HomeMy WebLinkAboutAgreement A-15-084 with Exodus Inc..pdf AGREEMENT NO. 15-084
FL-121 UMCBIdg319(YouthCrsis)
ExodusFoundation,I nc/DBH5630
1 FACILITY USE AGREEMENT
2 THIS FACILITY USE AGREEMENT (hereinafter"AGREEMENT") is made and entered
3 into this 10th day of March , 2015, by and between the COUNTY OF FRESNO, a
4 political subdivision of the State of California, 2220 Tulare Street, Suite 2100, Room 2101,
5 Fresno, California, 93721-2106, (hereinafter"COUNTY"), and EXODUS FOUNDATION, INC.,
6 a non-profit California corporation, with offices at 9808 Venice Boulevard, Suite 700, Culver
7 City, California 90232 (hereinafter"EXODUS"). COUNTY and EXODUS may, hereinafter, be
8 referred to collectively as"Parties" or individually as "Party".
9 WITNESSETH:
10 WHEREAS, COUNTY owns the building located at 4411 E. Kings Canyon, Fresno, CA
11 93702 (Building 319), Fresno, CA 93702 (hereinafter"Building"); and
12 WHEREAS, COUNTY has reached agreement with EXODUS' affiliate, Exodus
13 Recovery, Inc. (Exodus Recovery), to operate a Youth Crisis Stabilization Center Facility at the
14 Building; and
15 WHEREAS, the Board of Supervisors of COUNTY, pursuant to Government Code
16 section 26227, hereby finds that the operation of a Youth Crisis Stabilization Center Facility
17 providing psychiatric health services for children/youth is necessary to meet the social needs of
18 the population of the County of Fresno, including but not limited to, the areas of health, law
19 enforcement, public safety, rehabilitation, welfare, and education; and, is serving a public
20 purpose; and, is a necessary mental health program that will meet the health needs of Fresno
21 County; and, is in the public interest; and
22 WHEREAS, pursuant to Government Code section 26227, COUNTY finds that the
23 Building will not be needed for COUNTY purposes and the Building will be used to carry out the
24 provision of crisis stabilization services for children/youth of the County of Fresno by EXODUS'
25 affiliate, Exodus Recovery; and,
26 WHEREAS, COUNTY desires to enter into an agreement with EXODUS to allow for
27 and ensure the ongoing provision of crisis stabilization services for children/youth at the
28 Building by EXODUS' affiliate, Exodus Recovery; and
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1 WHEREAS, EXODUS represents and covenants that it is a duly organized and existing
2 nonprofit corporation under the laws of the State of Nevada and that it is tax-exempt under
3 Internal Revenue Code section 501(c)(3).
4 NOW, THEREFORE, in consideration of the mutual promises, covenants and
5 conditions hereinafter contained, such Parties, and each of them, do agree as follows:
6 1. PREMISES - COUNTY shall make available to EXODUS approximately three
7 thousand four hundred fifty (3,450) square feet of space at the location commonly known as
8 4411 E. Kings Canyon, Fresno, California 93702 (Building 319) as shown in Exhibit A, attached
9 hereto and by this reference incorporated herein (hereinafter"Premises").
10 2. TERM AND TERMINATION - The initial term of this AGREEMENT shall be effective
11 beginning on the first date of occupancy by Exodus Recovery through June 30, 2015. The first
12 date of occupancy shall be confirmed in writing between the COUNTY and EXODUS. Effective
13 July 1, 2015, this AGREEMENT shall renew for a one (1) year term upon the same terms and
14 conditions herein set forth, unless either COUNTY or EXODUS provides written notice of non-
15 renewal to the other Party no later than thirty (30) days prior to the close of the then current
16 term. In no event shall this AGREEMENT extend beyond June 30, 2016.
17 Notwithstanding anything to the contrary in this AGREEMENT, COUNTY shall have the
18 right to terminate this AGREEMENT immediately in the event that Exodus Recovery ceases to
19 perform any of its obligations and provide any of the services described in Section 3., herein
20 below. EXODUS acknowledges that Exodus Recovery is an affiliate of EXODUS and, as such,
21 Exodus Recovery's failure to perform any of its obligations as described in Section 3., herein
22 below shall be deemed EXODUS' failure to perform any of its obligations pursuant to the
23 AGREEMENT. As to COUNTY, the Director of Internal Services/Chief Information Officer or
24 the Director of the Department of Behavioral Health, or one of their designees, may provide
25 written notice of non-renewal or termination of this AGREEMENT.
26 3. CONSIDERATION - There is no monetary consideration for this AGREEMENT.
27 COUNTY acknowledges as adequate consideration for EXODUS' use of the Premises the
28 services provided by Exodus Recovery as set forth in Exodus Recovery's Scope of Work,
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1 attached hereto as Exhibit B, and incorporated herein by reference. Such consideration, in
2 addition to the mutual promises and covenants made herein by the Parties, is deemed by the
3 Parties to be sufficient.
4 4. UTILITIES - COUNTY shall be responsible for electricity, natural gas, water, sewer,
5 garbage, and telephone costs.
6 5. USE - EXODUS shall use the Premises twenty-four (24) hours per day every day of
7 the year to provide the services described in Exhibit B. EXODUS agrees that the use of the
8 Premises shall, at all times, be consistent with providing these services. EXODUS agrees to
9 not commit, suffer or permit any waste or nuisance on the Premises, and not to use or permit
10 the use of the Premises for any illegal or immoral purposes. EXODUS further agrees to
11 comply with all state laws, local ordinances and other governmental regulations which may be
12 required by any governmental authority.
13 COUNTY shall make the Premises available in "as is" condition. Prior to the execution
14 of this AGREEMENT, EXODUS shall visit the Premises and by its independent determination
15 confirm that the Premises are suitable for its use. COUNTY warrants that the Premises are
16 safe or suitable for EXODUS' intended use and are in compliance with all applicable laws,
17 ordinances and regulations for said use.
18 6. MAINTENANCE AND REPAIRS OF PREMISES - COUNTY shall be responsible for
19 the structural condition of the Premises and for all exterior and interior maintenance, including
20 but not limited to, the air conditioning, heating, plumbing, electrical, roof, painting, landscaping
21 and parking lot. COUNTY covenants that, insofar as only the aforementioned items are
22 concerned, the Premises shall be maintained in substantially the same condition as that
23 existing at the commencement of this AGREEMENT.
24 EXODUS or Exodus Recovery, at either's sole expense, may contract with a private
25 vendor for janitorial services at the Premises. EXODUS shall ensure that any private janitorial
26 service providing such services shall comply with the janitorial standards established by
27 COUNTY for its County-owned facilities, as shown in Exhibit C, attached hereto and by this
28 reference incorporated herein.
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1 EXODUS shall report (or ensure that Exodus Recovery reports) damages to the
2 Premises within twenty-four(24) hours after they occur to the Director of the Department of
3 Behavioral Health. EXODUS shall be responsible to pay for all damages caused by the
4 actions of Exodus Recovery patients, employees and invitees.
5 7. IMPROVEMENTS TO THE PREMISES - If EXODUS desires to make
6 improvements to the Premises, EXODUS shall provide drawings and plans describing the
7 improvements to the Director of the Department of Behavioral Health, for review and approval.
8 The COUNTY'S approval of EXODUS' request to make improvements shall not be
9 unreasonably withheld by COUNTY. EXODUS shall be solely responsible to pay for any and
10 all of its requested improvements.
11 The construction of EXODUS' improvements to the Premises shall only be performed
12 by COUNTY or its approved agent.
13 8. ENFORCEMENT OF AGREEMENT - If EXODUS shall default on any of the
14 covenants or agreements contained in this AGREEMENT, COUNTY shall give written notice of
15 such default to EXODUS, and EXODUS shall have thirty (30) days from the date the written
16 notice is sent to cure such default. If EXODUS does not cure the default within thirty (30) days,
17 COUNTY may, at its option, at any time after such default or breach and without any demand
18 on or notice to EXODUS or to any other person, of any kind whatsoever, re-enter and take
19 possession of the Premises and remove all persons or property therefrom, and EXODUS
20 waives any legal remedy to defeat COUNTY'S rights and possessions hereunder. However,
21 nothing contained herein shall prevent COUNTY from seeking any other legal or equitable
22 remedies in a court of law which arise from such breach or default.
23 9. NOTICES - All notices to be given under this AGREEMENT by either Party to the
24 other Party shall be in writing, and given by any one of the following methods:
25 (i) Personal delivery; or
26 (ii) Sent by certified United States mail, first class postage prepaid,
27 with return receipt requested, to the applicable addresses as set forth below, in which case
28 such notice shall be deemed given three (3) business days if COUNTY is the recipient, or three
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1 (3) business days if EXODUS is the recipient, after such deposit and postmark with the United
2 States Postal Service; or
3 (iii) Sent by a reputable overnight commercial courier, in which case
4 such notice shall be deemed given one (1) business day if COUNTY is the recipient, or one (1)
5 business day if EXODUS is the recipient, after such deposit with that courier to the applicable
6 addresses as set forth below.
7 The addresses and telephone numbers of the Parties for purposes of giving receiving
8 notices under this AGREEMENT are as follows:
9
10
11
COUNTY: EXODUS:
12 County of Fresno Exodus Foundation, Inc.
Robert W. Bash (FL-121) Luana Murphy, President/CEO
13 Director of Internal Services 9808 Venice Blvd, Suite 700
2220 Tulare Street, Suite 2100 Culver City, CA 90232
14 Fresno, CA 93721-2116 (310) 945-3350
(559) 600-1715
15
16 Provided however, such notices may be given to such person or at such other place
17 as either of the Parties may from time to time designate by giving written notice to the other
18 Party, and provided further however, in any event notices of changes of address or termination
19 of this AGREEMENT shall not be effective until actual delivery of such notice. Notices given
20 hereunder shall not be amendments or modifications to this AGREEMENT.
21 10. HOLD HARMLESS - EXODUS agrees to indemnify, save, hold harmless, and at
22 COUNTY'S request, defend the COUNTY, its officers, agents, and employees from any and all
23 costs and expenses, damages, liabilities, claims, and losses occurring or resulting to COUNTY
24 in connection with the performance, or failure to perform, by EXODUS, its officers, agents, or
25 employees under this AGREEMENT, and from any and all costs and expenses, damages,
26 liabilities, claims, and loses occurring or resulting to any person, firm, or corporation who may
27 be injured or damaged by the performance, or failure to perform of EXODUS, its officers,
28 agents, or employees under this AGREEMENT.
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1 The parties acknowledge that as between COUNTY and EXODUS each is responsible
2 for the negligence of its own employees and invitees.
3 11. INTERNAL SECURITY FOR THE PREMISES — EXODUS or its affiliate, Exodus
4 Recovery, at either's sole expense, may contract with a private security service for internal
5 security of the Premises. EXODUS shall ensure that in such event, the internal security
6 provided shall be provided twenty-four (24) hours per day every day of the calendar year.
7 12. INSURANCE —Without limiting the COUNTY'S right to obtain indemnification from
8 EXODUS or any third parties, EXODUS, at its sole expense, shall maintain in full force and
9 effect, the following insurance policies or a program of self-insurance, throughout the term of
10 this AGREEMENT:
11
12 a. Commercial General Liability - Commercial General Liability Insurance with
13 limits of not less than One Million Dollars ($1,000,000) per occurrence and an
14 annual aggregate of Two Million Dollars ($2,000,000). This policy shall be
15 issued on a per occurrence basis. COUNTY may require specific coverages
16 including completed operations, products liability, contractual liability, Explosion-
17 Collapse-Underground, fire legal liability, or any other liability insurance deemed
18 necessary because of the nature of this contract.
19 b. Property Insurance—Against all risk of loss to COUNTY property, at full
20 replacement cost with no coinsurance penalty provision, naming COUNTY as
21 an additional loss payee.
22 c. Automobile Liability - Comprehensive Automobile Liability Insurance with
23 limits for bodily injury of not less than Two Hundred Fifty Thousand Dollars
24 ($250,000) per person, Five Hundred Thousand Dollars ($500,000) per accident
25 and for property damages of not less than Fifty Thousand Dollars ($50,000), or
26 such coverage with a combined single limit of Five Hundred Thousand Dollars
27 ($500,000). Coverage should include owned and non-owned vehicles used in
28 connection with this AGREEMENT.
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1 d. Worker's Compensation - A policy of Worker's Compensation insurance
2 may be required by the California Labor Code.
3 e. Professional Liability Insurance - If EXODUS employs professional staff
4 (e.g., PH.D., R.N., L.C.S.W., M.F.C.C.) in providing services, with limits of not
5 less than One Million Dollars ($1,000,000) per occurrence, Three Million Dollars
6 ($3,000,000) annual aggregate.
7 f. Child Abuse/Molestation and Social Services Coverage — EXODUS or
8 Exodus Recovery shall have either separate policies or an umbrella policy with
9 endorsements covering Child Abuse/Molestation and Social Services Liability
10 coverage or have a specific endorsement on their General Commercial liability
11 policy covering Child Abuse/Molestation and Social Services Liability. The
12 policy limits for these policies shall be One Million Dollars ($1,000,000) per
13 occurrence with Two Million Dollars ($2,000,000) annual aggregate. The
14 policies are to be on a per occurrence basis.
15 EXODUS shall obtain endorsements to the Commercial General Liability insurance
16 naming the County of Fresno (hereinafter"County"), its officers, agents, and employees,
17 individually and collectively, as additional insured, but only insofar as the operations under this
18 AGREEMENT are concerned. Such coverage for additional insured shall apply as primary
19 insurance and any other insurance, or self-insurance, maintained by, County, its officers,
20 agents, and employees shall be excess only and not contributing with insurance provided
21 under EXODUS' policies herein. This insurance shall not be cancelled or changed without a
22 minimum or thirty (30) days advance written notice given to County.
23 Within (30) days from date EXODUS executes this AGREEMENT, EXODUS shall
24 provide certificates of insurance and endorsement as stated above for all of the foregoing
25 policies, as required herein, to the County of Fresno, Attn: ISD Lease Services (FL-121), 2220
26 Tulare Street, 21 st Floor, Room 2101, Fresno, CA 93721-2106, stating that such insurance
27 coverages have been obtained and are in full force; that the County, its officers, agents and
28 employees will not be responsible for any premiums on the policies; that such Commercial
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1 General Liability insurance names the County, its officers, agents, and employees, individually
2 and collectively, as additional insured, but only insofar as the operations under this
3 AGREEMENT are concerned; that such coverage for additional insured shall apply as primary
4 insurance and any other insurance, or self- insurance shall not be cancelled or changed
5 without a minimum of thirty (30) days advance, written notice given to County.
6 In the event EXODUS fails to keep in effect at all times insurance coverage as herein
7 provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate
8 this AGREEMENT upon the occurrence of such event.
9 All policies shall be with admitted insurers licensed to do business in the State of
10 California. Insurance purchased shall be purchased from companies possessing a current A.M
11 Best Company rating of A FSC VII or better.
12 COUNTY shall maintain during the term of this AGREEMENT the following policies of
13 insurance, which coverages may be provided in whole or in part through one or more programs
14 of self-insurance:
15 a. Commercial General liability insurance with limits of not less than One
16 Million Dollars ($1,000,000) per occurrence and an annual aggregate of not less
17 than Two Million Dollars ($2,000,000). This policy shall be issued on an
18 occurrence basis.
19 b. All-Risk property insurance.
20 13. INDEPENDENT CONTRACTOR - In performance of the work, duties and
21 obligations assumed by EXODUS under this AGREEMENT, it is mutually understood and
22 agreed that EXODUS, including any and all of the EXODUS' officers, agents, and employees
23 will at all times be acting and performing as an independent contractor, and shall act in an
24 independent capacity and not as an officer, agent, servant, employee, joint venturer, partner, or
25 associate of the COUNTY. Furthermore, COUNTY shall have no right to control or supervise
26 or direct the manner or method by which EXODUS shall perform its work and function.
27 However, COUNTY shall retain the right to administer this AGREEMENT so as to verify that
28 EXODUS is performing its obligations in accordance with the terms and conditions of the
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1 AGREEMENT.
2 COUNTY and EXODUS shall comply with all applicable provisions of law and the
3 rules and regulations, if any, of governmental authorities having jurisdiction over matters the
4 subject thereof.
5 Because of its status as an independent contractor, EXODUS shall have absolutely
6 no right to employment rights and benefits available to COUNTY'S employees. EXODUS shall
7 be solely liable and responsible for providing to, or on behalf of, its employees all legally-
8 required employee benefits. In addition, EXODUS shall be solely responsible and save/hold
9 COUNTY harmless from all matters, except for COUNTY AND COUNTY'S employee's gross
10 negligence and/or willful misconduct, relating to payment of EXODUS' employees, including
11 compliance with Social Security withholding and all other regulations governing such matters
12 14. SURRENDER OF POSSESSION - Upon the expiration or termination of this
13 AGREEMENT, EXODUS will surrender the Premises to COUNTY in such condition as existing
14 at the commencement of this AGREEMENT less reasonable wear and tear, and less the
15 effects of any breach of COUNTY'S covenant to maintain. EXODUS will not be responsible for
16 any damage which EXODUS was not obligated hereunder to repair.
17 15. FIXTURES - EXODUS agrees that any equipment, fixtures or apparatus installed in
18 or on the Premises by EXODUS shall become the property of COUNTY and may not be
19 removed by EXODUS at any time.
20 16. POSSESSORY INTEREST SUBJECT TO TAXATION AND PROPERTY
21 INTEREST SUBJECT TO ASSESSMENT - The Parties acknowledges that California
22 Revenue & Taxation Code § 107.6 provides, in relevant part, the following: '(a) The state or
23 any local public entity of government, when entering into a written contract with a private party
24 whereby a possessory interest subject to property taxation may be created, shall include, or
25 cause to be included, in that contract, a statement that the property interest may be subject to
26 property taxation if created, and that the party in whom the possessory interest is vested may
27 be subject to the payment of property taxes levied on the interest.' Accordingly, the Parties
28 agree that COUNTY is a 'local public entity of government,' and that EXODUS is a 'private
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1 party,' respectively, within the meaning of California Revenue & Taxation Code § 107.6(a), and
2 that this AGREEMENT is a 'contract,' which creates a possessory interest that is subject to
3 property taxation pursuant to California Revenue & Taxation Code § 107.6(a). In this regard,
4 under this AGREEMENT, EXODUS acknowledges and agrees that (1) the property interest
5 created by this AGREEMENT is subject to property taxation, and (2) EXODUS (i.e., the party in
6 whom the possessory interest is vested) shall, at its sole cost and expense, be subject to the
7 direct payment of property taxes levied on such interest, and shall directly pay any and all
8 property taxes levied on such interest, and any interest, penalties, or charges thereon for
9 EXODUS' late payment of, or failure to pay such amounts when they are due and payable.
10 The Parties acknowledge that California Constitution, Article XIIID (also known as
11 Proposition 218), § 2 provides as follows: '(b) 'Assessment' means any levy or charge upon
12 real property by an agency for a special benefit conferred upon the real property. 'Assessment'
13 includes, but is not limited to, 'special assessment,' 'benefit assessment,' 'maintenance
14 assessment' and `special assessment tax[;...] (e) `Fee' or 'charge' means any levy other than
15 an ad valorem tax, a special tax, or an assessment, imposed by an agency upon a parcel or
16 upon a person as an incident of property ownership, including a user fee or charge for a
17 property related service[; ... and] (g)' Property ownership' shall be deemed to include tenancies
18 of real property where tenants are directly liable to pay the assessment, fee, or charge in
19 question.' Accordingly, the Parties agree that this AGREEMENT creates and include a
20 tenancy of real property, which shall be deemed to be a `property interest' subject to
21 assessments, or fees or charges under California Constitution, Article XIIID, § 2. In this regard,
22 under this AGREEMENT, EXODUS acknowledges and agrees that (1) the tenancy of real
23 property created and included by this AGREEMENT is subject to assessments, and fees and
24 charges within the meaning of California Constitution, Article XIIID, § 2, and (2) EXODUS (i.e.,
25 the party in whom the tenancy of real property is vested) shall, at its sole cost and expense, be
26 subject to the direct payment of such assessments, and fees and charges levied on such
27 interest, and shall directly pay any and all such assessments, and fees and charges levied on
28 such interest, and any interest, penalties, or charges thereon for EXODUS' late payment of, or
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1 failure to pay such amounts when they are due and payable.
2 The provisions of this Section 16 shall survive the termination of this AGREEMENT.
3 17. RIGHT OF ENTRY - COUNTY, or its representative(s), shall have the right to enter
4 the Premises at any time during business hours with reasonable notice and at such other time
5 as EXODUS deems appropriate, to make any alterations, repairs or improvements to the
6 Premises. The normal business of EXODUS or its invitees shall not be unnecessarily
7 inconvenienced.
8 18. AMENDMENT - This AGREEMENT may be amended in writing by the mutual
9 consent of the Parties without in any way affecting the remainder.
10 19. NON-ASSIGNMENT- Neither Party shall assign, transfer or sub-contract this
11 AGREEMENT, nor their rights or duties under this AGREEMENT, without the prior written
12 consent of the other Party. Such consent is hereby granted for EXODUS to sub-lease the
13 Premises to Exodus Recovery for the purposes described herein.
14 20. GOVERNING LAW -Venue for any action arising out of or relating to this
15 AGREEMENT shall be in Fresno County, California. This AGREEMENT shall be governed by
16 the laws of the State of California.
17 21. DISCLOSURE OF SELF DEALING TRANSACTIONS - This provision is only
18 applicable if the EXODUS is operating as a corporation (a for-profit or non-profit corporation) or
19 if during the term of this AGREEMENT, EXODUS changes its status to operate as a
20 corporation.
21 Members of EXODUS' Board of Directors shall disclose any self-dealing transactions
22 that they are a party to while EXODUS is providing goods or performing services under this
23 AGREEMENT. A self-dealing transaction shall mean a transaction to which the EXODUS is a
24 party and in which one or more of its directors has a material financial interest. Members of the
25 Board of Directors shall disclose any self-dealing transactions that they are a party to by
26 completing and signing a Self-Dealing Transaction Disclosure Form (Exhibit D) and submitting
27 it to the County of Fresno prior to commencing with the self-dealing transaction or immediately
28 thereafter.
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1 22. AUTHORITY - Each individual executing this AGREEMENT on behalf of EXODUS
2 represents and warrants that that individual is duly authorized to execute and deliver this
3 AGREEMENT on behalf of EXODUS and that this AGREEMENT is binding upon EXODUS in
4 accordance with its terms. The terms of this AGREEMENT are intended by the Parties as a
5 final expression of their agreement with respect to such terms as are included in this
6 AGREEMENT and may not be contradicted by evidence of any prior or contemporaneous
7 agreement, arrangement, understanding or negotiation (whether oral or written).
8 23. ENTIRE FACILITY USE AGREEMENT - This AGREEMENT constitutes the entire
9 AGREEMENT between the COUNTY and EXODUS with respect to the subject matter hereof
10 and supersedes all prior AGREEMENTS, negotiations, proposals, commitments, writings,
11 advertisements, publications, and understandings of any nature whatsoever, unless expressly
12 referenced in this AGREEMENT.
13 HI
14 1//
15
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23 111
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27 III
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1 EXECUTED as of the date first herein written.
2 TENANT: LANDLORD:
3 EXODUS FOUNDATION, INC. COUNTY OF FRESN
4 B / By
5 Luana Murphy, A Deborah A. Poochigia hairman
President/Chief Executive icer Board of Supervisor
6
By ATTEST: BERNICE E. SEIDEL, CLERK
8 LeeAnn Skorohod, CHC, CCEP BOARD OF SUPERVISORS
Senior Vice President 6
9 By �' -tsn y &IL10
Deputy
10
APPROVED AS TO LEGAL FORM:
11 DANIEL C.
CCEDERBORG, COUNTY COUNSEL
12 By
13 Deputy
14 APPROVED AS TO ACCOUNTING FORM:
VICKI CROW, C.P.A.
15 AUDITOR-CONTROLLER/TREASURER-TAX
COLLECTOR
16 `
By ( i _
17 RE EN ED FOR AP OVAL:
18
19 Robert W. Bash, Director of Internal
Services/Chief Information Officer
20
RECOMMENDED FOR APPROVAL:
21 ,,
By
22 Dawan Ut6bht, Director, De artment of
Behavioral Health
23
Fund: 0001
24 Subs: 10000
Org No. 56302111
25 Acct. No. 7294
26 FL-121/Exodus/DBH5630(YouthCrisisStabilizationCenter)
27
28
COUNTY OF FRESNO
Faano,Califomia 13
Exhibit "A"
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Exhibit B
FL-121
Page 1 of 9
YOUTH CRISIS STABILIZATION CENTER
Scope of Work
ORGANIZATION: Exodus Recovery, Inc.
ADDRESS: 9808 Venice Boulevard, Suite 700, Culver City, CA 90232
SITE ADDRESS: 4411 E. Kings Canyon Road, Fresno, CA, 93702
SERVICES: Youth Crisis Stabilization Services
PROJECT DIRECTOR: Luana Murphy, MBA, President/CEO
Phone Number: (559) 453-6271
CONTRACT PERIOD: March 10, 2015— March 31, 2015 (Ramp Up Period)
April 1, 2015—June 30, 2015 (Initial Operational Period)
Effective July 1, 2015, shall continue one-year (Operational Period)
CONTRACT AMOUNT: $ 208,530 3/10/2015 through 3/31/2015 (Ramp Up Period)
$ 694,558 4/1/2015 through 6/30/2015 (Initial Operational Period)
$2,649,269 FY 2015-16 (Operational Period)
SCHEDULE OF SERVICES:
CONTRACTOR shall operate the Youth Crisis Stabilization Center (Youth CSC) twenty-four (24) hours per
day, seven (7) days per week. The Youth CSC shall be located at the Kings Canyon Campus at 4411 E. Kings
Canyon Road, Fresno, California 93702 (Building 319), a COUNTY-owned building, pursuant to a separate
lease agreement (and any related amendments) between COUNTY and Exodus Foundation, Inc., an affiliate
of CONTRACTOR.
TARGET POPULATION:
The target population will include children and youth up to 18 years of age from Fresno County, who are
exhibiting acute psychiatric symptoms that have been placed on a Welfare and Institutions Code (W&IC)
5150 designation or who request admittance to the Youth CSC on a voluntary status. CONTRACTOR will
provide crisis stabilization services to children and youth clients with an eight (8) bed maximum at any given
time. However, CONTRACTOR may be in the process of assessing or evaluating additional clients, as
necessary. CONTRACTOR will accept voluntary or involuntarily admitted clients regardless of source of
payment; clients may include Medi-Cal beneficiaries, Medicare and Medicare/Medi-Cal beneficiaries,
privately insured and indigent/uninsured clients who are referred by the Department of Behavioral Health
(DBH), a contract provider with the DBH, a hospital emergency department, law enforcement, or Emergency
Medical Services (EMS). Clients may also be family or self-referred.
These services shall be performed pursuant to W&IC, sections 5704.5(b), 5704.6(c), and 5614(b)(3) and
program principles and the array of treatment options required under W&IC, sections 5600.2 to 5600.9
inclusive:
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is the child health component of Medicaid.
Federal statutes and regulations state that children under age 21 who are enrolled in Medicaid are entitled to
EPSDT benefits and that States must cover a broad array of preventive and treatment services to include
crisis stabilization. The requirement is to maintain its funding for children's services at a level equal to or
more than the proportion expended for children's program services in FY 83-84.
Exhibit B
FL-121
Page 2 of 9
PROJECT DESCRIPTION:
CONTRACTOR shall be responsible to comply with the requirements of the Fresno County Mental Health Plan
(FCMHP) and must complete and submit supporting clinical and any other such documentation as may be
required by the COUNTY for every client served in the Youth CSC. The FCMHP will perform a utilization
review of all admissions to determine that the documentation demonstrates that medical necessity criteria as
defined by the California Department of Health Care Services (DHCS) was met for each duration of the
hospitalization, except for the episode of discharge.
CONTRACTOR shall be responsible to enter all Client Service Information, admission data and billing
information into the COUNTY data system (AVATAR) and will be responsible for any and all audit exceptions
pertaining to the delivery of services.
CONTRACTOR'S RESPONSIBILITIES:
A. CONTRACTOR shall ensure that the Youth CSC provides the following services:
1. Management and alleviation of client's acute psychiatric symptoms through effective therapeutic
interventions and supportive services to avoid the need for a higher level of psychiatric care
when clinically appropriate.
2. A recovery/strength based clinical program which has appropriate professional staffing on a
twenty-four (24) hour, seven (7) day a week basis.
3. A safe, secure environment for clients that encourages wellness and recovery.
4. A comprehensive multi-disciplinary evaluation and client-centered treatment plan.
5. Dietary services through the availability of nourishment or snacks in accordance with Title 22,
Division 5, Chapter 9, Article 3, Section 77077.
6. Admission procedures for clients, who are not on involuntary holds in accordance with Welfare
and Institutions Code 5150 and also individuals placed on W&I 5150 involuntary holds.
7. Treatment Planning — Under the clinical direction of the mental health clinician, the multi-
disciplinary treatment team formed by the Youth Crisis Stabilization staff shall provide the
following services:
a. Mental Status Examination
b. Medical Evaluation
c. Psycho-Social Assessment
d. Nursing Assessment
e. Multi-Disciplinary Milieu Treatment Program
f. Client Centered Treatment Planning
g. Aftercare Planning and Wellness Recovery Action Plan (WRAP)
8. Staffing
a. The staffing pattern for the crisis stabilization program shall meet all current State
licensing and regulatory requirements including medical staff standards, nursing staff
standards, social work and rehabilitation staff requirements pursuant to Title 9, Division 1,
Chapter 11, Article 3, Section 1840.348 of the California Code of Regulations (CCR) for
Exhibit B
FL-121
Page 3 of 9
Crisis Stabilization services. All staff that require federal/state licensure or certification will
be required to be licensed or certified in the State of California and be in good standing
with the state licensing or certification board. CONTRACTOR shall remain up-to-date with
all current regulatory changes and adhere to all new and/or modified requirements.
b. All facility staff who provide direct client care or perform coding/billing functions must meet
the requirements of the FCMHP Compliance Program. This includes the screening for
excluded persons and entities by accessing or querying the applicable licensing board(s),
the National Practitioner Data Bank (NPDB), Office of Inspector General's List of Excluded
Individuals/Entities (LEIE), Excluded Parties List System (EPLS) and Medi-Cal Suspended
and Ineligible List prior to hire and annually thereafter. In addition, all
licensed/registered/waivered staff must complete a FCMHP Provider Application and be
credentialed by the FCMHP's Credentialing Committee. All of CONTRACTOR's staff who
will have direct contact with the clients, shall have Department of Justice (DOJ), Federal
Bureau of Investigation (FBI), and Sheriff fingerprinting (Livescan) executed.
c. Peer and/or family support staff will be an active and key member of the multi-disciplinary
team to assist with treatment planning, mentoring, support and advocate with
clients/families during their time at the YOUTH CSC facility and will assist with discharge
planning and facilitate the client's transition to the appropriate lower level of care.
d. At the time of execution of this Agreement, the staffing requirements defined by the
California Code of Regulations, Title 9, Section 1840.348 for the Youth CSC are as
follows:
"(a) A physician shall be on call at all times for the provision of those Crisis Stabilization
Services that may only be provided by a physician.
(b) There shall be a minimum of one Registered Nurse, Psychiatric Technician, or
Licensed Vocational Nurse on site at all times beneficiaries are present.
(c) At a minimum there shall be a ratio of at least one licensed mental health or
waivered/registered professional on site for each four beneficiaries or other patients
receiving Crisis Stabilization at any given time.
(d) If the beneficiary is evaluated as needing service activities that can only be provided by
a specific type of licensed professional, such persons shall be available.
(e) Other persons may be utilized by the program, according to need.
(f) If Crisis Stabilization services are co-located with other specialty mental health
services, persons providing Crisis Stabilization must be separate and distinct from persons
providing other services.
(g) Persons included in required Crisis Stabilization ratios and minimums may not be
counted toward meeting ratios and minimums for other services."
9. Medical Records
a. The CONTRACTOR shall be responsible to enter all Client Service Information, admission
data and billing information into the COUNTY data system (AVATAR) and will be
responsible for any and all audit exceptions pertaining to the delivery of services.
b. The CONTRACTOR will be responsible for "release of information" requests for the Youth
CSC facility and shall adhere to applicable federal and state regulations.
Exhibit B
FL-121
Page 4 of 9
10. Clinical Staff - The clinical staff of CONTRACTOR shall be composed of all licensed mental
health or waivered/registered professionals as included in CCR, Title 9, Division 1, Chapter 11,
Article 3, Section 1840.348 (Crisis Stabilization Staffing Requirements).
11. Medical Staff — The medical staff shall include a physician and a registered nurse, psychiatric
technician or licensed vocational nurse and any other type of licensed professional needed to
address client needs pursuant to CCR, Title 9, Division 1, Chapter 11, Article 3, Section
1840.348 (Crisis Stabilization Staffing Requirements).
12. Pharmaceutical Services — CONTRACTOR shall provide for medication services on an as
needed basis and the staffing must reflect this availability pursuant to CCR, Title 9, Division 1,
Chapter 11, Article 3, Section 1840.338 (Crisis Stabilization Contact and Site Requirements) and
all other applicable federal/state regulations.
13. Assessment of Physical Health and Medical Backup Services — Pursuant to CCR, Title 9,
Division 1, Chapter 11, Article 3, Section 1840.338 (Crisis Stabilization Contact and Site
Requirements), CONTRACTOR shall provide admission history and physical examination, and
maintain a written agreement for medical services with one or more general acute care hospitals.
14. Utilization Review, Billing and Cost Report:
a. CONTRACTOR shall notify the COUNTY of any admission of a COUNTY client within
twenty-four (24) hours or the next business day in a manner approved by the COUNTY.
The notification method shall be mutually acceptable by both COUNTY and
CONTRACTOR.
b. CONTRACTOR shall be responsible to insure that documentation in the client's medical
record meets medical necessity criteria for the hours of service submitted to COUNTY for
reimbursement by federal intermediaries, third-party payers and other responsible parties.
c. CONTRACTOR shall enter all mental health data and billing information into the COUNTY
data system and will be responsible for any and all audit exceptions pertaining to the
delivery of services.
d. CONTRACTOR shall submit a complete and accurate DHCS Short/Doyle Medi-Cal Cost
Report for each fiscal year ending June 30th affected by the proposed agreement within
ninety (90) days following the end of each fiscal year.
e. CONTRACTOR shall insure that cost reports are prepared in accordance with the
Generally Accepted Accounting Principles and the standards set forth by the DHCS and
the COUNTY.
15. Patients' Rights and Certification Review Hearings:
a. CONTRACTOR shall adopt and post in a conspicuous place a written policy on patient
rights in accordance with section 70707 of Title 22 of the California Code of Regulations
and section 5325.1 of the California W&IC and Title 42 Code of Federal Regulations
section 438.100.
b. CONTRACTOR shall allow access to COUNTY clients by the Patients' Rights Advocate
designated by the COUNTY.
16. Grievances and Incident Reports - CONTRACTOR shall log all grievances and the disposition of
all grievances received from a client or a client's family in accordance with FCMHP policies and
procedures as indicated within Exhibit H. CONTRACTOR shall provide a summary of the
grievance log entries concerning COUNTY-sponsored clients to the DBH Director, or designee,
at monthly intervals, by the fifteenth (15th) day of the following month, in a format that is mutually
Exhibit B
FL-121
Page 5 of 9
agreed upon. CONTRACTOR shall post signs, provided by the COUNTY, informing clients of
their right to file a grievance and appeal.
CONTRACTOR shall notify COUNTY of all incidents or unusual occurrences reportable to state
licensing bodies that affect COUNTY clients within twenty-four (24) hours. The CONTRACTOR
shall use the Incident Report form as indicated within Exhibit I for such reporting.
Within fifteen (15) days after each grievance or incident affecting COUNTY-sponsored clients,
CONTRACTOR shall provide COUNTY with the complaint and CONTRACTOR's disposition of,
or corrective action taken to resolve the complaint or incident.
Within fifteen (15) days after CONTRACTOR submits a corrective action plan to a California
State licensing and/or accrediting body concerning any sentinel event, as the term is defined by
the licensing or accrediting agency, and within fifteen (15) days after CONTRACTOR receives a
corrective action order from a California State licensing and/or accrediting body to address a
sentinel event, CONTRACTOR shall provide a summary of such plans and orders to COUNTY.
17. Provide a safe and secure environment to provide for clinical and medical assessment,
diagnostic formulation, crisis intervention, medication management and clinical treatment for
mental health clients with acute psychiatric symptoms. This includes the manner in
which seclusion and restraint will be administered when necessary for the safety of the
clients, other clients in the program and staff.
18. CONTRACTOR shall utilize cost containment strategies for the provision of stock and
prescription medications to clients by contracting with a pharmaceutical benefits management
company, and provide the COUNTY with the type of formulary utilized by the program, and
provide the COUNTY with information regarding co-pays and/or generic substitutions.
19. Provide the appropriate type and level of staffing to provide for a clinical effective program
design that adheres to State staffing requirements.
20. Provide an intensive treatment program which has individualized treatment plans.
21. Stabilize the clients' acute psychiatric symptoms in the most expedient manner possible while
adhering to appropriate clinical care standards. This may include initiating a Treatment
Authorization Request (TAR) to the pharmacy and providing justification when psychotropic
medications are needed on an emergency basis.
22. Effectively partner with other programs in the COUNTY and community system (i.e. law
enforcement, local emergency departments, etc.) in accepting COUNTY clients for admission
for crisis stabilization services and also to work collaboratively in discharge planning to ensure
appropriate ongoing outpatient specialty mental health treatment services (COUNTY mental
health programs, community based organizations, etc.) are provided.
23. Identify COUNTY clients with frequent admissions during the fiscal year and develop
strategies with other COUNTY and community agencies to reduce readmissions and improve
clients' overall well-being through coordination of care.
24. Effectively interact with community agencies, other mental health programs and providers,
natural support systems and families to assist clients to be discharged to the appropriate
level of care.
Exhibit B
FLA 21
Page 6 of 9
25. Integrate mental health and substance use disorder services. The CONTRACTOR shall perform
the following:
a. Develop a formal written Continuous Quality Improvement (CQI) action plan to identify
measurable objectives toward the achievement of co-occurring disorders (COD) treatment
capability that will be addressed by the program during the contract period. These
objectives should be achievable and realistic for the program, based on a self-assessment
and the program priorities, but need to include attention to making progress on the
following issues, at minimum:
1. Welcoming policies, practices, and procedures related to the engagement of
individuals with co-occurring issues and disorders;
2. Removal or reduction of access barriers to admission based on co-occurring
diagnosis or medication;
3. Improvement in routine integrated screening, and identification in the data
system of how many clients served have co-occurring issues;
4. Developing the goal of basic co-occurring competency for all treatment and
support staff, regardless of licensure or certification, and
5. Documentation of coordination of care with collaborative mental health and/or
substance use disorder providers for each client.
B. Regarding cultural and linguistic competence requirements, CONTRACTOR shall:
1. Ensure compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45
C.F.R. Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial
assistance from discriminating against persons based on race, color, national origin, sex,
disability or religion. This is interpreted to mean that a limited English proficient (LEP) individual
is entitled to equal access and participation in federally funded programs through the provision of
comprehensive and quality bilingual services.
2. Create and maintain policies and procedures for ensuring access and appropriate use of trained
interpreters and material translation services for all LEP clients, including, but not limited to,
assessing the cultural and linguistic needs of its clients, training of staff on the policies and
procedures, and monitoring its language assistance program. The CONTRACTOR's procedures
must include ensuring compliance of any subcontracted providers with these requirements.
3. Ensure that minors shall not be used as interpreters.
4. Conduct and submit to COUNTY an annual cultural and linguistic needs assessment to promote
the provision and utilization of appropriate services for its diverse client population. The needs
assessment report shall include findings and a plan outlining the proposed services to be
improved or implemented as a result of the assessment findings, with special attention to
addressing cultural and linguistic barriers and reducing racial, ethnic, language, abilities, gender,
and age disparities.
5. Develop internal systems to meet the cultural and linguistic needs of the CONTRACTOR's client
census including the incorporation of cultural competency in the CONTRACTOR's mission;
establishing and maintaining a process to evaluate and determine the need for special -
administrative, clinical, welcoming, billing, etc. - initiatives related to cultural competency.
6. Develop recruitment and retention initiatives to establish contracted program staffing that is
reflective and responsive to the needs of the program and target population.
Exhibit B
FL-121
Page 7 of 9
7. Establish designated staff person to coordinate and facilitate the integration of cultural
competency guidelines and attend the COUNTY's DBH Cultural Competency Committee monthly
meetings. The designated person will provide an array of communication tools to distribute
information to staff relating to cultural competency issues.
8. Keep abreast of evidence-based and best practices in cultural competency in mental health care
and treatment to ensure that the CONTRACTOR maintains current information and an external
perspective in its policies. The CONTRACTOR shall evaluate the effectiveness of strategies and
programs in improving the health status of cultural-defined populations.
9. Ensure that an assessment of a client's sexual orientation is included in the bio-psychosocial
intake process. CONTRACTOR's staff shall assume that the population served may not be in
heterosexual relationships. Sensitivity to gender and sexual orientation must be covered in
annual training.
10. Utilize existing community supports, referrals to transgender support groups, etc., when
appropriate.
11. Attend annual Cultural Competence, Compliance, Health Insurance Portability and Accountability
Act (HIPAA), Billing, and Documentation training provided by COUNTY's DBH.
12. Report its efforts to evaluate cultural and linguistic activities as part of the CONTRACTOR's
ongoing quality improvement efforts in the monthly activities report. Reported information may
include clients' complaints and grievances, results from client satisfaction surveys, and utilization
and other clinical data that may reveal health disparities as a result of cultural and linguistic
barriers.
C. Regarding direct admissions to the YOUTH CSC from COUNTY's DBH programs or its contracted
providers, the CONTRACTOR agrees to the following:
1. To allow direct admits from COUNTY's DBH programs or its contracted providers when Youth
CSC has the capacity to accept clients for services.
2. Said direct admits shall not require medical clearance, if client would otherwise meet the
Emergency Medical Services 5150 Destination Policy requirements as mentioned hereinbelow in
Subsection F. However, in the event a referred client is known to possess a contagious medical
condition, said client shall be medically cleared by a local hospital prior to admission to the Youth
CSC operated by CONTRACTOR.
D. Regarding the provision of court testimony related to Youth CSC clients, CONTRACTOR agrees to
the following:
CONTRACTOR's staff shall provide court testimony relevant to Youth CSC clients, when
required.
E. Regarding placements of Youth in a Psychiatric Health Facility or other inpatient level of care:
CONTRACTOR's staff shall locate and coordinate transfer for any youth being treated at the
Youth CSC who is in need of further services and placement into a psychiatric health facility
(PHF) or other appropriate inpatient level of care. CONTRACTOR acknowledges that COUNTY
will be establishing a new Youth PHF adjacent to the Youth CSC facility in April 2015; however,
this provision applies to youth whose age or complex clinical or other co-occurring health needs
require placement at a non-County acute care facility. CONTRACTOR acknowledges that
transfer of youth may occur at all hours of the day and agrees to attend promptly to the needs of
the youth and will conduct the transfer as soon as feasibly possible.
Exhibit B
F L-121
Page 8 of 9
F. Regarding the Emergency Medical Services (EMS) 5150 Destination Policy, CONTRACTOR
agrees to the following:
CONTRACTOR agrees to follow the then-current Emergency Medical Services 5150 Destination
Policy as identified in Revised Exhibit L, attached hereto and incorporated herein. Said policy
may be updated periodically throughout the term of this Agreement; CONTRACTOR must
adhere to the most recent policies designated by the EMS 5150 Destination Policy. References
to the Children's Crisis Assessment Intervention Resolution (CCAIR) in Revised Exhibit L, reflect
services to be performed at COUNTY's Youth CSC, beginning April 1, 2015. Upon
commencement of services, the EMS 5150 Destination Policy will be updated accordingly.
G. CONTRACTOR shall participate in the following meetings:
1. CONTRACTOR shall participate in periodic workgroup meetings scheduled by staff from
COUNTY's DBH Mental Health Contracted Services Unit. The meetings shall be held monthly,
or as needed, to discuss contract requirements, data reporting, outcomes measurement,
training, policies and procedures, and overall program operations.
2. CONTRACTOR's administrative level agency representative, who is duly authorized to act on
behalf of CONTRACTOR, shall attend regularly scheduled monthly Behavioral Health Board
meetings (upon commencement of the newly-enacted Board).
3. CONTRACTOR shall attend quarterly or periodic DBH Contractor/Provider Meetings, as
scheduled by staff from COUNTY's Mental Health Contracted Services Unit, when deemed
necessary by the DBH Director, or designee.
H. Regarding the development of policies and protocols.-
CONTRACTOR and COUNTY's DBH shall collaborate on the development of specific policies
and protocols related to the daily operation of the Youth CSC. Such policies will include, but not
be limited to, the following: placement of youth in psychiatric health facilities or other inpatient
programs either locally or outside the county, facility limitations, and special client populations.
Such policies and protocols shall be mutually agreed upon between CONTRACTOR and
COUNTY's DBH Director, or designee. Any changes to such policies and protocols shall be
mutually agreed upon between CONTRACTOR and COUNTY's DBH Director, or designee.
COUNTY RESPONSIBILITIES:
COUNTY shall:
1. Perform a utilization review, annually at a minimum, (through its FCMHP) of ten percent (10%) of all
admissions to determine that the documentation demonstrates that medical necessity criteria as defined
by the DHCS were met throughout the duration of the crisis stabilization episode. The FCMHP will
maintain discretion regarding possible subsequent utilization review beyond ten percent (10%), as
necessary.
2. Provide oversight of the CONTRACTOR's Youth CSC program. In addition to contract monitoring of
program(s), oversight includes, but is not limited to, coordination with the DHCS in regard to program
administration and outcomes.
3. Assist the CONTRACTOR in making linkages to the appropriate level of care within the behavioral
health system of care to ensure continuity of care. This will be accomplished through regularly
scheduled meetings as well as formal and informal consultation.
Exhibit B
FL-121
Page 9 of 9
4. Participate in evaluating the progress of the overall program and the efficiency of collaboration with the
CONTRACTOR staff and will be available to the CONTRACTOR for ongoing consultation.
5. Receive and analyze statistical outcome data from CONTRACTOR throughout the term of contract on a
monthly basis. DBH will notify the CONTRACTOR when additional participation is required. The
performance outcome measurement process will not be limited to survey instruments but will also
include, as appropriate, client and staff interviews, chart reviews, and other methods of obtaining
required information.
6. Recognize that cultural competence is a goal toward which professionals, agencies, and systems should
strive. Becoming culturally competent is a developmental process and incorporates at all levels the
importance of culture, the assessment of cross-cultural relations, vigilance towards the dynamics that
result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to
meet culturally-unique needs. Offering those services in a manner that fails to achieve its intended
result due to cultural and linguistic barriers is not cost effective. To assist the CONTRACTOR's efforts
towards cultural and linguistic competency, DBH shall provide the following at no cost to
CONTRACTOR:
A. Mandatory cultural competency training including sexual orientation and sensitivity training for
CONTRACTOR personnel, at minimum once per year. COUNTY will provide mandatory training
regarding the special needs of this diverse population and will be included in the cultural
competence training(s). Sexual orientation and sensitivity to gender differences is a basic cultural
competence principle and shall be included in the cultural competency training. Literature suggests
that the mental health needs of lesbian, gay, bisexual, transgender (LGBT) individuals may be at
increased risk for mental disorders and mental health problems due to exposure to societal
stressors such as stigmatization, prejudice and anti-gay violence. Social support may be critical for
this population. Access to care may be limited due to concerns about providers' sensitivity to
differences in sexual orientation.
B. Assistance to CONTRACTOR in locating appropriate providers who can translate behavioral health
and substance abuse services information into COUNTY's threshold languages (English, Spanish,
and Hmong). Translation services and costs associated will be the responsibility of the
CONTRACTOR.
Exhibit H
To Scope of Work Exhibit B
Page 1 of 2
Fresno County Mental Health Plan
Grievances
The Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance
and appeal process and an expedited appeal process to resolve grievances and
disputes at the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHP and its fee-for-
service providers to give verbal and written information to Medi-Cal beneficiaries
regarding the following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a grievance
form, an appeal form, and Request for Change of Provider Form. All of these
beneficiary materials must be posted in prominent locations where Medi-Cal
beneficiaries receive outpatient specialty mental health services, including the waiting
rooms of providers' offices of service.
Please note that all fee-for-service providers and contract agencies are required to give
their clients copies of all current beneficiary information annually at the time their
treatment plans are updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without any
penalty, change in mental health services, or any form of retaliation. All Medi-Cal
beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self-addressed envelopes must be available for
beneficiaries to pick up at all provider sites without having to make a verbal or written
request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Exhibit H
To Scope of Work Exhibit B
Page 2 of 2
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other complaints and
concerns.
Informal provider problem resolution process—the provider may first speak to a
Provider Relations Specialist (PRS) regarding his or her complaint or concern.
The PRS will attempt to settle the complaint or concern with the provider. If the attempt
is unsuccessful and the provider chooses to forego the informal grievance process, the
provider will be advised to file a written complaint to the MHP address (listed above).
Formal provider appeal process—the provider has the right to access the provider
appeal process at any time before, during, or after the provider problem resolution
process has begun, when the complaint concerns a denied or modified request for MHP
payment authorization, or the process or payment of a provider's claim to the MHP.
Payment authorization issues—the provider may appeal a denied or modified request
for payment authorization or a dispute with the MHP regarding the processing or
payment of a provider's claim to the MHP. The written appeal must be submitted to the
MHP within ninety (90) calendar days of the date of the receipt of the non-approval of
payment.
The MHP shall have sixty (60) calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the decision
that addresses each issue raised by the provider, and any action required by the
provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request, the
MHP utilizes Managed Care staff who were not involved in the initial denial or
modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be asked to
submit a revised request for payment within thirty (30) calendar days of receipt of the
decision
Other complaints— if there are other issues or complaints, which are not related to
payment authorization issues, providers are encouraged to send a letter of complaint to
the MHP. The provider will receive a written response from the MHP within sixty (60)
calendar days of receipt of the complaint. The decision rendered buy the MHP is final.
Exhibit I
To Scope of Work Exhibit B
Page I of 2
FRESNO COUNTY MENTAL HEALTH PLAN
GRIEVANCES AND INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
• The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes this form, and the supervisor co-signs it.
• When more than one client is involved in an incident, a separate form must be completed
for each client.
Where the forms should be sent - within 24 hours from the time of the incident
• Incident Report should be sent to:
DBH Program Supervisor
Exhibit I
To Scope of Work Exhibit B
Page 2 of 2
INCIDENT REPORT WORKSHEET
When did this happen?(date/time) Where did this happen?
Name/DMH#
1. Background information of the incident:
2. Method of investigation: (chart review, face-to-face interview, etc.)
Who was affected? (If other than consumer)
List key people involved. (witnesses, visitors, physicians, employees)
3. Preliminary findings: How did it happen?Sequence of events. Be specific. If attachments are needed write
comments on an 8 1/2 sheet of paper and attach to worksheet.
Outcome severity: Nonexistent ® inconsequential ® consequential ® death ® not applicable ® unknown
4. Response: a)corrective action, b) Plan of Action, c)other
Completed by(print name)
Completed by(signature) Date completed
Reviewed by Supervisor(print name)
Supervisor Signature Date
CENTRAL CALIFORNIA Exhibit M
EMERGENCY MEDICAL SERVICES To Scope of Work Exhibit B
A Division of the Fresno County Department of Public Health
Manual Policy
Emergency Medical Services Number 547
Administrative Policies and Procedures
Page 1 of 10
Subject Patient Destination
References Title 13,Section 1106 of the California Code of Regulations Effective:
Title 22,Division 9,Chapter 7 of the California Code of Regulations 04/18/83
I. POLICY
Patients of the Prehospital EMS System shall be transported to an appropriately staffed and equipped hospital.
II. MEDICAL PATIENT DESTINATION
A. Medical Patients shall be transported to the appropriate destination in accordance with the following chart:
Fresno County Kings County Madera County Tulare County
777
Non-emergent Patient's Choice Patient's Choice Patient's Choice Patient's Choice
Life-threatening Closest Appropriate Closest Appropriate Closest Appropriate Closest Appropriate
Regional Medical Kaweah Delta Medical Regional Medical Kaweah Delta Medical
Acute current of injury Center or St.Agnes Center or Regional Center or St.Agnes Center or Regional
(acute MI) Medical Center Medical Center Medical Center Medical Center
uickest travel time (quickest travel time (quickest travel time (Quickest travel time
Stable Patient/Family Choice Patient/Family Choice Patient/Family Choice Patient/Family Choice
Kaweah Delta Medical
RMC or Children's*** RMC or Children's*** RMC or Children's *** Center or
Unstable (Quickest travel time) (Quickest travel time) (Quickest travel time) Sierra View District
Hospital***
(Quickest travel time
' N r gi;
5150-Adult CSC or Patient's Choice Patient's Choice within Patient's Choice within Patient's Choice within
within Fresno County Kings ounty Madera County Tulare County
CCAIR or Patient/Family Choice Patient/Family Choice Patient/Family Choice
5150—Children(<18 yrs) Patient/Family Choice within Kings County within Madera County within Tulare County
See criteria below
Kaiser(within Kaiser Kaiser designated N/A N/A N/A
Facility) facility
Veteran's Veteran's N/A N/A N/A
Administration Administration
*** If transport time is greater than 60 minutes,base hospital contact shall be made to determine appropriate destination.
Approved By Revision
Signatures on File at EMS Agency
EMS Division Manager 01/01/2015
Signature on File at EMS Agency
EMS Medical Director
Page 2 of 10
Subject: Policy
Patient Destination Number: 547
B. Medical Patient Destination—Considerations
1. In a non-emergent situation(as determined by the EMT or Paramedic at the scene and/or the Base Hospital
Physician/MICN giving medical direction),the patient will be taken to the receiving hospital of his/her
choice.If the patient is unable to determine this,the hospital designated by the private physician and/or
patient's family member will be utilized.
Paramedics and EMTs should determine where the patient normally receives their medical care and
encourage the patient to return to that hospital for medical care as long as the patient's medical condition
allows for such transport.
2. The Paramedic/EMT/MICNBHP should only provide the patient with alternatives for destination of
patient choice. It is inappropriate for the Paramedic/EMT/MICNBHP to endorse specific facilities or
provide personal opinion on the quality of local facilities.
3. Health Plans-If the patient is a member of a health plan with a preferred hospital,an attempt should be
made to transport the patient to a participating facility.
4. Closest Appropriate Hospital
a. The closest appropriate hospital is defined as the closest emergency department"equipped,staffed,
and prepared to administer care appropriate to the needs of the patient"(California Code of
Regulations,Title 13,Section 1106(b)2).
b. Closest is defined as the shortest travel time not necessarily the closest by distance.
C. The Base Hospital Physician will have the ultimate authority concerning patient destination.
d. The closest appropriate hospital does not mean that critically ill patients always go to the closest
"receiving"hospital. They go to the closest"appropriate"hospital. The following guidelines will
help to define"appropriate":
1) Due to short transport times,the appropriate receiving facility for a life-threatening
medical situation would be a hospital with a basic emergency service(holds a special
services permit from the California State Department of Health Services).Hospitals with
basic emergency services are:
a) Adventist Medical Center Hanford(AMC-H)
b) Children's Hospital Central California(Children's Hospital)
c) Clovis Community Medical Center(CCMC)
d) Kaiser Permanente Hospital(KPH)
e) Kaweah Delta Medical Center(KDMC)
0 Madera Community Hospital(MCH)
g) Saint Agnes Medical Center(SAMC)
h) Sierra View District Hospital(SVDH)
i) Tulare Regional Medical Center(TRMC)
j) Regional Medical Center(RMC)
2) Rural Areas-Due to prolonged travel times to the urban area,the appropriate receiving
hospital for a life-threatening medical situation would be a hospital with a standby
emergency service(holds a special services permit from the California State Department
of Health Services).Hospitals with stand-by emergency services that are approved to
receive ambulances are:
a) Adventist Medical Center Reedley(AMC-R)
b) Adventist Medical Center Selma(AMC-S)
Page 3 of 10
Subject: Policy
Patient Destination Number: 547
c) Coalinga Regional Medical Center(CRMC)
5. Acute Cardiac Emergency
In the event of an acute current of injury transport should be to a facility with interventional heart
catheterization capabilities. The following is a list of readings from various cardiac monitors:
• *** ACUTE MI *** (Zoll Monitor E Series)
• ***STEMI***(Zoll Monitor X Series))
• ***ACUTE MI SUSPECTED***(Physio-Control Monitor LifePak 12)
• ***MEETS ST ELEVATION MI CRITERIA*** (Physio-Control Monitor LifePak 15)
Transport should be either to:
• Regional Medical Center
• Kaweah Delta Medical Center
• Saint Agnes Medical Center;
whichever has the quickest transport time,if transport time is less than 60 minutes. If transport time is
greater than 60 minutes then transport to the closest appropriate facility or consider helicopter rendezvous.
Destination is determined by:
a. Interpretation of 12-lead ECG;or
b. Base Hospital consultation if required.
6. Patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway(this is defined as unable to maintain a BLS airway).
Example:If the patient can be bagged via a BVM without an ET Tube or OPA,this is not an
unstable airway.
b. Any patient with CPR in progress.
C. Any critically ill or unstable patient when Base Hospital contact is not possible(i.e.,Paramedic or
EMT must make the ultimate destination decision).
7. Patients who go to a non-receiving hospitals:
Patients may be transported to a non-receiving hospital only when the Base Hospital has contacted the
receiving doctor and received assurance of immediate acceptance of the patient. Such assurance should
then be documented on the Base Hospital run form.
8. Patients who go to a receiving hospital,which is not closest:
Unstable patients who request this hospital and,in the opinion of the Base Hospital Physician,the extra
travel time is not dangerous to the patient
Page 4 of 10
Subject: Policy
Patient Destination Number: 547
C. Fresno County 5150 Holds—Considerations
1. Fresno County 5150 patient criteria for transport Crisis Stabilization Center(CSC)and Children's Crisis
Assessment Intervention Resolution(CCAIR):
a. If the patient meets the following criteria,he/she shall be transported directly to Crisis Stabilization
Center(CSC)if age 18 or greater;or the Children's Crisis Assessment Intervention Resolution
(CCAIR)if under 18 years of age:
• No urgent medical complaint or evidence of acute medical/surgical/trauma problem requiring
urgent treatment prior to psychotic admission.
• No alteration in mental status due to dementia or delirium.
• Glasgow Coma Score 14 or 15.
• Complete vital signs within limits(HR,RR,BP,and GCS).
• Not febrile to palpation/measurement.
• Under the influence of alcohol or drugs,patient can walk without assistance and is able to
follow verbal commands(does not apply to CCAIR).
1) Adults:
a) Pulse:50-120.
b) Systolic Blood Pressure: 100-180.
c) Diastolic Blood Pressure: less than 120.
d) Respiratory Rate: 12-30.
2) Pediatrics:
a) Vital signs appropriate for children(policy 530.32).
NOTE: Refer to the Criteria for Transporting a Fresno County 5150 Patient Directly to Crisis
Stabilization Center(CSC)or CCAIR Screening Form attached to this policy.
Patients that Crisis Stabilization Center(CSC)cannot accept:
• Patients with dementia or delirium
• Patients with ongoing medical care(i.e.,patients who require continuous oxygen use,
catheters,wired devices,etc.)
• Patients in wheelchairs that cannot move independently
• Patients with any open wound,laceration,skin ulcer,or decubitus that requires anything
more that once daily dry gauze and tape dressing
b. All other patients on a 5150 hold in Fresno County not meeting the above criteria will be
transported to Patient/Family Choice within Fresno County.
C. Patients placed on a 5150 hold are to be transported to facilities within the county where the 5150
hold was initiated.
d. The 5150 destination policy does not apply to psychiatric patients who are voluntarily requesting
evaluation(not on a 5150 hold). If the patient is not on a 5150 hold,then transport will be to a
receiving facility of their choice,which includes CSC(Fresno County only)if patient meets
criteria within this policy.
e. Veteran's Administration
Page 5 of 10
Subject: Policy
Patient Destination Number: 547
2. The Veteran's Administration emergency department will accept all patients with a Veterans
Administration(VA)Identification Card or active duty Department of Defense(DOD)Card(Patient Name
Only,no dependant(s). Name of patient on card must be the patient requesting transport). No prior
approval or Base Hospital contact is necessary. if the patient requests transport to Veterans Administration
emergency department and does not have the identification noted above,contact the VA Emergency
Department directly for prior approval before the patient is transported. The complete name and the full
social security number will be required. Contact the Veteran's Administration on Med 6 or 241-3600.
3. Patients that cannot be transported directly to the Veteran's Administration are:
• Cardiac arrest due to trauma
Pediatric cardiac arrest
• Trauma Center Triage Criteria
• OB patient in active labor
• Gynecological complaints and known obvious pregnancy with vaginal bleeding
• ST-segment elevation myocardial infarction(STEMI)
NOTE: INTERFACILITY TRANSPORTS ARE NOT MANAGED THROUGH THIS PROCEDURE.
III. TRAUMA PATIENT DESTINATION
A. Trauma patients shall be transported to the appropriate destination in accordance with the following chart:
TRAUMA DESTINATION CHART
Assess0 Physiological Criteria
Fe0
stolic Blood Pressure:
Adults: <90 mm Hg
o Pediatrics: <80 mm Hg with signs and
symptoms of shock(Refer to EMS Policy
RMC o KDMC
530.32 for estimated weight formulas or
use Broselow Tape) (Consider air transport)
• Respiratory Rate:
o Adults: <10 or>30
o Children: <20 if underage 1
FiAssess Local Criteria
sgow Coma Score<13(or,in patients whose
rmal GCS is less than 15,or a decrease of two
o
or more of the patients GCS score)
• Penetrating injury to the head RMC
• Paraplegia (Consider air transport)
• Quadriplegia
• Any Burn(Air only)
Assess Anatomy of Injury
• Penetrating injuries to neck or torso
• Flail chest -♦ RMC or KDMC
• Two or more proximal long-bone fractures (Consider air transport)
• Amputation proximal to wrist or ankle
Page 6 of 10
Subject: Policy
Patient Destination Number: 547
Assess Burns
0 STABLE TRAUMA PATIENTS WITH:
• Partial/Full thickness burns>10%TBSA
F
• Partial/Full thickness circumferential burns RMC
• Partial/Full thickness burns to face,hands,feet, (Consider air transport)
major joints,perineum,or genitals
• Electrical burns with voltage>120 volts
• Chemical burns>10%TBSA
Assess Mechanism of Injury
• Falls
o Adults: >20 ft.(one story=10 ft.) RMC or KDMC
o Children: >10 ft.or 3 times height of the (Consider air transport)
child
. F
Special Considerations
GNIFICANT COMPLAINT:
e greater than 55 years
• Anticoagulation or bleeding disorders Consider transport to
• Pregnancy greater than 20 weeks RMC or KDMC
• Auto vs.Pedestrian>20 mph
• Motorcycle crash>20 mph
Paramedic/Flight Nurse Judgment
Consider RMC or KDMC
WITH A SIGNIFICANT COMPLAINT Base Hospital Consultation
SIGNIFICANT COMPLAINT
Transport According to Policy Perseveration
Deteriorating mental status
Severe chest pain
Severe shortness of breath
Severe abdominal pain
Sustained,overwhelming"Feeling of Doom"
Page 7 of 10
Subject: Policy
Patient Destination Number: 547
NOTE: If transport time is greater than 60 minutes for patients meeting trauma triage criteria,base hospital contact
shall be made to determine appropriate destination.
NOTE: If transport time is greater than 2 hours for patients meeting burn triage criteria,base hospital contact shall
be made to determine appropriate destination.
B. Triage Criteria
Triage criteria will determine if the patient will be transported to a trauma center or closest receiving hospital.
C. Trauma Patient Destination—Considerations
1. If the patient is in cardiac arrest from penetrating trauma in the greater Fresno or Visalia metropolitan area,
the patient should be transported to Regional Medical Center or Kaweah Delta Medical Center,bypassing a
closer receiving facility.However,if the transport time to Regional Medical Center or Kaweah Delta
Medical Center is greater than ten(10)minutes,then transport should be to the closest receiving facility
within ten minutes transport time(Refer to EMS Policy#550).
2. Trauma patients,meeting trauma center criteria,who have a transport time greater than 60 minutes to the
trauma center,will require base hospital contact for destination decision.
3. The following types of incidents should be consideration for transport to the designated Trauma Center,
based upon paramedic judgment:
a. Motorcycle Crash-Non-ambulatory with potential of significant injuries
b. Auto versus Pedestrian-Non-ambulatory with potential of significant injuries
NOTE: Paramedic judgment is based upon the paramedic's own knowledge and experience to determine if the
patient's condition would require transport to a designated Trauma Center due the mechanism of injury and
potential underlying injuries. The Paramedic may contact a Base Hospital for advice on destination.
4. Transport of Trauma Patients by Helicopter
A trauma patient should not be transported by helicopter unless they meet trauma triage criteria to be
transported to the Regional Trauma Center or the patient is inaccessible by ambulance(i.e.,wilderness
transports). EXCEPTION:When the paramedic feels helicopter transport of the patient would be
beneficial to the outcome of the patient.
5. Burn Patients
a. The following patients should be transported directly to the Regional Burn Center (Regional
Medical Center)bypassing other hospitals if ETA to Regional Medical Center is within two hours.
1) Patients with 2°(partial thickness) or 3°(full thickness) burns that are more than 10% total
body surface area
2) Patients with 2'(partial thickness)or 3°(full thickness)circumferential burns of any body part
3) Patients with 2°(partial thickness)or 3°(full thickness)burns to face,hands,feet,major joints,
perineum,or genitals
4) Electrical burns with voltage greater than 120 volts
5) Patients with chemical burns greater than 10%total body surface area.
6. Carbon Monoxide Poisoning-Early call-ins to Regional Medical Center should be made for patients that
appear to have significant exposure to carbon monoxide poisoning(altered mental status,vomiting,and
headaches).
Page 8 of 10
Subject: Policy
Patient Destination Number: 547
7. Trauma patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway(this is defined as unable to maintain a BLS airway).
Example:If the patient can be bagged via a BVM without an ET Tube or OPA,this is not an
unstable airway.
b. Any patient with CPR in progress(refer to EMS Policy#550).
C. Any critically injured or unstable patient when Base Hospital contact is not possible(i.e.,
Paramedic or EMT must make the ultimate destination decision).
IV. PATIENTS WHO REFUSE TRANSPORT TO THE APPROPRIATE HOSPITAL
A Base Hospital shall be contacted for the purpose of physician consultation on patients who meet one or more of the triage
criteria and refuse transport to the appropriate hospital. This will usually not be a problem with the acutely ill patient.
However,some patients with normal mental status may wish to be transported to a different hospital than the one selected via
the triage criteria. These situations should be treated as"Refusal of Medical Care and/or Transportation"situation(refer to
EMS Policy#546). The Base Hospital Physician,after radio contact,may allow the patient to go to the destination of their
choice,have a"Refusal of Medical Care and/or Transportation"signed or insist on transport to the designated hospital.
V. PATIENTS WHO CAN GO DIRECTLY TO AN EMERGENCY DEPARTMENT WAITING ROOM
Prehospital personnel shall utilize the emergency department patient entrance at all receiving hospitals for non-emergent
patients. Delivery of patients to the appropriate area of the emergency department is based on severity of illness.
Patients who meet the following criteria can be taken directly to the emergency department walk-in waiting room,bypassing
the ambulance entrance used for serious or critically ill patients.
• Patients 18 years old or older or minors accompanied by a responsible adult.
• Patient has normal,age appropriate vital signs(f 5%).
• Patient can sit unassisted and has reasonable mobility.
• Patient does not meet criteria for ETA call-in.
• Patient does not have IV access started by EMS.
• Patient is not on a 5150 hold or in custody.
EMS personnel must give report to a hospital employee authorized to triage,or take possession of the patient,and obtain a
signature for transfer of patient care. If there is a difference of opinion as to the appropriate waiting area,or location of the
patient,the hospital representative will make the final decision as to the disposition of the patient and provide the turnover
signature.
Page 9 of 10
Subject: Policy
Patient Destination Number: 547
VI. SPECIAL CONSIDERATION FOR OBSTETRICS OR PREGNANT PATIENTS REQUESTING ADVENTIST MEDICAL
CENTER—HANFORD
While Central Valley General Hospital will not have an emergency department,the hospital will still be open as an in-patient
/out-patient facility for OB/GYN services. Ambulance patients may be taken directly to Central Valley General Hospital
under the following circumstances:
• Transfers from a physician's office when the physician requests that the patient be taken directly to Central Valley
General Hospital
• An interfacility transfer from another hospital(i.e.,direct admit)
• Obstetrics or pregnancy related calls when directed by the Base Hospital(Adventist Medical Center—Hanford)to
transport directly to Central Valley General Hospital. A full standard call-in must be made to the Base Hospital on
all OB/GYN patients.
VII. SPECIAL CONSIDERATION FOR HEART HOSPTAL DESTINATION
While the Heart Hospital is a hospital within Central California EMS Region,it does not have an emergency
department and is not an approved facility for patient transports within EMS Policy and Procedures. Patients who are
requesting transport to the Heart Hospital from the prehospital setting will require Base Hospital contact to confirm
acceptance. Since the Heart Hospital is under the Community Medical Center organization,EMS personnel should contact
Regional Medical Center when requesting transport to the Heart Hospital. If attempts to contact Regional Medical Center
are unsuccessful,EMS personnel should contact another Base Hospital. Interfacility transfers involving the Heart Hospital
shall be in accordance with EMS Policy 4553,"ALS Interfacility Transports".
Central California EMS Agency
Criteria for Transporting a Fresno County 5150/Psychiatric Patient
Directly to CSC or CCAIR Screening Form
Patient's Name: EMS#:
Patient has urgent medical complaint or evidence of acute medical/surgical problem.
[] True—transport Patient/Family Choice [] False
Patient has alteration in mental status due to dementia or delirium.
[]True—transport Patient/Family Choice []False
Patient has a Glasgow Coma Score 13 or less.
[]True—transport Patient/Family Choice []False
There are lacerations with a gap of greater than 2 mm or fat/muscle visible in the wound(excludes any type of stab
wound).
[] True—transport Patient/Family Choice []False
There are lacerations or wounds inflicted by others.
[]True—transport Patient/Family Choice [] False
Complete vital signs are within limits:
Adults:
Pulse outside range of 50-120. []True—transport Patient/Family Choice []False
Systolic Blood Pressure outside range of 100-180. []True—transport Patient/Family Choice []False
Diastolic Blood Pressure greater than 120. [] True—transport Patient/Family Choice []False
Respiratory Rate outside range of 12-30. [] True—transport Patient/Family Choice []False
Pediatrics:
Vital signs inappropriate for children
(Policy 530.32) []True—transport Patient/Family Choice []False
Patient is febrile to palpation/measurement.
[]True—transport Patient/Family Choice [] False
Is patient under the influence of alcohol or drugs.
[]Yes []No
If yes,to under the influence of alcohol or drugs,does patient require assistance to walk.
[] True—transport Patient/Family Choice []False
If all of the above answers are False,patient may be transported to CSC/CCAIR. Otherwise transport is
Patient/Family Choice.
Patients that Crisis Stabilization Center(CSC)cannot accept:
• Patients with dementia or delirium
• Patients with ongoing medical care(i.e.,patients who require continuous oxygen use,catheters,
wired devices,etc.)
• Patients in wheelchairs that cannot move independently
• Patients with any open wound,laceration,skin ulcer,or decubitus that requires anything more that
once daily dry gauze and tape dressing
EXHIBIT"C"
FL-121
COUNTY OF FRESNO
CLEANING STANDARDS AND REQUIREMENTS
General —Applies to Most County Facilities
It is the intent of the County that County facilities be maintained at a high standard of
cleanliness. These specifications are intended to establish an acceptable level of
service. Cleaning frequencies are established as minimums. All items not specifically
included but found to be necessary to properly clean the buildings, shall be included as
though written into this Statement of Work.
The term "clean" includes, but is not limited to, the complete removal of trash, dirt,
dust, lint, webs, marks, stains, spots, spillages, graffiti, odors, film, gum, grease, tar,
paint, etc. or cleaning product residue.
Hours of Service
Cleaning of County facilities is to be done with as little hindrance of the County staff
and clients as possible. The cleaning schedule must be flexible to work around the
scheduling needs of building occupants.
Normal cleaning is to be done between the hours of 7:00 a.m. and 4:30 p.m. Periodic
tasks such as floor care may be scheduled for the swing shift which begins at 4:00
p.m.
Cleaning Requirements
This section defines the general cleaning components, standards and requirements
that apply to all buildings. In addition, there are some unique cleaning requirements
which may exceed and supplement these general standards due to the nature of a
building, the clients they serve and the services provided. Those site-specific cleaning
requirements are defined for each building.
Frequency (examples)
D-Daily
W-Weekly
M-Monthly
Q-Quarterly
SA-Semi-Annually
A-Annually
#D - # Days Per Week (e.g. 3D = 3 days per week)
MON, TUE, WED, THU, FRI - one day per week on a specific day
AN -As Needed (as determined by the County)
AR -As Requested
1
EXHIBIT"C"
FL-121
Routine and Periodic
The minimum required frequency for each task is defined in the specific task sheets for
each facility.
Routine - Cleaning tasks are ones that occur in the range of multiple times per day to
weekly.
Periodic - Cleaning tasks occur less frequently and are done at intervals such as
monthly, quarterly, semi-annually or annually.
Periodic tasks required advanced scheduling. This assures that building tenants will
have ample time to prepare for the service. It also gives building tenants the
opportunity to identify any particular problem areas that should be addressed.
Elevators
Routine - Clean and vacuum elevator tracks on all floors to remove debris. Vacuum
carpeted floor; sweep and damp mop hard surface floors. Clean elevator doors (on all
floors) and walls with the appropriate cleaner for the surface material (e.g. stainless
steel cleaner for stainless steel, wood cleaner for wood surfaces, general purpose
cleaner for other surfaces.) Dry with a clean dry cloth. Remove any graffiti with graffiti
remover and a damp cloth. Rinse with water and dry. Post wet floor sign, when
needed.
Periodic -
Exterior
Routine - Sweep the exterior entrance area to within 15' from entrance. Remove trash.
Remove all graffiti that can be removed with janitorial cleaners and processes. Report
other graffiti to DBH who will refer the work to County Facility Services.
Patios and courtyards that are within the perimeter of the building should be swept and
cleaned regularly
Periodic - Hose down cob webs and dirt from eves, awnings, and corners of facility
with a high pressure hose, where needed. Post wet floor signs. Mop up any puddled
water.
Floors
Hard Surface Floors
Maintain all floors in such a manner as to promote longevity and safety upon
completion of work; all floors shall be left in a clean, high luster shine, orderly and safe
condition at all times.
Remove and replace furniture as required to perform the work, exercising necessary
safety practices to prevent damage to County property and return to its proper place.
Post sufficient safety signs indicating slip hazards and/or wet floor when buffing, damp
mopping, stripping and waxing.
2
EXHIBIT "C"
FL-121
Routine - Resilient and Hard Tile:
Sweep to remove loose dirt and other material on all service days.
Spot clean all hard surface floors for (Spillages, stains, gum, candy, etc.) on all service
days.
Dust mop floors with a wide, treated dust mop, keeping the dust mop head on the floor
at all times. Pick up soil fro floor with a dustpan. Periodically shake out mop head into
a plastic bag. When mop head gets soiled, put n a container marked dirty mop heads
and replace with a clean mop head.
Damp mop all surface hard tile (concrete, ceramic, resilient, wood, quarry, terrazzo,
linoleum, etc) on all service days.
Upon completion of these tasks, floors shall be left in a clean, orderly, safe condition
and free of all scuff marks, dirt, dust, soil, spots, stains, deposits, oil, grease, gum,
finish residue buildup, etc.
Periodic - Clean all baseboards and floor drains. Cleaning requires the removal of
grime, dirt, wax build up, cleaning compound and finish residue, which builds up on the
baseboards, corners, edges and grout.
Spray-buff floor, using a floor machine equipped with a buffing pad, to a high luster.
Apply a new coat of finish as needed.
Machine scrub restroom floors with a disinfecting detergent cleaner.
Strip and refinish all resilient tile with 2 coats of skid-proof wax according to the
periodic cleaning. Finish shall be applied only to appropriate areas free of residual dirt
and build-up (i.e. swept, spot cleaned, and damp mopped) Floors are not to be left
unfinished after stripping/scrubbing.
Finish Requirements:
1. Removability
2. Slip Resistance
3. Durability
4. Gloss
5. Clear and no discoloration
6. Dry within 30 minutes.
7. Non- foaming wax
8. Non - powdering
9. Stability
10. Recoatability
11. Buffable
Carpeting
Routine -
Completely vacuum all high traffic areas.
3
EXHIBIT "C"
FL-121
Completely vacuum non-high traffic areas such as offices. This includes underneath
desks, chairs, between walls and filing cabinets, behind doors and in comers and
edges of carpet and wall. Move furniture as needed.
Spot clean to remove stains such those caused by spilled beverages, candy, gum, etc.
Use stain and gum remover for carpets.
Periodic - Deep clean all hard carpeted floors within the first 60 days of the
Agreement and then according to the frequencies for each building as
articulated in Exhibit A.
Deep clean all carpets with spin bonnet or hot water extraction equipment. At a
minimum of every fourth cleaning, hot water extraction cleaning is required in order to
deep clean.
Proper carpet cleaning shall result in a carpet free from all types of airborne soil, dry
dirt, spots, spills, stains, smudges and water/petroleum soluble soils. A cleaned carpet
shall be uniform in appearance when dry and vacuumed.
Carpet extraction is to be done according to the periodic schedule
Furniture
Furniture includes, but is not limited to desks, tables, reading tables, conference room
tables, interview room tables, chairs, windows, and reception area partitions.
Routine — Dust and spot clean furniture. Clean employee desktops only if they have
been cleared of papers.
Set-up conference rooms when requested by building occupants.
Periodic - Vacuum/spot clean all fabric stationary and movable chairs, benches,
couches, partitions, etc. Clean counters and cabinets, moldings, door frames, furniture
legs, arms rest. Note: personnel desks are not to be disturbed and or touched unless
cleared by the occupant with a note left instructing that it be cleaned. Restore all
furniture, wastepaper baskets, etc., to their original position.
Maintenance
The Janitorial staff will be vigilant and notice and report any maintenance issues
immediately so that they may be addressed and corrected. Contractor shall report all
maintenance-related problems to Facility Services. Examples include, but are not
limited to:
1. Burned-out lighting
2. Dripping or running faucets.
3. Leaking fixtures (such as toilets and urinals).
4. Continuously or long-running flush-o-meters.
5. Inadequate or non-flushing flush-o-meters.
4
EXHIBIT "C"
FL-121
6. Carpet tears that pose a trip hazard.
7. Loosened floor tiles.
8. Cracked or broken windows.
9. Door locking problems.
10. Pests (e.g. spiders, ants, roaches, mice)
Miscellaneous
Routine/As Needed —The Janitors are responsible for a variety of miscellaneous
tasks that don't fit into other categories. They include, but are not limited to:
• Changing batteries in automated air sanitizers, automated paper towel
dispensers and other similar items, as needed
Restrooms
Clean and disinfect all restrooms in the buildings at the frequencies identified in the
building-specific schedule. For purposes of restroom requirements, "clean" shall be
defined as disinfecting, polishing, and removing all water spots. Disinfectant must be a
"hospital" grade disinfectant that kills fungus, virus, and bacteria and has organic soil
tolerance.
Routine - Clean all toilets, toilet seats, urinals. This includes removing any
encrustation, stains, scale, deposits, and build-up.
Clean and polish all exposed fixtures and piping, lavatories, counters, changing tables,
dispensers, mirrors, partitions, doors, walls, moldings, ceiling and wall vents, shelves,
furniture, trim, baseboards, etc., in restrooms and adjacent lounge areas using a
germicidal detergent.
Deodorant urinal screens shall be used in urinals only. Highly scented disinfectants,
objectionable or odoriferous cleaners shall not be used
In many buildings, restrooms must be checked and touched up or re-cleaned multiple
times throughout a normal workday. Since the Contractor only works after normal
working hours, this will be the responsibility of the County.
Restroom Floors - Clean restroom floors according to the flooring standards, schedule,
and protocol described in the flooring section.
Stairways/Stairwells
Routine - Sweep stairwells and remove all trash. Damp mop stairs and remove any
stains, gum, etc.
Scrub and sanitize hand rails.
5
EXHIBIT"C"
FL-121
Periodic -
Supplies
The County is responsible for procurement, storage, distribution and supply of plastic
wastebasket liners, toilet tissue, paper towels, liquid hand soap, disposable liners for
sanitary napkin cans, blood and bodily fluid cleanup kits, and all cleaning products
necessary to perform the services required herein.
6
EXHIBIT"C"
FL-121
Item County currently uses
Blood spill and body fluid Sorb-It Absorbent
kits
Carpet Cleaner Reclaim Heavy Duty Carpet Cleaner
Floor Finish Pioneer Stay Brite Finish
Floor Sealer Pioneer Envirostar 2000
Floor Stripper Pioneer Formula X Heavy Duty Stripper
Lamps- Replacement The majority of lamps to be replaced are fluorescent
Lamps/light bulbs- T-8's, with some T-12's, in sizes ranging from 18"to
4' (41 k).There are also some compact fluorescent
and incandescent bulbs.
Liquid Hand Soap Generic antibacterial
Paper towels Georgia Pacific White Multifold Towel 20389
Preference 16 Packs/case
Scott rolled towels for Envision automated paper
towel dispensers
Sanitary Napkins Various
Toilet Paper Unbleached or non-chlorine bleached, must fit
dispensers installed in the building, and should
contain a minimum of 40% post-consumer recycled
paper(Georgia Pacific, Scott, or equal).
Jumbo Toilet Paper- 13728, "Acclaim" 8 rolls/case
Georgia Pacific White 1 ply Toilet Paper" Envision"
14580-01 80/case
Toilet Seat Covers Georgia Pacific White 1/2 Fold Seat Cover"Safe T
Guard"47046 20/case
Trash Can Liners manufactured using 30% recycled materials and of
good grade
Liners, Can small 24 x 23 .30 mil black CS/1000
Liners, Can Medium 30 x 36 .74 mil black CS/250
Liners, Can Medium 40 x 46 .8 mill black CS/250
Urinal Deodorant Various
Screens
Walk Off Mats Various locations
7
EXHIBIT "C"
FL-121
Stocking Dispensers
1. Dispensers are to be refilled and cleaned daily
2. No refill/extra supplies shall be stocked in the area of dispensers
3. All dispensers found to be less than half filled will be considered insufficient.
4. County will maintain ten (10) day's stock of restroom supplies in the Janitorial
closets at all facilities for the term of the contract. (Note: Some facilities may not
have a closet or room that can accommodate a 10 day supply. In those cases the
items shall be stored in the nearest County facility that can accommodate the
supplies).
Material Safety Data Sheets (MSDS) - Prior to the use of any product/chemical in the
building, Facility Services will have on hand a Material Safety Data Sheet for each
such product/chemical. These are maintained in a file in each janitorial closet where
materials area stored.
Surfaces
General Surfaces - Dust and clean all surfaces including, but not limited to the
following, to remove dust, finger marks, smudges, graffiti, gum, dirt buildup, and/or
accumulation:
• baseboards • light switches (and surrounding wall area)
• ceiling and wall vents • metal trim
• ceiling or shelf fans • moldings
• counters • partitions
• door frames • picture frames
• door jams • push plates
• doors • vending machines
• elevators • walls
• fire extinguishers • window blinds
• kick plates
General Surface cleaning requirements include:
• Ash Trays - Empty and Clean outside ashtrays, if applicable
• Brass and Chrome — Polish (brass, chrome, etc.) doorknobs, handrails, kick
plates and push plates on doors or other pieces of door trim. Use a cloth and
polish, wipe film dry.
• Chalkboards and Whiteboards - Chalkboards and white boards should only
be cleaned upon request and with appropriate cleaner provided by the user
department. Trays should be cleaned with a suitable cleaner.
8
EXHIBIT"C"
FL-121
• Drinking Fountains - Clean drinking fountains with germicidal detergent to
sanitize. Remove calcium deposits with an environmental stain remover. Wipe
off with a dry cloth, then polish and wipe dry. If drinking fountain drain is slow,
report it to maintenance.
• Glass - Clean both sides of entrance door glass, clean door glass frames and
accompanying glass panels including transoms (inside and outside), removing
all fingerprints and dirt. Spot clean all interior glass. Contractor shall clean all
interior glass partitions, inside exterior glass, display cases, mirrors,
Periodic
• Ceilings and Corners — Remove cobwebs from all ceilings, doors, and corners
within the building
• Light fixtures -. Clean light fixtures, as needed, to remove insects, dirt, etc., in
and on the fixtures.
• Vents, Grills and Diffusers - Clean/vacuum all supply and return air diffusers
and any other vents on walls or ceilings.
Trash and Recycling
Trash Pick-Up and Removal
Routine - Empty all waste receptacles, including wastebaskets, trash cans, and boxes
(if labeled "trash", etc.) Deposit the trash into appropriate waste disposal containers.
Empty boxes, papers, magazines, etc; outside of trash receptacles not labeled trash
are not to be removed.
Ensure all waste receptacles are maintained in a clean and odor-free condition. Wash
wastebaskets and replace plastic liners, as needed.
Remove all trash and waste to a designated on-site dumpster or compactor) for
disposal. CA.
Remove all trash and sweep sidewalks for ten feet (10') from all entrances/exits to the
building.
Recycling
Routine - Transport all recyclables such as mixed paper, plastic/glass and aluminum
containers from bins inside County offices to designated location containers. Note that
some buildings have extensive quantities of materials that must be recycled.
Empty large shredders and transport shredded paper to recycle locations. Empty
small, "personal" shredders only upon request from building occupants.
All cardboard is to be broken down before empting into the appropriate on-site
container (i.e. compactor, recycle bin).
Walk-Off Mats — Provide clean walk-off mats at all times in locations where they
currently exist.
9
EXHIBIT"C"
FL-121
Windows and Window Coverings
Routine - See "Surfaces" section regarding general glass cleaning.
Periodic— Periodic window glass cleaning is done by a window cleaning contractor.
Clean/dust all window coverings.
10
Exhibit "T
FL-121
SELF4)EAL ING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County"),
members of a contractor's board of directors (hereinafter referred to as "County Contractor'),
must disclose any self-dealing transactions that they are a party to while providing goods,
performing services, or both for the County. A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in
which one or more of its directors has a material financial interest"
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name, job title (if applicable), and date this disclosure is being
made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to
the County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the
transaction; and
b. The nature of the material financial interest in the Corporation's transaction that
the board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing
transaction described in Sections (3) and (4).
Mail the completed form to: County of Fresno
Attn: ISD Lease Services (FL-121)
Internal Services Department
2220 Tulare Street, Suite 2100, Room 2101
Fresno, CA 93721-2106
Exhibit T"
FL-121
(1)Company Board Member Information:
Name: Date:
Job Title:
(2)Company/Agency Name and Address:
(3)Disclosure(Please describe the nature of the self-dealing transaction you are a party to):
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a):
(5)Authorized Signature
Signature: Date:
EXHIBIT E
F L-121
From: Davidson, N. Roger
Sent: Thursday, February 12, 2015 9:10 AM
To: Hill, Brandon
Subject: Improvements to Building 319
1. Approximately 4200 sq. ft. exterior selective demolition to construct:
• 3 exterior accessible concrete ramps (with curbs), landings, handrails and retaining wall.
• exterior lighting replacement
• new exterior sally port with lighting and fire sprinkler
• landscape and landscape irrigation repair
• storefront glass with sidelights at 1 location
• glass doors at 2 locations
• cement plaster (stucco) repairs
Trades include demolition, concrete, electrical and landscape contractors.
2. Approximately 5700 sq. ft. Interior selective demolition to construct:
• 1 new accessible restroom and shower.
• 2 accessible public restrooms.
• 4 offices
• 1 seclusion room
• 1 med room
• 1 day room
• 1 dining room
• 1 exit corridor
• new wall at existing break room
• break room with extensive plumbing water and sewer work.
• 1 common area with nurse counter with cabinets, electrical power and data.
• common area, game room, day room, dining room, hall,
• padded seclusion room
• repair, install vinyl flooring/base and paint 3 existing staff restrooms.
• ceilings, lighting, door hardware, lighting controls, fire sprinkler retrofit and a/c diffuser
replacement throughout.
Trades include carpentry, flooring, ceramic tile, painting, ceiling, glass/glazing/door hardware,
bath hardware, fire sprinkler, plumbing, mechanical, electrical and communication contractors.
Roger Davidson AIA, Architect-Project Manager
Fresno County Department of Public Works and Planning,
Capital Projects Division
2220 Tulare Street, Sixth Floor
Fresno, California 93721
559-600-4477 Office
559-696-4130 Cell