1. PROPOSAL NARRATIVE REQUIREMENTS (Maximum 85 points)

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1 Single Source Requirements for Adult Residential Care Facility Instructions: If Vendor is interested in an opportunity to contract for Adult Residential Care Facility (RCF) services in FY15 with the County, please respond in writing to the following requirements for our RCF program. Due: Friday, May 2, 2014 (by 5:00pm to Evonne Lai at A. PROPOSAL NARRATIVE REQUIREMENTS Not to exceed twenty-five (25) pages. Organizational charts and resumes do not count towards the twenty-five page limit. Only the written responses to Section A.1. below are counted towards the page limit. 1. PROPOSAL NARRATIVE REQUIREMENTS (Maximum 85 points) a) What target population are you going to be providing Supplemental Services to? State your experience serving this population. b) Is your residential home currently licensed by the State Community Care Licensing? If yes, how long have you been licensed? How many beds do you have? How many clients can you serve? c) Can you describe how you intend to serve the target population you have chosen? Please include, programming activities and staffing to meet the needs of this population d) What is your experience working and providing services for the Severely Mentally Ill? Include your involvement with Case Managers and with other mental health providers. e) Provide details of how you intend to handle crisis situations. Please include the training and education you have in this area. f) Do you have a valid driver s license? Give a detailed description of your process of getting clients to both psychiatric and other medical appointments. g) Food services are very important to our clients. Outline how you intend to keep your menu updated and provide nutritional meals that meet the County Nutritional Guidelines and Standards? 5 points h) The physical appearance of our consumers is very important. Please provide a description of how you will assist clients in promoting good hygiene and grooming. 5 points

2 St. Joseph s Residential Care Home Single Source Requirements for Adult Residential Care Facility i) How many direct care staff do you have? State their experience working with individuals with mental health issues. j) List the languages that your staff speaks and how you intend to maintain staffing above the Community Care Licensing requirements. 5 points B. BUDGET PROPOSAL (Maximum ) It is required that the vendor states in writing which services they can provide and therefore comply with the proposed corresponding rates as well as the number of beds available to the County on July, 1, The following rates for Supplemental Services for Adult Residential Care Facilities will be reviewed by Santa Clara Valley Health and Hospital System Finance Department for accuracy and completeness and rated accordingly. a. Level 1: Basic Enhanced Supplemental Care Services- $30 per day b. Level 2: Deaf, Blind, Monolingual, Developmentally Disabled- $40 per day c. Level 3: Medically Frail/Insulin Dependent Adults-$50 per day d. Unsponsored Patient Basic Board and Care Rate- $ per month e. Please see Attachment G: Rates & Schedule of Services for Individual Treatment Rates for Supplemental Services for more details.

3 ATTACHMENT G RATES & SCHEDULE OF SUPPLEMENTAL SERVICES for ADULT RESIDENTIAL CARE FACILITY (RCF) CLIENTS The Mental Health Department (COUNTY) is prepared to offer the following supplemental rates for Contractor(s) to provide individualized services for clients who are mentally ill or Seriously Mentally Ill (SMI) and have a level of functioning, symptoms, and psychiatric history that necessitates supplemental service interventions. Clients are to be transitioned from a higher level of care to the safest and most appropriate residential type of setting based on their ability to function independently. A. Specialized Individualized Treatment Rates 1. In the case of the Mental Health Department (MHD) adult client who is mentally ill or seriously mentally ill (SMI) and needs supplemental services, the MHD will negotiate a mental health individualized treatment rate for placement depending on the individual client s needs. The majority of these clients have Social Security Insurance (SSI) that pays for basic board and care costs. MHD only pays for the individualized treatment rate which ranges from $ $50.00 per day depending on the severity of the medical and mental illness. If a client is unsponsored then MHD will also pay for the basic board and care costs. 2. The population to be served will be adults (ages 18-59) and older adults (60 and older), who are residents of Santa Clara County. All clients will meet the following criteria: 1) must have severe mental illness; 2) must currently reside in a locked or inpatient psychiatric facility, or must require this level of care to prevent placement in a locked psychiatric setting; and 3) must have been recommended for a community placement but continues to need a highly structured licensed care home. The majority of these clients have Social Security Insurance (SSI) that pays for basic board and care costs. B. Unsponsored patch- $ per month (rate could change on 7/1/14, since the SSI rate is set by the State) 1. Contractor will provide residential care facility services to mentally ill or SMI clients whose level of functioning, symptoms, and psychiatric history necessitates service intervention to maintain clients in community settings and who are not SSI eligible. These clients have no benefits. Standard of services will meet Community Care Licensing (CCL) requirements. This includes individuals who may suffer from an institutionalized syndrome including increased passivity, lack of confidence and lack of knowledge about the community. 2. If SSI is approved retroactively, then Contractor will reimburse County only for the daily unsponsored facility rate, back to the date when patient was granted retro SSI eligibility. C. Level: 1 Basic Supplemental Services - $30.00 per day Along with the basic board and care residential facility services that are provided for all clients according to CCL requirements, the MHD will pay for basic supplemental services for individuals with on-going mental Health issues, need assistance with daily living and are difficult to place. These clients could need the following services: 1

4 ATTACHMENT G a. Assistance with grooming and hygiene b. Assistance with incontinence c. Monitoring and/or assistance with eating difficulties d. Providing support and assistance for clients with difficult sleeping patterns e. Providing meaningful day activities and interaction with others f. Monitoring clients smoking behavior g. Providing transportation to medical/psychiatric appointments h. Monitoring medication compliance Clients could have the following issues: i. History of vulnerability j. History and/or currently is yelling and screaming k. History of destruction of property l. History of substance and/or alcohol abuse m. History of suicidal and/or homicidal behavior n. History of assaultive behavior to staff and peers o. Use of a walker or a wheelchair Expectation of RCF Provider for clients on $30.00 Supplemental Patch a. These clients may require verbal prompts and one to one assistance with personal/ hygiene care activities such as, assistance with bathing, hair care, dental care and medical care. b. Staff will provide one to one behavior management and supervision, for example re-directing the client, education, and by modeling appropriate behavior as needed to maintain the client in the community. c. Document frequency and intensity of inappropriate behavior and progress in skill development on an on-going basis on the Supplemental Log. d. Progress will be reviewed by an assigned 24 Hour Care staff bi-annually or as needed. D. Level 2 Deaf, Blind, Developmentally Disabled and/or Monolingual language Spanish or Vietnamese - $40.00 per day These following services are in addition to the items noted in Level 1 (listed above). This supplemental service is designed for clients with on-going mental issues, as well as, the following conditions that preclude them from being admitted into regular residential care facilities. This rate is specific for individuals with the following issues: a. Hearing loss or deaf b. Vision loss or legally blind c. Developmentally disabled or mental retardation d. Monolingual Spanish or Vietnamese language 2

5 ATTACHMENT G Expectation of RCF Provider for clients requiring a $40.00 Supplemental a. Provider has to structure the physical layout of the Board and Care home to serve clients with these specialized need mentioned above, in addition to all the requirements for level one $30.00 patch. b. Hearing loss or deaf: provider s board and care home has to be equipped with visual device (such as Video relay machines or other devices for individuals who are hard of hearing or Deaf) necessary for clients to communicate (both to staff and housemates) and get their basic needs met at all times. c. Vision loss or legally blind: providers physical layout of the building should be designed to serve this population, exit s and restroom should be within close proximity for clients to access easily. d. Developmentally disabled or mental retardation: provider are expected to have the physical layout of the building secure at all times and additional staffing beyond CCL (Community Care Licensing Regulations) to address these clients issues. Provider has to be able to offer one-to one assistance when necessary to provide assistance with activities of daily living. e. Monolingual Spanish or Vietnamese s: Providers are expected to have a staff or staffs that speak this language at all times. Providers will customize the home to offer culturally specific programming, such as linking clients to cultural activities outside of the home. Provider will serve culturally specific meals as necessary. E. Level 3- Medically Frail/Insulin Dependent Adults - $50.00 per day These following services are in addition to the items noted in Level 1 (listed above). This supplemental service is designed for clients with on-going mental issues, as well as, the following conditions that preclude them from being admitted into regular residential care facilities. This rate is specific for individuals with the following issues: a. Diabetic medical issues: b. High blood pressure medical issues c. Medically frail and other specialized care such as wound care. Individuals who require specialized equipment such as Sleep Apnea Machine, the use of Electric Wheel chair, Colostomy Bag and an Oxygen tank will need additional monitoring d. Diabetic: these are clients or individuals with a history of diabetes who require finger sticking and are unable to manage their disease and perform the basic selfcare required to stabilize blood sugar levels. e. Medically frail: these are individuals with significant medical issues that affects their mental health conditions such as health related (COPD, obesity, renal disease, individuals needing total care (daily assistance with hygiene and grooming such as bathing and dressing), Expectation of the Supplemental Provider for this level of care: a. Diabetic Individuals: the provider is expected to assistance clients to following up with all necessary blood work, and to assist clients with reading and interpreting their 3

6 ATTACHMENT G blood sugar level. Provider is expected to serve nutritionally appropriate meals to address their diabetic or other health needs. b. Medically Frail: Individuals with specialized equipment that need one- to- one assistance with these devices and require one- to- one supervision of the equipment. These include Sleep Apnea Machines, Electric Wheel chair, and colostomy bag. The home is required to provide assistance in order for the client to enjoy the quality of life c. The RCF provider is expected to hire staffing above the required minimum by Community Care Licensing to assist clients with medical and psychiatric needs d. Provider is expected to offer individuals in these homes specialized meals according to the prescribed physician and the food has to meet the County Nutritional guideline standards e. The provider is expected to Transport clients to all medical and Psychiatric appointments f. Provider is expected to provide on-going trainings to the staff on how to work with clients with mental health and medical needs and document these trainings. 4

7 Attachment A: Statement of Work A. Invitation The Santa Clara County Mental Health Department (County) is seeking Adult Residential Care Facilities (RCF) to provide Board and Care services to Santa Clara County mental health clients. Clients are mentally ill or Seriously Mentally Ill (SMI) and have a level of functioning, symptoms, and psychiatric history that necessitates supplemental service interventions. Clients are to be transitioned from a higher level of care to the safest and most appropriate residential type of setting based on their ability to function independently. The RCF may also be required to provide SMI clients with Supplemental Services to address a multitude of client needs from physical and medical disabilities to learning basic social and living skills. Supplemental Services are intended to assist clients in improving life skills that will enable them to move to less restrictive, more independent community living situations. These Supplemental Services are in addition to the standard Title 22 required services. Funding for this service is provided by the County. B. Target Population The population to be served will be adults (ages 18-59) and older adults (60 and older), who are residents of Santa Clara County. All clients will meet the following criteria: 1) must have severe mental illness; 2) must currently reside in a locked or inpatient psychiatric facility, or must require this level of care to prevent placement in a locked psychiatric setting; and 3) must have been recommended for a community placement but continues to need a highly structured licensed care home. The majority of these clients have Social Security Insurance (SSI) that pays for basic board and care costs. C. Goals and Objectives 1. The goal is to transition or move clients to an environment that is less restrictive. The objectives of this process include: a) Reducing recidivism of clients into emergency treatment and acute inpatient hospital settings; b) Preventing homelessness of SMI clients; c) Providing clients with stability and a home-like setting; and d) Reducing the Santa Clara County Mental Health Department s (SCCMHD) cost for inpatient care. 2. The goals of the Supplemental Service Program are to assist clients manage behavioral issues and to transition them smoothly from a locked or inpatient setting into community placement and to maintain the client in the less restrictive environment. 3. The Supplemental Services Program also assists clients to understand medication compliance and self-administration of medications to the best of their ability. 1

8 Attachment A: Statement of Work 4. The objective of the Supplemental Services Program is to assist clients who have difficult behaviors that interfere with standard RCF placement. D. Scope of Services 1. Supplemental Provider Services: a. The RCF Providers are expected to design and promote independence through teaching independent living skills that: i. Include the client, the provider and their case manager in development and understanding of their Supplemental Services Plan including the identified specific goals and discharge plan. ii. Provide services for clients with behaviors more difficult to manage and clients who have been institutionalized, if necessary the provider will provide one-to-one behavior management and staff supervision by utilizing prompts, education, and redirection and by modeling appropriate behaviors. iii. Follow the nutritional guidelines set up by Community Care Licensing, Santa Clara County, and the client s physician and provide related in-home classes to address the clients medical and psychiatric needs. iv. Provide nutritionally healthy meals to all clients and provide individualized meal plans for clients with special medical needs. v. Encourage the development of self-help skills, Activities of Daily Living, community mobility and appropriate social behaviors that will promote self-sufficiency. vi. Transport all clients receiving supplemental services to all medical and psychiatric appointments, and keep the case manager updated of pertinent information vii. Immediately attend to clients in crisis situations and notify both the case manager and the Public Guardian immediately. viii. Teach clients how to develop money management skills and access the Mental Health System of Care. ix. Assist clients in understanding their medications and selfadministration of medications. x. Provide services according to Community Care Licensing regulations for clients with medical issues, such as assisting diabetics with finger sticks, insulin injections and developing individualized plans to deal with the medical issues. 2

9 Attachment A: Statement of Work 2. General Program Procedures a. Referral Process. All clients authorized for the Supplemental Services Program will be informed by their case manager that this service is time limited and is based on service needs as determined by the 24-Hour Care staff. Clients are reauthorized for services at least every 6 months, or more often if needed based on special needs. b. The RCF Provider will keep SCCMHD informed of vacancies and referral trends and agrees to work collaboratively with SCCMHD, clients, conservators, family members, and other vendors to help clients transition from the Supplemental Services Program as soon as feasible. Payment will not be made, nor will any client be placed within the Supplemental Services Program without prior authorization from the 24-Hour Care staff. c. The provider will provide client specific supervision in a community setting 24 hours, 7 days a week as set forth by Federal and State regulations and CCL requirements. d. The Provider will provide clients with orientation to the specific facility program that will include but not be limited to: i. Introduction to the facility, staff, and other residents, ii. House rules, iii. Information on residents rights and responsibilities, iv. Description of scheduled activities and programs, v. Public transportation schedules, and vi. Description of Supplemental Services and tentative length of stay e. The RCF Provider will obtain necessary psychiatric and medical information to monitor client psychiatric and medical conditions, including diabetes and hypertension. f. During the client s first week the Provider will meet with the client and the case manager to confirm, and if necessary, modify the Supplemental Services Program Plan. The plan will delineate client participation and expectations. The case manager will notify 24-Hour Care staff of any changes to the plan. The RCF Provider will legibly document client progress monthly in the Supplemental Services Log (Attachment F). g. The RCF Provider will immediately contact the case manager if a client is having difficulty or is failing to carry out the goals of the client s Supplemental Services Program Plan. h. The RCF Provider will provide services in coordination with other mental health vendors and conservators. i. Utilization Review i. Clients are expected to progress from the Supplemental Services Program to non-supplemental status. The 24-Hour Care staff will assess clients and re-authorize services as needed, but at least every 6 3

10 Attachment A: Statement of Work months, and, will communicate the outcome to the Supplemental Provider and case manager. ii. If the 24-Hour Care staff determines that the client no longer requires Supplemental Services, the RCF Provider and Case Manager will be provided a 30 day written notice. iii. The RCF Provider will notify 24-Hour Care staff within 24 hours of client admission/discharge and bed holds using the notification log attached for authorization in accordance with SCCMHD Policies and Procedures. j. Discharges. Clients will be discharged from Supplemental Services program when 24-Hour Care staff has determined that the client no longer requires supplemental level of care. The case manager and the Supplemental Services Provider will jointly develop appropriate follow-up or other service linkages and document outcomes. k. Hours of Operation. Supplemental services will be provided 24-hours/day, seven days per week. 3. Staffing Requirements. The RCF Provider shall possess and maintain appropriate licenses and certificates in accordance with all applicable statutes and regulations. Background checks, criminal record review, Department of Justice clearances, etc., shall be obtained and maintained in accordance with CCL regulations and Santa Clara County Policy and Procedures. a. Staff shall be available twenty-four (24) hours a day, seven (7) days a week. Staff to client ratio in some approved Supplemental homes may be expected to exceed the minimum requirement by the CCL. b. This program may include offsite or out of facility treatment and rehabilitation activity for clients, and at no time shall there be less staff at the facility than is needed to attend to the needs of the clients and to meet program requirements. Scheduling of staff will provide for the maximum number of staff to be present during the times when clients are engaged in structured activities. c. At least one direct care service staff will be on the premises twenty-four (24) hours a day, seven (7) days a week d. Staffing patterns will reflect, to the extent feasible, at all levels, the cultural, linguistic, ethnic, sexual and other social characteristics of the client base served in the program. e. The RCF Provider shall be expected to have bilingual staff available for monolingual Spanish, Vietnamese, Chinese and Korean speaking clients, and American Sign Language services shall be available for the hearing and speech impaired for the RCF homes approved for language specific Supplemental Services. f. Staff schedules, other staff documentation required should be present at the RCF site. Staff levels need to be appropriate to provide necessary residential needs and employee schedules must be available for review by SCCMHD staff. 4

11 Attachment A: Statement of Work g. Professional Development and Training requirements will be in accordance with SCCMHD standards. h. The facility will have a licensed administrator that meets, but not limited to, all the requirements of Department of Social Services Community Care Licensing Division, State of California, Welfare and Institutions Code, Title 9 of California as described in the State of California, Manual of Policies and Procedures, Community Care Licensing Division, Social Rehabilitation i. Administrative Participation. A representative of the RCF Provider will attend regularly scheduled meetings, training sessions, seminars, and other meetings as scheduled by the SCCMHD. 4. Outcomes/Performance Indicators a. The 24 Hour Care staff will monitor all services provided under this scope of work on a regular basis. A program evaluation to review the appropriateness of client placement and the quality of care provided to clients will be conducted on an annual basis. If it is determined that a corrective plan is required in order to ensure compliance, the RCF Provider will comply within the time frame established in the applicable Corrective Action Plan. b. If the RCF Provider fails to comply with the Corrective Action Plan, the RCF Provider may be subject to further corrective action up to and including termination of the contract. c. Data Collection and Reporting Requirements. The RCF Provider shall provide the following data and abide by the following reporting requirements as directed by the SCCMHD: i. Length of stay is evaluated using SCCMHD UNICARE reports as well as internal data. ii. The 24 Hour Care staff will maintain a database of specific discharge locations of its clients, in addition to the discharge codes required by SCCMHD. Discharges to a residential program with a lower level of care, board and care facility, clean and sober living, supported housing, living with family, and independent living is considered a successful completion of the program. iii. The 24 Hour Care staff will track length of stay in the program, as well as length of stay out of the program, in the case of returning clients. In addition, the number of occurrences of inpatient psychiatric hospitalizations will be tracked, including Emergency Psychiatric Services (EPS) visits, and the number of days spent in inpatient psychiatry. iv. The RCF Provider intake assessment includes data on number of days of hospitalization within one year prior to enrollment in the program and previous cost center admission reports in UNICARE are used to cross-validate some of the self-reported data. 5

12 Attachment A: Statement of Work Continued tracking and logging of hospitalization data is captured during the program. v. Seventy percent of Supplemental clients will successfully complete the program and be discharged to a lower level of care within six months. vi. Forty percent of Supplemental Services clients will attain a fifty percent decrease in re-hospitalizations while participating in the program. 6

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