Abbreviated Onsite Center Onsite Tool Web by q4U295

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									Quality Assurance Onsite Monitoring Tool
          for Low Risk Centers
            Center Name

             FY 2011-2012
                   Center Name
               TABLE OF CONTENTS

SECTION             AREA                                  Assigned
Section IV          Victim of Crime Act Services (VOCA)   Both
Section V           DCF Certification Standards           Both
Section VI          CAP Review                            Both
Section VII         Program High Risk                     Program
Section VIII        Fiscal High Risk                      Fiscal




                             3                                      FY 2011-2012
Center Name
Scoring Summary

VI. CAP REVIEW                     0       0   #DIV/0!

                                    0
IV. VICTIM OF CRIMES ACT SERVICES (VOCA)   0   #DIV/0!

V. DCF CERTIFICATION STANDARDS     0       0   #DIV/0!

VII. PROGRAM HIGH RISK             0       0   #DIV/0!

VIII. FISCAL HIGH RISK             0       0   #DIV/0!




TOTAL                              0       0   #DIV/0!




                                       4                 FY 2011-2012
                                                             Section IV: VOCA
                                Center Name:                                       Center Name

                                                                   Compliance            I = Interview
                                                                                        O=Observation
                                                                  Yes No       NA     D= Documentation
               Area of Review                    Authority                           (List Who and What)   Comments     Score
A. General                                                         0       0   0                                       #DIV/0!
1. Are the services being provided by the
center meeting the needs of the victims they
are serving?                                      VOCA
2. Are there any barriers in providing direct
services to victims?                              VOCA
B. Services Indentification & Provision                            0       0   0                                       #DIV/0!
1.    Are the VOCA program services
accessible to persons with disabiliities?         VOCA
2. Does the center have a written plan to
identify and address accessibility issues for
crime victims?                                    VOCA
3. Does the center provide assistance to
survivors in applying for Victim's
Compensation?                                     VOCA
4. Is Crime Victim Compensation information
(brochures and/or posters) available in a
prominent location within the facility?
                                                  VOCA
5. Are Crime Victim Compensation materials
current with the correct Attorney General's
name?                                             VOCA
C. Administration of VOCA Project                                  0       0   0                                       #DIV/0!
1. Does the center maintain files on all          VOCA
participants?
2. Are participant files kept in a locked file
cabinet?                                          VOCA
3. Does the center maintain all participant
and program files for at least 5 years?           VOCA



                                                                       5                                              FY 2011-2012
                                                                 Section IV: VOCA
                                  Center Name:                                         Center Name

                                                                       Compliance            I = Interview
                                                                                            O=Observation
                                                                      Yes No       NA     D= Documentation
                Area of Review                       Authority                           (List Who and What)   Comments     Score
A. General                                                             0       0   0                                       #DIV/0!
4. Does the center have a written record
retention policy in accordance with the VOCA
agreement?                                            VOCA
5. Does the policy include procedures for
disposal of records?                                  VOCA
6. Is there an established procedure for data
collection (statistical, qualitative or other) for
the VOCA monthly performance report?
                                                      VOCA
7. Does the center measure performance of
VOCA funded programs? (survivor
satisfaction surveys, self-evaluations)               VOCA
8. Are there barriers to conducting
evaluations?                                          VOCA
9. Has the information gathered during
evaluations had an impact on service
delivery?                                             VOCA
10. Does the center have at least one staff
that has a current Victim's Services
Practitioner Designation for the Office of the
Attorney General?                                     VOCA
11. Does the center have consistent/reliable
sources from which volunteers are recruited?
                                                      VOCA
12. Does the center have an established
training process for volunteers?                      VOCA
13. Is there a specific person(s) responsible
for training volunteers?                              VOCA



                                                                           6                                              FY 2011-2012
                                                            Section IV: VOCA
                                 Center Name:                                     Center Name

                                                                  Compliance            I = Interview
                                                                                       O=Observation
                                                                 Yes No       NA     D= Documentation
                Area of Review                  Authority                           (List Who and What)   Comments     Score
A. General                                                        0       0   0                                       #DIV/0!
14. Is there a mechanism to assess the
training needs of volunteers?                    VOCA
15. Is there a specific person(s) responsible
for supervising volunteers?                      VOCA
16. Are volunteer hours documented with
timesheets?                                      VOCA
17. Are volunteer activities/duties
documented?                                      VOCA
18. Do volunteers provide services for VOCA
funded projects?                                 VOCA
19. Number of VOCA volunteers.                   VOCA
20. What is the average monthly commitment
of volunteers related to the VOCA-funded
project?                                         VOCA
D. Inventory Control                                              0       0   0                                       #DIV/0!
1. Does the subgrantee have a written
inventory control procedure?                     VOCA
2. Is equipment tagged with an inventory
number?                                          VOCA
E. File Review                                                    0       0   0                                       #DIV/0!
With a selection of five files:
1. Do files specifically note dates(s) of
service?                                         VOCA
2. Do files specifically note service(s)
provided?                                        VOCA
3. Do files note the type of
victimization/crime?                             VOCA



                                                                      7                                              FY 2011-2012
                                                              Section IV: VOCA
                                Center Name:                                        Center Name

                                                                    Compliance            I = Interview
                                                                                         O=Observation
                                                                   Yes No       NA     D= Documentation
               Area of Review                     Authority                           (List Who and What)   Comments     Score
A. General                                                          0       0   0                                       #DIV/0!
4. Do the files specifically note the
demographic information of the victim?             VOCA
5. Do the files indicate assistance with victim
compensation?                                      VOCA
Total Score                                                         0       0   0                                       #DIV/0!




                                                                        8                                              FY 2011-2012
                                                                    Section V: DCF
                                 Center Name:                                                 Center Name

                                                                         Compliance           I = Interview
                                                                                             O=Observation
                                                        Authority
                                                                         Yes No      NA    D= Documentation
                 Area of Review                                                           (List Who and What)   Comments   Score

A. GENERAL REQUIREMENTS                                                  0       0   0                                     #DIV/0!
1. Is there a copy of the mission statement?
                                                     DCF Certification
2. Is there a current board of directors list with
names, occupations, telephone numbers,
                                                     DCF Certification
emails, and addresses of all members?

3. Does the documentation show the board held
                                               DCF Certification
a meeting at least quarterly?
4. Is a local law enforcement agency
                                               DCF Certification
represented on the board?
5. Is there a current written endorsement from
one or more local law enforcement agencies?    DCF Certification

6. Are there interagency agreements for
                                                     DCF Certification
integrating existing services?
7. Is there documentation included of
community support, both programmatic and             DCF Certification
financial?
B. MANUALS/WRITTEN PROCEDURES REQUIREMENTS 0                                     0   0                                     #DIV/0!
1. Are there clearly written and defined intake
policies and procedures that contain a non-
discriminatory clause that states services shall
                                                 DCF Certification
not be denied to any person because of national
origin or spoken language, religion, age or
disability?




                                                                             9                                             FY 2011-2012
                                                                       Section V: DCF
                                 Center Name:                                                     Center Name

                                                                            Compliance            I = Interview
                                                                                                 O=Observation
                                                           Authority
                                                                            Yes No       NA    D= Documentation
                 Area of Review                                                               (List Who and What)   Comments   Score

2. Does the operating procedures manual
identify participants that it cannot serve and if so,   DCF Certification
is there a referral or contingency plan?
3. Is there a clearly written confidentiality policy
                                                        DCF Certification
that complies with s. 39.908, F.S.?
4. Are there written safety procedures including
a plan for natural disasters such as hurricanes
                                                        DCF Certification
or fires that may require relocation of the
participants?
5. Is there a comprehensive, up-to-date
database of information and referral resources
                                                        DCF Certification
that is made available to staff and volunteers
and for review by monitor(s)?
6. Are there written procedures for regularly
scheduled service-management staff meetings
for the purpose of evaluating progress in               DCF Certification
assisting participants with meeting their self-
identified objectives?
C. STAFFING REQUIREMENTS                                                    0        0   0                                     #DIV/0!
1. Is there a fulltime advocate services
                                                             F.A.C
manager?
2. Is there a full or part-time bookkeeper?                  F.A.C
3. Is there a description in the policy and
procedures of how, when and where staff and
                                                        DCF Certification
volunteers, including those newly hired, are
trained on privilege and confidentiality?



                                                                                10                                             FY 2011-2012
                                                                   Section V: DCF
                               Center Name:                                                   Center Name

                                                                        Compliance            I = Interview
                                                                                             O=Observation
                                                       Authority
                                                                        Yes No       NA    D= Documentation
                Area of Review                                                            (List Who and What)   Comments   Score

4 Are presentations and training to law
enforcement and other professionals who
                                                   DCF Certification
provide services to victims and dependents
being conducted?
5. Is there a community education person who
facilitates presentations to the public, in person
and through the media. These presentations
                                                   DCF Certification
should provide information on the incidence and
dynamics of domestic violence.

6. Is there a current and accurate list of staff,
paid and unpaid, who meet the requirements for
                                                  DCF Certification
advocate privilege according to s. 90.5063,
F.S.?
D. PROGRAM REQUIREMENTS                                                 0        0   0                                     #DIV/0!
1. Is there a schedule showing coverage of the
shelter being staffed 24 hours a day, 7 days a      DCF Certification
week by staff or trained volunteers?
2. If there is not a service exemption for the
following services, are descriptions included for
                                                    DCF Certification
each service including where, when and how
services are provided?
    a. 24-Hours a day, 7 days a week Hotline
                                                    DCF Certification
coverage
       1.) Do policies and procedures show that
center staff or volunteers covering the hotline
                                                    DCF Certification
are trained in crisis counseling, safety planning
and providing referral services?



                                                                            11                                             FY 2011-2012
                                                                   Section V: DCF
                               Center Name:                                               Center Name

                                                                        Compliance        I = Interview
                                                                                         O=Observation
                                                       Authority
                                                                        Yes No   NA    D= Documentation
                Area of Review                                                        (List Who and What)   Comments   Score

   b. Professional Training Services including
                                                   DCF Certification
Law Enforcement Personnel
   c. Community Education for Awareness of
                                                   DCF Certification
Domestic Violence
3. Is there a description of each of the following
services including where, when and how             DCF Certification
services are provided?
   a. Information and Referral Services
                                                   DCF Certification
   b. Counseling Services
                                                    DCF Certification
   c. Service Management Services
                                                    DCF Certification
   d. Temporary Emergency Shelter for More
                                                    DCF Certification
Than 24 Hours
   e. Assessment and Appropriate Referrals for
                                                    DCF Certification
Resident Children
4. Are statistical reports that detail the number
of domestic violence victims receiving required     DCF Certification
services kept and maintained?
5. Is each shelter participant provided with an
                                                    DCF Certification
individual advocate/counselor?
6. Is in-house counseling/advocacy at the
shelter facility available between the hours of     DCF Certification
8am and 10pm?
7. Is counseling/advocacy staff available for
participants at the shelter between the hours of    DCF Certification
10pm and 8am?



                                                                          12                                           FY 2011-2012
                                                                   Section V: DCF
                                 Center Name:                                                 Center Name

                                                                        Compliance            I = Interview
                                                                                             O=Observation
                                                       Authority
                                                                        Yes No       NA    D= Documentation
                 Area of Review                                                           (List Who and What)   Comments   Score

E. STAFF FILES                                                          0        0   0                                     #DIV/0!
1. Is the required 30 hours of Core Competency
training documented in the personnel files for
                                                    DCF Certification
those who are in advocate privilege positions,
paid or unpaid?
2. Do paid and unpaid staff (part-time or fulltime)
have the required 16 hours of annual training       DCF Certification
documented in their personnel files?
3. Have all paid and unpaid staff received yearly
in-service training on the implementation of
safety procedures including natural disasters,      DCF Certification
such as hurricane and fire plans?

F. FACILITY REQUIREMENTS                                                0        0   0                                     #DIV/0!
1. Is there a current fire inspection?
                                                   DCF Certification
2. Is there a current health inspection?
                                                   DCF Certification
3. Is the shelter equipped with telephones for
                                                   DCF Certification
resident and staff usage?
4. Have accommodations been made for the
hearing impaired, both on the hotline and on
                                                   DCF Certification
telephones for resident use within the shelter?

5. Is the facility accessible to residents in
                                                   DCF Certification
wheelchairs (ADA accessible)?




                                                                            13                                             FY 2011-2012
                                                                     Section V: DCF
                                Center Name:                                                    Center Name

                                                                          Compliance            I = Interview
                                                                                               O=Observation
                                                         Authority
                                                                          Yes No       NA    D= Documentation
                 Area of Review                                                             (List Who and What)   Comments   Score

6. Does the physical structure of the facility
allow flexibility in sleeping accommodations for      DCF Certification
adults, children and infants?
7. Is the individual privacy respected with single-
family and/or single participant                      DCF Certification
accommodations?
8. Have precautionary measures been taken to
                                                      DCF Certification
secure the safety of residents, such as:
    a. Are outside doors locked from outside at
                                                      DCF Certification
all times?
    b. Are all windows secured against entry?
                                                      DCF Certification
    c. Is outside and entranceway lighting in
                                                      DCF Certification
place?
    d. Are sprinklers or smoke alarms in each
                                                      DCF Certification
bedroom and in all hallways?
    e. Is playground equipment routinely
                                                      DCF Certification
checked for safety? If yes, by whom?
    f. Is there a fence surrounding the children's
                                                      DCF Certification
play area?
    g. Is the children's play area in view of the
                                                      DCF Certification
public?
    h. If previous question is "yes", is there a
                                                      DCF Certification
privacy fence surrounding the play area?
G. SHELTER SERVICE MANAGEMENT                                             0        0   0                                     #DIV/0!
1. Do service records of shelter residents
                                                      DCF Certification
include the following:



                                                                              14                                             FY 2011-2012
                                                                   Section V: DCF
                                Center Name:                                              Center Name

                                                                        Compliance        I = Interview
                                                                                         O=Observation
                                                       Authority
                                                                        Yes No   NA    D= Documentation
                 Area of Review                                                       (List Who and What)   Comments   Score

   a. Identifying information and other
demographic data such as name, age, race,
                                                    DCF Certification
ethnicity, gender, disability and number of
dependents?
   b. Pertinent history (of abuse by current
                                                    DCF Certification
abuser)?
   c. Safety/Service Management Plan?
                                                    DCF Certification
       1) Is there an individual participant-
                                                    DCF Certification
directed needs assessment?
       2) Is there a participant-directed service
plan developed with residents housed for 72         DCF Certification
hours or more?
          a) Does the service plan address
                                                    DCF Certification
participant-identified goals and objectives?
          b) Does the service plan provide the
coordination and arrangement of appropriate
                                                    DCF Certification
services provisions chosen by the participant?

      3) Is a participant-signed safety plan
included indicating participation in the
                                                    DCF Certification
development of the plan for those in shelter for
72 hours or more?
      4) Is there documentation of referrals?
                                                    DCF Certification
      5) Is there documentation of all services
                                                    DCF Certification
received?
   d. Signed liability forms?
                                                    DCF Certification



                                                                          15                                           FY 2011-2012
                                                                   Section V: DCF
                                Center Name:                                                   Center Name

                                                                         Compliance            I = Interview
                                                                                              O=Observation
                                                       Authority
                                                                         Yes No       NA    D= Documentation
                 Area of Review                                                            (List Who and What)   Comments   Score

   e. Signed release of information with
                                                    DCF Certification
termination date?
   f. Signed TANF forms?
                                                    DCF Certification
    g. If the participant has left, is there an exit
interview or documentation with explanation why
                                                     DCF Certification
an exit interview was not completed?

    h. Was the participant given the opportunity
to participate in a revised safety plan during their DCF Certification
stay after 72 hours or more?
2. Is a risk assessment of resident children
made at least 72 hours after intake? Do they         DCF Certification
include the following:
    a. Evaluation of medical needs?
                                                     DCF Certification
   b. Screening for child abuse?
                                                    DCF Certification
   c. Screening for behavioral issues?
                                                    DCF Certification
   d. Appropriate referrals?
                                                    DCF Certification
   e. Safety plan with child who is capable of
                                                 DCF Certification
carrying one out?
3. Are resident service records well maintained?
                                                 DCF Certification
H. OUTREACH CASE MANAGEMENT                                              0        0   0                                     #DIV/0!



                                                                             16                                             FY 2011-2012
                                                                    Section V: DCF
                                Center Name:                                                   Center Name

                                                                         Compliance            I = Interview
                                                                                              O=Observation
                                                        Authority
                                                                         Yes No       NA    D= Documentation
                 Area of Review                                                            (List Who and What)   Comments   Score

1. Are participant-directed service management
plans developed for non-resident participants
seen face-to-face for two advocacy/counseling DCF Certification
sessions? If yes, do they include th following:

   a. Identification data?
                                                     DCF Certification
   b. Dates of contact?
                                                     DCF Certification
   c. Individual participant-identified needs
                                              DCF Certification
assessment?
     d. Detailed participant-directed Service
                                              DCF Certification
Plan?
       1) Does the service plan address goals
and objectives chosen by the participant?     DCF Certification

        2) Does the service plan provide the
coordination and arrangement of appropriate DCF Certification
service provisions chosen by the participant?
   e. Participant-signed safety plan?
                                              DCF Certification
2.   Are outreach         service   records   well
                                                     DCF Certification
maintained?
I. ADDITIONAL SHELTER FACILITY (if
                                                                         0        0   0
more than one shelter)                                                                                                      #DIV/0!
SHELTER FACILITY
1. Is there a current fire inspection?
                                                     DCF Certification



                                                                             17                                             FY 2011-2012
                                                                     Section V: DCF
                                Center Name:                                                Center Name

                                                                          Compliance        I = Interview
                                                                                           O=Observation
                                                         Authority
                                                                          Yes No   NA    D= Documentation
                 Area of Review                                                         (List Who and What)   Comments   Score

2. Is there a current health inspection?
                                                      DCF Certification
3. Is the shelter equipped with telephones for
                                                      DCF Certification
resident and staff usage?
4. Have accommodations been made for the
hearing impaired, both on the hotline and on
                                                      DCF Certification
telephones for resident use within the shelter?

5. Is the facility accessible to residents in
                                                      DCF Certification
wheelchairs (ADA accessible)?
6. Does the physical structure of the facility
allow flexibility in sleeping accommodations for      DCF Certification
adults, children and infants?
7. Is the individual privacy respected with single-
family and/or single participant                      DCF Certification
accommodations?
8. Have precautionary measures been taken to
                                                      DCF Certification
secure the safety of residents, such as:
    a. Are outside doors locked from outside at
                                                      DCF Certification
all times?
    b. Are all windows secured against entry?
                                                      DCF Certification
   c. Is outside and entranceway lighting in
                                                      DCF Certification
place?
   d. Are sprinklers or smoke alarms in each
                                                      DCF Certification
bedroom and in all hallways?
   e. Is playground equipment routinely
                                                      DCF Certification
checked for safety? If yes, by whom?



                                                                            18                                           FY 2011-2012
                                                                   Section V: DCF
                                Center Name:                                                  Center Name

                                                                        Compliance            I = Interview
                                                                                             O=Observation
                                                       Authority
                                                                        Yes No       NA    D= Documentation
                Area of Review                                                            (List Who and What)   Comments   Score

    f. Is there a fence surrounding the children's
                                                   DCF Certification
play area?
    g. Is the children's play area in view of the
                                                   DCF Certification
public?
    h. If previous question is "yes", is there a
                                                   DCF Certification
privacy fence surrounding the play area?
SHELTER CASE MANAGEMENT                                                 0        0   0                                     #DIV/0!
1. Do case records of shelter residents include
                                                    DCF Certification
the following:
    a. Identifying information and other
demographic data such as name, age, race,
                                                    DCF Certification
ethnicity, gender, disability and number of
dependents?
    b. Pertinent history (of abuse by current
                                                    DCF Certification
abuser)?
    c. Survivor-directed service management
                                                    DCF Certification
plan?
       1) Is there an individual participant-
                                                    DCF Certification
directed needs assessment?
       2) Is there a participant-directed service
plan developed with residents housed for 72         DCF Certification
hours or more?
           a) Does the service plan address
goals and objectives chosen by the participant?     DCF Certification




                                                                            19                                             FY 2011-2012
                                                                   Section V: DCF
                                Center Name:                                               Center Name

                                                                         Compliance        I = Interview
                                                                                          O=Observation
                                                       Authority
                                                                         Yes No   NA    D= Documentation
                 Area of Review                                                        (List Who and What)   Comments   Score

         b) Does the service plan provide the
coordination and arrangement of appropriate
                                                    DCF Certification
services provisions chosen by the participant?

      3) Is a participant-signed safety plan
included indicating participation in the
                                                    DCF Certification
development of the plan for those in shelter for
72 hours or more?
      4) Is there documentation of referrals?
                                                    DCF Certification
      5) Is there documentation of all services
                                                    DCF Certification
received?
   d. Signed liability forms?
                                                    DCF Certification
   e. Signed release of information with
                                                    DCF Certification
termination date?
   f. Signed TANF forms?
                                                    DCF Certification
    g. If the participant has left, is there an exit
interview or documentation with explanation why
                                                     DCF Certification
an exit interview was not completed?

    h. Did the survivor participate in a revised
safety plan during their stay after 72 hours or  DCF Certification
more?
2. Is risk assessment of resident children made
at least 72 hours after intake? Do they include  DCF Certification
the following;



                                                                           20                                           FY 2011-2012
                                                                Section V: DCF
                               Center Name:                                                Center Name

                                                                     Compliance            I = Interview
                                                                                          O=Observation
                                                    Authority
                                                                     Yes No       NA    D= Documentation
                Area of Review                                                         (List Who and What)   Comments   Score

   a. Evaluation of medical needs?
                                                 DCF Certification
   b. Screening for child abuse?
                                                 DCF Certification
   c. Screening for behavioral issues?
                                                 DCF Certification
   d. Appropriate referrals?
                                                 DCF Certification
   e. Safety plan with child who is capable of
                                                 DCF Certification
carrying one out?
3. Are resident service records well maintained?
                                                 DCF Certification

OUTREACH SERVICE MANAGEMENT
                                                                     0        0   0
                                                                                                                        #DIV/0!
1. Are survivor-directed service management
plans developed for non-resident participants
seen face-to-face for two counseling sessions?   DCF Certification
If yes, do they include the following:

   a. Identification data?
                                                 DCF Certification
   b. Dates of contact?
                                                 DCF Certification
   c. Individual participant-directed needs
                                                 DCF Certification
assessment?
   d. Detailed participant-directed Service
                                                 DCF Certification
Plan?



                                                                         21                                             FY 2011-2012
                                                               Section V: DCF
                               Center Name:                                               Center Name

                                                                    Compliance            I = Interview
                                                                                         O=Observation
                                                   Authority
                                                                    Yes No       NA    D= Documentation
                Area of Review                                                        (List Who and What)   Comments   Score

     1) Does the service plan address goals
and objectives chosen by the participant?       DCF Certification

      2) Does the service plan provide the
coordination and arrangement of appropriate     DCF Certification
service provisions chosen by the participant?
   e. Participant Signed safety plan?
                                                DCF Certification
2. Are outreach service records well
                                                DCF Certification
maintained?
Total Score                                                         0        0   0                                     #DIV/0!




                                                                        22                                             FY 2011-2012
                                                      Section VI: CAP REVIEW
                              Center Name:                                       Center Name
                                                              Compliance        I = Interview
                                                                               O=Observation
                                                  Authority
                                                              Yes No   NA    D= Documentation
                Area of Review                                              (List Who and What)   Comments   Score

Finding I                                                     0    0   0                                     #DIV/0!
1. Center is now in compliance with finding # 1
                                                  Standards
of last year's monitoring tool.
2, Observed compliance or tested to see if in
compliance
                                                  Standards


3. Changes made to assure compliance?

                                                  Standards


Finding 2                                                     0    0   0                                     #DIV/0!
1. Center is now in compliance with finding # 1
                                                  Standards
of last year's monitoring tool.
2, Observed compliance or tested to see if in
compliance                                        Standards

3. Changes made to assure compliance?
                                                  Standards

Finding 3                                                     0    0   0                                     #DIV/0!
1. Center is now in compliance with finding # 1
                                                  Standards
of last year's monitoring tool.
2, Observed compliance or tested to see if in
compliance
                                                  Standards




                                                                  23                                         FY 2011-2012
                                                      Section VI: CAP REVIEW
                              Center Name:                                       Center Name
                                                              Compliance        I = Interview
                                                                               O=Observation
                                                  Authority
                                                              Yes No   NA    D= Documentation
                Area of Review                                              (List Who and What)   Comments   Score

3. Changes made to assure compliance?

                                                  Standards


Finding 4                                                     0    0   0                                     #DIV/0!
1. Center is now in compliance with finding # 1
                                                  Standards
of last year's monitoring tool.
2, Observed compliance or tested to see if in
compliance
                                                  Standards


3. Changes made to assure compliance?

                                                  Standards


Finding 5                                                     0    0   0                                     #DIV/0!
1. Center is now in compliance with finding # 1
                                                  Standards
of last year's monitoring tool.
2, Observed compliance or tested to see if in
compliance
                                                  Standards


3. Changes made to assure compliance?

                                                  Standards


Total Score                                                   0    0   0                                     #DIV/0!



                                                                  24                                         FY 2011-2012
                                                         Section VII: Program High Risk
                                 Center Name:                                        Center Name

                                                                    Compliance
                                                                                      I = Interview
                                                                                     O=Observation
                                                                    Yes   No   NA D= Documentation
                 Area of Review                         Authority                 (List Who and What)   Comments   Score
A. High Risk                                                         0     0   0                                   #DIV/0!
1. Every effort is made to provide services to
eligible individuals regardless of race, religion,
color, national origin, gender, age, mental or           FCADV
physical disability, sexual orientation, citizenship,   Standards
immigration status, marital status or language
spoken.
2. Counseling, service management and
                                                         FCADV
advocacy services offered are empowerment-
                                                        Standards
based, woman centered and survivor-directed.
3. Empowerment-based one-on-one support                  FCADV
sessions are available for participants.                Standards
4. Couples and/or family counseling that
                                                         FCADV
includes the presence of the abuser is not
                                                        Standards
provided by the center.
6. Participant records are not provided to
                                                         FCADV
stakeholders, partner agencies, and/or other
                                                        Standards
agencies.
7. The hotline is answered by staff or volunteers        FCADV
24 hours a day 7 days a week.                           Standards
8. The hotline is never answered by a prompting
device or an outside answering service,                  FCADV
ananswering machine, and/or voice mail.                 Standards

9. A safety plan appropriate to the caller’s
                                                         FCADV
situation is always developed during hotline
                                                        Standards
calls.




                                                                          25                                        FY 2011-2012
10. The Center has policies/procedures on
accommodating individuals with special needs
or special circumstances include out of area
referrals; alcohol or drug abuse addictions;
assisted living; male survivors; and/or
                                                         FCADV
traditionally underserved populations including
                                                        Standards
older survivors, survivors in same-sex
relationships, survivors living with disabilities,
and/or survivors from diverse cultural
backgrounds including non-English speaking
survivors.
11. The center does not withhold services from
                                                         FCADV
participants solely because of their use of
                                                        Standards
alcohol or drugs.
12. The center does not place restrictions on the
number of times a participant may enter shelter          FCADV
and/or requires a time limit before a survivor          Standards
may re-enter the shelter.
13. Emergency services and shelter are open &            FCADV
staffed 24 hours per day, 7 days per week.              Standards
                                                          F.A.C.
14. The center provides safe emergency shelter
with a structurally safe building including, but not
limited to doors, windows, and other external
access that is intruder-resistant; confidentiality of
                                                         FCADV
shelter stay; available safety information and
                                                        Standards
emergency safety planning; healthy
                                                          F.A.C.
accommodations annually inspected by local
health and fire inspectors; assurance of
advocate-victim privilege.

15. The center provides basic food groups,
                                                         FCADV
clothing, laundry detergent and hygiene items for
                                                        Standards
shelter residents.




                                                                    26   FY 2011-2012
16. Advocates closely analyze dynamics in all
relationships (e.g. heterosexual, same sex) to        FCADV
assure the person requesting services is the         Standards
survivor rather than the perpetrator.
17. The center ensures that all employees and
                                                      FCADV
volunteers are aware of and understand their
                                                     Standards
obligation to comply with Section 39.908
                                                       F.A.C.
(confidentiality statute).
18. When shelter is full, alternate
accommodations for survivor include                   FCADV
hotels/motels, FCADV sister shelters, homeless       Standards
shelters or other facilities that can provide safe     F.A.C.
refuge.
19. Prior Corrective Action Plans were                FCADV
completed and accepted by FCADV.                     Standards
20. Other (Check one): A) Additional
                                                      FCADV
Standard/Rule___ &/or B) Additional
                                                     Standards
Impact___
Total Score                                                      0    0   0   #DIV/0!




                                                                     27        FY 2011-2012
                                                      Section VII: Fiscal High Risk
                               Center Name:                                       Center Name

                                                                 Compliance
                                                                                   I = Interview
                                                                                  O=Observation
                                                                 Yes   No   NA D= Documentation
                Area of Review                     Authority                   (List Who and What)   Comments   Score
A. High Risk                                                      0     0   0                                   #DIV/0!
1. If an audit was performed for the previous
year, the recommendations/findings identified in
the Schedule of Findings and Questioned Costs,         SC
compliance report, internal control report,        215.97 F.S.
management letter, and any corrective action       OMB A-133
plans have been implemented or otherwise           CFOP 75-8
cleared. If not, explain discrepancies in notes.

2. Does the center maintain books of accounting
                                                 CFOP 75-8
by funding source?
3. Does the center maintain a chart of accounts? CFOP 75-8
4. Do financial reports presented to the Board
contain budget vs. actual variances?             CFOP 75-8

5. Does the center prepare and maintain an
operating budget detailed by source of funds,      CFOP 75-8
program, and expenditure category?                  Attach I

6. Is the center following the approved cost
allocation method?                                  Attach I

7. Conduct a minimal sample check review to
ensure the following items have been met:
a) The check and invoice amounts agree with
                                                   CFOP 75-8
one another.
b) The check is accompanied by the original
invoice/receipt.                                   CFOP 75-8

c) The center records appropriate coding on        CFOP 75-8
checks.


                                                                       28                                        FY 2011-2012
d) Invoices are paid timely.                      CFOP 75-8
e) Items purchased are allowable expenses.        CFOP 75-8
f) All documents are defaced upon payment.        CFOP 75-8
g) Checks and invoices have appropriate
management approval.                              CFOP 75-8

h) Dual signatures are on checks when required
by center policy.                                 CFOP 75-8

8. Does the center book match through its
accounting system and is there documentation        FCADV
to support the match? Ask to see                   Standards
documentation.
9. Check latest bank reconciliations performed
in the accounting software to make sure it is     CFOP 75-8
reviewed, and signed by the next level of
management?
10. All contract deliverables submitted timely.
Review with contract manager.                     CFOP 75-8

11. Conduct a review of personnel files for all
new employees since last on-site monitoring to
ensure the following items have been met:
a) Position description/responsibilities?
                                                  Attachment I

b) Qualifications for the position?
                                                  Attachment I

c) Documentation of the training received for the
year AND documentation of the mandated 30 Attachment I
hours of training for privilege?                  F.A.C.

d) Performance evaluations for employees
according to agency policy, but at least Attachment I
annually?




                                                                 29   FY 2011-2012
e) Proof of appropriate education, credentials,
and/or licensure is documented?                     Attachment I

f) References are in files according to agency
policy?                                             Attachment I

g) The center exercises appropriate
background screening according to agency             Standards
policy?
h) There is a signed confidentiality agreement in
each file or is in the employee handbook and         Attachment I
each employee has signed acknowledgement of
receipt of the policy.
I) If applicable, there is a copy of a valid drivers
license on file.                                     Attachment I

j) If applicable, there is a DMV check on file.
                                                    Attachment I

k) Drug free policy statements should be signed
and in employee files.                              Attachment I

l) W-4 Forms are in each file.
                                                    Attachment I

m) I-9 Forms are in separate personnel file
                                                    Attachment I

n) E-Verify forms are in each file.
                                                        SC

p) If applicable, employee is listed in privilege
certification database.                              Standards




                                                                    30   FY 2011-2012
q) All personnel, paid or unpaid, who work with Attachment I
individuals and their dependents must have           F.A.C
documented in their personnel file a core comp Standards
certificate for the first year of direct service
r) Signed attestation regarding Section 504 and
ADA                                                   SC
                                                 Attachment I

Total Score                                                     0    0   0   #DIV/0!




                                                                    31        FY 2011-2012

								
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