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Certified by: _______________________ Title: __________________________ Date: ____________ <br /> (Provider’s Signature) <br /> <br /> <br />EXHIBIT “B” <br /> <br />Scope of Services – FY 2021-22 <br />Outside Agency Performance Agreement <br /> <br />Agency Name: Senior Care of Orange County, Inc. <br />Program Name: Soltys Adult Day Health Program (Soltys Place) <br />Funding Award: 36,750 <br /> <br />Outline how the agency will spend Orange County’s funding award. <br />Program Services <br />Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2022. <br /> Reopen program services in accordance with NCDHHS licensing standards. <br /> Enable participants to engage in a supported, therapeutic environment to maintain health and well- <br />being <br /> Provide community support options for family care partners with respite services, including meals, <br />health status monitoring and treatments, and opportunities to connect socially. <br /> <br />Anticipated Outcomes <br />The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange <br />County, only (all Towns and municipalities). If you use percentages, you must also provide the total number of participants within <br />that measure’s description or for an earlier performance measure. <br />Performance Measures Anticipated <br />Results <br />Reopen the adult day health program on a standard schedule for interested participants in 10/21 <br />Build participant enrollment to 30 total participants averaging 15 participants per day by 5/1/22 <br /> Achieve average daily census of 20 participants by 7/1 by 7/1/22 <br /> <br /> <br /> <br /> <br /> <br /> <br />Expense Description Amount <br />Payroll Expense for Hourly Staff 24,000 <br />Snacks and Food (in excess of in-kind credit) 2,750 <br />Other Operating Expenses 10,000 <br /> <br /> <br /> <br />DocuSign Envelope ID: 72092D64-3271-4520-9022-FC0D55D2D85C <br />Executive Director 10/26/2021