Quality Improvement Project for Residential Care Homes for the Elderly

For Office Use Only

Serial No.:

Proposal to Implement Quality Improvement Project for Residential Care Homes for the Elderly (RCHEs)

Prescribed Form for Proposal Deadline of Submission: Not later than 5:00 p.m. on 31 August 2016

Late submission or submission not sent by hand may not be accepted for assessment.

Name of Applicant Organisation :

Key points to note:

1. This Prescribed Form for Proposal (PFP) should be typed and printed in A4 size paper in English (font size 12 in normal Times New Roman; line spacing = 1; and margins = 2.5 cm) or in Chinese (font size 13 in 新細明體; line spacing =1; and margins = 2.5 cm). Description in bullet points is preferable. Flow Charts and / or diagrams, if applicable, are also welcome.

2. This PFP should be completed in full, with input on each and every item on the form (mark ‘’ against , ‘Nil’ or ‘Not Applicable’ as appropriate; if not, the items shall be regarded as void). The space of the boxes of the PFP may be expanded to suit the presentation, but the format and the content of the PFP should not be amended or deleted in any way. All supporting documents should be attached wherever required.

3. This completed PFP should NOT be more than 20 pages in total as applicable to the whole of Part II, unless specified otherwise, of this PFP (including textual content, tables and / or charts in whatever presentation but readable format plus annexes and attachments to substantiate / supplement, if any), but excluding Parts I and III plus the requisite attachments to these two parts. The PFP should be properly page- numbered and indexed, and put in a binder.

4. SWD reserves the right not to assess information beyond the specified volume (that is, from page 21 and onwards of Part II) or those pages deviated from the prescribed format of this PFP to expand the volume.

5. The completed PFP must be submitted with six printed copies and one electronic copy (compact disc in Microsoft Word format) on or before 31 August 2016 at 5:00 p.m. to the following address by hand in a sealed envelope marked CONFIDENTIAL – “Application for Quality Improvement Project for Residential Care Homes for the

i Elderly” –

Director of Social Welfare [Attn: Ms CHAN Wai-ling Senior Social Work Officer (LORCHE)2] Licensing Office of Residential Care Homes for the Elderly Social Welfare Department Room 2354, Wu Chung House 213 Queen’s Road East Wan Chai, Hong Kong

6. Late submissions and submissions not sent by hand may not be accepted for assessment. It is the responsibility of the applicants to ensure that the application proposals are placed correctly as mentioned above. No claim for misplacement of proposals for whatever reasons will be considered. In case a rainstorm black warning or typhoon signal no.8 or above is hoisted between 2:00 p.m. and 5:00 p.m. on the closing date, the closing time for submitting proposals will be automatically extended to 5:00 p.m. on the first ensuing working day (excluding Saturday) without further announcement.

ii Part I Particulars of the Applicant Organisation

1. Name of Applicant Organisation Name in Chinese : Name in English :

2. Head of the Applicant Organisation: Name of Chairperson / Chief Executive / Executive Director (or equivalent) of the Organisation : Address of Head Office :

Telephone No. : Fax No. : Email Address :

3. Authorised Contact Person of this Application Name in Chinese : Name in English : Designation : Telephone No. : Fax No. : Email Address : Address :

4. Is your organisation a SUBVENTED Non-governmental Organisation1 (NGO)? (‘’ against  as appropriate)

 Yes [Subvented NGO of SWD does not have to complete this part and may proceed to Part III for further completion.]  No [Please provide further details in the following table.]

i. The applicant organisation is a bona-fide non-profit making organisation which

1 “Subvented Non-governmental Organisations (NGOs)” refer to the NGOs receiving regular subvention and service performance monitoring from SWD. NGOs receiving subsidies from SWD for the operation of service projects are not regarded as ‘subvented NGOs’.

iii is registered as a charitable institution or trust of a public character granted tax- exemption under section 88 of the Inland Revenue Ordinance (Cap. 112) in Hong Kong

Please attach document(s) of proof (Annex No. )

ii. Background of applicant organisation, including mission, brief history, source of operating expenses, and social welfare services provided

(a) Please attach the following document(s) of proof in Annex  Constitution / Memorandum and Articles of (Annex No. ) Association  Management structure and management personnel (Annex No. ) involved  Certified true copy of audited accounts for the past (Annex No. ) three years, including  Certified Audited Financial Statements for the three years prior to the date of submission of this proposal. The latest accounts must be for a period ending no more than 18 months before the date of submission of the proposal.  Certified Unaudited Management Accounts up to a period not earlier than six months before the date of submission of the proposal

(b) Mission  

(c) Brief history  

(d) Source of operating expenses  

(e) Social welfare services provided  

5. Is the applicant organisation approved by the Director of Social Welfare (DSW) for organising Health Worker Training Courses (HWTCs) for the Elderly or Combined HWTCs under the Residential Care Homes (Elderly Persons) Regulation (Cap. 459 sub. leg. A)? (‘’ against  as appropriate)

 Yes. The applicant Organisation is approved by DSW for organising HWTCs for the Elderly under the Residential Care Homes (Elderly Persons) Regulation.  Yes. The applicant Organisation is approved by DSW for organising Combined HWTCs under the Residential Care Homes (Elderly Persons) Regulation.

iv Part II Proposed Project [Unless specified otherwise, the whole of this Part III should NOT be more than 20 pages in total (including textual content, tables and / or charts in whatever presentation but readable format plus annexes and attachments to substantiate / supplement, if any). To suit the presentation, the space of the boxes of the PFP may be expanded, but the format and the content of the PFP should not be amended or deleted in any way.]

1. Project Design and Programme Contents Please state below the project design and programme contents including Classroom Learning for operators, home managers and RCHE staff; and On-site Coaching for RCHE staff and Seminars for RCHEs

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2. Experience in Accreditation and Relevant Training Please state below the relevant experience of your organisation in implementing accreditation or quality assurance programme for RCHEs and in providing training for RCHE staff

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3. Engagement of RCHEs Please state below strategies for engaging RCHEs to join the Project as well as the operators and different categories of RCHE staff to attend the training programmes

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4. Performance Management (a) Please state below the proposed outcome indicators with achievement level and means of measurement with reference to the project design and operation

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(b) Please state below the mechanism for monitoring and evaluating service quality and effectiveness

(5) Human Resources Management and Management Support (a) Please state below the number and qualifications / experience of professional staff and supporting personnel of the Project, with delineation of roles and responsibilities and line of accountability, organisational structure, etc.

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(b) Please state below the staff supervision system and training

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(c) Please state below the management support (e.g. central administration support, financial management, human resources management policy, etc.)

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6. Planning of Service Commencement

Please state below if premises and facilities are available for meeting the service commencement date (i.e. October 2016) are available and the implementation schedule with specified dates and detailed arrangements of the commencement of service

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7. Financial Management

(a) Please state below details of the planned budget by year including the breakdown of set-up cost, classroom learning and on-site coaching

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(b) Please state below the financial management system (e.g. budget planning,

2 projection, accounting, internal control system, auditing, etc.)

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8. Innovative and Value-added Measures Please suggest below any innovative and/or value-added measures relevant to the operation of the Project to enhance the effectiveness of implementation

 

3 Part III Annexes and Attachments, if any

Annex No. Topic / Content

In relation to the above application for the Quality Improvement Project for Residential Care Homes for the Elderly, I, the authorised signatory for and on behalf of the applicant organisation, hereby provide the information / documents for the verification and assessment by the Social Welfare Department (SWD). I hereby warrant that all information / documents provided or attached to this application are true, complete and correct. I understand that failure to provide any of the required information / documents may result in my application invalidated or not being considered. In such circumstances, SWD may withhold any funding allocation and any payment made will be returned to SWD.

Signature of the authorised signatory for and on behalf of the applicant organisation

Name of the authorised signatory : (in block letters)

Post title of the authorised signatory : (in block letters)

Organisation Stamp

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