HomeMy WebLinkAboutFUA Agreement with Signature Page Robert Bash.pdfFL-120 UMCBldg319PACT
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COUNTY OF FRESNO
Fresno, California 1
LICENSE AGREEMENT
THIS LICENSE AGREEMENT (“AGREEMENT”) is made and entered into this
_______ day of _____________, 2020, by and between the COUNTY OF FRESNO, a political
subdivision of the State of California, 333 Pontiac Way, Clovis, CA 93612, (“COUNTY”), and
CENTRAL STAR BEHAVIORAL HEALTH, Inc., a California for-profit corporation, whose
principal place of business is located at 1501 Hughes Way, Suite 150, Long Beach, CA 90810
through its affiliate, Central Star Behavioral Health, Inc (“LICENSEE”).
W I T N E S S E T H:
WHEREAS, COUNTY owns the building located at 4411 E. Kings Canyon, Fresno, CA
93702 (Building 319), Fresno, CA 93702 (the “Building”);
WHEREAS, COUNTY has reached agreement with LICENSEE to operate a
Adolescent Youth Acute Psychiatric Health Facility (PHF) at the Building;
WHEREAS, COUNTY hereby finds that the operation of an Adolescent Youth Acute
PHF providing psychiatric health services for adolescent youth is a necessary mental health
program that will meet the health needs of Fresno County, and is in the public interest; and
WHEREAS, pursuant to Government Code section 26227, COUNTY finds that the
youth acute psychiatric services to be provided by LICENSEE will not substantially conflict or
interfere with the use of the Building by the COUNTY and other occupants of the Building, that
the portion of the Building to be occupied by LICENSEE is not needed for County purposes,
and that the youth acute psychiatric services to be provided by LICENSEE will serve public
purposes, and COUNTY desires to enter into this Agreement to ensure the ongoing provision
of acute psychiatric services for youth at the Building by LICENSEE.
NOW, THEREFORE, in consideration of the mutual promises, covenants and
conditions hereinafter contained, such parties, and each of them, do agree as follows:
1. PREMISES - COUNTY shall make available to LICENSEE approximately seven
thousand sixty-nine (7,069) square feet of space at the location commonly known as 4411 E.
Kings Canyon, Fresno, CA 93702, in Building 319, as shown in Exhibit “A”, attached and
incorporated by this reference (“Premises”). If at any time during the term of this
23rd June
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AGREEMENT, COUNTY no longer owns the Premises, or COUNTY’s lease for the Premises
terminates, LICENSEE and COUNTY agree to amend this AGREEMENT to change the
location to a new premises, which will be owned or leased by COUNTY. COUNTY shall
determine the location of the new premises and shall notify LICENSEE of the new location at
least thirty (30) days in advance of that location change.
2. TERM AND TERMINATION – The term of this Agreement shall be for a period of
three (3) years, commencing on July 1, 2020, through and including June 30, 2023.
Subject to satisfactory outcomes performance and funding availability of the
corresponding service agreement for the adolescent youth PHF, this Agreement may be
extended for two (2) additional twelve (12) month periods upon the written approval of both
parties not later than sixty (60) days prior to the close of the then current Agreement term.
The COUNTY’s DBH Director, or designee, is authorized to execute such written approval on
behalf of COUNTY.
Notwithstanding any of the above, COUNTY shall have the right to terminate this
Agreement immediately in the event LICENSEE ceases to provide the services described in
Section 5, herein, in a manner that is to COUNTY’S sole satisfaction. As to COUNTY, the
Director of Internal Services or the Director of the Department of Behavioral Health, or one of
their designees, may provide written notice of termination of this AGREEMENT to LICENSEE.
3. CONSIDERATION - LICENSEE shall pay to COUNTY zero dollars ($0) in
compensation for this AGREEMENT. COUNTY agrees that the services provided by
LICENSEE are adequate consideration for use of the Premises. These services are set forth in
LICENSEE’s Scope of Work, attached as Exhibit “B”, and incorporated by this reference. Such
consideration, in addition to the mutual promises and covenants made herein by the Parties, is
deemed by the Parties to be sufficient consideration for use of the Premises.
4. UTILITIES - COUNTY shall provide for electricity, natural gas, water, sewer,
garbage, and telephone costs used at the Premises by LICENSEE in accordance with this
AGREEMENT. COUNTY cost of the utilities will be invoiced to the LICENSEE monthly.
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5. USE - LICENSEE shall use the Premises twenty-four (24) hours per day, 365 days
per year to provide the services described in Exhibit “B”. LICENSEE agrees that its use of the
Premises shall only be used to provide these services. LICENSEE agrees not to commit,
suffer or permit any waste or nuisance on the Premises, and not to use or permit the use of
the Premises for any illegal or immoral purposes. LICENSEE further agrees to comply with all
state laws, local ordinances and other governmental regulations which may be required by any
governmental authorities.
COUNTY shall make the Premises available in “as is” condition. Prior to the
execution of this AGREEMENT, LICENSEE shall visit the Premises, and by its independent
determination confirm that the Premises are suitable for its use.
6. MAINTENANCE AND REPAIRS OF PREMISES - COUNTY shall be responsible for
the structural condition of the Premises, and for all exterior and interior maintenance, including
but not limited to, air conditioning, heating, plumbing, roof, painting, landscaping, and parking
lot. COUNTY covenants that the Premises shall be maintained in substantially the same
condition as that existing at the commencement of this AGREEMENT.
LICENSEE shall contract with a private vendor for janitorial services at the Premises.
LICENSEE shall ensure that any private janitorial service providing such services shall comply
with the janitorial standards established by COUNTY for its County-owned facilities, as shown
in Exhibit “C”, attached and incorporated by this reference.
LICENSEE shall report any damages to the Premises within twenty-four (24) hours
after they occur to the Director of the Department of Behavioral Health.
LICENSEE shall be responsible to pay for all damages and resulting building
maintenance caused by the actions of LICENSEE’s patients, employees and invitees.
7. IMPROVEMENTS TO THE PREMISES - If LICENSEE desires to make
improvements to the Premises, LICENSEE shall provide drawings and plans describing the
improvements to the Director of the Department of Behavioral Health, for review and written
approval. LICENSEE’s request to make improvements shall not be unreasonably withheld by
COUNTY. LICENSEE shall pay all costs associated with its requested improvements.
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The construction of LICENSEE’s improvements to the Premises shall be performed by
COUNTY or its approved agent.
8. ENFORCEMENT OF AGREEMENT - If LICENSEE defaults on any of the
covenants or agreements contained in this AGREEMENT, COUNTY shall give written notice
of such default to LICENSEE, and LICENSEE shall have thirty (30) days to cure such default.
If LICENSEE does not cure the default within thirty (30) days, COUNTY may, at its option, at
any time after such default or breach and without any demand on or notice to LICENSEE or to
any other person, of any kind whatsoever, re-enter and take possession of the Premises, and
remove all persons or property therefrom, and LICENSEE waives any legal remedy to defeat
COUNTY'S rights and possessions hereunder. However, nothing contained herein shall
prevent COUNTY from seeking any other legal or equitable remedies in a court of law which
arise from such breach or default.
9. NOTICES - The persons and their addresses having authority to give and receive
notices under this AGREEMENT include the following:
COUNTY: LICENSEE:
County of Fresno Central Star Behavioral Health, Inc.
(FL-120) Senior Vice President
Director of Internal Services 1501 Hughes Way, Suite 150
333 W. Pontiac Way
Clovis, CA 93612
Facsimile: (559) 600-5927
Long Beach, CA 90810
Facsimile: (310) 221-6350
All notices between the COUNTY and LICENSEE provided for or permitted under this
AGREEMENT must be in writing and delivered either by personal service, by first-class United
States mail, by an overnight commercial courier service, or by telephonic facsimile
transmission. A notice delivered by personal service is effective upon service to the recipient.
A notice delivered by first-class United States mail is effective three (3) COUNTY business
days after deposit in the United States mail, postage prepaid, addressed to the recipient. A
notice delivered by an overnight commercial courier service is effective one COUNTY
business day after deposit with the overnight commercial courier service, delivery fees
prepaid, with delivery instructions given for next day delivery, addressed to the recipient. A
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notice delivered by telephonic facsimile is effective when transmission to the recipient is
completed (but, if such transmission is completed outside of COUNTY business hours, then
such delivery shall be deemed to be effective at the next beginning of a COUNTY business
day), provided that the sender maintains a machine record of the completed transmission. For
all claims arising out of or related to this AGREEMENT, nothing in this section establishes,
waives, or modifies any claims presentation requirements or procedures provided by law,
including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the
Government Code, beginning with section 810).
10. HOLD HARMLESS - LICENSEE agrees to indemnify, save, hold harmless, and at
COUNTY'S request, defend the COUNTY, its officers, agents, and employees from any and all
costs and expenses (including attorney’s fees and costs), damages, liabilities, claims, and
losses occurring or resulting to COUNTY in connection with the performance, or failure to
perform, by LICENSEE, its officers, agents, or employees under this AGREEMENT, and from
any and all costs and expenses (including attorney’s fees and costs), damages, liabilities,
claims, and loses occurring or resulting to any person, firm, or corporation who may be injured
or damaged by the performance, or failure to perform of LICENSEE, its officers, agents, or
employees under this AGREEMENT.
The provisions of this Section 10 shall survive termination of this AGREEMENT.
11. INTERNAL SECURITY FOR THE PREMISES – LICENSEE shall contract with a
private security service for internal security of the Premises. LICENSEE shall ensure that in
such event, the internal security provided shall be provided twenty-four (24) hours per day
every day of the calendar year.
12. INSURANCE – Without limiting the COUNTY’S right to obtain indemnification from
LICENSEE or any third parties, LICENSEE, at its sole expense, shall maintain in full force and
effect, the following insurance policies or a program of self-insurance, including but not limited
to, an insurance pooling arrangement or Joint Powers Agreement (JPA) throughout the term of
this AGREEMENT:
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a. Commercial General Liability - Commercial General Liability Insurance with
limits of not less than Two Million Dollars ($2,000,000) per occurrence and an
annual aggregate of Four Million ($4,000,000). This policy shall be issued on a
per occurrence basis. COUNTY may require specific coverages including
completed operations, products liability, contractual liability, Explosion-
Collapse-Underground, fire legal liability, or any other liability insurance
deemed necessary because of the nature of this contract.
b. Property Insurance – Against all risk of loss to COUNTY property, at full
replacement cost with no coinsurance penalty provision, naming COUNTY as
additional loss payee.
c. Automobile Liability - Comprehensive Automobile Liability Insurance with
limits of not less than One Million Dollars ($1,000,000.00) per accident for
bodily injury and for property damages. Coverage should include any auto
used in connection with this Agreement.
d. Worker’s Compensation - A policy of Worker’s Compensation insurance
may be required by the California Labor Code.
e. Professional Liability Insurance if LICENSEE employs professional staff
(e.g., PH.D., R.N., L.C.S.W., M.F.C.C.) in providing services, with limits of not
less than One Million ($1,000,000.00) Dollars per occurrence, Three Million
$3,000,000.00) Dollars annual aggregate.
f. Child Abuse/Molestation and Social Services Coverage – LICENSEE shall
have either separate policies or an umbrella policy with endorsements covering
Child Abuse/Molestation and Social Services Liability coverage, or have a
specific endorsement on its General Commercial liability policy covering Child
Abuse/Molestation and Social Services Liability. The policy limits for these
policies shall be $1,000,000 per occurrence with $2,000,000 annual aggregate.
The policies are to be on a per occurrence basis.
LICENSEE shall obtain endorsements to the Commercial General Liability insurance
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naming the County of Fresno (hereinafter “County”), its officers, agents, and employees,
individually and collectively, as additional insured, but only insofar as the operations under this
AGREEMENT are concerned. Such coverage for additional insured shall apply as primary
insurance and any other insurance, or self-insurance, maintained by, County, its officers,
agents, and employees shall be excess only, and not contributing with insurance provided
under LICENSEE’S policies herein. This insurance shall not be cancelled or changed without a
minimum or thirty (30) days advance written notice given to County.
LICENSEE hereby waives its right to recover from COUNTY, its officers, agents, and
employees any amounts paid by the policy of worker’s compensation insurance required by
this AGREEMENT. LICENSEE is solely responsible to obtain any endorsement to such policy
that may be necessary to accomplish such waiver of subrogation, but LICENSEE’s waiver of
subrogation under this paragraph is effective whether or not LICENSEE obtains such an
endorsement.
Within thirty (30) days from date LICENSEE executes this AGREEMENT, LICENSEE
shall provide certificates of insurance and endorsement as stated above for all of the foregoing
policies, as required herein, to the County of Fresno, Attn: ISD Lease Services (FL-120), 333
W. Pontiac Way, Clovis, CA 93612, stating that such insurance coverages have been obtained
and are in full force; that the County, its officers, agents and employees will not be responsible
for any premiums on the policies; that for such worker’s compensation insurance the
LICENSEE has waived its right to recover from the COUNTY, its officers, agents, and
employees any amounts paid under the insurance policy and that waiver does not invalidate
the insurance policy; that such Commercial General Liability insurance names the County, its
officers, agents, and employees, individually and collectively, as additional insured, but only
insofar as the operations under this AGREEMENT are concerned; that such coverage for
additional insured shall apply as primary insurance and any other insurance, or self- insurance
shall not be cancelled or changed without a minimum of thirty (30) days advance, written
notice given to County.
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In the event LICENSEE fails to keep in effect at all times insurance coverage as herein
provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate
this AGREEMENT upon the occurrence of such event.
All policies shall be with admitted insurers licensed to do business in the State of
California. Insurance purchased shall be purchased from companies possessing a current A.M
Best Company rating of A FSC VII or better.
COUNTY shall maintain during the term of this AGREEMENT the following policies of
insurance, which coverages may be provided in whole or in part through one or more
programs of self-insurance:
a. Commercial General liability insurance with limits of not less than One
Million Dollars ($1,000,000.00) per occurrence and an annual aggregate of not
less than Two Million Dollars ($2,000,000.00). This policy shall be issued on an
occurrence basis.
b. All-Risk property insurance.
13. INDEPENDENT CONTRACTOR - In performance of the work, duties and
obligations assumed by LICENSEE under this AGREEMENT, it is mutually understood and
agreed that LICENSEE, including any and all of the LICENSEE'S officers, agents, and
employees will at all times be acting and performing as an independent contractor, and shall
act in an independent capacity and not as an officer, agent, servant, employee, joint venturer,
partner, or associate of the COUNTY. Furthermore, COUNTY shall have no right to control or
supervise or direct the manner or method by which LICENSEE shall perform its work and
function. However, COUNTY shall retain the right to administer this AGREEMENT so as to
verify that LICENSEE is performing its obligations in accordance with the terms and conditions
of the AGREEMENT.
COUNTY and LICENSEE shall comply with all applicable provisions of law and the
rules and regulations, if any, of governmental authorities having jurisdiction over matters the
subject thereof.
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Because of its status as an independent contractor, LICENSEE shall have absolutely
no right to employment rights and benefits available to COUNTY'S employees. LICENSEE
shall be solely liable and responsible for providing to, or on behalf of, its employees all legally
required employee benefits. In addition, LICENSEE shall be solely responsible and save
COUNTY harmless from all matters, except for COUNTY AND COUNTY’S employee’s gross
negligence and/or willful misconduct, relating to payment of LICENSEE'S employees, including
compliance with Social Security withholding and all other regulations governing such matters
14. SURRENDER OF POSSESSION - Upon the expiration or termination of this
AGREEMENT, LICENSEE will surrender the Premises to COUNTY in such condition as
existing at the commencement of this AGREEMENT less reasonable wear and tear, less the
effects of any Casualty as herein defined, and less the effects of any breach of COUNTY'S
covenant to maintain. LICENSEE will not be responsible for any damage which LICENSEE
was not obligated hereunder to repair.
15. FIXTURES - LICENSEE agrees that any equipment, fixtures or apparatus installed
in or on the Premises by LICENSEE shall become the property of COUNTY and may not be
removed by LICENSEE at any time.
16. POSSESSORY INTEREST TAX - The parties acknowledge that California
Revenue & Taxation Code § 107.6 provides, in relevant part, the following: “(a) The state or
any local public entity of government, when entering into a written contract with a private party
whereby a possessory interest subject to property taxation may be created, shall include, or
cause to be included, in that contract, a statement that the property interest may be subject to
property taxation if created, and that the party in whom the possessory interest is vested may
be subject to the payment of property taxes levied on the interest.” Accordingly, the parties
agree that COUNTY is a ‘local public entity of government,’ and that LICENSEE is a “private
party,” respectively, within the meaning of California Revenue & Taxation Code § 107.6(a),
and that this AGREEMENT (to the extent that it may be necessary under California Revenue &
Taxation Code § 107.6(a) for the Parties to acknowledge and agree herein with respect to this
AGREEMENT) is a “contract,” which creates a possessory interest that may be subject to
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property taxation pursuant to California Revenue & Taxation Code § 107.6(a). LICENSEE
agrees to pay any possessory interest tax which may be levied upon the Premises. In this
respect, LICENSEE understands that LICENSEE's use of property owned by a tax-exempt
public agency may be subject to property taxation, and LICENSEE (the person in whom he
possessory interest is vested) is subject to the payment of property taxes levied on such
interest.
17. RIGHT OF ENTRY - COUNTY, or its representative(s), shall have the right to
enter the Premises at any time during business hours with reasonable notice, and at such
other time as COUNTY deems appropriate, to make any alterations, repairs or improvements
to the Premises. The normal business of LICENSEE or its invitees shall not be unnecessarily
inconvenienced.
18. AMENDMENT - This AGREEMENT may be amended in writing by the mutual
consent of the parties without in any way affecting the remainder.
19. NON-ASSIGNMENT - Neither party shall assign, transfer or subcontract this
AGREEMENT nor their rights or duties under this AGREEMENT without the prior written
consent of the other party.
20. GOVERNING LAW - Venue for any action arising out of or relating to this
AGREEMENT shall be in Fresno County, California. This AGREEMENT shall be governed by
the laws of the State of California.
21. DISCLOSURE OF SELF DEALING TRANSACTIONS - This provision is only
applicable if the LICENSEE is operating as a corporation (a for-profit or non-profit corporation)
or if during the term of this AGREEMENT, the LICENSEE changes its status to operate as a
corporation.
Members of LICENSEE’S Board of Directors shall disclose any self-dealing transactions
that they are a party to while LICENSEE is providing goods or performing services under this
AGREEMENT. A self-dealing transaction shall mean a transaction to which the LICENSEE is
a party and in which one or more of its directors has a material financial interest. Members of
the Board of Directors shall disclose any self-dealing transactions that they are a party to by
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completing and signing a Self-Dealing Transaction Disclosure Form (Exhibit “D”) and
submitting it to the County of Fresno prior to commencing with the self-dealing transaction or
immediately thereafter.
22. AUTHORITY - Each individual executing this AGREEMENT on behalf of
LICENSEE represents and warrants that that individual is duly authorized to execute and
deliver this AGREEMENT on behalf of LICENSEE, and that this AGREEMENT is binding upon
LICENSEE in accordance with its terms. The terms of this AGREEMENT are intended by the
parties as a final expression of their agreement with respect to such terms as are included in
this AGREEMENT and may not be contradicted by evidence of any prior or contemporaneous
agreement, arrangement, understanding or negotiation (whether oral or written).
23. ENTIRE AGREEMENT - This AGREEMENT constitutes the entire agreement
between the COUNTY and LICENSEE with respect to the subject matter hereof, and
supersedes all prior agreements, negotiations, proposals, commitments, writings,
advertisements, publications, and understandings of any nature whatsoever, unless expressly
referenced in this AGREEMENT.
Signatures on Following Page
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FL-120 Exhibit A | Building 319 Floorplan
Page 1 of 1
FL-120 Exhibit B – Scope of Work
Page 1 of 15
ADOLESCENT YOUTH ACUTE INPATIENT PSYCHIATRIC SERVICES
Psychiatric Health Facility (PHF)
Scope of Work
ORGANIZATION: Central Star Behavioral Health, Inc.
ADDRESS: 1501 Hughes Way, Suite 150, Long Beach, CA 90810
SITE ADDRESS: 4411 E. Kings Canyon Road, Fresno, CA 93702
SERVICES: Adolescent Youth Psychiatric Health Facility
PROJECT DIRECTOR: Kent Dunlap, Senior Vice President
CONTRACT PERIOD: July 1, 2020 – June 30, 2023 with an option for two (2) additional
12-month renewals, pursuant to satisfactory performance
CONTRACT AMOUNT: See Exhibit C
SCHEDULE OF SERVICES:
CONTRACTOR shall operate the youth adolescent Psychiatric Health Facility (PHF) twenty-four
(24) hours per day, seven (7) days per week (24/7).
TARGET POPULATION:
The target population will only include youth adolescents (hereinafter referred to as
adolescents), twelve (12) years of age up to eighteen (18) years of age, in acute mental health
distress who present a threat of harm to self, and/or threat of harm to others, and/or grave
disability (severe personal disorganization and inability for self-care and/or functioning safely in
the community). CONTRACTOR will not serve adolescents younger than twelve (12) years old.
In rare circumstances, the COUNTY DBH Director, or designee, has the ability to approve
admittance of a youth younger than twelve (12) years old.
Based on data collected from FY 2018-19, the target population will present the following
symptoms upon admission will include moods and emotional regulation (92%), self-harm (82%),
anger and aggression (44%), psychotic symptoms (19%), and co-occurring substance use
disorders (about 30%).
Adolescents will include those from all payor sources: Medi-Cal beneficiaries, Medicare and
Medicare/Medi-Cal beneficiaries, indigent/uninsured clients, and those with private insurance.
Adolescents may be admitted on either a voluntary or involuntary basis, and may be Medi-Cal
beneficiaries, Medicare and Medicare/Medi-Cal beneficiaries, and/or the indigent/uninsured.
Referrals are received from DBH and other COUNTY Departments, subcontracted providers
with DBH, hospital emergency departments, Juvenile Justice Campus (Fresno County’s
detention facility for adolescents), as well as other counties and agencies. Adolescents covered
by private insurance will be accepted via our contracts with and referrals from Kaiser
FL-120 Exhibit B – Scope of Work
Page 2 of 15
Permanente, and other insurers (Anthem Blue Cross, Avante Behavioral Health Plan, Cigna
Behavioral Health, Magellan, Aetna, Blue Shield, Federal Blue Shield, Beacon Health Options,
and MHN, the behavioral health subsidiary of Health Net, Inc. etc.)
Fresno County residents shall receive top priority for admission. During the prior contract term,
CONTRACTOR contracted with six (6) additional counties, and was also able to serve
adolescents from Kern, Tulare, Madera, Merced, Mariposa and Stanislaus counties.
CONTRACTOR shall continue to subcontract with these counties to provide admittance for their
respective adolescents. CONTRACTOR will continue to be responsible for contracting with
other County Mental Health Plans and healthcare coverage organizations to serve their
referrals. CONTRACTOR will work with Fresno County Mental Health Plan (FCMHP) to
understand the presumptive transfer process and how to admit adolescents who are medically
covered through another county yet residing in Fresno County at the time of need for inpatient
psychiatric services.
LOCATION OF SERVICES:
CONTRACTOR will operate the Adolescent PHF located in COUNTY Building 319 at 4411 E.
Kings Canyon Road, Fresno, CA 93702, pursuant to a separate lease agreement between
COUNTY and CONTRACTOR effective for the same contract term as this Agreement. This
lease agreement will be executed at the same time as this Agreement.
CONTRACTOR will work with COUNTY and DBH Facilities Unit to ensure the site meets and
maintains physical plant requirements for a PHF under CCR Title 22, Division 5, Chapter 9,
Article 5 and applicable Health and Safety Codes.
COUNTY is exploring possible alternative locations for its programs currently located on the
University Medical Center (UMC) Campus on Kings Canyon. CONTRACTOR will be expected
to work with COUNTY in the relocation of Adolescent PHF services in the event that a different
site is identified during the term of this Agreement. CONTRACTOR shall communicate and
coordinate with COUNTY during any such transition and perform a walk-through of any new
identified site to address facility design, service requirements, etc. and will implement any
standardized expectations for naming, branding and communications.
HOURS OF OPERATION
The Adolescent PHF shall be operated 24/7 with appropriate staffing ratios as per CCR Title
22 requirements (Division 5, Chapter 9, Article 3).
The DBH Facilities Unit shall be available to address building maintenance requests from
Monday through Friday, 8 AM through 5 PM. After-hours or emergency facility requests will
be processed by the COUNTY Internal Services Department (ISD) Facility Services.
Medical staff shall be under the supervision of CONTRACTOR’s Medical Director. A
physician shall be on-call at all times, and contract psychiatrists shall provide weekend
coverage. A Registered Nurse (RN) and/or Licensed Vocational Nurse (LVN) shall be awake
and on duty at all times. The PHF Clinical Director, a Licensed Marriage and Family Therapist
(LMFT) staff member shall supervise social workers and rehab staff.
FL-120 Exhibit B – Scope of Work
Page 3 of 15
RAMP-UP AND SERVICES START DATE
CONTRACTOR shall be prepared to continue providing adolescent inpatient PHF services on
July 1, 2020. A few new services (not included in the prior contract term) will require ramp-up
as discussed herein below.
Remodel and Equipment Replacement Plan:
The following items will be acquired or finalized during the first year of this Agreement contract
term.
- Replace older office furniture and information technology equipment including
desktops and monitors.
- Begin recruitment to hire additional new positions of Discharge Coordinator and
Transitional Age Youth (TAY) Peer Support Specialist, including all required
background checks.
- Complete other new staff hiring.
- Complete onboarding, orientation and training of new staff.
- Implementation of Child Adolescent Fellowship Program rotation which is further
outlined herein below.
CONTRACTOR will work closely with DBH staff to seamlessly relocate the Adolescent PHF
services in the event that a different site is identified during the contract term.
PROJECT DESCRIPTION:
CONTRACTOR shall operate an Adolescent PHF to serve up approximately 684 (57/month)
clients for each twelve (12) month period of this Agreement. Services include intensive, acute
care, trauma-informed residential treatment to adolescents. CONTRACTOR will provide
services for up to sixteen (16) adolescents at any given time. The Adolescent PHF shall provide
acute psychiatric inpatient hospitalization, coordinated discharge planning, and effective
linkages to post-hospital outpatient mental health treatment programs and other supportive
services for adolescents and their families.
CONTRACTOR shall be responsible to comply with the requirements of the FCMHP and must
complete and submit supporting documentation for all admissions regardless of payer source to
the FCMHP. The FCMHP will perform a utilization review of all admissions to determine that
the documentation demonstrates medical necessity criteria, as defined by the State of California
Department of Health Care Services (DHCS). The 16-bed facility will be licensed by DHCS and
shall meet all regulations required for operating a psychiatric health facility W&I Code 4080
Article 3; Health and Safety Code 1250.2 and meet Medi-Cal certification by the FCMHP.
CONTRACTOR shall be responsible to enter all Client Service Information (CSI), admission
data and billing information into the COUNTY DBH electronic health record (EHR) system
(currently AVATAR) and will be responsible for any and all audit exceptions pertaining to the
delivery of services.
FL-120 Exhibit B – Scope of Work
Page 4 of 15
CONTRACTOR’S RESPONSIBILITIES:
A. RESPONSIBILITIES
1. Management and alleviation of the adolescent’s acute psychiatric symptoms to
allow them to be discharged to a less restrictive level of care.
2. Clinical program shall be recovery/strengths based.
3. Adolescent PHF shall be staffed with appropriate professional staff 24/7.
4. Services shall be provided in a safe, secure and structured environment that
promotes the adolescent’s wellness and recovery, including connections to family
and community.
5. Services shall include comprehensive multi-disciplinary evaluation and a client-
centered care plan for each adolescent.
6. CONTRACTOR shall provide appropriate dietary services in accordance with Title
22, Division 5, Chapter 9, Article 3, Section 77077. A dietician shall be utilized for
menu planning and assessment for special dietary needs, consistent with Title 22
requirements.
7. CONTRACTOR shall have admission procedures in place for voluntary and
involuntary clients.
8. Treatment Planning – CONTRACTOR staff shall provide the following services
captured in written assessment and care plans:
a. Mental Status Examination
b. Medical Evaluation
c. Psycho-Social Assessment
d. Nursing Assessment
e. Multi-Disciplinary Milieu Treatment Program
f. Individualized Focused Treatment Planning
g. Aftercare Planning
9. Staffing:
a. CONTRACTOR’s staffing pattern and all staff working at the PHF shall meet
all 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 for Psychiatric Health
Facilities. All staff, which requires 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.
b. All CONTRACTOR’s facility staff, who provide direct patient care or perform
coding/billing functions, must meet the requirements of the FCMHP
FL-120 Exhibit B – Scope of Work
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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 licensed staff shall have
Department of Justice (DOJ), Federal Bureau of Investigation (FBI), and
Sheriff fingerprinting (Live Scan) executed.
c. CONTRACTOR’s Peer and/or Family Support staff shall be available to help
educate, support, and advocate on behalf of the adolescents and their
families during the hospitalization and will assist with discharge planning
and the transition to follow-up care.
10. Medical Records and Mandated Reporting:
a. CONTRACTOR shall be responsible to enter all CSI, admission data and
billing information into COUNTY DBH’s AVATAR and will be responsible for
any and all audit exceptions pertaining to the delivery of services.
b. CONTRACTOR will be responsible for “release of information” requests for
the PHF and shall adhere to applicable federal and state regulations.
c. CONTRACTOR shall report information and admission/discharge data to
OSHPD and meet the submission deadlines of June 30 and December 31
each calendar year.
11. Organized Clinical Staff – CONTRACTOR’s clinical staff will be licensed mental
health professionals as well as rehabilitation therapists with appropriate education,
credentialing and experience to reach status as a Qualified Mental Health
Professional (QMHP).
12. Pharmaceutical and Medication Services – CONTRACTOR shall implement
medication controls required by a licensed PHF for pharmaceutical and medication
services. CONTRACTOR shall have policies, procedures and physician/nursing
protocols in place regarding medication labeling, storage/security, orders, use of
medication carts, administration, polypharmacy, and monitoring.
13. Physical Health Care – CONTRACTOR will contract with a primary care physician
and a registered dietician. CONTRACTOR will provide a full health history to each
adolescent upon admission. CONTRACTOR will have a written agreement with
one or more acute care hospitals to provide services for youth requiring additional
services.
14. Schedule of Active Therapies - CONTRACTOR shall provide a daily schedule of
therapeutic activities that will be provided as part of the clinical treatment program.
The schedule shall include wellness education with motivational support, psycho-
social, and life skill building groups on varied topics, family therapy, creative
expressive arts, recreational and fitness programs. The treatment team is
expected to schedule the adolescent’s participation activities tailored to each
FL-120 Exhibit B – Scope of Work
Page 6 of 15
individual’s needs. There will also be daily meetings among the staff and
adolescents for general education and guidance about unit activities and to
collectively address milieu living issues.
15. Utilization Review, Billing and Cost Report:
a. CONTRACTOR shall notify DBH 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 ensure that documentation in the
adolescent’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 DBH’s EHR and will be responsible for any and all audit
exceptions pertaining to the delivery of services. For Medi-Cal billing
denials by the State, CONTRACTOR will maintain an error rate no
greater than five percent (5%).
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 ensure that cost reports are prepared in accordance
with general accounting principles and the standards set forth by the DHCS
and the COUNTY.
16. Patient’s 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 Welfare
and Institutions Code 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.
c. CONTRACTOR shall conduct Mental Health Certification Review Hearings
in accordance with regulations in a location within the facility that allows for
confidentiality and is compatible with and is least disruptive to the treatment
being provided to the COUNTY patient.
17. Grievances and Incident Reports - CONTRACTOR shall log all grievances and the
disposition of all grievances received from an adolescent or their family in
accordance with the FCMHP, as indicated in Exhibit H. CONTRACTOR shall
provide a summary of the grievance log entries concerning COUNTY 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 agreed upon between COUNTY and
FL-120 Exhibit B – Scope of Work
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CONTRACTOR. CONTRACTOR shall post signs, provided by the COUNTY,
informing the adolescents 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. CONTRACTOR shall use the Incident Report form, as indicated in
Exhibit I, for such reporting.
Within fifteen (15) days after each grievance or incident affecting COUNTY 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
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.
B. OBJECTIVES
CONTRACTOR shall provide the following objectives:
1. Safe and Secure Environment – CONTRACTOR shall provide for clinical and
medical assessment, diagnostic formulation, crisis intervention, medication
management and clinical treatment for mental health clients with acute
psychiatric disorder in a safe and secure environment. All staff will be trained
and certified by a nationally recognized assault crisis training that is principally
focused on crisis prevention and de-escalation.
2. Provide the appropriate type and level of staffing to provide for a clinically
effective program design.
3. Provide an intensive treatment program which has individualized client care
plans.
4. Stabilize adolescents as soon as possible in order to assist them in their
recovery from their acute mental illness crisis.
5. Effectively partner with other programs in the crisis service system of care in
accepting COUNTY adolescents for admission for acute inpatient psychiatric
services and also to work collaboratively in discharge planning to ensure
appropriate ongoing outpatient specialty mental health treatment services will
be provided post-release.
6. Identify COUNTY adolescents with frequent admissions during the fiscal year
and develop strategies with other COUNTY and community agencies to reduce
readmissions.
7. Effectively interact with community agencies, other mental health programs and
providers, natural support systems and families to assist adolescents to be
discharged to a lower level of care, as soon as clinically appropriate.
FL-120 Exhibit B – Scope of Work
Page 8 of 15
8. Work to integrate mental health and substance use disorder services through
comprehensive continuous integrated systems of care for the life span of those
served and to work as partners with a shared vision: to create a coordinated
and comprehensive system of service delivery via the County Comprehensive
Continuation Integrated System of Care (CCISC) as mentioned within this
Agreement.
C. Direct Admissions to the PHF
Regarding direct admissions to the PHF from COUNTY DBH programs or its
subcontracted providers, CONTRACTOR agrees to the following:
1. To allow direct admits from COUNTY DBH programs or its contracted
providers, when PHF beds are available.
2. Said direct admits shall not require medical clearance. However, in the event a
referred client is known to possess a contagious medical condition, said patient
shall be medically cleared by a local hospital prior to admission to the PHF
operated by CONTRACTOR.
D. Court Testimony for PHF Adolescents
Regarding the provision of court testimony related to PHF patients, CONTRACTOR
shall identify CONTRACTOR’s appropriate staff to provide court testimony relevant to PHF
clients, when required.
E. Cultural Competency
Regarding the PHF program and Cultural Competency, CONTRACTOR agrees to the
following:
CONTRACTOR refers to cultural competency as cultural attunement to remind staff of
the key values of humility, open-mindedness, avoiding assumptions, and lifelong learning about
others from diverse backgrounds versus a focus on achieving one-time competence.
F. Child-Adolescent Fellowship Program
CONTRACTOR agrees to the following:
CONTRACTOR’s Medical Director will work with the COUNTY’s DBH Medical Director
as well as the Medical Director of the University of California, San Francisco (UCSF) to plan and
coordinate for the Child-Adolescent Fellowship Program.
CONTRACTOR is prepared to accept two (2) Fellows/year (one at a time, each for a 6-
month rotation) as well as Residents (one at a time, each for a 2-month rotation). The number
of fellows and residents will be negotiated with DBH. Stipend payments would be provided by
the COUNTY under a yet to be determined and executed contract between COUNTY DBH and
FL-120 Exhibit B – Scope of Work
Page 9 of 15
UCSF.
CONTRACTOR is willing to provide supervision for the Fellowship via the PHF Medical
Director, as well as from a licensed PHF Administrator and Clinical Director. The Fellowship’s
Acting Attending will consult and co-sign all medical documentation, and the PHF Administrator
will consult and co-sign all clinical notes.
CONTRACTOR will work with UCSF and/or the COUNTY’s Designated Supervisor, if
requested, to implement and carry out the Child-Adolescent Fellowship Program.
G. Staffing Training:
CONTRACTOR has developed rich and comprehensive training plans that meet the
PHF requirement of 47 hours of staff training. CONTRACTOR staff shall participate in
comprehensive and on-going training that includes, but is not limited to:
1) New Hire Orientation,
2) CONTRACTOR’s Core Practices for Clinical Excellence in Mental Health
Services Delivery, and
3) CONTRACTOR’s course catalogue offerings of elective topics available through
e-learning or classroom trainings.
PHF staff will also be intensively trained in practices critical to the delivery of PHF
services, and treatment staff will receive additional training in Evidence Based Practices (EBPs).
All staff will be required to participate in any DBH trainings and meetings.
In addition to the above, staff receive a full calendar of training topics including cultural
attunement training as it relates to various cultures and backgrounds, including recovery,
LGBTQ, youth, homeless and monolingual persons. All new staff shall participate in an
overview of cultural attunement. Employees shall also attend the annual Re-Orientation
Training and take a quiz to measure understanding. Training is conducted using the state
Health Equity and Multicultural Diversity Training (HEMCDT). At the PHF, direct service
providers will be required to attend at least eight (8) hours of cultural competency training
annually, reported to DBH as required.
Additional PHF-specific trainings include: Emergency Procedures and Non-Violent Crisis
Intervention: including training in Pro-ACT and the use of restraints, how to contact emergency
personnel, as well as training in CPR, First Aid, and Emergency Management Plans.
H. Peer Support Resources
CONTRACTOR includes Peer/Family Advocates/Parent Partners and youth mentors,
and many other staff with lived experience as part of PHF services.
CONTRACTOR values Peer Support Staff with lived experience because of their unique
ability to engage with families from a place of shared experience. They also offer fresh and
insightful perspectives about service delivery issues such as access, respect, autonomy, and
FL-120 Exhibit B – Scope of Work
Page 10 of 15
quality of care. They also reinforce the innate potential for recovery, so critical during a family
crisis.
CONTRACTOR’s PHF Family Advocate helps to educate, support and advocate on
behalf of adolescents and families and assists with discharge planning and the transition to
follow-up care. They help lead Family Services, facilitating groups and working one-on-one with
the adolescents and families to articulate their voice and choice in the treatment process.
CONTRACTOR will add a Transitional Age Youth (TAY) Peer Specialist role to the PHF
services during this Agreement. This position will utilize a young adult (between the ages of 18
and 25) with lived experience in recovery. The TAY Peer Specialist will play a key role in
engaging with and articulating the voice of adolescents, from the perspective of someone who
has “been there.”
CONTRACTOR’s Peer Staff undergo the same Core Practices training as all other staff,
and also complete the CONTRACTOR’s Peer Staff Career Ladder training on family and client
voice and choice, identifying strengths, engagement strategies, communication and clarification
strategies, uncovering and understanding differences in perception, addressing stigma and
conveying hope. This curriculum is designed to enhance peer skills, increase confidence, and
help peers make a career of assisting others. They are supervised by the Clinical Director, and
supervision can consistent of one-on-one supervision, during meetings or be situationally
based. Hours of supervision may vary, typically, one (1) hour per week.
I. Discharge Coordinator
CONTRACTOR will have a Discharge Coordinator in the new Adolescent PHF. This position
will have primary responsibility for organizing discharge information and facilitating the
discharge of patients at the PHF; a process that begins at assessment and unfolds throughout
stay. Will participate in interdisciplinary meetings, collaboration and communication with
outside partners and resources, and with preparing clients for facility release.
J. Program Outcomes/Performance Outcomes Measures
CONTRACTOR’s Research and Program Practices (RPP) Department works closely
with the PHF to track and analyze COUNTY and DHCS-determined performance measures and
develops additional standardized and agency-specific assessment and outcome tools,
satisfaction surveys, and other meaningful performance measures, as needed.
CONTRACTOR is using its current EHR, 'myEvolv', by Netsmart Technologies Inc.
CONTRACTOR is open to switching to the COUNTY’s EHR known as AVATAR. If
CONTRACTOR decides to transition to the use of AVATAR, COUNTY and CONTRACTOR will
coordinate for an Amendment regarding usage and fees for access and maintenance of
COUNTY’s EHR.
Data tracked for the PHF program evaluation comes from varied sources, including:
1) PHF EHR data entered by program staff regarding client registry (demographics,
clinical profile, etc.), service utilization (incoming referrals, admit/discharge dates,
outgoing referrals and linkages); and risk behavior incident reports;
2) Exit interviews and survey methodologies to capture additional information and
FL-120 Exhibit B – Scope of Work
Page 11 of 15
perspectives, including satisfaction with the service and perceptions of results, from
adolescents, families and/or agency partners;
3) System of care data set analyses to assess patterns (including repeat use) of
crisis/hospital and other high-end services relative to community services and supports
by adolescents before and after their PHF service episodes.
The following table details the indicators CONTRACTOR anticipates tracking over the
next contract period, with the understanding that final measures will be agreed upon between
COUNTY and CONTRACTOR.
See outcome tables on the following pages.
FL-120 Exhibit B – Scope of Work
Page 12 of 15
Indicator (Type and Target) Who Applied Time of Measure Data Source Target Goal Expectancy
ACCESS
Time between receipt of a referral
to the PHF and contact with the
referring agency.
Time between referral and
admission to the PHF.
Intake Staff
(Nursing Dept) Admission Packet Tracker
SBHG EMR
% Referrals responded to within 1
hr. Average length of response
time.
% Referrals admitted to PHF
within 24 hrs. Average length of
referral to admission time.
ACCESS & EFFICIENCY
Denial rate of admissions when a
bed is available
Denial rate of PHF days not
meeting Medi-Cal necessity
criteria per utilization review.
Internal &
External QA/UR
Admissions &
Days in Setting
Packet Tracker
Internal &
County UR
% Denials of admissions when
bed is available will not exceed
20%
% Denials for PHF days due to
not meeting medical necessity will
not exceed 5%
EFFECTIVENESS
Reduced high-risk behaviors and
associated incidents.
PHF Psychiatrist,
Nurses & Social
Workers
BPRS at
admission, every
three days,
discharge (DC)
IRs completed at
time of incidents
Brief
Psychiatric
Rating Scale
(BPRS)
SBHG EMR
Incident Report
(IR)Tracking
Majority of clients will show
reductions in one or more
individualized target behaviors by
discharge (new tool -- we will set
baseline by Jan. 1, 2020).
IRs (esp. those related to
aggression, suicidality) will
continue at low rates per 1000
patient days as in prior years.
EFFECTIVENESS
Acquisition of coping,
communication and community
life skills.
PHF Psychiatrist,
Nurses & Social
Workers
Discharge (DC)
EMR DC Status
Form
Client/Family
DC Interviews/
Surveys
Majority of clients will have met
all/some of their treatment goals
and the majority of both clients
and caregivers will report
improved capacities by discharge
FL-120 Exhibit B – Scope of Work
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Indicator (Type and Target) Who Applied Time of Measure Data Source Target Goal Expectancy
EFFICIENCY
Average length of stay.
Internal QA Admission to
Discharge
Avatar
CONTRACTOR
EHR
Average length of stay will remain
stable, similar to prior years
(average of 6 days).
% of those who discharge within
10 days does not exceed 90%.
EFFECTIVENESS &
EFFICIENCY
Collaborative approaches and
treatment strategies to reduce
hospital readmission of clients,
esp. among those with frequent
PHF readmissions.
PHF
Nursing/Clinical
& QA Leaders &
Treatment Staff
(in collaboration
w/ external
entities)
Varied QI Projects
Undertaken
Annually
Varied QI
Projects
(Recidivism
data from
County and/or
EMR; project
specific
tracking logs
are also used)
Varied per QI Project
Examples:
% clients introduced to WRAP
% clients w/ family sessions
% clients/families endorsement of
service approach on DC surveys
% readmitted within 30 days of
DC
EFFECTIVENESS &
EFFICIENCY
Effective discharge planning as
demonstrated by referral and
linkage to other DBH
programs, community providers
and other community resources.
PHF
Nursing/Clinical
& QA Leaders &
Treatment Staff
(in collaboration
w/ external
entities)
DC planning starts
at admission and
continues daily
through DC to
Aftercare linkages
CONTRACTOR
EHR Aftercare
Plan
CONTRACTOR
EHR DC Status
Form
Post DC follow-
up phone
interviews*
Majority (85%) of PHF clients
return to a home/family setting
Majority (85%) of PHF clients DC
with at least 2 referral/linkages to
community resources & supports.
COUNTY also tracks KPIs related
to timely uptakes to next-on
services (e.g., 7 days, 48 hrs.).
CUSTOMER SATISFACTION
Multiple Protocols & Survey Items
Examples:
(Client) “More confident now,
after being in the program, in my
ability to recover and cope with
mental health problems.”
(Caregiver) “Family received the
help we needed for our child.”
Family Advocate
and/or PHF
Psychiatrist
QA/Others TBD
Client/Family:
Discharge &
(possibly) Post DC
Interviews/Surveys
Youth Survey
Caregiver
Survey
Post DC follow-
up phone
interviews*
Agency Partner
Surveys
Performance benchmark is 85%
items endorsed positively.
Items or areas that fall below
benchmark are reviewed and
prioritized for QI.
FL-120 Exhibit B – Scope of Work
Page 14 of 15
Indicator (Type and Target) Who Applied Time of Measure Data Source Target Goal Expectancy
(Agency Partner) “The program
provides a needed level of care in
the community.”
* Post discharge (DC) protocols are developed and available; we are assessing whether the team has capacity to sustain the data
gathering process, which is time-consuming. Pilot testing results will be available after January 1, 2020.
FL-120 Exhibit B – Scope of Work
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COUNTY RESPONSIBILITIES:
COUNTY shall:
1. Perform a utilization review (through its FCMHP) of all admissions to determine that the documentation
demonstrates that medical necessity criteria as defined by DHCS was met for each period of the
admission, except for the episode of discharge.
2. Provide oversight (through COUNTY DBH) of the CONTRACTOR’s PHF program. In addition to
contract monitoring of program(s), oversight includes, but not limited to, coordination with DHCS in
regard to program administration and outcomes.
3. Assist the CONTRACTOR in making linkages with the entire behavioral health system of care. This will
be accomplished through regularly scheduled meetings as well as formal and informal consultation.
4. Participate in evaluating the progress of the overall program and the efficiency of collaboration with the
CONTRACTOR’s staff and will be available to the contractor for ongoing consultation.
5. Receive and analyze statistical outcome data from CONTRACTOR throughout the term of this
Agreement on a monthly basis, or as requested by COUNTY. 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. Technical assistance to CONTRACTOR regarding cultural competency requirements and sexual
orientation training.
B. 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, and queer (or questioning)
(LGBTQ) 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.
C. Technical assistance for CONTRACTOR in translating behavioral health and substance use
disorder services information into DBH’s threshold languages (English, Spanish, and Hmong).
Translation services and costs associated will be the responsibility of the CONTRACTOR.
1
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. 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
Exhibit C | Janitorial Cleaning Standards
Page 1 of 10
2
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 the CCC 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.
Exhibit C | Janitorial Cleaning Standards
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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.
Exhibit C | Janitorial Cleaning Standards
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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.
Exhibit C | Janitorial Cleaning Standards
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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.
Exhibit C | Janitorial Cleaning Standards
Page 5 of 10
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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.
Exhibit C | Janitorial Cleaning Standards
Page 6 of 10
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Item County currently uses
Blood spill and body fluid
kits
Sorb-It Absorbent
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
Lamps/light bulbs -
The majority of lamps to be replaced are fluorescent
T-8’s, with some T-12’s, in sizes ranging from 18” to
4’ (41k). 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 1ply 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
Screens
Various
Walk Off Mats Various locations
Exhibit C | Janitorial Cleaning Standards
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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.
Exhibit C | Janitorial Cleaning Standards
Page 8 of 10
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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.
Exhibit C | Janitorial Cleaning Standards
Page 9 of 10
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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.
Exhibit C | Janitorial Cleaning Standards
Page 10 of 10
SELF-DEALING 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-100)
Internal Services Department
2220 Tulare Street, Suite 2100
Fresno, CA 93721-2106
FL-120 Exhibit D | Self-dealing Transaction Disclosure Form
Page 1 of 2
(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:
FL-120 Exhibit D | Self-dealing Transaction Disclosure Form
Page 2 of 2