HomeMy WebLinkAboutAgreement A-16-684-2 with First 5 for Nurse Liaison.pdf Agreement No. 16-684-2
County of Fresno, Department of Public Health
Contract#201617-0950
Nurse Liaison
Page 1
Amendment II to
Services Agreement
Fiscal Year 2019/2020
Parties
Commission: Children and Families Commission of Fresno County, California
Contractor: County of Fresno,Department of Public Health
Administrative
Original Contract Number: 201617-0950
Amendment 11 Contract Number: 201617-0950
Recitals
A. Commission and Contractor are parties to that certain Program Services
Agreement (the"Agreement'),dated July 1,2016,the Term of which is from July 1,2016 to June 30,
2o18(the"Original Term').
B. The Parties now desire to amend the Agreement to provide for an extension
of the Term and to modify the Services and Project Budget all as defined in the Agreement.
C. All capitalized terms used in this Amendment II to Program Services
Agreement (this"Amendment II") shall have the meanings provided for in the Agreement unless
otherwise specified in this Amendment II.
Therefore,in consideration of the above recitals,which are incorporated into this
Amendment II by reference,the Parties agree as follows:
1. Term. This Amendment II is made effective as of July 1,2019 (the"Effective
Date"). The Term of the Agreement is extended until June 30, 2020,unless
terminated earlier under the Agreement (the"Term' or as specified in this
Amendment II to the contrary.
2. Amendment to Section 2.1. Effective as of July 1,2019,Exhibit A will be
replaced with the Exhibit A,"Scope of Work(2019-2o Fiscal Year)"attached to this Amendment II
and incorporated herein by this reference. As of July 1,2019,except as needed to interpret and
enforce Contractor's responsibilities and obligations under the original Term of the Agreement,the
original Exhibit A attached to the Agreement will have no further force and effect.
3. Amendment to Section 4.1. Section 4.1 of the Agreement is deleted in its
entirety and replaced with the following:
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County of Fresno,Department of Public Health
Contract#201617-O950
Nurse Liaison
Page 2
4.1 Project Budget. Compensation for the Services provided from July 1,2019 to
June 30,2020 is based upon actual costs as described in Exhibit B.
Compensation for the Services will in no event exceed the total amount of
$i,,388,cmo (the"Contract Amount'). The Contract Amount includes
Compensation for Services remaining under the Original Term of the
Agreement. Compensation for Services provided prior to July 1,2019 shall
be in accordance with the original Agreement and this Amendment II.
4. Amendment to Section 4.2. The first sentence in Section 4.2 of the
Agreement is deleted in its entirely and replaced with the following (the remainder of
Section 4.2 is unaffected):
Commission will reimburse Contractor for all necessary,reasonable,and justifiable
expenses,as determined by Commission,incurred in accordance with the Project
Budget for providing the Services on behalf of Commission in an amount not to
exceed the Contract Amount.
S. Controlling Document; No Other Amendment. In the event of any conflict
between the terms of this Amendment II and the Agreement,the terms of this
Amendment II shall control. Except as amended by this Amendment II,all terms of
the Agreement shall remain in full force and effect,including,without limitation,all
monitoring,evaluation,data collection,contract review,auditing,inspection,and
record retention obligations set forth in Article 8 of the Agreement.
6. Bindincr Effect. The Agreement,as amended by this Amendment II,is
binding upon,and inures to the benefit of,the respective heirs,executors,
administrators,successors,and assigns of the Parties.
7. Headings and Construction. The subject headings of the sections and
paragraphs of this Amendment II are included for purposes of convenience only and
do not affect the construction or interpretation of any of its provisions. All words
used in this Amendment II include the plural as well as the singular number,and
vice versa;words used in this Amendment II in the present tense include the future
as well as the present;and words used in this Amendment II in the masculine gender
include the feminine and neuter genders,whenever the context so requires. No
provision of this Amendment II will be interpreted for or against a Party because that
Party or its legal representative drafted the provision,and this Amendment II will be
construed as if jointly prepared by the Parties.
8. Counterparts. This Amendment II may be signed by the Parties in different
counterparts and the signature pages combined to create one document binding on
all Parties.
g. Sicrnature Authority. Each Party represents that it has capacity,full power,
and authority to enter into this Amendment II and perform under modified terms of
the Agreement,and the person signing this Agreement on behalf of each Party has
been properly authorized and empowered to enter into this Amendment II.
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County of Fresno,Department of Public Health
Contract#201617-0950
Nurse Liaison
Page 3
Signatures
COMMISSION CONTRACTOR
CHILDREN AND FAMILIES COMMISSION COUNTY OF FRESNO,DEPARTMENT OF
OF FRESNO COUNTY PUBLIC HEALTH
REVIEWED AND RECOMMENDED
FOR APPROV L By:
W-41 /A Authorized Representative
By:
Emilia Reyes,Executive Di e�;K�
c Date of Signature: Q 110' 19
Date of Signature: g1,21,5119 Name: Nathan Magsig
Chairman of the Board of Supervisors
Title: of the County of Fresno
APPROVED AS TO L L FORM
• Federal Tax ID Number: _la.
By:
Ken eth Pric ,Legal Counsel ATTEST:
Date of Signature: / olZs��� BERNICE E. SEIDEL
Clerk of the Board of Supervisors
County,of�F`rJ no, State of California
By:
�JF,,, By LIoJJ/1
Brian Pacheco, Commission Chair
Date of Signature: /V�a3�19
FOR ACCOUNTING USE ONLY
Org:56201615
Fund/Subclass:0001/10000
Revenue:3530
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County of Fresno,Department of Public Health
Contract#201617-0950
Nurse Liaison
Page 4
EXHIBIT A
Scope of Work (2019-20 Fiscal Year)
A-1
FIRST5 Direct Services Face Sheet & Scope of Work
This document will be completed with First 5 Fresno County(F5FC)staff
and Service Provider during a development meeting.
A. Face Sheet
Agency Name: County of Fresno, Department of Contract Number: 201617-0950
Public Health Project ID Number: 0950-17
GL:
Project Name: Nurse Liaison SF1 — 10-8518-00 100 %
Start date/End date: 07/01/2016 - 06/30/2020
FY 16-17: $312,617
Agency Address: 1221 Fulton Street, Fresno, Contract amount: FY 17-18: $323,762
CA 93721 $1,388,930 FY 18-19: $402,560
FY 19-20: $349,991
Other Project Funding:
$ 1,607,083
BOS District: 3 Agency phone #: 559-600-3330
Mailing address if different than above: N/A
Website: www.fcdph.org
Strategic Plan Tier: Tier 1: Children Families
Project Description:
Briefly address what F5FC is funding and why. If applicable, describe the goals/outcomes. This will be placed on
the F5FC website.
The primary goal of the Nurse Liaison program is to prevent child maltreatment by improving health
outcomes and decreasing potential re-hospitalization rates for at-risk infants and children. The Nurse
Liaison program provides public health nurse liaison services to Community Regional Medical Center
and Valley Children's Hospital to support infants from the Neonatal Intensive Care Unit and their families
through the transition to community care as well as high risk infants and children under six years of age
living in Fresno County who because of organic or environmental factors may be at risk for growth and
developmental delays and who may face serious health problems. In addition, the program serves
children with developmental or behavior challenges identified through their child care provider and
pregnant or parenting teens referred from the CalLearn program. Nurse Liaisons provide assessment,
consultation, technical assistance, referral and linkage to a variety of community programs via a home
visitation model.
F5FC Contract Manager: Liliana Salcedo
Program Contact
Person who runs day to da program o erations/su ervisor/coordinator/mana er
Prefix: Mrs. Name: Megan Gunn Title: Supervising Public Health Nurse
E-mail: mgunn@fresnocountyca.gov Phone #: 559-600-3330
Finance Contact
Person responsible for submitting bud ets,financial reports and/or invoices
Prefix: Mr. Name: Michael Chu Title: Accountant
E-mail: mchu@fresnocountyca.gov Phone #: 559-600-6426
Notice Contact
Person who has legal authority to sign contract
Prefix: Mr. Name: David Pomaville Title: Director
E-mail: dpomaville@fresnocountyca.gov Phone #: 559-600-3200
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E]FIRST5S Direct Services Face Sheet & Scope of Work
FREPublic Contact
Person responsible for general public calls requesting program info, how to access services, media, etc.
Prefix: Ms. Name: Megan Gunn Title: Supervising Public Health Nurse
E-mail: mgunn@fresnocountyca.gov Phone #: 559-600-3330
Persimmony Contact Program Module — PROGRAM DATA ENTRY
(Person responsible for entering data)
Prefix: Ms. Name: Megan Gunn Title: Supervising Public Health Nurse
E-mail: mgunn@fresnocountyca.gov Phone #: 559-600-3330
Training: Access and No Training Required
Persimmony Contact Program Module — PROGRAM DATA APPROVAL
(Person responsible for approving submission of data)
Prefix: Ms. Name: Megan Gunn Title: Supervising Public Health Nurse
E-mail: mgunn@fresnocountyca.gov Phone #: 559-600-3330
Training: Access and No Training Required
Persimmony Contact Financial Module— FINANCIAL DATA ENTRY
(Person responsible for entering financial information)
Prefix: Mr. Name: Michael Chu Title: Accountant
E-mail: mchu@fresnocountyca.gov Phone #: 559-600-6426
Training: Access and No Training Required
Persimmony Contact Financial Module — FINANCIAL APPROVAL
(Person responsible for approving financial information)
Prefix: Ms. Name: Aphivanh (Aphi) Xayavath Title: Staff Analyst
E-mail: axayavath@fresnocountyca.gov Phone #: 559-600-3330
Persimmony Monitoring Module —ANNUAL CONTRACT REVIEW (ACR) ACCESS
Person responsible for responding to administrative and programmatic components of the ACR
Prefix: Ms. Name: Megan Gunn Title: Supervising Public Health Nurse
E-mail: mgunn@fresnocountyca.gov Phone #: 559-600-3330
Persimmony Monitoring Module —ANNUAL CONTRACT REVIEW (ACR) ACCESS
Person responsible for responding to financial component of the ACR
Prefix: Mr. Name: Michael Chu Title: Accountant
E-mail: mchu@fresnocountyca.gov Phone #: 559-600-6426
Agency Service Locations:
List all physical addresses where FSFC services take place. If more than three sites, please include in
this document by adding another row. Refer to the Fresno County website to find the correct County
District for each service location.
Location(s) District(s)
Location 1: 1221 Fulton Street, Fresno. CA 93721 District 3
County of Fresno Department of Public Health, Nurse Liaison,#201617-0950
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E]FIRST5S Direct Services Face Sheet & Scope of Work
FREFirst 5 Fresno County Strategic Plan and First 5 CA Result and Service Area Alignment:
Percent of Funding Dollar Amount
Goal per F5FC Strategic Plan: FY1920 FY1920
Goal 3: Strong Families 100% $349,991
Primary Strategy per Percent of Funding Dollar Amount
F5FC Strategic Plan: FY1920 FY1920
SP Multi-disciplinary Research-based Home Visitat 100% $349,991
State Result Percent of Clients Percent of Funding
Area/Outcome
State Service Area
Refer to the Annual Report&
School Readiness FY1920 FY1920
Appendices Fiscal Year
3. Improved Child Health 3h) Primary Specialty Medical Services 100% 100%
Is this an evidence based or research-based program?
(Please check one)
❑ Evidence Based
® Research Based
❑ N/A
County of Fresno Department of Public Health, Nurse Liaison,#201617-0950
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E]FIRST5S Direct Services Face Sheet & Scope of Work
FRECOUNTY
B. Demographic and Geographic Client Served Details
Types of Clients Served and Projected Numbers:
Please note that these fields reflect the client type options in Persimmon y and not family relationships. Include all
client level and aggregate clients included in sections C and D.
Total#of Clients
Type of Client
FY1920
Child 0<3 113
Child 3-5 37
Parent 50
Prenatal 0
Other(please specify): 0
TOTAL: 200
Total#of Clients
Provider Category
FY1920
Internal Program Staff 5
TOTAL: 5
Projected Numbers Served in Each Geographic Region:
Use the countywide box for programs providing services throughout the county.
Total#of Clients
Geographical Location of Clients to be Served
FY1920
County Wide 200
Total: 200
Geographical Total#of Clients Percent Urban (%) Percent Rural (%)
Location of
Clients to be
Served FY1920 FY1920 FY1920
Countywide 200 90% 10%
County of Fresno Department of Public Health, Nurse Liaison,#201617-0950
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E]FIRST5S Direct Services Face Sheet & Scope of Work
FRECOUNTY
C. Outputs: Services and Contacts
All services listed in section C are required to be entered in Persimmony on a monthly basis, refer to the Service Provider Manual for details.
All clients served by F5FC funds must meet age and residency requirements. Service Provider is required to maintain back-up documentation. The
information in the table below will remain the same for the full contract term (from one fiscal year to the next) unless otherwise specified or modified
throuah a contract amendment reauest.
Core Client Target#
Service Type F5FC Strategy Core (Expected#of clients Frequency Verification Method
Client Type receiving service)
FY1920
Total':45
Case management session -Parenting Parent Q1:5 z
Teen' SF1 Multi-disciplinary Research-based Home Visitat Q2:15 3 sessions Service log
Q3:10
Q4:15
Total:150
Q1:37
Case management sessions SF1 Multi-disciplinary Research-based Home Visitat Child Q2:37 3 sessions° Service log
Q3:38
Q4:38
Total:85
HP3 Development Screenings and Assessments Child Q1.20 Annually and as
SQ Q2:21 needed ASQ/ASQ:SE
Q3:22
Q4:22
Total:40
Q1:10 Annually and as
SQ:SE HP3 Development Screenings and Assessments Child Q2:10 needed ASQ/ASQ:SE
Q3:10
Q4:10
Total:95
Q1:22 Annually and as Service log
Developmental referral CP6 Resource,referral,coordination,and alignmen Child Q2:22 needed
Q3:25
Q4:26
Total:95
e Q1:22 Annually and as Service log
Other referral CP6 Resource,referral,coordination,and alignmen Child+Parent Q2:22 needed
Q3:25
Q4:26
Total:5
Q1:5 s Attendance Records/Sign-in sheets
Reflective practice session CP1 Professional dev and training for providers Provider Q2:5 Once a month
Q3:5
Q4:5
Total unduplicated clients to be served in the entire year
County of Fresno Department of Public Health, Nurse Liaison, #201617-0950
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FIFIRST5 Direct Services Face Sheet & Scope of Work
FRESNO COUNTY
D. Aggregate Services and Narrative
The information in the table below will remain the same for the full contract term (from one fiscal year to the next) unless otherwise specified or
modified through a contract amendment request. Service Provider is required to maintain back-up documentation. Data due Quarterly.
® Not Applicable-If your program does not provide aggregate services, please check this box
County of Fresno Department of Public Health, Nurse Liaison, #201617-0950
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E]FIRST5 Direct Services Face Sheet & Scope of Work
FRESNO COUNTY
Service Provider Staff Confidentiality Agreement & Request for Persimmony User Logon
All staff members of FSFC funded programs and projects (Service Providers)who are responsible for gathering or
maintaining confidential information and records must adhere to this agreement.
Responsibilities
During the performance of Service Provider assigned duties related to the FSFC project, Service Provider might
have access to confidential client information and records required for effective coordination and delivery of
services to children and their families. All confidential discussions, deliberations, records, and information
generated or maintained in connection with these activities shall be disclosed only to persons who have the need to
know and authority to access confidential consumer information or records. This includes information obtained and
conveyed through all media including the Persimmony database. Service Provider must not disclose any
confidential client information to any third party without the written authorization from the client or legally
authorized representative.
Legal Liabilities
Service Provider must adhere to the following:
• Notice:All applicable employees, agents, and subcontractors shall be notified of state requirements for
confidentiality and also notified that any person knowingly or intentionally violating the provisions of the state
law is guilty of a misdemeanor.
• Records pertaining to any individual recipient of FSFC will be confidential and will not be open to examination
for any purpose not directly connected with the administration of local evaluation.
• No person will publish, disclose, use, or permit the use of, or cause to be published, disclosed or used, any
confidential information pertaining to any individual recipient of FSFC services.
Prohibition of Re-Disclosing Confidential Client Information Employment Confidentiality
Agreement
This notice accompanies a disclosure of confidential information concerning a consumer of services funded by the
FSFC. The above referenced agency is prohibited from making any further disclosure of this confidential
information unless further disclosure is expressly permitted by the written authorization to release the information of
the person to whom it pertains or as otherwise permitted by these regulations. A general authorization for the
release of confidential information is NOT sufficient for this purpose.
Acknowledgement of Confidentiality and Prohibition of Re-Disclosing Confidential Client
Information Employment Confidentiality Agreement
The Agency acknowledges responsibility not to divulge any confidential information or records concerning clients of
FSFC funded services without proper written authorization. By signing the Direct Services Agreement, the Agency
accepts confidentiality and prohibition of re-disclosing confidential funding requirements.
County of Fresno Department of Public Health, Nurse Liaison,#201617-0950
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E]FIRST5 Direct Services Face Sheet & Scope of Work
FRESNO COUNTY
Type of Agreement: Amendment-Direct Service
Type of Procurement: ❑ Informal ® Formal ❑ Sole Source
Annual Contract Review: ® Formal ❑ Informal
BFF Policy Agreement Form Completed: ® Yes❑ No (attach form to contract) ❑ N/A
EFT Form Completed: ® Yes❑ No (attach form to contract)
W-9 Completed: ® Yes ❑ No
Persimmony Set-Up: (check all that apply)
❑ No data - only basic info for state reporting
❑ Aggregate data ® Financial module
® Client level data reporting ❑ Monthly reporting
® Narrative ® Quarterly reporting
® Performance module ❑ One time payment
❑ Financial module ® State upload
Type of Agency: (choose only one)
❑ City Government ❑ Private and/or for Profit Organization
❑ Community Benefit Organization (501(c)3 ❑ School District
® County Government ❑ State Government
❑ Faith Based Organization (attach policy) ❑ Other (please specify):
❑ Federal Government Agency
❑ Higher Education
F5FC Office Use Only
Commission Approved Date: 06/01/2016
F5FC Staff Review and FY1617 FY1718 FY1819 FY1920
Approval
Contract Manager 4/19/16 6/01/17 4/27/18 4/9/19
Approved
Strategies Reviewed &
Approved by Program & 4/19/16 6/23/17 N/A N/A
Evaluation Director
Agency name: County of Fresno Department of Public Contract number: 201617-0950
Health
Program name: Nurse Liaison Contract amount: 1,388,930
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E]FIRST5s Direct Services Face Sheet & Scope of Work
FRE • See Description of Services (end notes) •
Case management session- Parenting Teen: Case Management sessions include PHN visits at the
client's home or field visits as an alternative to the home (examples: school, restaurant, park, etc.). Case
management will be provided primarily to pregnant and/or parenting teens but may include case
management services to infants and children referred from the community. Referrals come from the
CalLearn program or other infant or children referrals.
Case management sessions may also include a telephone call no less than 5-10 minutes in length for
services such as follow-up with the referral source, consultation with medical providers, child care
providers, social workers, parents, and representatives of agencies involved with the client's follow-up
services. These case management sessions will be recorded in the nursing documentation notes.
2 Case management session (Parenting Teen) Frequency: It is expected that there will be an average
of three service contacts per client, however it may range from one to as many as needed for case
management services based on each client's needs and availability.
3 Case management session- Child: Case Management sessions include PHN visits at the client's
home, field or site visits. Field visits are defined as visits with the PHN at alternative sites such as a public
park, library or a restaurant. Site visits are defined as visits with the PHN at child care homes or centers.
Case management sessions may also include a telephone call no less than 5-10 minutes in length for
services such as follow-up with the referral source, consultation with medical providers, child care
providers, social workers, parents, and representatives of agencies involved with the client's follow-up
services. These case management sessions will be recorded in the nursing documentation notes.
Primary referral sources are Valley Children's Hospital and Community Regional Medical Center with
additional referrals being received from CPS, medical clinics, private doctors, community members, etc.
Referral sources also include child care centers, child care homes, preschools, CSN, etc.
4 Case management (Child) frequency: It is expected there will be an average of three service contacts
per client, however it may range from one to as many as needed for case management services based
on each client's needs and availability.
5 Other Referral (Child): Nurse Liaison will attach other referrals to the child or the parent/caregiver
depending on the specificity of the referral. These other referrals are to improve the environment and
decrease stressors on the child.
6 Reflective Practice- Frequency: Staff will participate in a group Reflective Practice (RP) and one-on-
one sessions with the SPHN. The average RP service per staff member is once a month. The focus of
these meetings will be to provide an opportunity to explore experiences, feelings and challenges
encountered with clients or with the challenges of the role of home visiting itself.
County of Fresno Department of Public Health, Nurse Liaison, #201617-0950
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County of Fresno,Department of Public Health
Contract#201617-0950
Nurse Liaison
Page 5
EXHIBIT B
Project Budget (2019-2o Fiscal Year)
B-1
1 FIRST 5 FRESNO COUNTY
2 Direct Service Budget
6
4 Agency Name: County of Fresno, Department of Public Health
5 Project Name: Nurse Liaison
6 Contract Term: 07/01/16-06/30/20
7 Contract Number: 201617-0950
8 Submission Date: 4/5/2019
9 Prepared by: Aphivanh Xayavath
10 Title: Staff Analyst
11
12
Year 1 Year 2 Year 3 Year 4
13 Actuals Actuals Budget Budget Total Program
Amount
14 07/01/16-6/30/17 07/01/17-06/30/18 07/01/18-06/30/19 07/01/19-06/30/20
15 Category
16 I. Personnel
17 A. Salaries 144,171 135,693 184,918 187,729 652,511
18 B. Benefits 96,882 96,858 126,268 128,942 448,949
19 C. Taxes 11,188 10,006 14,146 14,361 49,701
20 Total Personnel 252,241 242,557 325,332 331,032 1,151,162
21 II. Operating Expenses
22 A. Facilities Costs 4,579 4,826 5,933 5,366 20,704
23 B. Operational/Supplies 3,069 2,611 3,250 1,832 10,762
24 C. Training/Travel 2,832 1,200 4,913 2,832 11,777
25 Total Operating Expenses 10,480 8,637 14,096 10,030 43,243
26 III. Program Expenses
27 A. Materials and Supplies 2,889 2,983 5,332 3,929 15,133
28 T Total ProgramVxpensel 2,889 2,983 5,332 3,929 15,133
29 IV. Professional Services 7,000 6,060 9,000 5,000 27,060
30 VI. Indirect Costs 40,007 63,525 48,800 0 152,332
31
32 Total Program 312,617 323,762 402,560 349,991 $1,388,930
33
Year 1 Year 2 Year 3 Year 4 Total Other
34 VII. Other Funding Actuals Actuals Budget Budget Funding
35 A. Leveraged 344,725 376,600 452,238 433,520 1,607,083
36 B. Select Other Funding Sour( 0 0 0 0 0
37 C. Other Funding Source: 0 0 0 0 0
38 [Total Other Funding 344,725 376,600 452,238 433,520 1,607,083
Children Families Commission of Fresno County
nwww fir0MrPznn Urq
FIRST5 Service Provider Budget
FRESNO COUNTY
1 jAgency Name: County of Fresno, Department of Public Health Contract Term: 07/01/16-06/30/20
2 jProject Name: I Nurse Liaison Contract Number: 201617-0950
3
4
YEAR 3 Budget
5 First 5 Amounts Leveraged Select Other Funding Source: Select Other Funding Source:
6 07/01/18-6/30/19 07/01/18-6/30/19 07/01/18-6/30/19 07/01/18-6/30/19
7 I. Personnel Title FTE Amount Title FTE Amount Title FTE Amount Title FTE Amount
8 Supervising Public Health Nurse 0.36 25,574 Supervising Public Health Nurse 0.34 24,154 - -
9 The "Amount" should be: Annual Public Health Nurse II 0.50 48,207 Public Health Nurse II 0.50 48,207
10 Salary X the FTE whenever Public Health Nurse 1 0.41 28,235 Public Health Nurse 1 0.59 40,606
11 possible. Public Health Nurse 1 0.42 36,993 Public Health Nurse 1 0.58 51,086
12 1 FTE = 40 hours /week Public Health Nurse II 0.47 45,909 Public Health Nurse II 0.53 51,104
13
14
15 A. Total Salaries & FTE 2.16 184,918 2.54 215,157 - - - -
16 B. Benefits 68.283% 126,268 146,916 - -
17 C. Taxes 7.65% 14,146 16,459.51 - -
18 Personnel Subtotal 325,332 378,532 - -
Justification of Benefits and Estimated benefits rates reflect Unemployment Insurance (.0007738), Retirement (.5186-.6583), OASDI (.0765), Health Insurance
19 Taxes: ($7386-$9996 per FTE per year) and Benefits Administration ($104 per FTE per year).
20 II. Operating Expenses
21 A. Facilities Costs 5,933 8,301 - -
22 Narrative/Justification — Explain these costs and how they apply to the program, then state methodology (FTE, Square Footage, etc) for these costs and provide the calculation
Fresno County Department of Public Health, 1221 Fulton Mall, 4th floor, Fresno, CA 93721. Costs cover the facilities charged by square footage and
assigned phone lines. Telephones ($1,717), facility operation/maintenance services ($4,991), household expenses ($1,000), utilities ($4,611), and
23 security/alarm ($1,915). These are all Internal Service Funds charges. General Services Administration provides base amount for the department. Nurse
24 B. Operational/Supplies 3,250 1,750 - -
25 Narrative/Justification — Explain these costs and how they apply to the program, then state methodology (materials, services, leases) for these costs and provide the calculation
General office supplies such as paper, pencils, envelopes and filing supplies ($2,500) and postage ($500). Medical supplies for PHNs to use during home
visits ($2,400).
26
27 C. Training/Travel 4,913 6,875 1 -
28 Narrative/Justification — Explain these costs and how they apply to the program, then state methodology (name of local conferences & trainings) for these costs and provide the calculation
Fees for staff to attend local meetings, conferences, and trainings ($1,000). Staff private auto mileage reimbursement at a rate of$0.545 per mile ($2,200).
County vehicle maintenance/usage/garage ($8,588).
29
33 Operating Expenses Subtotal 14,096 1 16,926 1 - -
34 III. Program Expenses
Instructional Information In the Narrative/Justification box provide a detailed explanation of all program expenses considered on this line item and how they are to support the program participants (include calculations where applicable).
35
36 A. Materials and Supplies 5,332 - - -
37 Subtotal 5,332 - - -
38 Narrative/Justification — Provide the number of participants, cost per item, a description of the item, and justification for all expenses that support the clients of the program.
Forms, pamphlets educational materials (books for children) to evaluate, educate and foster Narrative/Justification for Materials and Supplies Narrative/Justification for Materials and Supplies Narrative/Justification for Materials and Supplies
physical/mental/social growth in Nurse Liaison clients.
39
40 1 IV. Professional Services (Contracts, MOU's, Sub agreements, etc.)
6/7/2019 2 of 4
Children Families Commission of Fresno County
FIR T 5 Service Provider Budget
FRESNO COUNTY
Instructional Information In the Narrative/Justification box provide a detailed explanation of all professional services considered on this line item and how they are to support the program or staff(include calculations where applicable). Any
41 services exceeding $5,000 must have attached a narrative delineating services.
43 Subtotal 9,000 - - -
Estimated costs for interpreters/translators who provide services for various languages through Narrative/Justification — Narrative/Justification — Narrative/Justification —
a Countywide contract. Interpreting services at a rate of$40.00 per hour.
44
50 Program Totalsi 353,760 395,458 - -
51 VI. Indirect (= Program Totals - Equipment x Percentage of Indirect)
Instructional Information In the Narrative/Justification box explain these costs, how they will support/benefit the program, and how the percentage was determined.
52
53 A. Indirect Rate 15.00% 48,800 56,780
Fresno County Department of Public Health's indirect cost rate is 26.5% of the total personnel costs, prepared following OMB's 2 CFR Part 200 guidelines Narrative/Justification — Narrative/Justification —
and approved by County of Fresno's Auditor-Controller/Treasure-Tax Collector Department. Lower rate applied to this budget to ensure sufficient funding
54 for direct costs and remaining within funding allocation.
551 Total Proposed Budget 402,560 452,238 - -
6/7/2019 3 of 4
1 Agency Name: County of Fresno,Department of Public Health Contract Term: 07/01/16-06/30/20
2 Project Name: Nurse Liaison Contract Number: 201617-0950
3
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YEAR 4 Budget
5 First 5 Amounts Leveraged Select Other Funding Source: Select Other Funding Source:
6 07/01119.6/30120 07/01/19-6/30120 07/01119.6/30/20 07101/19.6/30/20
7 I. Personnel Title FTE Amount Title FTE Amount Title FTE Amount Title FTE Amount
8 Supervising Public Health Nurse 0.30 29,927 Supervising Public Health Nurse 0.40 40,937 - -
9 Public Health Nurse II 0.42 41,402 Public Health Nurse II 0.58 56,945 - -
The"Amount"should be:Annual
10 Salary X the FTE whenever Public Health Nurse 1 0.38 29,568 Public Health Nurse 1 0.62 48,441 - -
11 possible. Public Health Nurse 1 0.51 41,831 Public Health Nurse 1 0.49 37,759 - -
12 1 FTE=40 hours/week Public Health Nurse II 0.45 45,001 Public Health Nurse 11 0.55 55,284 - -
13
14
15 A. Total Salaries&FTE 2.06 187,729 2.64 239,366 - - - -
16 B. Benefits 68.685% 128,941.66 164,409 -
17 C. Taxes 1 7.65% 14,361.27 18,311 - -
18 Personnel Subtotal 331,032 422,086 - -
Justification of Benefits and Estimated benefits rates reflect unemployment Insurance(.00182),Retirement(.5116-.648),OASDI(.0765),Health Insurance
19 Taxes: ($8,643-$11.510 per FTE per year)and Benefits Administration($109 per FTE per year).
20 It. Operating Expenses
21 A. Facilities Costs 5,366 6,948 - -
22 Narrative/Justification—Explain these costs and how they apply to the program,then state methodology(FTE,Square Footage,etc)for these costs and provide the calculation
Fresno County Department of Public Health,1221 Fulton Mall,4th floor,Fresno,CA 93721. Telephones($1,815),facility operation/maintenance services
($4,600),utilities($4,000),and security/alarm($1,899). These are all Internal Service Funds charges by square footage and assigned phone lines for the
23 program.General Services Administration provides base amount for the department.Nurse Liaison staff account for approximately 950 sq ft.
24 B. Operational/Supplies 1,832 1 818 - -
25 Narrative/Justification—Explain these costs and how they apply to the program,then state methodology(materials,services,leases)for these costs and provide the calculation
General office supplies such as paper,pencils,envelopes and filing supplies($1,250)and postage($200).Medical supplies for PHNs to use during home
visits($1,200).
26
27 C.TraininglTravel 2,832 3,668 - -
28 Narrative/Justification—Explain these costs and how they apply to the program,then state methodology(name of local conferences&trainings)for these costs and provide the calculation
Fees for staff to attend local meetings,conferences,and trainings($1,000).Staff private auto mileage reimbursement at a rate of$0.58 per mile($2,000).
County vehicle maintenance/usage/garage($3,500).
29
33 Operating Expenses Subtotal 10,030 1 11,434 - -
34 III. Program Expenses
Instructional Information In the Narrative/Justification box provide a detailed explanation of all program expenses considered on this line item and how they are to support the program participants(include calculations where applicable).
35
36 A. Materials and Supplies 3,929 - - -
37 Subtotal 3,929 - - -
38 Narrative/Justification—Provide the number of participants,cost per item,a description of the item,and justification for all expenses that support the clients of the program.
Forms,pamphlets,educational materials(books and toys for children)to evaluate,educate and Narrative/Justification for Materials and Supplies Narrative/Justification for Materials and Supplies Narrative/Justification for Materials and Supplies
foster physical/mental/social growth in Nurse Liaison clients.
39
40 IV. Professional Services(Contracts,MOU's,Sub agreements,etc.)
Instructional Information In the Narrative/Justification box provide a detailed explanation of all professional services considered on this line item and how they are to support the program or staff(include calculations where applicable).Any
41 services exceeding$5,000 must have attached a narrative delineating services.
43 Subtotal 5,000 - - -
Estimated costs for interpreters/translators who provide services for various languages through a Narrative/Justification— Narrative/Justification— Narrative/Justification—
Countywide contract.Interpreting services at a rate of$40.00 per hour.
44
50 Program Totals
51 VI.Indirect(=Program Totals-Equipment x Percentage of Indirect)
Instructional Information In the Narrative/Justification box explain these costs,how they will support/benefit the program,and how the percentage was determined.
52
53 A. Indirect Rate 0.00% - -
Narrative/Justification— Narrative/Justification—
54
55 Total Proposed Budget