quality assurance onsite monitoring tool - fcadv 12-13 fiscal onsite tool (pdf... · quality...

Quality Assurance Onsite Monitoring Toolfor

Center Name

FY 2012-2013

Revised July 2012

Revised July 2012

SECTION AREA AssignedSection I Board of Directors AdministrativeSection II Financial FiscalSection III Administrative AdministrativeSection IV Human Resources AdministrativeSection VI Professional Development AdministrativeSection VII Subcontracting AdministrativeSection XIII Primary Prevention Administrative

TABLE OF CONTENTS#VALUE!

Revised July 2012

I. BOARD OF DIRECTORS 0 0 #DIV/0!

II. FINANCIAL 0 0 #DIV/0!

III. ADMINISTRATIVE 0 0 #DIV/0!

IV. HUMAN RESOURCES 0 0 #DIV/0!

VI. PROFESSIONAL DEVELOPMENT 0 0 #DIV/0!

VII. SUBCONTRACTING 0 0 #DIV/0!

VII. PRIMARY PREVENTION #REF! #REF! #REF!

VIII. CAP REVIEW 0 0 #DIV/0!

ADMINISTRATIVE #REF! #REF! #REF!

TOTAL #REF!

Scoring Summary#VALUE!

Revised July 2012

Center Name:

DCF VOCAYes No

NA

A. Governance and Leadership 0 0 0 #DIV/0!1. Does the center have a board of directors?

F.A.C. X

2. If the board president changed, has thecenter notified the contract manager withinfive (5) business days? Was contactinformation also supplied?

SC

3. Does the board of directors operate withintheir quorum?

Center Bylaws

4. Ascertain if a certified center that operatesunder the umbrella of another agency has aseparate center Advisory Board, budget, andprogram policies for the center.

Standards; F.A.C. X

5. Does the center have established meetingguidelines, including when and wheremeetings will be held and a process forchanging meeting dates and times?

Standards

6. Does the center have establishedstandards covering board and officervacancies and terms of office (e.g.nominations, voting, length of term)?

Admin Standards

7. Does the center have an establishedprocess for removal of board members andofficers for cause and for non-attendance?

Admin Standards

8. Has the center established and definedofficer responsibilities and duties?

Admin Standards

9. Do the officers consist of, at a minimum,a President, a Treasurer, and a Secretary?

Admin Standards;

F.A.C.X

Section I: Board of Directors

Area of Review

Center Name

Comments ScoreAuthority

Compliance I = InterviewO=Observation

D= Documentation(List Who and What)

Revised July 2012

Center Name:

DCF VOCAYes No

NA


Area of Review

Center Name




F. Board Responsibilities 0 0 0 #DIV/0!1. Has the center established a policy thatdefines board responsibilities? Standards 2. Does the policy include that: a) Individual board members shall not speak or act for the board without approval of the board?

Standards

b) It is the responsibility of the board to provide fiscal oversight and strategic leadership rather than administrative details? Clear distinctions shall be established between board and staff roles with board focus on major involvement on the intended long-term impact of the organization, not the administrative or programmatic means of obtaining those effects.

Admin Standards;

F.A.C.X

c) Board members shall not serve in a volunteer staff capacity (day-to-day operations) to ensure the integrity of the board governance role? (Board members shall not have access to participant files and board members shall not be permitted to engage in direct service work with center participants. This does not restrict Board members or their family member from assisting with special projects.)

Standards

Revised July 2012

Center Name:

DCF VOCAYes No

NA


Area of Review

Center Name




3. Has the center established fiscal policies(approval of the annual budget, audit,investments, protection of assets, andsignatory authority)?

Standards

4. Does the Boad periodically review financial statements? (How frequently?) Standards

5. Does the center have an established policy regarding expectations and responsibilities/ limitations of the board, including their responsibility to provide personal financial support of the center?

Standards

6. Has the center established a policy regarding standing and other committees (e.g. regarding responsiblities, membership and documentation of procedures)?

Standards

Revised July 2012

Center Name:

DCF VOCAYes No

NA


Area of Review

Center Name




I. Board Orientation/Training/Self Assessment 0 0 0 #DIV/0!1. Has the center established minimumrequired board training and orientationpolicies?

Standards

2. Do board policies include the following: a) Orientation and training shall be completed within the first six months? Standards b) Members should not accept an office before completing training? Standards c) That orientation and training include: (1) Roles and responsibilities Standards (2) By-laws and policy review Standards (3) Fiscal review Standards (4) History of center Standards (5) Program services and service

Standards

(6) Privilege and confidentiality Standards (7) Basic domestic violence training Standards J. Conflict of Interest/Ethics/Code of Conduct for Board Members 0 0 0 #DIV/0!1. Does the center have established policiesthat include: a) Awarding contracts Standards b) Honoraria and other forms of compensation Standards c) Becoming a participant or employee Standards d) Interactions with program participants and employees, including: (1) Hiring Standards (2) Gifting Standards

Revised July 2012

Center Name:

DCF VOCAYes No

NA


Area of Review

Center Name




(3) Soliciting Standards (4) Socializing Standards (5) Nepotism Standards

Revised July 2012

Center Name:

DCF VOCAYes No

NA


Area of Review

Center Name




K. Board Composition 0 0 0 #DIV/0!1. Does the center have establishedguidelines addressing the composition of theboard?

Admin Standards;

F.A.C.x

a) Does one board member represent law enforcement?

Admin Standards;

F.A.C.x

b) Does the board racially and ethnically reflect the demographics of the population served?

Admin Standards;

F.A.C.x

L. Board Role with Executive Director 0 0 0 #DIV/0!1. Does the center have an established policy that addresses authority delegated to the executive director and executive limitations?

Admin Standards

2. Does the policy address: a) The performance evaluation, compensation, and benefits of the executive director? (The policy is clear that it is the responsibility of the board to do an annual evaluation of the executive director and determine the compensation/benefit package established by the board.)

Admin Standards

b) The executive director's role regarding communication to the board and employee supervision?

Admin Standards

c) That the executive director supervises all other employees and the board's role in supervision is limited to the executive director?

Admin Standards

Total Score 0 0 0 #DIV/0!

Revised July 2012

Center Name:

DCF VOCAYes No NA

A. Audits 0 0 0 #DIV/0!1. Did the center expend, during its previous fiscal year, more than $500,000 in federal or state funds and obtain an OMB A-133 audit?

SC; OMB A-133; CFOP 75-8

2. If an audit was performed for the previous year, the recommendations/findings identified in the Schedule of Findings and Questioned Costs, compliance report, internal control report, management letter, and any corrective action plans have been implemented or otherwise cleared. If not, explain discrepancies in notes.

SC; 215.97 F.S.; OMB A-133; CFOP 75-8

3. Does the center have an established policy to contract for anindependent audit of agency records for each fiscal year, whichincludes review by the board of directors?

Standards

B. Accounting/Financial System 0 0 0 #DIV/0!1. Does the center maintain books of accounting by funding source? CFOP 75-8

2. Does the center maintain a chart of accounts? CFOP 75-83. Do financial reports presented to the Board contain budget versus actual variances? CFOP 75-8

4. Does the center prepare and maintain an operating budget detailed by source of funds, program, and expenditure category?

CFOP 75-8; SC

5. Do the revenue and expenditure reports indicate variances between actual and projected expenses? CFOP 75-8

6. Is the center following the approved cost allocation method? SC

Section II: Financial Center Name

Comments ScoreArea of Review Authority

ComplianceI = Interview

O=ObservationD= Documentation

(List Who and What)

Revised July 2012

Center Name:

DCF VOCAYes No NA





(List Who and What)C. Cash Disbursements 0 0 0 #DIV/0!1. Does the center have a cash disbursement policy? Admin

Standards 2. Does the center have an established policy to address when twosignatures are required and any limitations on who the secondsignature should be?

Admin Standards

3. Conduct a check review to ensure the following items have been met: a) The check and invoice amounts agree with one another. CFOP 75-8 b) The check is accompanied by the original invoice/receipt. CFOP 75-8c) The center records appropriate coding on checks. CFOP 75-8d) Invoices are paid timely. CFOP 75-8e) Items purchased are allowable expenses. CFOP 75-8f) All documents are defaced upon payment. CFOP 75-8g) Checks and invoices have appropriate management approval. CFOP 75-8

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

Revised July 2012

Center Name:

DCF VOCAYes No NA





(List Who and What)D. Return of Funds 0 0 0 #DIV/0!1. If unallowable expenditures were charged to the contract, or the center has otherwise been overpaid, the center has made arrangements to reimburse FCADV?

CFOP 75-8; SC

2. If so, progress has been made to reconcile any obligation payable to FCADV?

CFOP 75-8; SC

E. Match 0 0 0 #DIV/0!1. Does the center book match through its accounting system and is there documentation to support the match?

CFOP 75-8; SC

2. Does the center prepare and maintain a match operating budget detailed by source of funds, program, and expenditure category? CFOP 75-8;

SC

G. Payroll 0 0 0 #DIV/0!1. The Federal Quarterly Payroll Tax Return (Form 941) and supporting documentation indicate that the center is remitting payroll taxes, including federal withholding tax, and both employee and employer share of FICA.

CFOP 75-8

2. The Florida Unemployment Compensation Tax (UCT)-6 and supporting documentation verifies that the center is filing state unemployment compensation returns.

CFOP 75-8

3. Have all individual positions been paid according to the approved budget? Identify any decrepancies. CFOP 75-8

4. From a sample of randomly selected timesheets, verify appropriate payment made to employees according to established payroll procedures.

CFOP 75-8

5. Does the center have a properly documented payroll register that differentiates between administrative and program personnel? CFOP 75-8

Revised July 2012

Center Name:

DCF VOCAYes No NA





(List Who and What)H. Purchasing 0 0 0 #DIV/0!1. Does the center have established purchasing procedures? Procedures shall address the following:

CFOP 75-1; Admin

Standardsa) Procurement of products or materials with recycled content for use in carrying out state-funded projects. SC b) The value at which three oral bids and at which three written bids are required.

CFOP 75-8; Admin

Standards

2. Does the center have established petty cash procedures? Admin

Standards I. Internal Controls 0 0 0 #DIV/0!1. Is check signing limited to those authorized to make disbursements and whose duties exclude posting and recording of cash received?

CFOP 75-8

2. Is the person making deposits different from the person who prepares the deposit slip? CFOP 75-8

3. Is the person who prepares the payroll different from the person who approves the payroll? CFOP 75-8

4. Is the person receiving the monthly bank statement in the mail different from the person performing the monthly reconciliations? CFOP 75-8

5. Are checks received in the mail restrictively endorsed immediately upon opening the mail? CFOP 75-8

6. Is cash received from fundraising events properly controlled, accounted, and reported? CFOP 75-8

7. Are bank reconciliations performed monthly in the accounting software, reviewed, and signed by the next level of management? CFOP 75-8

Revised July 2012

Center Name:

DCF VOCAYes No NA





(List Who and What)J. Policies 0 0 0 #DIV/0!1. Is it center policy that only the executive director and/or the president of the board are authorized to sign contracts and financially obligate the agency?

Admin Standards

2. Does the center maintain bank accounts for agency funds in accordance with applicable state and federal institutions?

Admin Standards

3. Does the center have a policy related to maintaining financial condition and activities?

Admin Standards

4. Is it center policy to maintain financial planning and budgeting? Admin Standards

5. Is it center policy to maintain/protect assets? Admin Standards

6. If the center receives endowed gifts, does it has a policy that addresses the investment philosophy, restrictions and risk tolerance for endowed gifts?

Admin Standards


Revised July 2012

Center Name:

DCF VOCAYes No NA

A. Corrective Action Plan Review 0 0 0 #DIV/0!1. If a monitoring visit was performed in the year previous to this review, have all deficiencies been corrected or cleared within the specified time frames? If not, explain discrepancies in notes.

CFOP 75-8

2. If a certification report required corrective action in its most recent certification of the center, have all deficiencies been corrected or cleared within the specified deadline? If not, explain in notes.

CFOP 75-8; F.A.C X

B. Insurance 0 0 0 #DIV/0!1. Is documentation available to confirm the types and amounts of insurance specified in the contract (e.g. a copy of the declaration page)?

SC; CFOP 75-8

2. Was liability insurance provided as directed in the Standard Contract? The center has furnished FCADV written verification of liability coverage?

SC

3. Are all insurance policies current? SC4. Is the center the beneficiary of any policies bought with FCADV funds? SC

5. Has an insurance bond from a responsible commercial surety company been purchased and maintained?

SC

6. At minimum, has bond and employee dishonesty insurance been required for center fiscal staff or those responsible for major fiscal functions and is it included in the center's professional liability insurance policy?

SC

7. Does the insurance bond cover all of the following workers authorized to handle funds received or disbursed under the contract: Officers, employees and agents of the center?

SC

Center NameSection III: Administrative




(List Who and What)

Revised July 2012

Center Name:

DCF VOCAYes No NA





(List Who and What)

8. As determined by the surety company, has the center ensured that the insurance bond is in an amount commensurate with the funds handled and consistent with good business practice?

SC

Revised July 2012

Center Name:

DCF VOCAYes No NA





(List Who and What)

C. Required Reports 0 0 0 #DIV/0!1. Have all required reports listed in Attachment Ibeen submitted in a timely manner, as required? Listreports below.a) Alice/Stars Report SCb) Monthly Status Report SCc) Monthly Invoice SCd) Quarterly Board Minutes SCe) Disaster/Crisis/Risk Plan SCf) Quarterly Financial Report SCf) HHS Compliance Report SCh) Other Reports (specify) SCD. Inventory/Fixed Assets 0 0 0 #DIV/0!1. Does the center conduct a physical inventory of equipment at least annually? (Applicable only when the center budgets FCADV dollars for fixed assets). Verify ID stickers are on at least three items.

CFOP 75-8; SC

2. If the inventory includes non-expendable property (fixed assets) and information technology resources, are property records maintained which, at a minimum, include:a) Property ID number and Serial Number SCb) Description SCc) Source of funds SCd) Acquisition date SCe) Cost SCf) Condition of property SCg) Location of property SCh) Does the service contract have an acquisition cost or value of $1000 or more per unit, except equipment which has no monetary threshold?

SC

i) If applicable, date property ownership will be transferred to state. SC

Revised July 2012

Center Name:

DCF VOCAYes No NA





(List Who and What)

j) Depreciation schedule for fixed assets SC

Revised July 2012

Center Name:

DCF VOCAYes No NA





(List Who and What)

3.Where property was purchased wholly or in part by federal funds, has the center complied with OMB Circular A-110 and OMB Circular A-102?

SC

4. If applicable, did the center obtain required FCADV permission prior to disposing of any property bought with FCADV funds?

SC

5. Have transfers, replacements, and dispositions of property been documented? SC

6. Does physical observation indicate that property is being used as authorized by the contract? SC

7. Does physical observation indicate that the property is adequately protected from theft, deterioration, and damage?

SC

E. Travel 0 0 0 #DIV/0!1. Does the center have written travel policies in compliance with section 112.061 F.S.? The policies shall include at minimum:

SC

a) Basis for reimbursement is state per diem or actual expenses for lodging and meal allowances for overnight travel.

SC

b) Documentation supporting travel expenditures. SCc) Supervisory approval of travel reimbursement. SCd) Persons (e.g., volunteers, interns, etc.) who travel at the program’s expense are identified. SC

e) Travel reimbursements are submitted on the State of Florida Voucher for Reimbursement of Travel Expenses (Form C-676) or equivalent.

SC

f) For any conference travel, the center has submitted the State of Florida Authorization to Incur Travel Expense (Form C-676C) with a copy of the program or agenda, prior to the travel date.

SC

F. Sponsorship 0 0 0 #DIV/0!

Revised July 2012

Center Name:

DCF VOCAYes No NA





(List Who and What)

1. If applicable, has the center complied with s. 286.25 FS, regarding sponsorship requirements?

SC

Revised July 2012

Center Name:

DCF VOCAYes No NA





(List Who and What)

G. Publicity 0 0 0 #DIV/0!1. If applicable, did the the center obtain prior written consent when the center and its employees, agents, and representatives:

SC

a) Use any State Mark, the name of the State’s mark, in advertising, publicity, or any other promotional endeavor?

SC

b) Represent, directly or indirectly, that any product or service provided by the center has been approved by FCADV?

SC

c) Refer to the existence of this contract in press releases, advertising, or materials? SC

H. Lobbying 0 0 0 #DIV/0!1. Has the center complied with s. 216.347 F.S., which prohibits the use of contract funds for the purpose of lobbying the legislature, judicial branch, or a state agency?

SC

I. Records & Record Retention 0 0 0 #DIV/0!1. Is it center policy to retain financial, personnel, and program participants' records in compliance with the guidelines of the Dept. of Children and Families and all applicable state and federal laws?

SC

2. Does the center have a public access to records policy? SC

3. Does the center have an established policy for maintaining records in such a way as to prevent inappropriate destruction of or unauthorized access to financial, personnel, and program participant records?

SC; Admin Standards

4. Does the center have a policy to address both paper and computer-generated records? Is policy in compliance with the guidelines of the department and FCADV?

SC; Admin Standards

Revised July 2012

Center Name:

DCF VOCAYes No NA





(List Who and What)

J. Other Provisions 0 0 0 #DIV/0!1.Is it true that the center has not represented itself as an officer or employee of the State of Florida? SC

2. Is it true that any discoveries or inventions from the course of work or services, or any copyrightable books, manuals, or films funded by the State of Florida were referred to the Florida Department of State for possible patent protection?

SC


Revised July 2012

Center Name:

DCF VOCAYes No NA

A. Personnel Policies 0 0 0 #DIV/0!

1. Does the center have a written policy to address gifts and gratuities?

Admin Standards

a) Ascertain if the policy addresses under what circumstances it is or is not appropriate to accept gifts or gratuties.

Admin Standards

b) Ensure policy addresses token gifts of appreciation from program participants to center staff, as well as gifts and gratuities from donors, volunteers, community members and board members.

Admin Standards

2. Does the center have a written policy on non-discrimination with regard to race, creed, religion, color, gender, sexual orientation, disability, marital status, veteran status, national origin, age or any other characteristics protected by law?

Admin Standards

3. Does the center have a written policy on recruitment and hiring?

Admin Standards

4. Does the center have a written policy on when or if to conduct background screening? Policy is in compliance with federal, state, local, and contract requirements?

Admin Standards

5. Verify that background screening policy does not prohibit the hiring of individuals with criminal records and takes into account that battered women may commit crimes to survive.

Admin Standards

6. Does the center have a written drug free workplace policy to address the use of illegal drugs, as well as abuse of legal drugs, and the disciplinary action taken for violation?

Standards

Section IV: Human Resources Center Name

ScoreArea of Review Authority


D= Documentation(List Who and What) Comments

Revised July 2012

Center Name:

DCF VOCAYes No NA





7. Does the center have a written policy that prohibits nepotism (hiring of relatives) between board and staff, staff that directly answer to family members or are in the line of authority of a family member and any nepotism with the potential to create fiscal, internal-control issues?

Admin Standards

8. Does the center have a written policy to address fraternization with regard to program participants?

Standards

Revised July 2012

Center Name:

DCF VOCAYes No NA





9. Does the center have a written policy to provide a workplace where domestic violence issues are addressed with victim safety as the priority?

Admin Standards

10. Ascertain whether the policy addresses the services and safety of employees who are victims of domestic violence as well as employee perpetrators. The policy shall apply regardless of whether the incident occurred during or out of work, or on or off center property.

Admin Standards

11. Zero-tolerance policy of domestic violence perpetrated by employees? SC

12. Does the center have a written policy to define employee status,( i.e. non-exempt, temporary, and permanent)? Definition should be consistent with labor law.

Admin Standards

13. Does the center have a policy that stipulates annual performance evaluations for employees? The policy shall include written guidelines for performance evaluation and salary review.

Admin Standards

14. Does the center have written guidelines for constructive, corrective, and progressive disciplinary guidelines? Procedures shall include the protocol for enforcement of the guidelines.

Admin Standards

15. Does the center have a written policy(s) regarding termination and attendance that are in accordance with Florida law and rules? The policy contains the following:

Standards

a) Voluntary termination: the center shall have established a policy that addresses an expectation of notice and what the consequences might be if notice is not received.

Standards

b) Involuntary Termination: The center shall have established a policy regarding involuntary termination that includes some at-will language.

Standards

Revised July 2012

Center Name:

DCF VOCAYes No NA





c) Center has a written policy that addresses attendance requirements. This policy shall include abandonment of position (usually 3 days unexcused absences) and specify that abandonment of position is considered voluntary termination.

Standards

Revised July 2012

Center Name:

DCF VOCAYes No NA





16. Does the center have a policy on employee compensation? Standards

17. Does the center have a policy addessing benefits to include: employee leave, workers' compensation, health insurance, and retirement?

Standards

18. Does the center have a policy that employee records are the property of the center? The policy shall state conditions for employee review.

Standards

19. Does the center have an established policy to address sexual harassment of both staff and program participants?

Standards

20. Do centers with the qualifying number of employees provide family medical leave and comply with Florida Statutes?

Standards

B. Staffing Requirements 0 0 0 #DIV/0!1. At a minimum, does the domestic violence center staffing consist of one full time executive director or administrator, one full-time advocate services manager, and one half time accounting manager pursuant to 65 H-1 and the Standard Contract?

F.A.C. x

2. Are additional staffing levels maintained as per contract, if applicable? SC

3. Did the center notify FCADV within five (5) business days when the executive director or equivalent position was vacated and was the name of the interim contact person provided?

SC

4. Has the center notified FCADV of additional staffing changes as per contract? SC

5. Has the center complied with required staffing credentials/qualification for key management staff as outline in 65 H-1?

F.A.C x

C. Staff Management 0 0 0 #DIV/0!1. All staff members who provide counseling, service management and advocacy are provided opportunities to debrief.

Admin Standards

Revised July 2012

Center Name:

DCF VOCAYes No NA





D. Employee Personnel Files 0 0 0 #DIV/0!1. Verify if personnel records are maintained according to agency policy. SC

2. Do staff personnel files include the following information:

a) Position description/responsibilities? SC

b) Qualifications for the position? SC

c) Documentation of the training received for the year AND documentation of the mandated 30 hours of training for privilege?

SC; F.A.C. x

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

SC

e) Proof of appropriate education, credentials, and/or licensure is documented?

SC

f) References are in files according to agency policy? SC

g) The center exercises appropriate background screening according to agency policy?

SC

h) There is a signed confidentiality agreement in each file or is in the employee handbook and each employee has signed acknowledgement of receipt of the policy.

SC

i) If applicable, there is a copy of a valid drivers license on file. SC

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

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

l) W-4 Forms are in each file. SC

m) I-9 Forms are in separate personnel file SCn) E-Verify forms are in each file. SCo) If applicable, employee is listed in privilege certification database. Standards

Revised July 2012

Center Name:

DCF VOCAYes No NA





p) All personnel, paid or unpaid, who work with individuals and their dependents must have documented in their personnel file a core comp certificate for the first year of direct service employment and sixteen (16) hours of annual training for all subsequent years.

SC; F.A.C.;

Standardsx

q) Signed attestation regarding Section 504 and ADA. SC

r) Signed attestation regarding Effective Communication. SC

s) Certificate of Completion for Effective Communication. SC


Revised July 2012

Center Name:

DCF VOCAYes No NA

A. Training 0 0 0 #DIV/0!

1. Does the center have a policy on training?Admin

Standards2. Has training regarding safety principles and universal precautions been documented according to agency policy?

Admin Standards

3. Has the center developed, implemented, and revised annually a staff training and development plan to ensure that all new employees, current employees, and volunteers meet training requirements as required by this rule?

F.A.C. x

4. Does the plan include policies and procedures for implementing training activities, course titles, descriptions, objectives, number of hours, names of instructors with title or position or source, dates or timeframes, and training requirements for each staff position?

F.A.C. x

5. Has the training of each employee and volunteer been documented in the staff member’s personnel file or training record and includes activities or course titles, number of hours, names of instructors and title or position, and dates of completion?

F.A.C. x

Section V: Professional Development Center Name

I = InterviewO=Observation

D= Documentation(List Who and What) Comments ScoreArea of Review Authority

Compliance

Revised July 2012

Center Name:

DCF VOCAYes No NA




Compliance

6. Does the plan address at minimum the following items: F.A.C.

a) Competency-Based Core Training: Advanced-level training on domestic violence that includes the knowledge and skills needed to work in domestic violence program areas such as crisis intervention, safety planning, and advocacy. All staff members who supervise, coordinate, and/or provide direct advocate or counseling services to center participants shall successfully complete 30 hours of domestic violence competency-based core training. The successful completion of this training is required in order for an employee and participant to assert the evidentiary privilege afforded by Section 90.5036, F.S.

F.A.C. x

b) Emergency Training: In addition to in-service training, all staff members shall receive, at a minimum, annual training on implementing the center’s emergency management plan.

F.A.C. x

c) Guidelines regarding prevention of accidents? Standardsd) Training regarding safety principles and techniques? Standards

8. Has the advocate completed a total of 30 hours of core and specialized training to obtain privilege, which shall include:

Revised July 2012

Center Name:

DCF VOCAYes No NA




Compliance

a) Completing the 24-hour FCADV Competency-Based Core Curriculum as presented by FCADV training department staff or an FCADV Authorized Trainer, or completing a competency-based core curriculum approved by the FCADV training department staff in advance of the training and presented by a trainer(s) of a Florida certified domestic violence center?

F.A.C.; SC;

Admin Standards

x

b) Completing a minimum of six hours of additional specialized training (may include on the job orientation or training of skills related to performance of required duties)?

F.A.C.; SC;

Admin Standards

x

Revised July 2012

Center Name:

DCF VOCAYes No NA




Compliance

9. Have direct-service staff and volunteers received advocate-victim privilege prior to any unsupervised contact with participants?

Admin Standards

B. Training Exemptions 0 0 0 #DIV/0!1. Are individuals or groups providing specialized services exempt from training and registration?

Admin Standards

2. The center has and maintains a contract that includes provisions for survivor and shelter confidentiality, orientation to the center’s services (and any policies and procedures relevant to the services being provided), and an agreement outlining services (including limitations) to be provided?

Admin Standards

C. Victim Advocate Privilege 0 0 0 #DIV/0!1. Has the application for advocate-victim privilege been submitted to FCADV by executive director as required?

Admin Standards

2. Has the executive director certified, by witness of a notary public, that the advocate(s) being registered have completed the required 30 hours of training for advocate-victim privilege?

Admin Standards

3. Are advocates applying for privilege current employees or volunteers of the center?

Admin Standards

4. Has the center notified FCADV on a quarterly basis of any advocate who is no longer an employee or volunteer of the center?

Admin Standards


Revised July 2012

Center Name:

Yes No NA

A. Approval 0 0 0 #DIV/0!1. Has the center received written FCADV approval for subcontracting any work under this contract?

SC

B. Subcontract Document 0 0 0 #DIV/0!1. Have contractual audit and record keeping requirements been included in any related subcontract or assignments entered into under this contract?

SC

C. Invoice and Service Delivery 0 0 0 #DIV/0!1. Is the provider paying the subcontractor within 7 working days of receiving FCADV payments, unless otherwise stated in contract between provider and subcontractor?

SC

2. From a sample of contract invoices, verify whether required supporting documentation (such as time sheets, vendor receipts, service records) is available.

SC

3. Verify that service events billed can be traced to the records of the individual actually performing the service (e.g., van driver, therapist, trainer, etc.).

SC


Section VI: Subcontracting Center Name




(List Who and What)

Revised July 2012

Center Name:

Yes No NA

A. Prevention Deliverables 0 0 0 #DIV/0!1. Did the center participate in the previous quarter(s) Regional Webinars schedule during this fiscal year?

Prevention Deliverables

2. Did the center conduct the previous quarterly Community Action Team meeting(s) during this fiscal year?


3. Has the center conducted two rounds of primary prevention programming with youth?


a. Are there sign-in sheets for each session? Prevention Deliverables

b. Are there copies of pre-/post-tests for each participant of each of the two rounds?


c. Are there copies of the FCADV-approved Group Process Notes form for each session?


d. Are there completed FCADV Evaluation Tools populated with participant responses in Excel format?


4. Has the center attended at least one of the following Prevention Events by May 6, 2013:


a. One-day regional trainings in September 2012 Prevention

Deliverables b. Two-day Primary Prevention Institute in November 2012 Prevention

Deliverables c. One-day Youth Summit on February 9, 2013 Prevention

Deliverables

Section VII: PREVENTION Center Name

Area of Review Authority



(List Who and What) Comments Score

Revised July 2012

5. In regard to rubric submission of currriculum review, has the center provided FCADV with a copy of the curriculum currently being used for programming by April 5, 2013?


6. In regard to rubric submission of curricum review, has the center submitted the completed rubic by April 5, 2013?



Revised July 2012

Center Name:

Yes No NA

Finding I 0 0 0 #DIV/0!1. Center is now in compliance with finding # 1 of last year's monitoring tool. Standards

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 # 2 of last year's monitoring tool. Standards

2, Observed compliance or tested to see if in compliance. Standards





Section VIII: CAP REVIEW Center Name

Area of Review

Authority



(List Who and What) Comments Score

Revised July 2012








Revised July 2012

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