournctl ~ illJffiOom~ctl
•
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la! Service Units Entered vs. Authorized - [Query] l!lliJfl The report indicates for the month entered the number of units authorized to the client for that month (based on either the Monthly Amounts function or the schedule in effect on the last day of the month) compared to the number of units actually delivered to the client.

Agency Home Care Specialists
Service
Month/iear
Funding Sources
- -
jo112006 July, 2006

I ---------
.Query L []ear !)ncel
,..J
/4
I:; Service Unit Entered vs. Authorized Report-Agency: Home Care S - Units Units Units
CJient:, Nam& Service Star't Date Authoriz.eq Delivered Authorized · Units·
Montalban, Ricardo Personal Care 7/1/2005 0.00 0.00 0.00 Montalban, Ricardo Homemaker 11/1/2005 15.00 1.00 14.00 Service Units in a Date Range
Overview Q queries for service unit records matching the criteria entered for active and inactive clients. One row will be displayed for each service unit record found.

Records with negative quantities will also be displayed.

Common use(s) Reporting service unit totals and/or costs for specific services or agencies.

Query criteria Required fields are marked with an (*) asterisk.

Agency (one or all)
Funding Sources (one / many / all)
Services (one / many / all)
Start Date & End Date*: “Date of
Service” must fall between these two
dates.
(Meal) Sites (one / many / all)
In the example above, Q will look for all service unit records (delivered units) entered for Home Care Specialist agency for Personal Care OR Chore OR Homemaker service with service dates between 7/1/06 and 9/30/06.

Results
Accessible table(s): Service Unit record and Client record (right-click on name) Special Functions: None
6 Q System Administrator Workbook
rev 1/07 ME
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 ~ufillrnrn rnrn~ rn ffi rnoo ffiffirnrnrn
•
... Service Units in a Date Range - [Query]
This report shows all services unit quantities. together with their costs. that have bee, within a given date rang
Agency jHome Care Specialists
Funding Sources
Services Personal Care; Chore; Homemaker;
Start Date 07 /01 /2006 j
End Date 09/30/ 2006 ·]
Sites
Service Units for All Agencies - All Funding Sources Services: Personal Care, Chore, Homema Agency Service Funding Source Client pate Quantity Agenc_ Service Total Col
Home Care Specialists Personal Care LNK POS Beatty, Warren 9/16/2006 4.00 $86.00 Home Care Specialists Personal Care LNK POS Beatty, Warren 9/l 7 /2006 4.00 $86.00 Home Care Specialists Personal Care LNK POS Beatty, Warren 9/18/2006 4.00 $86.00 Home Care Specialists Personal Care LNK POS Beatty, Warren 9/18/2006 -4.00 ($8600) Home Care Specialists Personal Care Title 1118 Beatty, Warren 9/18/2006 20.00 $430.00 Title III - Intake and Assessment
Forms Guide

CALIFORNIA DEPARTMENT OF AGING

HOME AND COMMUNITY LIVING DIVISION
www.aging.ca.gov
July 2021
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 n _ CALIFORNIA
A~rNG
Table of Contents
Overview ................................................................................................................................................... 3 Data Performance Reporting Requirements ............................................................................................ 4 Designing Forms that Work ...................................................................................................................... 6 Required Title III B, C, and D (Clusters I & II), Registered Client Fields..................................................... 7 Required Title III E, Registered Caregiver Fields (Group 1)....................................................................... 9 Required Title III E, Registered Care Receiver Fields (Group 1) ................................................................ 12 Required Registered Client Level Detail .................................................................................................... 13 Federal Poverty Determination ................................................................................................................ 18 Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) Functional Impairment Status .................................................................................................................................... 20 Nutritional Risk Assessment ..................................................................................................................... 3 Legal Assistance Service Category - Case Information ............................................................................. 3 Optional Client Level Detail ...................................................................................................................... 3 Required Title III B, C, D and VII B (Cluster III), Non-Registered Client Fields........................................... 4 Required Title III E, Non-Registered Client Fields ..................................................................................... 4 Data Performance References .................................................................................................................. 4 Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 1 3
4 0
2 3
Overview
Introduction
Data and the information created from data elements contribute to valuable knowledge aboutservice use and client demographics. It is a source for Area Agencies on Aging (AAA), California Department of Aging (CDA), and U.S. Administration for Community Living (ACL) performance measures.

Background
AAA staff spends a large percentage of their time reading, completing, processing, and retrieving forms created or received by the agency.

Forms are an important part of the operations that aid in the collection and documentation of information. Well-designed and well-managed forms can reduce errors and save time and money.

Purpose
The purpose of this guide is to help AAA staff identify the required ACL and CDA Title III data elements. This guide provides AAAs with guidance, resources, and sample layouts and forms t help AAAs evaluate and design agency intake forms.
his guide does not address Community Based Service Programs (CBSP), Health Insurance Counseling and Advocacy Program (HICAP), Long-Term Ombudsman Program, Senio Community Services Employment Program (Title V), or fiscal forms.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 0 NOTE: T
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Purpose
The Older Americans Act (OAA) requires a report of statistical data reflecting the number of service units provided and the number of registered clients or the estimated clients/audience reached.

Process
Data Performance Management Process
Entity Role
Provider
or
AAA
collects and tracks client/user information and service units reports service utilization units, consumer demographics and expenditures
maintains records
AAA
plans and administers OAA data management system(s)
implements CDA data reporting requirements
develops and maintains written procedures
analyzes, corrects, and verifies data
monitors and evaluates local services
trains staff and provides technical assistance to the providers, clients, and caregivers
reports data to CDA via the statewide California Aging Reporting System (CARS)
CDA
sets data reporting standards
monitors and evaluates AAA programs
plans and administers the CARS
provides AAAs with training and technical assistance as needed reports data and program information to ACL and the California State Legislature
ACL
provides Congress, states and other stakeholders with National Aging Program Information System (NAPIS) data
CARS Approval
AAAs shall assure that all data submitted is complete, accurate, timely, and verifiable.

AAA staff must approve CARS File Upload quarterly data and NAPISCare annual data within 10 days of notice of passed status. If the data cannot be corrected within 10 days, AAA staff mus provide an explanation in the comments box in the report screen. CDA will be able to review the data after the 10- day approval period.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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NAPIS Validation
As part of the annual year-end performance reporting process, the AAA Director, or designee,will be required to validate the NAPIS data.

What is Reviewed?
CDA reviews the accuracy and completeness of the reported data on a regular basis. CDA reviews intake and assessment forms, reporting performance information, supporting documents, and reporting procedures during the CDA monitoring process.

AAAs shall keep complete records/documents on file to support all reports submitted to CDA. All paper and electronic client information records, data elements, and printouts collected are confidential and shall be secured and remain protected from unauthorized disclosure.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Introduction
The arrangement of the questions on the form will make it easier to enter, complete, and retrieve information.

Group Data
Group related items with clearly defined sections to make the form easier to fill out. It can also eliminate the need for backtracking and reduces incomplete or missing data elements.

Databases may have separate data entry screens for
Client Detail Identification
Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), and/or Nutritional Risk Assessment
Establish Item Sequence
Arrange questions in a sequence that will match the structure of the database configuration. This will allow for easier data entry from one section to the next without having to search the form for the correct entry area.

Make Required Questions Clear
Make required data elements clear and visible. Design forms to clearly define form fields with bound boxes and headers.

What is Reviewed?
CDA reviews AAA forms to ensure all required data collection elements are integrated. See Chart Guidelines.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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Required Title III B, C, and D (Clusters I & II),
Registered Client Fields
Chart Guidelines
Apply the following chart to determine if intake form(s) have required data collection and reporting elements for Title III B, C, and D (Clusters I and II) Programs. See page 4 for NonRegistered fields.

CARS Title III B, C, and D (Clusters I and II) Required Registered Client Fields Service Category Service Units Registered
Client 1
ADL &
IADL 2
Nutritional
Risk 3
Case
Information 4
Funding
Source
Personal Care X Hour X X III B
Homemaker X Hour X X III B
Chore X Hour X X III B
Adult Day
Care/Health X Hour X X III B
Case Management X Hour X X III B
Congregate Meals X Meal X X III C
Home-Delivered
Meals X Meal X X X III C
Nutritional
Counseling
X Session per
Participant X X III C
Assisted
Transportation
X One-way
Trip X III B
Legal Assistance X Hour X X III B
(X) Required Element1
Registered Client
Required Client Level Detail
Participant I to
Determine
Unduplicated Count
Birth Date
Zip Code
Rural
Gender
Sex at Birth
Sexual Orientation or
Sexual Identity
Race
Ethnicity
Poverty Status
Living Arrangement
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 • D
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ADL/IADL Required Functional Rating Scale for each of the following:

ADL: Eating
ADL: Bathing
ADL: Toileting
ADL: Transferring
in/out of bed/chair
ADL: Walking
ADL: Dressing
IADL: Meal Preparation
IADL: Shopping
IADL: Medication
Management
IADL: Money
Management
IADL: Using Telephone
IADL: Heavy Housework
IADL: Light Housework
IADL: Transportation
ADL & IADL Functional Impairment Rating Scale
(1) Independent: Can perform a task without human assistance. (2) Verbal Assistance: Requires verbal prompting to begin or complete a task. (3) Some Human Help: Requires some physical assistance to perform a task. (4) Lots of Human Help: Requires substantial assistance to perform a task. (5) Dependent: Totally dependent on another person to perform a task. (6) Declined to State
(0) Missing
Or as default, report only three levels: 1, 3, or 5 (and 6 – Declined to State). 3 Nutritional Risk - Required Score
(1) Yes: Nutritional risk with score of 6 or higher.
(2) No: Nutritional score with 5 or lower.
(3) Declined to State
(0) Missing
Scores are based on the Determine Your Nutritional Health checklist. 4 Case Information
Case ID
Case Opened Date
Case Closed Date
Service Type
Service Level
Refer to CARS Specifications spreadsheet for file reportin structure and optional data elements.

Refer to Services Categories and Data Dictionary document for category definitions. All documents can be found at www.aging.ca.gov/Providers_and_Partners/ Area_Agencies_on_Aging/.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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Required Title III E, Registered Caregiver Fields (Group 1) Chart Guidelines
Apply the following chart to determine if intake form(s) have the required data collection and reporting elements for the Title III E Family Caregiver Support Program (FCSP) Caregivers of Older Adults and Older Elderly Relative. See page for Non-Registered fields.

CARS Title III E, FCSP Caregivers of Older Adults/Older Elderly Relative, Required Registered Caregiver Fields
Family Caregiver
Service Category Service Units Registered Caregiver 1
Assessment X Hour X
Counseling X Hour X
Peer Counseling X Hour X
Support Group X Hour X
Training X Hour X
Case Management X Hour X
In-Home Supervision X Hour X
Homemaker Assistance X Hour X
In-Home Personal Care X Hour X
Home Chore X Hour X
Out-of-Home Day Care X Hour X
Out-of-Home Overnight Care X Hour X
Assistive Devices X Device/Occurrence X
Home Adaptations X Modification/Occurrence X
Registry X Hour/Occurrence X
Emergency Cash/Material Aid X Assistance/Occurrence X
(X) Required Element
1 Registered Caregiver Required Client Level Detail
Participant ID to Determine
Unduplicated Count
Birth Date
Zip Code
Rural Designation
Gender
Sex at Birth
Sexual Orientation or
Sexual Identity
Race
Ethnicity
Poverty Status
Living Arrangement
Relationship Status
Employment Status
Caregiver Relationship
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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Registered Client Fields
Chart Guidelines
Apply the following chart to determine if intake form(s) have required data collection and reporting elements for the Care Receiver in the Title III E, Family Caregiver Support Program (FCSP), CARS Title III E, FCSP Caregivers of Older Adults, Required Registered Care Receiver Fields Caregivers of Older Adults Service Category Registered Care Receiver 2 ADL & IADL 3 Assessment X X
Counseling X X
Peer Counseling X X
Support Group X X
Training X X
Case Management X X
In-Home Supervision X X
Homemaker Assistance X X
In-Home Personal Care X X
Home Chore X X
Out-of-Home Day Care X X
Out-of-Home Overnight Care X X
Assistive Devices X X
Home Adaptations X X
Registry X X
Emergency Cash/Material Aid X X
2 Registered Care Receiver Required Client Level Detail Required Element
Participant ID to
Determine
Birth Date
Zip Code
Gender
Sex at Birth
Sexual Orientation or
Sexual Identity
Race
Ethnicity
Poverty Status
Living Arrangement
Relationship Status
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Older Adults.
{X)
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Rural Designation
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Caregivers of
3 ADL/IADL Required Functional Rating Scale for each of the following:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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Required Title III E, Registered Care Receiver Fields
(Group 1), Continued
Chart Guidelines
Apply the following chart to determine if intake form(s) have required data collection an reporting elements for the Care Receiver in the Title III E FCSP CARS Title III E, FCSP Older Elderly Relative Required Registered Care Receiver Fields Older Elderly Relative Service Category Registered Care Receiver 2 Assessment (Supportive Services) X
Counseling (Supportive Services) X
Peer Counseling (Supportive Services) X
Support Group (Supportive Services) X
Training (Supportive Services) X
Case Management (Supportive Services) X
In-Home Supervision (Respite Care) X
Homemaker Assistance (Respite Care) X
In-Home Personal Care (Respite Care) X
Home Chore (Respite Care) X
Out-of-Home Day Care (Respite Care) X
Out-of-Home Overnight Care (Respite Care) X
Assistive Devices (Supplemental Services) X
Home Adaptations (Supplemental Services) X
Registry (Supplemental Services) X
Emergency Cash/Material Aid (Supplemental Services) X
(X) Required Element
2 Registered Care Receiver Required Client Level Detail Participant ID to
Determine
Unduplicated Count
Birth Date
Zip Code
Rural Designation
Gender
Sex at Birth
Sexual Orientation or
Sexual Identity
Race
Ethnicity
Poverty Status
Living Arrangement
Relationship Status
NOTE: There are no ADL or IADL data collection requirements for Care Receivers in FCSP Caring Child Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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Refer to CARS Specifications spreadsheet for file reporting structure and optional data elements.

Refer to Services Categories and Data Dictionary document for category definitions. All documents can be found at www.aging.ca.gov/Providers_and_Partners/Area_Agencies_on_Aging/.

Required Registered Client Level Detail
Introduction
OAA programs use client demographic elements for targeting and/or reporting purposes. The required registered client level details are birth date, zip code, rural designation, gender, sex at birth, sexual orientation or gender identity, race, ethnicity, poverty status, and living arrangement.

Service Categories Required
The following are the programs that require collecting client level detail for registered clients, FCSP caregivers and care receivers.

Title III B, C, and D, Supportive and Nutrition Services Personal Care
Homemaker
Chore
Home-Delivered Meals
Adult Day Care/Health
Case Management
Congregate Meals
Nutritional Counseling
Assisted Transportation
Legal Assistance
Title III E, FCSP Caregivers of Older Adults/Older Elderly Relative:

Caregiver & Care Receiver

SUPPLEMENTAL SERVICES
Assessment
Counseling
Peer Counseling
Support Group
Training
Case Management

RESPITE CARE
In-Home Supervision
Homemaker Assistance
In-Home Personal Care
Home Chore
Out-of-Home Day Care
Out-of-Home Overnight
Care

SUPPLEMENTAL SERVICES
Assistive Devices
Home Adaptations
Registry
Emergency Cash/ Material Aid
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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What is Reviewed?
CDA reviews registered client level details for completeness. The client’s information is self- reported and collected annually. If a client declines to provide information, document the action. Service cannot be denied to eligible clients declining to provide information.

All the listed data elements, except for birth date, include a “Declined to State” option which is calculated separately from “missing” information. Missing information occurs when a client is not asked to identify the required demographic data element or information was not entered into the AAA database.

Birthday
Collect the month (##), day (##), and year (####) of birth.

Elements Zip Code
Zip Code can be collected as ##### or ##### - ####.

Sexual Orientation and Gender Identity (SOGI)
The following lists contain the various options available to report SOGI data to CARS:

GENDER CARS

OPTIONS
Male
Female
Transgender Female to
Male
Transgender Male to
Female
Genderqueer/Gender
Non-binary
Not listed.

Please specify:

Declined to State
Missing

SEX AT BIRTH CARS

OPTIONS
Male
Female
Declined to State
Missing

SEXUAL ORIENTATION

OR SEXUAL IDENTITY CARS

OPTIONS
Straight/ Heterosexual
Bisexual
Gay/Lesbian/Same- Gender Loving
Questioning/ Unsure
Not listed.

Please specify:

Declined to State
Missing
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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Rural Designation
The Administration of Community Living (ACL) requires that rural designation now be determined by Rural-Urban Commuting Area (RUCA) codes. These codes classify census tracts using measures such as population density, urbanization, and daily commuting. Each zip code has a corresponding RUCA code.

The zip code files are available on the resource page of the OAAPS.

Rural RUCA codes: 4.0, 4.2, 5.0, 5.2, 6.0, 6.1, 7.0, 7.2, 7.3, 7.4, 8.0, 8.2, 8.3, 8.4, 9.0, 9.1, 9.2, 10.0, 10.2,

10.3, 10.4, 10.5, and 10.6.

Non-Rural RUCA codes: 1.0, 1.1, 2.0, 2.1, 3.0, 4.1, 5.1, 7.1, 8.1, and 10.1.

To find more information on RUCA codes visit the USDA Economic Research Service’s Rural-Urban Commuting Area codes website at www.ers.usda.gov/data-products/.

Rural CARS Options
Rural
Urban
Declined to State
Missing
Race
The following reflects the Office of Management and Budget’s (OMB) reporting requirement for collecting race, and California’s Government Code Section 8310.5 reporting requirement for collecting different Asian and Native Hawaiian/Other Pacific Islander groups.

Race CARS Options
White
American
Indian or Alaska
Native
Black or
African
American
Chinese
Japanese
Filipino
Korean
Vietnamese
Asian Indian
Laotian
Cambodian
Other Asian
Guamanian
Hawaiian
Samoan
Other Pacific Islander
Declined to State
Missing
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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Ethnicity
The following reflects the OMB’s ethnicity reporting requirement. Hispanic or Latino origin is Ethnicity CARS Options
Not Hispanic/Latino
Hispanic/Latino
Declined to State
Missing
Living Arrangement
ACL defines “living alone” as a one-person household (using the Census definition of household) the householder lives by his or herself in an owned or rented place of residence in a noninstitutional setting.

Living Arrangement CARS Options
Alone
Not Alone
Declined to State
Missing
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 a separate question from the race category .
where
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Unique Participant ID
ACL requires that State Units on Aging (SUA) report the total unduplicated clients who were served in registered services. The most accurate method to avoid duplicating information is by assigning a unique participant identifier to a client (generally, each AAA data management system creates this identifier once the minimum data elements are entered into the system). All services received by the client can be tracked by tying them to the client’s unique participant identifier.

When developing a unique identification number, AAAs must ensure that personal, sensitive, and confidential information is protected from inappropriate or unauthorized access or disclosure. AAAs must have written confidentiality procedures to ensure that no personal information is disclosed by the AAA or provider without informed consent of the client.

OAA services cannot be denied to eligible clients if they do not wish to disclose their information.

The unique “Participant ID” must be collected as an integer.

Termination Date
This is the date on which the participant stopped receiving a service. This date must be collected as YYYY-MM-DD.

Termination Reason
This field identifies the reason for terminating services (i.e., deactivating a client).

Reason for Deactivation CARS Options
Deceased
No Longer MSSP Eligible
Moved out of Service Area
Will not Follow Care Plan
No Longer Desires Services
On Hold
No Longer SNF Certifiable
Past Active
Institutionalization
On Waiting List
High Cost of Services
Other Reason
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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Federal Poverty Determination
Introduction
While the OAA is concerned with the provision of services to all older persons, it requires assurance that preference is given to older individuals with greatest economic or social need, particular attention to low-income minority individuals.

Under the OAA, “greatest economic need” means the need resulting from an income level at or poverty levels established by OMB.

ACL uses the Federal Poverty Guidelines for targeting and reporting.

Service Categories Required
The following are the programs that require collecting that require collecting poverty status for registered clients, or FCSP caregivers and care receivers.

SUPPORTIVE SERVICES
Assessment
Counseling
Peer Counseling
Support Group
Training
Case Management

RESPITE CARE
In-Home Supervision
Homemaker Assistance
In-Home Personal Care
Home Chore
Out-of-Home Day Care
Out-of-Home Overnight
Care

SUPPLEMENTAL SERVICES
Assistive Devices
Home Adaptations
Registry
Emergency Cash/Material
Aid
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 below
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What to Include?
Create a question to determine if the client, caregiver, or care receiver is at or below 100 percent of the federal poverty level.

Information is self-reported and collected annually.

What is Reviewed?
CDA will review demographic data to determine if AAAs are reaching individuals who are at or below the federal poverty line.

Use one of the examples below or create one. If the form does not list the federal poverty amounts, include an instructional sheet.

Example 1
At or Below FPL (Low Income)
Above FPL
Declined to State
Example 2
Total # Living in Household:

Approx. Monthly Gross Income: $
Declined to State
Example 3
# of Household Members (Circle One) 1 2 3 4 5 6 7 8+
What is Your Approximate Household Income? $ Per Month/ Per Year Declined to State
Example 4
Living Alone: Less than $#,### Per Month
Two Person Household: Less than $#,### Per Month
Other
Declined to State
Resources
The U.S. Department of Health and Human Services (HHS) updates information periodically.

The Federal Register Poverty Guidelines are normally published in late January each year.

CDA Title III Forms Guide (July 2021
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □
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The
guidelines can also be found on the Assistant Secretary for Planning and Evaluation website at www.aspe.hhs.gov/poverty-guidelines.

Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) Functional Impairment Status
Introduction
OAA programs use the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living functional impairment scale to identify individuals with functional limitations. AAAs must also review functional limitations to determine eligibility for the provision of FCSP Caring Elderly Respite Care and Supplemental Services.

The OAA preference is to give services to older individuals with greatest social need. The term “greatest social need” means the need caused by non-economic factors that include (A) physical and mental disabilities
(B) language barriers
(C) cultural, social, or geographical isolation, including isolation caused by racial or ethnic status that
(i) restricts an individuals’ ability to perform normal daily tasks (ii) threatens such individuals’ capacity to live independently ACL uses ADL and IADL characteristics for targeting frail older individuals and reporting purposes.

Service Categories Required
The table below lists the programs that require ADL and IADL limitation status for registered clients.

Title III B and C-2, Supportive and Nutrition Services
Personal Care
Homemaker
Chore
Home-Delivered Meals
Adult Day Care/Health
Case Management
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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{IADL)
for
Service Categories Required, Continued
The table below lists the programs that require ADL and IADL limitation status for registered care receivers in the FCSP Caregivers of Older Adults.

Title III E, FCSP Caregivers of Older Adults (Care Receiver)

SUPPORTIVE SERVICES
Assessment
Counseling
Peer Counseling
Support Group
Training
Case Management

RESPITE CARE
In-Home Supervision
Homemaker Assistance
In-Home Personal Care
Home Chore
Out-of-Home Day Care
Out-of-Home Overnight
Care

SUPPLEMENTAL SERVICES
Assistive Devices
Home Adaptations
Registry
Emergency Cash/Material Aid
What to Include?
Create six (6) ADL and eight (8) IADL questions with the functional ability rating scale to determine the impairment level of the applicant or client.

Information is self-reported and collected annually. Conduct reassessment as needed, based on changes in the client’s status within the year.

NOTE: Arrange questions to match database entry sequence.

How to Determine Score?
ACL defines “impairment in Activities of Daily Living (ADL)” as the inability to perform one or more of the following six activities of daily living without personal assistance, stand-by assistance, supervision or cues: eating, dressing, bathing, toileting, transferring in and out of bed/chair, and walking.

ACL defines “impairment in Instrumental Activities of Daily Living (IADL)” as the inability to perform one or more of the following eight instrumental activities of daily living without personal assistance, or stand-by assistance, supervision or cues: preparing meals, shopping for personal items, medication management, managing money, using the telephone, doing heavy housework, doing light housework, and transportation ability (transportation ability refers to the individual's ability to make use of available transportation without assistance).

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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The ADL and IADL functional ability rating scale is applied to each question. The CARS system will count the number of ADLs and IADLs where verbal or human assistance is required. An applicant’s or client’s sum determines the overall level of functional impairment.

What is Reviewed?
CDA will review demographic data to determine if the AAA is reaching individuals who are functionally impaired.

To qualify for Title III E, FCSP Caring for Elderly Respite Care and Supplemental Services care receivers must have two or more ADL limitations or a cognitive impairment.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 • If the Combined Total Number of ADLs & IADLs is 0
Then Client is independent, has no functional limitations. • If the Combined Total Number of ADLs & IADLs is 1-2
Then Client is frail, has minimal or mild functional impairments. • If the Combined Total Number of ADLs & IADLs is 3 or greater Then Client is severely disabled and vulnerable to loss of independence.

Example 1:

Displays descriptive questions with ADL and IADL examples.

ADLs and IADLs - How would you rate your ability to perform the following daily activities? 1=No Assistance Needs, 2=Requires Verbal Assistance, 3=Some Human Help,4=Lots of Human Help, 5=Cannot Do It At All
ACTIVITIES OF DAILY LIVING (RATE 1-5)
Can you manage eating without any help?
Can you bathe or shower without any help?
Can you use the toilet without any help?
Can you get in and out of bed or chair without any help? Can you walk around inside without any help?
Can you dress without any help?
INSTRUMENTAL ACTIVITIES OF DAILY LIVING (RATE 1-5)
Can you prepare meals for yourself without help?
Can you shop for food and other things you need without help? Can you take your medications without help?
Can you handle your own money, like keeping track of bills without help? Can you answer the telephone or make a phone call without help? Can you do heavy housecleaning, like yard work and laundry, without any help? Can you do light housekeeping, like dusting or sweeping, without help? Can you use public transportation or drive beyond walking distances without help? Notes:

Declined to State
Example 2:

Displays a list of the ADLs and IADLs. Staff may provide description information.

ADLs and IADLs (Activities of Daily Living and Instrumental Activities of Daily Living) Please rate your functional abilities for the following activities.

RATING SCALE: 1 = Independent, 2 = Verbal Assistance, 3 = Some Human Help, 4 = Lots of Human Help, 5 = Dependent, 6 = Declined to State
ADLS:

Eating ___________ Dressing ___________ Transferring ___________ In/Out of Chair ___________ Walking ___________
Toileting ___________
IADLs
Meal Preparation ___________
Shopping ___________ Medication Management ___________
In/Out of Chair ___________ Walking ___________
Toileting ___________ Notes:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □
Example 3:

Displays descriptive questions with ADL and IADL examples.

Displays all 5 functional ability rating scale options plus “Declined to State.” Staff may provide descriptive information.

Client ADL and IADL
(Activities of Daily Living and Instrumental Activities of Daily Living – Annual Assessment) Please check level of functional ability.

ADLs: 1 –
Independent
2 – Verbal
Assistance
3 – Some
Human Help
4 – Lots of
Human Help
5 –
Dependent
Declined to
State
Eating
Bathing
Toileting
Transferring In/
Out of Bed/ Chair
Walking
Dressing
Notes:

IADLs: 1 –
Independent
2 – Verbal
Assistance
3 – Some
Human Help
4 – Lots of
Human Help
5 –
Dependent
Declined to
State
Meal Preparation
Shopping
Medication
Management
Money
Management
Using Telephone
Heavy Housework
Light Housework
Transportation
Notes:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Example 4:

Displays the minimum functional ability 3-option rating scale plus “Declined to State.” Activities of Daily Living (ADL):

Circle One For Each
1=No Assistance, 3=Some Human Help,
5=Cannot Perform (Dependent),
Instrumental of Daily Living (IADL):

Circle One For Each
1=No Assistance, 3=Some Human Help, 5=Cannot Perform
(Dependent)
Eating................................................. 3 5 Meal Preparation............................... 3 5 Bathing .............................................. 3 5 Shopping ............................................ 3 5 Toileting............................................. 3 5 Medication Management.................. 3 5 Transferring In/Out of Bed/Chair...... 3 5 Money Management ......................... 3 5 Walking.............................................. 3 5 Using Telephone ................................ 3 5 Dressing............................................. 3 5 Heavy Housework .............................. 3 5 Ligh Housework ............................... 3 5
Declined to State Transportation .................................. 1 3 5 Example 5:

Displays ADL and IADLs with descriptive functional ability rating scales.

ADLs and IADLs (Activities of Daily Living and Instrumental Activities of Daily Living) Please rate your functional ability for the following activities.

Client/Elderly Care Receiver Activities of Daily Living (ADL) Fields Eating (Rated Level )
Reaching for, picking up, grasping utensil and cup; getting food on utensil, bringing food, utensil, cup to mouth, chewing, swallowing food and liquids, manipulating food on plate. Cleaning face and hands as necessary following a meal.

Independent (able to feed self)
Verbal assistance (able to feed self but needs verbal assistance such as reminding or encouragement to eat)
Some human help (assistance needed during meal, e.g., to apply assistive device, get beverage or push more food to within reach, etc., but constant presence of another person required) Lots of human help (able to feed self but cannot hold utensils, cups, glasses, etc., constant presence of another person is required)
Dependent (unable to feed self at all)
Declined to State
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 (1)
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1 1
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not
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1 Example 5, Continued
Bathing (Rated Level )
Bathing means cleaning the body using a tub, shower, or sponge bath including getting a basin of water, managing faucets, getting in and out of a tub, reaching head and body parts for soaping, rinsing, and drying.

City Council and Authorities ConcurrentOctober 10, 2023

City Council and Authorities Concurrent
October 10, 2023