HomeMy WebLinkAboutAgreement A-24-367 Amendment II to Master Agreement.pdf Agreement No. 24-367
1 AMENDMENT NO. 2 TO SERVICE AGREEMENT
2 This Amendment No. 2 to Service Agreement ("Amendment No. 2") is dated
3 July 9, 2024 and is between each individual Contractor listed in Revised Exhibit A-1
4 "Specialized Supplemental Board and Care Home Contractor List" attached hereto and
5 incorporated herein by reference, and collectively hereinafter referred to as Contractor(s), and
6 the County of Fresno, a political subdivision of the State of California ("County").
7 Recitals
8 A. On June 7, 2022, the County and the Contractor(s) entered into Specialized
9 Supplemental Board and Care Home Services Master Agreement, effective July 1, 2022, which
10 is County agreement number A-22-230, as amended by County agreement number A-23-269
11 on June 20, 2023, effective July 1, 2023.
12 B. Contractor(s) have licensed residential care facilities, staff and expertise, to provide
13 Specialized Supplemental Board and Care Home services, for County placed persons served
14 with a mental health condition.
15 C. The County is increasing Supplemental Services Rates for Fiscal Year 2024-25,
16 effective August 1, 2024, and revising the Specialized Supplemental Board and Care Homes
17 Scope of Work to add a list of services that may be provided by Contractor(s) and monitoring
18 language to increase accountability of services provided.
19 D. Contractor Donald Haskins DBA Haskins Residential Care was previously referred to in
20 this Agreement as Haskins Residential Care.
21 E. The County and the Contractor(s) now desire to further amend the Agreement regarding
22 the changes below.
23 The parties therefore agree as follows:
24 1. All references to Revised Exhibit A shall be deemed references to Revised Exhibit A-1,
25 which is attached and incorporated by this reference.
26 2. All references to Exhibit B Scope of Work shall be deemed references to Revised Exhibit
27 B, which is attached and incorporated by this reference.
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1 3. All references to Revised Exhibit D shall be deemed references to Revised Exhibit D-1,
2 which is attached and incorporated by this reference.
3 4. That Section One (1) "Services", Subsection D of County Amendment A-23-269
4 beginning on Page Two (2), Line Twenty-Six (26) with the word "For" and ending on Page Three
5 (3), Line Nine (9) with word "elopement", is deleted in its entirety and replaced with the
6 following:
7 "For the purposes of this Agreement, the term "bed hold" includes beds held vacant for
8 persons served who are temporarily [not more than seven (7) consecutive days] absent from a
9 facility. An emergency bed-hold for psychiatric and non-psychiatric reasons beyond seven (7)
10 days must be approved by the County's Department of Behavioral Health (DBH) Director, or
11 designee. The County will pay up to the first seven (7) bed-hold days as stated in Revised
12 Exhibit D-1 "Fresno County DBH Specialized Supplemental Board and Care Homes Approved
13 Rates by Contractor" without approval. Contractor(s) must submit an authorization (for bed
14 holds over seven days) or notification (for bed holds up to seven days) request via Special
15 Services Authorization (SSA) Form, to County's DBH no later than two (2) business days after
16 person served returns to the facility. The County will have the final say on a case-by-case
17 basis if an extended bed-hold of beyond seven (7) days is necessary. The Contractor will notify
18 the County immediately if Contractor has knowledge that the person served will require
19 treatment at a facility or is eloped lasting seven (7) days or more. A bed hold for non-
20 psychiatric reasons include, but are not limited to, medical hospitalization or elopement."
21 5. That Section One (1) "Services" of County Agreement A-22-230, beginning on Page Two
22 (2), Line Seventeen (17), after the word "herein", the following Subsections are added:
23 F. Upon expiration or termination of this Agreement for any reason, Contractor(s)
24 agrees to assist County's DBH in the placement of persons served placed by County who can
25 no longer remain at Contractor(s) facilities.
26 G. Contractor(s) shall notify County thirty (30) days prior to listing for sale,
27 relocating, or closing a facility used for services under this agreement. If Contractor(s) sells,
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1 relocates, or closes their facility, they agree to assist County's DBH in movement of persons
2 served to another contracted facility thirty (30) days before the facility is sold, moved, or closed.
3 H. Access to Records. Contractor(s) shall provide County with access to all
4 documentation of services provided under this Agreement for County's use in administering
5 this Agreement. Contractor(s) shall allow County, CMS, the Office of the Inspector General, the
6 Controller General of the United States, and any other authorized Federal and State agencies
7 to evaluate performance under this Agreement, and to inspect, evaluate, and audit any and all
8 records, documents, and the premises, equipment and facilities maintained by the
9 Contractor(s) pertaining to such services at any time and as otherwise required under this
10 Agreement.
11 6. That Section Four (4), subsection D of the Amendment A-23-269 beginning on Page
12 Four (4), Line Twenty (20) with the word "In" and ending on Page Five (5), Line Two (2) with
13 word "DBHLPSConservatorship@fresnocountyca.gov", is deleted in its entirety and replaced
14 with the following:
15 "In addition, the County agrees to pay and Contractor(s) agree to receive compensation for
16 delivering specialized services authorization (SSA) services to augment services under this
17 Agreement for persons served as authorized by County. A SSA Form must be used to request
18 services for persons served who require services above and beyond services identified per facility
19 by the RISE Team. Services are defined in Revised Exhibit B, "Specialized Supplemental Board
20 and Care Homes Scope of Work", Section II — Services, of this Agreement. The SSA Form may
21 be approved/denied on a case-by-case basis by County when necessary and applicable, and is in
22 addition to the approved rate identified in Revised Exhibit D-1. SSA Forms may be submitted to
23 be reviewed/approved per person served, per month by County DBH for up to a maximum of thirty
24 (30) days, with justification. Contractor(s) must submit an authorization request in a format
25 determined by County, to County's DBH the day that a determination is made that SSA services
26 are needed for an authorized person served, but no later than two (2) business days after such
27 determination is made. Contractor(s) shall submit SSA Forms to County's DBH electronically via
28 email to: DBHLPSConservatorship@fresnocountyca.gov."
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1 7. That Section Twenty-Nine (29) "Monitoring" of County Agreement A-22-230, beginning
2 on Page Twenty-Three (23), Line Two (2), beginning with the word "Contractor(s)" and ending
3 on Page Twenty-Three (23), Line Six (6) with word "Agreement", is deleted in its entirety and
4 replaced with the following:
5 "Right to Monitor. County or any subdivision or appointee thereof, and the State of
6 California or any subdivision or appointee thereof, including the Auditor General, shall have
7 absolute right to review and audit all records, books, papers, documents, corporate minutes,
8 financial records, staff information, records of persons served, other pertinent items as
9 requested, and shall have absolute right to monitor the performance of Contractor(s) in delivery
10 of services provided under this Contract. Full cooperation shall be given by the Contractor(s) in
11 the delivery of services provided under this Agreement. Full cooperation shall be given by the
12 Contractor(s) in any auditing or monitoring conducted, according to this Agreement.
13 Cooperation. Contractor(s) shall cooperate with County in the implementation,
14 monitoring and evaluation of this Agreement and comply with any and all reporting requirements
15 established by County. Should County identify an issue or receive notification of a complaint or
16 potential/actual/suspected violation of requirements, County may audit, monitor, and/or request
17 information from Contractor(s) to ensure compliance with laws, regulations, and requirements,
18 as applicable.
19 Record Maintenance. Contractor(s) shall maintain all records and management books
20 pertaining to service delivery and demonstrate accountability for contract performance and
21 maintain all fiscal, statistical, and management books and records pertaining to the program.
22 Records should include, but not be limited to, documents required by licensing, in the Scope of
23 Work, and other primary source documents. Fiscal records shall be kept in accordance with
24 Generally Accepted Accounting Principles and must account for all funds, tangible assets,
25 revenue and expenditures. Fiscal records must also comply with the Code of Federal
26 Regulations (CFR), Title II, Subtitle A, Chapter 11, Part 200, Uniform Administrative
27 Requirements, Cost Principles, and Audit Requirements for Federal Awards."
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1 8. When both parties have signed this Amendment No. 2, the Agreement, Amendment No.
2 1 and this Amendment No. 2 together constitute the Agreement.
3 9. The Contractor represents and warrants to the County that:
4 a. The Contractor is duly authorized and empowered to sign and perform its obligations
5 under this Amendment.
6 b. The individual signing this Amendment on behalf of the Contractor is duly authorized
7 to do so and his or her signature on this Amendment legally binds the Contractor to
8 the terms of this Amendment.
9 10. The parties agree that this Amendment may be executed by electronic signature as
10 provided in this section.
11 a. An "electronic signature" means any symbol or process intended by an individual
12 signing this Amendment to represent their signature, including but not limited to (1) a
13 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
14 electronically scanned and transmitted (for example by PDF document) version of an
15 original handwritten signature.
16 b. Each electronic signature affixed or attached to this Amendment (1) is deemed
17 equivalent to a valid original handwritten signature of the person signing this
18 Amendment for all purposes, including but not limited to evidentiary proof in any
19 administrative or judicial proceeding, and (2) has the same force and effect as the
20 valid original handwritten signature of that person.
21 c. The provisions of this section satisfy the requirements of Civil Code section 1633.5,
22 subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part
23 2, Title 2.5, beginning with section 1633.1).
24 d. Each party using a digital signature represents that it has undertaken and satisfied
25 the requirements of Government Code section 16.5, subdivision (a), paragraphs (1)
26 through (5), and agrees that each other party may rely upon that representation.
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1 e. This Amendment is not conditioned upon the parties conducting the transactions
2 under it by electronic means and either party may sign this Amendment with an
3 original handwritten signature.
4 11. This Amendment may be signed in counterparts, each of which is an original, and all of
5 which together constitute this Amendment.
6 12. The Agreement as previously amended and as amended by this Amendment No. 2 is
7 ratified and continued. All provisions of the Agreement as previously amended and not
8 amended by this Amendment No. 2 remain in full force and effect.
9 [SIGNATURE PAGE FOLLOWS]
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1 The parties are signing this Amendment No. 2 on the date stated in the introductory
2 clause.
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CONTRACTOR(S): COUNTY OF FRESNO
4
PLEASE SEE SIGNATURE
6 PAGES ATTACHED Nathan Magsig, Chairman of the Board of
Supervisors of the County of Fresno
7
Attest:
8 Bernice E. Seidel
Clerk of the Board of Supervisors
g County of Fresno, State of California
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By:
11 Depu y
12 For accounting use only:
13 Org No.: 56302175
Account No.: 7295/0
14 Fund/Subclass.: 0001/10000
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The parties hereto have executed this Fmend.Tent too. 2 to A eerrf-nt j%'o. 22-230 as cf the
2 day and year first hereinabove written.
3
CONTRACTOR:
4
AWS HOME OF BLESSL\G A.\D JOV L\C
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7 By L'kj m f�Ctil
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9 Print Name
10 / ,n'1► n5 � i
Title:
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%failing Address:
14 6631 E. Cetti Ave
Fresno, CA 93727
15 (559) 708-3485
Contact: Akxvant Malhi
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COUNTY OF FRES\O
Fresno,CA
MCamScanner
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
day and year first hereinabove written.
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3 CONTRACTOR:
4 AWS HOME OF CARE, LLC
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6 n
8 Print Name A Kw Av-3 L\
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10 Title: MY"L� ���� .
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Mailing Address:
13 122 W. San Gabriel
14 Clovis, CA 93612
(559) 708-3485
15 Contact: Akwant Malhi
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COUNTY OF FRESNO
Fresno,CA
MCamScanner
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
day and year first hereinabove written.
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CONTRACTOR:
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4 ANJALEONI ENTERPRISES, INC DBA LEONIE HOUSE
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6 �
By
7 Xj
8 Print Name &IrdL y I Sul L'V1�vcv
g
n _ I
10 Title: dL,Vti..f YG� V 'YG�lr�-Lv�J�
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Mailing Address:
13 3086 Armstrong Ave
14 Clovis, CA 93611
(559) 347-9900/779-4071
15 Contact: Sundari Susan Kendakur
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COUNTY OF FRESNO
Fresno, CA
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
day and year first hereinabove written.
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CONTRACTOR:
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4 ANNE SIPPI CLINIC TREATMENT GROUP
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6 By
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8 Print Name Nathan Petty
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10 Title: CFO
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13 Mailing Address:
14 Anne Sippi Clinic Treatment Group
Attn: Laura Vargas
15 18200 Highway 178
Bakersfield, CA 93306
16 (661) 871-9697
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18 Location of Services:
Anne Sippi Clinic Treatment Group—Riverside Ranch
19 18200 Hwy 178
Bakersfield, CA 93306
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Anne Sippi Clicnic Treatment Group—Los Angeles
21 2457 Endicott Street
22 Los Angeles, CA 90032
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COUNTY OF FRESNO
Fresno,CA
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
day and year first hereinabove written.
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CONTRACTOR:
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4 BENEVOLENT RESIDENTIAL CARE SERVICE, LLC.
DBA DAILEY'S HAVEN
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By
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8 Print Name Estelle Dailey
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10 Title: Administrator/Owner
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Mailing Address:
13 5261 E. McKenzie Ave
14 Fresno, CA 93727
(559) 456-9940/970-1536
15 Contact: Estelle Dailey
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COUNTY OF FRESNO
Fresno, CA
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
day and year first hereinabove written.
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CONTRACTOR:
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4 BK HOUSE OF GRACE,LLC
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6 By
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8 Print Name `?✓f' w N m-y
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10 Title: AM-WX1wr
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Mailing Address:
13 1463 N. Archie Ave
14 Fresno, CA 93703
(559) 244-9484
15 Contact: Balwinder Kaur
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COUNTY OF FRESNO
Fresno,CA
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
day and year first hereinabove written.
2 a
CONTRACTOR:
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4
BONAVENTE HOME FOR THE ELDERLY 11
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6 By
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8 Print Narne Nida A. Bonavente
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10 Title: Owner Licensee
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Mailing Address:
13 2788 W. Fir Ave
14 Fresno, CA 93711
(559) 313-9052
15 Contact: Nida Bonavente
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COUNTY OF FRESNO
Fresno,CA
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
day and year first hereinabove written.
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3 CONTRACTOR:
4 THE CHIMES HOME
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7 By
8 Aoog
Print Name
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10 Title: ® dcc� 1
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13 Mailing Address:
2845 N. Armstrong Ave
14 Fresno, CA 93727
(559)244-0479/369-9949
15 Contact: Amor Alegre
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COUNTY OF FRESNO
Fresno,CA
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
day and year first hereinabove written.
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CONTRACTOR:
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4 GARDEN MANOR
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By
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8 Print Name Joan Black
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10 Title: Licensee/Administrator
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Mailing Address:
13 4983 E. Olive Ave
14 Fresno, CA 93727
(559) 255-8650xl0l/289-3166
15 Contact: Joan Black
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COUNTY OF FRESNO
Fresno, CA
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
day and year first hereinabove written.
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CONTRACTOR:
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4 GOLDRIDGE HOME, LLC
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By
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8 Print Name °� �"
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10 Title:
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Mailing Address:
13 2145 Goldridge St
14 Selma, CA 93662
(559) 708-2877
15 Contact: Rosemarie Riemcr
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COUNTY OF FRESNO
Fresno,CA
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of ft e
day and year first'hereinabove ri en.
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C RACTOR:
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4 D NALD HASKINS
D A HASKINS RESIDENTIAL CARE
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1311)
B
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9 Pr nt Name
,L ns
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11 Ti le: �2G2
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14 M ailing Address:
1 C 37 S. Chestnut Ave
15 Fr s o, CA 93702
(5 9)453-6832/352-5240
16 Contact: Natalie Haskins
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COUNTY OF FR SN
Fres o, C
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2 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
3 day and year first hereinabove written.
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5 CONTRACTOR:
6 JAN-ROY PLACE OF FRESNO, INC.
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8
By
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10 Print Name Joycelyn Hopper
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12 Title: Administrator
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Mailing Address:
15 4766 E. Illinois Ave
16 Fresno, CA 93702
(559) 940-9708/890-0839
17 Contact: Joycelyn Hopper
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Location of Services:
19 Jan-Roy Place of Fresno
20 4766 E. Illinois Ave.
Fresno, CA 93702
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Jan-Roy Place of Fresno 2
22 4266 N. 91h St.
23 Fresno, CA 93726
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COUNTY OF FRESNO
Fresno, CA
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
day and year first hereinabove written.
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CONTRACTOR:
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4 MARIAN HOMES, INC.
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7 '
By
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9 Print Name Sundari Susan Kendakur
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11 Title: Administrator, President
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14 Mailing Address:
3086 Armstrong Ave
15 Clovis, CA 93611
(559) 347-9900/779-4071
16 Contact: Sundari Susan Kendakur
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18 Location of Services:
Sierra Villa Rest Home
19 175 W. Sierra Ave.
Clovis, CA 93612
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Marian Homes 3
21 3238 Jasmine Ave.
22 Clovis, CA 93611
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COUNTY OF FRESNO
Fresno,CA
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
day and year first hereinabove written.
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CONTRACTOR:
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4 MARK A GISLER
dba RUBY'S VALLEY CARE HOME
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7 By '.'� �•' -
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Print Name1��
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Title: Cwoe
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13 Mailing Address:
14 9919 S. Elm Ave
Fresno, CA 93706
15 (209) 329-1159
Contact: Mark and Mary Gisler
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COUNTY OF FRESNO
Fresno,CA
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
2 day and year first hereinabove written.
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4 CONTRACTOR:
MODESTO RESIDENTIAL LIVING CENTER
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6
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8 By
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10 ` Print Name Ve4g11$ A, W yrt,-roc-�b
11 Title: OWV)C-r lAdmlhlS+m+DY
I
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14 Mailing Address:
1932 Evergreen Ave
15 Modesto, CA 95350
16 (209) 530-9300
Contact: Lena Baldwin
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COUNTY OF FRESNO
Fresno,CA
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
day and year first hereinabove written.
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CONTRACTOR:
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4 PROVIDIAN RESIDENTIAL CARE SERVICES INC.
dba FILLMORE CHRISTIAN GARDEN
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6
By
9 Print Name Inthone Milly
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11 Title: Owner
12 June 15, 2024
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14 Mailing Address:
4826 E. Fillmore Ave
15 Fresno, CA 93727
(559) 307-4170
16 Contact: Inthone Milly
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COUNTY OF FRESNO
Fresno, CA
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
day and year first hereinabove written.
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CONTRACTOR:
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4 ROYAL BOARD AND CARE HOME FOR THE ELDERLY
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6
7 By
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Print Name ,Aurora Rigon
9 !
10 Title: Administrator
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13 Mailing Address:
3407 N. Fresno Street
14 Fresno, CA 93726
(559) 903-6846
15 Contact: Rudy and Aurora Rigon
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COUNTY OF FRESNO
Fresno, CA
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
day and year first hereinabove written.
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3 CONTRACTOR:
4 SIERRA MEADOWS SENIOR CARE,INC.
5 dba RIVER BLUFFS MEMORY CARE
6
7
8 By C777�9 Print Name
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11 Title: 'PrS►C�Q(1`�
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14 Mailing Address:
5425 W. Spruce Ave.
15 Fresno, CA 93722
(559) 840-0422
16 Contact: Donna Hurley
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COUNTY OF FRFSNO
Fresno, CA
1 The parties hereto have executed this Amendment No. 2 to Agreement No. 22-230 as of the
day and year first hereinabove written.
2
CONTRACTOR:
3
4 SUNSHINE BOARD AND CARE II
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6
By
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8 Print Name Aurora Rigon
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10 Title: Administraor
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Mailing Address:
13 1642 W. Robinson Ave
14 Fresno, CA 93705
(559) 903-2401
15 Contact: Aurora and Rudy Rigon
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COUNTY OF FRESNO
Fresno, CA
The parties hereto have executed this Amendment No. 2 to Agreement No, 22-230 as of the
day and year first hereinabove written.
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CONTRACTOR:
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4 VALLEY COMFORT HOME, INC
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6 ray �U,0u.��a
�U
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8 Print Name P12�5C'(w5 (aU f NT3
9 10 Title: h O H 1►�1�J_
(2-A TD R-
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Mailing Address:
13 6579 E. Fillmore Ave
14 Fresno,CA 93727
(559)495-8273/454-0704
15 Contact: Priscilla Quinto
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COUNTY OF FRESH(
Fresno,CA
Created with Scanner Pro
Specialized Supplemental Board and Care Home Contractor List Revised Exhibit A-1
VENDOR FACILITY LOCATION CONTACT PERSON
AK's Home of Blessing and Joy,Inc. Akwant Malhi
Remit to: 6631 E Cetti Ave 559-708-3485
6631 E.Cetti Ave Fresno Ca,93727 jchatha1983@hotmail.com
Fresno,Ca 93727
AK's Home of Care,LLC Akwant Malhi
Remit to: 122 W San Gabriel 559-708-3485
122 W San Gabriel Clovis,Ca 93612 jchathal983@hotmail.com
Clovis,CA 93612
Anjaleoni Enterprise,Inc. Sundari Susan Kendakur
dba Leonie House 2931 Caesar Ave 559-347-9900 or 559-779-4071
Remit to: Clovis,Ca 93611 anjaleoni@me.com
3086 Armstrong Ave
Clovis,Ca 93611
ASC Treatment Group Anne Sippi Clinic(Bakersfield) Nick Damian
Remit to: 18200 Hwy 178 (661)871-9697
18200 Hwy 178 Bakersfield,Ca 93311 ndamian@annesippiclinic.com
Bakersfield,Ca 93306
Anne Sippi Clinic(Los Angeles)
2457 Endicott Street
Los Angeles,Ca 90032
Benevolent Residential Care Service,LLC. Estelle Dailey
dba Dailey's Haven 4479 N.Eddy Ave 559-456-9440 or 559-970-1536
Remit to: Fresno,Ca 93727 estelle.dailevl@comcast.net
5261 E McKenzie
Fresno,Ca 93727
BK House of Grace,LLC Rosemarie Riemer
Remit to: 1463 N Archie Ave 559-708-2877
813 S Douglas Ave. Fresno,Ca 93703 roseriemer@gmail.com
Fresno,Ca 93727
Bonavente Home for the Elderly II Rosemarie Riemer
Remit to: 6097 Harrison 559-708-2877
2788 W Fir Ave. Fresno,Ca 93711 roseriemer@gmail.com
Fresno,Ca 93711
The Chimes Home Amor Alegre
Remit to: 3041 E Clinton 559-244-0479 or 559-369-9949
2845 N Armstrong Ave Fresno,Ca 93703 amoralegre122@gmail.com
Fresno,Ca 93727
Garden Manor,Inc. Joan Black
Remit to: 4983 E Olive Ave 559-255-8650 x201
4983 E Olive Ave. Fresno,Ca 93727 gardenmanor4983@vahoo.com
Fresno,Ca 93727
Goldridge Home,LLC Rosemarie Riemer
Remit to: 2145 Goldridge St. 559 708-2877
2145 Goldridge St. Selma,CA 93662 roseriemer@gmail.com
Selma,CA 93662 godriegehome@gmail.com
Donald Haskins Donald Haskins
dba Haskins Residential Care 1037 S Chestnut Ave 559-453-6832 or 559-352-5240
Remit to: Fresno,Ca 93702 natalieh@haskinsrescare.com
1037 S Chestnut Ave
Fresno,Ca 93702
Jan-Roy Place of Fresno,Inc. Jan-Roy Place of Fresno Joycelyn Hopper
Remit to: 4766 E Illinois Ave 559-940-9708 or 559-890-0839
4766 E Illinois Ave Fresno,Ca 93702 janroy8693@gmail.com
Fresno,Ca 93702
Jan-Roy Place of Fresno 2
4266 N 9th St.
Fresno,Ca 93726
Revised 6/5/24 Page 1 of 2
Specialized Supplemental Board and Care Home Contractor List Revised Exhibit A-1
VENDOR FACILITY LOCATION CONTACT PERSON
Marian Homes,Inc. Sierra Villa Rest Home Sundari Susan Kendakur
Remit to: 175 W Sierra Ave 559-347-9900 or 559-779-4071
3086 Armstrong Ave Clovis,Ca 93612 anlaleoni@me.com
Clovis,Ca 93611
Marian Homes 3
3238 Jasmine Ave
Clovis,Ca 93611
Mark A Gisler Mark Gisler
dba Ruby's Valley Care Home 9919 S Elm Ave 209-329-1159
Remit to: Fresno,Ca 93706 marebot@aol.com
9919 S Elm Ave.
Fresno,Ca 93706
Modesto Residential Living Center Lena Baldwin
Remit to: 1932 Evergreen Ave 209-530-9300
1932 Evergreen Ave Modesto,Ca 95350 modestorlc@vahoo.com
Modesto,Ca 95350
Providian Residential Care Services,Inc. Inthone Milly
dba Fillmore Christian Gardens 4826 E Fillmore 559-307-4170
Remit to: Fresno,Ca 93727 Inthonemilly@providianres.com
4826 E Fillmore
Fresno,Ca 93727
Royal Board and Care Home for the Elderly Rudy Rigon
Remit to: 3407 N Fresno 559-903-6846
3407 N Fresno St Fresno,Ca 93726 rudygrigon@gmail.com
Fresno,Ca 93726
Sierra Meadows Senior Care,Inc. Donna Hurley
dba River Bluffs Memory Care
Remit to: 5425 W.Spruce 559 840-0422
5425 W.Spruce Ave. Fresno,Ca 93722 dhurlev@riverbluffsmcc.com
Fresno,Ca 93722
Sunshine Board and Care II Aurora Rigon
Remit to: 1642 W Robinson Ave 559-903-2401
1642 W Robinson Ave Fresno,Ca 93705 auroraarigon@gmail.com
Fresno,Ca 93705
Valley Comfort Home,Inc. Priscilla Quinto
Remit to: 6579 E Fillmore Ave 559-495-8273 or 559-454-0704
6579 E Fillmore Ave. Fresno,Ca 93727 precydguinto@vahoo.com
Fresno,Ca 93727
Revised 6/5/24 Page 2 of 2
Revised Exhibit B
Page 1 of 18
SPECIALIZED SUPPLEMENTAL BOARD AND CARE HOME SERVICES
SCOPE OF WORK
I. QUALITY ASSURANCE STANDARDS FOR LICENSED RESIDENTIAL CARE FACILITIES -
BASIC CARE AND SUPERVISION
PROGRAM
1.1 Each facility shall have a written Program Design (Title 22, Plan of Operation) approved by the
Department of Behavioral Health (DBH) which contains a statement of purpose, a statement of
goals, a description of program methods and a staff training plan.
1.2 The activities and opportunities provided to each person served shall be consistent with the
written Program Design.
1.3 The facility administrator, person served, and agency referral person/authorized representatives
shall be involved in the development of the person's served "Appraisal/ Needs and Services
Plan." Appraisal/Needs and Service Plan shall be completed as indicated in Title 22, Section
80068.2, to meet the goals, objectives, and activities appropriate to the person served. This plan
shall be completed and placed in the person's served record on or before the first day of
placement and kept current.
1.4 The facility shall ensure continuity in each person's served planned activities by having staff
communicate and participate with other agencies in case conferences and in the development
of a plan of care or educational plan.
1.5 The supervision and training shall be provided to each person served follows the objectives and
plans written in the "Appraisal/Needs and Appraisal Plan."
1.6 The facility shall provide supervision and training seven (7) days per week with a staff ratio
adequate to implement the "Appraisal/Needs and Services Plan."
1.7 The facility shall have a written monthly Activity Schedule posted for all hours that persons
served are awake and under the supervision of the facility, seven (7) days per week. The
Activity Schedule reflects the time and place of usual person served activities. The Activity
Schedule shall reflect at least one recreational activity each day and at least one activity in the
community each week. The facility shall maintain copies of the monthly Activity Schedules and
provide a copy to the DBH RISE team when requested.
1.8 The facility shall teach and enable persons served to practice skills and behaviors that are
necessary for attaining greater independence in the facility and in the community in accordance
with the "Appraisal/Needs and Services Plan." The facility shall encourage use of leisure time in
a constructive manner.
1.9 Daily activities shall be age appropriate.
1.10 Natural environments and materials shall be used in teaching skills to persons served.
Revised Exhibit B
Page 2 of 18
1.11 Training techniques shall be individualized in accordance with the "Appraisal/Needs and
Services Plan."
1.12 Training techniques shall be consistent with the principles of least restrictive method.
1.13 All staff responsible for carrying out a person's served "Training/Treatment" shall be familiar with
its objectives and methods of implementation.
1.14 There shall be continuity, through staff changes, in training provided to persons served, as
evidenced by either oral or written communications between staff on different shifts.
1.15 Every twelve (12) months the "Appraisal/Needs and Services Plan" shall be reviewed by the
case manager/authorized representative, person served, and facility staff to measure and
document progress of set objectives and/or the need to modify. Documentation of review shall
be kept in the person's served record.
1.15.1 Every six (6) months the person served shall be assessed by case manager with input
from the Contractor.
1.16 When it is determined that the "Appraisal/Needs Service Plan" requires updates, facility staff
shall bring this to the attention of the case manager. The facility staff, case manager, and
person served shall participate in the revision, as appropriate.
1.17 Staff shall keep daily progress notes of activities and participation in milieu and provide a copy
to the DBH RISE team when requested.
RIGHTS
2.1 A statement of person served rights is posted where it is easily accessible to persons served
and visitors. The statement includes a description of procedures to be followed and whom to
contact if the person has questions or complaints regarding rights.
2.2 Upon admission, each person served shall receive instruction on his or her rights through
communication methods which are appropriate for that person.
2.3 There shall be no denial of person's served rights unless the facility follows the procedures
specified by law.
2.4 House rules must be written and posted and are appropriate for the persons served.
2.5 The facility's house rules shall be explained to each person served via communication methods
which are appropriate for that person.
2.6 Facility shall have a complaint procedure which persons served may use to appeal a decision
made by a staff member.
Revised Exhibit B
Page 3 of 18
2.7 The complaint procedure must be written and posted and, upon admission, explained to each
person served via communication methods which are appropriate for that person.
2.8 All persons served shall have access to the facility 24 hours a day.
COMMUNITY INTEGRATION
3.1 If the facility is located in a residential neighborhood, it must be physically compatible with
residences in that neighborhood.
3.2 Persons served shall have access to resources available to other members of the local
community and shall be given regular opportunities to use those resources.
3.3 Persons served must be given opportunities to practice community and independent living skills
in their local community.
3.4 The facility shall provide group activities which include activities involving six (6) or fewer
persons served.
3.5 The facility shall offer at least one recreational activity a week in the community appropriate to
the interests or development of interests of the persons served. (Refer to Section 1.7)
SOCIAL - PSYCHOLOGICAL ENVIRONMENT
4.1 The physical aspects of the facility must be appropriate to the age and physical abilities of the
persons served.
4.2 Persons served shall eat in the dining room or eating areas typically used by family and/or staff
members.
4.3 Each person served shall wear/have properly fitting clothing.
4.4 Each person served shall receive training, or be assisted, in selecting clothing which is
appropriate to his or her age, sex, and the season.
4.5 Each person served shall be allowed to wear his or her own clothing.
4.6 There shall be recognition and acceptance by staff of person's served cultural and ethnic
differences.
4.7 Communication and interaction between staff and persons served shall reflect respect and
caring.
4.8 Staff shall make an effort to establish positive relationships with persons served via
communication methods which are appropriate for those persons.
Revised Exhibit B
Page 4 of 18
4.9 Staff shall make an effort to establish positive relationships with person's served family
members.
4.10 Persons served shall share in facility decision-making through weekly house meetings designed
to encourage participation.
4.11 Persons served shall be encouraged to pursue individual interests and schedules.
4.12 The facility shall be furnished, decorated, and arranged to provide a home-like, non-institutional
atmosphere.
4.13 Bathroom facilities must be designed and equipped to afford privacy.
4.14 No more than two (2) persons served shall share a bedroom.
4.15 Bedrooms shall not be used as passageways to other rooms.
4.16 Persons served must be allowed to use bedrooms as a place to be alone.
4.17 Persons served shall have access to all common areas of the residence, except controlled
storage areas and staff designated areas.
HEALTH
5.1 Within three (3) days of admission, each person served shall be scheduled an appointment with
a primary care doctor for a physical exam. If a person served has a diagnosed medical condition
for which they are prescribed medication (e.g., diabetes), the primary care doctor appointment
should be completed within thirty (30) days of admission. Otherwise, primary care doctor
appointments must be completed within sixty (60) days of admission.
5.2 Within six (6) months of admission, each person served shall:
5.2.1 Complete a dentist appointment for a dental cleaning, any needed follow up care, and
regular appointments once a year thereafter;
5.2.2 Complete an Optometrist/Ophthalmologist appointment and follow up care once each
two (2) years thereafter;
5.2.3 For persons served 45 years and older, complete a colonoscopy and endoscopy and as
ordered by a doctor;
5.2.4 For women persons served 45 years and older, complete a mammogram and every two
(2) years thereafter;
5.2.5 For women persons served 18 years old and older, receive a gynecological exam with
an OBGYN and annually thereafter; and
Revised Exhibit B
Page 5 of 18
5.2.6 Contractor staff shall obtain a copy of any doctor's note the same day as the
appointment and shall submit to the conservator for all doctor's visits as described
above.
5.3 Staff shall keep a record of all medical notes from the primary care doctor and shall provide
copies to the DBH RISE Conservatorship Office.
5.4 Persons served who require adaptive devices (eyeglasses, hearing aids, dentures, wheelchairs,
etc.) shall be given assistance in securing and maintaining these devices.
5.5 Staff shall ensure each person served displays good personal hygiene with regard to skin, nails,
teeth, hair and clothing and the facility shall provide personal grooming supplies. Staff shall
encourage each person served to maintain adequate grooming.
5.5 The facility shall have a method for ensuring that the nutritional needs of all persons served are
satisfied. Monthly menus must be posted and corrected as served in accordance with Title 22
Section 80076.
5.6 The food served in the facility must provide a variety, must be presented in an appetizing
manner and should reflect the ethnicity of the persons served (Title 22 Section 80076).
5.7 Notice of any unusual incident (AWOL, hospital admission, abuse), accident or death shall be
immediately reported to the Case Manager, Specialized Supplemental Board and Care
Coordinator, Conservator/Guardian (as appropriate), and State Community Care Licensing. A
copy of the incident report shall be provided to the Department of Behavioral Health Case
Manager by the end of the next business day.
5.8 Facility shall notify the Conservator/Guardian within 24 hours of all person's served movements
(e.g., admissions to a general hospital, acute psychiatric facility, and/or AWOL).
MENTAL HEALTH
6.1 Telehealth support—All persons served shall have access to a computer (with sound) and be
allowed privacy to attend psychiatry appointments and court evaluations with a doctor.
6.2 Facilities that have an onsite board-certified psychiatrist or psychiatric nurse practitioner shall
provide mental health treatment, including psychiatric medications.
6.3 Facilities that have an onsite board-certified psychiatrist or psychiatric nurse practitioner shall
maintain a record of the psychiatrist/psychiatric nurse practitioner's notes and provide copies to
the DBH RISE Conservatorship team upon request.
6.4 Prior to starting a new psychiatric medication or increasing the dose of an existing psychiatric
medication, the facility's board certified psychiatric or psychiatric nurse practitioner must get the
approval from the Deputy Conservator.
6.5 Psychiatric medications cannot be prescribed and/or refilled by the facility's primary care doctor,
and this includes as needed psychiatric medications (e.g., Ativan as a PRN for anxiety).
Revised Exhibit B
Page 6 of 18
6.6 Staff must present a copy of the person's served Medication Administration Record at each
follow-up mental health appointment.
6.7 Staff shall provide documents (e.g., Medication Administration Record, progress notes), as
requested by DBH RISE Conservatorship Team, prior to a LPS Conservatorship evaluation with
a DBH psychiatrist.
PHYSICAL ENVIRONMENT AND SAFETY
7.1 The facility shall be safe, clean and well maintained, both inside and out.
7.2 Each person served shall be provided with a comfortable bed with clean linens, warm blankets
and a pillow.
7.3 Each person served shall be provided closet space and a dresser or drawer space for the
exclusive use of the person.
7.4 All person's served medications must be stored in a centrally located, locked storage area. All
medications received and dispensed shall be entered in the medication log. If medications
require refrigeration, the medications shall be safely stored in a locked refrigerator.
7.5 All potentially dangerous non-edible or toxic items shall be clearly labeled and stored away from
food supplies.
7.6 The facility must be equipped with first aid supplies and a first aid manual.
7.7 The facility shall provide fire/disaster plan training for staff and persons served and shall
conduct and document at least one drill each quarter.
7.8 Vehicles used for transporting persons served shall be properly maintained and equipped with
seat belts. Persons served must use seat belts when vehicle is in motion.
ADMINISTRATION
8.1 Relevant chapters of Title 22 shall be maintained in the administrative offices of the facility and
available to all staff and persons served upon request.
8.2 A notice shall be posted stating that the results of State Licensing evaluations are available
upon request to persons served or other persons with a legitimate need to know.
8.3 The facility shall operate within the limitations of its license.
8.4 The facility shall maintain a record of any person's served money handled by the facility,
documenting each person's served income, disbursements made to the person served and
expenditures made on behalf of them by facility staff.
8.5 When cash is given to a person served, he/she must sign or place his/her mark on a receipt or
log specifying the cash amount.
8.6 Receipts shall be retained for expenditures made on behalf of the person served by facility staff.
Revised Exhibit B
Page 7 of 18
8.7 A person's served funds shall only be used by themselves or for their expenditures.
8.8 Persons' served funds shall be kept separate from facility funds.
8.9 The facility shall have procedures for protecting person's served personal property from loss or
abuse and which also allows each person served easy access to his/her own property.
8.10 The facility shall have established screening procedures to evaluate a potential employee's
character and his/her employment history. The facility shall comply with any and all State
Department of Social Services, Community Care Licensing Division's requirements for
screening and fingerprinting.
8.11 The facility administrator or designee shall be available at all hours to respond to any needs
from staff or persons served. There shall be a notice posted with the administrator's 24-hour
contact number.
8.12 The facility shall provide or arrange for local transportation and/or training in use of public
transportation in order for persons served to:
❖ participate in programs and services outside the facility.
❖ engage in activities of daily living and leisure activities/events as cited in each person's
served "Appraisal/Needs and Services Plan."
8.13 The facility will encourage persons' served use of public transportation. The facility shall be
responsible to ensure the person's served safety regardless of the mode of transportation
chosen.
8.14 The facility shall provide transportation and supervision to get persons served safely to and from
medical/dental appointments and communicates adequately with the medical/dental provider.
8.15 All staff shall have knowledge about legal requirements for reporting person served abuse.
PERSON SERVED RECORDS
9.1 A document file of person's served records shall be maintained at the facility for each person.
Each person's served file shall include, but is not limited to, the following information:
• Person served rights
• Person's served social security number
• Name, address and phone numbers of conservator or family member
• Dates of major illnesses
• Record of psychiatric/medical/dental treatments
• Admission physical and diagnosis
• Record of allergies
• TB clearance
• Funeral arrangements
• Weight record
• Person's served personal property list
Revised Exhibit B
Page 8 of 18
• Current admission agreement
• Current "Facility Service Plan"
• Weekly progress notes and monthly summary written by staff having direct
supervision/observation of the person served.
9.2 All treatment services to be provided to the person served, except emergency services, are
noted in "Facility Service Plan."
9.3 The facility shall maintain a medical log for each person served: type of medication, dosage,
frequency of administration, time of each administration, and initials of staff supervising
administration of medication. The facility shall make clear on the medication log which
medications are psychotropic medications. Psychotropic medications shall indicate: name of
medication, reason for its use and possible side effects.
9.4 Person served records are confidential in accordance with California Welfare and Institutions
Code provisions.
9.5 Any consent for release of information provided by the person served, or their conservator shall
specify:
• Information to be released
• Purpose of the release
• Agency or person to whom release is to be made
• The time period for which the release is valid
9.6 Consents for Release of Information are maintained permanently in the person's served record.
9.7 Person served records shall contain monthly summary notes addressing all needs/services in
the "Facility Service Plan" and other significant events/observations affecting the person.
TRAINING
10.1 Direct-care staff shall complete on-the-job training by the facility within one (1) month following
employment. At a minimum, the subjects covered in the training shall include: Special Incident
Reports, health and emergency procedures, medications, person served rights and abuse
reporting.
10.2 Direct-care staff shall complete orientation within one (1) month from start date of employment.
The orientation includes at least the following topics: awareness of mental health programs,
review of quality assurance standards, and the placement packet.
10.3 All direct-care staff shall have a current first aid training and CPR certification from an
appropriate agency, such as the Red Cross.
10.4 The facility administrator shall complete at least twenty (20) hours per year of continuing
education or in service training. Topics of education or training shall be chosen from those
approved by the State Community Care Licensing Division.
Revised Exhibit B
Page 9 of 18
10.5 Direct-care staff shall complete at least nine (9) hours of continuing education or in service
training in mental health issues or related topics. Topics of education or training are chosen
from those approved by the State Community Care Licensing Division.
II. SERVICES
County shall pay Contractor(s) a supplemental service rate as determined by services provided
which have been identified and approved by RISE Team. Such services will be audited as
needed by County's Department of Behavioral Health (DBH), with a frequency of no less than
once per fiscal year. Services shall be listed on each facility's rate sheet to ensure appropriate
placement based on each person's served needs. Contractor(s) shall not invoice Special
Services for services that have been identified per facility by the RISE Team.
Services provided to persons served include, but are not limited to:
• Provide three (3) meals and three (3) snacks per day (Title 22 87555)
• Medication Management (assistance with taking, cheeking, and documentation of
consumption) (Title 22 80075)
• Provide enough forks, glasses, and plates for each person (Title 22 80076)
• Doctor visits - transport to and return safely from doctor visits) (Title 22 80075, 87465)
• Clearly defined menu, for thirty (30) days for all three (3) meals, and adherence to menu
(Title 22 80076)
• Assistance with grooming (e.g. hair cut/trim, etc.)
• Logging showers
• Documentation for court- Psychiatrist notes, discharge papers, behavior notes must be
returned to DBH three (3) weeks prior to court date
• Maintain a staff/person Served ratio as defined in CCL regs (Title 22 85065.5).
o There shall be at least one person capable of and responsible for communicating
with emergency personnel in the facility at all times.
• Staff in milieu not just on site (staff available for care and supervision of person served)
• Maintaining person served records such as progress notes and financial records (Title
22 80070)
• Basic safe and healthful (clean) living accommodations and services (87307)
• Personal assistance and care as needed by the person served and as indicated in the
pre-admission appraisal, with those activities of daily living such as dressing, eating,
bathing, toileting, and assistance with taking prescribed medications, as specified in
Section 87608, Postural Supports.
• Regular observation, documentation, and reporting of the person's served physical and
mental condition, as specified in Section 87466,
o Includes observation of the person served and change in person served status
• A planned activities program which includes social and recreational activities appropriate
to the interests and capabilities of the resident, as specified in Section 87219, Planned
Activities
• Support for ASL/non-English — provide interpreter
• Support for ASL/non-English — direct communication
• Enhancement of independent living skills other than care and supervision
• Higher frequency medical transporting
• Mobility assistance (Ambulation, etc.) with person served cooperation
Revised Exhibit B
Page 10 of 18
• Mitigating arsonist tendencies (redirection and risk management)
• Managing verbal aggression
• Multiple 9-1-1 calls/false reporting behavioral issues
• Advanced medical needs with hospice
• Transportation for other than medical reasons and care and supervision (e.g., visiting
family, outings, etc.)
• Group— Biweekly activities/hobbies (Fun)
• Security or controlled access (in and out of facility)
• Medical supports requiring license professional (active dressing changes/wound care)—
In-house
• Using AOD/toxicology screening/intervention support
• Destruction of property
• Multiple 9-1-1 calls/false reporting due to MH symptoms
• Preventative measures of elopement (cognitive or behavioral)
• Efforts to locate an eloped person served
• Certified Service Animal/Pet Therapy
• Mitigating instigative behaviors
• Emotional support/behavioral management for person served — Documented
• Group—AA/12 Step/Rehab/SUD
• Higher staffing ratio - over one direct care staff to three persons served
• Mobility assistance without person served cooperation all needs
• Dealing with inappropriate physical/sexual touching
• Acceptances of person served with multiple failed placements/evictions
• Advanced medical needs without hospice
• Cultural needs—Age/LGBTQIA+/Ethnicity/Language Barriers
• Specialized trainings for staff for emotional/behavioral support for SMI/AOD
• Equine Therapy
• Hygiene related to encopresis/enuresis — Grooming: Soiled clothing/bedding
• Process for physical intimacy
III. CERTIFICATION REQUIREMENTS
A. Facilities eligible to be certified for payment for Specialized Supplemental Board and Care
Home services from Fresno County Department of Behavioral Health SHALL:
1. Be a licensed Adult Residential Care Facility or licensed Residential Care Facility for the
Elderly, authorized by the California State Department of Social Services, Community
Care Licensing Division, to provide care and supervision to mentally disabled adults.
2. Ensure the facility administrator has completed 20 hours per year of the continuing
education or in-service training in mental health issues or related topics, in accordance
with the education or training specifications of the California State Department of Social
Services, Community Care Licensing Division.
3. Ensure all direct care staff employed by the facility participate in the training activities
specified in the "Fresno County Department of Behavioral Health, Quality Assurance
Revised Exhibit B
Page 11 of 18
Standards for Licensed Adult Residential Care Facilities, and Residential Care Facilities,
Section 9."
4. Provide information for monthly billing and other data, as required by the County's
management information system.
5. Provide a monthly statement of all persons served living in the facility.
B. Facilities SHALL be certified for participation by the County and services SHALL be provided
through written agreement. THESE FACILITIES SHALL:
1. Cooperate with County staff, subsequent to referral and with authorization by the
County, in completing the "Appraisal/Needs and Services Plan," as indicated by the
California Department of Social Services, Adult Residential Facilities, Division 6, Chapter
1, Section 80068.2, to meet the goals, objectives, and activities appropriate to the
person served. This plan shall be completed and placed in the person's served record on
or before the first day of placement and kept current.
2. Complete a "Facility Service Plan" indicating the specific services to be provided to
address the needs identified in the "Appraisal/Needs and Services Plan." This plan shall
be completed and placed in the person's served record on or before the first day of
placement.
3. Maintain individual person served records, on the premises, in accordance with "Fresno
County Department of Behavioral Health, Quality Assurance Standards for Licensed
Adult Residential Care Facilities and Residential Care Facilities, Section 8 - Person
Served Records" to promote the services to each individual. These records SHALL
include:
a. The "Appraisal/Needs and Services Plan" specifying the needs to be addressed.
b. Weekly progress notes and monthly summary notes and maintain in person's
served record.
C. Weekly notes SHALL:
i. Address all needs, objectives, and services provided by facility staff to
implement the "Facility Service Plan" for each person served.
ii. Address significant occurrences affecting the person served (incidents,
illness. exacerbation of symptoms, signs of improved functioning, etc.), as
appropriate.
iii. Describe behavioral observations and symptoms.
iv. Be written by staff having direct supervision/observation of the person
served.
Revised Exhibit B
Page 12 of 18
d. Monthly summary notes SHALL reflect all needs and services addressed in the
"Needs/Appraisal Plan." (Refer to "Fresno County Department of Behavioral
Health, Quality Assurance Standards for Licensed Adult Residential Care
Facilities and Residential Care Facilities, Section 8 - Person Served Records.").
e. All other documents/information as required by State Community Care Licensing
Division.
4. Allow access to the facility, to the extent authorized by law, by County and State staff for
assessment of consumer(s), monitoring of the contract, record review, consultation with
staff, and evaluation of the facility and services.
5. Maintain the capability to provide the services required to meet the specialized needs of
person's served, as identified in their' "Appraisal/Needs and Services Plans."
6. Cooperate and consult with County staff to improve/enhance/modify program services to
meet the need of persons served as indicated in their "Appraisal/Needs and Services
Plans."
7. Inform COUNTY's Case Manager and Specialized Supplemental Board and Care Home
Services Coordinator immediately and provide a written report within 24 hours of all
incidents necessitating an incident report to State Licensing Division. Incidents to be
reported include, but are not limited to, death, accident/injury, abuse, and absence
without leave (AWOL).
8. Inform the Coordinator within 24 hours of all person served movements (i.e. admissions
to a general hospital, acute psychiatric facility, and/or AWOL).
9. As persons served increase ability to function in particular areas, increase persons
served responsibilities for own care/activities in those areas, as specified in their
"Appraisal/Needs and Services Plan."
10. Offer persons served opportunities to function/perform in those areas where they are
competent or are learning new life skills.
11. Encourage consumers to take increased responsibility for own treatment by setting self-
established goals.
12. Provide scheduled and posted activities to encourage the development of activities
satisfying to persons served, as specified in their"Appraisal/Needs and Services Plans."
The posted monthly schedules SHALL reflect the interests of persons served, expose
them to and develop a variety of leisure interests, and develop interpersonal skills and
relationships.
C. Specialized Supplemental Board and Care Home services may consist of, but not limited to, all
of the components listed below. They are to be provided to each person served as specified in
their "Appraisal/Needs and Services Plan," or as the need arises.
Revised Exhibit B
Page 13 of 18
1. Training in grooming and hygiene and supervision to ensure grooming/hygiene is
maintained at an adequate level.
2. Training in activities of daily living: These may include, but are not limited to:
a. Budgeting: Developing a spending plan for necessities/personal shopping, how
to plan for larger purchases, how to make economical purchases, where to shop,
credit buying, opening a savings account, etc.
b. Use of money: Paying bills, making change, getting receipts, keeping money
safe, opening an account, etc.
C. Menu planning, shopping for and preparing individual/family sized/balanced
meals, reading instructions/recipes, kitchen hygiene/cleanliness, use of kitchen
utensils and appliances.
d. Housekeeping/cleaning/making own bed.
e. Laundry and maintenance of clothing.
f. Education on the following topics:
i. Maintaining good health and eating wholesome and nutritious diet
ii. Basic disease prevention concepts
iii. Importance of regular exercise and adequate sleep
iv. Proper use of over-the-counter medication
V. Dangers of excessive use of alcohol, tobacco and street drugs
vi. Proper use of the transportation system
3. Assistance with personal shopping, as appropriate. Assistance with coordinating clothing
and making purchases to complete/supplement wardrobe.
4. Training to develop adequate medication management skills including, but not limited to:
a. When and how much of each medication to take
b. How to read instructions on medication containers
C. How to relate and talk with the doctor about symptoms, complaints and side
effects of medications.
5. Working with persons served to express feelings appropriately including, but not limited
to:
a. Dealing with conflict
b. Dealing with anger
C. Dealing with loss or grief
Revised Exhibit B
Page 14 of 18
d. Expressing a variety of feelings, including positive feelings
6. Working with persons served to develop skills including, but not limited to:
a. Starting and maintaining conversations
b. Dealing with family, and significant others
C. Talking with persons of either gender
d. Asserting own needs/desires/choices
7. Encouraging observations of culturally appropriate holidays, events, and traditions, in
accordance with the ethnic background of persons served and their wishes. This may
include, but not be limited to, offering activities, foods, and decorations appropriate to the
person served.
8. Providing close supervision of and interactions with persons served who require
management of difficult behavioral problems consistent with the "Appraisal/ Needs and
Services Plan." This may include, but not be limited to:
a. Providing support and encouragement
b. Providing specific individualized directions
C. Providing alternative activities
d. Setting specific behavioral limitations
e. Allowing for the appropriate expression of feelings
f. Separating the person served from others, when interactions tend to exacerbate
behaviors
g. Establishing a behavioral contract with the person served
IV. SPECIALIZED TRANSITIONAL RESIDENTIAL SERVICES PROGRAM REQUIREMENTS
In the event persons served fall under more than one category as set forth below, COUNTY shall pay
only one rate which is to be mutually agreed upon by COUNTY'S Department of Behavioral Health
(DBH) and CONTRACTOR(S). Please note: possession of care exemptions approved by Community
Care Licensing (CCL) will be required to provide services to persons served with specialized medical
needs.
PERSON SERVED CATEGORIES:
Revised Exhibit B
Page 15 of 18
A. CHRONIC INEBRIATES: dual diagnosis persons served needing controlled community access.
Services provided will include:
1. 15-minute visuals, 24/7, 365 days
2. In-house psychiatrist with assessments done on site
3. On call 24/7 psychiatrist with standing orders for PRN & injectables
4. Prevocational job training on site with a community re-entry based philosophy
5. On-site Drug &Alcohol counselors
6. Day Treatment: Recovery models: WRAP &Wellness
7. On-site dietician to provide healthy diets
B. SPECIAL NEEDS
1. Diabetic—trained staff(incl. LVN, dietary) available to meet CCL Title 22 Section
80092.8. Services provided will include:
a. Insulin shots
b. Diabetes maintenance including, but not limited to insulin injections and blood
sugar monitoring
C. On-site dietician to provide special diet (sugar free menu)
d. Blood sugar monitoring by licensed, qualified staff
e. 50% of staff shall be certified Medical Assistants
f. 15-minute visuals, 24/7, 365 days a year
g. On call 24/7 psychiatrist with standing orders for PRN & injectables
h. Prevocational job training on site with a community re-entry-based philosophy
i. Day Treatment: Recovery models: WRAP &Wellness
2. Conditions of Life —facility upgrades &trained staff available to meet CCL Title 22
Section 80077.2-3, 80001d.(2) for persons served who rely on others to assist with most
activities of daily living, persons served with lack of hazard awareness/impulse control or
with medical conditions for which they need assistance/observation;
Services provided will include:
Revised Exhibit B
Page 16 of 18
a. 15-minute visuals 24/7 365 days a year
b. On-site dietician to provide special diets as required
C. 50% staff are certified Medical Assistants to monitor health conditions
d. On call 24/7 Psychiatrist with standing orders for PRN & injectables
e. Prevocational job training on-site with a community re-entry based philosophy
f. Day Treatment: Recovery models: WRAP &Wellness
g. CCL waiver for persons served needing oxygen
3. Non-Ambulatory: all the above facility services shall be available to non-ambulatory
persons served. In addition to diabetic, dual-diagnosis and other conditions of life
services, the facility shall provide:
a. Trained staff available to assist non-ambulatory persons served with ADL's.
Facility-wide training shall be rendered to ensure the safety of non-ambulatory
persons served with regards to egress, mobility and emergency procedures
b. Transportation to allow non-ambulatory persons served to participate in
community outings
4. Ambulatory Issues -trained staff(incl. LVN, dietary) available to meet CCL Title 22
Section 80010.
a. Amputee
b. Wheelchair dependent (for mobility)
C. Walkers/Other Walking Assistance Devices
d. Visual Impairment/Including Legal Blindness
5. Medical —trained staff to provide care for persons served who have any of the following
restricted health conditions, or who require any of the following health services:
a. Colostomy bags—as specified in CCL Title 22, Section 87621
b. Oxygen dependent persons served - as specified in CCL Title 22, Section 87618
C. Catheter services - as specified in CCL Title 22, Section 87623.
C. Facilities shall have trained staff available to provide care within a facility intended for individuals
with mental health disorders, specific characteristics, and a history of additional behaviors/legal
status including, but not limited to the following:
Revised Exhibit B
Page 17 of 18
1. Behavioral/Legal Status
2. LIDS Conservatorship:
a. Accept persons served moving from locked and out of town (possible) Institute of
Mental Disease (IMD)
b. Accept persons served from acute inpatient psychiatric facilities
3. Aggressive Behaviors:
a. History of physical aggressive episode toward a person (general)
4. Fire Setting
5. Elopement
a. Elopement is considered not returning by curfew.
6. Sexual Assault or Sex Offender status
7. Young Adults
a. Young adults considered to be between the ages of 18—24 years old
8. Individuals with mild developmental delays
a. "Mild developmental delay" defined as borderline intellectual functioning with an
IQ of just below 80.
Revised Exhibit D-1
Fresno County Department of Behavioral Health
Specialized Supplemental Board and Care Homes
Approved Rates by Provider
Fiscal Year 2024-25
Social Security Income
Contract Provider County Approved Daily Services Daily Room and Total Daily Rate
Supplemental Services Rate Board and Care and
Supervision Rate
AK's Home of Blessing and Joy, Inc. $98.94 $45.96 $144.90
AK's Home of Care, LLC $70.69 $45.96 $116.65
Anjaleoni Enterprises, Inc. - dba Leonie House $128.52 $45.96 $174.48
ASC Treatment Group - dba Anne Sippi Clinic (Bakersfield) $187.43 $45.96 $233.39
ASC Treatment Group - dba Anne Sippi Clinic (Los Angeles) $187.43 $45.96 $233.39
Benevolent Residential Care Services LLC- dba Dailey's Haven $133.88 $45.96 $179.84
BK House of Grace, LLC $97.57 $45.96 $143.53
Bonavente Home for the Elderly II $101.90 $45.96 $147.86
The Chimes Home $119.95 $45.96 $165.91
Garden Manor $126.21 $45.96 $172.17
Goldridge Home, LLC $143.82 $45.96 $189.78
Donald Haskins - dba Haskins Residential Care $194.04 $45.96 $240.00
Jan-Roy Place of Fresno, Inc. $128.52 $45.96 $174.48
Jan-Roy Place of Fresno 2 $128.52 $45.96 $174.48
Marian Homes, Inc. - dba Sierra Villa Rest Home $128.52 $45.96 $174.48
Marian Homes 3 $128.52 $45.96 $174.48
Mark A Gisler- dba Ruby's Valley Care Home $165.03 $45.96 $210.99
Modesto Residential Living Center, Inc. $86.70 $45.96 $132.66
Providian Residential Care Services Inc. -dba Fillmore Christian Gardens $133.88 $45.96 $179.84
Royal Board and Care Home for the Elderly $94.10 $45.96 $140.06
Sierra Meadows Senior Care, Inc. - dba River Bluffs Memory Care $250.67 $45.96 $296.63
Sunshine Board and Care II $94.86 $45.96 $140.82
Valley Comfort Home, Inc. $118.58 $45.96 $164.54
** Bed holds shall be paid for a period of seven (7) calendar days at a rate that is reimbursed at 50%of the daily rate per contracted provider.
Revised 05/28/24