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DocuSign Envelope ID: C5305795- 2DF5- 4A04- B090- 9F458AA520CB <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Current Year Estimated Results <br />The 2017 Caregiver Survey showed 100% of 50 reporting families <br />observing improvements in their family member's functioning. <br />Next Year Projected Results <br />It is projected that the 2018 Caregiver Survey will show over 90% of <br />(projected 55 respondent) reporting families observing improvements in <br />their family member's functioning. <br />3. Program Activity Name <br />Maintain Program Standards: <br />Program administration assures that all aspects of the program are in <br />compliance with the state rules for annual certification <br />Program Goal <br />The program strives for a level of excellence and maintains standards <br />required by the State Division of Aging and Adult Services <br />Performance Measures <br />(While the annual caregiver survey is a good tool for measuring qualitative <br />standards of the program, state licensure is also a measurable marker.) <br />Charles House Association will continue to surpass the NC Standards and <br />maintain state certification tooperate as an adult day program. <br />Previous Year Program Results <br />Charles House received recertification by the State Division of Aging and <br />Adult Services in July, 2016 <br />Current Year Estimated Results <br />Charles House received recertification by the State Division of Aging and <br />Adult Services in June, 2017 <br />Next Year Projected Results <br />It is projected that Charles House will successfully complete recertification <br />by the State Division of Aging and Adult Services in summer, 2018 <br />4. Program Activity Name <br />Program Goal <br />Performance Measures <br />Previous Year Program Results <br />Current Year Estimated Results <br />Next Year Projected Results <br />PROGRAM INFORMATION 2/12/2018 10:47:30 AM 3 <br />